Objective To investigate the effects of mask BiPAP noninvasive positive ventilation (NIPPV) during treadmill exercise on dyspnea index and exercise endurance in stable patients with severe chronic obstructive pulmonary disease (COPD). Methods Twenty inpatients with stable severe COPD between August 2015 and January 2016 were recruited in the study. The following parameters were measured before and after 8-week rehabilitation by NIPPV during treadmill exercises, including 12-minute walking distance (12MWD), Borg dyspnea score, mean pulmonary arterial pressure (mPAP), PaO 2 and PaCO 2, times of acute exacerbation in 1 year, adverse reactions, and adherence. Results After rehabilitation for 8 weeks, the following parameters were improved than those before treatment including 12MWD [(810±20) mvs. (680±15) m,P<0.01], Borg dyspnea score (2.4±0.1vs. 4.4±0.3,P<0.01), mPAP [(34.4±2.7) mm Hgvs. (43.5±3.8) mm Hg], PaCO 2 [(49.8±4.9) mm Hgvs. (64.3±5.2) mm Hg], PaO 2 [(64.4±4.1) mm Hgvs. (52.3±3.9) mm Hg] and the times of acute exacerbation (2.1±0.7vs. 4.3±2.1,P<0.01). Adverse reactions included oropharyngeal drying (2 cases) and gaseous distention (8 cases) which can be tolerated without special treatment. Conclusion Mask NIPPV during treadmill exercise is safe and effective for stable patients with severe COPD and worthy of clinical application.
ObjectiveTo investigate the value of noninvasive positive pressure ventilation in patients with high risk of weaning induced pulmonary oedema.MethodsFrom June 2018 to June 2019, 63 patients with mechanical ventilation in the Department of Critical Care Medicine of the First Hospital of Lanzhou University were enrolled. Randomized digital table method was randomly divided into two groups and the resulting random number assignment was hidden in opaque envelopes, the experimental group received non-invasive positive pressure ventilation (n=32), and the control group received mask oxygen therapy ventilation (n=31). The heart rate, respiratory rate, means arterial pressure, hypoxemia, reintubation, blood gas analysis and other indicators were compared between the two groups after 2 hours of weaning. The length of hospital stay, mortality and complications were compared between the two groups.ResultsAfter 2 hours of weaning, the heart rate and respiratory rate were significantly lower in the non-invasive positive pressure ventilation group than in the mask group (P<0.05). There was no difference in mean arterial pressure between the two groups of patients, which was not statistically significant (P>0.05). The incidence of hypoxemia, laryngeal edema and reintubation in the noninvasive positive pressure ventilation group was significantly lower than that in the mask group, which was statistically significant (P<0.05), and the blood gas analysis index was better than the mask group (P<0.05). The non-invasive positive pressure ventilation group was significantly shorter than the mask group in the length of hospital stay and intensive care unit (P<0.05). The hospital mortality rate in 28 days was lower than that in the mask group (P<0.05), but there was no difference in tracheotomy, pneumothorax and subcutaneous emphysema between the two groups (P>0.05).ConclusionsNoninvasive positive pressure ventilation can effectively prevent hypoxemia, laryngeal edema, and re-intubation in patients at high risk of withdrawal related pulmonary edema. It can also shorten the length of hospital stay, which is worth clinical attention and promotion.
ObjectiveTo explore the effect of goal directed analgesia on patients with noninvasive positive pressure ventilation (NPPV) in the intensive care unit (ICU).MethodsThis was a retrospective study. Two hundred sixty-four patients requiring non-invasive positive pressure ventilation were enrolled in the ICU of this hospital, including 118 patients in the empirical analgesia group and 146 in the goal directed analgesia group. The empirical analgesia group was treated with remifentanil to analgesia and propofol, midazolam or dexmedetomidine to sedation. The sedative depth maintained <1 measured by the score of the Richmond restless sedative scale (RASS). The same analgesic and sedative drug were first used in the goal directed analgesia group to maintain the Critical Care Pain Observation Tool score <2, and the RASS score <1 was maintained after the analgesia depth were achieved. Whether the patients occurred delirium was assessed by the Confusion Assessment Method for the ICU. The dosage of analgesic and sedative drugs, the dependability (based on the total ventilation time in the first 24 hours after ventilation), the incidence of delirium, the rate of invasive ventilation, the total time of NPPV and the length of stay of ICU were observed in the two groups.ResultsThere were no significant differences in age, sex, APACHEⅡ score, mean arterial pressure, heart rate, respiratory rate, SpO2, arterial blood gas and the reason of NPPV between the two groups. The dosage of analgesic and sedative drugs in the goal directed analgesia group were less than the empirical analgesia group, and the dependability was higher than that of the empirical analgesia group ［(12.6±5.8)h vs. (10.9±4.8)h, P<0.05), and the incidence of delirium and the rate of invasive ventilation were also lower than those of the empirical analgesia group (15.8% vs. 25.4%, P<0.05; 32.9% vs. 44.9%, P<0.05). The total time of NPPV in the goal directed analgesia group was shorter than that of the empirical analgesia group ［(28.6±8.8)h vs. (37.3±10.7)h, P<0.05), but there was no significant difference in the length of stay in ICU.ConclusionGoal directed analgesia can improve the dependability of NPPV patients, reduce the use of sedative drugs, and decrease the incidence of delirium and rate of invasive ventilation.
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.
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.
Objective To investigate the feasibility of dexmedetomidine hydrochloride in sedation practices during NPPV for patients with acute exacerbation of COPD ( AECOPD) and respiratory failure. Methods 50 patients with AECOPD and respiratory failure, admitted in ICU between January 2011 and April 2012, were divide into an observation group and a control group. All patients received conventional treatment and noninvasive positive pressure ventilation ( NPPV) . Meanwhile in the observation group, dexmedetomidine hydrochloride ( 1 μg/kg) was intravenously injected within 10 minutes, then maintained using a micropump by 0.1 ～0. 6 μg·kg- 1 ·h- 1 to maintaining Ramsay Sedation Scale ( RSS) score ranged from 2 to 4. The patients’compliance to NPPV treatment ( conversion rate to invasive ventilation) and ICU stay were compared between two groups. Heart rate,mean arterial pressure, respiratory rate, and arterial blood gas ( pH, PaO2 , PaCO2 ) before and 24 hours after treatment were also compared. Results After 24 hours treatment, heart rate, mean arterial pressure, respiratory rate, and arterial blood gas were all improved in two groups, while the improvements were more remarkable in the observation group. The conversion rate to invasive ventilation ( 4% vs. 16% ) and ICUstay [ ( 5.47 ±3.19) d vs. ( 8.78 ±3.45) d] were lower in the observation group than those in the control group. ( P lt;0.05) . Conclusion Dexmedetomidine hydrochloride may serve as a safe and effective sedative drug during NPPV in patients with AECOPD and respiratory failure.
Objective To study the effect of noninvasive positive pressure ventilation (NPPV) in chronic obstructive pulmonary disease (COPD) patients with hypercapnic coma secondary to respiratory failure.Methods COPD patients with or without coma secondary to respiratory failure were both treated by bi-level positive airway pressure (BiPAP) ventilation on base of routine therapy.There were 32 cases in coma group and 42 cases in non-coma group.Such parameters as arterial blood gas (ABG)，Glasgow coma scale (GCS)，time of NPPV therapy，achievement ratio，and adverse effects were investigated.Results 30 patients in the coma group were improved after NPPV treatment (26 cases recovered consciousness treated by BiPAP in 2 hours，3 cases recovered between 3~8 hours，1 case recovered after 24 hours).The parameters of ABG，the tidal volume and the minute ventilation volume were improved after BiPAP.The time of effective therapy was (9±4) days in the coma group and (7±3) days in the non-coma group with no significant difference (Pgt;0.05).The achievement ratio was similar in two groups (93.75% vs 97.62%，Pgt;0.05).But the incidence of gastrointestinal tympanites reached to a higher level in the coma group (80.5%) than the non-coma group (10.6%).Conclusion COPD patients with hypercapnic coma secondary to respiratory failure isn’t the absolute contraindication of NPPV treatment.
Objective To systematically evaluate the efficacy of home noninvasive positive pressure ventilation (HNPPV) on patients with severe stable chronic obstructive pulmonary disease in China. Methods Systematic literature search was performed in Chinese BioMedical Literature Database, WanFang Data, VIP Database, Chinese National knowledge Infrastructure databases from inception to January 2018. All randomized controlled trials (RCTs) that reported comparison of the efficacy of HNPPV on patients with severe stable chronic obstructive pulmonary disease were included. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. Results A total of 767 patients from 14 studies were included in this meta-analysis. The combined results showed that, compared with the control group, HNPPV could significantly reduce the mortality (relative risk 0.51, 95%CI 0.33 – 0.78, P=0.002) and PaCO2 ［weighted mean difference (MD) –10.78, 95%CI –13.17 – –8.39, P<0.000 01］ of patients, improve the levels of PaO2 (MD 7.84, 95%CI 5.81 – 9.87, P<0.000 01), FEV1 (MD 0.13, 95%CI 0.08 – 0.18, P<0.000 01), and the quality of life (MD –6.27, 95% CI –9.04 – –3.51, P<0.000 01). Conclusion HNPPV can reduce the mortality of patients, improve the gas exchange, pulmonary function and the quality of life, but more large sample, high-quality, and multicenter RCT studies are needed.
Objective The risk factors of noninvasive positive pressure ventilation (NPPV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with failure of respiratory failure were identified by meta-analysis, so as to provide a basis for early clinical prevention and treatment failure and early intervention. Methods PubMed, The Cochrane Library, EMbase, China National Knowledge Infrastructure, Wanfang, VIP and CBM Data were searched to collect studies about risk factors about failure of noninvasive positive pressure ventilation in AECOPD and respiratory failure published from January 2000 to January 2021. Two researchers independently conducted literature screening, literature data extraction and quality assessment. Meta-analysis was performed on the final literature obtained using RevMan 5.3 software. Results Totally 19 studies involving 3418 patients were recruited. The statistically significant risk factors included Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score, pre-treatment PCO2, pre-treatment pH, Glasgow Coma Scale (GCS), respiratory rate (RR) before treatment, body mass index (BMI), age, C-reactive protein (CRP), renal insufficiency, sputum disturbance, aspiration of vomit. Conclusions High APACHE-Ⅱ score, high PCO2 before treatment, low pH value before treatment, low GCS score, high RR before treatment, low BMI, advanced age, low albumin, high CRP, renal insufficiency, sputum disturbance, and vomit aspiration were the risk factors for failure of respiratory failure in patients with COPD treated by NIPPV. Failure of non-invasive positive pressure ventilation in COPD patients with respiratory failure is affected by a variety of risk factors, and early identification and control of risk factors is particularly important to reduce the rate of treatment failure.
Objective To investigate the effects of noninvasive positive pressure ventilation (NPPV) on patients with acute left heart failure. Methods Twenty patients with acute left heart failure diagnosed between September 2013 and July 2014 were randomized into treatment group (n=10) and control group (n=10). Both groups used conventional sedations, diuretics and drugs that strengthened the heart and dilated the vessels, while early use of NPPV was applied in the experimental group. Arterial blood gas analysis [pH value, pressure of arterial carbon dioxide (PaCO2), and pressure of arterial oxygen (PaO2)], heart rate (HR), respiration, duration of Intensive Care Unit (ICU) stay and invasive mechanical ventilation, duration of overall mechanical ventilation, and success case numbers before and two hours after treatment were observed and analyzed. Results For the control group, two hours after treatment, PaO2 was (67.0±8.5) mm Hg (1 mm Hg=0.133 kPa), HR was (124±10) times/min, Respiration was (34±4) times/min, the duration of ICU stay was (6.0±1.1) days, invasive ventilation was for (32.0±3.1) hours, and the total time of mechanical ventilation was (32.0±3.1) hours. Those indexes for the treatment group two hours after treatment were: PaO2, (82.3±8.9) mm Hg; HR, (98±11) times/min; respiration, (24±4) times/min; the duration of ICU stay, (4.0±0.8) days; invasive ventilation time, (16.0±1.3) hours; the total time of mechanical ventilation, (26.0±1.8) hours. All the differences for each index between the two groups were statistically significant (P < 0.05). Conclusion Early application of NPPV can rapidly relieve clinical symptoms and reduce the medical cost for patients with acute left heart failure.