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Noninvasive positive pressure ventilation (NPPV) does not require the establishment of an invasive artificial airway, and it can reduce the complications of invasive ventilation and alleviate the pain of children.Meanwhile, it has become a clinically accepted auxiliary ventilation technology.At present, chronic lung diseases in children are gradually increasing in clinical cases, including bronchopulmonary dysplasia, asthma and so on, and they seriously affects the growth and development of children and the quality of life.With the development of medical technology, the use rate of NPPV in the treatment of children′s chronic lung disease is gradually increasing.This paper reviews the main modes, adverse reactions and compliance of NPPV in the treating various chronic lung diseases in children.
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Objective:To observe the effect of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) on the prognosis of patients with coronavirus disease 2019 (COVID-19) accompanied with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology when authors worked as medical team members for treating COVID-19. COVID-19 patients with pulse oxygen saturation/fraction of inspiration oxygen (SpO 2/FiO 2, S/F) ratio < 235, managed by medical teams [using S/F ratio instead of oxygenation index (PaO 2/FiO 2) to diagnose ARDS] from February to April 2020 were included. The patients were divided into NIPPV group and HFNC group according to their oxygen therapy modes. Clinical data of patients were collected, including general characteristics, respiratory rate (RR), fraction of FiO 2, SpO 2, heart rate (HR), mean arterial pressure (MAP), S/F ratio in the first 72 hours, lymphocyte count (LYM), percentage of lymphocyte (LYM%) and white blood cell count (WBC) at admission and discharge or death, the duration of dyspnea before NIPPV and HFNC, and the length from onset to admission. The differences of intubation rate, all-cause mortality, S/F ratio and RR were analyzed, and single factor analysis and generalized estimation equation (GEE) were used to analyze the risk factors affecting S/F ratio. Results:Among the 41 patients, the proportion of males was high (68.3%, 28 cases), the median age was 68 (58-74) years old, 28 cases had complications (68.3%), and 34 cases had multiple organ dysfunction syndrome (MODS, 82.9%). Compared with HFNC group, the proportion of complications in NIPPV group was higher [87.5% (21/24) vs. 41.2% (7/17), P < 0.05], and the value of LYM% was lower [5.3% (3.4%-7.8%) vs. 10.0% (3.9%-19.7%), P < 0.05], the need of blood purification was also significantly lower [0% (0/24) vs. 29.4% (5/17), P < 0.05]. The S/F ratio of NIPPV group gradually increased after 2 hours treatment and RR gradually decreased with over time, S/F ratio decreased and RR increased in HFNC group compared with baseline, but there was no significant difference in S/F ratio between the two groups at each time point. RR in NIPPV group was significantly higher than that in HFNC group after 2 hours treatment [time/min: 30 (27-33) vs. 24 (21-27), P < 0.05]. There was no significant difference in rate need intubation and hospital mortality between NIPPV group and HFNC group [66.7% (16/24) vs. 70.6% (12/17), 58.3% (14/24) vs. 52.9% (9/17), both P > 0.05]. Analysis of the factors affecting the S/Fratio in the course of oxygen therapy showed that the oxygen therapy mode and the course of illness at admission were the factors affecting the S/F ratio of patients [ β values were -15.827, 1.202, 95% confidence interval (95% CI) were -29.102 to -2.552 and 0.247-2.156, P values were 0.019 and 0.014, respectively]. Conclusion:Compared with HFNC, NIPPV doesn't significantly reduce the intubation rate and mortality of patients with COVID-19 accompanied with ARDS, but it significantly increases the S/F ratio of those patients.
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Objective:To explore the early application effect of the bedside sitting respiratory training in patients with respiratory failure and noninvasive positive pressure ventilation of the acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 102 patients with respiratory failure and noninvasive positive pressure ventilation of the AECOPD treated in Shanghai Public Health Clinical Center from June 2018 to December 2019 were selected and divided into the control group and the research group by random digits table method with 51 cases in each group. The control group was given the conventional treatment and nursing measures; and the research group was given the bedside sitting respiratory training. Pulmonary functional and blood -gas analysis parameters, clinical outcome of patients, etc. before and after the intervention between the two groups were compared. Results:After the intervention, the forced expiratory volume in one second (FEV 1), forced vital capacity(FVC), FEV 1/FVC were (1.79±0.22) L, (3.09±0.28) L, (62.16±5.94)% in the research group, and (1.43±0.18) L, (2.66±0.23) L, (53.48±5.31)% in the control group, the differences were statistically significant(t values were 8.36, 8.00, 7.19, P<0.01). Arterial partial pressure of carbon dioxide (PaCO 2) and arterial partial pressure of oxygen (PaO 2) in blood gas analysis were (51.14±3.79) mmHg(1 mmHg=0.133 kPa), (71.07±5.49) mmHg in the research group, and (57.52±3.86) mmHg, (65.62±5.27) mmHg in the control group, the differences were statistically significant ( t values were -7.78, 4.72, P<0.01). The non-invasive positive pressure ventilation time, hospital stays were (7.41±1.76) d, (11.27±2.41) d in the research group, and (9.79±2.11) d, (15.46±3.12) d in the control group, the differences were statistically significant ( t values were -5.71, -6.70, P<0.01). The incidence of adverse events was 3 cases in the research group, 1 case in the control group, the difference was no statistically significant ( P>0.05). Conclusions:The application of the bedside sitting respiratory training in patients with respiratory failure and noninvasive positive pressure ventilation of the AECOPD can effectively improve the pulmonary physiological function, shorten the noninvasive positive pressure ventilation time and hospitalization time, which has clinical application value.
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Objective:To study the effect of high flow humidification oxygen inhalation on hypoxemia in patients undergoing cardiac surgery and the effect of postoperative weaning time.Methods:A total of 80 patients with hypoxemia after cardiac surgery from January 2018 to January 2020 were selected for the study, according to the random number table, they were divided into the observation group and the control group, 40 cases each.The control group was treated with noninvasive positive pressure ventilation, while the observation group was treated with high flow humidification and oxygen absorption. The weaning time, the changes of the arterial oxygen partial pressure (PaO 2), partial pressure of carbon dioxide (PaCO 2), oxygenation index (PaO 2/FiO 2), pH value, spontaneous breathing frequency (RR), heart rate before and after treatment 2 h, 6 h, 24 h, and the incidence of complications were compared between the two groups. Results:The weaning time in the observation group was (35.51±4.61) h, and that in the control group was (44.04±3.85) h, the difference was statistically significant( t value was 8.982, P<0.01). The PaO 2 in the observation group at 2, 6, 24 h after treatment were (73.96±4.32), (79.82±3.61), (94.82±2.71) mmHg(1 mmHg=0.133 kPa), and those in the control group were (70.72±3.10), (75.63±3.88), (90.27±3.55) mmHg, the differences were statistically significant( t values were 3.854, 5.000, 6.443, P<0.01). The PaO 2/FiO 2 in the observation group at 2, 6, 24 h after treatment were (239.45±18.74), (269.85±20.09), (291.83±17.30) mmHg, and those in the control group were (226.74±20.72), (251.12±16.74), (279.65±19.40) mmHg, the differences were statistically significant( t values were 2.877, 4.530, 2.964, P<0.01). The RR in the observation group at 2, 6, 24 h after treatment were (24.74±2.03), (22.61±1.86), (18.63±2.05) times/min, and those in the control group were (26.07±1.89), (24.24±1.73), (20.11±1.87) times/min, the differences were statistically significant( t values were 3.033, 4.058, 3.373, P<0.01). The heart rate in the observation group at 2, 6, 24 h after treatment were (83.32±4.88), (76.06±4.71), (70.34±3.82) times/min, and those in the control group were (86.06±3.29), (80.91±4.31), (75.71±6.22) times/min, the differences were statistically significant( t values were 2.944, 4.805, 4.653, P<0.01). The total incidence of complications in the observation group was 7.50%(3/40), and that in the control group was 25.00%(10/40), the difference was statistically significant( χ 2 value was 4.501, P<0.05). Conclusions:High flow humidification and oxygen absorption is well for patients with hypoxemia after cardiac surgery, which effectively improve the blood gas index, shorten the weaning time, reduce the incidence of complications, and have good safety, which is worth popularizing.
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@#AIM: To investigate the clinical effect of non-invasive positive pressure ventilation in patients with nonischemic central retinal vein occlusion(RVO)combined with severe obstructive sleep apnea hypopnea syndrome.<p>METHODS: A retrospective analysis was performed on 66 patients(66 eyes)with nonischemic central retinal vein occlusion combined with severe obstructive sleep apnea hypopnea syndrome in our hospital from December 2017 to December 2018. 30 of the patients(30 eyes)received intraocular anti-vascular therapy with Lucentis and retinal laser irradiation therapy combined with noninvasive positive pressure ventilation(observation group). Totally 36 patients(36 eyes)only received intraocular anti-vascular therapy with Lucentis and retinal laser irradiation therapy(control group). The differences of the best corrected visual acuity(BCVA)and retinal thickness at lesion sites were compared and analyzed between two groups before treatment and at the 1mo, 3mo and 6mo after treatment.<p>RESULTS: There were statistically significant differences of both retinal thickness and BCVA between two groups at different time points(<i>P</i><0.05). Both retinal thickness and BCVA of the observation group were lower than those of the control group at the 3 and 6mo after treatment(<i>P</i><0.01). There was no significant difference between the retinal thickness of the 3mo after treatment and that of the 6mo after treatment in the control group(<i>P</i>>0.05), while there were significant differences of retinal thickness between two groups of the other time points in the control group or any two groups of the time points in the observation group(<i>P</i><0.05); BCVAs of the 1, 3 and 6mo after treatment were significantly lower than that of before treatment in the observation group(<i>P</i><0.05), while the BCVAs of the 3, 6mo after treatment were significantly higher than that of the 1mo after treatment in the control group(<i>P</i><0.05), but no significant difference of BCVA was observed between any two group of the other time points in the observation group or control group(<i>P</i>>0.05).<p>CONCLUSION: Noninvasive positive pressure ventilation is beneficial for patients with nonischemic(RVO)combined with severe obstructive sleep apnea hypopnea syndrome to improve the therapeutic effect.
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Objective: To compare the efficacy and safety between humidified high flow nasal cannula (HHFNC) and noninvasive positive pressure ventilation (NPPV) in patients with chronic obstructive pulmonary disease (COPD) complicated with type 2 respiratory failure after extubation. Methods: Seventy-two patients with COPD complicated with type 2 respiratory failure were enrolled after extubation and were randomized into HHFNC group and NPPV group at 1: 1 ratio, with 36 patients in each group. The blood gas analysis index, respiratory rate, heart rate, mean arterial pressure, reintubation rate, incidence of tracheotomy, intensive care unit stay, incidence of adverse events and mortality were compared between the two groups before treatment and 2, 12, 24 h after treatment. Results: The pH at 24 h, partial pressure of oxygen in artery (PaO2) at 2 h and 12 h, and oxygenation index (PaO2/FiO2) at 2 h and 12 h after treatment were significantly higher in the HHFNC group compared with the NPPV group (all P0.05), while the overall incidence of adverse events, intolerance rate, flatulence rate and aspiration rate were significantly lower in the HHFNC group than those in the NPPV group (all P 0.05). Conclusion: The short-time efficacy and safety of HHFNC are better than NPPV in treatment of COPD complicated with type 2 respiratory failure.
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Objective To evaluate the therapy effect and clinical value of non-invasive positive-pressure ventilation (NPPV) treatment in acute respiratory distress syndrome (ARDS) caused by severe acute pancreatitis. Methods Data of 22 cases of AP with ARDS who were treated with NPPV were retrospectively analyzed. The oxygenation index (OI), PaO2, PaCO2, respiratory rate (RR) and heart rate (HR) were measured and analyzed before and after NPPV treatment. Results All of cases recovered from ARDS. The PaO2, SpO2 and RR decreased 2 h after NPPV treatment [(81.60 ± 12.56) mmHg (1 mmHg=0.133 kPa) vs. (61.50 ± 5.71) mmHg, (95.66 ± 5.13)% vs. (88.52 ± 4.41)% and (24.49 ± 2.01) times/min vs. (33.37 ± 2.96) times/min] (P<0.05). The OI, PaO2, SpO2 and RR further decreased 12 h after NPPV treatment [(367.89 ± 49.58) mmHg vs. (214.64 ± 20.93) mmHg, (105.19 ± 17.60) mmHg vs. (61.50 ± 5.71) mmHg; 0.991 ± 0.026 vs. 0.885 ± 0.044] (P < 0.05). The OI, PaO2, PaCO2 and SpO2 increased significantly, in contrast, RR and HR descended 24 h after NPPV treatment (P < 0.05). Conclusions NPPV treatment can effectively improve oxygenation of patients with ARDS caused by SAP. NPPV has a good value of clinical application and is worth spreading.
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Objective To study the clinical application value of long term home noninvasive positive pressure ventilation in the therapy of silicosis patients with type 2 respiratory failure. Methods A total of 85 silicosis patients with type 2 respiratory failure were enrolled, and their clinical data were retrospectively analyzed. According to the therapeutic method, they were divided into noninvasive positive pressure ventilation group (group A) and basic therapy group (group B). The various indicators of the patients were analyzed before and after the treatment including vital signs, laboratory indicators, 6-minute walking distance (6MWD), and modified dyspnea index (mMRC). The admission times, length of hospital stay and annual mortality of the patients were also recorded by follow-up after the treatment for one year. Results After the one year follow-up, the heart rate, respiratory rate, PaO2, PaCO2, SO2％, 6MWD, and mMRC of group A were significantly improved than those of group B (all P<0.05). The admission times and the length of hospital stay of group A were lower than those group B (all P<0.05). There was no difference in the annual mortality between the two groups (P>0.05). Conclusions The therapeutic method of home noninvasive positive pressure ventilation has significant effects on silicosis combined with type 2 respiratory failure. It can improve clinical symptoms and the quality of life, and reduce the length of hospital stay and admission times, and reduced medical insurance burden.
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Objective To compare the clinical efficacy of high-flow nasal cannula oxygen therapy (HFNC) with non-invasive positive pressure ventilation (NPPV) in patients with traumatic cervical spinal cord injury complicated with acute respiratory failure (ARF).Methods A prospective randomized controlled trial was performed in EICU of the First Affiliated Hospital of Zhengzhou University from May 2016 to January 2018.One hundred sixty-eight consecutive patients with traumatic cervical spinal cord injury complicated with ARF,who did not respond to conventional oxygen therapy,were assigned to the HFNC or NPPV treatment group sequenced by the random number table.The baseline clinical characteristics of randomized participants and respiratory frequency (RR),PaCO2,mean arterial pressure (MAP) at 1,12,24,48 h after treatment were evaluated.Comfortable scale,tracheal intubation rate within 28 d,duration of mechanical ventilation,length of stay in ICU and mortality rate were compared as well.Results There was no significant differences in baseline clinical characteristics,such as sex,age.between the two groups (P＞0.05).RR and PaCO2 were lower in the HFNC group at all time point.In addition,the HFNC group had significantly lower PaCO2 than the NPPV group at 24 and 48 h after treatment (P＜0.01);Oxygenation index (PaO2/FiO2) was improved in both groups,and the HFNC group had superior oxygenation index than the NPPV group at 12,24,48 h after treatment (P＜0.01).Furthermore,the HFNC group had better comfort scale (6.93±0.71 vs 4.29±0.93,P＜0.01),shorter length of stay in ICU and duration of mechanical ventilation compared to the NPPV group (P＜0.01).There was no significant differences in tracheal intubation rate and mortality rate between the two groups (P＞0.05).Conclusions In addition to the superior efficacy in improving respiratory function and shortening length of stay in ICU,HFNC was well tolerated by patients with traumatic cervical spinal cord injury complicated with ARF,and could be recommended in clinical practice.
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The cause of sleep-disordered breathing in patients with neuromuscular disease is due to a sharp decrease in lung volume during supine sleep and the disease-induced upper airway collapse or cardiopulmonary failure. Polysomnography is used for the diagnosis of sleep - disordered breathing. Noninvasive positive pressure ventilation is the standard management for sleep-disordered breathing.
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Objective To explore the clinical effect of fluticasone propionate combined with noninvasive positive pressure ventilation in the emergency treatment of AECOPD .Methods 88 AECOPD patients were selected, and they were divided into two groups by digital random method ,44 cases in each group.The control group received conventional treatment, the observation group received fluticasone propionate and noninvasive positive pressure ventilation treatment.The curative effect of the two groups was compared .Results The total effective rate of the observation group was 100.0%,which was higher than 70.5% of the control group (χ2 =10.827,P =0.000).After treatment,in the observation group,the FVC was (2.50 ±0.32)L,forced expiratory volume in one second (FEV1 ) was (1.36 ±0.20) L,the first second forced expiratory solvent percentage of predicted value ratio (FEV1%) was (51.23 ±4.32),the arterial oxygen pressure(PaO2 ) was (10.51 ±2.10) kPa,arterial partial pressure of carbon dioxide(PaCO2 ) was (5.15 ±1.19) kPa,and in the control group,the FVC was (2.00 ±0.30) L,FEV1 was (1.08 ±0.12)L,FEV1% was (40.6 ±4.03),PaO2 was (9.32 ±2.11) kPa,PaCO2 was (6.06 ±1.23) kPa,the differences between the two groups were statistically significant (t =7.940,9.192,8.102,8.920,9.920,P =0.023, 0.006,0.011,0.008,0.005).The readmission rate of the observation group was 4.5%,which was significantly lower than 13.6% of the control group (χ2 =9.298,P =0.000).Conclusion Fluticasone propionate combined with noninvasive positive pressure ventilation in the treatment of AECOPD patients can effectively improve lung function , reduce the relapse rate of the disease.
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This paper reviews the current status of health education intervention, health education intervention model and evaluation indicators of intervention effect in noninvasive positive pressure ventilation in China.By analysing the existing problems in the health education of noninvasive positive pressure ventilation, this artical will provide the basis for exploring the new health education mode ,so as to improve the effect of non-invasive positive pressure ventilation and the patients′quality of life.
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Objective To investigate the clinical effect of fluticasone propionate combined with noninvasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease (COPD).Methods 88 cases of COPD patients from October 2014 to October 2016 in our hospital were selected and randomly divided into two groups of the control group observation group with 44 cases in each group.The control group was treated with conventional treatment, the observation group was treated with fluticasone propionate plus noninvasive positive pressure ventilation, and then the curative effect of the two groups was compared.Results The total effective rate of observation group was 100% higher than that of the control group 70.5%, the difference was statistically significant (P<0.05), after treatment, the observation group of FVC (2.50 +0.32) L, FEV1 (1.36 +0.20) L, FEV1%(51.23+4.32), PaO2(10.51+2.10) kPa, PaCO2(5.15 +1.19) kPa, compared with the control group, the difference was statistically significant (P<0.05), the observation group recurrence rate 4.5% was lower than the control group 13.6%, the difference was statistically significant (P <0.05).Conclusion COPD patients with fluticasone propionate combined noninvasive positive pressure ventilation, can effectively improve lung function, reduce disease recurrence rate, a significant effect.
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Objective To evaluate the level of clinical treatment in severe stable double COPD noninvasive positive pressure ventilation (BiPAP) + tiotropium + Symbicort regimen effect. Methods 210 patients with moderate to severe COPD patients as the research object, divided into group I, group II, group III, 1 BiPAP + group with tiotropium bromide in the treatment scheme, group II Implementation of tiotropium + Symbicort treatment group enabled BiPAP + tiotropium + Symbicort. Results Group comparison indexes of pulmonary function level and lung function indexes were found in the three groups after treatment showed a rising trend comparison between groups after treatment, the levels of the indicators of lung function showed the most significant increases in group I, group II indexes of pulmonary function approximation. In group 6-MWD group with the longest distance difference index (P<0.05), group II and group I but the difference between does not have statistical significance Conclusion BiPAP + tiotropium bromide + Cr is an effective treatment for moderate and severe stable COPD, which is beneficial to improve the quality of life of patients.
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Objective:To analyze the clinical efficacy of Seretide combined with noninvasive positive pressure ventilation (NIPPV) in the treatment of chronic obstructive pulmonary disease (COPD) complicated with type 2 respiratory failure (RF).Methods:120 patients of COPD complicated with type 2 RF were randomly divided into the observation group and the control group.All patients were treated with routine,symptomatic and supportive treatment,based on that NIPPV was used in the control group,and the observation group was treated with Seretide on the basis of NIPPV.The levels of arterial blood gas,inflammatory factors,pulmonary function and CAPS score before and after treatment were compared and analyzed.Results:After treatment,the pH,PaO2 and SaO2 of both groups were significantly increased,PaCO2 levels weresignificantly decreased,serum IL-33,TNF-oα and sICAM-1 levels were significantly decreased,FVC,PEFR,FEV1％ and FEV1/FVC were significantly decreased,and the CAPS scores were significantly decreased;the changes of all the index mentioned above in the observation group were more statistically significant (P＜0.05).Conclusion:Seretide com bined with NIPPV could more effectively decrease the levels of inflammatory factors and improve the blood gas and lung function in the patients of COPD with type 2 respiratory failure.
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OBJECTIVE: To observe the rehabilitation effect of non-invasive positive pressure ventilation( NPPV) in treating pneumoconiosis patients with pulmonary dyspnea. METHODS: A retrospective analysis was used to analyze the treatment compliance,treatment time,treatment effect and adverse reactions of 295 pneumoconiosis patients who had undergone inpatient NPPV treatment. RESULTS: The median of NPPV treatment time of 295 pneumoconiosis patients was 14( 1-281)days. The treatment compliance rate was 79. 66 %( 235 /295). The dyspnea improvement rate was 73. 22 %( 216 /295).The Chi-square test results showed that the dyspnea improvement rate increased with the prolonged treatment time( P <0. 01). Among these,the dyspnea improvement rates of groups with treatment time of 10 days,20 days and ≥ 30 days were higher than group with treatment time < 10 days,the dyspnea improvement rate of the group with treatment time ≥30days was higher than 10 days group( P < 0. 01). The incidence of adverse reactions was 7. 12 %. CONCLUSION: NPPV treatment could improve dyspnea symptoms of pneumoconiosis patients with less adverse reaction.
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Objective:TTo observe the clinical efficacy of noninvasive positive pressure ventilation(NIPPV)for AECOPD with respiratory failure and disturbance of consciousness.Methods:A total of 58 AECOPD patients with respiratory failure and consciousness in our hospital from 2011 July to August 2015 were randomly divided into NIPPV group and control group. The control group was received conventional therapy, and NIPPV was added to the NIPPV group. The heart rate(HR), respiratory rate(RR), Glasgow coma score(GCS) and blood gas analysis of patients before and after 24 h, 72 h of treatment, and the adverse reactions in NIPPV group were observed.Results: The PaCO2, RR, HR at 24 h and 72 h were significantly lower and PaO2 and GCS were significantly increased in NIPPV group. Compared to the control group, PaO2, PaCO2, HR and GCS after 24 h and 72 h were different (t=11.29,t=9.19,t=9.21,t=11.23,t=10.30,t=7.28, t=10.34,t=6.69;P0.05). Some patients in NIPPV group had initial discomfort, facial skin hyperemia erosion, mild gastrointestinal discomfort and fear, which were improved after symptomatic treatment.Conclusion: NIPPV treatment for AECOPD patients with respiratory failure and disturbance of consciousness which can effectively correct respiratory acidosis and CO2 retention. The spontaneous breathing and arterial oxygen level of patient can be gradually recovered, which are better than the conventional treatment.
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Objective To evaluate the clinical efficacy of noninvasive positive pressure ventilation (NPPV) in the treatment of patients with acute respiratory distress syndrome (ARDS), and to look for the predictors of failure of NPPV. Methods A retrospective observation was conducted. ARDS patients underwent NPPV admitted to emergency intensive care unit (EICU) of Guangdong General Hospital from January 2013 to December 2015 were enrolled. The patients were divided into success group and failure group according to the clinical efficacy. The condition of the patients in the two groups was evaluated, and ARDS classification and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score before treatment were recorded. Etiological composition of ARDS was analyzed. The parameters, including heart rate (HR), respiratory rate (RR), oxygenation index (PaO2/FiO2), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (SaO2), were recorded before and 2 hours after the treatment of NPPV. Multivariate logistic regression analysis was conducted for predicting the independent factors inducing the failure of NPPV treatment of patients with ARDS. Results The date of 137 patients with ARDS were collected, excluding the followed patients, 6 with coma, 18 with hemodynamic instability, 5 with severe hypoxia, and 5 with incomplete date. Finally, a total of 103 patients entered the statistics. There were 69 patients in NPPV success group, and 34 in failure group. Compared with success group, APACHE Ⅱ score in the failure group was higher (21.4±6.2 vs. 19.7±8.9), the ratios of patients with severe ARDS and those induced by pulmonary infection were higher [82.4% (28/34) vs. 5.8% (4/69), 32.4% (11/34) vs. 8.7% (6/69), respectively, both P < 0.05]. HR and RR before NPPV in the failure group were significantly higher than those of success group [HR (bpm): 124±13 vs. 117±12, RR (bpm): 39±5 vs. 33±4], and PaO2/FiO2, PaO2, PaCO2, and SaO2 were significantly lower than those of the success group [PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 104±10 vs. 156±12, PaO2 (mmHg): 53±8 vs. 68±7, PaCO2 (mmHg): 31±5 vs. 37±7, SaO2: 0.83±0.07 vs. 0.91±0.05, all P < 0.05]. It was shown by logistic regression analysis that severe ARDS [odds ratio (OR) = 10.533, 95% confidence interval (95%CI) = 5.847-89.852, P = 0.000], pulmonary infection resulted ARDS (OR = 4.831, 95%CI = 1.688-13.825, P = 0.003) and PaO2/FiO2 < 140 mmHg 2 hours after treatment (OR = 7.049, 95%CI = 1.266-39.236, P = 0.026) were the independent risk factors of NPPV failure for the treatment of patients with ARDS. Conclusions Patients with severe ARDS and pulmonary infection derived ARDS were the risk factors of failure to NPPV in ARDS. Lack of improvement in oxygenation 2 hours after NPPV is the predictor of NPPV failure and change to invasive ventilation.
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Objective To investigate the effect of noninvasive positive pressure ventilation NIPPV in treatment of chronic obstructive pulmonary disease with acute exacerbation of respiratory failure. Methods From April 2014 to January 2015, 80 patients with chronic obstructive pulmonary disease and acute exacerbation of respiratory failure in our hospital were enrolled in this study. The patients received anti-infectious, antispasmodic, expectorant, correct electrolyte imbalance and symptomatic and supportive cure. BiPAP Symchrony ventilator was applied in the patients in the treatment group, and low flow nasal catheter ventilation therapy was given to patients in the control group. The following parameters were observed and compared: (1)The clinical efficacy of two groups of patients; (2) RR, PaO2, PaCO2, pH changes of patients before and at 2, 24 hours after ventilation therapy. (3) Intubation and mechanical ventilation, mortality, average length of stay and complications that occur during treatment. Results After treatment, the total effective rate of patients in the treatment group was significantly higher than that of patients in the control group (P < 0.05). At the end of treatment, RR, PaO2, PaCO2, pH changes, aeration at 2 h, 24 h post ventilation of patients in the treatment group improved significantly (P<0.05). The intubation and mechanical ventilation rate, mean hospital stay of patients in the treatment group were significantly shorter than theose of patients in the control group (P<0.05). Conclusion To patients with chronic obstructive pulmonary disease and acute exacerbation of respiratory failure, NIPPV can improve clinical outcomes, improve the patient′s oxygen partial pressure and oxygen saturation, shorter hospital stays, inhibit the rates of mechanical ventilation.
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ObjectiveTo investigate the influence of exhalation valve location as well as its type on carbon dioxide (CO2) rebreathing during noninvasive positive pressure ventilation (NPPV).Methods With a standardized NPPV experimental model system, the exhalation valve was respectively installed between the ventilator tube and mask (positionⅠ), or on the mask (positionⅡ). This study included four groups according to the position and type of exhalation valve, namely: single-arch exhalation valve was installed on the positionⅠ (A group), and positionⅡ (C group, the distal end of single-arch exhalation valve was blocked); plateau exhalation valve was installed on the positionⅠ (B group) and positionⅡ (D group, the distal end of plateau exhalation valve was blocked). Under standard experimental condition, the pressure of end-tidal carbon dioxide (PETCO2) was monitored in the trachea or the mask through adjusting the expiratory positive airway pressure (EPAP, EPAP was set at 5 cmH2O and 10 cmH2O, 1 cmH2O = 0.098 kPa) and tidal volume (VT, VT was set at 300, 400, 500 mL). Leakage of exhalation valve was monitored when single-arch exhalation and plateau exhalation valves were respectively placed in the positionⅠ through adjusting the inspiratory positive airway pressure (IPAP at 5, 10, 15, 20 cmH2O respectively). Results① Under standard experimental condition, when EPAP was 5 cmH2O, PETCO2 (mmHg, 1 mmHg = 0.133 kPa) in the trachea was 69.6±3.4, 61.4±2.7, 54.8±1.5, 49.8±1.3 in A, B, C, D groups respectively; and it was 24.8±1.9, 21.8±1.6, 2.8±0.8, 1.8±0.8 in the mask, respectively. When EPAP was 10 cmH2O, the PETCO2 in the trachea was 64.2±3.6, 57.2±3.7, 48.8±2.6, 41.8±2.6 in A, B, C, and D groups respectively; and it was 23.0±1.6, 20.2±1.6, 2.2±0.8, 1.2±0.8 in the mask, respectively. For the same exhalation valve type, exhalation valve being installed on positionⅡ could induce significantly lower PETCO2 in the trachea and mask than that being installed on positionⅠ (allP< 0.05). For the same expiratory valve position, plateau exhalation valve produced significantly lower PETCO2 than single-arch valve (allP< 0.05).② As the VT increased, the PETCO2 in the trachea of each group was reduced obviously. When VT was 500 mL, PETCO2 (mmHg) was significantly lower than VT, which were 300 mL and 400 mL (A group: 51.4±2.7 vs. 72.8±2.9, 69.6±3.4; B group: 44.8±2.4 vs. 65.4±2.1, 61.4±2.7;C group: 36.8±1.9 vs. 59.0±1.6, 54.8±1.5; D group: 28.8±1.9 vs. 52.6±2.0, 49.8±1.3; allP< 0.05).③ When exhalation valve type was placed in positionⅠ, the air leakage of single-arch exhalation valve was increased to (15.8±1.9), (20.2±1.9), (23.8±2.8), (28.0±1.6) L/min, and the plateau exhalation valve was essentially unchanged to (24.2±1.6), (23.8±1.6), (25.2±1.6), (25.2±1.6) L/min as the IPAP was increased from 5, 10, 15, to 20 cmH2O. Conclusions Exhalation valve fixing on mask is more appropriate for CO2 discharge than that fixed on tube-mask valve. Plateau exhalation valve as well as moderately increasing VT is beneficial for CO2 discharge and CO2 rebreathing prevention.