The management of acute ventilatory failure in chronic obstructive lung disease.

CUTE VENTILATORY FAILURE, GENERALly defined as an abrupt increase in carbon dioxide tension, is a common complication of chronic obstructive lung disease. When severe and uncompensated, coma and death may result unless heroic measures are taken to assist or stimulate respiration. However, milder episodes of carbon dioxide retention also occur in patients with the “emphysema-bronchitis syndrome,’ especially during acute respiratory infections or with exacerbations of congestive heart failure. These milder episodes may respond promptly to treatment of the underlying cardiopulmonary disorder, requiring neither mechanical ventilatory assistance nor respiratory stimulant drugs. Such episodes have been reported previously by Cohn, Carroll and Riley’ and by Westlake, Simpson and Kaye2 and have been relatively common in our experience. The rapid “spontaneous” relief of acute ventilatory failure in these patients is worthy of emphasis since one might have erroneously ascribed their improvement to specific ventilator stimulants or artificial respiration had such therapies been employed.