Clinical Experience of Prone Position, PSV, and NIPPV in a Patient with TRALI: Case Report / 대한수혈학회지

Transfusion related acute lung injury (TRALI) is rare, but can sometimes lead to serious complication, and increases transfusion related mortality. We report on a case of a 21-year-old female with a femoral arterial rupture. Because of a massive hemorrhage, she was given nine units of packed red blood cell (RBC), nine units of fresh frozen plasma (FFP), and eight units of platelet. One hour after the end of blood transfusion, the patient experienced a sudden onset of dyspnea, tachypnea, cyanosis, and hypoxemia in the recovery room. Her breathing sounds were markedly decreased and bilateral diffuse crackles were detected. There were no signs of volume overload. A chest X-ray showed bilateral coarse alveolar infiltrates and a CT scan showed bilateral non-cardiogenic diffuse pulmonary edema with pleural effusion. Pressure support ventilation (PSV) and noninvasive positive pressure ventilation (NIPPV) were applied via a full-face CPAP mask after changing to prone position. She showed slow improvement, and achieved a full recovery over the next seven days.

Clinical Experience of Prone Position, PSV, and NIPPV in a Patient with TRALI: Case Report / 대한수혈학회지

Transfusion related acute lung injury (TRALI) is rare, but can sometimes lead to serious complication, and increases transfusion related mortality. We report on a case of a 21-year-old female with a femoral arterial rupture. Because of a massive hemorrhage, she was given nine units of packed red blood cell (RBC), nine units of fresh frozen plasma (FFP), and eight units of platelet. One hour after the end of blood transfusion, the patient experienced a sudden onset of dyspnea, tachypnea, cyanosis, and hypoxemia in the recovery room. Her breathing sounds were markedly decreased and bilateral diffuse crackles were detected. There were no signs of volume overload. A chest X-ray showed bilateral coarse alveolar infiltrates and a CT scan showed bilateral non-cardiogenic diffuse pulmonary edema with pleural effusion. Pressure support ventilation (PSV) and noninvasive positive pressure ventilation (NIPPV) were applied via a full-face CPAP mask after changing to prone position. She showed slow improvement, and achieved a full recovery over the next seven days.

Pneumothorax Associated with Noninvasive Intermittent Positive Pressure Ventilation in Duchenne Muscular Dystrophy: A case report

Duchenne muscular dystrophy (DMD) is a severe X-linked recessive disorder characterized by rapid progression of muscle wasting and weakness. Long term noninvasive intermittent positive pressure ventilation (NIPPV) is an important treatment for neuromuscular patients with chronic respiratory failure. NIPPV is easy to administer and life-threatening complications are rare. We report two cases of pneumothorax associated with long term NIPPV in DMD. Given the increasing utilization of chronic NIPPV, we suggest that caregivers and patients must be aware of this potentially life-threatening complication.

Clinical Evaluation of NIPPV in the Treatment of Interstitial Lung Disease Combined with Respiratory Failure / 医学研究杂志

Objective To discuss the effect and possibility of NIPPV in ILD combined with respiratory failure. Methods A total of 37 cases of ILD combined with respiratory failure admitted by our hospital during Feb 2004 to Oct 2007 were divided into treatment group (20 cases) and control group (17 cases). Routine pharmaceutical intervention was adopted in both groups while NIPPV was given in the patients of treatment group. The symptoms、signs and the arterial blood gases were observed and analyzed. Results Among 20 patients,3 gave up treatment , 17 patients were successfully treated with the NIPPV therapy. There were significant improvement of PaCO2、PaO2、pH and respiratory rate ,heart rate after 2h NIPPV. Conclusion NIPPV is an effective method for ILD combined with respiratory failure,which can save the patients life and decrease the complications.

Treatment of acute lung injury with pathologic pregnancy by non-invasive mechanical ventilation / 重庆医科大学学报

Objective:To discuss the effect of non-invasive mechanical ventilation on acute lung injury with pathologic pregnancy.Methods:A clinical retrospective analysis was carried out to investigate 45 cases of acute lung injury in pathologic pregnancy treated by non-invasive mechanical ventilation in central ICU.Results:Forty-four patients of forty-five were cured (97.8%).Only one patient(2.22%) developed ARDS,and changed to be treated by invasive mechanical ventilation.Conclusion: Pathologic pregnancy is the high risk group of AIS.Using NIPPV early is an effective way to treat,with high success rate of emergency care.The keys of treatment are early diagnosis,early treatment and monitoring of the development of ARDS.

Noninvasive Positive Pressure Ventilation (NIPPV) for Patients with Acute Respiratory Failure after Cardiovascular Surgery / 日本心臓血管外科学会雑誌

NIPPV provides positive pressure ventilation through a face mask without intubation. We performed NIPPV for 2 patients with acute respiratory failure following cardiovascular surgery. (Case 1) A 63-year-old man, who had had COPD (Hugh-Jones class III), underwent replacement of the aortic arch. He was extubated after 5 days. However, he was re-intubated under controlled ventilation because of deterioration of his respiratory condition. The patient had NIPPV after extubation on postoperative day 14 because he was alert and had no cardiovascular compromise. On the 18th postoperative day he was weaned from NIPPV. (Case 2) A 67-year-old man underwent coronary artery bypass surgery. On the next day he was extubated, but he suffered from hypoxemia due to impaired respiratory condition on postoperative day 3. The patient underwent NIPPV instead of conventional mechanical ventilation because his condition was stable except for respiration. Respiratory condition improved quickly and he was weaned from NIPPV on the 7th postoperative day. NIPPV is an effective method for managing patients with acute respiratory failure after cardiovascular surgery.

Investigate the practical value of non-invasive positive pressure ventilation in the treatment of acute left heart failure / 中国实用内科杂志

ObjectiveTo investigate the practical value of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute left heart failure(ALHF).MethodsThe clinical effects and complications of NIPPV performed on 36 cases with severe ALHF on the basis of conventional treatment were evaluated and compared with previous treatment without NIPPV.ResultsOf 36 cases with ALHF treated by NIPPV,30 cases improved,6 cases were altered to receive invasive ventilation or dead.Total effective rate was 83.3%.Compared with 42 cases with severe ALHF treated only by conventional treatment in the past 5 years,with only 26 cases being successfully salvaged and effective rate being 61.9%,significant difference (P

A clinical analysis on treatment of patients who suffered from acute exa cerbations of chronic obstructive pulmonary disease (COPD) with type Ⅱ respirat ory failure / 中国实用内科杂志

Objective To study the clinical effect of noninva si ve positive pressure ventilation(NIPPV)on the treatment of acute exacerbations o f chronic obstructive pulmonary disease(COPD)with type Ⅱ respiratory failure.Methods Observe the data in arterial blood gas (pH,PaO2,PaCO2 ),the course of disease in the hospital ,the rate of endotracheal intubation ,the mortality of the patients in NIPPV and compare with those of the patients without NIPPV treatment before.Results The data in arterial blood gas had been improved signif icantly in NIPPV after 24h.The course of disease in hospital was significantly s horter,and the rate of endotracheal intubation and mortality of the patients wa s significantly lower in NIPPV than those in no NIPPV.There was remarkably diffe rence between two groups.In NIPPV,the rate of endotracheal intubation were sig nificantly lower in light and moderate respiratory failure than those in severe respiratory failure(P

The Usefulness of Noninvasive Positive Pressure Ventilation in Patients With Acute Respiratory Failure after Extubation / 결핵

BACKGROUND: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in paients who developed acute respiratory failure after extubation. METHOD: We retrospectively analyzed thirty one patients (eighteen males and thirteen females, mean ages 63+/-13.2 years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 cmH2O of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. RESULTS: 1) NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. 2) There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and PaO2/FiO2 between the success and the failure group. 3) Heart rate and respiration rate were significantly decreased with increase SaO2 after thirty minutes of NIPPV in both groups (p<0.05). Ho wever, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in SaO2 leading to endotracheal reintubation. 4) The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases (62% vs 39%) (p=0.007). 6) The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease (n=9), aggravation of undelying disease (n=5), mask intolerance (n=2), and retained airway secretion (n=1). CONCLUSION: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.

A case of juvenile form Pompe's disease manifested as chronic alveolar hypoventilation

We describe a case of the juvenile form of Pompe's disease that presented as primary alveolar hypoventilation due to respiratory muscle involvement. This 17-year-old girl had been asymptomatic until this admission, although she had a delayed puberty. Arterial blood gas analysis, pulmonary function test as well as physical findings were compatible with chronic alveolar hypoventilation syndrome. Since she had lower extremity muscle weakness and pseudomyotonic discharge on electromyography a muscle biopsy was done, which revealed glycogen storage disease. The patient was managed successfully with nasal intermittent positive pressure ventilation.

Sequential invasive and non-invasive mechanical ventilation in respiratory failure due to acute organophosphate poisoning / 重庆医科大学学报

Objective:To discuss the effect of sequential invasive and non-invasive mechanical ventilation on severe organophosphate poisoning with respiratory failure(RF).Methods:A clinical retrospective analysis was carried out to investigate 32 cases of severe organophosphate poisoning with RF treated by sequential invasive and non-invasive mechanical ventilation in EICU.Results:Twenty-eight patients of thirty-two were cured(87.5%).Four patients developed intermediate syndrome(IMS),2 patients died(6.3%).Conclusion:Sequential invasive and non-invasive mechanical ventilation is an effective therapy on severe organophosphate poisoning with RF.Attention must be paid to acute respiratory failure(ARF) caused by IMS.

Nursing of NIPPV therapy for severe acute pancreatitis with ARDS / 重庆医科大学学报

Objective:To explore the effect and the nursing methods of NIPPV(noninvasive positive pressure ventilation) therapy in severe acute pancreatitis complicated with ALI(acute lung injury)/ARDS (acute respiratory distress syndrome).Methods:52 patients with acute critical pancreatitis in our centual ICU from (January,2000 to June,2004)were analyzed.Among them,32 patients with ALI/ARDS,in which 29 patierts were treated by NIPPV and 3 patients were treated by IPPV.Results:Among 29 patients treated with NIPPV,25 patients were cured and 4 patients were further treated with IPPV,among them 3 patients died.Conclusion:There are following advantages for SAP patients complicating with ALI/ARDS treated by NIPPV:less suffering,maintenance of normal function of upper respiratory tract and reduction in the rate of lung infection.Furthermore it also shortens the time of hospitalization and saves money for patients,while increased cure rate combined with comprehensive therapy.