Management of Ventilation Dead Space in a Patient with Severe Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a debilitating condition characterized by progressive airflow limitation and respiratory failure. In severe cases, patients may require mechanical ventilation to alleviate respiratory distress. However, the presence of dead space in ventilator tubing can significantly impact the effectiveness of this treatment.

A recent case highlights the importance of addressing dead space in ventilator tubing in patients with severe COPD. A 76-year-old man weighing 108 kg presented with substantial hematuria and underwent urgent cystoscopy and urinary bladder clot evacuation under general anesthesia. The patient's preoperative pulmonary function test revealed no response to bronchodilators, indicating a severe degree of airflow limitation.

During the procedure, the patient was unconscious and rapidly deteriorating, prompting the re-intubation and mechanical ventilation to decrease ventilation dead space and work of breathing. Despite initial improvement with bag-valve-mask ventilation, conservative treatment measures failed to achieve significant benefits, including jaw thrust, insertion of a nasal airway, and changing the nasal cannula to a non-rebreather mask.

As the patient's condition continued to deteriorate, he became hypoxic, tachypneic, and somnolent. Fortunately, after a 2-hour procedure, he met our extubation criteria and was successfully extubated in the operating room. He was then transferred to the post-anesthesia care unit on supplemental oxygen at 4 L/min via nasal cannula.

This case underscores the critical need for effective management of dead space in ventilator tubing in patients with severe COPD. By addressing this issue, healthcare providers can optimize ventilation and improve patient outcomes.

Dead space in ventilator tubing