UMEM Educational Pearls

Category: Critical Care

Title: COPD and mechanical ventilation

Keywords: bicarbonate, pH, COPD, mechanical ventilation (PubMed Search)

Posted: 5/20/2008 by Mike Winters, MD (Updated: 10/21/2021)
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COPD and mechanical ventilation

  • In some studies, the failure rate of non-invasive positive pressure ventilation (CPAP, BiPAP) in acute exacerbations of COPD has been as high as 50%
  • When setting the ventilator in patients with COPD, keep in mind that the majority have chronic ventilatory failure with a chronic compensatory respiratory acidosis
  • Pearl: Look at the serum bicarbonate level obtained from a recent period of stability
  • A recent serum bicarbonate level can provide an indirect indication of the patient's baseline PaCO2 if you have no prior ABGs
  • Rather than target a PaCO2 of 40 mm Hg, manipulate the ventilator to target the patient's baseline serum bicarbonate or a pH of 7.35 - 7.38.

References

Ward NS, Dushay KM. Clinical concise review: Mechanical ventilation of patients with chronic obstructive pulmonary disease. Crit Care Med 2008;36:1614-9.