Sleep Quality for Patients Receiving Noninvasive Positive Pressure Ventilation and Nasal High-Flow Oxygen Therapy in an ICU: Two Case Studies

Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.

Effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with COPD and type II respiratory failure

Objective:T o analyze the effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with chronic obstructive pulmonary disease (COPD) and type II respiratory failure. Methods:90 patients with COPD and type II respiratory failure were randomly divided into observation group and control group (n=45). Control group received conventional therapy, observation group received conventional therapy+adjuvant noninvasive positive pressure ventilation, and differences in blood gas parameters, cardiac function, inflammatory state, etc., were compared between two groups of patients 2 weeks after treatment. Results:Arterial blood gas parameters pH and alveolar-arterial partial pressure of oxygen [P(A-a)O2] levels of observation group were higher than those of control group while, potassium ion (K+), chloride ion (Cl-) and carbon dioxide combining power (CO2CP) levels were lower than those of control group 2 weeks after treatment;echocardiography parameters Doppler-derived tricuspid lateral annular systolic velocity (DTIS) and pulmonary arterial velocity (PAV) levels were lower than those of control group (P<0.05) while pulmonary artery accelerating time (PAACT), left ventricular end-diastolic dimension (LVDd) and right atrioventricular tricuspid annular plane systolic excursion (TAPSE) levels were higher than those of control group (P<0.05);serum cardiac function indexes adiponectin (APN), Copeptin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), cystatin C (CysC), growth differentiation factor-15 (GDF-15) and heart type fatty acid binding protein (H-FABP) content were lower than those of control group (P<0.05);serum inflammatory factors hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), IL-8, IL-10, and transforming growth factor-β1 (TGF-β1) content were lower than those of control group (P<0.05). Conclusions:Adjuvant noninvasive positive pressure ventilation can optimize the blood gas parameters, cardiac function and inflammatory state in patients with COPD and type II respiratory failure, and it is of positive significance in improving the overall treatment outcome.

Impact of noninvasive positive pressure ventilation on the gene expression of ubiquitin system of skeletal muscle in patients with acute exacerbation of chronic obstructive pulmonary disease

Objective:To investigate the change and relativity of noninvasive positive pressure ventilation(NIPPV)on the gene expression of ubiquitin system of skeletal muscle in patient with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:80 patients with AECOPD were divided into two groups based on whether the NIPPV treatment was given or not,38 cases in the study group and 42 in the control group.The blood gas analysis and pulmonary function were monitored and recorded before and 14 days after treatment.A skeletal muscle biopsy was performed 14 days after therapy.The mRNA expression of ribosomal protein S21(RPS21)and ubiquitin in skeletal muscle cell were measured by RT-PCR.Results:After 14 days treatment,the levels of PaCO_(2),PaO_(2),PH and FEV_(1)% in the NIPPV group improved much better than in the control group(p<.05).The gene expression of RPS21 and ubiquitin was obviously lower in the study group than in the control group(p<.05).The level of RPS21 was negatively related with PaO_(2),PH and FEV1%,and the level of ubiquitin was negatively related with PaO_(2) and FEV1%,but positively correlated with PaCO_(2).The area under the ROC curves of RPS21,ubiquitin,PaCO_(2) and FEV_(1)% were 0.771,0.885,0.821 and 0.734 respectively in the study group.The cut-off points were 103.978,8.128,45.350 and 51.350 respectively.The sensitivity evaluation of acid poisoning was 90.9%,and the specificities for each were 75%,75%,50% and 50%.Conclusions:NIPPV is effective for AECOPD patients through the gene expression of ubiquitin system of skeletal muscle.

Noninvasive Ventilation Interfaces in the Treatment of Acute Respiratory Insufficiency: A Critical Review

Background: Noninvasive ventilation (NIV) is an important therapeutic modality for the treatment of acute respiratory failure (ARF). In this review, we critically analyze randomized controlled trials on the most used NIV interfaces in the treatments of ARF. Methods: The searches were conducted in the Medline, Lilacs, PubMed, Cochrane, and Pedro databases from June to November 2021. The inclusion criteria were Randomized clinical trials (RCTs) published from 2016 to 2021 in Portuguese, Spanish, or English and involving adults (aged ≥ 18 years). The eligibility criteria for article selection were based on the PICO strategy: Population—Adults with ARF;Intervention—NIV Therapy;Comparison—Conventional oxygen therapy, high-flow nasal cannula (HFNC) oxygen therapy, or NIV;Outcome—improvement in ARF. The search for articles and the implementation of the inclusion criteria were independently conducted by two researchers. Results: Seven scientific articles involving 574 adults with ARF due to various causes, such as chest trauma, decompensated heart failure, coronavirus disease 2019 (COVID-19), and postoperative period, among others, were included. The interfaces cited in the studies included an oronasal mask, nasal mask, full-face mask, and helmet. In addition, some favorable outcomes related to NIV were reported in the studies, such as a reduction in the rate of orotracheal intubation and shorter length of stay in the ICU. Conclusions: The most cited interfaces in the treatment of ARF were the oronasal mask and the helmet.

Bi-level Nasal Positive Airway Pressure(BiPAP)versus Nasal Continuous Positive Airway Pressure(CPAP)for Preterm Infants with Birth Weight Less Than 1500g and Respiratory Distress Syndrome Following INSURE Treatment:A Two-center Randomized Controlled Trial

The present study aimed to examine the effectiveness of bi-level positive airway pressure(BiPAP)versus continuous positive airway pressure(CPAP)in preterm infants with birth weight less than 1500 g and respiratory distress syndrome(RDS)following intubation-surfactant-extubation(INSURE)treatment.A two-center randomized control trial was performed.The primary outcome was the reintubation rate of infants within 72 h of age after INSURE.Secondary outcomes included bronchopulmonary dysplasia(BPD),necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP)and incidences of adverse events.Lung function at one year of corrected age was also compared between the two groups.There were 140 cases in the CPAP group and 144 in the BiPAP group.After INSURE,the reintubation rates of infants within 72 h of age were 15%and 11.1%in the CPAP group and the BiPAP group,respectively(P>0.05).Neonates in the BiPAP group was on positive airway pressure(PAP)therapy three days less than in the CPAP group(12.6 d and 15.3 d,respectively,P<0.05),and on oxygen six days less than in the CPAP group(20.6 d and 26.9 d,respectively,P<0.05).Other outcomes such as BPD,NEC,ROP and feeding intolerance were not significantly different between the two groups(P>0.05).There was no difference in lung function at one year of age between the two groups(P>0.05).In conclusion,after INSURE,the reintubation rate of infants within 72 h of age was comparable between the BiPAP group and the CPAP group.BiPAP was superior to CPAP in terms of shorter durations(days)on PAP support and oxygen supplementation.There were no differences in the incidences of BPD and ROP,and lung function at one year of age between the two ventilation methods.

Effectiveness and safety of noninvasive positive-pressure ventilation for severe hypercapnic encephalopathy due to acute exacerbation of chronic obstructive pulmonary disease:a prospective case-control study

Background Although severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation （NPPV）, increasing clinical reports showed it was effective in patients with impaired consciousness and even coma secondary to acute respiratory failure, especially hypercapnic acute respiratory failure （HARF）. To further evaluate the effectiveness and safety of NPPV for severe hypercapnic encephalopathy, a prospective case-control study was conducted at a university respiratory intensive care unit （RICU） in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） during the past 3 years. Methods Forty-three of 68 consecutive AECOPD patients requiring ventilatory support for HARF were divided into 2 groups, which were carefully matched for age, sex, COPD course, tobacco use and previous hospitalization history, according to the severity of encephalopathy, 22 patients with Glasgow coma scale （GCS） 〈10 served as group A and 21 with GCS 〉10 as group B. Results Compared with group B, group A had a higher level of baseline arterial partial CO2 pressure （（102±27） mmHg vs （74±17） mmHg, P〈0.01）, lower levels of GCS （7.5±1.9 vs 12.2±1.8, P〈0.01）, arterial pH value （7.18±0.06 vs 7.28±0.07, P〈0.01） and partial 02 pressure/fraction of inspired 02 ratio （168±39 vs 189±33, P〈0.05）. The NPPV success rate and hospital mortality were 73% （16/22） and 14% （3/22） respectively in group A, which were comparable to those in group B （68% （15/21） and 14% （3/21） respectively, all P〉0.05）, but group A needed an average of 7 cmH20 higher of maximal pressure support during NPPV, and 4, 4 and 7 days longer of NPPV time, RICU stay and hospital stay respectively than group B （P〈0.05 or P〈0.01）. NPPV therapy failed in 12 patients （6 in each group） because of excessive airway secretions （7 patients）, hemodynamic instability （2）, worsening of dyspnea and deterioration of gas exchange （2）, and gastric content aspiration （1）. Conclusions Selected patients with severe hypercapnic encephalopathy secondary to HARF can be treated as effectively and safely with NPPV as awake patients with HARF due to AECOPD; a trial of NPPV should be instituted to reduce the need of endotracheal intubation in patients with severe hypercapnic encephalopathy who are otherwise good candidates for NPPV due to AECOPD.

Effect of noninvasive, positive pressure ventilation on patients with severe, stable chronic obstructive pulmonary disease： a meta-analysis

Background This meta-analysis evaluated the effect of noninvasive, positive pressure ventilation on severe, stable chronic obstructive pulmonary disease （COPD）. Methods PUBMED, CNKI, Wanfang, EMBASE and the Cochrane trials databases were searched. Randomized controlled trials of patients with severe, stable COPD and receiving noninvasive positive pressure ventilation, compared with sham ventilation or no ventilation, were reviewed. The mortality, physiological and health related parameters were pooled to yield odds ratio （OR）, weighted mean differences or standardized mean differences （SMD）, with 95% confidence interval （CI）. Results Eight parallel and three crossover randomized controlled trials met the inclusion criteria. Pooled analysis for parallel, randomized controlled trials showed noninvasive positive pressure ventilation： （1） Did not affect the 12- or 24-month mortality （OR 0.82, 95% Ch 0.48 to 1.41）; （2） Improved the arterial carbon dioxide tension （SMD -0.88, 95% Ch -1.43 to -0.34）; （3） Did not improve forced expiratory volume in one second （SMD 0.20, 95% CI： -0.06 to 0.46）, maximal inspiratory pressure （SMD 0.01, 95% Ch -0.28 to 0.29） or 6-minute walk distance （SMD 0.17, 95% Ch -0.16 to 0.50）; （4） Subgroup analysis showed noninvasive positive pressure ventilation improved the arterial carbon dioxide tension in hypercapnic patients. Pooled analysis for crossover randomized controlled trials did not show improvement in arterial blood gas or forced expiratory volume in one second with noninvasive positive pressure ventilation. Conclusions Noninvasive positive pressure ventilation improves the arterial carbon dioxide tension but does not improve the mortality, pulmonary function, or exercise tolerance and should be cautiously used in severe stable chronic obstructive pulmonary disease.

Effect of noninvasive positive pressure ventilation on weaning success in patients receiving invasive mechanical ventilation： a meta-analysis

Background Noninvasive positive pressure ventilation （NIPPV） has been proposed to shorten the duration of mechanical ventilation in intubated patients, especially those who fail initial weaning from invasive mechanical ventilation （IMV）. However, there are also some discrepancies in terms of weaning success or failure, incidence of re-intubation, complications observed during study and patient outcomes. The primary objective of this update was to specifically investigate the role of NIPPV on facilitating weaning and avoiding re-intubation in patients intubated for different etiologies of acute respiratory failure, by comparing with conventional invasive weaning approach. Methods We searched randomized controlled trials （RCTs） comparing noninvasive weaning of early extubation and immediate application of NIPPV with invasive weaning in intubated patients from PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Knowledge and Springerlink databases. Records from conference proceedings and reference lists of relevant studies were also identified. Results A total of 11 RCTs with 623 patients were available for the present analysis. Compared with IMV, NIPPV significantly increased weaning success rates （odds ratio （OR）： 2.50, 95% confidence interval （C/）： 1.46-4.30, P=0.0009）, decreased mortality （OR： 0.39, 95% CI： 0.20-0.75, P=0.005）, and reduced the incidence of ventilator associated pneumonia （VAP） （OR： 0.17, 95% CI： 0.08-0.37, P 〈0.00001） and complications （OR： 0.22, 95% CI： 0.07-0.72, P=0.01）. However, effect of NIPPV on re-intubation did not reach statistical difference （OR： 0.61, 95% CI： 0.33-1.11, P=0.11）. Conclusions Early extubation and immediate application of NIPPV is superior to conventional invasive weaning approach in increasing weaning success rates, decreasing the risk of mortality and reducing the incidence of VAP and complications, in patients who need weaning from IMV. However, it should be applied with caution, as there is insufficient beneficial evidence to definitely recommend it in terms of avoidinQ re-intubation.

Efficacy and safety of noninvasive positive pressure ventilation in the treatment of acute respiratory failure after cardiac surgery

Background Although noninvasive positive pressure ventilation （NPPV） has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respiratory failure after cardiac surgery.Therefore,we conducted a prospective randomized control study in a university surgical intensive care unit to evaluate the efficacy and safety of NPPV in the treatment of acute respiratory failure after cardiac surgery,and explore the predicting factors of NPPV failure.Methods From September 2011 to November 2012 patients with acute respiratory failure after cardiac surgery who had indication for the use of NPPV were randomly divided into a NPPV treatment group （NPPV group） and the conventional treatment group （control group）.The between-group differences in the patients＇ baseline characteristics,re-intubation rate,tracheotomy rate,ventilator associated pneumonia （VAP） incidence,in-hospital mortality,mechanical ventilation time after enrollment （MV time）,intensive care unit （ICU） and postoperative hospital stays were compared.The factors that predict NPPV failure were analyzed.Results During the study period,a total of 139 patients who had acute respiratory failure after cardiac surgery were recorded,and 95 of them met the inclusion criteria,which included 59 males and 36 females with a mean age of （61.5±11.2） years.Forty-three patients underwent coronary artery bypass grafting （CABG）,23 underwent valve surgery,13 underwent CABG＋valve surgery,13 underwent major vascular surgery,and three underwent other surgeries.The NPPV group had 48 patients and the control group had 47 patients.In the NPPV group,the re-intubation rate was 18.8％,tracheotomy rate was 12.5％,VAP incidence was 0,and the in-hospital mortality was 18.8％,significantly lower than in the control group 80.9％,29.8％,17.0％ and 38.3％ respectively,P ＜0.05 or P ＜0.01.The MV time and ICU stay （expressed as the median （P25,P75）） were 18.0 （9.2,35.0） hours and 4.0 （2.0,5.0） days,which were significantly shorter than in the control group,96.0 （26.0,240.0） hours and 6.0 （4.0,9.0） days respectively,P ＜0.05 or P ＜0.01.The postoperative hospital stays of the two groups were similar.The univariate analysis showed that the NPPV success subgroup had more patients with acute lung injury （ALl） （17 vs.0,P=0.038）,fewer patients with pneumonia （2 vs.7,P ＜0.001） and lower acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） scores （16.1±2.8 vs.21.8±3.2,P ＜0.001）.Multivariate analysis showed that pneumonia （P=-0.027） and a high APACHE Ⅱ score ＞20 （P=-0.002） were the independent risk factors of NPPV failure.Conclusions We conclude that NPPV can be applied in selected patients with acute respiratory failure after cardiac surgery to reduce the need of re-intubation and improve clinical outcome as compared with conventional treatment.Pneumonia and a high APACHE Ⅱ score ＞20 might be the independent risk factors of NPPV failure in this group of patients.

Early use of non-invasive positive pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease:a multicentre randomized controlled trial

Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructivepulmonary disease (AECOPD)·In previous clinical studies, non-invasive positive pressure ventilation (NPPV)was proved to be successful only for AECOPD patients with severe respiratory failure·We hypothesized that, theoutcomes of AECOPD would be improved if NPPVis early (within 24 to 48 hours of admission) administered inthose patients with respiratory muscle fatigue and mild respiratory insufficiency, especially in patients withoutfulfilling the conventional criteria of mechanical ventilatory support·Methods Aprospective multicentre randomized controlled trial was conducted in19 hospitals in China over16months·Three hundred and forty-two AECOPD patients with pH≥7·25 and PaCO2>45 mmHg were recruitedon general ward and randomly assigned to standard medical treatment (control group) or early administration ofadditional NPPV (NPPV group)·Results The characteristics of two groups on admission were similar·The number of AECOPD patientsrequiring intubations in NPPV group was much fewer than that of the control group (8/171 vs 26/71,P=0·002)·Subgroup analysis showed the needs for intubation in mildly (pH≥7·35) and severe (pH<7·30)acidotic patients in NPPVgroup were both decreased (9/80 vs2/71,P=0·047 and 8/30 vs3/43,P=0·048,respectively)·The mortality in hospital was reduced slightly by NPPV but with no significant difference (7/171vs 12/171,P=0·345)·Respiratory rate (RR),scale for accessory muscle use and arterial pHimproved rapidlyat the first 2 hours only in patients of NPPV group·After 24 hours, the differences of pH, PaO2, scale foraccessory muscle use and RR in NPPV group [(7·36±0·06) mmHg, (72±22) mmHg, (2·5±0·9) /min,(22±4) /min] were statistically significant compared with control group (7·37±0·05) mmHg, (85±34)mmHg, (2·3±1·1) /min, (21±4) /min,P<0·01 for all comparisons]·Conclusions The early use of NPPV on general ward improves arterial blood gas and respiratory pattern,decreases the rate of need for intubation in AECOPD patients·NPPV is indicative for alleviating respiratorymuscle fatigue and preventing respiratory failure from exacerbation·

Clinical characteristics and outcomes associated with nasal intermittent mandatory ventilation in acute pediatric respiratory failure

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.

HFNC与NIPPV对AECOPD合并Ⅱ型呼吸衰竭患者的临床疗效观察

目的探讨经鼻高流量氧疗(high-flow nasal cannula,HFNC)与无创正压通气(non-invasive positive pressure ventilation,NIPPV)对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭患者的临床疗效。方法选取2021年1月至2023年1月福建医科大学附属泉州第一医院重症医学科AECOPD患者146例,根据治疗方法不同分为NIPPV组(n=47)、HFNC组(n=49)和常规治疗组(n=50)。NIPPV组采用NIPPV治疗,HFNC组采用HFNC治疗,常规治疗组采用常规氧疗和抗感染治疗。比较3组循环指标、血气指标、呼吸支持时间、气道护理次数及舒适(general comfort questionnaire,GCQ)评分。结果146例患者中男76例、女70例,年龄56~77岁,平均(66.2±5.3)岁。与治疗前相比,治疗2 h和治疗24 h时,3组呼吸频率(respiratory rate,RR)和HR较低;治疗6 h和治疗24 h时,HFNC组RR、HR均低于NIPPV组和常规治疗组,差异有统计学意义(P<0.05)。与治疗前相比,治疗7 d后3组PaO_(2)均升高、PaCO_(2)均降低;治疗7 d后,与NIPPV组和常规组相比,HFNC组PaO_(2)较高、PaCO_(2)较低,差异有统计学意义(P<0.05)。3组呼吸支持时间和气道护理次数的差异有统计学意义(P<0.05),其中NIPPV组呼吸支持时间较短,HFNC组气道护理次数较少。结论HFNC可以改善AECOPD合并Ⅱ型呼衰患者的部分循环指标和血气指标,患者舒适度更好,但呼吸支持时间较长。

NIPPV在重症肺炎集束化治疗中的应用

目的分析无创正压通气(NIPPV)在重症肺炎集束化治疗策略中的应用价值。方法对我院29例重症肺炎患者在集束化治疗策略中早期采用双水平气道正压通气治疗,比较治疗前后患者的临床表现,血气指标等变化。结果采用NIPPV治疗的重症肺炎患者临床症状、血气指标明显改善,同治疗前相比有显著差异(P<0.05);死亡率明显降低。结论在重症肺炎集束化治疗策略中早期应用NIPPV治疗,可阻止病情进一步发展,减少有创机械通气的应用,改善预后。

NIPPV联合噻托溴铵吸入治疗慢阻肺合并慢性呼衰的疗效观察

目的观察无创正压通气(non-invasive positive pressure ventilation,NIPPV)联合噻托溴铵吸入治疗慢阻肺合并慢性呼吸衰竭(呼衰)的临床疗效。方法选取2016年1月至2017年12月本院收治的慢阻肺合并慢性呼衰患者80例,随机将其分为研究组与对照组,各40例。对照组单纯予以NIPPV治疗,研究组在此基础上加用噻托溴铵吸入治疗。比较两组治疗前后的动脉血气指标及肺功能指标水平的差异,同时记录两组治疗情况及病死率。结果经治疗后,研究组肺功能指标FEV1、FEV1%、FVC均明显高于对照组(P<0.05);研究组动脉血气指标PaO2、SaO2明显高于对照组,而PaCO2则低于对照组(P<0.05);研究组住院时间、气管插管率及死亡率均优于对照组,差异有统计学意义(P<0.05)。结论NIPPV联合噻托溴铵吸入治疗可有效改善慢阻肺合并慢性呼衰患者肺功能以及动脉血气,具有较好的临床效果,值得临床推荐。

NIPPV治疗AECOPD合并昏迷的严重Ⅱ型呼吸衰竭的临床观察

目的:评价无创正压通气(NIPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并意识障碍的严重Ⅱ型呼吸衰竭(PaC02>80mmHg)的疗效。方法:31例严重Ⅱ型呼吸衰竭、意识丧失的AECOPD患者,在常规治疗基础上给予NIPPV治疗,并动态监测血气、神志等临床征象等情况。结果:NIPPV治疗可迅速改善患者的意识、呼吸困难、心率(HR)、呼吸频率(RR)和血气(pH、PaCO2)(P<0.01),通气24h可获进一步改善(P<0.05),成功率90.32%,气管插管率9.7%,病死率6.5%。结论:NlPPV是救治AECOPD合并意识障碍、严重Ⅱ型呼吸衰竭的有效手段。

NIPPV治疗慢性阻塞性肺疾病合并重度高碳酸血症呼吸衰竭的护理

目的观察分析无创正压通气慢性阻塞性肺疾病急性加重（Noninvasive positive pressure ventilation,NIPPV）治疗慢性阻塞性肺疾病急性加重（Acute Exacerbations of chronic obstructive pulmonary disease,AECOPD）合并重度高碳酸血症呼吸衰竭患者的治疗效果与护理方法。方法观察2012年5月-2013年12月收治的48例次PaCO2〉6.40kPa（80mmHg）的AECOPD合并呼吸衰竭患者,在常规药物治疗及氧疗基础上,应用NIPPV治疗。通过自身对照,观察患者NIPPV治疗前、治疗5-72h和治疗结束后血气指标变化和病情改善程度。结果48例次患者中,46例次IPPV治疗5-72h后,首次血气指标中PCO2和pH下降明显,差异有统计学意义（P〈0.01）;PO2上升,差异无统计学意义;2例次无创通气失败,气管插管行有创机械通气,38例次氧疗结束后的血气指标与治疗前比较,差异有统计学意义（P〈0.01）,病情稳定后出院。结论 NIPPV治疗能有效改善COPD合并重度高碳酸血症呼吸衰竭患者的通气功能,但对氧合的改善早期不明显。

NIPPV联合FB检查治疗AECOPD合并Ⅱ型呼吸衰竭患者疗效观察

目的观察无创正压通气(NIPPV)联合纤维支气管镜(FB)检查治疗急性加重期慢性阻塞性肺疾病患者(AECOPD)合并Ⅱ型呼吸衰竭的效果。方法以2014年3月至2015年3月在我院治疗的80例AECOPD合并Ⅱ型呼吸衰竭患者为观察对象。根据随机数表法将其分为对照组和观察组,每组各40例。对照组给予NIPPV治疗,观察组在NIPPV治疗1 h后给予床旁FB检查及灌洗治疗。比较两组患者的治疗效果、治疗前后的血气指标、肺功能的变化,以及治疗前后APACHEⅡ和意识得分的差异。结果观察组患者的治疗总有效率为95.0%(38/40),明显高于对照组的77.5%(31/40),差异具有统计学意义(P<0.05);两组患者治疗前的肺功能和血气指标比较差异均无统计学意义(P>0.05),治疗后,两组患者的FVC、FEV1、FEV1/FVC、Pa O2和p H均较治疗前升高,Pa CO2均较治疗前降低,且观察组降低更明显,差异均具有统计学意义(P<0.05);治疗前两组患者的APACHEⅡ和意识评分比较差异均无统计学意义(P>0.05),治疗后,两组患者的上述指标均降低,且观察组降低更明显,差异均具有统计学意义(P<0.05);观察组患者腹胀、面部受压、口干、头晕和腹痛的发生率为52.5%(21/40),对照组为47.5%(19/40),差异无统计学意义(P>0.05)。结论 NIPPV联合FB检查治疗对AECOPD合并Ⅱ型呼吸衰竭有较好的治疗效果,且不会增加相关并发症的发生。

乌司他丁联合NIPPV治疗AECOPD合并Ⅱ型呼吸衰竭的疗效及安全性

目的研究乌司他丁联合无创正压机械通气(NIPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD合并Ⅱ型呼吸衰竭患者的疗效及安全性。方法选择2019年2月至2020年2月榆林市星元医院收治的122例AECOPD合并Ⅱ型呼吸衰竭患者为研究对象,按照随机数表法将患者分为研究组和对照组各61例。对照组患者给予NIPPV治疗,研究组患者给予乌司他丁联合NIPPV治疗,均连续治疗一周。比较两组患者治疗后的效果、治疗前后动脉血二氧化碳分压(PaCO_(2))、血氧分压(PaO_(2))、pH值,一秒用力呼气容积(FEV)、用力肺活量(FVC)、一秒率(FEV/FVC)水平和丙二醛(MDA),超氧化物歧化酶(SOD),谷胱甘肽过氧化物酶(GSH-Px)水平,以及不良反应发生情况。结果治疗后,研究组患者的总有效率为95.08%,明显高于对照组的80.33%,差异有统计学意义(P<0.05);治疗后,研究组患者的PaO_(2)、p H值分别为(10.82±1.12)mmHg、7.39±0.08,明显高于对照组的(9.23±1.06)mm Hg、7.32±0.06,PaCO_(2)水平为(6.20±0.31)mmHg,明显低于对照组的(7.01±0.32)mmHg,差异均有统计学意义(P<0.05);治疗后,研究组患者的FEV、FVC、FEV/FVC水平分别为(2.15±0.36)L、(3.79±0.38)L、(55.90±9.47)%,明显高于对照组的(1.46±0.31)L、(3.01±0.32)L、(47.82±8.19)%,差异均有统计学意义(P<0.05);治疗后,研究组患者的MDA水平为(5.21±1.35)μmol/L,明显低于对照组的(7.30±1.76)μmol/L,SOD、GSH-Px水平分别为(102.01±15.79)U/mL、(180.01±17.32)U/L,明显高于对照组的(91.75±12.58)U/mL、(151.86±15.61)U/L,差异均有统计学意义(P<0.05);两组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论乌司他丁联合NIPPV可有效改善AECOPD合并Ⅱ型呼吸衰竭患者的动脉血气指标及肺功能,有效清除氧自由基,临床应用效果显著且安全性较高。

鼻罩与面罩连接NIPPV在慢性阻塞性肺疾病急性加重期患者治疗中的临床效果和不良反应

目的探讨鼻罩与面罩连接无创正压双水平机械通气(NIPPV)在慢性阻塞性肺疾病急性加重期(AECOPD)患者治疗中的临床效果和不良反应。方法选择该院2015年12月至2016年12月AECOPD患者50例,随机分组为面罩组和鼻罩组,每组25例,面罩组采用经口鼻面罩双水平正压通气治疗,鼻罩组采用经鼻罩双水平正压通气治疗。对比两组患者治疗前和治疗后的动脉血气变化、不良反应、电解质紊乱、代谢性碱中毒发生情况。结果与治疗前对比,鼻罩组和面罩组治疗后pH明显上升,PaO_2明显上升,PaCO_2明显降低,与治疗前比较,差异均有统计学意义(P<0.05)。而两组PaO_2和PaCO_2治疗后比较差异无统计学意义(P>0.05)。两组患者治疗后Na^+水平明显上升,K^+明显下降,与治疗前比较,差异均有统计学意义(P<0.05)。面罩组治疗后Na^+高于鼻罩组,K^+低于鼻罩组,差异有统计学意义(P<0.05)。两组患者治疗后代谢性碱中毒发生率明显上升,与治疗前比较,差异均有统计学意义(P<0.05);面罩组治疗后代谢性碱中毒发生率(80.0%)高于鼻罩组(48.0%),差异有统计学意义(P<0.05)。与面罩组(40.0%)对比,鼻罩组不良反应发生率(12.0%)明显更低,组间比较差异具有统计学意义(P<0.05)。结论鼻罩和面罩均能够有效地改善AECOPD患者的血气情况和通气情况,但面罩更容易发生酸碱度失衡和代谢碱中毒,经鼻罩不良反应更少,更容易被患者所接受。

NIPPV在AECOPD合并重度二氧化碳潴留患者中的应用效果分析

目的探讨无创正压通气(NIPPV)在急性加重期慢性阻塞性肺疾病(AECOPD)合并重度二氧化碳潴留患者中的应用效果。方法选取2010年4月至2014年9月凉山州第一人民医院收治的AECOPD合并重度二氧化碳潴留患者138例作为研究对象,在常规治疗的基础上采用NIPPV治疗,分析治疗前后患者心率(HR)、呼吸(R)、氢离子浓度指数(pH)、血氧饱和度(SaO2)、氧分压(PaO2)和二氧化碳分压(PaCO2)改善情况。结果本次研究中气管插管率为21.01%(29/138),病死率为5.80%(8/138),NIPPV有效率为81.88%(113/138)。HR和R在治疗2h后虽有一定下降,但与治疗前比较差异无统计学意义(P>0.05)。治疗24h后HR和R均有较大幅度下降,与治疗前及治疗后2h比较,差异有统计学意义(P<0.05)。SaO2、pH和PaO2在治疗2h后及24h后增高均较为明显,而PaCO2在治疗2h后及24h后下降均较明显,不同时点间的比较差异均有统计学意义(P<0.05)。结论 NIPPV对合并重度二氧化碳潴留的AECOPD患者有良好的治疗效果,血气指标能够得到迅速改善。