Controlled expiration in patients with chronic obstructive pulmonary disease on ventilatory support

Chronic respiratory failure develops over the years in many patients with chronic obstructive pulmonary disease (COPD). During exacerbations of COPD the gas-exchange is known to deteriorate in these patients. This acute-on-chronic respiratory failure may ultimately lead to hypercapnic coma. Mechanical ventilation has to be applied to maintain gas-exchange. As this treatment does not affect the pathophysiological mechanisms leading to the respiratory failure, mechanical ventilation can only be considered as rescue therapy. Altered respiratory mechanics associated with COPD may hamper ventilatory support. For the same reasons weaning from the ventilator is considered to be a cumbersome process, in many patients requiring long-tenn ventilatory support. These altered respiratory mechanics can be elucidated in tenns of elastic recoil of the lung and airways resistance. In this chapter these features will be described with emphasis on spontaneous breathing as well as mechanical ventilation. Adaptations of equipment used for ventilatory support and weaning purposes that may improve ventilation and gas-exchange in COPD, will be reviewed. Finally an outline of the investigations described in this thesis will be given. The popUlation of patients that is the subject of this thesis consists of those who are suffering from severe chronic airways obstruction in whom loss of elasticity of lung tissue may be present. Though COPD may not be the exactly right nomenclature for the condition present in all of those patients, it was applied to all patients because destruction of elastic tissue of a minor degree is difficult to demonstrate or exclude in a living person.

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