AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric i...AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortality Ⅲ(PRIsM-Ⅲ) scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV) were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%) failed treatment and required MV.The majority of the patients(74%) had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P = 0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲ scores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P < 0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.展开更多
目的探讨适应性支持通气(adaptive support ventilation,ASV)在老年急性呼吸窘迫综合征病人中的临床应用价值。方法入组2013年1月至2016年6月入住江苏省省级机关医院重症监护病房的年龄≥65岁的急性呼吸窘迫综合征行有创机械通气的病人3...目的探讨适应性支持通气(adaptive support ventilation,ASV)在老年急性呼吸窘迫综合征病人中的临床应用价值。方法入组2013年1月至2016年6月入住江苏省省级机关医院重症监护病房的年龄≥65岁的急性呼吸窘迫综合征行有创机械通气的病人32例,将ASV模式与同步间歇指令通气模式(SIMV)进行前后自身比较,探讨ASV模式对呼吸力学、血流动力学、血气指标及舒适度的影响。结果两种模式下病人动脉血氧合指数、二氧化碳分压、乳酸水平比较差异无统计学意义(P>0.05),分钟通气量、胸肺动态顺应性、潮气量差异亦无统计学意义(P>0.05),但在ASV模式下病人气道峰压、平均气道压力、吸气阻力及呼吸频率明显低于SIMV模式(P<0.05),重症监护室疼痛观察工具法(CPOT)评分、躁动镇静评估表(RASS)评分、丙泊酚使用剂量亦降低(P<0.05),ASV通气模式下地佐辛及咪达唑仑使用剂量较SIMV模式有下降趋势,但差异无统计学意义(P>0.05)。结论 ASV模式可改善老年急性呼吸窘迫综合征病人呼吸力学指标,增加舒适度,安全有效。展开更多
目的评价适应性支持通气(ASV)模式加肺复张策略(LRM)在急性呼吸窘迫综合征(ARDS)患者中的效果。方法收集创伤后合并ARDS的患者28例,先采用间歇正压通气(IPPV)模式维持8 h后,随机选择ASV或继续IPPV机械通气。选择ASV通气模式时,其分钟通...目的评价适应性支持通气(ASV)模式加肺复张策略(LRM)在急性呼吸窘迫综合征(ARDS)患者中的效果。方法收集创伤后合并ARDS的患者28例,先采用间歇正压通气(IPPV)模式维持8 h后,随机选择ASV或继续IPPV机械通气。选择ASV通气模式时,其分钟通气量设置应与IPPV时相同。通气时,两种模式下的呼气末正压(PEEP)均按0、5、10cmH2O依次增加,每一PEEP的通气时间为60 m in。ASV通气模式时,在每一PEEP水平加用LRM(ASV+LRM模式)。前一通气模式使用3h后,将通气模式调为IPPV,PEEP调到0;1h后换另一种模式。每个PEEP水平通气50 m in时,用Swan-Ganz导管、心电监测仪、呼吸机监测记录患者的血流动力学、呼吸力学和氧代谢指标。结果在同一PEEP水平下,ASV+LRM模式与IPPV模式相比较,血流动力学参数差异无统计学意义(P>0.05);但在ASV+LRM模式时,同一PEEP水平下气道峰值压(PIP)降低,差异有统计学意义(P<0.05);当PEEP为5cmH2O时,肺动态顺应性、动脉氧分压和氧供均增加,差异也有统计学意义(P<0.05)。结论 ASV+LRM模式比IPPV模式更有利于ARDS患者的通气治疗。展开更多
基金supported by NIH National Center for Advancing Translational Science,No.UL1TR001881
文摘AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortality Ⅲ(PRIsM-Ⅲ) scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV) were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%) failed treatment and required MV.The majority of the patients(74%) had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P = 0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲ scores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P < 0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.
文摘目的探讨适应性支持通气(adaptive support ventilation,ASV)在老年急性呼吸窘迫综合征病人中的临床应用价值。方法入组2013年1月至2016年6月入住江苏省省级机关医院重症监护病房的年龄≥65岁的急性呼吸窘迫综合征行有创机械通气的病人32例,将ASV模式与同步间歇指令通气模式(SIMV)进行前后自身比较,探讨ASV模式对呼吸力学、血流动力学、血气指标及舒适度的影响。结果两种模式下病人动脉血氧合指数、二氧化碳分压、乳酸水平比较差异无统计学意义(P>0.05),分钟通气量、胸肺动态顺应性、潮气量差异亦无统计学意义(P>0.05),但在ASV模式下病人气道峰压、平均气道压力、吸气阻力及呼吸频率明显低于SIMV模式(P<0.05),重症监护室疼痛观察工具法(CPOT)评分、躁动镇静评估表(RASS)评分、丙泊酚使用剂量亦降低(P<0.05),ASV通气模式下地佐辛及咪达唑仑使用剂量较SIMV模式有下降趋势,但差异无统计学意义(P>0.05)。结论 ASV模式可改善老年急性呼吸窘迫综合征病人呼吸力学指标,增加舒适度,安全有效。
文摘目的评价适应性支持通气(ASV)模式加肺复张策略(LRM)在急性呼吸窘迫综合征(ARDS)患者中的效果。方法收集创伤后合并ARDS的患者28例,先采用间歇正压通气(IPPV)模式维持8 h后,随机选择ASV或继续IPPV机械通气。选择ASV通气模式时,其分钟通气量设置应与IPPV时相同。通气时,两种模式下的呼气末正压(PEEP)均按0、5、10cmH2O依次增加,每一PEEP的通气时间为60 m in。ASV通气模式时,在每一PEEP水平加用LRM(ASV+LRM模式)。前一通气模式使用3h后,将通气模式调为IPPV,PEEP调到0;1h后换另一种模式。每个PEEP水平通气50 m in时,用Swan-Ganz导管、心电监测仪、呼吸机监测记录患者的血流动力学、呼吸力学和氧代谢指标。结果在同一PEEP水平下,ASV+LRM模式与IPPV模式相比较,血流动力学参数差异无统计学意义(P>0.05);但在ASV+LRM模式时,同一PEEP水平下气道峰值压(PIP)降低,差异有统计学意义(P<0.05);当PEEP为5cmH2O时,肺动态顺应性、动脉氧分压和氧供均增加,差异也有统计学意义(P<0.05)。结论 ASV+LRM模式比IPPV模式更有利于ARDS患者的通气治疗。
