Can a patient with severe lung obstruction on spirometry (Pulmonary Function Test) use a respirator (ventilator)?

From the Guidelines

A patient with severe lung obstruction on spirometry can use a respirator, but careful assessment and monitoring are crucial to ensure optimal treatment and minimize complications. The use of non-invasive ventilation (NIV) in patients with severe lung obstruction has been supported by studies, such as the one published in Thorax in 2002 1, which highlights the importance of adjusting treatment parameters to individual patient needs. When using a respirator, it is essential to:

• Check medical treatment prescribed and that it has been given
• Consider physiotherapy for sputum retention
• Adjust FiO2 to maintain SpO2 between 85% and 90%
• Check mask fit and consider a chin strap or full-face mask if using a nasal mask
• Ensure the circuit is set up correctly and check for leaks
• Monitor for re-breathing and adjust EPAP or inspiratory trigger as needed
• Observe patient synchronization with the ventilator and adjust rate and/or IE ratio as necessary

In patients with severe lung obstruction, the goal of respirator use is to improve gas exchange, reduce respiratory muscle fatigue, and prevent respiratory failure. The selection of the respirator type and settings should be individualized based on the patient's condition, with NIPPV like BiPAP often being preferred for COPD patients. Regular follow-up is crucial to assess effectiveness and make necessary adjustments to the treatment plan. According to the study 1, most patients treated with NIV for acute respiratory failure can be weaned from ventilatory support within a few days, but some may require longer-term NIV, and consideration should be given to referring the patient to a center providing home NIV.

From the Research

Patient Eligibility for Respirator Use

• A patient with severe lung obstruction on spirometry may be able to use a respirator, but it depends on various factors, including the severity of the obstruction and the type of respirator used 2, 3.
• Non-invasive ventilation (NIV) is a type of respirator that can be used to support patients with acute respiratory failure, including those with severe lung obstruction 2, 4, 3.
• NIV has been shown to improve gas exchange, relieve respiratory muscle fatigue, and reduce morbidity and mortality in patients with acute respiratory failure 2.
• However, NIV may not be suitable for all patients with severe lung obstruction, and the decision to use NIV should be made on a case-by-case basis, taking into account the patient's individual needs and medical history 3.

Spirometry and Respirator Use

• Spirometry is a crucial diagnostic tool for assessing lung function and determining the severity of lung obstruction 5, 6.
• The results of spirometry can help guide the use of respirators, including NIV, and inform treatment decisions 5, 6.
• However, spirometry is not always used consistently in clinical practice, and efforts are needed to increase its use in the diagnosis and management of chronic obstructive pulmonary disease (COPD) and other respiratory conditions 5.

Considerations for Respirator Use

• The use of respirators, including NIV, requires careful consideration of the patient's individual needs and medical history 2, 4, 3.
• Clinicians should be aware of the potential benefits and risks of respirator use, including the risk of complications and the need for close monitoring 2, 4, 3.
• The choice of respirator and the settings used should be tailored to the individual patient's needs, taking into account factors such as the severity of lung obstruction and the patient's overall medical condition 3.