Severe airflow obstruction is one of the most common causes of acute respiratory failure encountered in medical ICUs. Although most patients with life-threatening exacerbations of asthma or chronic obstructive pulmonary disease (COPD) respond to a noninvasive approach, in certain instances, endotracheal intubation and mechanical ventilatory support are necessary for survival. Although often lifesaving, mechanical ventilation of patients with severe airflow obstruction is associated with many complications that may result in serious morbidity or even death.69 An important cause of ventilator-related complications is excessive dynamic pulmonary hyperinflation,<sup>72 Slutsky A.S. Mechanical ventilation. ACCP Consensus Conference Chest 1993 ;  104 : 1833-1857  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> a process that occurs primarily in the setting of severe airflow obstruction. In addition, patients may suffer complications related to the drugs used to treat underlying airway disease or to facilitate ventilatory support by inducing relaxation of respiratory muscles.<sup>44 Leatherman J.W., Fleugel W., David W. , e al. Diffuse muscle weakness in mechanically ventilated patients with severe asthma Am J Respir Crit Care Med 1996 ;  153 : 1686-1690

Cliccare qui per andare alla sezione Riferimenti46 Lin R.Y., Smith A.J., Hergenroeder P. High serum atbuterol levels and tachycardia in adult asthmatics treated with high-dose continuously aerosolized atbuterol Chest 1993 ;  103 : 221-225  [cross-ref]

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This article review selected topics relevant to the use of mechanical ventilation in patients with severe airflow obstruction. Areas discussed include the bedside assessment of respiratory system mechanics, the ventilatory determinants of dynamic pulmonary hyperinflation, the role of controlled hypoventilation with permissive hypercapnia, and the delivery of bronchodilators during mechanical ventilation. Weaning from mechanical ventilation and the use of noninvasive ventilation are covered elsewhere in this issue.