El debate actual sobre el empleo de la ventilación mecánica no invasiva

RESUMEN La cuestión del empleo de la ventilación mecánica no invasiva es un tema de debate actual. La comunidad médica científica, nacional e internacional, participa activamente en el mismo a través de la publicación de artículos científicos que abordan la complejidad y sutileza de los asuntos relacionados con su indicación como medida de soporte vital a utilizar en determinados enfermos con insuficiencia respiratoria aguda o crónica, de diversas etiologías. El presente trabajo tiene como objetivo resaltar la necesidad de una reflexión basada en una fundamentación biomédica, científica y humanista sobre el uso de la ventilación mecánica, sustentada en los sólidos principios de la eticidad, para alcanzar soluciones viables y precisas que faciliten un mayor grado de consenso sobre este polémico asunto.

ABSTRACT The question of the use of noninvasive mechanical ventilation is a topic of current debate. The scientific national and international medical community takes active part in it through the publication of scientific articles that approach the complexity and subtlety of its indication like a vital support to be used in certain patients with acute or chronic respiratory insufficiency of several different etiologies. The main aim of this work was to stand out the necessity of a reflection based on biomedical, scientific, humanistic grounds on the use of mechanical ventilation sustained on solid ethical principles, to reach viable and precise solutions that facilitate a bigger consent degree on this polemic topic.

Incidência e fatores de risco associados à falha na ventilação não invasiva em pacientes pediátricos / Incidence and risk factors associated with noninvasive ventilation failure in pediatric patients

Introdução: O suporte ventilatório é usado para o tratamento de pacientes com insuficiência respiratória aguda (IRpA) ou crônica agudizada. A ventilação não-invasiva (VNI) na IRpA pediátrica é amplamente usada em bebês prematuros e crianças, porém até a data atual os estudos têm sido escassos. Portanto, o objetivo do presente estudo foi determinar os fatores de risco associados à falha na VNI em uma unidade de terapia intensiva pediátrica.Métodos: Coorte retrospectiva a partir de prontuários de pacientes admitidos na unidade de terapia intensiva (UTI) Pediátrica de um Hospital de Caxias do Sul, entre maio de 2017 e outubro de 2019, que utilizaram VNI.Resultados: A incidência de falha na VNI foi de 33%. Asma (RR = 1,36; IC95% = 1,08-1,72), uso de VNI em pacientes pós-extubação (RR = 1,97; IC95% = 1,17-3,29), uso contínuo da VNI (RR = 2,44; IC95% = 1,18-5,05), encerramento à noite (RR = 2,52; IC95% = 1,53-4,14), modalidade final ventilação mandatória intermitente sincronizada (SIMV) (RR = 4,20; IC95% = 2,20-7,90), pressão expiratória positiva final (PEEP) no início da ventilação (6,8 ± 1,1; p < 0,01) e fração inspiratória de O2 (FIO2) final (53,10 ± 18,50; p < 0,01) foram associados à falha. Adicionalmente, a pressão arterial sistólica (PAS) inicial (118,68 ± 18,68 mmHg; p = 0,02), a frequência respiratória inicial (FR) (47,69 ± 14,76; p = 0,28) e final (47,54 ± 14,76; p < 0,01) foram associados a falha.Conclusão: A modalidade ventilatória final SIMV, demostra ser o melhor preditor de risco de falha, seguido do turno em que a VNI é finalizada, onde à noite existe maior risco de falha. Além disso, foram preditores de falha, porém com menor robustez, a pressão positiva inspiratória (PIP) final e a FR final.

Introduction: Ventilatory support is used for the treatment of patients with acutely chronic or acute respiratory failure (ARF). Noninvasive ventilation (NIV) in pediatric ARF is widely used in preterm infants and children, but studies to date have been limited. Therefore, the aim of the present study was to determine the risk factors associated with NIV failure in a pediatric intensive care unit.Methods: This retrospective cohort study was based on medical records of patients admitted to the pediatric intensive care unit of a hospital in Caxias do Sul, southern Brazil, between May 2017 and October 2019, who used NIV.Results: The incidence of NIV failure was 33%. Asthma (relative risk [RR] = 1.36; 95% confidence interval [CI] = 1.08-1.72), post-extubation use of NIV (RR = 1.97; 95% CI = 1.17-3.29), continuous use of NIV (RR = 2.44; 95% CI = 1.18-5.05), completion at night (RR = 2.52; 95% CI = 1.53-4.14), final mode synchronized intermittent mandatory ventilation (SIMV) (RR = 4.20; 95% CI = 2.20-7.90), positive end-expiratory pressure at the beginning of ventilation (6.8 ± 1.1; p < 0.01), and final fraction of inspired oxygen (53.10 ± 18.50; p < 0.01) were associated with failure. Additionally, initial systolic blood pressure (118.68 ± 18.68 mmHg; p = 0.02), initial respiratory rate (IRR) (47.69 ± 14.76; p = 0.28), and final respiratory rate (47.54 ± 14.76; p < 0.01) were associated with failure.Conclusion: The final ventilatory mode SIMV proves to be the best failure risk predictor, followed by the shift in which NIV is completed, as there is a greater risk of failure at night. In addition, final positive inspiratory pressure and final respiratory rate were less robust predictors of failure.

Effect of high-flow nasal cannula oxygen on patients with chronic obstructive pulmonary disease and mild hypercapnia: a retrospective cohort study based on the Medical Information Mart for Intensive Care-Ⅳ database / 中华危重病急救医学

Objective:To observe the effect of high-flow nasal cannula oxygen therapy (HFNC) in patients with chronic obstructive pulmonary disease (COPD) and mild hypercapnia, and to evaluate the early predictive ability of physiological parameters in these patients.Methods:A retrospective cohort study was conducted based on Medical Information Mart for Intensive Care-Ⅳ (MIMIC-Ⅳ) updated in September 2020 and the data of adult patients with COPD and mild hypercapnia [45 mmHg (1 mmHg = 0.133 kPa) < arterial partial pressure of carbon dioxide (PaCO 2)≤ 60 mmHg] from 2008 to 2019 were collected. These patients were assigned to the HFNC group or non-invasive ventilation (NIV) group according to whether they received HFNC or NIV. Baseline data such as gender, age, body mass index (BMI), simplified acute physiology scoreⅡ (SAPSⅡ), Charlson comorbidity index (CCI) and physiological parameters were collected. A propensity score matching was conducted according to the baseline data of the HFNC group patients. The 48-hour and 28-day intubation rates, 28-day mortality, length of intensive care unit (ICU) stay, the length of hospital stay, and the changes in physiological parameters within 48 hours after treatment were compared between the two groups. The receiver operating characteristic curve (ROC curve) was drawn and the ratio of heart rate over pulse oxygen saturation (HR/SpO 2) and ROX index [SpO 2 / (inhaled oxygen concentration, FiO 2×respiratory rate, RR)] were analyzed to predict the 24-hour and 48-hour intubation rates. Results:A total of 524 520 inpatient records were screened and 153 patients were included, while 37 patients in the HFNC group and 116 patients in NIV group. There were 31 patients in the HFNC group and 84 patients in the NIV group remained after propensity score matching according to the baseline data. There were no significant differences in the baseline data of gender, age, BMI, SAPSⅡ, CCI score, physiological parameters and prognosis data except the length of ICU stay. The length of ICU stay in HFNC group was significant longer than that of the NIV group [days: 4.6 (3.1, 10.0) vs. 3.1 (1.6, 5.8), P < 0.05]. HR and RR at 40- 48 hours were significantly lower than those at 0-8 hours after treatment only in the HFNC group [HR (bpm): 84.1±12.2 vs. 91.1±16.4, RR (times/min): 19.8±4.9 vs. 21.6±4.1, both P < 0.05]. Both in the HFNC group and NIV group the pH increased (7.42±0.08 vs. 7.36±0.05 and 7.41±0.06 vs. 7.36±0.05, both P < 0.05) and PaCO 2 decreased significantly [mmHg: 46.3 (39.5, 51.0) vs. 49.8 (45.5, 54.0) and 46.0 (40.5, 51.5) vs. 49.5 (45.5, 55.3), both P < 0.05]. The HR, PaO 2 were higher in the HFNC group than those in the HFNC group at 40-48 hours after treatment [HR (bpm): 91.1±15.4 vs. 84.1±12.2, PaO 2 (mmHg): 99.5 (86.0, 132.3) vs. 85.8 (76.5, 118.0), both P < 0.05], PaO 2/FiO 2 were lower in the HFNC group than that in the HFNC group at 40-48 hours after treatment [mmHg: 223.8 (216.5, 285.0) vs. 278.0 (212.3, 306.0), P < 0.05]. Both HR/SpO 2 and ROX index at 4 hours after treatment had predictive value for 24-hour and 48-hour intubation in the HFNC group. The areas under ROC curve (AUC) of HR/SpO 2 at 4 hours after treatment in the HFNC group were larger than those of ROX index for predicting 24-hour and 48-hour intubation (24-hour: 0.649 vs. 0.574, 48-hour: 0.692 vs. 0.581, both P < 0.01); the 95% confidence interval (95% CI) of 4 hours HR/SpO 2 and for ROX index predicting 24 hours and 48 hours intubation were 0.497-0.780, 0.567-0.799, 0.450-0.694 and 0.454-0.716, respectively. The high sensitivity of HR/SpO 2 and ROX index in predicting 24-hour and 48-hour intubation were 84.6%, 92.9%, 88.2% and 94.4%, respectively, and the low specificity were 52.3%, 23.7%, 54.7% and 29.6%, respectively. Conclusions:HFNC can be used in COPD patients with mild hypercapnia, but it cannot replace NIV. The accuracy of ROX index at 4 hours after HFNC treatment in predicting intubation in COPD patients with mild hypercapnia is poor.

Study on the effects of different humidifying liquids applied to non-invasive mechanical ventilation airway humidification / 药学实践杂志

Objective To study the effects of different airway humidification fluid applied to non-invasive mechanical ventilation.Methods 121cases of non-invasive mechanical ventilation admitted to the hospital from May 2016to May 2017were randomly divided into three groups.40cases in group A received sterile water for injection as humidifying liquid.40cases in group B received normal saline and 41cases in group C received 1.25％sodium bicarbonate water solution.The viscosity of sputum and the comfort of humidification for the three groups were compared.Results On day 1, there was no significant difference in the sputum viscosity among the three groups. (F=0.230, P=0.795).On day 2, group A had the highest sputum viscosity, followed by group B and group C.The difference was statistically significant (F=4.416, P＜0.05).The same results were obtained on day 3with statistically significant difference (F=11.388, P＜0.001).Group C had the highest comfort score among the three groups with statistically significant difference (F=37.901, P＜0.001).Conclusion 1.25％sodium bicarbonate water solution makes sputum more diluted and gives patients with better comfort.It can be considered as the fluid of choice for patients with high sputum amount.

La ventilación mecánica no invasiva desde un análisis de la ciencia, la tecnología y la sociedad / Noninvasive mechanical ventilation from an analysis of science, technology and society

RESUMEN Dentro de la enorme cantidad de temas reinantes relacionados con el desarrollo científico-tecnológico actual, se encuentra indudablemente el del empleo de la ventilación mecánica no invasiva (VMNI) como medida de soporte vital. Aunque no se trata de una obra especifica que presente un panorama completo y exacto, de todos y cada uno de los problemas relacionados con el empleo de la misma, los autores pretenden con el artículo realizar una breve reflexión del tema desde el enfoque de la ciencia, la tecnología y la sociedad en el momento actual, de manera que constituya un marco útil para el examen de estos temas, su debate, reflexión e intercambio de opiniones en el contexto de los servicios de la salud.

ABSTRACT Among the huge number of current issues related to the current scientific-technological development is undoubtedly the use of non-invasive mechanical ventilation (NIMV) as a measure of life support. Although it is not a specific work that presents a complete and accurate picture of each one of the problems related to the use of it. Authors intend with the article to make a brief reflection on the subject from the perspective of science, technology and society at the present time, so that it constitutes a useful framework for the examination of these issues, debate, reflection and exchange of opinions in the context of health services.

Role of noninvasive mechanical ventilation in patients with severe avian influenza A (H7N9) complicated with acute respiratory distress syndrome / 中华危重病急救医学

Human infection with avian influenza A (H7N9) is an acute contagious respiratory disease. Acute respiratory distress syndrome (ARDS) is a common complication in patients with severe avian influenza A (H7N9), for whom mechanical ventilation (MV) is an important supportive method. A patient, suffered from severe avian influenza A (H7N9) and complicated with ARDS, was admitted to the Second Affiliated Hospital of Guizhou Medical University in January 2017. With very intensive care for oxygenation, respiration and consciousness, and monitoring, she was successfully cured by comprehensive managements, among which noninvasive mechanical ventilation (NIV) was the major respiratory support method. The result demonstrate that, in patients with conscious state, satisfied expectoration ability and relatively good cooperation, and with close observation of oxygenation and respiratory rate, NIV may be accepted as an effective method for patient with ARDS caused by severe avian influenza A (H7N9).

A Study of the Level Expression and Clinical Efficacy of Noninvasive Mechanical Ventilation in the Treatment of Insulin-like Growth Factor Ⅰ, Ⅱ and Cathepsin B in Patients with Chronic Obstructive Pulmonary Disease / 昆明医科大学学报

Objective To investigate the clinical effect of noninvasive mechanical ventilation in the treatment of chronic obstructive pulmonary disease (COPD) and the expression of insulin-like growth factor (IGF) Ⅰ, Ⅱand cathepsin B (CB) in patients.Methods 89 patients with chronic obstructive pulmonary disease from January2014 to June 2017 in the hospital for treatment were retrospectively chosen as the research objects. They were randomly divided into the control group (n = 43) and the study group (n = 46). The control group was treated with conventional therapy. The study group was treated with noninvasive mechanical ventilation on the basis of the control group. The observation period was 10 days of treatment, the level of the indicators of lung function, arterial blood gas changes of the both groups were detected, and the clinical treatment efficiency was taken for statistics. At the same time, the levels of IGF-Ⅰ, Ⅱ and CB in patients were analyzed.Results (1) The lung function of the study group: the lung function VC [ (302.72 ± 40.79) m L], the maximum expiratory flow PEF (421.72 ± 37.59) L/min], and the first expiratory volume FEV1 [ (83.24 ± 11.65) ％], were significantly higher than that of the control group (P＜0.05). (2) The arterial blood gas in the study group: arterial oxygen partial pressure (PaO2) [ (99.24 ± 10.16) mm Hg], partial pressure of carbon dioxide (PaCO2) [ (43.32 ± 5.37) mm Hg], oxygenation index (PaO2/FiO2) [ (281.02 ± 19.74) ％ ], were better than the level of detection in the control group (P＜0.05). (3) The effective rate of clinical treatment was 93.48％ in the study group, which was significantly higher than that in the control group of 67.44％ (P＜0.05). (4) The IGF-Ⅰ [ (11.47 ± 1.53) ug/L] and IGF-Ⅱ [ (28.27± 11.49) ug/L] in the study group were lower than those in the control group, while CB [ (1.03 ± 0.24) ng/ml]was higher than that of the control group (P＜0.05).Conclusions Noninvasive mechanical ventilation is helpful to clear the recovery of lung function in patients with chronic obstructive pulmonary disease, can alter the abnormal expression of insulin-like growth factor I, II and cathepsin B levels in patients, and the clinical treatment effect is significant.

Ventilación no invasiva en insuficiencia respiratoria aguda pediátrica: rol del terapeuta ventilatorio / Non-invasive mechanical ventilation in pediatric acute respiratory failure: the role of the respiratory therapist

Currently, Chilean pediatric intensive care units use non-invasive mechanical ventilation as ventilation support in acute respiratory conditions. However, there are differences in methodology and the number of patients treated annually. These units have a physiotherapist who has progressively incorporated skills related to non-invasive mechanical ventilation application, as well as to other forms of respiratory support and care in general. At present the role of the therapist is fundamental to the ventilatory support of patients with acute respiratory failure

En la actualidad todas las unidades de cuidados intensivos pediátricos nacionales utilizan Ventilación Mecánica no Invasiva como método de soporte ventilatorio en condiciones agudas, no obstante, estas difieren en metodología de aplicación y número de pacientes conectados anualmente. El kinesiólogo que se desempeña como terapeuta respiratorio en estas unidades, ha incorporado de manera progresiva competencias técnicas que lo relacionan con la aplicación de la ventilación no invasiva, así como con otras formas de soporte ventilatorio y cuidados respiratorios en general. Particularmente en ventilación mecánica no invasiva, existe importante dependencia de los cuidados que este profesional puede ofrecer y que son requeridos durante todo el desarrollo de la terapia

Effects of high-flow nasal catheter and noninvasive mechanical ventilation on respiratory failure after thymectomy in patients with myasthenia gravis / 中国实用护理杂志

Objective To observe the reintubation rate of acute respiratory failure after thymectomy in patients with myasthenia gravis (MG) by two kinds of oxygen therapy (HFNC) and noninvasive mechanical ventilation. Methods Sixty-seven patients were treated with HFNC (observation group), and 80 patients were treated with noninvasive mechanical ventilation(control group). The baseline of the two groups was comparable. Results The rate of re-intubation and ICU stay time was 18.42%(14/76) , (5.35 ± 1.95) din control group and 7.50%(6/80), (3.42 ± 1.61) d in observation group. The difference was statistically significant (χ2=4.159,P =0.041;t =5.135,P=0.025).The respiratory rate、SpO2, PaO2, PaCO2 was (28.27 ± 4.32)beats/min, 0.9107 ± 0.0130, (86.43 ± 5.66)mmHg, (57.44 ± 5.73) mmHg in observation group and (24.84 ± 2.48) beats/min, 0.8867 ± 0.0309, (81.31 ± 2.85) mmHg, (65.38 ± 10.00) mmHg in control group. The difference was statistically significant (t =5.189-58.502,all P<0.01 or<0.05). Conclusion HFNC can improve the respiratory function of patients with myasthenia gravis after thymectomy, reduce the incidence of respiratory failure and re-intubation rate.

Effects of high-flow nasal catheter and noninvasive mechanical ventilation on respiratory failure after thymectomy in patients with myasthenia gravis / 中国实用护理杂志

Objective To observe the reintubation rate of acute respiratory failure after thymectomy in patients with myasthenia gravis (MG) by two kinds of oxygen therapy (HFNC) and noninvasive mechanical ventilation. Methods Sixty-seven patients were treated with HFNC (observation group), and 80 patients were treated with noninvasive mechanical ventilation(control group). The baseline of the two groups was comparable. Results The rate of re-intubation and ICU stay time was 18.42%(14/76) , (5.35 ± 1.95) din control group and 7.50%(6/80), (3.42 ± 1.61) d in observation group. The difference was statistically significant (χ2=4.159,P =0.041;t =5.135,P=0.025).The respiratory rate、SpO2, PaO2, PaCO2 was (28.27 ± 4.32)beats/min, 0.9107 ± 0.0130, (86.43 ± 5.66)mmHg, (57.44 ± 5.73) mmHg in observation group and (24.84 ± 2.48) beats/min, 0.8867 ± 0.0309, (81.31 ± 2.85) mmHg, (65.38 ± 10.00) mmHg in control group. The difference was statistically significant (t =5.189-58.502,all P<0.01 or<0.05). Conclusion HFNC can improve the respiratory function of patients with myasthenia gravis after thymectomy, reduce the incidence of respiratory failure and re-intubation rate.

Parálisis diafragmática bilateral idiopática tratada con ventilación mecánica no invasiva / Idiopathic bilateral diaphragmatic paralysis with noninvasive mechanical ventilation

Resumen La parálisis diafragmática bilateral es infrecuente y puede ser idiopática o más comúnmente asociada a varias entidades. Describimos el caso de un varón de 61 años con antecedentes de asma bronquial quien desarrolló parálisis difragmática bilateral sin causa evidente, la cual es excepcional. El paciente presentó disnea progresiva y ortopnea, que no mejoraban con antibioterapia ni esteroides sistémicos, por lo que se descartaron diversas etiologías como neuralgia lateral amiotrófica y finalmente se le diagnosticó parálisis diafragmática lateral en base a la exploración física y las pruebas de imagen. Se inició ventilación mecánica no invasiva con gran mejoría clínica.

Bilateral paralysis of the diaphragm is uncommon and can be either idiopathic or more frequently associated with several medical conditions. We describe the case of a 61-year-old man with a history of asthma who developed severe bilateral diaphragmatic paralysis without any obvius cause, which is exceptional. The patient manifested progressive dyspnea and debilitating orthopnea with no improvement with antibiotics or systemic steroids. Different etiologies were discarded as amyotrophic lateral neuralgia, and he was diagnosed of bilateral diaphragmatic paralysis based on physical examination and imaging tests. Noninvasive mechanical ventilation was started with great clinical improvement.

High-flow nasal cannulae and noninvasive mechanical Ventilation forthe treatment of postoperative respiratory function failure / 中国实用护理杂志

Objective To observe the high-flow nasal cannulae can reduce indoor postoperative intensive care patients with tracheal intubation in offline acute respiratory failure after extubation reintubation rates. Methods 53 cases of postoperative acute hypoxia type patients with respiratory failurein the ICU in offline after extubation were divided into two groups, control group of 24 patients, 29 cases of observation group patients. Control group patients in the event of a failure after using non-invasive mechanical ventilation (NIMV) and observation group of patients using HFNC. All other patients with same treatment and nursing. Compare two groups of patients reintubation rates. Results Observation group of reintubation rate was 20.69%(6/29), the control group was 45.83%(11/24), reintubation rate difference of two groups of patients were statistically significant (χ2=3.81, P < 0.05). Conclusions HFNC can reduce postoperative extubation after weaning reintubation rates in patients with acute respiratory failure.

Risk assessment of acute exacerbation of chronic obstructive pulmonary disease treated by noninvasive mechanical ventilation / 中华危重病急救医学

Objective To analyze the risk factors for the failure of noninvasive mechanical ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and to help the clinical risk assessment and decision making.Methods A retrospective case control study was conducted.The patients with AECOPD undergoing NIV admitted to Kaifeng Emergency Center from June 2011 to March 2016 were enrolled,and they were divided into two groups according to whether NIV was successful or not within 12 hours.The nutritional status,blood gas analysis,serum electrolytes,D-dimer,renal function,serum pre-albumin,as well as kinetic vital signs,Glasgow coma scale (GCS) score,expression of respiratory distress,and spontaneous expectoration were recorded.Logistic forward stepwise regression analysis was used to analyze the factors for failure of NIV.Results 122 patients.with the initial NIV were enrolled,with NIV failure in 41 patients within 12 hours,accounted for 33.6％.Compared with NIV success group,the percents of respiratory rate ≥ 25 breaths/min (75.6％ vs.17.3％),expectoration disorders (78.0％ vs.19.8％),circulatory disorders (61.0％ vs.18.5％),malnutrition (61.0％ vs.11.1％),decreased serum pre-albumin (58.5％ vs.17.3％),and GCS score ＜ 12 (75.6％ vs.28.4％) in NIV failure group were significantly increased (all P ＜ 0.05).But there were no significant differences in gender,age,body temperature,blood gas analysis,D-dimer,serum creatinine between two groups.It was shown by the results of binary logistic regression analysis that respiratory rate,expectoration disorders,circulatory disorders,malnutrition,serum pre-albumin,and GCS score were the factors of NIV failure [odds ratio (OR) values were 10.879,6.338,9.860,23.273,8.862,6.774,and P values were 0.011,0.038,0.024,0.003,0.015,0.041,respectively].It was shown by the results of logistic stepwise regression analysis that respiratory rate ≥ 25 breaths/min,expectoration disorders,circulatory disorders,malnutrition,decreased serum pre-albumin,and GCS score ＜ 12 were independent risk factors of NIV failure (OR values were 6.610,5.403,5.138,8.153,4.979,5.100,and P values were 0.007,0.013,0.023,0.007,0.027,0.023,respectively).Conclusions The multiple independent risk factors can induce NIV failure within 12 hours in emergency patients with AECOPD,i.e.increased respiratory rate,expectoration dysfunction,circulatory disorders,malnutrition,decreased serum pre-albumin,and decreased GCS score.Emergency physicians should pay attention to these early risk factors in AECOPD patients,which can be taken as correct judgment and guide.

Clinical Observation of Noninvasive Mechanical Ventilation Combined with Aerosol Inhalation in the Treat-ment of Acute Exacerbation of COPD Complicating with Respiratory Failure / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of noninvasive mechanical ventilation combined with aero-sol inhalation drug in the treatment of AECOPD complicating with respiratory failure. METHODS:90 patients diagnosed as AECO-PD complicating with respiratory failure were selected and randomly divided into observation group and control group,with 45 cas-es in each group. Both groups received routine treatment as oxygen supply at low flow rate,anti-infection,relieving asthma,venti-lation,cardiotonic,spasmolysis and nutritional support. Control group received noninvasive mechanical ventilation;observation group was additionally given aerosol inhalation of Budesonide atomized liquid+terbutaline+ipratropium bromide,bid. Both groups received 7 d of treatment. Clinical efficacy of 2 groups were compared as well as pH value,PaCO2,PaO2,HR,RR and PEF lev-els before and after treatment. The occurrence of ADR was observed. RESULTS:Total effective rate of observation group was 93.3%,which was significantly higher than 73.3% of control group,with statistical significance(P0.05). pH value,PaO2 and PEF of 2 groups increased after treatment,while PaO2,HR and RR decreased;the observation group was better than the con-trol group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Noninvasive me-chanical ventilation combined with aerosol inhalation drug is effective in the treatment of AECOPD complicating with respiratory failure,and can effectively improve blood gas indexes,HR,RR and PEF with good safety.

Factores pronósticos del éxito de la ventilación mecánica no invasiva en la insuficiencia respiratoria aguda / Predictive factors for the success of noninvasive mechanical ventilation in acute respiratory failure i: en

Se realizó un estudio observacional, descriptivo y analítico, de casos y controles, de 41 afectados con insuficiencia respiratoria aguda, tratados con ventilación mecánica no invasiva y egresados de las unidades de atención a pacientes en estado grave en el Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, del 2012 al 2013, con vistas a describir la variabilidad de los parámetros fisiológicos y hemogasométricos, así como estimar la capacidad de pronóstico de estos en el desenlace exitoso del procedimiento. En la serie la media de edad fue de 60 años, predominó el sexo masculino (61,0 %), la técnica fue exitosa en 80,5 % y se constataron resultados significativos de éxito en pacientes con enfermedad pulmonar obstructiva crónica, asma bronquial e insuficiencia respiratoria aguda posextubación (76,9; 87,5 y 100,0 %, respectivamente). El éxito de la ventilación mecánica no invasiva trajo aparejada una mejoría considerable en los integrantes de la casuística al final de la evaluación de todos los parámetros fisiológicos y hemogasométricos, a excepción, en este último caso, de la presión arterial de dióxido de carbono y el bicarbonato sódico. Finalmente se concluyó que solo la escala de coma de Glasgow y la presión arterial de oxígeno presentaron importancia significativa para el pronóstico de éxito.

An observational, descriptive and analytic case-control study was conducted in 41 patients with acute respiratory failure, treated with noninvasive mechanical ventilation and discharged from the care units for acutely ill patients at "Saturnino Lora Torres" Provincial Teaching Clinical Surgical Hospital of Santiago de Cuba, from 2012 to 2013, to describe the variability of hemogasometric and physiologic parameters and to estimate their predictive power in the successful outcome of the procedure. In the series the mean age was 60 years, with a predominance of males (61.0%), the technique was successful in 80.5% and significant results of success were observed in patients with chronic obstructive pulmonary disease, bronchial asthma and postextubation acute respiratory failure (76.9; 87.5 and 100.0%, respectively). The success of noninvasive mechanical ventilation led to a significant improvement in patients of the case material at the end of the evaluation of all physiologic and hemogasometric parameters, except for carbon dioxide blood pressure and sodium bicarbonate. Finally, it was concluded that only the Glasgow Coma Scale and oxygen blood pressure had a significant importance for the success prognosis.

Ventilación no invasiva como coadyuvante al ejercicio en pacientes con enfermedad respiratoria crónica: efectos fisiológicos e implicancia clínica / Noninvasive ventilation during exercise in patients with chronic respiratory disease

Noninvasive ventilation (NIV) has been widely used for the treatment of acute and chronic respiratory diseases (CRD) in both adults and children. In the rehabilitation setting, NIV has shown a positive impact in improving exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). However, there are no data regarding its efficiency in children with CRD. In this article we reviewed the pathophysiological aspects about the origin of the ventilatory constraints during exercise in patients with COPD justifying the inclusion of ventilator assistance in training protocols; also we presented recommendations for proper incorporation of ventilator therapy in rehabilitation. The purpose of this review is to provide data for the design of future studies to evaluate the applicability of this therapeutic strategy for children with chronic respiratory disease.

La asistencia ventilatoria no invasiva (VNI) ha sido ampliamente utilizada para el tratamiento de enfermedades respiratorias agudas y crónicas, tanto en adultos como en población infantil. En el contexto de la rehabilitación, la VNI ha mostrado un impacto positivo al mejorar la tolerancia al ejercicio en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). No obstante, no existen datos respecto a su eficiencia en niños con enfermedades respiratorias crónicas. En el presente texto se revisan los aspectos fisiopatológicos que sustentan el origen de la limitación ventilatoria al ejercicio, presente en los pacientes con EPOC, y que justifican la incorporación de la asistencia ventilatoria a los protocolos de entrenamiento. Por otro lado, se presentan recomendaciones para una apropiada incorporación de la terapia ventilatoria a la rehabilitación. El propósito de la presente revisión es proporcionar datos para el diseño de futuros estudios que evalúen la aplicabilidad de esta estrategia terapéutica a niños con enfermedades respiratorias crónicas.

Ventilación no invasiva durante el ejercicio en niños con bronquiolitis obliterante post infecciosa: a propósito de un caso / Noninvasive ventilation during exercise in children with post infectious bronchiolitis obliterans: case report

Pulmonary rehabilitation is part of bronchiolitis obliterans comprehensive treatment. However, ventilatory constraints, often observed in these patients, difficult to achieve appropriate workloads in order to get physiological adaptations which increase the functional capacity and improve the performance in their daily life activities. In this case report, we describe the effects of non-invasive ventilation (NIV) during exercise on an adolescent with BO. He showed less dyspnea, fatigue legs, he improved oxygenation and endurance time. These results show the potential usefulness of NIV as an adjunct to exercise in this group of patients. However, further studies are needed to confirm these hypotheses.

La rehabilitación respiratoria forma parte del tratamiento de la bronquiolitis obliterante (BO) post-infecciosa. Sin embargo, la limitación ventilatoria, a menudo observada durante el ejercicio, dificulta el logro de cargas de trabajo adecuada para alcanzar adaptaciones fisiológicas que permitan incrementar la capacidad funcional y mejorar el desempeño en sus actividades cotidianas. En el presente caso clínico se muestran los efectos de la ventilación no invasiva (VNI) sobre el rendimiento físico de un adolescente con BO, observándose disminución de la disnea, fatiga de piernas, mejorando la oxigenación y el tiempo de resistencia durante el ejercicio asistido. Estos resultados muestran la posible utilidad de esta herramienta como coadyuvante al ejercicio en este grupo de pacientes. No obstante, futuros estudios clínicos son necesarios para confirmar estas hipótesis.

Home Mechanical Ventilation in South Korea

PURPOSE: To survey the use of invasive and noninvasive home mechanical ventilation (HMV) methods in South Korea from the perspective of physical medicine and rehabilitation (PM&R). MATERIALS AND METHODS: For 413 users of HMV, retrospective reviews of PM&R interventions and survey of HMV methods employed from Mar 2000 to Dec 2009. RESULTS: Of the 413 users, the majority of whom with progressive neuromuscular disorders (NMDs) (n=358), 284 patients initially used noninvasive mechanical ventilation (NIV), while 63 others who were using tracheostomy mechanical ventilation switched to NIV as part of their rehabilitation. The NMD patients began HMV at an earlier age (34.9+/-20.3 yrs), and used for longer (14.7+/-7.5) hours than patients with non-neuromuscular causes of respiratory impairment. CONCLUSION: Noninvasive management was preferred over invasive ones, and transition to the former was a result of PM&R interventions.

Soporte respiratorio muscular para evitar el fallo respiratorio y la traqueotomía: ventilación no invasiva y técnicas de tos asistida / Respiratory muscle aids to prevent respiratory failure and tracheotomy: Noninvasive mechanical ventilation and mechanically assisted coughing

El propósito de este artículo es describir el uso de técnicas de soporte respiratorio muscular no invasivo con el fin de prevenir la insuficiencia respiratoria y el fallo ventilatorio, permitiendo la extubación y decanulación de pacientes considerados "imposibles de destetar''. La aplicación de presión en la vía aérea de forma no invasiva durante la inspiración puede proporcionar un soporte ventilatorio continuo en pacientes con poca o inexistente capacidad vital. Así mismo, podrá alcanzarse un pico flujo espiratorio efectivo en pacientes con una disfunción severa de los músculos espiratorios. En abril de 2010 un consenso clínico de 19 centros en 18 países describió 1623 pacientes neuromusculares con atrofia muscular espinal tipo 1, distrofia muscular de Duchenne (DMD) y esclerosis lateral amiotrófica que sobrevivieron utilizando soporte ventilatorio continuo sin necesidad de traqueotomía. De esta serie de pacientes, 76 (47%) precisaron ventilación no invasiva continua en un periodo de seguimiento de 15 años. De estos 76.22 (30.1%) de los enfermos fueron extubados y 35 (4.6%) decanulados en cuatro centros especializados. En estos centros se extuban rutinariamente pacientes con distrofia muscular de Duchenne considerados "imposibles de destetar", de forma que ninguno de sus más de 250 enfermos ha requerido traqueotomía. Esta aproximación en el tratamiento se está abriendo camino en varios centros de España, México y América45.

The purpose of this article is to describe the use of noninvasive inspiratory and expiratory muscle aids to prevent ventilatory insufficiency and failure, and to permit the extubation and tracheostomy tube decannulation in "unweanable" patients. Noninvasive airway pressure aids can provide a continuous support to respiratory ventilation for patients with little or no vital capacity and can provide effective cough flows in patients with severely dysfunctional expiratory muscles. In April 2010, a consensus of clinicians from 19 centers in 18 countries reported the experience of noninvasive ventilation in 1623 patients with spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis (ALS), who survived without tracheotomy. The survival was for more than 15 years in 76 patients. Among these 76 patients, 22 (30.1%) were extubated and 35 (4.6%) were decannulated in four specialized centers. In these centers, unweanable DMD patients are routinely extubated; none of over 250 such patients has undergone tracheotomy. This approach is now being introduced into different centers in Spain, Mexico and the United States.

Ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria aguda / Noninvasive mechanical ventilation in patients with acute respiratory failure i:en

Se realizó un estudio observacional, descriptivo y transversal de 54 pacientes con insuficiencia respiratoria aguda, atendidos en la Unidades de Cuidados Intensivos e Intermedios del Hospital Clinicoquirúrgico Docente "Saturnino Lora Torres" de Santiago de Cuba desde enero hasta agosto del 2011, a fin de valorar la eficacia de la ventilación artificial mecánica no invasiva en estos afectados que además presentaron otras afecciones clínicas (para postergar o evitar la ventilación mecánica invasiva). Los integrantes de la serie fueron seleccionados de forma no probabilística por criterios de expertos, teniendo en cuenta además los criterios de inclusión del Grupo Iberolatinoamericano de Ventilación Mecánica No Invasiva. Se demostró la efectividad de la técnica en la mejoría clínica y hemogasométrica de estos pacientes especialmente en los que se agudizó la enfermedad pulmonar obstructiva crónica.

An observational, descriptive and cross-sectional study of 54 patients with acute respiratory failure, assisted in the Intensive and Intermediate Care Unit from "Saturnino Lora Torres" Teaching Clinical Surgical Hospital in Santiago de Cuba was carried out from January to August, 2011, in order to evaluate the effectiveness of the artificial mechanical noninvasive ventilation in these affected patients, who also presented other clinical disorders (to delay or to avoid the invasive mechanical ventilation). The members of the series were selected in a non probabilistical way based on the experts' criteria, also keeping in mind the inclusion criteria from the Iberolatinoamerican Group of Non Invasive Mechanical Ventilation. The effectiveness of the technique was demonstrated in the clinical and hemogasometric improvement of these patients especially those in whom the chronic, obstructive lung disease worsened.