Chronic obstructive pulmonary disease (COPD) is a long-term and often progressive lung condition that makes breathing difficult. In some cases, breathing can become so challenging that people require help from a mechanical ventilator.
COPD encompasses emphysema and chronic bronchitis, which adversely affect breathing by interfering with airflow in and out of the lungs. In the United States, COPD affects about 12.5 million people.
The article below covers why someone with COPD may need a ventilator, types of ventilation, and the potential duration of ventilation for people with COPD.
The main reason someone with COPD may need a ventilator is due to respiratory failure.
Sudden worsening of COPD is the
People with COPD may have lungs that must work hard to inhale oxygen and exhale carbon dioxide (CO2). The diaphragm, which plays a role in breathing, may also not work as efficiently in people with the condition.
A person with COPD who is having difficulty breathing may eventually become tired. This may lead to respiratory failure as CO2 levels climb and oxygen levels fall due to insufficient breathing.
Low oxygen levels
When an individual with COPD cannot get enough air into their lungs, they may develop respiratory failure due to the inability to maintain typical oxygen levels.
If these levels become too low, hypoxia develops. This means the lungs cannot provide sufficient amounts of oxygen for the tissues in the body to function. People with low oxygen levels may also develop hypoxemia, which is a condition involving low oxygen levels in the blood.
High carbon dioxide levels
Alternatively, some people with COPD may develop respiratory failure due to high CO2 levels.
When CO2 levels build, a person may experience hypercapnia, where there is too much CO2 in the blood. People with high CO2 levels may also experience respiratory acidosis, which results in high levels of acid in the blood.
Medical complications
Someone with COPD may also require a ventilator due to complications from a co-existing medical condition or certain surgical interventions.
Goals
With mechanical ventilation, the machine takes over the work of breathing. The goal of mechanical ventilation for people with COPD is to improve gas exchange, decrease the work of breathing, and rest the muscles involved.
Ventilators deliver a mixture of oxygen and air into a person’s lungs to help oxygen get into the body. They also hold a constant amount of low pressure, or positive end-expiratory pressure, which stops the air sacs in the lungs from collapsing.
There are two main types:
Invasive ventilation
Invasive mechanical ventilation typically involves the insertion of an endotracheal tube. A practitioner will insert this through a person’s mouth or nose into their trachea.
If a person requires a ventilator for an extended period or the tube cannot pass through the oropharynx, they may insert a tracheostomy tube. Doctors typically insert this through a surgical incision in the trachea.
However, a doctor usually reserves invasive mechanical ventilation for intensive care units or the operating room.
Noninvasive ventilation
In noninvasive ventilation, also known as noninvasive positive pressure ventilation, doctors do not use an endotracheal tube. Instead, people receive breathing support through a nasal mask or face mask.
Practitioners often try noninvasive ventilation first before invasive. Doctors also may prescribe noninvasive ventilation for home use.
A 2021 study found that people who received noninvasive ventilation at home experienced a significant reduction in emergency room visits and hospitalizations compared with those who did not.
According to the American Thoracic Society, healthcare professionals aim to help people stop using a ventilator as soon as possible. Some may only need ventilation for a few hours or days, while others may need much longer. In some cases, a person may not be able to live without a ventilator.
Research from 2018 involving 670 people with severe COPD requiring mechanical ventilation for acute respiratory failure found that the median duration of ventilation was
Outlook
The outlook for people with COPD on a ventilator may vary. Some may come off the ventilator, recover, and go home. In other cases, the outcome may be less favorable.
Various factors may affect a person’s outcome and how long they need to use a ventilator, such as:
- how well their lungs were before ventilation began
- their overall health
- how many other organs are affected
Possible risks of using ventilators include:
- infections
- lung injury
- side effects from medication doctors administer during ventilation
- a pneumothorax, which is puncturing of the lung
- inability to stop using a ventilator
Survival rates
The survival rates for people with COPD on a mechanical ventilator may vary depending on individual factors. This may include what caused the respiratory failure, such as:
- a flare-up of COPD symptoms
- an infection
- complications from another medical condition
For example, the 2018 study this article mentions above found that the overall mortality rate of COPD exacerbation in people with severe COPD on invasive mechanical ventilation in an intensive care unit was
COPD is a long-term condition that can make breathing difficult. It may lead to low oxygen levels or high carbon dioxide in the blood, both of which can cause respiratory failure.
Doctors may use mechanical ventilation, including invasive or noninvasive ventilation, to treat respiratory failure in people with COPD. The goals of ventilation include improving gas exchange, resting respiratory muscles, and decreasing respiratory distress.
The amount of time people may need to use a ventilator can vary depending on individual factors, such as their overall health. A healthcare professional may be able to provide more information about a person’s outlook on an individual basis.