▲简化模型来解释在肺泡和气道病变容易塌陷的部分肺区域发生的呼气流量限制的发病机制。从肺顶端到基底部有一个胸膜内压(Ppl)梯度。注意小气道关闭是不均匀的，往往发生在肺体积较小的地方。
病理生理学
▲慢性阻塞性肺病加重和哮喘发作中呼吸衰竭的生理病理学
▲动态过度充气的主要不良影响。EELV=呼气末容积，VA/Q=通气灌注比，WOB=呼吸功，RR=呼吸窘迫，VT=潮气量；灰色部分为辅助呼吸。
一般呼吸支持策略
阻塞性患者的有创控制通气：
目标、监测动态气体潴留及设置策略
▲在健康受试者(A)中，呼气流量在呼气末止于基线，排除动态过度充气。慢性阻塞性肺病患者(B组)呼气流量在呼气末不止于基线，提示动态过度充气和内在呼气末正压(PEEPi)。
▲在病人管理的不同阶段的治疗选择。NIV=无创通气，PEEP=呼气末正压，NAVA=神经调节呼吸机辅助;PA=V比例辅助通气
▲在控制通气和辅助通气下对阻塞性患者进行呼吸机设置的一般原则
阻塞性患者的辅助有创通气及脱机策略
▲流量、气道压力和食管压力信号显示内源性呼气末正压(PEEPi)，定义为触发呼吸机(第一次努力)前所需的压力下降。当吸气努力未能克服由PEEPi引起的负荷，因此未能触发呼吸机呼吸(第二次努力)时，会发生无效触发。第二次呼吸时，PEEPi大于患者产生的食管压力下降。
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