Expiratory Flow Limitation in Mechanically Ventilated Patients
The highest pulmonary ventilation that a subject can achieve is ultimately limited by the highest flow rates that can be generated. Most normal subjects and endurance-trained athletes do not exhibit expiratory flow limitation even during maximal exercise [1, 2]. In contrast, patients with chronic obstructive pulmonary disease (COPD) may exhibit expiratory flow limitation even at rest, as first reported by Hyatt . This is based on the observation that, even at rest, many patients with severe COPD often breathe tidally along their maximal expiratory flow-volume (MEFV) curve (Fig. 1) . The presence of expiratory flow limitation during tidal breathing promotes dynamic hyperinflation with a concurrent increase in inspiratory work, functional impairment of inspiratory muscles, and adverse effects on hemodynamics and dyspnea [4, 5]. It also plays a central role in causing acute ventilatory failure.
KeywordsChronic Obstructive Pulmonary Disease Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome Patient Ventilator Induce Lung Injury Peripheral Airway
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