Current concepts in mechanical ventilation for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is the most common cause of ch ronic respiratory insufficiency in the developed world today and is a commo n underlying etiology for acute ventilatory failure. Until recently, invasi ve positive pressure ventilation was the most commonly used ventilatory mod ality in patients with respiratory failure caused by COPD. Complications of barotrauma and respiratory infection occur commonly when invasive ventilat ion is used, and costs of care can be high. In recent years, newer pathophy siological insights and the increasing use of noninvasive ventilation have changed the ventilatory management of COPD. The following reviews the respi ratory pathophysiology of COPD that is relevant to mechanical ventilation, discusses the evidence supporting use and selection of patients for noninva sive ventilation, makes recommendations for the optimal management of patie nts receiving invasive mechanical ventilation, and examines evidence on out comes.