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Kang: Is It Essential to Consider Respiratory Dynamics?
Editorial

Korean J Crit Care Med 2017;32(2):223-224.

Published online: 31 May 2017

DOI: https://doi.org/10.4266/kjccm.2017.00276

Is It Essential to Consider Respiratory Dynamics?

Youngjoon Kang

Department of Emergency Medicine, Jeju National University Hospital, Jeju, Korea

Youngjoon Kang Department of Emergency Medicine, Jeju National University Hospital, 15 Aran 13- gil, Jeju 63241, Korea Tel: +82-64-754-8044 Fax: +82-64-754-8044 E-mail: jedarm@jejunu.ac.kr

Copyright © 2017 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Chronic obstructive pulmonary disease (COPD), which is marked by a fixed obstruction of the airway, is a progressive disease including emphysema and chronic bronchitis. According to data from the fourth Korea National Health and Nutrition Survey, the prevalence of COPD is 13.4% in South Korea [1]. Intensive care unit (ICU) admission is required in more than 25% of patients with COPD [2]. ICU stays of patients with lung hyperinflation are longer compared to patients without lung hyperinflation [3].
In an acute exacerbation of COPD, airway resistance rises, positive end expiratory pressure (PEEP) rises, and hyperinflation of lungs occurs. Increased lung volume by hyperinflation compresses inferior vena cava and right ventricle, therefore decreases cardiac output and blood pressure. Moreover, asymmetric lung compliance aggravates unilateral lung hyperinflation which is found in unilateral lung transplantation, fibrosis or pneumonia of a single lung [4,5]. Severe obstruction increases work of breathing and fatigue of respiratory muscles [6].
With the understanding about respiratory dynamics, the better strategies will be discussed. The uneven distribution of volume could be reduced by reducing the diameter of the airway [7]. Measurement of lung hyperinflation is integral to the assessment of physiological impairment in individuals with COPD and can effectively be targeted for treatment [8].
Recognition and successful management of the unilateral lung hyperinflation may avoid complications such as barotrauma and hypotension associated with the presence of intrinsic PEEP [9].

Notes

No potential conflict of interest relevant to this article was reported.

References

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8. O’Donnell DE, Webb KA, Neder JA. Lung hyperinflation in COPD: applying physiology to clinical practice. COPD Res Pract. 2015; 1:4.
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9. Kollef MH, Turner JF. Intrinsic PEEP and unilateral lung hyperinflation: pathophysiology and clinical significance. Chest. 1992; 102:1220–4.
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