Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul;68(7):973-982.
doi: 10.4187/respcare.10560.

Acute Hypercapnic Respiratory Failure in COPD

Neil R MacIntyre  1
Affiliations

Acute Hypercapnic Respiratory Failure in COPD

Neil R MacIntyre. Respir Care. 2023 Jul.

Abstract

COPD is a progressive inflammatory process affecting both the airways and alveolar structures of the lungs. Exacerbations of COPD are episodes of acute worsening of this inflammatory process, often triggered by infections. The most severe exacerbations are characterized by substantial air trapping and inspiratory muscle overload, which leads to hypercapnic respiratory failure. Pharmacologic therapies focus on intense bronchodilator administration (usually by aerosol), corticosteroids, and antibiotics. Respiratory life support technologies are often needed for severe exacerbations and range from carefully titrated supplemental O2 administration to positive-pressure ventilation (both invasive and noninvasive). Future life support strategies will likely involve extracorporeal life support technologies.

Keywords: COPD; COPD exacerbations; air trapping (intrinsic PEEP); hypercapnic respiratory failure; inspiratory muscle overload; positive-pressure ventilation (invasive and noninvasive).

PubMed Disclaimer

Conflict of interest statement

Dr MacIntyre discloses relationships with Baxter and Inogen.

Figures

Fig. 1.
Fig. 1.
One-year outcomes in 4,791 subjects with COPD requiring invasive mechanical ventilation. Note an in-hospital mortality of 23% and an overall one-year mortality of 68%. From Reference 27, with permission.
See this image and copyright information in PMC

References

    1. Barnes PJ. Pathophysiology of COPD. In Crapo J, editor. Atlas of chronic obstructive pulmonary disease. Philadelphia: Springer Science; 2008:19-32.
    1. Burrows B, Earle RH. Course and prognosis of chronic obstructive lung disease. N Engl J Med 1969;280(8):397-404. - PubMed
    1. Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet 2007;370(9589):786-796. - PMC - PubMed
    1. Hogg JC, Macklem PT, Thurlbeck WM. Site and nature of airway obstruction in chronic obstructive lung disease. N Engl J Med 1968;278(25):1355-1360. - PubMed
    1. Younes M. Load responses, dyspnea, and respiratory failure. Chest 1990;97(3 Suppl):59S-68S. - PubMed

MeSH terms