The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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Review
The role of PEEP in patients with chronic obstructive pulmonary disease during assisted ventilation.
In patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (COPD), the intrinsic positive end-expiratory pressure (PEEPi) can significantly increase workload for ventilation. It has been suggested that, in the presence of expiratory flow limitation, application of low levels of PEEP by the ventilator can be used to reduce PEEPi and therefore the magnitude of the inspiratory effort during assisted mechanical ventilation (or pressure support) and weaning. Clearly, pulmonary hyperinflation should not be further enhanced in order not to counteract the beneficial effect of removing PEEPi by decreasing respiratory muscle length and force. ⋯ Therefore, application of PEEP in COPD patients requires close monitoring of the end-expiratory lung volume. This can be accomplished, among other noninvasive ways (e.g. the inductive plethysmography), by inspection of flow/volume curves during application of increasing levels of PEEP. The shape of the expiratory limb of the flow/volume curve can also suggest the presence of dynamic hyperinflation and expiratory flow limitation.
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Long-term oxygen therapy requires a practical regulated oxygen delivery system which works in the home. Although face-masks are cheap and efficient, they are awkward and need removal for talking and eating. Few patients would comply with this for 15 h her day. ⋯ Permanent tracheostomy is not indicated in most cases of hypoxic chronic obstructive airways disease (COAD). Nasal prongs would seem the most reasonable method of oxygen delivery. Their use with oxygen concentrators lessens the need for oxygen conservation.