Usage of Noninvasive Ventilator in the Emergency Department

PURPOSE: A general analysis of patients in the Emergency Department (ED) and the Intensive Care Unit (ICU) was performed to evaluate the effectiveness of a noninvasive ventilator (NIV) for the effective treatment of patients in respiratory distress without using endotracheal intubation. METHODS: The 38 patients who were treated with a NIV from December 1, 2001, to September 31, 2002, were studied. The ER doctors investigated prospectively sex, age, the causes of disease, the main symptoms, the duration of treatment, the mode of ventilation, the vital signs and the arterial blood gas analysis at the time of admission and after 30 minutes of NIV use, adaptation of patients, complications, and the success or failure of the treatment. RESULTS: 1) General features: Out of 38 cases, 25 males and 13 females, the average age was 60.61 years old. In group X (treatment success), the average age was significantly lower than it was in group Y (treatment failures). 2) The causes of disease and symptoms: The causes of disease were as follows: asthma and chronic obstructive pulmonary disease, 13 patients; drug intoxication, 8 patients; pulmonary edema, 8 patients; respiratory failure, 2 patients; lung contusion, 3 patients; pneumonia, 2 patients. 3) Adaptation and complications: 11 patients adapted well, 18 patients adapted normally, and 11 patients failed. Complications were minimal and included gastric distension in 2 patients and xerophthalmia in another 2. 4)Vital signs and arterial blood gas analysis results: The arterial blood gas analysis performed after 30 minutes in treatment showed improved results, but only the pH had any effect on success or failure. CONCLUSION: NIV had a success rate of 72%. The factors influencing success were surveyed according age, pH level before treatment, pH P a C O2 S a O2 30 minutes after treatment, and adaptation.

Noninvasive Estimation of Pulmonary Arterial Pressure by a Pulsed Doppler Echocardiography

Fifty nine patients who had been admitted to Seoul National University Hospital from April to October in 1986 were prospectively examined by a pulsed Doppler echocardiography on one day before cardiac catheterization. The sample volume was placed both just proximal and distal to pulmonic valve on 2-D echocardiogram. 1) Among the three morphologic patterns of the flow velocity, triangular and intermediate types indicate pulmonary hypertension (sensitivity 84%, specificity 86%), and round type indicates normal pulmonary arterial pressure (sensitivity 86%, specificity 84%). 2) In the group with pulmonary hypertension acceleration time and ejection time were measured shorter (P<0.01), and prejection period was measured longer than the group without pulmonary hypertension (P<0.05). 3) The best correlation was obtained between PEP/AT and mean pulmonary arterial pressure (r=0.77). Acceleration time alone also correlated well with mean arterial pulmonary pressure(r=-0.69). 4) In STI measurement and its correlation with pulmonary arterial pressure, no significant difference was observed when recorded in main pulmonary artery or right ventricular outflow tract. But in the latter position, late, systolic fluttering and variation in curve morphology occured less likely. 5) Our results indicate that the pulsed Doppler echocardiography is useful not only in the diagnosis of pulmonary hypertension but also in the quantitative estimation of pulmonary arterial pressure in different heart diseases. Futhermore this method may be a good tool for follow-up evaluation after surgical or medical treatment of patients with pulmonary hypertension.