The optimum timing to wean invasive ventilation for patients with AECOPD or COPD with pulmonary infection

Abstract

Yuanlin Song,1 Rongchang Chen,2 Qingyuan Zhan,3 Shujing Chen,1 Zujin Luo,4 Jiaxian Ou,1 Chen Wang3 1Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 2Guangzhou Institute of Respiratory Disease, Guangzhou, 3Department of Respiratory and Critical Care Medicine, Beijing China-Japan Friendship Hospital, 4Department of Pulmonary Medicine, Chaoyang Hospital, Beijing, People’s Republic of China Abstract: COPD is characterized by a progressive decline in lung function and mental and physical comorbidities. It is a significant burden worldwide due to its growing prevalence, comorbidities, and mortality. Complication by bronchial-pulmonary infection causes 50%–90% of acute exacerbations of COPD (AECOPD), which may lead to the aggregation of COPD symptoms and the development of acute respiratory failure. Non-invasive or invasive ventilation (IV) is usually implemented to treat acute respiratory failure. However, ventilatory support (mainly IV) should be discarded as soon as possible to prevent the onset of time-dependent complications. To withdraw IV, an optimum timing has to be selected based on weaning assessment and spontaneous breathing trial or replacement of IV by non-IV at pulmonary infection control window. The former method is more suitable for patients with AECOPD without significant bronchial-pulmonary infection while the latter method is more suitable for patients with AECOPD with acute significant bronchial-pulmonary infection. Keywords: mechanical ventilation, weaning, spontaneous breathing trial, pulmonary control window, chronic obstructive pulmonary disease

Keywords

• pulmonary infection control window
• mechanical ventilation
• COPD
• weaning
• sequentitial ventilation