Bronchial obstruction in intensive care

Bronchial obstruction due to one of the major pulmonary diseases asthma, COPD, or emphysema are a common problem in intensive care medicine as the leading cause or as comorbidity. While in pharmacological therapy no major changes have occurred during the last few years, two major advances have been reached in ventilation therapy which are in the focus of this review. First the non invasive ventilation (NIV) has been shown to prove efficient in treating acute on chronic respiratory failure in COPD patients and is capable of shortening the duration of hospital stay. In addition NIV can be used successfully in weaning after long time ventilator therapy and improve prognosis in COPD patients. Secondly the strategy of invasive ventilation therapy has changed significantly. "Permissive hypercapnia" is unequivocally established in severe bronchial obstruction in situations of limited ventilation. When intrinsic PEEP and elevated airway resistance are present PEEP may be useful and the upper limit of airways peak pressure that we are used to in "protective ventilation" of ARDS patients can be necessary and useful to exceed.