Short-term application of noisy pressure support ventilation in patients of AECOPD with respiratory failure / 天津医药

ABSTRACT

Objective To investigate the effects of noisy pressure support ventilation (Noisy PSV) in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure, and to provide basic support for the new weaning mode for AECOPD. Methods A single-center, prospective, randomized, crossover clinical research was conducted. A total of forty-six AECOPD combined with respiratory failure patients who mechanically ventilated more than 24 hours in intensive care unit (ICU) of Tianjin Haihe Hospital from November 2014 to October 2015 were enrolled in this study. When the respiratory failure improved through conventional treatment, patients were mechanically ventilated with conventional PSV and Noisy PSV for two hours respectively in random sequence during spontaneous breathing recovery phase. The pressure support (PS) level was titrated to reach tidal volumes (Vt) about 8 mL/kg in both modes. The level of positive end-expiratory pressure (PEEP) and fraction of inspired oxygen were kept unchanged in both modes. The coefficient of variation of PS during Noisy PSV was set at 30%. Data of gas exchange, hemodynamics, lung functional parameters, breathing patterns and patient-ventilator synchrony were analyzed. Results All of the patients were well tolerated with the two modes, and no adverse reactions were found. The changes of gas exchange, hemodynamics, respiratory mechanics in PSV and Noisy PSV showed a clinical acceptable range. The variability of Vt was significantly increased in Noisy PSV mode than that in conventional PSV mode. While the number of asynchrony events was decreased in Noisy PSV mode than that in conventional PSV mode. Conclusion The Noisy PSV is safe and feasible for patients of AECOPD with respiratory failure, which may be a new weaning mode for AECOPD.