Current concepts in mechanical ventilation for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is the most common cause of chronic respiratory insufficiency in the developed world today and is a common underlying etiology for acute ventilatory failure. Until recently, invasive positive pressure ventilation was the most commonly used ventilatory modality in patients with respiratory failure caused by COPD. Complications of barotrauma and respiratory infection occur commonly when invasive ventilation is used, and costs of care can be high. In recent years, newer pathophysiological insights and the increasing use of noninvasive ventilation have changed the ventilatory management of COPD. The following reviews the respiratory pathophysiology of COPD that is relevant to mechanical ventilation, discusses the evidence supporting use and selection of patients for noninvasive ventilation, makes recommendations for the optimal management of patients receiving invasive mechanical ventilation, and examines evidence on outcomes.