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Objective:To observe the physiological effect of bi-level positive airway pressure (BiPAP) ventilation among stable chronic obstructive pulmonary disease (COPD) patients.Methods:This was a small sample size, exploratory, interventional study. A total of 10 outpatients with stable COPD were included from Department of Pulmonary and Critical Care Medicine of Zhujiang Hospital, Southern Medical University between January 2018 and December 2018. The BiPAP mode of noninvasive mechanical ventilation was adopted. The inspiratory positive airway pressure was gradually increased from 10 cmH 2O (1 cmH 2O=0.098 kPa) to 24 cmH 2O, and each time by 2 cmH 2O. The expiratory positive airway pressure remained unchanged at 4 cmH 2O. Baseline and test data were collected before and during the ventilation for comparison, including total respiratory cycle time (T tot), inspiratory time (T i), inspiratory time (T e), inspiratory tidal volume (V Ti); mouth pressure (P mo), esophageal pressure (P eso), transdiaphragmatic pressure (P di), esophageal pressure time product (PTP es), diaphragm pressure time product (PTP di), root mean square of electromyography of diaphragm (RMS), V e/RMS, inspiratory capacity (IC), the change in end-expiratory lung volume (ΔEELV) and dynamic PEEPi (PEEPi dyn). Results:All the 10 patients completed the trial. Compared to calm breathing, V Ti, V e, P mo, IC, ΔEELV score and V e/RMS increased significantly with increasing pressure levels (all P<0.05); T e only increased significantly at 20-22 cmH 2O pressure levels compared to calm breathing ( P<0.05). P di, PTP es, PTP di, RMS and RMS/RMS max decreased significantly with increasing levels (all P<0.05). PTP es and PTP di converged to 0 and no longer showed significant changes after the 18 cmH 2O pressure level. RMS and RMS/RMS max flattened out at pressure level greater than 16 cmH 2O. T i/T tot only significantly decreased at the 20 cmH 2O pressure level compared to calm breathing. PEEPi dyn showed a tendency to decrease and then increase with increasing pressure levels. Conclusion:BiPAP ventilation, at appropriate pressure levels, significantly relieves pulmonary ventilation disorders and reduces the load of respiratory muscle in patients with stable COPD.
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Objective:To evaluate the clinical effectiveness and safety of three different non-invasive ventilation strategies in initial treatment of neonatal respiratory distress syndrome(RDS).Methods:A total of 111 premature infants with RDS who were admitted to the NICU from Jan 2019 to Dec 2019 were divided into nasal continuous positive airway pressure(NCPAP)group( n=35), bi-level positive airway pressure(BiPAP)group( n=30)and nasal intermittent positive pressure ventilation(NIPPV)group( n=46)as an initial respiratory support.A retrospective study was conducted to compare pH, PaCO 2, PaO 2, P/F value(PaO 2/FiO 2)before 4 to 6 hours after treatment, the incidence of non-invasive ventilation failure, non-invasive ventilation time, invasive ventilation time, duration of oxygen therapy and the incidence of complications among the three groups. Results:Four to 6 hours after treatment, the blood gas indexes of pH, PaO 2 and P/F were significantly higher and PaCO 2 was significantly lower than those before the treatment in the three groups ( P<0.05). PaO 2 and P/F in both BiPAP group and NIPPV group were higher than those in NCPAP group ( P<0.05). PaCO 2 was lower in BiPAP group than that in NCPAP group ( P<0.05), but there were no statistical differences of the blood gas indexes between BiPAP group and NIPPV group ( P>0.05). The incidence of non-invasive ventilation failure was significantly lower in the BiPAP group and NIPPV group than that in NCPAP group ( P<0.012 5), while no signifficant difference was observed between BiPAP group and NIPPV group ( P>0.05). Moreover, no signifficant differences were found among three groups regarding non-invasive ventilation time, ventilation time of successful non-invasive ventilation, invasive ventilation time, duration of oxygen therapy and the incidence rates of bronchopulmonary dysplasia, necrotizing enterocolitis, periventricular-intraventricular hemorrhages, retinopathy of prematurity( P>0.05). Conclusion:NIPPV and BiPAP as an initial respiratory support for RDS in preterm infants augment the beneficial effects of NCPAP contributing to improvement of oxygenation, reduction of the rate of intubation within five days postnatal life without the relevant complications.
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Objective To investigate the effect of Bi-level positive airway pressure ventilation (BiPAP) combined with Seretide on quality of life of elder patients with moderate and severe chronic obstructive pulmonary disease (COPD) and type Ⅱ respiratory failure.Methods Eighty elderly patients with moderate to severe COPD and type Ⅱ respiratory failure were selected and randomly divided into observation group (n =40) and control group(n =40).The two groups were given conventional anti infection,oxygen inhalation,spasmolysis,expectorantand other conventional treatment,and the use of BiPAP ventilator assisted ventilation.Patients in observation group were administered the combined of Seretide and BiPAP treatment,and patients in control were received only BiPAP.Arterial blood gases before and after 7 d treatment,lung function and quality of life evaluation results (SQGR score) before and after 7 d,3 months and 6 months treatment,were measured.Results There were significant differences in terms of arterial blood gases,pulmonary function key indicators,SQGR score between two groups before and after treatment(P ＜ 0.01).PaCO2 was significantly after 7 d of treatment in observed group was (42.9 ± 7.9) mmHg,lower than that of the control group ((47.6 ± 8.0) mmHg; t =8.467,P ＜0.001).There was no significant difference in terms of forced expiratory volume in one second(FEV1) in both groups at 7 d,3 months,6 months after treatment (P ＞ 0.05).FEV1/forced vital capacity (FVC) in two group at 3 months,6 months after treatment were different compared to 7 d after treatment (observation group:(49.9 ±5.1)％ and (47.1 ±4.2)％,(50.2 ± 5.0)％ and(47.1 ±4.2)％ ;control group:(49.0 ± 5.4)％and (46.6 ± 5.9) ％,(49.8 ± 5.2) ％ and (46.6 ± 5.9) ％ ; P ＜ 0.05).SQGR score in observation group at six months after treatment were (40.8 ± 8.5),significantly lower than that of 7 d after treatment(45.9 ± 10.8),P ＜ 0.05),and significantly lower than the control group after 6 months of treatment ((40.8 ± 8.5) vs (46.0± ± 8.0),P ＜ 0.05).Conclusion Seretide combined with BiPAP treatment can significant improve lung function and the quality of life of patients with moderate and severe COPD and type Ⅱ respiratory failure.
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A total of 122 patients with acute left ventricular failure from January 2011 to December 2013 at our hospital were recruited and divided randomly into control group (n =62) and observation group (n =60).Control group received conventional therapy and Bi-level positive airway pressure (Bi-PAP) was added along with conventional therapy for observation group.And 12 and 8 patients died in control and observation groups respectively within 24 h after treatment and there was no statistical difference.The BNP levels of the control group pre-treatment and at 1 h and 24 h post-treatment were (1 040 ± 315),(995 ± 245) and (570 ± 164) ng/L.The BNP levels of observation group pre-treatment and at 1 h and 24 h posttreatment were (1 080 ±209),(995 ±245) and (490 ± 138) ng/L.BNP of observation group at 1 h and 24 h post-treatment decreased significantly compared with that pre-treatment and control group (P ＜0.01).Only at 24 h post-treatment,the BNP level of control group decreased significantly compared with that pretreatment (P ＜ 0.01).
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Objective To investigate the concentrations of serum N-terminal brain natriuretic peptide (NT-pm BNP) and high-sensitivity C-reactive protein (hs-CRP) of acute exacerbation of chronic obstrnctive pulmonary disease(AECOPD) patients treated by bi-level positive airway pressure(BiPAP) for with respiratory failure.Methods A total of 100 respiratory failure in patients with AECOPD were divided into study group and control group,and 50 cases of each group.Patients in study group were received the conventional treatment(anti infection,diastolic bronchial,cough and phlegm and oxygen therapy) combined with BiPAP therapy,while in control group were received the conventional treatment.Blood samples were drawn at beginning and 3 d later.Serum hs-CRP and NT-pro BNP levels were determined,and the expenses and duration of hospitalization of two groups were compared.Result After treatment,the level of serum NT-pro BNP in study group and control group were (105.79 ± 4.56) ng/L and (113.33 ± 3.26) ng/L,and the difference was statistically signifi cant (t =3.03,P ＜ 0.05).The serum hs-CRP levels were (10.83 ± 16.35) mg/L and (26.39 ± 26.87) mg/L in study and control group,and the differences were statistically significant (t =-3.44,P ＜ 0.05).The expenses and duration of hospitalization in study group were both less than those in control group((11.15 ± 1.86) d vs.(12.78±2.25) d;(6 659.11 ±1 609.49) yuan vs.(8 031.31 ±1 449.79) yuan;t=-3.87,-4.38;P ＜0.05).Conclusion Early BiPAP therapy in AECOPD patients with respiratory failure in patients is showed that NT-pro BNP and hs-CRP levels faster decrease and disease is recovery remission,which suggests that NTpro BNP or BNP for AECOPD patients and respiratory failure condition monitoring,clinical efficacy have some clinical value.
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Objective To compare the therapeutic effects in respect of ventilatory response and the change of hemodynamics of two modes of mechanical ventilation [ proportional assist ventilation (PAV) vs.Bi-level positive airway pressure ventilation (BiPAP) ] on patients with acute cardiogenic pulmonary edema (ACPE).Methods Thirty-two patients diagnosed as ACPE were recruited from May 2008 to April 2009.After conventional therapy ( cardiotonic,diuretic,vasodilators,oxygen) were ineffective for half an hour,32 patients were randomly divided into three groups:control group ( 12 cases kept conventional treatment without mechanical ventilation),BiPAP group ( 12 cases were treated with BiPAP mode of non-invasive mechanical ventilation plus conventional treatment) and PAV group (8 cases were treated with PAV mode of non-invasive mechanical ventilation along with conventional treatment ).Results PaO2,RR and oxygenation index were improved significantly in three groups after 1 hour treatment ( P ＜ 0.05 ).While PaO2 and oxygenation index in noninvasive ventilation groups were higher than those in control group ( P ＜0.05 ).The time required for amelioration of dyspnea in noninvsaive ventilation groups was shorter than that in control group ( P ＜ 0.05 ).The peak airway pressure and the index of degree of comfort ( VAS score,auxiliary respiratory muscles score) in PAV group were lower than those in BiPAP group (P ＜ 0.05 ).Conclusions Both modes of noninvasive mechanical ventilations could improve the oxygenation and relief of dyspnea in patients with ACPE.PAV and BiPAP had the similar effect in patients with ACPE.The synchronization and comfort in PAV group were better than those in BiPAP group.The PAV mode of noninvasive mechanical ventilation was well accepted by patients with ACPE.
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ObjectiveTo analyze the affection of salmeterol/fluticasone combined with bi-level positive airway pressure ventilation on lung function and life quality in treatment of chronic obstructive pulmonary disease (COPD) stable phase patients.MethodsOne hundred and four moderate and severe COPD stable phase patients were divided into two groups by random digits table with 52 cases each,Observation group were treated with salmeterol/fluticasone combined with bi-level positive airway pressure ventilation,and control group were treated with bi-level positive airway pressure ventilation.The lung function and life quality between two groups were compared.ResultsThe levels of forced expiratory volume in one second (FEV1),FEV]forced vital capacity (FVC) and 75 percent of forced expiratory flow(FEF75) after treatment were higher than those before treatment in obseration group[ (2.27 ± 0.45 ) L vs.( 1.55 ± 0.30) L,(69.12 ±7.71)％ vs. (55.65 ±5.11)％,(0.62 ±0.22) L/s vs. (0.31 ±0.13) Us] and control group [ ( 1.87 ± 0.39 ) L vs.( 1.56 ± 0.31 ) L,(62.79 ± 6.86 )％ vs.(55.69 ± 5.13 )％,(0.45 ± 0.18 ) L/s vs.(0.32 ± 0.14)L/s] with significant differences (P ＜0.05),and the levels of FEV1,FEV]FVC and FEF75 after treatment in observation group were higher than those in control group with significant differences(P ＜ 0.05 ).The scores of respiratory symptoms, activity limitation, disease impact and St.George respiratory questionnaire (SGRQ) total score after treatment were lower than those before treatment in observation group [(24.15 ±9.68) scores vs. (59.28 ± 17.70) scores,(21.39 ±7.43) scores vs. (44.15 ± 13.91) scores,(18.61 ± 6.39) scores vs. (46.54± 14.58) scores,(21.85 ± 8.14) scores vs.(48.86 ± 15.75) scores] and control group [ (42.36 ± 12.19) scores vs. (58.72 ± 17.65) scores,(36.28 ± 9.35) scores vs. (43.21 ± 13.46) scores,(29.35 ± 8.24) scores vs.(45.67 ± 14.29) scores,(33.69 ± 9.26) scores vs. (48.37 ± 15.42) scores] with significant differences (P ＜ 0.05),and the scores of respiratory symptoms,activity limitation,disease impact and SGRQ total score in observation group were lower than those in control group with significant differences (P＜0.05).ConclusionsSalmeterol/fluticasone combined with bi-level positive airway pressure ventilation in treatment of COPD stable phase can improve lung function,andenhance life quality,which can be applied in clinic.
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Objective To study the effect of Bi-level positive airway pressure (BiPAP) on hemodynamics in patients with the chronic obstructive pulmonary disease (COPD) combined coronary heart disease.Methods One hundred patients with COPD combined coronary heart disease treated by BiPAP ventilation were enrolled.The blood gas analysis and the hemodynamics were monitored and analyzed in patients with the COPD combined coronary heart disease before treatment and after BiPAP ventilation treatment for 2 hours,24 hours,72 hours and 1 week.Results PaCO2 decreased significantly after 2-hour's treatment by BiPAP ventilation( P ＜ 0.05) and the heart rate and systolic blood pressure also decreased significantly after 24-hour's treatment by BiPAP ventilation.The left ventricurlar ejection fraction( [ 65.63 ± 6.86 ] ％ vs.[ 56.21 ±5.26]％,P ＜ 0.05 )was significantly improved after BiPAP reatilation treatment for one week.The mean pulmonary arterial pressure ( [ 3.74 ± 0.96 ] vs [ 5.12 ± 1.12 ] kPa,P ＜ 0.01 ),angina pectoris ( [ 0.20 ± 0.01 ]time/d vs [ 0.69 ± 0.03 ] time/d,P ＜ 0.05 ) were significantly decreased.Conclusion COPD combined coronary heart disease patients may achieve an optimal effect by BiPAP ventilation.BiPAP ventilation has no impact on the hemodynamics in patients with the COPD combined coronary heart disease.
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Objective To investigate the influences of Bi-level positive airway pressure(BiPAP)to night-time hy- poxemia and change of sleep structure in the patients with overlap syndrome(OS).Methods 25 patients with OS,19 with primary snoring(PS)were monitored and diagnosed by nocturnal polysomnography(PSG)for parameters of sleep efficiency(SE)and sleep architecture.The data of patients with OS were rechecked after 2-month's BiPAP treatment. Results In OS group,the level of FEV1%,FEV1/FVC,SaO2 A,SaO2 L,SE,REM and S3+4 were significantly lower than those in PS(P
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Objective To investigate the benefits of long-term home noninvasive positive pressure ventilation(NIPPV) for patients with stable chronic obstructive pulmonary disease(COPD). Methods From 2006 to 2007,46 patients with chronic respiratory failure due to stable COPD receiving NIPPV in Croix Rousse Hospital were retrospectively analysed.The arterial blood gas analysis of before treatment,1,3,6,12,24 and 36 months after treatment were compared,and the lung function of before treatment,6,12,24 and 36 months after treatment were also compared. Results PaCO2 of 1,3,6,12,24 and 36 months after receiving NIPPV significantly decreased(P
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Respiratory failure and respiratory complication are most reasons that result in death of ALS patients.Respiratory support,especially non-invasive Bi-level positive airway pressure,may improve living quality and prolong survival time.Treatment of respiratory support was gradually accepted and focused in the worldwide.In addition,malnutrition is an independent poor prognostic factor for ALS.Percutaneous endoscopic gastrostomy can ensure enough energy intake,improve nutritional status and prolong survival time.The profit and indication of BiPAP and PEG were Summarized.
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BACKGROUND: Noninvasive ventilation has been used extensively for the treatment of patients with neuromuscular weakness or restrictive chest wall disorders complicated by hypoventilatory respiratory failure. Recently, noninvasive positive pressure ventilation has been used in patients with alveolar hypoventilation,chronic obstructive pulmonary disease(COPD),and adult respiratory distress syndrome. Sanders and Kern reported treatment of obstructive sleep apnea with a modification of the standard nasal CPAP device to deliver seperate inspiratory positive airway pressure(IPAP) and expiratory positive airway pressure(EPAP).Bi-level positive airway pressure (BiPAP) unlike nasal CPAP, the unit delivers a different pressure during inspiration from that during expiration The device is similar to the positive pressure ventilator or pressure support ventilation. METHOD AND PURPOSE: Bi-level positive airway pressure(BiPAP) system(Respironics, USA) was applied to seven patients with acute respiratory failure and three patients on conventional mechanical ventilation. RESULTS: 1) Two of three patients after extubation were successfully achieved weaning from conventional mechanical ventilation by the use of BiPAP ventilation with nasal mask. Five of seven patients with acute respiratory failure successfully recovered without use of conventional mechanical ventilation. 2) PaO2 lhour after BiPAP ventilation in acute respiratory failure patients significantly improved more than baseline values(p<0.01)). PaCO2 lhour after BiPAP ventilation in acute respiratory failure patients did not change significantly more than baseline values. CONCLUSION: Nasal mask BiPAP ventilation can be one of the possible alternatives of conventional mechanical ventilation in acute respiratory failure and supportive method for weaning from mechanical ventilation.
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Humans , Intermittent Positive-Pressure Ventilation , Masks , Noninvasive Ventilation , Positive-Pressure Respiration , Respiration, Artificial , Respiratory Distress Syndrome , Respiratory Insufficiency , Sleep Apnea, Obstructive , Thoracic Wall , Ventilation , Ventilators, Mechanical , WeaningABSTRACT
Objective:To evaluate the clinical efficacy and analysis influence factors on treatment of the aged COPD with acute respiratory failure by using harmless bi-level positive airway pressure. Method:Twenty-five patients who were identified the aged COPD with acute respiratory failure were divided into two groups randomly:13 in treatment group in which BiPAP was used in addition of conventional treatment;12 in control group in which nasal catheter oxygen inhalation was used. The change of the arterial blood gas and the clinical performance were observed before and 2 hours、72 hours 、120hours after treatment. Result: It is confirmed that the BiPAP can raise PaO2, lower PaCO2, improve PH,HR and R(P
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Objective To assess the efficacy and safety of non invasive positive pressure ventilation (NPPV) in the treatment of cor pulmonale with acute exacerbation after multiple endotracheal intubation mechanical ventilation. Methods Thirty three patients with acute exacerbation of cor pulmonale, male 31, female 2, aged 81 4?4 7 years old, having undergone endotracheal intubation varying from 2 to 5 times, were treated with NPPV by Bi level positive airway pressure (BiPAP) mode. Results Among all patients, twenty of them (60 6%) could tolerate NPPV with significant improvement in pH(7 23?0 05 vs 7 39?0 04),PaCO 2 (9 98?2 27kPa vs 7 56?1 67kPa), PaO 2 (6 69?2 01kPa vs 10 92?2 33kPa), respectively ( P