Chronic obstructive pulmonary disease (COPD) affects 14 million Americans and is the fourth leading cause of death in the United States.<sup>166 Society, American Thoracic Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease Am J Respir Crit Care Med 1995 ;  152 : S77-121

Cliccare qui per andare alla sezione Riferimenti</sup> Acute ventilatory failure (AVF) is a common and recurrent complication, often requiring treatment with mechanical ventilation (MV). Since the first use of MV for patients with COPD in the 1950s,<sup>125 Munck O., Kristensen H., Lassen H. Mechanical ventilation for acute respiratory failure in diffuse chronic lung disease Lancet 1961 ;  1961 : 66-67  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> ventilator technology and understanding of the pathophysiology of COPD have advanced dramatically. Still, the best strategy for managing patients with AVF and COPD is yet to be defined. This review explores the use of MV in COPD, emphasizing pathophysiology, common management pitfalls, and ways to improve patient–ventilator synchrony.