Epidemiological characteristics and risk factors of severe respiratory failure in elderly patients with chronic obstructive pulmonary disease / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics and risk factors of severe respiratory failure in elderly patients with chronic obstructive pulmonary disease (COPD). Methods A total of 288 COPD patients admitted to our hospital from January 2018 to December 2021 were selected. The patients were divided into control group (no severe respiratory failure) and observation group (severe respiratory failure) according to whether severe respiratory failure occurred during hospitalization. The FEV1 and FEV1/FVC values and clinical symptoms of the two groups were compared. Univariate analysis and logistic regression analysis were used to analyze the influencing factors of severe respiratory failure in COPD patients. Results Among of 288 COPD patients, 86 cases (29.86%) developed severe respiratory failure. The proportion of severe respiratory failure in male patients aged ≥70 years was significantly higher (P3 times per year (OR=4.573) were the risk factors for severe respiratory failure in elderly COPD patients (P<0.05). Conclusion The elderly COPD hospitalized patients have a higher risk of severe respiratory failure, and most of them are male patients over 70 years old. Especially for patients over 70 years old with hypoproteinemia, more than 3 acute exacerbations per year, and nosocomial infection, active intervention should be given to prevent the risk of severe respiratory failure.

Diagnóstico de neumotórax hipertensivo por ecografía. A propósito de un caso clínico / Diagnosis of pneumothorax hypertensive by ultrasound. TO purpose of a clinical case

La ecografía realizada por médicos clínicos no radiólogos se ha convertido en una herramienta de inestimable valor, que facilita el ejercicio profesional de los médicos de emergencia, cuidados críticos, anestesistas, pediatras, internistas, entre otros. Presentamos el caso de un paciente que sufre un cuadro de insuficiencia respiratoria grave y shock que requiere intubación orotraqueal y asistencia ventilatoria mecánica, luego de una nefrectomía izquierda complicada con lesión esplénica, lesión de diafragma y de pleura diafragmática. Se diagnosticó neumotórax hipertensivo mediante ecografía y se realizó el drenaje inmediato, con buenos resultados clínicos.(AU)

Ultrasound performed by non-radiological clinicians has become an invaluable tool, which facilitates the professional practice of emergency and critical care physicians, anesthesiologists, pediatricians, internists, among others. We present the case of a patient who suffers from severe respiratory failure and shock requiring orotracheal intubation and mechanical ventilatory assistance after a complicated left nephrectomy with splenic injury, and diaphragmatic and diaphragmatic pleura lesions. We diagnosed hypertensive pneumothorax by ultrasound and immediate drainage was performed, with good clinical results.(AU)

Comparison of Cardiorespiratory Effects of Pressure Controlled Ventilation with Volume Controlled Ventilation in Severe Respiratory Failure / 대한마취과학회지

Pressure controlled ventilation has been proposed to recruit closed alveolar units and improve oxygenation through changing the inspiratory flow pattern from a square wave as used with volume controlled ventilation to a rapidly exponentially decaying curve and through maintaining airway pressure at a constant level throughout the inspiratory phase. The purpose of this study was to evaluate the cardiorespiratory efficacy of pressure controlled ventilation in severe respiratory failure. Cardiorespiratory values were measured in ten patients with severe respiratory failure on volume controlled and pressure controlled ventilation. Tidal volume, ventilatory rate, PEEP, inspiratory:expiratory ratio and FIO2 were maintained at the same level for both ventilatory modalities. Changing from volume controlled ventilation to pressure controlled ventilation was associated with significant improvement in PaO2 and decrease in peak inspiratory pressure. There were no significant changes in other cardiorespiratory values, such as arterial blood pressure, heart rate, inspiratory pause pressure and static compliance. These results suggest that pressure controlled ventilation may be a beneficial ventilatory modality in the treatment of severe respiratory failure compared to volume controlled ventilation.