Objective:This study aims to evaluate the clinical efficacy of non-invasive positive pressure ventilation(NIPPV)in patients with severe bronchial asthma combined with respiratory failure.Methods:90 patients with sever...Objective:This study aims to evaluate the clinical efficacy of non-invasive positive pressure ventilation(NIPPV)in patients with severe bronchial asthma combined with respiratory failure.Methods:90 patients with severe bronchial asthma combined with respiratory failure between September 2022 and December 2023 were selected for the study and randomly divided into the experimental group(NIPPV-assisted treatment)and the control group.The differences between the two groups were compared in terms of total effective rate of treatment,days of clinical symptom disappearance,days of hospitalization,lung function indexes,incidence of adverse reactions,and quality of life.Results:Patients in the experimental group had a significantly higher total effective rate of treatment(97.78%)than the control group(75.56%).In terms of pulmonary function indexes,patients in the experimental group showed significant improvement after treatment,especially the increase in forced expiratory volume and forced vital capacity,while these improvements were not as obvious in the control group.In addition,the incidence of adverse reactions was significantly lower in the experimental group than in the control group,suggesting that the application of NIPPV is relatively safe.Quality of life assessment also showed that patients in the experimental group had significantly better quality of life than the control group after treatment.Conclusion:This study demonstrated the effectiveness of NIPPV as an adjunctive treatment for severe bronchial asthma combined with respiratory failure.NIPPV can improve lung function,reduce the incidence of adverse effects,increase the overall effectiveness of the treatment,and contribute to the improvement of patients'quality of life.Therefore,NIPPV should be regarded as an effective and safe treatment in clinical management,especially in patients with severe bronchial asthma combined with respiratory failure,where its application has potential clinical significance.展开更多
BACKGROUND Neonatal respiratory distress syndrome(NRDS)is one of the most common diseases in neonatal intensive care units,with an incidence rate of about 7%among infants.Additionally,it is a leading cause of neonatal...BACKGROUND Neonatal respiratory distress syndrome(NRDS)is one of the most common diseases in neonatal intensive care units,with an incidence rate of about 7%among infants.Additionally,it is a leading cause of neonatal death in hospitals in China.The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant AIM To explore the effect of pulmonary surfactant(PS)combined with noninvasive positive pressure ventilation on keratin-14(KRT-14)and endothelin-1(ET-1)levels in peripheral blood and the effectiveness in treating NRDS.METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included.Of these,64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation.The expression of KRT-14 and ET-1 in the two groups was compared.The deaths,complications,and PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)blood gas indexes in the two groups were compared.Receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.RESULTS The observation group had a significantly higher effectiveness rate than the control group.There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions,such as bronchial dysplasia,cyanosis,and shortness of breath.After treatment,the levels of PaO_(2)and PaO_(2)/FiO_(2)in both groups were significantly higher than before treatment,while the level of PaCO_(2)was significantly lower.After treatment,the observation group had significantly higher levels of PaO_(2)and PaO_(2)/FiO_(2)than the control group,while PaCO_(2)was notably lower in the observation group.After treatment,the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels.The observation group had a reduction of KRT-14 and ET-1 levels than the control group.ROC curve analysis showed that the area under the curve(AUC)of KRT-14 was 0.791,and the AUC of ET-1 was 0.816.CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy.KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.展开更多
Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe p...Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia. Methods: A total of 68 patients with COPD complicated by severe pneumonia who were treated in the hospital between November 2015 and April 2017 were collected, retrospectively analyzed and then divided into the group A (n=35) who received noninvasive positive pressure ventilation and the group B (n=33) who received lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation. The differences in arterial blood gas and serum index levels were compared between the two groups before and after treatment. Results: Before treatment, there was no statistically significant difference in arterial blood gas index levels as well as serum contents of inflammatory mediators, stress hormones and myocardial enzyme spectrum indexes between the two groups. After treatment, arterial blood gas indexes PH and PaO2 levels of group B were higher than those of group A;serum inflammatory mediators HMGB1, PCT and hs-CRP contents were lower than those of group A;serum stress hormones Cor, AngⅠ and AngⅡcontents were lower than those of group A;serum myocardial enzyme spectrum indexesα-HBDH and cTn-Ⅰ contents were lower than those of group A. Conclusion: Lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation can effectively optimize the arterial blood gas levels, reduce systemic inflammatory stress state and protect the myocardial function of patients with COPD complicated by severe pneumonia.展开更多
Objective:To analyze the clinical efficacy of early application of bi-level positive airway pressure ventilation in the treatment of COPD with type II respiratory failure.Method:A total of 58 patients with COPD and ty...Objective:To analyze the clinical efficacy of early application of bi-level positive airway pressure ventilation in the treatment of COPD with type II respiratory failure.Method:A total of 58 patients with COPD and type II respiratory failure admitted to our hospital from January 2017 to January 2019 were randomly divided into observation group and control group,with 29 cases in each group.Among them,the control group was received routine treatment while the observation group was treated with bi-level positive pressure airway ventilation in addition of conventional treatment.The arterial blood gas analysis,mortality rate and hospitalization time of these two groups before and after treatment were compared.Result:The blood pH,partial pressure of oxygen(PaO2)and arterial oxygen saturation(SaO2)of these two groups were significantly higher after the treatment while PaO2 alone was decreased.The difference was statistically significant(P<0.05).The results of arterial blood gas analysis in the observation group were significantly improved compared with those before treatment.The mortality rate and hospitalization time were significantly less than the control group,and the difference was statistically significant(P<0.05).Conclusion:Early clinical application of bi-level positive airway pressure ventilation in the treatment of COPD with type II respiratory failure has a significant clinical effect in reducing the mortality rate and hospitalization time of patients,and thus it is worthy of clinical application.展开更多
<strong>Rationale: </strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Acute respiratory failur...<strong>Rationale: </strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Acute respiratory failure is an uncommon complication of pregnancy. However, it is the most frequent organ dysfunction associated with obstetric admissions to an intensive care unit. The obstetric population is a different group due to its physiology and the presence of the fetus that lacks evidence in the literature within the subject of ventilatory support. Noninvasive positive pressure ventilation (NIPPV) is often avoided due to the lack of knowledge on the safety and efficacy of this modality. </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Currently,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> there are no guidelines for the management of respiratory failure in pregnancy. </span><b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">To provide evidence in support of the use of NIPPV as a safe and reasonable modality for pregnant patients with respiratory failure. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">We retrospectively reviewed medical records of 29 pregnant patients of the Obstetric Critical Care Unit of a tertiary hospital in Panamá City who received NIPPV from 2013 to 2015. Failure to response was defined as the lack of increase in the </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pa</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">O</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">/FiO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> ratio or clinical deterioration 6 hours after initiating NIPPV. Demographics, indication for NIPPV, duration of treatment, as well as maternal and fetal outcomes were collected. </span><b><span style="font-family:Verdana;">Measurements</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Main</span></b> <b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Mean age was 28.4 ± 6 years, mean body mass index 27.4 ± 3.3, and mean gestational age at admission was 30</span><sup><span style="font-family:Verdana;">5/7</span></sup><span style="font-family:Verdana;"> ± 5 weeks. Twenty-four patients (82.8%) met the criteria for acute lung injury (ALI) and an additional two (6.9%) for acute respiratory distress syndrome (ARDS). The mean duration of ventilation was 50.6 ± 17.27 hours. Statistically significant differences were noted between the </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pa</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">O</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">/FiO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> ratios in failure and successful patients within 2 hours of NIPPV therapy (P = 0.007) and </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pa</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">O</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">/FiO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> ratio within 6 hours of NIPPV therapy (P = 0.03). Success was defined when the patient was administered NIPPV, resulting in an improvement (increase in </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">p</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">a/FiO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> ratio) of her ventilatory parameters. Three patients (10.3%) failed to respond to NIPPV and needed to be converted to invasive mechanical ventilation. Patients who required intubation had a longer duration of ICU stay (P = 0.006) and overall hospital stay (P = 0.03). None of patients presented aspiration during NIPPV therapy. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The current series is the largest report of pregnant patients requiring ventilatory support who received NIPPV as first line of therapy. This report shows the usefulness of this ventilation modality, avoiding intubation with its risks, of a significant number of patients, especially ventilator-associated pneumonia.</span></span></span></span>展开更多
An airway pressure and flow data acquisition system is developed to investigate the approach to building the bi-level positive airway pressure BiPAP in a ventilator.A number of experiments under different breathing si...An airway pressure and flow data acquisition system is developed to investigate the approach to building the bi-level positive airway pressure BiPAP in a ventilator.A number of experiments under different breathing situations and states are conducted and the experimental data are recorded.According to the data from these experiments the variation characteristics of the pressure and flow are analyzed using Matlab. The data analysis results show that the pressure increases while the flow decreases in the expiratory phase contrarily the pressure decreases while the flow increases in the inspiratory phase during the apnea state both the pressure and the flow remain unchanged. According to the above variation characteristics of breath a feedback-based method for creating bi-level positive airway pressure is proposed. Experiments are implemented to verify the BiPAP model. Results demonstrate that the proposed method works effectively in following respiration and caters well to most polypnea and apnea events.展开更多
Objective: To investigate the clinical effects of the mask continuous positive airway pressure (CPAP) mechanical ventilation in children with severe pneumonia. Methods: A total of 100 cases of children with severe pne...Objective: To investigate the clinical effects of the mask continuous positive airway pressure (CPAP) mechanical ventilation in children with severe pneumonia. Methods: A total of 100 cases of children with severe pneumonia were randomly divided into two groups, study group with 50 children and control group with 50 children. These 100 children were given comprehensive treatment measures: treatment of anti-infection, anti-respiratory failure, anti-heart failure (if necessary), relieving cough and reducing sputum, aerosol inhalation, limited fluid volume, nutrition support etc. Children in the study group were added mask continuous positive airway pressure mechanical ventilation (CPAP). Children in the control group were added ordinary mask oxygen inhalation. Investigated and checked the treatment effect in these two groups. Results: After treatment, SaO2, PaO2 in both two groups were showed significantly higher than before the treatment. PaO2 of the study group is obviously higher than the control group. The oxygen inhalation time of the study group was obviously lesser than the control group. The total effective rate of the study group was significantly higher than the control group which was 96.0% vs 66.0%. Conclusion: The mask continuous positive airway pressure (CPAP) mechanical ventilation can significantly improve the related symptoms and blood gas status of the children with severe pneumonia, shorten the oxygen inhalation time and had remarkable effect.展开更多
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 dis...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.展开更多
Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chr...Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.展开更多
The following case describes the favorable application of airway pressure release ventilation (APRV) in a patient with pulmonary hypertension who developed respiratory failure and abdominal compartment syndrome after ...The following case describes the favorable application of airway pressure release ventilation (APRV) in a patient with pulmonary hypertension who developed respiratory failure and abdominal compartment syndrome after abdominal closure from an incarcerated umbilical hernia. A 66-year-old male with past medical history of restrictive lung disease, obstructive sleep apnea and pulmonary hypertension, presented to the operating room for an incarcerated inguinal hernia. After abdominal closure, he gradually developed decreased oxygen saturation and hypotension. APRV was initiated during post operative day 2 after inability to maintain adequate oxygen saturation with resultant hypotension on pressure control ventilation with varying degrees of positive end expiratory pressure and 100% inspired oxygen concentration. The initial set high pressure on APRV was 35 mm Hg. Yet, in lieu of decreasing lung compliance, it peaked at 50 mm Hg. Eventually, inhaled Nitric Oxide was initiated post operative day 3 due to increasing pulmonary arterial pressures. A bedside laparotomy was eventually performed when bladder pressures peaked to 25 mm Hg. APRV gradually and temporally improved the oxygen saturation and decreased the pulmonary arterial pressures with subsequent increase in systemic blood pressures. APRV promoted alveolar recruitment and decreased the shunting associated with abdominal compartment syndrome. Better oxygen saturations lead to increases in blood pressure by decreasing the effects of hypoxic pulmonary vasoconstriction on the right ventricle (RV). In patients with decreasing lung compliance and pulmonary comorbidities, APRV appears safe and allows for improve oxygenation, after failure with conventional modes of ventilation.展开更多
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 ...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.展开更多
Background The evidence for non-invasive positive pressure ventilation (NIPPV) used in patients with severe stable chronic obstructive pulmonary disease (COPD) is insufficient. The aim of the meta-analysis was to ...Background The evidence for non-invasive positive pressure ventilation (NIPPV) used in patients with severe stable chronic obstructive pulmonary disease (COPD) is insufficient. The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change, lung function, health-related quality of life (HRQL), survival and mortality in severe stable COPD patients. Methods Randomized controlled trials (RCTs) and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010. Two reviewers independently assessed study quality. Data were combined using Review Manager 5.0. Both pooled effects and 95% confidence intervals were calculated. Results Five RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures. The weighted mean difference (WMD) for the partial pressure of carbon dioxide in artery (PaCO2) was -3.52 (-5.26, -1.77) mmHg and for the partial pressure of oxygen in artery (PaO2) 2.84 (0.23, 5.44) mmHg. There were significant improvements in dyspnea and sleep quality, but gained no benefits on lung function. The standardized mean difference (SMD) for the forced expiratory volume in 1 second (FEV1) was 0.00 (0.29, 0.29). And the benefits for exercise tolerance, mood, survival and mortality remained unclear. Conclusions Patients with severe stable COPD can gain some substantial treatment benefits when using NIPPV, especially improvements in gas change, dyspnea and sleep quality. Studies of high methodological quality with large population, especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.展开更多
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
Adaptive servo-ventilation(ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea(CSA). Heart failure patients often have sleep...Adaptive servo-ventilation(ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea(CSA). Heart failure patients often have sleep-disordered breathing, which consists of either obstructive sleep apnea(OSA) or CSA. Other medical conditions, such as stroke, acromegaly, renal failure, and opioid use may be associated with CSA. Continuous positive airway pressure(CPAP) therapy is widely used for patients with OSA, but some of these patients develop CSA on CPAP, which is called treatmentemergent CSA. CPAP can be useful as a treatment for these various forms of CSA, but it is insufficient to eliminate respiratory events in approximately half of patients with CSA. As compared to CPAP, ASV may be a better option to treat CSA, with sufficient alleviation of respiratory events as well as improvement of cardiac function in heart failure patients. In patients without heart failure, ASV can also alleviate CSA and relieve their symptom. Recently, ASV has been widely used for patients with various forms of CSA. ASV may be also used in the setting without CSA, but it should be assessed more carefully. Clinicians should have a better understanding of the indications for ASV in each setting.展开更多
文摘Objective:This study aims to evaluate the clinical efficacy of non-invasive positive pressure ventilation(NIPPV)in patients with severe bronchial asthma combined with respiratory failure.Methods:90 patients with severe bronchial asthma combined with respiratory failure between September 2022 and December 2023 were selected for the study and randomly divided into the experimental group(NIPPV-assisted treatment)and the control group.The differences between the two groups were compared in terms of total effective rate of treatment,days of clinical symptom disappearance,days of hospitalization,lung function indexes,incidence of adverse reactions,and quality of life.Results:Patients in the experimental group had a significantly higher total effective rate of treatment(97.78%)than the control group(75.56%).In terms of pulmonary function indexes,patients in the experimental group showed significant improvement after treatment,especially the increase in forced expiratory volume and forced vital capacity,while these improvements were not as obvious in the control group.In addition,the incidence of adverse reactions was significantly lower in the experimental group than in the control group,suggesting that the application of NIPPV is relatively safe.Quality of life assessment also showed that patients in the experimental group had significantly better quality of life than the control group after treatment.Conclusion:This study demonstrated the effectiveness of NIPPV as an adjunctive treatment for severe bronchial asthma combined with respiratory failure.NIPPV can improve lung function,reduce the incidence of adverse effects,increase the overall effectiveness of the treatment,and contribute to the improvement of patients'quality of life.Therefore,NIPPV should be regarded as an effective and safe treatment in clinical management,especially in patients with severe bronchial asthma combined with respiratory failure,where its application has potential clinical significance.
文摘BACKGROUND Neonatal respiratory distress syndrome(NRDS)is one of the most common diseases in neonatal intensive care units,with an incidence rate of about 7%among infants.Additionally,it is a leading cause of neonatal death in hospitals in China.The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant AIM To explore the effect of pulmonary surfactant(PS)combined with noninvasive positive pressure ventilation on keratin-14(KRT-14)and endothelin-1(ET-1)levels in peripheral blood and the effectiveness in treating NRDS.METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included.Of these,64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation.The expression of KRT-14 and ET-1 in the two groups was compared.The deaths,complications,and PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)blood gas indexes in the two groups were compared.Receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.RESULTS The observation group had a significantly higher effectiveness rate than the control group.There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions,such as bronchial dysplasia,cyanosis,and shortness of breath.After treatment,the levels of PaO_(2)and PaO_(2)/FiO_(2)in both groups were significantly higher than before treatment,while the level of PaCO_(2)was significantly lower.After treatment,the observation group had significantly higher levels of PaO_(2)and PaO_(2)/FiO_(2)than the control group,while PaCO_(2)was notably lower in the observation group.After treatment,the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels.The observation group had a reduction of KRT-14 and ET-1 levels than the control group.ROC curve analysis showed that the area under the curve(AUC)of KRT-14 was 0.791,and the AUC of ET-1 was 0.816.CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy.KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.
文摘Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia. Methods: A total of 68 patients with COPD complicated by severe pneumonia who were treated in the hospital between November 2015 and April 2017 were collected, retrospectively analyzed and then divided into the group A (n=35) who received noninvasive positive pressure ventilation and the group B (n=33) who received lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation. The differences in arterial blood gas and serum index levels were compared between the two groups before and after treatment. Results: Before treatment, there was no statistically significant difference in arterial blood gas index levels as well as serum contents of inflammatory mediators, stress hormones and myocardial enzyme spectrum indexes between the two groups. After treatment, arterial blood gas indexes PH and PaO2 levels of group B were higher than those of group A;serum inflammatory mediators HMGB1, PCT and hs-CRP contents were lower than those of group A;serum stress hormones Cor, AngⅠ and AngⅡcontents were lower than those of group A;serum myocardial enzyme spectrum indexesα-HBDH and cTn-Ⅰ contents were lower than those of group A. Conclusion: Lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation can effectively optimize the arterial blood gas levels, reduce systemic inflammatory stress state and protect the myocardial function of patients with COPD complicated by severe pneumonia.
文摘Objective:To analyze the clinical efficacy of early application of bi-level positive airway pressure ventilation in the treatment of COPD with type II respiratory failure.Method:A total of 58 patients with COPD and type II respiratory failure admitted to our hospital from January 2017 to January 2019 were randomly divided into observation group and control group,with 29 cases in each group.Among them,the control group was received routine treatment while the observation group was treated with bi-level positive pressure airway ventilation in addition of conventional treatment.The arterial blood gas analysis,mortality rate and hospitalization time of these two groups before and after treatment were compared.Result:The blood pH,partial pressure of oxygen(PaO2)and arterial oxygen saturation(SaO2)of these two groups were significantly higher after the treatment while PaO2 alone was decreased.The difference was statistically significant(P<0.05).The results of arterial blood gas analysis in the observation group were significantly improved compared with those before treatment.The mortality rate and hospitalization time were significantly less than the control group,and the difference was statistically significant(P<0.05).Conclusion:Early clinical application of bi-level positive airway pressure ventilation in the treatment of COPD with type II respiratory failure has a significant clinical effect in reducing the mortality rate and hospitalization time of patients,and thus it is worthy of clinical application.
文摘<strong>Rationale: </strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Acute respiratory failure is an uncommon complication of pregnancy. However, it is the most frequent organ dysfunction associated with obstetric admissions to an intensive care unit. The obstetric population is a different group due to its physiology and the presence of the fetus that lacks evidence in the literature within the subject of ventilatory support. Noninvasive positive pressure ventilation (NIPPV) is often avoided due to the lack of knowledge on the safety and efficacy of this modality. </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Currently,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> there are no guidelines for the management of respiratory failure in pregnancy. </span><b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">To provide evidence in support of the use of NIPPV as a safe and reasonable modality for pregnant patients with respiratory failure. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">We retrospectively reviewed medical records of 29 pregnant patients of the Obstetric Critical Care Unit of a tertiary hospital in Panamá City who received NIPPV from 2013 to 2015. Failure to response was defined as the lack of increase in the </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pa</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">O</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">/FiO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> ratio or clinical deterioration 6 hours after initiating NIPPV. Demographics, indication for NIPPV, duration of treatment, as well as maternal and fetal outcomes were collected. </span><b><span style="font-family:Verdana;">Measurements</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Main</span></b> <b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Mean age was 28.4 ± 6 years, mean body mass index 27.4 ± 3.3, and mean gestational age at admission was 30</span><sup><span style="font-family:Verdana;">5/7</span></sup><span style="font-family:Verdana;"> ± 5 weeks. Twenty-four patients (82.8%) met the criteria for acute lung injury (ALI) and an additional two (6.9%) for acute respiratory distress syndrome (ARDS). The mean duration of ventilation was 50.6 ± 17.27 hours. Statistically significant differences were noted between the </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pa</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">O</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">/FiO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> ratios in failure and successful patients within 2 hours of NIPPV therapy (P = 0.007) and </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pa</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">O</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">/FiO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> ratio within 6 hours of NIPPV therapy (P = 0.03). Success was defined when the patient was administered NIPPV, resulting in an improvement (increase in </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">p</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">a/FiO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> ratio) of her ventilatory parameters. Three patients (10.3%) failed to respond to NIPPV and needed to be converted to invasive mechanical ventilation. Patients who required intubation had a longer duration of ICU stay (P = 0.006) and overall hospital stay (P = 0.03). None of patients presented aspiration during NIPPV therapy. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The current series is the largest report of pregnant patients requiring ventilatory support who received NIPPV as first line of therapy. This report shows the usefulness of this ventilation modality, avoiding intubation with its risks, of a significant number of patients, especially ventilator-associated pneumonia.</span></span></span></span>
基金The National Natural Science Foundation of China(No.51275090)the Science and Technology Support Program of Jiangsu Province(No.BE2011608)the Program for Special Talent in Six Fields of Jiangsu Province(No.2008144)
文摘An airway pressure and flow data acquisition system is developed to investigate the approach to building the bi-level positive airway pressure BiPAP in a ventilator.A number of experiments under different breathing situations and states are conducted and the experimental data are recorded.According to the data from these experiments the variation characteristics of the pressure and flow are analyzed using Matlab. The data analysis results show that the pressure increases while the flow decreases in the expiratory phase contrarily the pressure decreases while the flow increases in the inspiratory phase during the apnea state both the pressure and the flow remain unchanged. According to the above variation characteristics of breath a feedback-based method for creating bi-level positive airway pressure is proposed. Experiments are implemented to verify the BiPAP model. Results demonstrate that the proposed method works effectively in following respiration and caters well to most polypnea and apnea events.
文摘Objective: To investigate the clinical effects of the mask continuous positive airway pressure (CPAP) mechanical ventilation in children with severe pneumonia. Methods: A total of 100 cases of children with severe pneumonia were randomly divided into two groups, study group with 50 children and control group with 50 children. These 100 children were given comprehensive treatment measures: treatment of anti-infection, anti-respiratory failure, anti-heart failure (if necessary), relieving cough and reducing sputum, aerosol inhalation, limited fluid volume, nutrition support etc. Children in the study group were added mask continuous positive airway pressure mechanical ventilation (CPAP). Children in the control group were added ordinary mask oxygen inhalation. Investigated and checked the treatment effect in these two groups. Results: After treatment, SaO2, PaO2 in both two groups were showed significantly higher than before the treatment. PaO2 of the study group is obviously higher than the control group. The oxygen inhalation time of the study group was obviously lesser than the control group. The total effective rate of the study group was significantly higher than the control group which was 96.0% vs 66.0%. Conclusion: The mask continuous positive airway pressure (CPAP) mechanical ventilation can significantly improve the related symptoms and blood gas status of the children with severe pneumonia, shorten the oxygen inhalation time and had remarkable effect.
文摘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.
文摘Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.
文摘The following case describes the favorable application of airway pressure release ventilation (APRV) in a patient with pulmonary hypertension who developed respiratory failure and abdominal compartment syndrome after abdominal closure from an incarcerated umbilical hernia. A 66-year-old male with past medical history of restrictive lung disease, obstructive sleep apnea and pulmonary hypertension, presented to the operating room for an incarcerated inguinal hernia. After abdominal closure, he gradually developed decreased oxygen saturation and hypotension. APRV was initiated during post operative day 2 after inability to maintain adequate oxygen saturation with resultant hypotension on pressure control ventilation with varying degrees of positive end expiratory pressure and 100% inspired oxygen concentration. The initial set high pressure on APRV was 35 mm Hg. Yet, in lieu of decreasing lung compliance, it peaked at 50 mm Hg. Eventually, inhaled Nitric Oxide was initiated post operative day 3 due to increasing pulmonary arterial pressures. A bedside laparotomy was eventually performed when bladder pressures peaked to 25 mm Hg. APRV gradually and temporally improved the oxygen saturation and decreased the pulmonary arterial pressures with subsequent increase in systemic blood pressures. APRV promoted alveolar recruitment and decreased the shunting associated with abdominal compartment syndrome. Better oxygen saturations lead to increases in blood pressure by decreasing the effects of hypoxic pulmonary vasoconstriction on the right ventricle (RV). In patients with decreasing lung compliance and pulmonary comorbidities, APRV appears safe and allows for improve oxygenation, after failure with conventional modes of ventilation.
文摘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.
文摘Background The evidence for non-invasive positive pressure ventilation (NIPPV) used in patients with severe stable chronic obstructive pulmonary disease (COPD) is insufficient. The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change, lung function, health-related quality of life (HRQL), survival and mortality in severe stable COPD patients. Methods Randomized controlled trials (RCTs) and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010. Two reviewers independently assessed study quality. Data were combined using Review Manager 5.0. Both pooled effects and 95% confidence intervals were calculated. Results Five RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures. The weighted mean difference (WMD) for the partial pressure of carbon dioxide in artery (PaCO2) was -3.52 (-5.26, -1.77) mmHg and for the partial pressure of oxygen in artery (PaO2) 2.84 (0.23, 5.44) mmHg. There were significant improvements in dyspnea and sleep quality, but gained no benefits on lung function. The standardized mean difference (SMD) for the forced expiratory volume in 1 second (FEV1) was 0.00 (0.29, 0.29). And the benefits for exercise tolerance, mood, survival and mortality remained unclear. Conclusions Patients with severe stable COPD can gain some substantial treatment benefits when using NIPPV, especially improvements in gas change, dyspnea and sleep quality. Studies of high methodological quality with large population, especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.
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.
基金Partly supported by a Grant-in-Aid for Scientific Research(C),No.26507010a grant to the Respiratory Failure Research Group from Ministry of Health,Labor and Welfare,Japan
文摘Adaptive servo-ventilation(ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea(CSA). Heart failure patients often have sleep-disordered breathing, which consists of either obstructive sleep apnea(OSA) or CSA. Other medical conditions, such as stroke, acromegaly, renal failure, and opioid use may be associated with CSA. Continuous positive airway pressure(CPAP) therapy is widely used for patients with OSA, but some of these patients develop CSA on CPAP, which is called treatmentemergent CSA. CPAP can be useful as a treatment for these various forms of CSA, but it is insufficient to eliminate respiratory events in approximately half of patients with CSA. As compared to CPAP, ASV may be a better option to treat CSA, with sufficient alleviation of respiratory events as well as improvement of cardiac function in heart failure patients. In patients without heart failure, ASV can also alleviate CSA and relieve their symptom. Recently, ASV has been widely used for patients with various forms of CSA. ASV may be also used in the setting without CSA, but it should be assessed more carefully. Clinicians should have a better understanding of the indications for ASV in each setting.