Objective To explore the effect of respiratory training based on mechanical vibration-assisted sputum expulsion on arterial blood gases in patients with chronic obstructive pulmonary type 2 respiratory failure and clinical efficacy observation. Methods 105 patients with chronic obstructive pulmonary disease combined with type 2 respiratory failure who were hospitalized in our hospital from November 2019 to February 2023 were selected as study subjects. They were randomly numbered and divided into experimental and control groups according to the order of admission, and 3 patients withdrew from the study cohort due to their own reasons, and 51 cases each of the experimental and control groups were finally included. Patients in the control group were given conventional treatment and lung function exercise, while the experimental group was given respiratory training with mechanical vibration-assisted sputum expulsion. Lung function and blood gas analysis indexes were measured before and 2 weeks after treatment to evaluate the clinical efficacy and incidence of adverse events in the two groups. Results After the treatment, pulmonary function indexes such as PEF, FVC, FEV1 and FEV1/FVC, and blood gas analysis indexes such as PaO2, PaCO2 of the experimental group and daily sputum excretion improved significantly compared with those of the pre-treatment and control groups (P<0.05). The total clinical efficacy rate of the patients in the experimental group was significantly higher than that of the control group (P<0.05), and the incidence of adverse events was lower than that of the control group, but the difference was not statistically significant (P>0.05). Conclusion Respiratory training based on mechanical vibration-assisted sputum expectoration can help improve the lung function and blood gas level of patients with chronic obstructive pulmonary disease combined with type 2 respiratory failure, and it has a certain clinical value in promoting the rehabilitation and prognosis of patients.
ObjectiveTo investigate the effects of arterial blood gas index control during invasive mechanical ventilation on prognosis in COPD patients with type Ⅱ respiratory failure. MethodsSeventy-six COPD patients with hypercapnic respiratory failure who underwent invasive mechanical ventilation were recruited in the study. The patients were divided into group A with conventional arterial blood gas index control [pH of 7.40±0.05,PaO2 of (70±5)mm Hg,PaCO2 of (55±5)mm Hg],and group B with low index control [pH of 7.35±0.05,PaO2 of (60±5)mm Hg,PaCO2 of (60±5)mm Hg]. Two groups were compared on the required parameters of invasive mechanical ventilation,the duration of invasive mechanical ventilation,the incidence rate of sequential therapy in noninvasive mechanical ventilation,ventilator associated pneumonia and secondary intubation,etc. ResultsThe required parameters of invasive mechanical ventilation in group B including tidal volume (VT) and pressure support (PS),the duration of invasive mechanical ventilation,the incidence rate of sequential therapy in noninvasive mechanical ventilation,ventilator associated pneumonia and secondary intubation were all significantly lower than those in group A (P<0.05). ConclusionThe strategy to permit a lower PaO2 and carbon dioxide retention to a certain extent at lower FiO2,VT and PS levels in invasive mechanical ventilation can reduce the duration of invasive mechanical ventilation and the occurrence of ventilator associated complications,and improve the prognosis in COPD patients with type Ⅱ respiratory failure.
高频通气(HFV)是一种高通气频率和低潮气量的通气方式，其通气频率至少为机体正常呼吸频率的4倍，而潮气量近于或小于解剖死腔。其主要类型包括：高频正压通气、高频喷射通气和高频振荡通气等。其中，高频振荡通气(HFOV)是目前公认的最先进高频通气技术，在临床中应用最广泛。
摘要:目的：探讨纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中的临床应用价值。方法：237例慢阻肺合并重度呼吸衰竭患者,随机分为纤支镜经口引导气管插管组(纤支镜组)125例和喉镜经口引导气管插管组(喉镜组)112例,分别在纤支镜和喉镜引导下按常规进行气管插管术。结果：纤支镜组和喉镜组一次获得插管成功率分别为984%和920%(P＜005),平均插管时间分别为（613±391） min 和（926±415） min(P＜005)。纤支镜组有5例患者出现咽喉部少量出血,并发症发生率为40%;喉镜组共有12例发生并发症,并发症发生率为107%(P＜005),其中齿、舌、咽或喉部损伤6例,反射性呕吐致误吸2例,单侧肺通气1例,插入食管2例,心跳呼吸骤停1例。结论：纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中是一种简便快速、成功率高和并发症少的有效方法,值得临床推广应用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
ObjectiveTo systematically evaluate the effect of high-flow nasal cannula in immunocompromised patients with acute respiratory failure.MethodsRandomized controlled trials (RCT) or cohort studies on the efficacy of high-flow oxygen therapy in immunocompromised patients with acute respiratory failure were reviewed by computer in PubMed, EMBASE, Cochrane Library, and China Knowledge Network, Wanfang and VIP databases. The group used HFNC and the control group used a mask or a nasal catheter to give oxygen-based conventional oxygen therapy (COT) or noninvasive ventilation (NIV). Two investigators conducted quality assessments and data extractions based on the Cochrane Collaboration Risk Assessment Manual and the Newcastle-Ottawa Scale. Meta analysis was performed using RevMan 5.3 software. The main outcome measures included tracheal intubation rate, and intensive care unit (ICU) mortality. The secondary outcomes included ICU hospitalization time.ResultsThe study included 13 articles (4 RCTs, 9 cohort studies), a total of 1133 subjects, with 583 in the HFNC group and 550 in the control group (280 in the COT and 270 in the NIV). Meta-analysis showed that HFNC was significantly different from COT in reducing tracheal intubation rate in immunocompromised patients with respiratory failure (OR=0.49, 95%CI 0.33 - 0.72, P=0.0003), but no statistical significance compared with NIV (OR=0.73, 95%CI 0.52 - 1.02, P=0.07); two-combination analysis showed that HFNC had a significant advantage in reducing tracheal intubation rate compared with COT/NIV (combined OR=0.61, 95%CI 0.47 - 0.79, P=0.0002). In terms of ICU mortality, there was a statistically significant difference between HFNC and COT (OR=0.59, 95%CI 0.35 - 1.01, P=0.05) or NIV (OR=0.63, 95%CI 0.44 - 0.91, P=0.01). The results of the two subcombinations and analysis did not change (combined OR=0.62, 95%CI 0.46 - 0.83, P=0.002). In terms of ICU hospital stay, there was no statistically significant difference between HFNC and COT (MD=−4.52, 95%CI −9.43 - 0.39, P=0.07), but the difference was statistically significant compared with NIV (MD=−1.46, 95%CI −2.41 - −0.51, P =0.003); the two sub-combinations and analysis results showed significant difference (combined MD=−3.41, 95%CI −6.16 - −0.66, P=0.01). According to different research types, after subgroup analysis, the analysis results were not different from the combined results. Sensitivity analysis revealed that HFNC could significantly reduce the patient's ICU hospital stay compared with the control group oxygen therapy. The results of the funnel chart analysis show that there were publication offsets in the studies on tracheal intubation rate and ICU mortality included in the literature; studies on ICU hospital stays had a smaller publication offset.ConclusionsCompared with COT, HFNC can reduce the tracheal intubation rate of patients, but there is no significant difference compared with NIV; HFNC can reduce the ICU mortality of patients compared with COT/NIV. However, due to the high heterogeneity between the studies, whether HFNC can reduce ICU hospital stay remains to be further explored.
ObjectiveTo observe the clinical efficacy of invasive-noninvasive sequential mechanical ventilation in the treatment of chronic obstructive pulmonary disease (COPD) complicated by type Ⅱ respiratory failure. MethodsA total of 100 patients with COPD complicated with type Ⅱ respiratory failure from March 2013 to April 2014 were randomly divided into control group and study group (with 50 patients in each). While the control group was given continuous invasive ventilation treatment, the study group was treated with invasive-noninvasive sequential ventilation. The ventilation time, Intensive Care Unit (ICU) monitoring and hospitalization time, the serum concentrations of C-reactioin protein (CRP) before and after treatment and the ventilator associated pneumonia (VAP) and hospital mortality rate were observed and compared between the two groups. ResultsFor patients in the study group, ICU monitoring time, ventilation time and hospitalization time were (9.4±8.1), (10.3±5.8), and (14.7±8.2) days, respectively, significantly shorter than those in the control group[(17.5±10.8), (15.2±7.7), and (22.8±7.4) days] (P<0.05). The incidence of VAP and nosocomial VAP mortality in the study group were 4.0% and 2.0% respectively, which were significantly lower than those in the control group (22.0% and 20.0%), and the differences were statistically significant (P<0.05). ConclusionIn the clinical treatment of COPD patients with type Ⅱ respiratory failure, invasive-noninvasive sequential ventilation treatment is effective in shortening the duration of ventilation and hospitalization time, controlling the incidence of VAP, and reducing the mortality rate, which is worthy of clinical popularization.
Abstract： Objective To analyze risk factors associated with postoperative respiratory failure in patients with valvular surgery. Methods Between January 2001 and November 2010, clinical data of 618 patients with 339 males and 279 fameles at age of 10-74（44.01±13.95）years,undergoing valvular operations were investigated retrospectively. We divided the patients into two groups according to the presence （74 patients）or absence（544 patients）of postoperative respiratory failure. Its risk factors were evaluated by univariate and multivariate logistic regression analysis. Results The hospital mortality rate of valvular surgery was 6.1%（38/618）.The morbidity rate of respiratory failure was 12.0%（74/618） with hospital mortality rate at 17.6%（13/74） which was significantly higher than those patients without postoperative respiratory failure at 4.6%（25/544, χ2=18.994, P=0.000）. Univariate analysis showed age＞ 65 years（P=0.005）, New York Heart Association（NYHA）classⅣ（P=0.014）, election fraction＜ 50.0%（P=0.003）, cardiopulmonary bypass time＞ 3 h（P=0.001）, aortic cross clamping time＞ 2 h（P=0.008）, concomitant operation（ valvular operation with coronary artery bypass grafting, Bentall or radiofrequency ablation maze operation（P=0.000）, reoperation（P=0.012）, postoperative complications （P=0.000）, and blood transfusion＞ 2 000 ml（P=0.000） were important risk factors for postoperative respiratory failure. Multivariate logistic regression showed that concomitant operation（P=0.003）, reoperation（P=0.010）, postoperative complications（P=0.000）, and blood transfusion＞2 000 ml（P=0.012）were significant independent predictive risk factors. Conclusion This study suggest that patients with predictive risk factors of postoperative respiratory failure need more carefully treated. The morbidity of these patients would be reduced through improving perioperative management, shortening cardiopulmonary bypass time and reducing postoperative complications.
Objective To explore the predictive value of serum procalcitonin (PCT), D-dimer (D-D) and decoy receptor 3 (DcR3) for prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure undergoing non-invasive ventilation (NIV). Methods A total of 95 patients with AECOPD and respiratory failure undergoing basic treatment and NIV in the hospital were retrospectively enrolled between September (n=65) 2017 and February 2021. According to prognosis after treatment, they were divided into a good prognosis group and a poor prognosis group (n=30). The general data of all patients were collected. The influencing factors of prognosis were analyzed by multivariate logistic regression model. The levels of DcR3, PCT and D-D were detected by enzyme-linked immunosorbent assay, colloidal gold colorimetry and immunoturbidimetry. The patients condition was assessed by scores of acute physiology chronic health evaluation scoring system Ⅱ (APACHEⅡ). The partial pressure of arterial oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were recorded. And the above indexes between the two groups were compared. The relationship between DcR3, PCT, D-D and APACHEⅡ score, PaO2, PaCO2 was analyzed by Pearson correlation analysis. The prognostic value of DcR3, PCT and D-D was analyzed by receiver operating characteristic (ROC) curve. Results There was no significant difference in gender, GOLD grading or underlying diseases between the poor prognosis group and the good prognosis group (P>0.05), but there were significant differences in age, DcR3, PCT, D-D, APACHEⅡ score, PaO2 and PaCO2 after treatment (P<0.05). DcR3, PCT, D-D, APACHEⅡ score and PaCO2 in the poor prognosis group were higher than those in the good prognosis group, while PaO2 was lower than that in the good prognosis group (P<0.05). Logistic regression analysis showed that DcR3 ≥5.50 ng/mL (OR=21.889), PCT ≥ 5.00 μg/L (OR=3.782), D-D ≥3.00 μg/L (OR=4.162) and APACHEⅡ score ≥20 points (OR=2.540) were all influencing factors of prognosis (P<0.05). The results of Pearson correlation analysis showed that DcR3, PCT and D-D were positively correlated with APACHEⅡ score and PaCO2, while negatively correlated with PaO2 (P<0.05). The results of ROC curve analysis showed that area under ROC curve of DcR3, PCT and D-D for predicting the prognosis were 0.745 (95%CI 0.631 - 0.859), 0.691 (95%CI 0.579 - 0.803) and 0.796 (95%CI 0.696 - 0.895), respectively (P<0.05). Conclusion The serum DcR3, PCT and D-D levels are related to disease progression in patients with AECOPD and respiratory failure after NIV, which have good predictive efficiency for prognosis and can be applied as important biological indexes to evaluate prognosis and guide treatment.
Objective To investigate the effectiveness of noninvasive positive pressure ventilation( NPPV) in acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) complicated with severe type Ⅱ respiratory failure.Methods 37 patients who were admitted fromJanuary 2008 to June 2009 due to AECOPD complicated with severe type Ⅱ respiratory failure and had received NPPV therapy were enrolled as a NPPV group. Another similar 42 cases who had not received NPPV therapy served as control. All subjects received standard medication therapy according to the guideline. Arterial blood gases before and after treatment, the duration of hospitalization and intubation rate were observed. Results The arterial pH, PaO2 ,and PaCO2 improved significantly after treatment as compared with baseline in both groups ( P lt; 0. 05) .Compared with the control group, the average duration of hospitalization was significantly shorter ( 10 ±5 vs.19 ±4 days, P lt;0. 05) and the intubation rate was significantly lower ( 2. 7% vs. 16. 7% , P lt;0. 05) in the NPPV group. Conclusion The use of NPPV in AECOPD patients complicated with severe type Ⅱ respiratory failure is effective in improving arterial blood gases, reducing the duration of hospitalization and intubation rate.
Objectives To assess the prognostic value of blood sugar level for acute respiratory failure patients undergoing mechanical ventilation. Methods The study collected 139 acute respiratory failure patients undergoing mechanical ventilation admitted between February 2012 and October 2013. The patients were divided into a hyperglycemic group (n=123, blood sugar ≥143 mg/dl) and a non-hyperglycemic group (n=16, blood sugar <143 mg/dl). The data for basic clinical pathological characteristics and the blood sugar levels were collected, and the correlation between the blood sugar level and the prognosis was assessed using single factor analysis and logistic regression method. Results In the study, 88.49% of patients with acute respiratory failure undergoing mechanical ventilation had hyperglycemia (blood sugar ≥143 mg/dl). The proportions of patients with APACHEⅡ score ≥10, chronic obstructive pulmonary disease (COPD) or hypoxemia in the hyperglycemic group were significantly higher than those in the non-hyperglycemic group (P<0.05). APACHEⅡ ≥10, COPD and hypoxemia were significant risk factors for hyperglycemia. At the same time, the proportions of patients in the death group with hyperglycemia ≥143 mg/dl ( OR=8.354, 95%CI 1.067-65.388, P=0.018), APACHEⅡ≥10 ( OR=2.545, 95%CI 1.109-6.356, P=0.046), COPD ( OR=2.871, 95%CI 1.203-6.852, P=0.015), and hypoxemia ( OR=3.500, 95%CI 1.556-7.874, P=0.002) were significantly higher than those in the survival group. Kaplan-Meier curve analysis found that the overall survival of the hyperglycemic patients with acute respiratory failure was significantly lower than that in the non-hyperglycemic patients (P<0.001). Conclusion Blood sugar level can be used as an independent predictor for acute respiratory failure patients undergoing mechanical ventilation.