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Abstract The novel coronavirus pneumonia (NCP) outbreak occurred in Wuhan, China at the end of 2019. Here, we report the clinical characteristics and therapeutic procedure for a case of severe NCP. The patient was started on glucocorticoids and non-invasive ventilator treatment. After treatment, the patient's symptoms improved, and the status was confirmed as NCP negative. Our results may provide clues for the treatment of NCP.
Subject(s)
Humans , Female , Pneumonia, Viral/therapy , Coronavirus Infections/therapy , Betacoronavirus , Glucocorticoids/administration & dosage , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome , Coronavirus Infections , Coronavirus Infections/drug therapy , Combined Modality Therapy , Pandemics , Noninvasive Ventilation , Middle AgedABSTRACT
Objective To investigate the clinical features of patients with heart failure and the safety and efficacy of noninvasive ventilator in patients with heart failure.Methods Sequentially enrolled 65 patients who were diagnosed with decompensated heart failure in Tianjin Chest Hospital Heart Center from October 2016 to October 2017 and who had acute heart failure during hospitalization requiring noninvasive ventilator,were divided into the HF-PEF group (n=19) and HF-REF group (n=46).The clinical data of the two groups and the observation indexes before and after the application of the non-invasive ventilator were compared.Results Comparing the admission data of the two groups,the proportion of patients with hypertension (57.9％ vs 21.7％,P=0.005) and LVEF(％) (53.00±4.85 vs 33.07±7.24,P＜0.01)were significantly higher in the HF-PEF group than those in the HF-REF group;LVEDD (mm) in the HFPEF group was significantly lower than that in the HF-REF group (50.00±5.23 vs 63.82±8.95,P＜0.01).In the two groups of patients with acute left heart failure,blood lactate levels (mmol/L) in the HF-PEF group (4.20±1.06 vs 2.02±0.88,P＜0.05) and systolic blood pressure (mmHg) (151.32±43.40 vs 117.90± 19.55,P＜0.05) were significantly higher than those in the HF-REF group.After the application of non-invasive ventilator,systolic blood pressure (mmHg) (34.38±9.36 vs 16.94±5.19,P=0.038) and PaCO2 (mmHg)(2.49±0.98 vs-0.06±0.00,P=0.025),and lactic acid (mmol/L) (2.06±0.67 vs 0.04±0.01,P=0.001) were significantly lower in the HF-PEF group than those in the HF-REF group.While the NT-proBNP level (ng/L) (13 064.90±1 963.83 vs 11 687.13±1 028.03,P=0.848) did not decrease significantly,and the time of non-invasive ventilator application (h)was significantly longer than that in the HF-REF group (152.74±10.61 vs 71.03±10.41,P=0.013).Conclusions Hypertension is the main cause of HF-PEF group.The systolic blood pressure and blood lactate level in HF-PEF patients with acute left heart failure are significantly higher than HF-REF patients.Non-invasive ventilator is also safe and effective for the treatment of acute left heart failure in HF-PEF patients,but HF-PEF patients with acute left heart failure have a longer clinical remission time.
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Objective: To explore and discuss the clinical curative effect on intermittent positive pressure breathing therapy of non - invasive ventilator in the treatment for chronic obstructive pulmonary disease (COPD) of elderly patients with complication of acute respiratory failure. Methods: 112 elderly patients who were COPD (all of patients were acute exacerbation period) with complication of acute respiratory failure were divided into control group (60 cases) and observation group (52 cases) as the random number table. A series of basic therapy including routine anti-inflammatory, relieving asthma and expectorant therapy were implemented for all of patient. And the non-invasive ventilator was used to implement non-invasive mechanical breathing therapy. In this therapy, patients of control group were implemented sustaining positive pressure breathing therapy, while patients of observation group were implement intermittent non-invasive positive pressure breathing therapy (1:1). The curative effect, pH value (at 6,24 and 72h), PaO2 (at 6,24 and 72h), PaCO2 (at 6,24 and 72h) and complications between the two methods were compared. Results: There was no significant difference in the general demographic characteristics between the two groups. For patients at 6, 24 and 72 h, the differences of the pH value, PaO2and PaCO2 between pre and post-treatment were significant in observation group (F=5.669, F=6.985, F=7.628, P<0.05) and control group (F=5.311, F=6.892, F=7.958, P<0.05) , respectively. The differences of the pH value, PaO2 and PaCO2 at 6h, 24h and 72h were significant (at 24h, F=6.776, F=7.098, F=7.673. at 72 h, F=7.883, F=6.983, F=7.335, P<0.05),respectively. For two groups, the differences of pH value, PaO2 and PaCO2 at pre-weaning, post-weaning 6h and post-weaning 12h were not significant. While the mechanical ventilation time and mechanical ventilation rate of observation group were significant lower than that of control group (t=3.591, x2=3.052, P<0.05). Besides, the incidences of complications including flatulence, trachea intubation, respiratory and relative pneumonia of observation group were significant lower than that of control group (x2=4.997, P<0.05). Conclusion: The new method can significantly shorten duration of breathing and duration of hospital stays. And its incidence of complication is lower while safety of treatment is relatively higher than that of traditional method.
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Objective To explore the clinical efficacy of tiotropium and salmeterol xinafoate and fluticasone propionate powder for inhalation combined with noninvasive ventilator in the treatment of respiratory failure, and to provide reference for clinical treatment.Methods 72 patients with respiratory failure were randomly divided into treatment group (n=36) and control group (n=36).The patients were randomly divided into treatment group and control group.Patients in the control group were treated with conventional noninvasive ventilators and treatment group were treated with tiotropium and salmeterol xinafoate and fluticasone propionate powder for inhalation on the basis of control group.Then compare the exercise tolerance, arterial carbon dioxide partial pressure, heart rate, pH, respiratory rate, blood oxygen pressure between two groups.Results After the treatment, condition of the patients in the two groups have different degrees of improvement.The final results showed that the average hospital stay was significantly reduced, respiratory frequency was(28 ±5) times/min in treatment group, heart rate was(98 ±16) times per minute, PaO2 also increased to(72 ±3) mmHg, PaCO2 was(57 ±17) mmHg, pH value increased to (7.42 ±0.03), compared with the control group, with statistically significant difference (P<0.05).Conclusion In patients with clinical implementation of tiotropium and seretide combined with non-invasive ventilator treatment of respiratory failure, can significantly improve the patient's condition, so that patients with respiratory function was significantly improved, so that the indicators of patients tend to normal.Its can effectively reduce PaCO2 , increased PaO2 and speed up its cure rate.
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Objective To understand the status of implementation of invasive ventilator circuit changes in ICU nurses at the 3A general hospitals in Shanxi Province, and mastering and demand of related knowledge of ICU nurses, and by this discuss the possible causes of execution inconsistency in invasive ventilator circuit changes interval so as to provide a clear basis for the specification and circuit changes. Methods After a review of relevant literature at home and abroad as well as expert consultation, a self-designed questionnaire was established, take two ways of on-site issuance and mailing, ICU nurses from 13 hospitals were selected randomly to investigate about the invasive circuit changes interval in Shanxi Province. Results A total of 724 nurses from 34 ICU of 13 hospitals were surveyed. A unified circuit changes interval of ICU accounted for 73.5% (527/717). ICU nurses currently provisions and practical implementation of invasive ventilator circuit changes interval tend to 7 d. Different ICU provisions and ICU nurses actual implementation of circuit change were significantly different (χ2=24.839, 35.760, P < 0.01). Conclusions Hospitals should choose the right way to strengthen the ICU nurses invasive ventilator circuit changes training interval and knowledge, to develop the term for their own security environment, thereby reduce the workload of nurses, reduce medical costs and improve care service quality.
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Objective:To investigate the efficacy of non-invasive ventilation in chronic obstructive pulmonary disease (COPD) with type Ⅱrespiratory failure. Methods: Ninety two cases with COPD patients with typeⅡrespiratory failure were randomly divided into observation group and control group. Basic treatment was given. While non-invasive ventilation was given to observation group and nasal catheter oxygen was given to control group. Results:The total effective rate of observation group was higher than control group(x2=18.90, P<0.01);the improvement of pH, PaCO2, PaO2, RR, HR and SaO2 in observation group was better(t=6.43, t=-5.23, t=4.38, t=6.28, t=-8.53, t=9.31;P<0.05). Conclusion:Treatment of non-invasive ventilation combined with basic therapy in COPD patients with typeⅡrespiratory failure can significantly alleviate their condition and improve prognosis.
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Objective To investigate the effect of noninvasive ventilator therapy on serum C-reactive protein (CRP), endothelin-1 (ET-1) and tumor necrosis factor-α (TNF-α) levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and its clinical significance. Methods One hundred cases of moder-ate and severe OSAHS patients were selected by the method of parallel opening. All of the patients were given health education requirement , quitting smoking and wine , low fat diet and exercise to lose weight and other con-ventional treatment. The patients were randomly divided into the treatment group of 42 cases with noninvasive ventilator treatment , 44 cases treated with conventional treatment , to observe the changes of serum CRP , ET-1 and TNF-α levels and PSG parameters after 12 weeks in two groups. Results Apnea hypopnea index (AHI), oxygen desaturation index (ODI), the lowest oxygen saturation (LSpO2), and the average oxygen saturation MSpO2 in OSAHS patients were significantly improved after treatment (P < 0.01), but the degree of improvement in the two groups after treatment was significantly higher than the control group (P < 0.01). Plasma CRP, ET-1 and TNF-α levels in the two groups after treatment were lower than before treatment (P < 0.05 or P < 0.01), but the treatment group was significantly higher than that of the control group ( P < 0 . 05 or P < 0 . 01 ) . Conclusion Noninvasive ventilator therapy in improving the OSAHS monitoring data of patients with PSG can effectively reduce the serum CRP, TNF-α, ET-1 level, reduce the body′s inflammatory reaction.
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Objective:To reveal the difference of airway peak pressure of different brands and models invasive ventilator in our hospital through test and analysis, and reveal that the difference might bring potential threat to the critical patients.Methods: Using adult simulated lung with adjustable respiratory resistance and compliance as the load of invasive ventilator to measure airway peak pressure of invasive ventilator in constant pressure controlled ventilation mode. Results: The results showed that the measured ventilators surely have differences in airway peak pressure in constant pressure controlled ventilation mode.Conclusion: For severe patients, if we ignore the peak airway pressure difference between invasive ventilators, there may be a threat to the critical patients.
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Objective To observe the efficiency of two nebulization inhalation therapy methods in patients with non-invasive ventilation. Methods 60 patients with non-invasive ventilation were divided in-to two groups (30 cases in each group). Based on combination therapy, the observation group received oxy- gen drived nebulizer inhalation therapy through tube system of non - invasive ventilator, the control group re- ceived inhalation therapy by oxygen drived nebulizer directly with halt of non- invasive ventilation. The effi- ciency of two methods was compared between the two groups. Results At the end of treatment SaO2 in the observation group remained nearly unchanged, while that of the control group significantly de-creased,beart rate increased in both groups,bot the amplitude was lower in the observation group. Patients in the observation group showed no evident discomfort, alleviated gasp and eosy expectoration. Conclu-sions Inhalation therapy through tube system of non- invasive ventilator was more efficient and it is worthy of wide clinical application.