You are caring for a patient with severe COPD who will require intubation and mechanical ventilation. To limit or prevent the development of dynamic hyperinflation, your next step should be:
Increase the minute ventilation.
+Increase the expiratory flow rates of the ventilator.
+Increase the I–E ratio of the ventilator.
+Reduce the Fio2.
+Intubate with a small diameter endotracheal tube.
Dynamic hyperinflation can occur in patients with COPD because of inadequate expiratory time leading to air trapping. This dynamic hyperinflation can result in an increased work of breathing for the patient. Ways to counteract this can include minimizing the tidal volume to reduce exhaled volume, increase the expiratory flow rates, increase the I–E ratio of the ventilator, the use of bronchodilators and corticosteroids may also be of help. Externally applied PEEP may also be of assistance in counteracting the intrinsic PEEP (auto PEEP).