Intermittent Mandatory Ventilation In the Treatment of Patients With Chronic Obstructive Pulmonary Disease

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Abstract
Patients with acute respiratory failure secondary to chronic obstructive pulmonary disease (COPD) usually can be managed with conservative therapy. Although criteria for mechanical ventilation vary, most physicians agree that mental obtundation during hypoxemia or an increasing Paco2 with acidemia indicates failure of conservative measures and necessitates either controlled or assisted mechanical ventilation. Intermittent mandatory ventilation (IMV), recently introduced, has several advantages over previously employed methods of ventilating the patient with COPD. The technic allows the intubated patient to spontaneously breathe a controlled oxygen (O2) mixture while providing mechanical hyperinflation at preset intervals. As the rate of the ventilator is decreased, spontaneous ventilation may increase and weaning is gradual. Control by the patient of his minute ventilation gives a more physiologic Paco2 and pHa than does either controlled or assisted ventilation, with less likelihood of alkalosis and its attendant disadvantages. Ventilation time is decreased, since weaning begins as soon as mechanical ventilation is instituted.

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