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

ABSTRACT

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 groupscontrol 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.