This study evaluates the safety and efficacy of high tidal volumes generated by "Adapted Support Ventilation (ASV) mode' in mechanically ventilated severe COPD patients. Every patient will be ventilated consecutively with ASV and Volume Control (VC) modes at 2 different levels of minute volume in 2 sets. ASV mode is expected to be safe measured by adequate inspiratory transpulmonary pressures and expected to be as effective as VC mode with lower intrinsic positive end expiratory pressure (iPEEP) levels.
Acute exacerbation of Chronic Obstructive Lung Disease
Being intubated for less than 24 hours
Not being planned to be extubated in 24 hours
Expiratory time constant (RCexp) more than > 2.0 s
Restrictive lung pathologies
Impaired hemodynamic status
Esophageal pathologies
Bronchopleural fistula
Crossover
Minute volume target of 100%
Other interventionPatients will be ventilated to reach minute volume target of %100 (100 ml per ideal body weight).
Minute volume target to reach PaCO2 less than 45% (high tidal volume)
Other interventionPatients will be ventilated to reach minute volume target associated with PaCO2 less than 45%.
Transpulmonary inspiratory pressure (Ptinsp)
Ptpinsp will be measured with an inspiratory pause maneuver.
Intrinsic Positive End Expiratory Pressure (PEEPi)
PEEPi will be measured with an expiratory hold maneuver.
Mean arterial pressure
Mean arterial pressure measured by invasive or non-invasive methods
PaO2, FiO2 ratio
Ratio of arterial partial oxygen pressure to inspired fraction of oxygen
Heart rate
Heart rate measured by ECG
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