双水平正压无创通气治疗急性心源性肺水肿的研究

目的 观察双水平正压（BiPAP）无创通气治疗急性心源性肺水肿的临床疗效。方法 对35例常规治疗不能改善症状的急性心源性肺水肿患者应用BiPAP无创通气，观察通气前后心率（HR）、呼吸（R），经皮测定动脉血氧饱和度（SaP2）和动脉血气分析等指标变化。结果 35例患者经BiPAP治疗2h后临床体征和动脉血气分析明显改善（P〈0．05），29例顺利停机，抢救成功率82．9％。结论 早期合理使用BiPAP无创通气，可较迅速改善急性心源性肺水肿患者临床症状和低氧血症，提高抢救成功率。     

无创正压通气治疗急性心源性肺水肿的应用和护理

总结了无创正压通气治疗各种原因引起的急性心源性肺水肿的应用和护理,其护理重点包括:心理护理、舒适护理、病情的严密观察、呼吸道的严格管理以及并发症的积极防治。认为无创正压通气治疗使患者低氧血症被迅速纠正,呼吸频率、心率、平均动脉压明显改善,酸中毒纠正,取得了良好的效果,为提高患者的治疗成功率提供了保证。     

无创正压通气辅助治疗急性心源性肺水肿27例临床护理

通过对27例急性心源性肺水肿(ACPE)患者在常规治疗的基础上给予无正压通气(NIPPV)治疗,并给予有针对性的护理.结果本组患者无一例死亡.说明NIPPV是抢救ACPE改善全身组织氧供的一种安全有效的方法.     

无创正压通气辅助治疗36例急性心源性肺水肿患者的护理

目的探讨无创面罩呼吸机正压通气(NIPPV)辅助治疗急性心源性肺水肿(ACPE)的效果与护理措施。方法回顾性分析本科36例急性心源性肺水肿的临床护理资料,在强心、利尿、扩血管、解痉平喘治疗基础上,使用无创正压通气辅助治疗,给予临床监测及护理措施,对比治疗前后HR、RR、MAP、SpO2的改善情况。结果本组患者均顺利接受NIPPV治疗,ACPE得到控制,无气管插管通气病例;36例患者通气后20min的心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、血氧饱和度(SpO2)等参数均有明显改善(P<0.05)。结论符合使用无创正压通气指征的ACPE患者,使用NIPPV治疗是一种安全、有效的方法,全面的护理是治疗成功的关键。     

无创正压通气治疗急性心源性肺水肿的疗效观察及护理

目的 探讨无创正压通气治疗急性心源性肺水肿患者的疗效及护理要点.方法 对21例常规抗心力衰竭治疗无效的急性肺水肿患者使用无创正压通气.观察无创正压通气前与通气后1h患者生命体征、氧分压、并发症发生情况和肺水肿改善情况.结果 本组21例患者除2例因病情无改善,改予经鼻纤支镜引导下气管插管机械通气,19例患者经治疗肺水肿改...     

无创正压通气治疗急性心源性肺水肿36例

目的 评价无创正压通气治疗急性心源性肺水肿的疗效。方法 选择36例急性心源性肺水肿患者,在高流量吸氧及常规药物治疗不能纠正缺氧时,经面罩给予无创正压通气,观察治疗前、治疗后0．5h、1h、2h后临床症状、体征和动脉血气分析的变化。结果 经面罩无创正压通气治疗后,36例患者中32例（88．89％）临床症状、体征明显改善,血气分析中PaO2明显升高（P〈0．01）、PaCO2有所下降（P〈0．05）,避免了进一步有创机械通气治疗带来的损伤和经济负担;4例（11．11％）经无创正压通气治疗无效,改为经口气管插管机械通气;死亡2例。结论 应用无创正压通气可明显改善急性心源性肺水肿患者的症状、体征和血气分析结果,可作为急性心源性肺水肿安全、快速、有效的治疗手段之一。     

无创正压通气在急性心源性肺水肿治疗中的时机选择

目的探讨无创正压通气在急性心源性肺水肿治疗中的应用时机。方法 42例急性心源性肺水肿患者随机分为对照组22例与干预组20例。对照组给予镇静、利尿、强心、扩张支气管、吸氧等常规治疗15min后行双水平气道正压（bi-level positive airway pressure,BiPAP）治疗。干预组先给予BiPAP治疗,15min后给予镇静、利尿、强心、扩张支气管、吸氧等常规治疗。观察2组治疗前、治疗第2,24h时心率、呼吸频率、平均动脉压（mean arterial pressure,MAP）、pa（O2）、pa（CO2）,并比较2组治疗过程中插管率、病死率及住院时间。结论 BiPAP治疗2h后,对照组17例,干预组18例发绀及呼吸困难好转,肺部啰音减少。2组治疗第2,24h心率、呼吸频率、MAP、pa（O2）、pa（CO2）水平均较治疗前改善（P〈0.05）,2组治疗24h各项指标比较差异无统计学意义（P〉0.05）。2组插管率、病死率比较差异有统计学意义（P〈0.05）,住院时间比较差异无统计学意义（P〉0.05）。结论对急性心源性肺水肿患者尽早实施BiPAP治疗,可降低插管率和病死率。     

双水平无创正压通气用于急性心源性肺水肿的临床分析

选取2010年5月～2012年10月收治急性心源性肺水肿患者120例,随机分为对照组和观察组各60例。其中对照组采用包括持续吸氧、扩血管、利尿及纠正水电解质酸碱平衡等常规治疗;观察组在对照组治疗基础上,加用双水平无创正压通气治疗。比较两组患者治疗前后心率、血气指标及临床症状、体征改善时间等。对照组和观察组患者治疗前心率及血气指标组间比较无显著差异(P>0.05);观察组患者治疗后心率及血气指标较治疗前均明显改善,且改善程度优于对照组,组间比较差异显著(P<0.05)。双水平无创正压通气用于急性心源性肺水肿临床效果确切,能够显著纠正肺部通气功能,改善临床症状、体征,促进病情好转,具有临床推广使用价值。     

无创正压通气治疗急性心源性肺水肿的临床疗效观察

目的：观察无创正压通气（ NPPV）治疗急性心源性肺水肿的临床疗效。方法对48例急性心源性肺水肿引起的急性呼吸衰竭患者行NPPV,观察治疗期间心率和经皮血氧饱和度的变化,比较治疗前及治疗后2 h血气情况。结果急性心源性肺水肿患者治疗后2h缺氧症状得到明显改善,心悸、呼吸困难及紫绀明显好转,心功能评级明显降低（P﹤0.01）。结论对急性心源性肺水肿引起的急性呼吸衰竭行NPPV疗效显著,具有良好的临床实用价值,值得推广。     

面罩正压通气治疗急性心源性肺水肿

目的 探讨面罩正压通气治疗急性心源性肺水肿的疗效。方法 回顾分析1999年2月－2000年7月经此法治疗的11例严重心源性肺水肿的临床资料。结果 10例有效,1例无效,有效率91％。结论 面罩正压通气治疗急性心源性肺水肿并发症少,疗效好。但不适宜极度烦躁或深昏迷,自主呼吸微弱的患者。     

Pressure support noninvasive positive pressure ventilation treatment of acute cardiogenic pulmonary edema

We assessed cardiogenic pulmonary edema (CPE) patient response to full mask pressure support noninvasive positive pressure ventilation (NPPV). Adult patients presenting to the emergency department (ED) in acute respiratory failure who clinically required endotracheal intubation (ETI) were studied. In addition to routine therapy consisting of oxygen, nitrates, and diuretics, patients were started on full mask NPPV using a Puritan Bennett 7200 ventilator delivering pressure support 10 cm H(2)O, PEEP 5 cm H(2)O, FiO(2) 100%. Pressure support was titrated to achieve tidal volumes of 5 to 7 mL/kg, and PEEP titrated to achieve oxygen saturation (SaO(2)) > 90%. Outcome measures included arterial blood gas (ABG), Borg dyspnea score, vital signs, and need for ETI. Twenty patients mean age 74.7 +/- 14.3 years were entered on the study. Initial mean values on FiO(2) 100% by nonrebreather mask: pH 7.17 +/-.13, paCO(2) 65.5 +/- 19.4 mmHg, paO(2) 73.8 +/- 27.3 mm Hg, SaO(2) 89.7 +/- 10.0%, Borg score 8.1 +/- 1.4, and respiratory rate(RR) 38 +/- 6.3. At 60 minutes of NPPV, improvement was statistically significant: pH 7.28 (difference.11; 95% CI.04-.19), paCO(2) 45 (difference 20.5; 95% CI 8-33), Borg score 4.1 (difference 4.0; 95% CI 3-5), and RR 28.2 (difference 9.8; 95% CI 5-14). NPPV duration ranged from 30 minutes to 36 hours (median 2 hours, 45 minutes). Eighteen patients (90%) improved allowing cessation of NPPV. Two patients with concomitant severe chronic obstructive pulmonary disease (COPD) required ETI. There were no complications of NPPV. NPPV using full face mask and pressure support provided by a conventional volume ventilator is an effective treatment for CPE and may help prevent ETI.     

无创性正压通气治疗急性心源性肺水肿的临床探讨

目的 :探讨无创性正压通气治疗急性心源性肺水肿的疗效。方法 :3 0例常规治疗效果不佳的急性心源性肺水肿患者予无创性正压通气 ,观察治疗前后症状体征和动脉血气变化。结果 :无创性正压通气能迅速改善急性心源性肺水肿患者的症状、体征和动脉血气 ,在治疗开始后的 1/2h内PCO2 有显著性差异 (P <0 0 5 ) ,HR、RR、pH、SBP和PO2 有非常显著性差异 (P <0 0 1)。结论 :对符合指征的急性心源性肺水肿患者可首先使用无创性正压通气治疗     

Continuous positive airway pressure vs. proportional assist ventilation for noninvasive ventilation in acute cardiogenic pulmonary edema

Objective To compare continuous positive airway pressure (CPAP) and proportional assist ventilation (PAV) as modes of noninvasive ventilatory support in patients with severe cardiogenic pulmonary edema. Design and setting A prospective multicenter randomized study in the medical ICUs of three teaching hospitals. Patients Thirty-six adult patients with cardiogenic pulmonary edema (CPA) with unresolving dyspnea, respiratory rate above 30/min and/or SpO₂ above 90% with O₂ higher than 10 l/min despite conventional therapy with furosemide and nitrates. Interventions Patients were randomized to undergo either CPAP (with PEEP 10 cmH₂O) or PAV (with PEEP 5–6 cmH₂O) noninvasive ventilation through a full face mask and the same ventilator. Measurements and results The main outcome measure was the failure rate as defined by the onset of predefined intubation criteria, severe arrythmias or patient's refusal. On inclusion CPAP (n = 19) and PAV (n = 17) groups were similar with regard to age, sex ratio, type of heart disease, SAPS II, physiological parameters (mean arterial pressure, heart rate, blood gases), amount of infused nitrates and furosemide. Failure was observed in 7 (37%) CPAP and 7 (41%) PAV patients. Among these, 4 (21%) CPAP and 5 (29%) PAV patients required endotracheal intubation. Changes in physiological parameters were similar in the two groups. Myocardial infarction and ICU mortality rates were strictly similar in the two groups. Conclusions In the present study PAV was not superior to CPAP for noninvasive ventilation in severe cardiogenic pulmonary edema with regard to either efficacy and tolerance. T. Rusterholtz and P.-E. Bollaert contributed equally to this study. This work was supported in part by Respironics Inc., Murrysville, PA, USA.     

Prehospital noninvasive pressure support ventilation for acute cardiogenic pulmonary edema.

Severe acute cardiogenic pulmonary edema (ACPE) can successfully be treated with noninvasive pressure support ventilation (NIPSV) in a clinical setting. Whether prehospital NIPSV starting early at patients' home and being continued until hospital arrival is feasible and improves ACPE emergency care is examined in this study. End points of the study were oxygen saturation at hospital admission and clinical outcome. Twenty-three patients suffering from severe cardiac pulmonary edema with severe dyspnea, an oxygen saturation of less than 90% and basal rales were included in this controlled prospective randomized trial. All patients received standard medical treatment and 10 patients were additionally treated with NIPSV (pressure support level, 12 cmH2O; positive endexpiratory pressure, 5 cmH2O; FiO2, 0.6) whereas the other patients received oxygen (8 l/min) via Venturi face mask. Improvement in oxygen saturation was significantly faster in the NIPSV group and oxygen saturation was higher at the time of the hospital admission (NIPSV=97.3+/-0.8%; standard=89.5+/-2.7%, P=0.002). A trend toward higher troponin T levels was seen in the standard treatment group. The need for intensive care treatment did not differ, and one patient of each treatment group died in hospital. No complications were noted during the treatment with NIPSV. Prehospital NIPSV is feasible and able to improve emergency management of ACPE.     

A comparison of bilevel and continuous positive airway pressure noninvasive ventilation in acute cardiogenic pulmonary edema

Background

Whether bilevel positive airway pressure (BiPAP) is advantageous compared with continuous positive airway pressure (CPAP) in acute cardiogenic pulmonary edema (ACPO) remains uncertain. The aim of the meta-analysis was to assess potential beneficial and adverse effects of CPAP compared with BiPAP in patients with ACPO.

Methods

Randomized controlled trials comparing the treatment effects of BiPAP with CPAP were identified from electronic databases and reference lists from January 1966 to December 2012. Two reviewers independently assessed study quality. In trials that fulfilled inclusion criteria, we critically evaluate the evidence for the use of noninvasive ventilation on rates of hospital mortality, endotracheal intubation, myocardial infarction, and the length of hospital stay. Data were combined using Review Manager 4.3 (The Cochrane Collaboration, Oxford, UK). Both pooled effects and 95% confidence intervals (CIs) were calculated.

Results

Twelve randomized controlled trials with a total of 1433 patients with ACPO were included. The hospital mortality (relative risk [RR], 0.86; 95% CI, 0.65-1.14; P = .46; I² = 0%) and need for requiring invasive ventilation (RR, 0.89; 95% CI, 0.57-1.38; P = .64; I² = 0%) were not significantly different between patients treated with CPAP and those treated with BiPAP. The occurrence of new cases of myocardial infarction (RR, 0.95; 95% CI, 0.77-1.17; P = .53, I² = 0%) and length of hospital stay (RR, 1.01; 95% CI, − 0.40 to 2.41; P = .98; I² = 0%) were also not significantly different between the 2 groups.

Conclusions

There are no significant differences in clinical outcomes when comparing CPAP vs BiPAP. Based on the limited data available, our results suggest that there are no significant differences in clinical outcomes when comparing CPAP with BiPAP.     

The role of noninvasive ventilation in acute cardiogenic pulmonary edema

Citation

Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J: Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008, 359:142-151 [1].

Background

Noninvasive ventilation (NIV) (continuous positive airway pressure [CPAP] or noninvasive intermittent positive-pressure ventilation [NIPPV]) appears to be of benefit in the immediate treatment of patients with acute cardiogenic pulmonary edema and may reduce mortality.

Methods

Objective

To determine whether noninvasive ventilation reduces mortality and whether there are important differences in outcome associated with the method of treatment (CPAP or NIPPV).

Design

Open, prospective, randomized controlled trial.

Setting

26 emergency departments in hospital in the UK between July 2003 and April 2007.

Subjects

1069 patients age >16 years with a clinical diagnosis of acute cardiogenic pulmonary edema, as determined by chest radiograph, respiratory rate >20 breaths/min, and arterial pH < 7.35. Exclusion criteria included a requirement for a lifesaving or emergency intervention, inability to give consent, or previous recruitment in the trial.

Intervention

All patients received standard concomitant therapy. Patients were randomly assigned to standard oxygen therapy (up to 15 liters per minute via face mask), CPAP (5 to 15 cm of water), or NIPPV (inspiratory pressure, 8 to 20 cm of water; expiratory pressure, 4 to 10 cm of water).

Outcomes

The primary end point for the comparison between noninvasive ventilation and standard oxygen therapy was death within 7 days after the initiation of treatment, and the primary end point for the comparison between NIPPV and CPAP was death or intubation within 7 days.

Results

A total of 1069 patients (mean [± SD] age, 77.7 ± 9.7 years; female sex, 56.9%) were assigned to standard oxygen therapy (367 patients), CPAP (346 patients), or NIPPV (356 patients). There was no significant difference in 7-day mortality between patients receiving standard oxygen therapy (9.8%) and those undergoing noninvasive ventilation (9.5%, P = 0.87). There was no significant difference in the combined end point of death or intubation within 7 days between the two groups of patients undergoing noninvasive ventilation (11.7% for CPAP and 11.1% for NIPPV, P = 0.81). As compared with standard oxygen therapy, noninvasive ventilation was associated with greater mean improvements at 1 hour after the beginning of treatment in patient-reported dyspnea (treatment difference, 0.7 on a visual-analogue scale ranging from 1 to 10; 95% confidence interval [CI], 0.2 to 1.3; P = 0.008), heart rate (treatment difference, 4 beats per minute; 95% CI, 1 to 6; P = 0.004), acidosis (treatment difference, pH 0.03; 95% CI, 0.02 to 0.04; P < 0.001), and hypercapnia (treatment difference, 0.7 kPa [5.2 mm Hg]; 95% CI, 0.4 to 0.9; P < 0.001). There were no treatment-related adverse events.

Conclusion

In patients with acute cardiogenic pulmonary edema, noninvasive ventilation induces a more rapid improvement in respiratory distress and metabolic disturbance than does standard oxygen therapy but has no effect on short-term mortality.     

无创正压通气对急性肺水肿疗效的观察

目的观察无创正压通气对急性肺水肿低氧血症的疗效。方法选择15例心源性或非心源性急性肺水肿所致的低氧血症患者,进行无创正压通气,并行心电监护、有创动脉血压、血氧饱和度、呼吸频率、血气分析、尿量等指标的监测。结果15例急性肺水肿患者存活14例,死亡1例,抢救成功率93.33％。治疗2小时后患者由烦躁转入安静,心率、呼吸频率减慢,氧分压明显提高,通气前后比较P＜0.05。结论无创正压通气,通过调节压力支持和呼气末正压水平,可降低肺间质和肺泡的渗出水肿,促进肺泡复张,改善通气血流比率,有利于气体弥散,从而提高动脉氧分压和氧饱和度。     

双水平正压通气在急性心源性肺水肿中的应用

目的:探讨双水平正压通气治疗急性心源性肺水肿的疗效。方法:收集内科2003年1月至2007年8月收治的92例急性心源性肺水肿患者的临床资料并进行分析。治疗组46例在应用常规抗心源性肺水肿药物的同时联用BiPAPS/T30或BiPAP-Synchrony呼吸机进行无创通气治疗,对照组46例只应用常规药物治疗。结果:治疗组患者临床症状、体征明显改善,心率、呼吸频率、血压与治疗前比较显著降低,SaO2与治疗前比较显著增高(P<0.05),总有效率93.5%。对照组总有效率仅为82.6%。结论:双水平正压通气治疗急性心源性肺水肿疗效确切。     

急性心源性肺水肿时非侵入性呼吸机治疗的研究

目的　研究应用非侵入性呼吸机治疗急性心源性肺水肿的临床价值。方法　对31名难治性急性心源性肺水肿的患者应用非侵入性鼻面罩双相气道正压通气 (BiPAP)治疗 ,观察通气前后心率、尿量、平均血压 (MAP)、血氧饱和度 (SaO2 )、呼吸频率、呼气末二氧化碳分压 (PetCO2 )、血气分析和心功能等指标的变化。结果　患者经 2～ 6h的鼻面罩BiPAP治疗后心率明显减慢 (P <0 0 0 1)、尿量明显增加 (P <0 0 0 1)、PaO2 和SaO2 明显提高 (P <0 0 0 1)、PaCO2 和PetCO2 改变不明显 (P >0 0 5 )、心功能明显改善、高血压心脏病者MAP下降显著 (P<0 0 0 1)。结论　对急性心源性肺水肿应用非侵入性鼻面罩BiPAP治疗是安全而有效的 ,值得在临床推广使用