Mechanical ventilation in patients with chronic obstructive pulmonary disease and bronchial asthma

Abstract

Chronic obstructive pulmonary disease (COPD) and bronchial asthma often complicate the surgical patients, leading to post-operative morbidity and mortality. Many authors have tried to predict post-operative pulmonary complications but not specifically in COPD. The aim of this review is to provide recent evidence-based guidelines regarding predictors and ventilatory strategies for mechanical ventilation in COPD and bronchial asthma patients. Using Google search for indexing databases, a search for articles published was performed using various combinations of the following search terms: ‘Predictors’; ‘mechanical ventilation’; COPD’; ‘COPD’; ‘bronchial asthma’; ‘recent strategies’. Additional sources were also identified by exploring the primary reference list.

Effect of acute kidney injury on weaning from mechanical ventilation in chronic obstructive pulmonary diseases patients with respiratory failure

“…Increase in serum creatinine by 0.3 mg/dL or more within 48 h Increase in serum creatinine to 1.5 times baseline or more within the last 7 days Ventilator setting for both groups [10]:…”

“…Ventilator setting for both groups [ 10 ]: Starting with assist control mode ventilation with a volume target Fraction of inspired oxygen (FiO 2 ) was set to target SpO 2 of 88–92% Tidal volume (VT) 6–8 ml/kg, respiratory rate (RR) 12–14/min, inspiratory: expiratory (I: E) ratio = 1:3 or more, flow rate 80–100 L/min, peak inspiratory pressure (PIP) of < 40–45 cm H 2 O and Pplat < 30 cm H 2 O was acceptable PEEP setting and inspiratory pressure support started at 5 cm H 2 O and 10 cm H 2 O, respectively. …”

Cardiac intensive care management of high-risk percutaneous coronary intervention using the venoarterial ECMO support

“…Indeed, spontaneous breathing causes both hemodynamic and neuroendocrine effects: the former encompasses a decrease in intrathoracic pressure which leads to an increase in LV afterload and venous return, resulting in increased RVEDVand LVEDV, while the latter leads to an increase in the myocardial oxygen consumption due to a significant sympathetic activation. This last neuroendocrine activation is generally more pronounced in COPD patients which had a significant higher risk of complications during the weaning process [55,56]. Importantly, HR-PCI patients supported with ECMO represent a subgroup of patients at higher risk of ventilatory-induced lung injury (VILI).…”

Principles of oxygen administration and ventiltory support in patients with acute exacerbations of chronic obstructive pulmonary disease

“…Ciljevi mehaničke ventilacije su: smanjenje disajnog rada, odmor disajne muskulature, poboljšanje gasne razmene, izbegavanje ili sprečavanje razvoja dinamske hiperinflacije (DH) i povećanja unutrašnjeg (intrinsic) poziti- [29] vnog pritiska na kraju ekspirijuma (iPEEP) . Strategije ventilacije kojima se ovo postiže su produžavanje ekspiratornog [30,31] vremena i primena spoljašnjeg (extrinsic) ePEEP-a .…”