Risk factors of mortality among COVID-19 patients receiving non-invasive ventilation at Addis Ababa governmental COVID-19 treatment centers

Introduction: during the global COVID-19 pandemic, non-invasive ventilation has become a widely utilized method for treating patients experiencing acute respiratory failure. Noninvasive pressure ventilation is frequently employed as a standard approach for managing acute respiratory failure resulting from COVID-19 pneumonia, as opposed to invasive ventilation methods. However, there is a lack of research on its effectiveness. Therefore, this study aimed to determine the risk of mortality among COVID-19 patients receiving non-invasive ventilation. Methods: a multi-centric retrospective cross sectional study was conducted on the records of 402 patients at the Eka Kotebe COVID-19 Center, St. Peter COVID-19 Care Center, and Millennium COVID-19 Treatment Center. The systematic random selection technique was employed in order to select the study unit, and data was extracted from patient charts using a pretested method and validated before being entered into Epi-data Manager 4.6 versions. Descriptive, bivariate, and multivariable analyses were performed using binary logistic regression in SPSS 25. In the multivariate logistic regression, a predictor variable was considered to have a significant connection if its p-value was less than 0.05 at a 95% confidence level. Results: four hundred and two patient records were reviewed during the study period and showed the mean patient´s age was 62.6 years, with male predominance. It revealed that 11.7% [CI: 8.7-15.2] of COVID-19 patients who received non-invasive positive pressure ventilation died, as being critical for COVID-19 patients was a main cause of noninvasive initiation. Patients over the age of 60 were more likely to die among those who received noninvasive ventilation for COVID-19 [AOR = 5.4 95% CI 1.32, 23.1]. Conversely, patients without diabetes were less likely to die [AOR = 0.23 95% CI 0.11, 0.48]. Moreover, patients with a tidal volume greater than 500 ml were more likely to pass away [AOR =2.2 95% CI 1.11,4.43], as were those who were on non-invasive ventilation (NIV) for more than 8 days [AOR = 0.24 95% CI.08, 0.81]. Conclusion: the significance of patients who were given non-invasive ventilators ended up dying. Age, diabetes, and high tidal volumes are linked to a higher risk of death. Non-invasive ventilation for over eight days showed a protective effect. Removing factors that caused NIV and ventilated COVID-19 patients' deaths may reduce mortality.

Modeling the noninvasive bi-level positive airway pressure ventilation therapy system and simulated application / 生物医学工程学杂志

Without artificial airway though oral, nasal or airway incision, the bi-level positive airway pressure (Bi-PAP) has been widely employed for respiratory patients. In an effort to investigate the therapeutic effects and measures for the respiratory patients under the noninvasive Bi-PAP ventilation, a therapy system model was designed for virtual ventilation experiments. In this system model, it includes a sub-model of noninvasive Bi-PAP respirator, a sub-model of respiratory patient, and a sub-model of the breath circuit and mask. And based on the Matlab Simulink, a simulation platform for the noninvasive Bi-PAP therapy system was developed to conduct the virtual experiments in simulated respiratory patient with no spontaneous breathing (NSB), chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS). The simulated outputs such as the respiratory flows, pressures, volumes, etc, were collected and compared to the outputs which were obtained in the physical experiments with the active servo lung. By statistically analyzed with SPSS, the results demonstrated that there was no significant difference ( P > 0.1) and was in high similarity ( R > 0.7) between the data collected in simulations and physical experiments. The therapy system model of noninvasive Bi-PAP is probably applied for simulating the practical clinical experiment, and maybe conveniently applied to study the technology of noninvasive Bi-PAP for clinicians.

Effect of BiPAP ventilation on respiratory physiology in patients with stable COPD / 中华健康管理学杂志

Objective:To observe the physiological effect of bi-level positive airway pressure (BiPAP) ventilation among stable chronic obstructive pulmonary disease (COPD) patients.Methods:This was a small sample size, exploratory, interventional study. A total of 10 outpatients with stable COPD were included from Department of Pulmonary and Critical Care Medicine of Zhujiang Hospital, Southern Medical University between January 2018 and December 2018. The BiPAP mode of noninvasive mechanical ventilation was adopted. The inspiratory positive airway pressure was gradually increased from 10 cmH 2O (1 cmH 2O=0.098 kPa) to 24 cmH 2O, and each time by 2 cmH 2O. The expiratory positive airway pressure remained unchanged at 4 cmH 2O. Baseline and test data were collected before and during the ventilation for comparison, including total respiratory cycle time (T tot), inspiratory time (T i), inspiratory time (T e), inspiratory tidal volume (V Ti); mouth pressure (P mo), esophageal pressure (P eso), transdiaphragmatic pressure (P di), esophageal pressure time product (PTP es), diaphragm pressure time product (PTP di), root mean square of electromyography of diaphragm (RMS), V e/RMS, inspiratory capacity (IC), the change in end-expiratory lung volume (ΔEELV) and dynamic PEEPi (PEEPi dyn). Results:All the 10 patients completed the trial. Compared to calm breathing, V Ti, V e, P mo, IC, ΔEELV score and V e/RMS increased significantly with increasing pressure levels (all P<0.05); T e only increased significantly at 20-22 cmH 2O pressure levels compared to calm breathing ( P<0.05). P di, PTP es, PTP di, RMS and RMS/RMS max decreased significantly with increasing levels (all P<0.05). PTP es and PTP di converged to 0 and no longer showed significant changes after the 18 cmH 2O pressure level. RMS and RMS/RMS max flattened out at pressure level greater than 16 cmH 2O. T i/T tot only significantly decreased at the 20 cmH 2O pressure level compared to calm breathing. PEEPi dyn showed a tendency to decrease and then increase with increasing pressure levels. Conclusion:BiPAP ventilation, at appropriate pressure levels, significantly relieves pulmonary ventilation disorders and reduces the load of respiratory muscle in patients with stable COPD.

Clinical application of three non-invasive ventilation strategies in initial treatment of neonatal respiratory distress syndrome / 中国小儿急救医学

Objective:To evaluate the clinical effectiveness and safety of three different non-invasive ventilation strategies in initial treatment of neonatal respiratory distress syndrome(RDS).Methods:A total of 111 premature infants with RDS who were admitted to the NICU from Jan 2019 to Dec 2019 were divided into nasal continuous positive airway pressure(NCPAP)group( n=35), bi-level positive airway pressure(BiPAP)group( n=30)and nasal intermittent positive pressure ventilation(NIPPV)group( n=46)as an initial respiratory support.A retrospective study was conducted to compare pH, PaCO 2, PaO 2, P/F value(PaO 2/FiO 2)before 4 to 6 hours after treatment, the incidence of non-invasive ventilation failure, non-invasive ventilation time, invasive ventilation time, duration of oxygen therapy and the incidence of complications among the three groups. Results:Four to 6 hours after treatment, the blood gas indexes of pH, PaO 2 and P/F were significantly higher and PaCO 2 was significantly lower than those before the treatment in the three groups ( P<0.05). PaO 2 and P/F in both BiPAP group and NIPPV group were higher than those in NCPAP group ( P<0.05). PaCO 2 was lower in BiPAP group than that in NCPAP group ( P<0.05), but there were no statistical differences of the blood gas indexes between BiPAP group and NIPPV group ( P>0.05). The incidence of non-invasive ventilation failure was significantly lower in the BiPAP group and NIPPV group than that in NCPAP group ( P<0.012 5), while no signifficant difference was observed between BiPAP group and NIPPV group ( P>0.05). Moreover, no signifficant differences were found among three groups regarding non-invasive ventilation time, ventilation time of successful non-invasive ventilation, invasive ventilation time, duration of oxygen therapy and the incidence rates of bronchopulmonary dysplasia, necrotizing enterocolitis, periventricular-intraventricular hemorrhages, retinopathy of prematurity( P>0.05). Conclusion:NIPPV and BiPAP as an initial respiratory support for RDS in preterm infants augment the beneficial effects of NCPAP contributing to improvement of oxygenation, reduction of the rate of intubation within five days postnatal life without the relevant complications.

Efeitos da pressão positiva contínua e de dois níveis na via aérea em edema agudo de pulmão cardiogênico: uma revisão sistemática / Effects of continuous positive pressure and of two levels on the airline in acute cardiogenic lung edema: a systematic review

INTRODUÇÃO: O edema agudo de pulmão cardiogênico (EAPC) representa uma importante causa de insuficiência respiratória aguda podendo ser atenuada com a instalação de ventilação mecânica não-invasiva (VNI). OBJETIVO: Comparar pressão positiva contínua (CPAP) e pressão positiva de dois níveis (BIPAP) na via aérea em pacientes adultos com EAPC, quanto à função pulmonar, ao tempo de permanência, suas complicações e a dispneia através de uma revisão sistemática. METODOLOGIA: Ensaios clínicos controlados e randomizados (ECR), revisados por dois revisores independentes, conforme recomendações PRISMA, nas bases de dados PubMed e Biblioteca Cochrane. Incluídos estudos originais que utilizaram a CPAP e a BIPAP em pacientes com EAPC publicados na língua inglesa. A Escala PEDro foi utilizada para analisar a qualidade metodológica dos estudos e a Cochrane Collaboration para análise de risco de viés. RESULTADOS: Foram incluídos 13 artigos, publicados entre os anos 1997 e 2014. Os níveis de CPAP variaram entre 5 e 20 cmH2O nos estudos, e BIPAP apresentou-se com pressão inspiratória positiva (IPAP) entre 8 e 20 cmH2O e pressão expiratória positiva (PEEP) entre 3 e 10 cmH2O. Os estudos apresentaram CPAP e BIPAP sem diferença estatisticamente significante para a melhora da função pulmonar (FR, PaO2 e PaCO2), tempo de internamento, taxas de mortalidade, entubação e infarto agudo do miocárdio (IAM); mostrando-se como modalidades igualmente eficazes. CONCLUSÃO: CPAP e a BIPAP garantem os mesmos efeitos para melhora da função pulmonar, não mantém relação com a permanência da internação e complicações, e melhoram o quadro de dispneia.

INTRODUCTION: Acute cardiogenic lung edema (EAPC) represents an important cause of acute respiratory failure and can be attenuated with the installation of non-invasive mechanical ventilation (NIV). OBJECTIVE: To compare the use of continuous positive pressure (CPAP) and two-way positive airway pressure (BIPAP) in adult patients with acute pulmonary edema of pulmonary function, length of stay and complications, and dyspnea through a systematic review METHODOLOGY: Systematic review of randomized controlled trials (RCTs) performed by two independent reviewers, as recommended by the PRISMA platform, in the PubMed and Cochrane Library databases. Original studies using CPAP and BIPAP were used in patients with acute cardiogenic lung edema published in English. The PEDro Scale was used to analyze the methodological quality of the studies and Cochrane Collaboration. RESULTS: We included 13 articles, published between 1997 and 2014. CPAP levels ranged from 5 to 20 cmH2O in the studies, and BIPAP presented positive inspiratory pressure (IPAP) between 8 and 20 cmH2O and positive expiratory pressure (EPAP) between 3 and 10 cmH2O. The studies presented CPAP and BIPAP without statistically significant difference for the improvement of the pulmonary function (FR, PaO2 and PaCO2), permanence of hospitalization, mortality rates, intubation and acute myocardial infarction (AMI); as equally effective modalities. CONCLUSION: CPAP and BIPAP guarantee the same effects to improve pulmonary function, does not maintain relation with the permanence of hospitalization and complications, namely: mortality, intubation and AMI, and improve dyspnea.

Efecto de un dispositivo binivel autoajustable sobre los eventos respiratorios en pacientes con Síndrome de Apnea Obstructiva del Sueño / Effect of an auto-bilevel device on respiratory events in patients with obstructive sleep Apnea syndrome

RESUMEN Objetivo: Evaluar el efecto de un dispositivo binivel autoajustable sobre los eventos respiratorios en pacientes adultos con síndrome de apnea obstructiva del sueño (SAOS) grave. Se revisaron las polisomnografías (PSG) realizadas con el uso de un dispositivo de binivel autoajustable. La arquitectura de sueño, eventos respiratorios, saturación de O2 (SpO2) y dióxido de carbono exhalado (EtCO2) se compararon entre la PSG basal y la PSG terapéutica. Resultados: Se incluyeron 10 PSG. El dispositivo binivel autoajustable corrigió la arquitectura de sueño; disminuyó el índice de apnea hipopnea (IAH) de 76 (39-137) a 14 (6-13) a expensas de apneas obstructivas y mixtas (p < 0,05), no se observó descenso significativo en las hipopneas. Las apneas centrales incrementaron de 0,5 (0-12,4) a 8,2 (0-20) h−1. La SpO2 y EtCO2 mejoraron. Conclusiones: En pacientes con SAOS grave el dispositivo binivel autoajustable corrige la arquitectura de sueño, mejora la SpO2 y EtCO2 y disminuye el IAH a expensas de apneas obstructivas y mixtas, pero podría no eliminar las hipopneas e incrementar las apneas centrales.

Objective: To evaluate the effect of an auto-bilevel device on respiratory events in adults with severe obstructive sleep apnea syndrome (OSAS). Polysomnographies (PSG) with the use of auto-bilevel device were reviewed. Sleep architecture, respiratory events, O2 saturation (SpO2) and exhaled carbon dioxide (EtCO2) were compared among baseline and therapeutic PSG. Results: We included 10 PSG. Auto-bilevel device corrected the sleep architecture; the apnea hypopnea index (AHI) decreased from 76 (39-137) to 14 (6-13) at the expense of obstructive and mixed apneas (p < 0.05), there was no significant decrease in hypopneas. Central apneas increased from 0.5 (0-12.4) to 8.2 (0-20) h−1. SpO2 and EtCO2 improved. Conclusions: In severe OSAS auto-bilevel device corrects sleep architecture, improves SpO2 and EtCO2 and decreases AHI at the expense of obstructive and mixed apneas, but could not eliminate hypopneas and even could increase central apneas.

Application of BIPAP ventilation in children patients with severe hand foot and mouth disease complicating neurogenic pulmonary edema / 重庆医学

Objective To investigate the influence of two different mechanical ventilation modes of bi-level positive airway pressure ventilation(BIPAP)and synchronized intermittent ventilation (SIMV)on the respiratory function and clinical curative effect in children patients with severe hand foot and mouth disease(HFMD)complicating neurogenic pulmonary edema.Methods Thirty children patients with severe HFMD complicating neurogenic pulmonary edema receiving mechanical ventilation were divided into the SIMV group (control group)and BIPAP group (experimental group).The lung protective ventilation strategy was applied in both groups.After 30 min use of SIMV and positive end expiratory pressure (PEEP)ventilation,the experimental group changed to use the BIPAP ventilation mode,while the control group still used the initial parameters.The airway peak pressure,alveolar plat-form (Pplat)pressure,lung compliance,pH value,arterial blood CO2 partial pressure (PaCO2 )and oxygenation index (PaO2/FiO2 )at 0 h (baseline value),24,48,72 h after mechanical ventilation were monitored.Besides,the duration of mechanical ventila-tion,28 d mortality rate and the length of ICU stay were observed.Results Thirty children patients smoothly spent their acute re-spiratory failure period.One case in each group during the later period of treatment was transferred to the other hospital for contin-uous therapy.Among them the transferred case in the control group finally died due to give up treatment.The rest 28 cases all were cured and discharged from hospital.The 28 d mortality rates in the two groups were 6.67% and 0% respectively,with no statistical difference (P >0.05).Compared with the control group,the airway peak pressure,Pplat and PaCO2 after mechanical ventilation for 24,48,72 h in the experimental group were significantly decreased(P <0.05);the lung compliance and PaO2/ FiO2 improvement was significantly higher than that in the control group(P <0.05);meanwhile the duration of mechanical ventilation and the length of ICU stay in the experimental group were shorter than those in the control group (P <0.05).Conclusion The BIPAP mode used in the mechanical ventilation therapy of the children patients with severe HFMD complicating neurogenic pulmonary edema can pro-vide better effective ventilation,improve oxygenation and respiratory function,and shorten the duration of mechanical ventilation.

Restoration of Large Skin Defect on Nose Dorsum using Nasalis Island Pedicle Flap with Bilevel Undermining / 대한피부과학회지

Reconstruction of defects on the lower third of the nose is always a challenge, as dissection of tissues in this area is not simple due to both a lack of elasticity and the structural complexity of the mid-facial area. When the defect size is less than 1.5 cm on the nose, primary closure or a bilobed flap is widely-used, while a skin graft is required for reconstruction of larger defects. Here we present two cases of a nasalis myocutaneous island pedicle flap with bilevel undermining with a relatively large nasal dorsum defect (>2 cm). The nasalis myocutaneous island pedicle flap with bilevel undermining was performed in order to maximize the movement of skin flaps and minimize the secondary movement of flaps after surgery. The nasal tip showed a slight upward movement immediately after surgery that subsequently moved down to a normal level. This technique can be utilized for reconstruction of the lower part of the nose for defects 2 cm or larger in size by maximizing the movement of the flap within the nasal structure. A major advantage is a higher flap survival rate due to proper arterial supply and the procedure results in relatively reduced secondary motion of the flap after the surgery.

A Case of Rapidly Developed Obesity Hypoventilation Syndrome in a Patient with Kyphoscoliosis / 수면정신생리

Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.

Application of bilevel positive airway pressure in treatment of respiratory distress syndrome in preterm infants / 吉林大学学报(医学版)

Objective To explore the influence of intubation-surfactant-extubation (InSurE)therapy combined with bilevel positive airway pressure (BiPAP)in the use time of mechanical ventilation,and to clarify the value of BiPAP in the treatment of respiratory distress syndrome in the preterm infants.Methods Toral 95 preterm infants with respiratory distress syndrome were treated with InSurE therapy during January 2011 to October 2014. Among them,the preterm infants before January 2013 were selected as control group who were treated with InSurE and nasal continuous positive airway pressure (nCPAP).After January 2013, 60 preterm infants were treated with BiPAP,as BiPAP group.The rates of InSurE failure,the need for mechanical ventilation (MV)on the 7th day after InSurE failure, total non-invasive ventilation time, total mechanical ventilation time, atmospheric oxygen therapy time and incidence of clinical complications were compared between two groups.Results ① There were no significant differences in the clinical data of the preterm infants between two groups, such as gender and age.② Although there was no significant difference in the failure rate of InSurE,but the rate of repeated mechanical ventilation during 1 week in BiPAP group was lower than that in control group (P <0.01).③ The Rank sum test result showed that the total time of non invasive ventilation in BiPAP group was longer than that in control group (P <0.01).The total time of invasive mechanical ventilation and oxygen therapy in BiPAP group was lower than that in control group (P < 0.05).④ The incidence of retinopathy of prematurity (ROP)and bronchopulmonary dysplasia (BPD)in BiPAP group was lower than that in control group.Conclusion BiPAP can significantly reduce the use of invasive mechanical ventilation after the failure of InSurE,thereby decreases the oxygen toxicity and barotrauma hazards.

Ventilación mecánica domiciliaria con doble nivel de presión positiva: Experiencia de un hospital de Buenos Aires / Home Mechanical Ventilation with Bilevel Positive Pressure. Experience from a Buenos Aires Hospital

Introducción: La ventilación domiciliaria con equipos de doble nivel de presión positiva (DNPP) es un tratamiento de uso cada vez más frecuente en nuestro medio. Objetivo: Analizar la situación actual de los pacientes con ventilación domiciliaria del Hospital Churruca. Sus características demográficas, clínicas, de uso del ventilador y relacionadas con la prestación del servicio en domicilio. Materiales y métodos: Se localizó a los pacientes a los que se les prescribió un equipo entre el 2000 y 2013. Se citaron a control para completar y actualizar datos referidos al uso de la ventilación. Para la clasificación de patologías respiratorias se utilizó la metodología del estudio Eurovent. Se entregó un cuestionario para valorar aspectos relacionados con el acceso al servicio técnico y controles domiciliarios. Resultados: Se analizaron 43 pacientes. Sexo femenino 58%, índice masa corporal 37,52 ±11,5 kg/m2. Dentro de las patologías el 58% causas pulmonares, 26% torácicas, 14% neuromusculares. El 79% fueron localizados y el 21% fueron considerados perdidos. Se objetivó uso actual en 62%, abandono en el 26% y 12% fallecimientos. En el grupo Torácicas el abandono fue del 50%.El 56% de los encuestados refirió conocer la manera de acceder al servicio técnico. Al 50% nunca se le realizó un control del equipo. Conclusiones: Existe una mayoría de sexo femenino y una prevalencia alta de obesidad. La mayor parte de los pacientes ventilados fueron por causas pulmonares y con elevada tasa de abandono global, sobretodo en el grupo torácicas. Quedó en evidencia un escaso control de los equipos en el domicilio.

Introduction: Mechanical ventilation equipment for home use is an increasingly common treatment in clinical practice. Objective: Analyze the current situation of patients attending Churruca Hospital with home mechanical ventilation. Describe demographic and clinical characteristics, related to ventilator use and to provision of the home technical services. Materials and Methods: We identified the patients who were prescribed mechanical ventilation from 2000 to 2013. We invited them to come to the hospital to complete and update data about the ventilator use. The Eurovent methodology was used for the classification of respiratory diseases. A questionnaire was delivered to evaluate aspects related to health service access and home control. Results: 43 patients were analyzed; 58% were females, the body mass index was 37.52 ± 11.5 kg/m2. Respiratory diseases: Lung pathologies, 58%; Thoracic pathologies, 26%; Neuromuscular diseases, 14%. 79% of patients were located and 21% were considered lost of sight. 62% currently used the equipment, 26% had stopped using the ventilator and 12% of patients had died. Dropout was registered in 50% of the thoracic group. Among all located patients, 56% reported knowing how to access to home technical service and 50% had never had an equipment control at home. Conclusions: We observed both a female predominance and a high prevalence of obesity among the patients included in the study. Pulmonary diseases were the major reason for prescription of mechanical ventilation at home .We observed a high default rate, especially in the thoracic pathology group. There were few equipment controls at home.

Effects of Bi-level positive airway pressure on the level of B-type natriuretic peptide in patients with acute left ventricular failure / 中华全科医师杂志

A total of 122 patients with acute left ventricular failure from January 2011 to December 2013 at our hospital were recruited and divided randomly into control group (n =62) and observation group (n =60).Control group received conventional therapy and Bi-level positive airway pressure (Bi-PAP) was added along with conventional therapy for observation group.And 12 and 8 patients died in control and observation groups respectively within 24 h after treatment and there was no statistical difference.The BNP levels of the control group pre-treatment and at 1 h and 24 h post-treatment were (1 040 ± 315),(995 ± 245) and (570 ± 164) ng/L.The BNP levels of observation group pre-treatment and at 1 h and 24 h posttreatment were (1 080 ±209),(995 ±245) and (490 ± 138) ng/L.BNP of observation group at 1 h and 24 h post-treatment decreased significantly compared with that pre-treatment and control group (P ＜0.01).Only at 24 h post-treatment,the BNP level of control group decreased significantly compared with that pretreatment (P ＜ 0.01).

Analysis the treatment effect of different ventilator parameters on acute left heart failure / 中国综合临床

Objective To investigate clinical efficacy of different ventilator parameters on acute left heart failure.Methods One hundred and nineteen patients with acute left heart failure were randomly divided into A,B,C,D group.Patients in A,B,C,D groups were treated separately with higher air pressure,high pressure,medium pressure or low pressure respectively.In each group,clinical efficacy,heart rate (HR),arterial partial pressure of oxygen (PaO2),pulse oxygen saturation (SpO2),partial pressure of carbon dioxide (PaCO2) and pH were measured.Results There were significant differences among the four groups in terms of HR,PaO2,SpO2,PaCO2 and pH (F =32.21,29.46,12.34,36.47,18.38 ; P ＜ 0.05).Compared with that in A,C and D group,the levels of HR,PaO2,SpO2,PaCO2 and pH in B group were significant difference (P ＜ 0.05).Meanwhile those indices in B group were difference among before and after treatment (t =12.25,13.46,8.75,9.83,2.58 ;P ＜ 0.05).The efficacy rates of four groups were significant different (x2 =0.97,P =0.012),and in B group was 93.1％,higher than that of other 3 groups(71.0％,65.6％,51.8％ ;P ＜0.05).Condusion The ventilator parameters(10-15 cmH2O,55％-75％ FiO2 at beginning and later revised the FiO2 to 30％-40％) was proved to be worthy in treating acute left heart failure.

Effect of Bi-level positive airway pressure ventilation combined with Seretide on quality of life of elder patients with moderate and severe chronic obstructive pulmonary disease and type Ⅱ respiratory failure / 中国综合临床

Objective To investigate the effect of Bi-level positive airway pressure ventilation (BiPAP) combined with Seretide on quality of life of elder patients with moderate and severe chronic obstructive pulmonary disease (COPD) and type Ⅱ respiratory failure.Methods Eighty elderly patients with moderate to severe COPD and type Ⅱ respiratory failure were selected and randomly divided into observation group (n =40) and control group(n =40).The two groups were given conventional anti infection,oxygen inhalation,spasmolysis,expectorantand other conventional treatment,and the use of BiPAP ventilator assisted ventilation.Patients in observation group were administered the combined of Seretide and BiPAP treatment,and patients in control were received only BiPAP.Arterial blood gases before and after 7 d treatment,lung function and quality of life evaluation results (SQGR score) before and after 7 d,3 months and 6 months treatment,were measured.Results There were significant differences in terms of arterial blood gases,pulmonary function key indicators,SQGR score between two groups before and after treatment(P ＜ 0.01).PaCO2 was significantly after 7 d of treatment in observed group was (42.9 ± 7.9) mmHg,lower than that of the control group ((47.6 ± 8.0) mmHg; t =8.467,P ＜0.001).There was no significant difference in terms of forced expiratory volume in one second(FEV1) in both groups at 7 d,3 months,6 months after treatment (P ＞ 0.05).FEV1/forced vital capacity (FVC) in two group at 3 months,6 months after treatment were different compared to 7 d after treatment (observation group:(49.9 ±5.1)％ and (47.1 ±4.2)％,(50.2 ± 5.0)％ and(47.1 ±4.2)％ ;control group:(49.0 ± 5.4)％and (46.6 ± 5.9) ％,(49.8 ± 5.2) ％ and (46.6 ± 5.9) ％ ; P ＜ 0.05).SQGR score in observation group at six months after treatment were (40.8 ± 8.5),significantly lower than that of 7 d after treatment(45.9 ± 10.8),P ＜ 0.05),and significantly lower than the control group after 6 months of treatment ((40.8 ± 8.5) vs (46.0± ± 8.0),P ＜ 0.05).Conclusion Seretide combined with BiPAP treatment can significant improve lung function and the quality of life of patients with moderate and severe COPD and type Ⅱ respiratory failure.

Effect of noninvasive positive pressure ventilation on Brain Natriuretic Peptide and high sensitive C-reactive protein of acute exacerbation of chronic obstructive pulmonary disease patients with respiratory failur / 中国综合临床

Objective To investigate the concentrations of serum N-terminal brain natriuretic peptide (NT-pm BNP) and high-sensitivity C-reactive protein (hs-CRP) of acute exacerbation of chronic obstrnctive pulmonary disease(AECOPD) patients treated by bi-level positive airway pressure(BiPAP) for with respiratory failure.Methods A total of 100 respiratory failure in patients with AECOPD were divided into study group and control group,and 50 cases of each group.Patients in study group were received the conventional treatment(anti infection,diastolic bronchial,cough and phlegm and oxygen therapy) combined with BiPAP therapy,while in control group were received the conventional treatment.Blood samples were drawn at beginning and 3 d later.Serum hs-CRP and NT-pro BNP levels were determined,and the expenses and duration of hospitalization of two groups were compared.Result After treatment,the level of serum NT-pro BNP in study group and control group were (105.79 ± 4.56) ng/L and (113.33 ± 3.26) ng/L,and the difference was statistically signifi cant (t =3.03,P ＜ 0.05).The serum hs-CRP levels were (10.83 ± 16.35) mg/L and (26.39 ± 26.87) mg/L in study and control group,and the differences were statistically significant (t =-3.44,P ＜ 0.05).The expenses and duration of hospitalization in study group were both less than those in control group((11.15 ± 1.86) d vs.(12.78±2.25) d;(6 659.11 ±1 609.49) yuan vs.(8 031.31 ±1 449.79) yuan;t=-3.87,-4.38;P ＜0.05).Conclusion Early BiPAP therapy in AECOPD patients with respiratory failure in patients is showed that NT-pro BNP and hs-CRP levels faster decrease and disease is recovery remission,which suggests that NTpro BNP or BNP for AECOPD patients and respiratory failure condition monitoring,clinical efficacy have some clinical value.

Affection of salmeterol/fluticasone combined with bi-level positive airway pressure ventilation on lung function and life quality in treatment of chronic obstructive pulmonary disease stable phase patients / 中国医师进修杂志

ObjectiveTo analyze the affection of salmeterol/fluticasone combined with bi-level positive airway pressure ventilation on lung function and life quality in treatment of chronic obstructive pulmonary disease (COPD) stable phase patients.MethodsOne hundred and four moderate and severe COPD stable phase patients were divided into two groups by random digits table with 52 cases each,Observation group were treated with salmeterol/fluticasone combined with bi-level positive airway pressure ventilation,and control group were treated with bi-level positive airway pressure ventilation.The lung function and life quality between two groups were compared.ResultsThe levels of forced expiratory volume in one second (FEV1),FEV]forced vital capacity (FVC) and 75 percent of forced expiratory flow(FEF75) after treatment were higher than those before treatment in obseration group[ (2.27 ± 0.45 ) L vs.( 1.55 ± 0.30) L,(69.12 ±7.71)％ vs. (55.65 ±5.11)％,(0.62 ±0.22) L/s vs. (0.31 ±0.13) Us] and control group [ ( 1.87 ± 0.39 ) L vs.( 1.56 ± 0.31 ) L,(62.79 ± 6.86 )％ vs.(55.69 ± 5.13 )％,(0.45 ± 0.18 ) L/s vs.(0.32 ± 0.14)L/s] with significant differences (P ＜0.05),and the levels of FEV1,FEV]FVC and FEF75 after treatment in observation group were higher than those in control group with significant differences(P ＜ 0.05 ).The scores of respiratory symptoms, activity limitation, disease impact and St.George respiratory questionnaire (SGRQ) total score after treatment were lower than those before treatment in observation group [(24.15 ±9.68) scores vs. (59.28 ± 17.70) scores,(21.39 ±7.43) scores vs. (44.15 ± 13.91) scores,(18.61 ± 6.39) scores vs. (46.54± 14.58) scores,(21.85 ± 8.14) scores vs.(48.86 ± 15.75) scores] and control group [ (42.36 ± 12.19) scores vs. (58.72 ± 17.65) scores,(36.28 ± 9.35) scores vs. (43.21 ± 13.46) scores,(29.35 ± 8.24) scores vs.(45.67 ± 14.29) scores,(33.69 ± 9.26) scores vs. (48.37 ± 15.42) scores] with significant differences (P ＜ 0.05),and the scores of respiratory symptoms,activity limitation,disease impact and SGRQ total score in observation group were lower than those in control group with significant differences (P＜0.05).ConclusionsSalmeterol/fluticasone combined with bi-level positive airway pressure ventilation in treatment of COPD stable phase can improve lung function,andenhance life quality,which can be applied in clinic.

Effect of Bi-level positive airway pressure ventilation on the hemodynamics in patients with the chronic obstructive pulmonary disease combined coronary heart disease / 中国综合临床

Objective To study the effect of Bi-level positive airway pressure (BiPAP) on hemodynamics in patients with the chronic obstructive pulmonary disease (COPD) combined coronary heart disease.Methods One hundred patients with COPD combined coronary heart disease treated by BiPAP ventilation were enrolled.The blood gas analysis and the hemodynamics were monitored and analyzed in patients with the COPD combined coronary heart disease before treatment and after BiPAP ventilation treatment for 2 hours,24 hours,72 hours and 1 week.Results PaCO2 decreased significantly after 2-hour's treatment by BiPAP ventilation( P ＜ 0.05) and the heart rate and systolic blood pressure also decreased significantly after 24-hour's treatment by BiPAP ventilation.The left ventricurlar ejection fraction( [ 65.63 ± 6.86 ] ％ vs.[ 56.21 ±5.26]％,P ＜ 0.05 )was significantly improved after BiPAP reatilation treatment for one week.The mean pulmonary arterial pressure ( [ 3.74 ± 0.96 ] vs [ 5.12 ± 1.12 ] kPa,P ＜ 0.01 ),angina pectoris ( [ 0.20 ± 0.01 ]time/d vs [ 0.69 ± 0.03 ] time/d,P ＜ 0.05 ) were significantly decreased.Conclusion COPD combined coronary heart disease patients may achieve an optimal effect by BiPAP ventilation.BiPAP ventilation has no impact on the hemodynamics in patients with the COPD combined coronary heart disease.

Therapeutic effects of two modes of non-invasive mechanical ventilation on patients with acute cardiogenic pulmonary edema / 中华急诊医学杂志

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.

Study on clinical application of bi-level positive airway pressure after removal of endotracheai intubation for Chronic Obstructive Pulmonary Disease complicated with type Ⅱ respiratory failure / 中国综合临床

Objective To evaluate the therapeutic effects of noninvasive bi-level positive airway pressure (BiPAP) ventilation after extubation in chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure.Methods Forty-one intubated COPD eases with severe respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study.At the time of pulmonary infection control (PIC) window,the extubation was conducted and followed by BiPAP ventilation in 21 cases (the experimental group),while the other 20 COPD cases with similar clinical characteristics,as the control group,who continuously received invasive mechanical ventilation after PIC window.Outcomes including the duration of invasive ventilation,the total duration of ventilation support,success rate,the incidence of ventilator associated pneumonia (VAP) and mortality rate were observed and compared between the two groups.Results The two groups had similar clinical characteristics and gas exchange at the time of PIC window (P ＞ 0.05 ).Compared with the control group,the experimental group had shorter duration of invasive mechanical ventilation (6.9±3.0) d vs.(13.1 ±4.3) d,t=5.38,P＜0.001),lower rate of VAP (1/20 vs.8/20,x2 =5.51,P=0.02) andhigher extubation rate (20/21 vs.13/20,x2 =4.19,P =0.04).Conclusion In COPD patients with intubation and mechanical ventilation for respiratory failure,BiPAP ventilation after extubation at the point of PIC window may improve patients' prognosis.

Pre-test of non-invasive ventilation in the treatment of serious dyspnea patients caused by main airway stenosis / 中国医师进修杂志

ObjectiveTo evaluate the effect of high-frequency jec ventilation and bilevel positive airway pressure (BiPAP) ventilation in the severe dyspnea caused by central airway stenosis and explore the deferent application of two ventilation models.MethodsA retrospective analysis was designed to collect the serious dyspnea patients caused by central airway stenosis from January 2006 to January 2009.The patients were divided into group H and group B according to the different ventilation models,and the effect of relieving dyspnea and ameliorating hypoxemia was compared.ResultsSeven cases were in group H,and 9 cases were in group B.The therapeutic effect of relieving dyspnea was 14.29 ％(1/7) in group H.There were only 4 cases accepting high-frequency jec ventilation and the effect of relieving dyspnea was 25.00％(1/4).Two cases failed in high-frequency jec ventilation treatment and succeeded in BiPAP treatment thereafter,and 1 case failed in BiPAP treatment initially but was treated effectively by high-frequency jec ventilation after dyspnea relapsed.In group B,there were only 6 cases accepting BiPAP ventilation and the effect ofrelieving dyspnea was 83.33％ (5/6),and after adding the cases who accepting the sequential therapy of high-frequency jec ventilation and BiPAP ventilation the effect rate was 88.89％ (8/9).The difference had statistical significance(P =0.006).In ameliorating hypoxemia,the effect rate of group H was 100.00％ (7/7),of group B was 88.89％(8/9),and the difference had no statistical significance (P =0.563 ).Conclusions The high-frequency je ventilation is effective to relieve hypoxemia but is short of relieving dyspnea and subjective symptom,and it is suit for life support preoperative and intraoperative.The BiPAP ventilation is effective to relieve dyspnea and subjective symptom and hypoxemia,so the treatment effect is better than high-frequency jec ventilation,and it is suit in relieving symptom temporarily,pre-operative preparation and malignant tumor palliative treatment.