Desde el punto de vista fisiopatológico muestran un incremento de la resistencia de la vía aérea, hiperinsuflación pulmonar, y elevado espacio muerto anatómico, lo que conduce a un mayor trabajo respiratorio. Los pacientes con EPOC y asmáticos utilizan una proporción sustancial de ventilación mecánica en la UCI, y su mortalidad global en tratamiento con ventilación mecánica puede ser significativa. The purpose of this article is to provide a concise update of the most relevant aspects for the optimal ventilatory management in these patients. One major cause of the morbidity and mortality arising during mechanical ventilation in these patients is excessive dynamic pulmonary hyperinflation (DH) with intrinsic positive end-expiratory pressure (intrinsic PEEP or auto-PEEP). The physician must be cautious to avoid complications related to mechanical ventilation during ventilatory support. The current evidence supports the use of noninvasive positive-pressure ventilation for these patients (especially in COPD), but invasive ventilation also is required frequently in patients who have more severe disease. The main goal of mechanical ventilation in these kinds of patients is to improve pulmonary gas exchange and to allow for sufficient rest of compromised respiratory muscles to recover from the fatigued state. If ventilatory demand exceeds work output of the respiratory muscles, acute respiratory failure follows. From the pathophysiological standpoint, they have increased airway resistance, pulmonary hyperinflation, and high pulmonary dead space, leading to increased work of breathing. COPD and asthmatic patients use a substantial proportion of mechanical ventilation in the ICU, and their overall mortality with ventilatory support can be significant.
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