Invasive mechanical ventilation in exacerbations of chronic obstructive pulmonary disease.

Exacerbations of chronic obstructive pulmonary disease are appropriately treated when severe airflow obstruction does not respond to intensive therapy, including, at times, noninvasive mechanical ventilation. Ventilatory strategies include avoidance of the ventilatory complications of dynamic pulmonary hyperinflation with its resultant intrinsic positive end-expiratory pressure, thereby decreasing the risk of hypotension and barotrauma. Initial ventilator settings should include an expiratory flow rate between 8-10 L.min-1, a tidal volume of 8-10 mL.kg-1 and a respiratory rate of 11-14 breaths.min-1 as well as an inspiratory flow rate of 100 L.min-1. Further adjustments are made on the basis of gas exchange and pulmonary mechanics. Medical therapies include beta-agonists and corticosteroids.