ObjectiveTo evaluate the effects of home mechanical ventilation (HMV) for stable chronic obstructive pulmonary disease (COPD) patients with respiratory failure in Tongzhou district of Beijing city. MethodsTwenty stable COPD patients with respiratory failure were included in the study.During the one-year follow-up period,4 patients died and 1 withdrew and 15 patients finished the follow-up.The patients was followed up by telephone each month and guided in drug administration,HMV,and rehabilitation therapy.At the beginning of the study and one year later,the patients were interviewed and accessed on the general data,nutritional status,COPD assessment test (CAT),Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,and arterial blood gas analysis. ResultsAt the end of one-year follow-up,nutrition index,CAT,Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,pH,and PaO2 did not change significantly (P>0.05),while PaCO2 decreased significantly compared with those at the beginning of the study (P<0.05).Compared with the past year,the times of hospitalization due to acute exacerbation of COPD was significantly reduced during the follow-up year (P<0.05). ConclusionHMV can ameliorate carbon dioxide retention and reduce times of hospitalization due to acute exacerbation of COPD for COPD patients with respiratory failure.
Objective To determine the efficacy and prognosis of noninvasive positive pressure ventilation (NPPV) in exacerbations of chronic obstructive pulmonary disease (COPD). Methods Trials were located through electronic searches of MEDLINE, EMBASE, Springer, and Foreign Journals Integration System (from the start date to March 2008). We also checked the bibliographies of retrieved articles. Statistical analysis was performed with The Cochrane Collaboration’s software RevMan 4.2.10. Results A total of 19 trials involving 1 236 patients were included. Results showed that: (1) NPPV vs. conventional therapy: NPPV was superior to conventional therapy in terms of intubation rate (RR 0.36, 95%CI 0.27 to 0.49), failure rate (RR 0.62, 95%CI 0.43 to 0.90), and mortality (RR 0.49, 95%CI 0.34 to 0.69). The length of hospital stay was shorter in the NPPV group compared with the conventional group (WMD – 3.83, 95%CI – 5.78 to – 1.89), but the length of ICU stay was similar. The changes of PaO2, PaCO2, and pH were much more obvious in the NPPV group compared with the conventional group. The change of respiratory rate was more significant in the NPPV group compared with the conventional group (WMD – 3.75, 95%CI – 5.48 to – 2.03). At discharge and follow-up, there were no significant differences in FEV1, pH, PaCO2, PaO2, and vital capacity between the two groups. (2) NPPV vs. invasive ventilation: the mortality was similar between the two groups. The incidence of complications was lower in the NPPV group compared with the invasive group (RR 0.38, 95%CI 0.20 to 0.73). The length of ICU stay, duration of mechanical ventilation, and weaning time were shorter in the NPPV group than those of the invasive group. At discharge and follow-up, clinical conditions were similar between the two groups. Conclusion The limited current evidence showed that NPPV was superior to conventional therapy in improving intubation rate, mortality, short term of blood-gas change, the change of respiratory rate; and superior to invasive ventilation in the length of hospital stay and the incidence of complication. There were no difference among them in discharge and follow-up.
ObjectiveTo observe the predictive value of Volume OXygeneration (VOX) index for early non-invasive positive pressure ventilation (NIPPV) treatment in patients with type I Respiratory failure. MethodsRetrospective analysis was made on the patients with type I Respiratory failure admitted to the intensive care medicine from September 2019 to September 2022, who received early NIPPV treatment. After screening according to the discharge standard, they were grouped according to the NIPPV 2-hour VOX index. The observation group was VOX Youden index >20.95 (n=69), and the control group was VOX index ≤20.95 (n=64). Collect patient baseline data and NIPPV 2-hour, 12-hour, and 24-hour arterial blood gas values, and calculate NIPPV outcomes, intubation status, NIPPV usage time, hospital stay, and mortality rate. ResultsThere was a statistically significant difference in respiratory rate (RR) between the baseline data onto the two groups of patients, but others not. After early NIPPV treatment, the 2-hour oxygenation index (P/F) [(182.5 ± 66.14) vs. (144.1 ± 63.6) mm Hg, P<0.05] of the observation group showed a more significant increase. The failure rate of NIPPV intubation within 12 hours was lower (4.35% vs. 32.81%, P<0.05), the success rate of NIPPV withdrawal from 24 hours was higher (40.58% vs. 0%, P<0.05), and the failure rate of NIPPV intubation was lower (4.35% vs. 46.88%, P<0.05). The comparison of treatment outcomes showed that the intubation rates in the observation group (4.35% vs. 67.19%, P<0.05) was lower. The threshold of NIPPV 2-hour VOX index 20.95 was used as a predictor of Tracheal intubation, with sensitivity of 74.7% and specificity of 93.5%. ConclusionIn the early NIPPV treatment of patients with type I Respiratory failure, the NIPPV 2-hour VOX index>20.91 is taken as the evaluation index, which can better to predict the improvement in hypoxia and the risk of NIPPV failure Tracheal intubation, and has clinical significance.
目的:评价无创正压通气(NIPPV)在救治慢性阻塞性肺疾病(COPD)急性加重期并严重呼吸衰竭患者中的临床疗效。方法:对2006年1月至2008年1月入选的47例COPD急性加重期并严重呼吸衰竭患者使用双水平无创正压呼吸机面罩辅助通气, 患者均伴有不同程度的意识障碍,动态观察NIPPV治疗前和治疗后2 h、8 h、1 d及3 d动脉血气、神志、治疗后患者的转归,NIPPV的不良反应及并发症。结果:本组47例患者中,41例经NIPPV治疗2 h、8 h、1 d及3 d后与治疗前比较,PaO2明显升高Plt;0.01,PaCO2明显降低Plt;0.01,pH明显升高Plt;0.01,均脱机出院,有效率达87.23%(41/47);6例改为有创通气,其中3例经有创机械通气治疗后脱机成功,1例因上消化道出血死亡,2例自动出院.结论:双水平无创正压通气对有选择的COPD急性加重期并严重呼吸衰竭患者治疗疗效确切,它能迅速缓解病情,减少患者的气管插管和气管切开以及相应的并发症,提高生活质量。
Objective To explore the effects of enteral tube feeding on moderate AECOPD patients who underwent noninvasive positive pressure ventilation ( NPPV) . Methods Sixty moderate AECOPD patients with NPPV admitted from January 2009 to April 2011 were recruited for the study. They were randomly divided into an enteral tube feeding group (n=30) received enteral tube feeding therapy, and an oral feeding group (n=30) received oral feeding therapy. Everyday nutrition intake and accumulative total nutrition intake in 7 days, plasma level of prealbumin and transferrin, success rate of weaning, duration of mechanical ventilation, length of ICU stay, rate of trachea cannula, and mortality rate in 28 days were compared between the two groups. Results Compared with the oral feeding group, the everyday nutrition intake and accumulative total nutrition intake in 7 days obviously increased (Plt;0.05) , while the plasma prealbumin [ ( 258.4 ±16.5) mg/L vs. (146.7±21.6) mg/L] and transferrin [ ( 2.8 ±0.6) g/L vs. ( 1.7 ±0.3) g/L] also increased significantly after 7 days in the enteral tube feeding group( Plt;0.05) . The success rate of weaning ( 83.3% vs. 70.0%) , the duration of mechanical ventilation [ 5. 6( 3. 2-8. 6) days vs. 8. 4( 4. 1-12. 3) days] , the length of ICU stay [ 9. 2( 7. 4-11. 8) days vs. 13. 6( 8.3-17. 2) days] , the rate of trachea cannula ( 16. 6% vs. 30. 0% ) , the mortality rate in 28 days ( 3. 3% vs. 10. 0% ) all had significant differences between the enteral tube feeding group and the oral feeding group. Conclusions For moderate AECOPD patients with NPPV, enteral tube feeding can obviously improve the condition of nutrition and increase the success rate of weaning, shorten the mechanical ventilation time and the mean stay in ICU, decrease the rate of trachea cannula and mortality rate in 28 days. Thus enteral tube feeding should be preferred for moderate AECOPD patients with NPPV.
ObjectiveTo investigate whether noninvasive positive pressure ventilation (NIV) will improve preoxygenation in critically ill patients in intensive care unit (ICU) before intubation, when compared with bag-valve-mask (BVM).MethodsThis was a single-centered, prospective and randomized study. The patients in the study were those who required tracheal intubation in the ICU of the First Affiliated Hospital of Guangzhou Medical University and Guangzhou Institute of Respiratory Health from June 2015 to June 2017. These critically ill patients were provided with BVM or NIV assisted preoxygenation randomly. The data of the NIV group and the control group were compared and the application values of NIV in preoxygenation of critically ill patients were evaluated.ResultsA total of 106 patients participated in this study, including 75 males and 31 females and with an average age of (65.0±12.6) years. The patients were classified either into the control group (BVM assisted preoxygenation, n=53), or the NIV group (NIV assisted pre-oxygenation, n=53). The causes of intubation in the control group and the NIV group were as follows: pneumonia [40 patients (75.5%) vs. 39 patients (73.6%)], chronic obstructive pulmonary disease [12 patients (22.6%) vs. 11 patients (20.8%)], and other disease [1 patient (1.9%) vs. 3 patients (5.7%)], which showed no significant difference between the two groups. The scores of the Acute Physiology and Chronic Health Evaluation System Ⅱ of the control group and the NIV group were 20 (17, 26) vs. 20 (16, 26), P=0.86, which also showed no significant difference. The oxygen saturation of the pulse (SpO2) before preoxygenation were similar in both the control group and the NIV group 92% (85%, 98%) vs. 91% (85%, 98%), P=0.87. After preoxygenation, SpO2 was significantly higher in the NIV group than in the control group 99% (96%, 100%) vs. 96% (90%, 99%), P=0.001. For the subgroup of patients with SpO2 less than 90% before preoxygenation, the respective SpO2 in the control group and the NIV group were 83% (73%, 85%) vs. 81% (75%, 86%), P=0.75; after preoxygenation, SpO2 in the NIV group was significantly higher than in the control group 99% (96%, 100%) vs. 94%(90%, 99%), P=0.000. For the subgroup of patients with SpO2 of 90% or more before preoxygenation, the respective SpO2 in the control group and the NIV group were similar 95.5% (92%, 99%) vs. 96% (94%, 99%), P=0.52; and continued to be similar after preoxygenation 98% (95%, 100%) vs. 99% (96%, 100%), P=0.1. The duration of mechanical ventilation of the control group and the NIV group was 17 (10, 23)d vs. 19 (11, 26)d (P=0.86). The 28 days survival rate of the control group and the NIV group was 73.6% vs. 71.7% (P=0.34). The mortality rate in the control group and NIV group were 31.3% and 31.7% (P=0.66).ConclusionsWhen compared with the use of BVM, NIV assisted preoxygenation is effective and safe for critically ill patients. Critically ill patients with severe hypoxemia will benefit more from NIV assisted preoxygenation.
Objective To analyze the risk factors of treatment failure by noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and explore the best time that NPPV be replaced by invasive ventilation when NPPV failure occurs. Methods The data of patients with ARF due to AECOPD who were treated with NPPV from January 2013 to December 2015 were retrospectively collected. The patients were divided into two groups: the NPPV success group and the NPPV failure group (individuals who required endotracheal intubation or tracheotomy at any time). The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score was analyzed; the Glasgow Coma Scale score, respiratory rate (RR), pH value, partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2) ratio, and partial pressure of carbon dioxide were also analyzed at admission, after 2 hours of NPPV, and after 24 hours of NPPV. Results A total of 185 patients with ARF due to AECOPD were included. NPPV failed in 35.1% of the patients (65/185). Multivariate analysis identified the following factors to be independently associated with NPPV failure: APACHEⅡscore≥30 [odds ratio (OR)=20.603, 95% confidence interval (CI) (5.309, 80.525), P<0.001], RR at admission≥35 per minute [OR=3.723, 95%CI (1.197, 11.037), P=0.020], pH value after 2 hours of NPPV<7.25 [OR=2.517, 95%CI (0.905, 7.028), P=0.070], PaO2 after 2 hours of NPPV<60 mm Hg (1 mm Hg=0.133 kPa) [OR=3.915, 95%CI (1.374, 11.508), P=0.010], and PaO2/FiO2 after 2 hours of NPPV<200 mm Hg [OR=4.024, 95%CI (1.542, 11.004), P=0.010]. Conclusion When patients with ARF due to AECOPD have a higher severity score, have a rapid RR at admission, or fail to improve in terms of pH and oxygenation after 2 hours of NPPV, the risk of NPPV failure is higher.
ObjectiveTo investigate the application value of noninvasive ventilation (NIV) performed in patients with unplanned extubation (UE) in intensive care unit (ICU).MethodsThis was a retrospective analysis. The clinical data, application of NIV, reintubation rate and prognosis of UE patients in the ICU of this hospital from January 2014 to December 2018 were reviewed, and the patients were assigned to the control group or the NIV group according to the application of NIV after UE. The data between the two groups were compared and the application effects of NIV in UE patients were evaluated.ResultsA total of 66 UE patients were enrolled in this study, including 44 males and 22 females and with an average age of (64.2±16.1) years. Out of them, 41 patients (62.1%) used nasal catheter or mask for oxygenation as the control group, 25 patients (37.9%) used NIV as the NIV group. The Acute Physiology andChronic Health EvaluationⅡ score of the control group and the NIV group were (18.6±7.7) vs. (14.8±6.3), P=0.043. The causes of respiratory failure in the control group and the NIV group were as follows: pneumonia 16 patients (39.0%) vs. 7 patients (28.0%), postoperative respiratory failure 7 patients (17.1%) vs. 8 patients (32.0%), chronic obstructive pulmonary disease 8 patients (19.5%) vs. 6 patients (24.0%), others 5 patients (12.2%) vs. 4 patients (16.0%), heart failure 3 patients (7.3%) vs. 0 patients (0%), nervous system diseases 2 (4.9%) vs. 0 patients (0%), which showed no significant difference between the two groups. Mechanical ventilation time before UE were (12.5±19.8) vs (12.7±15.2) d (P=0.966), PaO2 of the control group and the NIV group before UE was (114.9±37.4) vs. (114.4±46.3)mm Hg (P=0.964), and oxygenation index was (267.1±82.0) vs. (257.4±80.0)mm Hg (P=0.614). Reintubation rate was 65.9% in the control group and 24.0% in the NIV group (P=0.001). The duration of mechanical ventilation was (23.9±26.0) vs. (21.8±26.0)d (P=0.754), the length of stay in ICU was (34.4±36.6) vs. (28.5±25.8)d (P=0.48). The total mortality rate in this study was 19.7%. The mortality rate in the control group and NIV group were 22.0% and 16.0% (P=0.555).ConclusionPatients with UE in ICU may consider using NIV to avoid reintubation.