Effect of series of resistance levels on flow limitation in mechanically ventilated COPD patients

In severe chronic obstructive pulmonary disease (COPD) lung emptying is disturbed by airways compression and expiratory flow limitation. Application of an external resistance has been suggested to counteract airways compression and improve lung emptying. We studied the effect of various resistance levels on lung emptying in mechanically ventilated COPD patients. In 18 patients an adjustable resistor was applied. The effect on airways compression was assessed by iso-volume pressure–flow curves (IVPF) and by interrupter measurements. Respiratory mechanics during unimpeded expirations were correlated to the results obtained with the resistances. The resistances caused an increase in iso-volume flow at the IVPF-curves in six patients, indicating that airways compression was counteracted. Interrupter measurements showed that overshoots in flow (as measure of flow limitation) were significantly reduced by the resistor. These effects could be predicted on basis of respiratory mechanics during unimpeded expiration. In conclusion, mechanically ventilated COPD patients can be identified in whom application of external resistances counteracts airways compression and reduces flow limitation.