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INTRODUÇÃO: O edema agudo de pulmão cardiogênico (EAPC) representa uma importante causa de insuficiência respiratória aguda podendo ser atenuada com a instalação de ventilação mecânica não-invasiva (VNI). OBJETIVO: Comparar pressão positiva contínua (CPAP) e pressão positiva de dois níveis (BIPAP) na via aérea em pacientes adultos com EAPC, quanto à função pulmonar, ao tempo de permanência, suas complicações e a dispneia através de uma revisão sistemática. METODOLOGIA: Ensaios clínicos controlados e randomizados (ECR), revisados por dois revisores independentes, conforme recomendações PRISMA, nas bases de dados PubMed e Biblioteca Cochrane. Incluídos estudos originais que utilizaram a CPAP e a BIPAP em pacientes com EAPC publicados na língua inglesa. A Escala PEDro foi utilizada para analisar a qualidade metodológica dos estudos e a Cochrane Collaboration para análise de risco de viés. RESULTADOS: Foram incluídos 13 artigos, publicados entre os anos 1997 e 2014. Os níveis de CPAP variaram entre 5 e 20 cmH2O nos estudos, e BIPAP apresentou-se com pressão inspiratória positiva (IPAP) entre 8 e 20 cmH2O e pressão expiratória positiva (PEEP) entre 3 e 10 cmH2O. Os estudos apresentaram CPAP e BIPAP sem diferença estatisticamente significante para a melhora da função pulmonar (FR, PaO2 e PaCO2), tempo de internamento, taxas de mortalidade, entubação e infarto agudo do miocárdio (IAM); mostrando-se como modalidades igualmente eficazes. CONCLUSÃO: CPAP e a BIPAP garantem os mesmos efeitos para melhora da função pulmonar, não mantém relação com a permanência da internação e complicações, e melhoram o quadro de dispneia.
INTRODUCTION: Acute cardiogenic lung edema (EAPC) represents an important cause of acute respiratory failure and can be attenuated with the installation of non-invasive mechanical ventilation (NIV). OBJECTIVE: To compare the use of continuous positive pressure (CPAP) and two-way positive airway pressure (BIPAP) in adult patients with acute pulmonary edema of pulmonary function, length of stay and complications, and dyspnea through a systematic review METHODOLOGY: Systematic review of randomized controlled trials (RCTs) performed by two independent reviewers, as recommended by the PRISMA platform, in the PubMed and Cochrane Library databases. Original studies using CPAP and BIPAP were used in patients with acute cardiogenic lung edema published in English. The PEDro Scale was used to analyze the methodological quality of the studies and Cochrane Collaboration. RESULTS: We included 13 articles, published between 1997 and 2014. CPAP levels ranged from 5 to 20 cmH2O in the studies, and BIPAP presented positive inspiratory pressure (IPAP) between 8 and 20 cmH2O and positive expiratory pressure (EPAP) between 3 and 10 cmH2O. The studies presented CPAP and BIPAP without statistically significant difference for the improvement of the pulmonary function (FR, PaO2 and PaCO2), permanence of hospitalization, mortality rates, intubation and acute myocardial infarction (AMI); as equally effective modalities. CONCLUSION: CPAP and BIPAP guarantee the same effects to improve pulmonary function, does not maintain relation with the permanence of hospitalization and complications, namely: mortality, intubation and AMI, and improve dyspnea.
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Noninvasive Ventilation , Pulmonary Edema , Heart FailureABSTRACT
Objective To explore the influence of intubation-surfactant-extubation (InSurE)therapy combined with bilevel positive airway pressure (BiPAP)in the use time of mechanical ventilation,and to clarify the value of BiPAP in the treatment of respiratory distress syndrome in the preterm infants.Methods Toral 95 preterm infants with respiratory distress syndrome were treated with InSurE therapy during January 2011 to October 2014. Among them,the preterm infants before January 2013 were selected as control group who were treated with InSurE and nasal continuous positive airway pressure (nCPAP).After January 2013, 60 preterm infants were treated with BiPAP,as BiPAP group.The rates of InSurE failure,the need for mechanical ventilation (MV)on the 7th day after InSurE failure, total non-invasive ventilation time, total mechanical ventilation time, atmospheric oxygen therapy time and incidence of clinical complications were compared between two groups.Results ① There were no significant differences in the clinical data of the preterm infants between two groups, such as gender and age.② Although there was no significant difference in the failure rate of InSurE,but the rate of repeated mechanical ventilation during 1 week in BiPAP group was lower than that in control group (P <0.01).③ The Rank sum test result showed that the total time of non invasive ventilation in BiPAP group was longer than that in control group (P <0.01).The total time of invasive mechanical ventilation and oxygen therapy in BiPAP group was lower than that in control group (P < 0.05).④ The incidence of retinopathy of prematurity (ROP)and bronchopulmonary dysplasia (BPD)in BiPAP group was lower than that in control group.Conclusion BiPAP can significantly reduce the use of invasive mechanical ventilation after the failure of InSurE,thereby decreases the oxygen toxicity and barotrauma hazards.
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Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.
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Female , Humans , Middle Aged , Airway Obstruction , Hypoxia , Apnea , Blood Gas Analysis , Disorders of Excessive Somnolence , Dyspnea , Emergency Service, Hospital , Hypercapnia , Hypertension, Pulmonary , Hypoventilation , Obesity Hypoventilation Syndrome , Obesity, Morbid , Polysomnography , Pulmonary Heart Disease , Sleep Apnea, Obstructive , SnoringABSTRACT
ObjectiveTo evaluate the effect of high-frequency jec ventilation and bilevel positive airway pressure (BiPAP) ventilation in the severe dyspnea caused by central airway stenosis and explore the deferent application of two ventilation models.MethodsA retrospective analysis was designed to collect the serious dyspnea patients caused by central airway stenosis from January 2006 to January 2009.The patients were divided into group H and group B according to the different ventilation models,and the effect of relieving dyspnea and ameliorating hypoxemia was compared.ResultsSeven cases were in group H,and 9 cases were in group B.The therapeutic effect of relieving dyspnea was 14.29 ％(1/7) in group H.There were only 4 cases accepting high-frequency jec ventilation and the effect of relieving dyspnea was 25.00％(1/4).Two cases failed in high-frequency jec ventilation treatment and succeeded in BiPAP treatment thereafter,and 1 case failed in BiPAP treatment initially but was treated effectively by high-frequency jec ventilation after dyspnea relapsed.In group B,there were only 6 cases accepting BiPAP ventilation and the effect ofrelieving dyspnea was 83.33％ (5/6),and after adding the cases who accepting the sequential therapy of high-frequency jec ventilation and BiPAP ventilation the effect rate was 88.89％ (8/9).The difference had statistical significance(P =0.006).In ameliorating hypoxemia,the effect rate of group H was 100.00％ (7/7),of group B was 88.89％(8/9),and the difference had no statistical significance (P =0.563 ).Conclusions The high-frequency je ventilation is effective to relieve hypoxemia but is short of relieving dyspnea and subjective symptom,and it is suit for life support preoperative and intraoperative.The BiPAP ventilation is effective to relieve dyspnea and subjective symptom and hypoxemia,so the treatment effect is better than high-frequency jec ventilation,and it is suit in relieving symptom temporarily,pre-operative preparation and malignant tumor palliative treatment.
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Objective To compare the effect between bilevel positive airway pressure (BiPAP) and routine drugs treatment to patients with obstructive sleep apnea hypopnea syndrome ( OSAHS ) complicated with stroke. Methods Twenty-nine patients with OSAHS complicated with stroke were randomly divided into two groups, 15 cases in the treatment group and 14 cases in the control group. Patients in the treatment group were applied BiPAP and routine drugs including degrading intracranial pressure, promoting blood flow, improving microcirculation. BiPAP were maintained for two months and over 10 hours daily. The control group was executed only routine drugs treatment. Results The difference of apnea hyponea index( AHI) and frequency of below 90% O2 saturation during sleep time between pre-therapy and post treatment was significantly higher in the treatment group(36. 8 ± 10. 7 and 105. 3 ± 17. 9) than in the control group (20. 8 ± 8. 1 and 44. 4 ± 24. 3 ) ( P < 0. 01 ) . The difference of lowest nighttime SaO2 between pre- and post-therapy was significantly higher in the treatment group( - 11. 7 ±8. 1)% than in control group(-2. 0 ± 8. 9) % ( P <0. 01). The difference of neurologic impairment score was significantly higher in the treatment group ( 16. 0 ± 2. 6) than in the control group ( 10. 1 ± 3. 6) ( P < 0. 01 ) . As for whole blood viscosity and red blood cell aggregation index,there was no significant difference between pre- and post-therapy(P> 0. 05). Conclusions BiPAP combined with routine drugs can significantly improve sleep anapnea indexs and neurologic impairment scores in patients with OSAHS complicated with stroke than only drug treatment. Blood rheology's indexs could not obtain amelioration in short period.
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Objective To investigate the clinical effect and nursing methods of bilevel positive air-way pressure(BiPAP)ventilation in patients with neurogenic pulmonary edema(NPE).Methods Totally 11 NPE patients from January 2004 to December 2007 were enrolled.Ventilation support adopted specific invasive BiPAP mode of Puritan-Bennett840.Aiway pressure release ventilation(APRV)tactics was ap- plied in this mode.The blood oxygen saturation rote(SpO2),acidity-alkalinity(pH),arterial oxygen pres-sure(PaO2),arterial carbon dioxide pressure(PaCO2)were analyzed and compared between synchronized intemittent mandatory ventilation(SIMV)mede2 h and 24 h after BiPAP ventilation.Results Among,arterial blood gas analysis of 11 patients,SpO2 and PaO2 were obviously ameliorated after BiPAP ventilation compared with SIMV ventilation.No side-effect occurred.Conclusions The application of invasive Bi- PAP ventilation support in NPE patients proved to be a fast and effective method.
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Obesity-Hypoventilation syndrome (OHS) is characterized by morbid obesity, hypoxia, and hypercapnea during wakefulness without parechymal lung disease or severe obstructive sleep apnea. A woman was admitted because of mental deterioration and diagnosed as OHS on the basis of obesity and hypoventilation, while awake, after ruling out other causes. By bilevel positive airway pressure (BiPAP) therapy, hypercapnea and hypoxia were resolved. We report that BiPAP can be an effective treatment for severe hypercapnea and hypoxia in OHS, which obviate the need for invasive endotracheal intubation.
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Female , Humans , Hypoxia , Hypoventilation , Intubation, Intratracheal , Lung Diseases , Obesity , Obesity Hypoventilation Syndrome , Obesity, Morbid , Sleep Apnea, Obstructive , WakefulnessABSTRACT
0 05),but arterial oxygen tension and FEV 1 were elevated obviously (P