Mechanical ventilation and COPD: from pathophysiology to ventilatory management

In the chronic obstructive pulmonary disease (COPD). lung and chest-wall morphological alterations determine important and peculiar approaches to mechanical ventilation. Lung emphysema and reduced elastic recoil increase expiratory time, thus worsening dynamic hyperinflation, while airways chronic inflammation rises resistances and can determine distal air-trapping. Muscle wasting and fast fibers prevalence can result in weakness and in an earlier onset of muscle fatigue, prolonging the weaning process. In this narrative review, we explored the connection between altered pathophysiology and necessity for respiratory assistance in COPD, focusing on non-invasive and invasive respiratory management, lung monitoring and weaning difficulties.

Automated summary

This article explores the importance and specificity of mechanical ventilation in chronic obstructive pulmonary disease (COPD) in relation to morphological changes in the lungs and chest wall. Lung emphysema and reduced elastic recoil increase expiratory time, worsening lung overinflation, while chronic airway inflammation increases resistance and can lead to distal air-trapping. Muscle wasting and dominance of fast fibers may result in weakness and earlier onset of muscle fatigue, prolonging the weaning process.