Non-invasive Positive Pressure Ventilation for Pulmonary Edema in Kidney Transplanted Patient / 대한마취과학회지

Non-invasive positive pressure ventilation (NIPPV) was mainly applied to acute respiratory failure in chronic obstructive pulmonary disease (COPD) and to intrinsic lung disease such as neuromuscular disorders. It has been reported that this maneuver reduces morbidity, mortality and hospital stay in patients in the intensive care unit. We observed a 32-year-old female renal transplantation patient who developed pulmonary edema during the perioperative state. The mainteance of an endotracheal tube in intubated patients who were on immunosuppresive therapy might increase nosocomial pneumonia significantly. In this case, the mortality increase was expected, therefore we considered that early extubation and mask continuous positive airway pressure (mask CPAP) could help. By using mask CPAP, the patient showed a good response and the pulmonary edema was improved. We report a case about the benefits of NIPPV in the treatment of pulmonary edema in an immunosuppressed patient of which the result was very satisfactory.

Comparison of Respiratory Effects of Continuous Flow CPAP System with Demand Flow CPAP System / 대한마취과학회지

BACKGROUND: Continuous positive airway pressure (CPAP) during spontaneous breathing has contributed greatly to the management of the neonatal respiratory distress syndrome and adult respiratory failure associated with acute lung disease. CPAP systems may be grouped into two general categories, demand flow CPAP system and continuous flow CPAP system. The purpose of this study was to evalute the respiratory effects of continuous flow CPAP system compared with demand flow CPAP system. METHODS: Cardiorespiratory values were measured in twelve respiratory failure patients on demand flow CPAP system and continuous flow CPAP system made by authors. CPAP level and FIO2 were maintained at the same level for both modalities. RESULTS: Changing from demand flow CPAP to continuous flow CPAP was associated with significant decrease in tidal volume(demand flow CPAP 450+/-153.0 ml, continuous flow CPAP 338+/-73.8 ml), airway pressure fluctuation(demand flow CPAP 6.4+/-1.2 cmH2O, continuous flow CPAP 2.4+/-0.7 cmH2O) and improvement in arterial oxygen partial pressure (demand flow CPAP 90.0+/-20.9 mmHg, continuous flow CPAP 105.9+/-24.6 mmHg). There were no significant changes in other cardiorespiratory values, such as arterial blood pressure, heart rate and respiratory rate. CONCLUSIONS: These results suggest that continuous flow CPAP system may be a beneficial modality in the management of respiratory failure patients compared to demand flow CPAP system.