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Korean J Crit Care Med > Volume 18(2); 2003 > Article
Korean Journal of Critical Care Medicine 2003;18(2): 67-73.
종설 : 만성폐쇄성폐질환을 위한 기계적 환기법
안태훈
조선대학교 의과대학 마취통증의학교실
Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease
Tae Hun An
Department of Anesthesiology and Pain Medicine, College of Medicine, Chosun University, Gwangju, Korea. ath620@hanmail.net
ABSTRACT
Patients with severe chronic obstructive pulmonary disease (COPD) may require mechanical ventilation following cardiac or general surgery, in connection with thoracic surgery such as lobectomy, wedge resection, lung reduction or bullectomy, during an episode of acute respiratory failure (ARF) secondary to a disease other than COPD such as sepsis, drug overdose, or trauma or for acute-on-chronic respiratory failure (the COPD exacerbation) where acute illness, usually presumed to be infectious in nature, destabilizes the characteristically compensated state. Ventilatory intervention is often life-saving when patients with asthma or COPD experience acute respiratory compromise. Although both noninvasive and invasive ventilation methods may be viable initial choice, which is better depends upon the severity of illness, the rapidity of response, coexisting disease, and capacity of the medical environment. In addition, noninvasive ventilation often relieves dyspnea and hypoxemia in patients with stable severe COPD. This review will only briefly cover noninvasive ventilation and focus primarily on the management of the intubated, mechanically ventilated patient with COPD, with particular emphasis on factors unique to this patient population such as the propensity for dynamic hyperinflation and auto-PEEP, barotrauma, difficult weaning and the prognosis following mechanical ventilation.
Key Words: ARDS; Auto-PEEP; COPD; Dynamic hyperinflation; Mechanical ventilation; Noninvasive ventilation; Weaning
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