Respiratory failure in COPD

SummaryChronic obstructive pulmonary disease (COPD) is a cluster of heterogenic disorders, characterized by expiratory flow limitation that is not completely reversible and in most cases progressive. COPD exacerbation represents one of the leading causes of ICU admission; while in the past patients with COPD exacerbation were treated with conventional pharmacological treatment plus O2, followed by invasive ventilation in case of treatment failure, an integrated approach combining noninvasive ventilation (NIV) as first-line treatment with conventional ventilation only in those patients who fail NIV or present contraindications seem able to offer optimal clinical results. The aim of this review is to discuss an updated approach for the optimal treatment of patients with COPD exacerbation, starting from a pathophysiological basis.