[Guideline for mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (2007)].

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is one of the major causes of chronic morbidity and mortality throughout the world, while acute exacerbation of COPD (AECOPD) is one of the important causes for the patient to be hospitalized. As COPD is a disease state characterized by irreversible airflow limitation and dynamic pulmonary hyperinflation, the mechanical ventilation strategy for its AECOPD is different from other diseases. To improve the clinical result of mechanical ventilation for AECOPD, Chinese Society of Critical Care Medicine of Chinese Medical Association held a consensus conference to draft a guideline by categorizing all the information gathered from the literature into five grades from A to E, with A being the highest, according to a modified Delphi criteria. The main recommendations were as follows: 1. Noninvasive positive ventilation (NPPV) should be the routine option for AECOPD patients, particularly in hospitalized patients with mild to moderate exacerbations (7.25<pH<7.35) with obvious dyspnea (with use of accessory respiratory muscles). Appropriate choice of nose or nose and mouth mask, careful monitoring and staff training play important roles in the successful use of NPPV. 2. Invasive positive pressure ventilation is used in serious respiratory failure to ensure the effective ventilation and airway toilet. 3. Proper selection of ventilation mode, and careful adjustment of tidal volume, respiratory rate, inspiratory flow rate and positive end-expiratory pressure are important in oder to avoid dynamic pulmonary hyperinflation. 4. Sequential ventilation (early extubation following by NPPV) is recommended as a weaning strategy for intubated patients. 5. For those in whom exacerbation is due to pulmonary infection, NPPV should be initiated with pulmonary infection control (PIC) as the window to decrease the duration of invasive ventilation, the risk of ventilator associated pneumonia, and hospital mortality.