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| The first 150 words of the full text of this article appear below. |
Acute exacerbations of chronic obstructive pulmonary disease
(COPD) are a frequent cause of admission to hospital and the intensive
care unit (ICU). During these episodes a major deterioration in gas
exchange is accompanied by a worsening in the clinical condition of the
patient, characterised by a rapid and shallow breathing pattern, severe
dyspnoea, right ventricular failure, and encephalopathy. The
pathophysiological pathway of all these features is the inability of
the respiratory system to maintain adequate alveolar ventilation in the
presence of major abnormalities in respiratory mechanics. Hypercapnia,
acidosis, and hypoxaemia all ensue, leading to clinical deterioration
in cardiovascular and neurological functions. What triggers the
abnormal breathing pattern of the patient is still unclear. Although it
has been suggested that rapid shallow breathing may afford a protection against the development of respiratory muscle fatigue, this notion has
been challenged by studies of weaning off mechanical ventilation where
the occurrence of acute
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