From the Research
For COPD exacerbation, the recommended ventilator settings for inspiratory to expiratory (I:E) ratio should typically be 1:3 to 1:5, allowing for prolonged expiratory time. This means for every second of inspiration, there should be 3-5 seconds of expiration. Initial ventilator settings should include a low respiratory rate (8-12 breaths/minute), tidal volume of 6-8 mL/kg ideal body weight, and FiO2 titrated to maintain SpO2 between 88-92% 1. The prolonged expiratory time is crucial for COPD patients experiencing exacerbations because they have airflow obstruction and air trapping. Their airways collapse during expiration, requiring more time to fully exhale and prevent auto-PEEP (intrinsic positive end-expiratory pressure). Without adequate expiratory time, patients develop dynamic hyperinflation, which increases work of breathing, causes hemodynamic compromise, and raises the risk of barotrauma. Monitoring for auto-PEEP is essential, and ventilator settings should be adjusted based on arterial blood gases and the patient's clinical response. Some key points to consider when managing COPD exacerbations include:
- Targeted O2 therapy to improve outcomes, titrated to an SpO2 of 88-92% 1
- Use of inhaled short-acting bronchodilators, which can be provided by various devices such as nebulizers or pressurized metered-dose inhalers 1
- Noninvasive ventilation (NIV) as standard therapy for patients with COPD exacerbation, supported by clinical practice guidelines 1
- Management of auto-PEEP as a priority in mechanically ventilated patients with COPD, achieved by reducing airway resistance and decreasing minute ventilation 1
- Addressing trigger asynchrony and cycle asynchrony to improve patient-ventilator interaction 1
- Extubation to NIV for patients with COPD 1