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Objective:To investigate the therapeutic effect of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NPPV) on patients with pulmonary edema caused by seawater drowning.Methods:A retrospective analysis method was used. Based on the Utstein database of emergency drowning in the First Hospital of Qinhuangdao, the clinical data of patients with seawater drowning pulmonary edema admitted to the emergency medicine department of the First Hospital of Qinhuangdao from January 1, 2019 to December 31, 2022 were collected. The patients were divided into NPPV group and HFNC group according to different ventilation methods. The general data, endotracheal intubation rate in 7 days, arterial blood gas analysis indexes [arterial partial pressure of oxygen (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2), arterial oxygen saturation (SaO 2)] and hemodynamic indexes (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, blood lactic acid) before and after treatment, length of stay in intensive care unit (ICU), oxygen therapy comfort of the two groups were compared. Results:A total of 54 patients were enrolled, including 21 patients in the NPPV group and 33 patients in the HFNC group. There were no significant differences in gender, age, state of consciousness and other general information between the two groups. Compared with NPPV group, the rate of endotracheal intubation in HFNC group within 7 days was significantly lower [24.2% (8/33) vs. 33.3% (7/21), P < 0.05]. Before treatment, there were no significant differences in arterial blood gas analysis and hemodynamics between the two groups. After treatment, the above indexes in both groups were significantly improved compared with those before treatment, and PaO 2, SaO 2, systolic blood pressure, diastolic blood pressure and mean arterial pressure in HFNC group were significantly higher than those in NPPV group [PaO 2 (mmHg, 1 mmHg≈0.133kPa): 93.56±6.37 vs. 82.14±6.25, SaO 2: 1.02±0.09 vs. 0.95±0.11, systolic blood pressure (mmHg): 117.37±8.43 vs. 110.42±8.38, diastolic blood pressure (mmHg): 79.43±7.61 vs. 72.21±4.32, mean arterial pressure (mmHg): 92.34±6.32 vs. 85.12±5.38], PaCO 2, heart rate and blood lactic acid were significantly lower than those in NPPV group [PaCO 2 (mmHg) : 34.26±5.63 vs. 37.24±6.22, heart rate (times/min): 73.38±7.56 vs. 86.25±5.41, blood lactic acid (mmol/L): 1.38±0.36 vs. 2.25±1.14], and the differences were statistically significant (all P < 0.05). In addition, the length of ICU stay in HFNC group was significantly shorter than that in NPPV group (days: 13.30±2.38 vs. 16.27±4.26), and the comfort rate of oxygen therapy was significantly higher than that in NPPV group [66.7% (22/33) vs. 42.8% (9/21)], with statistical significance (all P < 0.05). Conclusion:HFNC can improve the oxygenation of patients with pulmonary edema caused by seawater drowning, improve hemodynamics, reduce the rate of tracheal intubation, shorten the length of ICU stay, and improve the comfort of oxygen therapy, which has certain clinical application value.
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Objective:To explore the predictive value of HACOR score [heart rate (H), acidosis (A), consciousness (C), oxygenation (O), and respiratory rate (R)] on the clinical outcome of non-invasive positive pressure ventilation in patients with pulmonary encephalopathy due to chronic obstructive pulmonary disease (COPD).Methods:A prospective study was conducted. The patients with COPD combined with pulmonary encephalopathy who were admitted to Henan Provincial People's Hospital from January 1, 2017 to June 1, 2021 and initially received non-invasive positive pressure ventilation were enrolled. Besides non-invasive positive pressure ventilation, standard medical treatments were delivered to these patients according to guidelines. The need for endotracheal intubation was judged as failure of non-invasive ventilation treatment. Early failure was defined as the need for endotracheal intubation within 48 hours of treatment, and late failure was defined as the need for endotracheal intubation 48 hours and later. The HACOR score at different time points after non-invasive ventilation, the length of intensive care unit (ICU) stay, the total length of hospital stay, and the clinical outcome were recorded. The above indexes of patients with non-invasive ventilation were compared between successful and failed groups. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive effect of HACOR score on the failure of non-invasive positive pressure ventilation in the treatment of COPD with pulmonary encephalopathy.Results:A total of 630 patients were evaluated, and 51 patients were enrolled, including 42 males (82.35%) and 9 females (17.65%), with a median age of 70.0 (62.0, 78.0) years old. Among the 51 patients, 36 patients (70.59%) were successfully treated with non-invasive ventilation and discharged from the hospital eventually, and 15 patients (29.41%) failed and switched to invasive ventilation, of which 10 patients (19.61%) were defined early failure, 5 patients (9.80%) were late failure. The length of ICU and the total length of hospital stay of the non-invasive ventilation successful group were significantly longer than those of the non-invasive ventilation failure group [length of ICU stay (days): 13.0 (10.0, 16.0) vs. 5.0 (3.0, 8.0), total length of hospital stay (days): 23.0 (12.0, 28.0) vs. 12.0 (9.0, 15.0), both P < 0.01]. The HACOR score of patients at 1-2 hours in the non-invasive ventilation failure group was significantly higher than that in the successful group [10.47 (6.00, 16.00) vs. 6.00 (3.25, 8.00), P < 0.05]. However, there was no significant difference in HACOR score before non-invasive ventilation and at 3-6 hours between the two groups. The ROC curve showed that the area under the ROC curve (AUC) of 1-2 hour HACOR score after non-invasive ventilation for predicting non-invasive ventilation failure in COPD patients with pulmonary encephalopathy was 0.686, and the 95% confidence interval (95% CI) was 0.504-0.868. When the best cut-off value was 10.50, the sensitivity was 60.03%, the specificity was 86.10%, positive predictive value was 91.23%, and negative predictive value was 47.21%. Conclusions:Non-invasive positive pressure ventilation could prevent 70.59% of COPD patients with pulmonary encephalopathy from intubation. HACOR score was valuable to predict non-invasive positive pressure ventilation failure in pulmonary encephalopathy patients due to COPD.
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Objective:To investigate the application value of ROX index in evaluating the effect of high-flow nasal cannula oxygen therapy (HFNC) on patients diagnosed with respiratory failure, and to find a simpler and more effective method to observe the efficacy of HFNC.Methods:A retrospective cohort study was conducted. Patients who were admitted to department of critical care medicine of the Tianjin Third Central Hospital from April 2020 to August 2022, diagnosed with type Ⅰ respiratory failure, and treated with HFNC after failure of conventional oxygen therapy were enrolled. Oxygenation index (PaO 2/FiO 2), fraction of inspired oxygen (FiO 2), gas flow rate at the initial time of admission, and pulse oxygen saturation (SpO 2), FiO 2 and respiratory rate (RR) at 2, 4, 6, 8, 10 and 12 hours of HFNC were collected, and ROX index was calculated. The patients with symptoms and PaO 2/FiO 2 improved after HFNC treatment and without higher respiratory support lately were defined as HFNC success, while other patients with symptoms worsening and needing follow-up non-invasive positive pressure ventilation (NIPPV) or invasive positive pressure ventilation (IPPV) were defined as HFNC failure. The tendency of changes in the ROX index at each time point was observed. Receiver operator characteristic curve (ROC curve) was plotted to obtain the optimum cut-off value of ROX index for predicting HFNC outcome and the optimal monitoring time point for HFNC. Results:A total of 142 patients were eventually enrolled, among whom 96 patients (67.61%) were in treated with HFNC successfully, while 46 patients (32.39%) were recorded as HFNC failure (39 patients and 7 patients received NIPPV or IPPV, respectively), with an overall intubation rate of 4.93% (7/142). Compared with the HFNC success group, the HFNC failure group had lower PaO 2/FiO 2 [mmHg (1 mmHg ≈ 0.133 kPa): 208.8±37.3 vs. 235.7±48.3, P < 0.01] and higher initial gas flow rate (L/min: 46.4±3.9 vs. 42.3±4.9, P < 0.01). However, there was no significant difference in gender, age, primary diagnosis, severity of disease, hemoglobin (Hb), C-reactive protein (CRP), and brain natriuretic peptide (BNP) between the two groups. In the HFNC failure group, there were 12 patients (26.09%) received progressive oxygen therapy within 12 hours of HFNC, of which 3 patients (6.52%) occurred within 6 hours, while the other 9 patients (19.57%) occurred after 6 hours. The initial ROX index was not statistically significant between the two groups. Both groups showed a continuous increasing ROX index with longer treatment duration of HFNC, and the ROX index at all of the time points of the HFNC failure group was significantly lower than that of the HFNC success group with statistically significant difference (2 hours: 9.39±2.85 vs. 10.91±3.51, 4 hours: 8.62±2.29 vs. 11.40±3.18, 6 hours: 7.62±1.65 vs. 11.85±3.45, 8 hours: 7.79±1.59 vs. 11.62±3.10, 10 hours: 7.97±1.62 vs. 12.44±2.75, 12 hours: 8.84±2.51 vs. 12.45±3.03, all P < 0.05). The ROC curve analysis showed that the areas under the ROC curve (AUC) of ROX index assessing the effect of HFNC at the time of treating 6, 8 and 10 hours were better than 2, 4 and 12 hours (0.890, 0.903, 0.930 vs. 0.585, 0.738 and 0.829), indicating that the ROX index could determine the efficacy at the early stage of HFNC (within 6 hours). When the optimum cut-off value of ROX index was 8.78, the sensitivity was 90.6%, and the specificity was 76.5%. Conclusion:The ROX index at 6 hours of HFNC has a certain predictive value for the efficacy of HFNC with an optimum cut-off value of 8.78, which can provide clinical health care personnel a method for observing the efficacy of HFNC, and guide the correct selection of oxygen therapy modality at an early stage and timely adjustment of oxygen therapy strategy.
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Objective:To explore the pros and cons of sequential high-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) immediately following early extubated patients with severe respiratory failure (SRF) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD), so as to provide evidence for clinical selection of optimal scheme.Methods:Consecutive AECOPD patients admitted to the respiratory intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 2019 to September 2020 were screened for enrollment. Patients were between 40 years old and 85 years old with acute exacerbation of bronchial-pulmonary infection, who received endotracheal intubation mechanical ventilation (ETI-MV) as the initial respiratory support method. The pattern of synchronous intermittent mandatory ventilation (SIMV) was used in the study. The parameters were set as follows: tidal volume (VT) 8 mL/kg, support pressure 10-15 cmH 2O (1 cmH 2O = 0.098 kPa), positive end-expiratory pressure (PEEP) 4-6 cmH 2O and the ratio of inspiratory to expiratory time 1.5-2.5∶1. Under these conditions, the plateau pressure (Pplat) was maintained less than 30 cmH 2O. The minimum fraction of inspired oxygen was adjusted to keep the pulse oxygen saturation no less than 0.92. When the pulmonary infection control window (PIC window) occurred, the subjects were extubated immediately and randomly divided into two groups, with one group receiving HFNC (called HFNC group), the other group receiving NIPPV (called NIPPV group). Patients with failed sequential HFNC or NIPPV underwent tracheal re-intubation. The rate of tracheal re-intubation within 7 days of extubation, complications (such as nose and face crush injury and gastric distension), in-hospital mortality, duration of ETI before PIC window, length of RICU stay and length of hospital stay were compared, respectively. Results:Forty-four patients were enrolled in the study, 20 in the HFNC group and 24 in the NIPPV group. There was no significant difference in the duration of ETI before PIC window between HFNC and NIPPV groups (hours: 95.9±13.1 vs. 91.8±20.4, P > 0.05). The rate of tracheal re-intubation within 7 days in the HFNC group was significantly higher than that in the NIPPV group [35.0% (7/20) vs. 4.2 % (1/24), P < 0.05]. However, the incidence of complication in the HFNC group was significantly lower than that in the NIPPV group [0% (0/20) vs. 25.0% (6/24), P < 0.05]. Compared with the NIPPV group, the in-hospital mortality in the HFNC group was slightly higher [5.0% (1/20) vs. 4.2% (1/24)], the length of RICU stay (days: 19.5±10.8 vs. 15.5±7.2) and the length of hospital stay (days: 27.4±12.2 vs. 23.3±10.9) were slightly longer, without statistical differences (all P > 0.05). Conclusion:For early extubated patients with SRF due to AECOPD, the compliance of sequential HFNC increased and the complications decreased significantly, but the final effect may be worse than sequential NIPPV.
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Objective: To observe the clinical application of dexmedetomidine (Dex) combined with non-invasive positive pressure ventilation (NIPPV) in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary encephalopathy, and to clarify its effectiveness Methods: A total of 80 patients with AECOPD and pulmonary encephalopathy were collected and divided into control group and Dex group according to the random digit table (n=40). The patients in control group were treated with conventional therapy, including antibiotics, phlegm, spasmolysis and NIPPV and so on. The patients in Dex group were treated with Dex based on conventional therapy. The heart rate (HR), blood pressure, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbondioxide, the rate of endotracheal intubation, the effective rate of NIPPV and the compliance of NIPPV of the patients in two groups were analyzed before and after treatment. The expectoration capacity, delirium and anxiety of the patients in two groups were evaluated. Results: After conventional treatment, the HR, blood pressure and PaCO2 in two groups were lower than before treatment, and the PaO2 was higher than before treatment; the degrees of changes of the above indicators in Dex group were more obvious, the differences were statistically significant (P0. 05). The incidene rate of delirium and anxiety score of the patients in Dex group were lower than those in control group (P<0. 05). Conclusion: Dex combined with NIPPV is a safe and effective method in the treatment of the patients with AECOPD and pulmonary encephalopathy without obvious adverse effects.
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Objective To explore the clinical effect of non-invasive positive pressure ventilation(NPPV)for treatment of acute left heart failure after mitral valve replacement. Methods Sixty patients with acute left heart failure after mitral valve replacement in Xinxiang Central Hospital from April 2009 to August 2017 were selected. The patients were divided into control group and NPPV group,with 30 patients in each group. The patients in the control group were treated with double oxygen ab-sorption (mask and nasal catheter),strong heart,diuresis and dilated blood vessels. Based on the treatment of control group, the patients in NPPV group were treated with NPPV therapy. The plasma N-terminal pro-B-type natriuretic peptide(NT-proB-NP)level of patients in the two groups was monitored by rapid determination of immunofluorescence before treatment and 6,24 hours after treatment. The respiratory frequency,blood oxygen saturation,heart rate and oxygen partial pressure monitoring of patients in the two groups was monitored before treatment and 2,6 and 24 hours after treatment. Results The total effective rate of patients in the control group and NPPV group was 92. 4％(26 / 28)and 96. 6％(28 / 29)respectively;there was no sig-nificant difference in the total effective rate between the two groups(χ2 = 1. 25,P > 0. 05). There was no significant difference in the plasma NT-proBNP level between the two groups before treatment (P > 0. 05);the level of NT-proBNP at 6,24 h after treatment was significantly lower than that before treatment in the two groups (P < 0. 05);the level of NT-proBNP of patients in the NPPV group was significantly lower than that in the control group at 6,24 h after treatment (P < 0. 05). There was no significant difference in the respiratory frequency,blood oxygen saturation,heart rate and oxygen partial pressure between the two groups before treatment(P > 0. 05). Compared with before treatment,the respiratory frequency and heart rate of patients were decreased and the blood oxygen saturation,oxygen partial pressure were increased at 2,6,24 h after treatment in the two groups (P < 0. 05). There was no significant difference in the oxygen partial pressure between the two groups at 2 h after treat-ment(P > 0. 05);the oxygen partial pressure of patients in the NPPV group was significantly higher than that in the control group at 6,24 h after treatment(P < 0. 05);there was no significant difference in the respiratory frequency,blood oxygen satu-ration and heart rate between the two groups at each time piont after treatment(P > 0. 05). Conclusion NPPV is an effective treatment for acute left heart failure after mitral valve replacement.
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Objective To evaluate the predictive factors for failure of non-invasive positive pressure ventilation (NIPPV) in immunosuppressed patients with acute respiratory failure (ARF). Methods The clinical data of 118 immuno-deficient patients treated with NIPPV in the respiratory and intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 2012 to August 2017 were retrospectively analyzed. The patients were divided into a non-endotracheal intubation (ETI) group (n = 62) and ETI group (n = 56) according to whether ETI was performed during the hospitalization period or not. Each observed indicator was analyzed by univariate analysis, and factors leading to failure of NIPPV were further analyzed by Logistic regression. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of risk factors for failure of NIPPV in immunosuppressed patients with ARF. Results The non-intubation rate for NIPPV in immunosuppressed patients was 50.8% (60/118). Compared with the non-ETI group, the body temperature, pH value in the ETI group were significantly increased, the partial pressure of arterial carbon dioxide (PaCO2) was significantly decreased, the ratio of oxygenation index (PaO2/FiO2) < 100 mmHg (1 mmHg = 0.133 kPa), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score ≥ 20, and the number of cases requiring catecholamine were significantly increased, the mortality was significantly increased. Multivariate Logistic regression analysis showed that the APACHE Ⅱ score ≥ 20 [odds ratio (OR) = 15.274, 95% confidence internal (95%CI) = 2.175-107.252, χ2= 7.516, 1 = 0.006], PaO2/FiO2< 100 mmHg (OR = 0.075, 95%CI = 0.014-0.408, χ2= 8.968, 1 = 0.003), and need for catecholamine (OR = 35.736, 95%CI = 6.974-183.124, χ2= 18.400, 1 < 0.001) were independent risk factors for failure of NIPPV. ROC curve analysis showed that the APACHE Ⅱ score ≥ 20 and PaO2/FiO2< 100 mmHg could predict failure of NIPPV, the area under ROC curve (AUC) of the APACHE Ⅱ score ≥ 20 was 0.787, the sensitivity was 83.93%, the specificity was 69.35%, the positive predict value (PPV) was 71.21%, the negative predict value (NPV) was 82.69%, the positive likelihood ratio (PLR) was 2.74, the negative likelihood ratio (NLR) was 0.23, and Youden index was 0.53; the AUC of PaO2/FiO2< 100 mmHg was 0.757, the sensitivity was 80.65%, the specificity was 66.07%, the PPV was 68.18%, the NPV was 78.85%, the PLR was 2.38, the NLR was 0.29, and Youden index was 0.47. Conclusions 50.8% of immunocompromised and ARF patients treated with NIPPV did not require ETI, which is independent of the etiology of ARF. APACHE Ⅱ score ≥ 20, PaO2/FiO2<100 mmHg, and the need for catecholamine are predictive factors for failure of NIPPV in immunocompromised patients.
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Objective To investigate the application of non-invasive positive pressure ventilation in emergency department in China.Methods A questionnaire survey was carried out in the emergency department in China,then the results were analyzed.Results Out of the 317 hospitals,non-invasive ventilators were available in the emergency department in 150 clinics (47.3％).Among them,144 clinics were the tertiary hospitals,and 6 clinics were the secondary hospitals.The leading five causes for NPPV were as follows:acute exacerbation of chronic obstructive pulmonary diseases (AECOPD) (29.7％),acute cardiogenic pulmonary edema (23.2％),ventilator weaning (11.2％),acute respiratory distress syndrome (ARDS) (9.0％),and extubation failure (8.7％).The bi-level positive airway pressure (BiPAP) S/T was the most commonly used ventilation mode (51.8％),followed by the continuous positive airway pressure (CPAP)(30.3％) and BiPAP (S)(12.5％).The oronasal mask (73.7％) and the nasal mask (24.2％) were the most favorable interfaces for NPPV.The reasons for NPPV underusing mainly included insufficient training (36.8％),lacking of related knowledge (22.9％),medical teaching staff shortage (21.1％) and poor compliance of patients (11.0％).The main causes of the failure of NPPV were as follows:poor tolerance (31.5％),irrational parameters setting (25.6％),unfitness of interface (17.8％),airway secretions (14.7％),and disorders of consciousness (10.4％).Conclusions In China,the types of patients most commonly treated with NPPV in the emergency department are those with AECOPD and acute cardiogenic pulmonary edema.Barriers to popularize the use of NPPV in the emergency department include availability of equipment,physician with familiarity in operating the NPPV,and human resources required for NPPV.
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Non-invasive positive pressure ventilation(NPPV)can avoid upper respiratory tract trauma due to tracheotomy and reduce iatrogenic infection as well as minimize the pain of the patients. NPPV therapy has been in-creasingly developed in congenital and secondary disordered breathing diseases such as neuromuscular diseases,cranio-facial malformation,obstructive sleep apnea hypopnea syndrome and other aliments. Though this therapy method is available and effective,the compliance with home NPPV treatment is relatively low. Various factors can influence adhe-rence of NPPV therapy. Individual and family factors are associated with compliance with NPPV,such as the patient′s age,inherited metabolic diseases,family economic status and educational level of the main caretakers. The structure of ventilator along with physician-patient communication also affect the treatment compliance. Now,the influencing fac-tors of compliance with home NPPV treatment in children were reviewed.
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Objective To systematically analyze the research trend of home non-invasive positive pressure ventilation in China. Methods The related literature in CBM database, CNKI database, Wanfang database and VIP database about home non-invasive positive pressure ventilation were reviewed and analyzed by Bibliometric. Results There were 214 articles retrieved, which had an increasing tendency.They were distributed in 135 kinds of journals and 28 provinces.The most research type was the experimental research(39.72%)and the research content focused on clinical effects of home non-invasive ventilation (47.67%). The average duration of researches was 12.33 months and the average interval for follow-up was 6.33 weeks. Conclusions Providing scientific and effective long-term medical support, optimizing the application process of home non-invasive ventilation and formulating scientific clinical standard should be the future research direction.
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Objective To evaluate the feasibility and effect of sequential treatment by the heated humidified high flow nasal cannula oxygen therapy (HFNC) in mechanically ventilated patients following endotracheal tube extubation.Methods A prospective randomized controlled trial was conducted. Forty-nine patients with the sequential treatment after tracheal intubation extraction admitted to Department of Critical Care Medicine of Shanghai Tenth People's Hospital from January 1st to December 31st 2016 were enrolled. The patients were randomly divided into HFNC group (n = 25) and non-invasive positive pressure ventilation (NPPV) group (n = 24) in accordance with the random numbertable. During the study, arterial blood gas and the sputum viscosity were assessed at 12, 24, and 48 hours after NPPV or HFNC treatment, and the nasal and facial pressure ulcers within 1 week was also recorded. Receiver operating characteristic curve (ROC) was plotted, and the effect of NPPV or HFNC on oxygenation was analyzed.Results Among the 25 patients in the HFNC group, 1 patient who was re-intubated and 2 patients who were changed to NPPV were excluded, and a total of 22 patients with complete data were enrolled in HFNC group. Among the 24 patients in the NPPV group, 1 patient who gave up the treatment and 1 patient who was re-intubated were excluded, and a total of 22 patients with complete data were enrolled in NPPV group. After the sequential treatment, most patients in NPPV group showed moderate viscous sputum (12, 12 and 10 cases at 12, 24 and 48 hours, respectively), whereas the patients in HFNC group showed thin sputum (15, 16 and 15 cases at 12, 24 and 48 hours, respectively). Sputum viscosity of patients in HFNC group at each time point was significantly lower than that in NPPV group (allP < 0.01). Arterial oxygen saturation (SaO2) and arterial partial pressure of oxygen (PaO2) at 12, 24 and 48 hours in the HFNC group were significantly higher than those in the NPPV group [SaO2: 0.978±0.009 vs. 0.906±0.139 at 12 hours, 0.976±0.019 vs. 0.924±0.103 at 24 hours, 0.973±0.019 vs. 0.935±0.079 at 48 hours; PaO2 (mmHg, 1 mmHg = 0.133 kPa): 97.85±22.99 vs. 79.24±25.86 at 12 hours, 108.10±43.87 vs. 84.44±29.24 at 24 hours, 102.31±39.02 vs. 79.04±27.46 at 48 hours, allP < 0.05], however, the difference in arterial partial pressure of carbon dioxide (PaCO2) at all of the time points between the two groups was not significant. In NPPV group, 4 patients with nasal and facial pressure ulcers was found, and all with Ⅰ phase of pressure ulcers, and no nasal and facial pressure ulcers was found in HFNC group, which was significantly decreased as compared with NPPV group (χ2 = 4.400,P = 0.036). A good effect of oxygen therapy was defined as PaO2 at 48 hours after the sequential treatment was increased by 20% as compared with that before the treatment. ROC curve analysis showed that the area under the ROC curve (AUC) of HFNC on improving oxygenation was higher than that of NPPV (0.917 vs. 0.830); when PaO2 at 48 hours after HFNC treatment was 76.25 mmHg, the sensitivity was 100%, and the specificity was 75.0%.Conclusions Compared with NPPV, adoption of HFNC as sequential treatment is a feasible manner in dealing with the mechanically ventilated patients after endotracheal tube extubation, which can improve the oxygenation as well as reducing the degree of sputum viscosity and incidence of nasal and facial pressure ulcers. HFNC is a promising therapy, which may be worthy to recommend broadly in such a clinical situation.
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Objective To systematically evaluate the efficacy of high-flow nasal cannulae oxygen (HFNC) in patients with respiratory failure.Methods Computerized PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP, Wanfang Database up to March 31st, 2017, all published available randomized controlled trials (RCTs) or cohort studies about HFNC therapy for patients with respiratory failure were searched. The control group was treated with face mask oxygen therapy (FM) or non-invasive positive pressure ventilation (NIPPV), while the experimental group was treated with HFNC. The main outcomemeasurements included endotracheal intubation rate, patient comfort, and the secondary outcome was in-hospital mortality. The quality of the literature was completed by two professionally trained evidence-based medical students, and meta-analysis was performed on quality-compliant literature. Funnel plot was used to analyze the publication bias.Results A total of 17 articles were enrolled including 15 RCTs and 2 cohort studies. There were 3909 patients enrolled, 1907 patients in HFNC group, and 2002 in control group (1068 patients with FM, and 934 with NIPPV). Meta-analysis showed that HFNC had a significant advantage over FM in reducing the tracheal intubation rate of patients with respiratory failure [odds ratio (OR) = 0.51, 95% confidence interval (95%CI) = 0.29-0.89,P = 0.02], but there was no significant difference as compared with that of NIPPV (OR = 0.80, 95%CI = 0.54-1.17,P = 0.25). It was shown by pooled analysis of two subgroups that compared with FM/NIPPV, HFNC had a significant advantage in reducing tracheal intubation rate in patients with respiratory failure (pooledOR = 0.66, 95%CI = 0.47-0.94, P = 0.02). Compared with FM, patients with respiratory failure were more likely to receive HFNC for comfort [standardized mean difference (SMD) = -0.41, 95%CI = -0.56 to -0.26,P < 0.00001]. There was no significant difference in hospital mortality between HFNC and FM (OR = 0.82, 95%CI = 0.55-1.24,P = 0.35) or NIPPV (OR = 0.66, 95%CI = 0.37-1.17, P = 0.16). The results of pooled analysis of two subgroups were still unchanged (pooledOR = 0.75, 95%CI = 0.54-1.05, P = 0.09). It was shown by the funnel analysis that there was a bias in the study of tracheal intubation rate in the literature, while the bias of patient comfort and hospital mortality was low.Conclusions Compared with FM, HFNC could reduce the rate of tracheal intubation in patients with respiratory failure, but no difference was found as compared with NIPPV. Compared with FM, HFNC made patients more comfortable, and it was easier to be accepted and tolerated. However, there was no difference in hospital mortality among FM, NIPPV, and HFNC.
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Objective To evaluate the effect of long term home non-invasive positive pressure ventilation (HNIPPV ) in stable severe chronic obstructive pulmonary disease (COPD) .Methods Forty-two patients with stable severe COPD after hospital dis-charge were divided into 2 groups :The observation group (conventional treatment + HNIPPV ,22 patients) and control group (con-ventional treatment ,20 patients) .Parameters before and after one year follow-up observation were compared ,which includes arterial bloods gases ,lung function test ,6-min walking distance(6MWD) ,dyspnea grade ,scoring for emotional disorders ,the hospitalization rates .Results PaCO2 ,PaO2 ,6MWD ,dyspnea grade ,scoring for emotional disorders ,the hospitalization rates improved after one year in the observation group (P < 0 .05) .There were no significance of FVC and FEV1 between the two groups after one year . There were no patients who were dead or exited with other reason after one year in the two groups .Conclusion Long term HNIP-PV could decrease exacerbations ,respiratory failure and increase life quality ,this therapy is effective and safe for patients with sta-ble severe COPD .
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Objective To explore the clinical effects of non-invasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease accompanied with respiratory failure. Methods A total of 112 patients with chronic obstructive pulmonary disease accompanied with respiratory failure in our hospital from January 2012 to Febru-ary 2014 as research objects, and were divided into the control group (50 cases) and observation group (62 cases), the control group was treated with nasal catheter oxygen therapy on the routine treatment, the observation group was treated with non-invasive positive pressure ventilation on the routine treatment, the clinical effects of two groups were ob-served. Results After treatment, the levels of pH, PaO2, SpO2 were increased while the level of PaCO2 was declined compared with before treatment and the change improved significantly in observation group than that in control group (P﹤0.05); After treatment for 7 days, the respiratory frequency, cyanosis, short breath, heart rate and respiratory muscle movement disorders in observation group were significantly improved than those before treatment, and were also signifi-cant improved than those of control group (P﹤0.05). Conclusion Non-invasive positive pressure ventilation is signifi-cantly with curative effect for treatment of chronic obstructive pulmonary disease accompanied with respiratory failure, it can significantly improve respiratory function in patients, to correct hypoxemia and CO2 retention, it has few adverse reactions and is worth of clinical application.
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Ventilator-associated pneumonia (VAP) is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged. In this article we will review recent literature pertaining to evidence-based VAP-prevention strategies that have resulted in clinically relevant outcomes. A multidisciplinary strategy for prevention of VAP is recommended. Those interventions that have been shown to have a clinical impact include the following: (i) Non-invasive positive pressure ventilation for able patients, especially in immunocompromised patients, with acute exacerbation of chronic obstructive pulmonary disease or pulmonary oedema, (ii) Sedation and weaning protocols for those patients who do require mechanical ventilation, (iii) Mechanical ventilation protocols including head of bed elevation above 30 degrees and oral care, and (iv) Removal of subglottic secretions. Other interventions, such as selective digestive tract decontamination, selective oropharyngeal decontamination and antimicrobial-coated endotracheal tubes, have been tested in different studies. However, the evidence for the efficacy of these measures to reduce VAP rates is not strong enough to recommend their use in clinical practice. In numerous studies, the implementation of VAP prevention bundles to clinical practice was associated with a significant reduction in VAP rates. Future research that considers clinical outcomes as primary endpoints will hopefully result in more detailed prevention strategies.
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Objective To determine whether Nutritional Risk Screening 2002 (NRS2002) of admission independently predicts outcome of non-invasive positive pressure ventilation (NIPPV) in chronic obstructive pulmonary disease (COPD) patients during hypercapnic respiratory failure.Methods Patients with COPD presenting with hypercapnic respiratory failure at Sichuan University Hospital between December 2010 and May 2012 and receiving NIPPV were studied prospectively.NRS2002 was measured before NIV administration.233 patients met the inclusion criteria,with NIPPV failed in 71 cases and succeed in 162 cases.The patients were followed up till they were discharged.Results After multivariate Logistic regression,the items such as baseline PaCO2,NRS2002 score could predicted 76.4％ of the failure outcome.The area under the curve was 0.767.The positive predictive value was 35.23％.The negative predictive value was 84.21％.Conclusions We can predict the risk failure of NIPPV in patients with COPD and hypercapnic respiratory failure with NRS2002 score and baseline PaCO2,and adjust the treatment project according to the evaluation result.NRS2002 supply non-invasive and portable method for predicting the failure of NIPPV.
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Objective To investigate the clinical efficacy of the treatment of long-term non-invasive positive pressure ventilation (NIPPV) combined with inhaling corticosteroids in patients with stable chronic o0bstructive pulmonary disease(COPD) complicated with respiratory failure,and to investigate the impact of longterm NIPPV combined with inhaling corticosteroids on serum levels of matrix metalloproteinase-9 (MMP-9).Methods Eighty outpatients of stable severe COPD complicated with respiratory failure divided them equally into two treatment groups (the experimental and the control groups).The two groups of patients were given oxygen therapy,inhalation of Salmeterol and fluticasone propionate powder for one year.The experimental group received additionally NIPPV therapy for 1 year.The outcomes measured included St.George's questionnaire (SGRQ) score,MMRC score,6-min working time (6-MWT),arterial partial pressure of oxygen (PaO2),partial pressure of carbon dioxide(PaCO2),Forced expiratory volume in 1 (FEV1％),and the serum levels of MMP-9 before and after treatment,and frequency of acute exacerbations of COPD and hospital says in the last one year and the following 12 months.Results After 1 year,the differences of SGRQ score,MMRC score,6-MWT,PaO2,PaCO2,FEV1％,MMP-9 in the experimental group ((63.38 ±4.46) vs.(52.93 ±4.30),t =10.67,P =0.00;(3.60±0.50) vs.(2.40 ±0.50),t =10.82,P=0.00;(159.90 ±6.50) m vs.(247.10±9.66) m,t=47.39,P=0.00;(56.85 ± 1.67) mm Hg vs.(66.10 ±2.59) mm Hg,t =10.67,P =0.00;(60.38 ±3.58)mm Hgvs.(51.88 ±3.05)mm Hg,t=10.82,P=0.00; (38.93 ±3.22)％ vs.(42.12 ±3.11)％,t=47.39,P =0.00;(182.58 ±6.60) μg/L vs.(171.73 ±6.19) μg/L,t =7.58,P =0.00) were statistically significant compared to the control group ((63.88 ± 4.88) vs.(54.30 ± 4.13),t =8.77,P =0.00; (3.65 ± 0.48) vs.(2.70±0.46),t =8.97,P =0.00;(157.98 ±5.97) m vs.(218.08±13.12) m,t =26.38,P=0.00;(56.65 ±1.51)mm Hg vs.(62.60 ± 1.91)mm Hg,t=8.77,P=0.00; (60.20 ±3.52)mm Hg vs.(56.25 ±3.09)mm Hg,t =8.97,P =0.00; (38.93 ±2.96) ％ vs.(40.70 ±3.27)％,t =26.38,P =0.00; (180.55 ±4.78) μg/L vs.(173.05 ± 5.28) μg/L,t =6.66,P =0.00).The frequency of acute exacerbations of COPD and hospital stay days were significantly decreased in the experimental group than in the control group.Conclusion Long-term NIPPV combined with inhaling corticosteroids could significantly improve the quality of life and lower the serum levels of MMP-9 of patients with severe stable COPD complicated with respiratory failure.
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Objective To compare the therapeutic effects in respect of ventilatory response and the change of hemodynamics of two modes of mechanical ventilation [ proportional assist ventilation (PAV) vs.Bi-level positive airway pressure ventilation (BiPAP) ] on patients with acute cardiogenic pulmonary edema (ACPE).Methods Thirty-two patients diagnosed as ACPE were recruited from May 2008 to April 2009.After conventional therapy ( cardiotonic,diuretic,vasodilators,oxygen) were ineffective for half an hour,32 patients were randomly divided into three groups:control group ( 12 cases kept conventional treatment without mechanical ventilation),BiPAP group ( 12 cases were treated with BiPAP mode of non-invasive mechanical ventilation plus conventional treatment) and PAV group (8 cases were treated with PAV mode of non-invasive mechanical ventilation along with conventional treatment ).Results PaO2,RR and oxygenation index were improved significantly in three groups after 1 hour treatment ( P ＜ 0.05 ).While PaO2 and oxygenation index in noninvasive ventilation groups were higher than those in control group ( P ＜0.05 ).The time required for amelioration of dyspnea in noninvsaive ventilation groups was shorter than that in control group ( P ＜ 0.05 ).The peak airway pressure and the index of degree of comfort ( VAS score,auxiliary respiratory muscles score) in PAV group were lower than those in BiPAP group (P ＜ 0.05 ).Conclusions Both modes of noninvasive mechanical ventilations could improve the oxygenation and relief of dyspnea in patients with ACPE.PAV and BiPAP had the similar effect in patients with ACPE.The synchronization and comfort in PAV group were better than those in BiPAP group.The PAV mode of noninvasive mechanical ventilation was well accepted by patients with ACPE.
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Objective To investigate the change of HR,RR and arterial blood gas in the treatment of BiPAP ventilation in patients with acute pulmonary.Methods Fifty eight patients with acute pulmonary edema were randomized into two groups.The control group(n =29)were given conventional general treatment only,but treatment group(n =29)were given BiPAP ventilation besides conventional treatment.4 h later,heart rate (HR),respiratory rate(RR),SaO2,pH,PaO2 and PaCO2 were compared between the two groups.Hospitalization duration and incidence of invasive mechanical ventilation were recorded after discharge.Results Compared with pre-treatment,HR,RR,SaO2 and PaO2 in treatment group were improved significantly(HR 124 ± 12 beat/min vs 83 ±6 beat/min,t =5.372,P ＜0.01)(RR 37 ±5 beat/min vs 19 ± 8 beat/min,t =4.285,P ＜0.01)(SaO2 81.4％ ±5.4％ vs94.1％ ±4.2％,t=2.731,P＜0.05)(PaO2 53.2±5.4 mm Hg vs 89.1 ±8.5 mm Hg,t=5.763,P ＜0.O1).And these four indicators were also improved in control group after treatment,(HR 123 ± 10 beat/min vs 95 ± 8 beat/min,t =t =3.459,P ＜ 0.01)(RR 36 ± 7 beat/min vs 24 ± 6 beat/min,t =3.127,P ＜0.01)(SaO2 81.8％ ±5.7％ vs 88.3 ±4.5％％,t =2.314,P ＜0.05)(PaO2 53.5 ±4.6 mm Hg vs 72.8 ±9.5 mm Hg,t =3.756,P ＜0.01).HR,RR,SaO2 and PaO2 in treatment group were more significantly improved than that of control group(P ＜ 0.01 or P ＜ 0.05).Hospitalization duration in treatment group was significantly shorter than that of control group(9 d vs 15 d,t =3.763,P ＜ 0.01).The incidence of invasive ventilation were lower than that of control group too(but P ＞ 0.05.Conclusion These results suggested that BiPAP ventilation can regulate HR RR and blood gas value to accetable levels,shorten hoptipitalization duration and reduce the incidence of invasive ventilation.It is proved to be an effective therapeutic technique in the treatment of acute pulmonary edema patients.
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Objective To observe the effect of early non-invasive positive pressure ventilation(NIPPV)on the treatment of serious hypoxemia induced by acute left heart failure. Methods Forty patients with acute left heart failure( Grade Ⅳ heart function)were randomly divided into two groups. Patients in both groups accepted supportive treatment included cardiotonics, diuretics, vasodilators, in additional to these high concentrations of oxygen were given in conventional group, and non-invasive positive pressure ventilation were given in NIPPV group by biphasic positive airway pressure(BiPAP). Systolic blood pressure, heart rate, respiratory rate, blood-gas analysis( pH, PaO2, PaCO2, SaO2 )and clinical signs were observed at 2 hours after treatments. Results Compared to control,RR( [ 19.55 ± 1.88] vs [21.85 ±3.51 ] ) BPM] ,HR ( [96.40 ±2.80] vs[ 103.20 ±6.78 ] BPM), SBP ( [ 116.30 ± 8.95 ] mm Hg vs [ 122.50 ± 6.13 ] mm Hg), pH (7.404 ± 0.027 vs 7.358 ±0.05) ,SaO2 ( [93.57 ± 1.18]% vs [91.97 ± 1.85]% ) ,PaO2 ( [75.58 ±4.61 ]mm Hg vs [68.38 ±7.95]mm Hg), PaCO2 ( [ 38.69 ± 3.06 ] mm Hg vs [ 43.61 ± 2.65 ] mmHg) were significantly different in NIPPV group( t = 2.582,4.146,2.558,3.534,3.256,3.505,5.428, Ps ＜ 0.05 ). We found no significant differences in the comparisons before treatments. Hypoxia improved in NIPPV group,and the total effective rate was 95% in NIPPV group and 70% in control group,which showed significant difference( x2 =4.329 ,P ＜0.05 ) Conclusion BiPAP non-invasive positive pressure ventilation combined with routine treatment in treating heart failure, could promptly correct hypoxia, improve heart function and shortening disease course.