Treatment of Respiratory Failure due to Advanced Chronic Obstructive Lung Disease

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Abstract
Chronic obstructive lung disease (COLD) causes in excess of 25,000 deaths each year in the United States. Also, 5 to 10 million Americans are partially or totally disabled with COLD. Thus, COLD is a common and important cause of respiratory failure. Acute respiratory failure caused by COLD requires strikingly different treatment than that caused by the adult respiratory distress syndrome (ARDS). The patient with COLD usually does not require endotracheal intubation, while the patient with ARDS often requires early intubation and mechanical ventilation. In contrast to ARDS, the short-term prognosis for the patient with acute respiratory failure caused by chronic airway obstruction is good, while the long-term prognosis is poor.1 Gottlieb and Balchum2 found a death rate of 66% within two years of the first attack of respiratory failure in patients with COLD. If the patient with ARDS survives, the prognosis for return to normal lung function is