Severe bronchial obstruction due to one of the major pulmonary diseases: asthma, COPD, or emphysema often
requires mechanical ventilation support. Otherwise, patients are at risk of severe hypooxygenation with consecutive
overloading and dilatation of the right cardiac ventricle with subsequent failure. This review focuses on how to manage
a calculated ventilation therapy of patients suffering from bronchial obstruction and relevant patents. Options and pitfalls
of invasive and non-invasive ventilation in the intensive care setting regarding clinical improvement and final outcome are
discussed. The non-invasive ventilation is very efficient in treating acute or chronic respiratory failure in COPD patients
and is capable of shortening the duration of hospitalization. Further non-invasive ventilation can successfully support the
weaning after a long-lasting ventilation therapy and improve the prognosis of COPD patients. “Permissive hypercapnia” is
unequivocally established in invasive ventilation therapy of severe bronchial obstruction in situations of limited ventilation.
When intrinsic positive end-expiratory pressure (PEEP) and elevated airways resistance are present PEEP may be useful
although external-PEEP application relieves over-inflation only in selected patients with airway obstruction during
controlled mechanical ventilation. Upper limit of airways peak pressure used in “protective ventilation” of adult respiratory
distress syndrome (ARDS) patients can be exceeded under certain circumstances.
Keywords: ARDS, asthma, COPD, emphysema, obstruction, PEEP, permissive hypercapnia, ventilation therapy.
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