Mechanical Ventilation in COPD

• Mechanical ventilation of the patient with obstructive lung disease can be challenging, primarily due to the presence of dynamic hyperinflation.
• In the initial phase of ventilation, it is important to prevent complications of hyperinflation and not to target normalization of blood gas values.
• Recommended initial ventilator settings include:
  • Mode: Volume assist-control
  • Inspiratory flow waveform: square
  • Tidal volume: 6-8 ml/kg PBW
  • RR: 12 bpm
  • Inspiratory flow: 60-90 L/min
• The effect of PEEP is variable with each patient.  When titrating PEEP, be sure to frequently measure plateau pressure and discontinue titration should Pplat increase.

References

Demoule A, et al. How to ventilate obstructive and asthmatic patients. Intensive Care Med. 2020; 46:2436-2449.