Effect of non-invasive mechanical ventilation on sleep and nocturnal ventilation in patients with chronic respiratory failure

BACKGROUND: Chronic respiratory failure (CRF) is associated with nocturnal hypoventilation. Due to the interaction of sleep and breathing, sleep quality is reduced during nocturnal hypoventilation. Non-invasive mechanical ventilation (NMV), usually performed overnight, relieves symptoms of hypoventilation and improves daytime blood gas tensions in patients with CRF. The time course of the long term effect of NMV on sleep and breathing during both spontaneous ventilation (withdrawing the intervention) and NMV was investigated in patients with CRF due to thoracic restriction. METHODS: Fifteen consecutive patients (13 women) of mean (SD) age 57.9 (12.0) years with CRF due to thoracic restriction were included in the study. During the one year observation period four polysomnographic studies were performed: three during spontaneous breathing without NMV-before initiation of NMV (T0) and after withdrawing NMV for one night at six months (T6) and 12 months (T12-)-and the fourth during NMV after 12 months (T12+). Daytime blood gas tensions and lung function were also measured. RESULTS: Spontaneous ventilation (in terms of mean oxygen saturation) progressively improved (from T0 to T12-) during both REM sleep (24.8%, 95% CI 12.9 to 36.9) and NREM sleep (21.5%, 95% CI 12.4 to 30.6). Sleep quality during spontaneous ventilation also improved in terms of increased total sleep time (26. 8%, 95% CI 11.6 to 42.0) and sleep efficiency (17.5%, 95% CI 5.4 to 29.6) and decreased awakenings (54.0%, 95% CI 70.3 to 37.7). Accordingly, REM and NREM sleep stages 3 and 4 significantly improved. However, the most significant improvements in both nocturnal ventilation and sleep quality were seen during NMV at 12 months. CONCLUSIONS: After long term NMV both spontaneous ventilation during sleep and sleep quality in patients with CRF due to thoracic restriction showed evidence of progressive improvement compared with baseline after withdrawal of NMV for a single night at six and 12 months. However, the greatest improvements in nocturnal ventilation and sleep were achieved during NMV at 12 months.     

Long term non-invasive domiciliary assisted ventilation for respiratory failure following thoracoplasty.

BACKGROUND--Ventilatory failure is a well recognised complication of patients who have had a thoracoplasty for tuberculosis, but there are few data regarding the value of long term non-invasive assisted ventilation in this situation. METHODS--Thirty two patients who had had a thoracoplasty 20-46 years previously and who had developed respiratory failure were treated with nocturnal cuirass assisted ventilation or nasal positive pressure ventilation. Their survival and changes in arterial blood gases, nocturnal oximetry, and pulmonary function tests were assessed. RESULTS--The actuarial survival rates at one, three, five, and seven years after starting treatment were 91%, 74%, 64%, and 55%, respectively. Only seven of the 13 deaths were directly attributable to chronic respiratory or cardiac failure. The arterial PO2, PCO2, mean nocturnal oxygen saturation, vital capacity, and maximal inspiratory and expiratory pressures had all improved at the time of the initial post-treatment assessment (mean 12 days after starting treatment), but no subsequent improvements were seen after up to 48 months of follow up. Neither survival nor physiological improvements were correlated with the patients' age, the interval since thoracoplasty, or the pretreatment arterial blood gas tensions or results of pulmonary function tests. CONCLUSIONS--These results show that, even when ventilatory failure has developed, the prognosis with non-invasive assisted ventilation is good and the physiological abnormalities can be partially reversed. Patients who develop respiratory failure after a thoracoplasty should be considered for this type of long term domiciliary treatment.     

Physiological effects and optimisation of nasal assist-control ventilation for patients with chronic obstructive pulmonary disease in respiratory failure

BACKGROUND: A study was undertaken to investigate the effects of non- invasive assist-control ventilation (ACV) by nasal mask on respiratory physiological parameters and comfort in acute on chronic respiratory failure (ACRF). METHODS: Fifteen patients with chronic obstructive pulmonary disease (COPD) were prospectively and randomly assigned to two non-invasive ventilation (NIV) sequences in spontaneous breathing (SB) and ACV mode. ACV settings were always optimised and therefore subsequently adjusted according to patient's tolerance and air leaks. RESULTS: ACV significantly decreased all the total inspiratory work of breathing (WOBinsp) parameters, pressure time product, and oesophageal pressure variation in comparison with SB mode. The ACV mode also resulted in a significant reduction in surface diaphragmatic electromyographic activity to 36% of the control values and significantly improved the breathing pattern. SB did not change the arterial blood gas tensions from baseline values whereas ACV significantly improved both the PaO2 from a mean (SD) of 8.45 (2.95) kPa to 13.31 (2.15) kPa, PaCO2 from 9.52 (1.61) kPa to 7.39 (1.39) kPa, and the pH from 7.32 (0.03) to 7.40 (0.07). The respiratory comfort was significantly lower with ACV than with SB. CONCLUSIONS: This study shows that the clinical benefit of non-invasive ACV in the management of ACRF in patients with COPD results in a reduced inspiratory muscle activity providing an improvement in breathing pattern and gas exchange. Despite respiratory discomfort, the muscle rest provided appears sufficient when ACV settings are optimised.


     

Cerebral haemodynamics in patients with chronic renal failure: effects of haemodialysis

Background. We measured middle cerebral artery (MCA) flow velocity(FV), dynamic pressure autoregulation, and carbon dioxide reactivity(CRCO₂) in patients with chronic renal failure before and afterhaemodialysis using transcranial Doppler ultrasonography. Methods. Twelve patients on long-term haemodialysis were recruited.MCA FV was measured continuously. The transient hyperaemic responsetest was used to assess cerebral autoregulation, and per centchange in FV per kPa change in end-tidal carbon dioxide wascalculated to assess CRCO₂. All measurements were recorded beforeand after haemodialysis. Results. MCA FV (mean [SD]) decreased from 57 (10) cm s^–1before to 46 (13) cm s^–1 after haemodialysis (P<0.01).The transient hyperaemic response ratio (THRR) was (mean [SD])1.29 (0.13) before haemodialysis and did not change significantlyfollowing haemodialysis (1.36 [0.10]). CRCO₂ was 21.7 (8.3)%kPa^–1 before haemodialysis and remained unchanged afterwards(20.9 [3.8]% kPa^–1). Values in normal subjects for MCAFV, THRR and CRCO₂ are 56 (12) cm s^–1, 1.26 (0.13) and22 (6)% kPa^–1, respectively. Conclusions. MCA FV decreases significantly after haemodialysis.Dynamic pressure autoregulation and CRCO₂ remain normal in patientswith chronic renal failure, and are not altered significantlyby haemodialysis. Presented at the European Society of Anaesthesiologists AnnualCongress Amsterdam, May 1999.     

Mechanisms of improvement of respiratory failure in patients with restrictive thoracic disease treated with non-invasive ventilation

BACKGROUND: Nocturnal non-invasive ventilation (NIV) is an effective treatment for hypercapnic respiratory failure in patients with restrictive thoracic disease. We hypothesised that NIV may reverse respiratory failure by increasing the ventilatory response to carbon dioxide, reducing inspiratory muscle fatigue, or enhancing pulmonary mechanics. METHODS: Twenty patients with restrictive disease were studied at baseline (D0) and at 5-8 days (D5) and 3 months (3M). RESULTS: Mean (SD) daytime arterial carbon dioxide tension (Paco(2)) was reduced from 7.1 (0.9) kPa to 6.6 (0.8) kPa at D5 and 6.3 (0.9) kPa at 3M (p = 0.004), with the mean (SD) hypercapnic ventilatory response increasing from 2.8 (2.3) l/min/kPa to 3.6 (2.4) l/min/kPa at D5 and 4.3 (3.3) l/min/kPa at 3M (p = 0.044). No increase was observed in measures of inspiratory muscle strength including twitch transdiaphragmatic pressure, nor in lung function or respiratory system compliance. CONCLUSIONS: These findings suggest that increased ventilatory response to carbon dioxide is the principal mechanism underlying the long term improvement in gas exchange following NIV in patients with restrictive thoracic disease. Increases in respiratory muscle strength (sniff oesophageal pressure and sniff nasal pressure) correlated with reductions in the Epworth sleepiness score, possibly indicating an increase in the ability of patients to activate inspiratory muscles rather than an improvement in contractility.     

Short-term effects of calcium antagonists on renal haemodynamics in patients with chronic renal failure

Experimental evidence suggests that pharmacological manipulations of glomerular haemodynamics may affect the progression of chronic renal insufficiency and scarring. In this study, we have investigated the short-term (4 weeks) renal haemodynamic effects of nifedipine and nitrendipine (10 mg/thrice daily) in two separate groups of 6 patients with stable chronic renal failure (CRF) (glomerular filtration rate, GFR: 9.7-47.8 ml/min/1.73 m2). Patients were studied on three occasions: (1) before the administration of the calcium antagonist, (2) after 4 weeks of treatment and (3) 4 weeks after the discontinuation of the drug. Mean arterial pressure fell significantly on nifedipine: from 116.33 +/- 12.25 to 107.22 +/- 18.67 mm Hg, p less than 0.05, and on nitrendipine: from 112.22 +/- 10.04 to 102.22 +/- 13.77 mm Hg, p less than 0.05. There was no significant effect of either calcium antagonist on GFR, effective renal plasma flow (ERPF), proteinuria or natriuresis. Consequently, renal vascular resistance (RVR) fell in both experimental groups, nifedipine: from 51.40 +/- 28.77 to 44.97 +/- 30 dyn s cm-5 x 10(3) (mean +/- SD), and nitrendipine: from 37.04 +/- 18.46 to 30.47 +/- 15.56 dyns s cm-5 x 10(3), p less than 0.05. These results show that calcium antagonists reduce systemic blood pressure whilst GFR and ERPF are maintained. The fall in the RVR of patients with CRF treated with calcium antagonists may confer on these agents a therapeutic advantage in the management of progressive renal insufficiency.     

右美托咪定与吗啡用于慢性阻塞性肺病患者机械通气时对呼吸力学影响的比较

目的研究右美托咪定（dexmedetomidine,DEx）和盐酸吗啡对慢性阻塞性肺病急性发作期（acute exacerbation of chronic obstructive pulmonary disease, AECOPD）行机械通气患者呼吸力学的影响。方法入选AECOPD伴呼吸衰竭行机械通气患者40例;在同样的分钟通气量和呼气末正压的设置下,采用随机对照的方法分为两组（对照组、试验组）,每组20例,对照组使用吗啡进行镇静治疗,实验组使用盐酸DEX。记录两组患者急性生理功能和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluation, APACHE Ⅱ）评分、脑电双频指数（bispectral index,BIS）评分、Ramsay镇静评分等指标。比较两组患者镇静前后生命体征、血气的变化和镇静后呼吸力学参数的变化。结果与对照组比较,实验组中平均动脉压（mean arterial pressure,MAP）和脉搏[（80±3）mmHg比（75±4）mmHg（1mmHg=0．133kPa）和（90±3）次/min比（79±3）次/min]降低（P〈0．01）,平均气道压mean airway pressure,Paw）、平台压（plateau pressure,eplat）[（7．5±0．7）cm H2O比（6．2±0．6）cm H2O（1cmH2O=0．098kPa）、（19．8±1．7）cmH20比（18．0±1．1）cmH2O]明显降低（P〈0．01）,峰食道压力（peak esophageal pressure,PPEAKES）、PPEAKEE与基准食道压力差（the peak esophageal manometry reference esophagus pressure difference, dPEs）[（-3．4±0．7）cmH2O比（-5．4±1．0）cmH2O、（-6．9±1．0）cmH2O比（-9．8±1．3）cmH2O]变大（P〈0．01）,吸气末屏气期间的跨肺压（ folding Screen the end of the suction gas during transpulmonary pressure, Ptp Plat）、肺静态顺应性（pulmonary static compliance,cst）[（25．5±2．3）cmH2O比（26．0±2．6）cmH2O、（20．5±1．9）cmH2O比（20．1±1-2）cmH2O]变化无统计学意义（P〉0．05）,气道阻力（airway resistance,Raw）[（20．3±3．9）cmH2O·L-1·s-1比（15．6±1．4）cmH2O·L-1·s-1]变小（P〈0．01）,患者呼吸功（patient work of breathing,WOBp）[（0．11±0．02）j/L比（0．16±0．04）j／L]明显增加[1（P〈0．01）,机械呼吸功（mechanical work of breathing,WOBv）[（0．49±0．10）g/L比（0．43±0．06）j／L]明显降低（P〈0．05）。机械通气时间、重症监护室（ICU）入住时间[（76±5）h比（64±3）h、（6．0±1．5）d比（4．6±0．9）d]减少（P〈0．05）。结论与吗啡比较,DEX能提高机械通气患者的镇静效果、降低Raw、提高肺顺应性,有利于实施保护性通气策略,同时降低呼吸负荷和呼吸做功,因而能降低呼吸氧耗。     

Long term domiciliary oxygen treatment for chronic respiratory failure reviewed.

The use of long term domiciliary oxygen therapy in the Sheffield area from June to August 1987 has been surveyed. Of the 74 patients prescribed long term domiciliary oxygen therapy, 64 were visited at home. These had arterial blood gas tensions or oxygen saturation measured (while breathing oxygen and air), and the indications for long term domiciliary oxygen therapy were examined retrospectively. Fifty two patients had chronic bronchitis and emphysema, the remainder having pneumoconiosis, bronchiectasis, fibrosing alveolitis, and congestive cardiac failure. Of the 54 cases where indications for treatment could be compared with the Department of Health and Social Security (DHSS) guidelines, only 23 (43%) met the full DHSS criteria before the start of treatment. The median length of treatment was 16 months. At follow up 51 patients had an arterial oxygen tension (PaO2) greater than 8.0 kPa when breathing oxygen. They had a significantly higher PaO2 when breathing air than before long term oxygen therapy (6.7 (SD 1.2) kPa before oxygen treatment, 7.6 (1.4) kPa on reassessment). A similar change was seen in the 23 patients assessed as recommended by the DHSS (6.1 (0.8) kPa; 7.2 (1.2]. PaO2 during the breathing of air was less than 7.3 kPa at reassessment in only 21 (33%) patients. Thirteen patients had carboxyhaemoglobin concentrations above 2.5%, the 95th centile of the distribution in nonsmokers in the laboratory.     

鼻面罩无创正压通气联用呼吸兴奋剂治疗慢阻肺呼吸衰竭合并肺性脑病患者的疗效

目的：评价鼻面罩无创正压通气联用呼吸兴奋剂治疗慢阻肺呼吸衰竭合并肺性脑病患者的疗效。方法将68例慢阻肺呼吸竭合并肺性脑病患者随机分为对照组和观察组,分别给予鼻面罩无创正压通气治疗和鼻面罩无创正压通气联用呼吸兴奋剂治疗,评价联合治疗方法的临床疗效。结果两组患者通气3h 后和治疗结束时的 pH、PaO2和 PaCO2较治疗前均明显好转,观察组患者的恢复情况优于对照组（P ＜0.05）。经过治疗后,观察组患者通气有效率85.29%,明显高于对照组（P ＜0.05）,气管插管率和胃胀气发生率分别为14.71%和32.35%,低于对照组（P＜0.05）,两组患者的住院病死率均为2.94%,差异无统计学意义（P＞0.05）。结论鼻面罩无创正压通气联用呼吸兴奋剂治疗慢阻肺呼吸竭合并肺性脑病的临床效果优于单纯鼻面罩无创正压通气,是一种较好的治疗方法。     

Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success.

BACKGROUND--Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. METHODS--Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one as successful (78%) or unsuccessful (22%) according to survival and to the need for endotracheal intubation. RESULTS--Pneumonia was the cause of acute respiratory failure in 38% of the unsuccessful episodes but only in 9% of the successful ones. Success with non-invasive mechanical ventilation was associated with less severely abnormal baseline clinical and functional parameters, and with less severe levels of acidosis assessed during an initial trial of non-invasive mechanical ventilation. CONCLUSIONS--The severity of the episode of acute respiratory failure as assessed by clinical and functional compromise, and the level of acidosis and hypercapnia during an initial trial of non-invasive mechanical ventilation, have an influence on the likelihood for success with non-invasive mechanical ventilation and may prove to be useful in deciding whether to continue with this treatment.     

Invasive and non-invasive determinants of pulmonary hypertension in patients with chronic heart failure.

BACKGROUND: In patients with chronic heart failure, pulmonary hypertension is an important predictive marker of adverse outcome. Its invasive and non-invasive determinants have not been evaluated. OBJECTIVE: This study was performed to evaluate hemodynamic determinants of pulmonary hypertension in chronic heart failure and to compare the predictive value of Doppler indices with that of invasively measured hemodynamic indices. METHODS: Right heart catheterization and transthoracic echo-Doppler were simultaneously performed in 259 consecutive patients with chronic heart failure (ejection fraction 24% +/- 7%) who were in sinus rhythm and receiving optimized medical therapy. Systolic pulmonary artery pressure (sPAP), cardiac index, transpulmonary gradient pressure, and pulmonary wedge pressure (PWP) were measured invasively. Left atrial and ventricular systolic and diastolic volumes, the ratio of maximal early to late diastolic filling velocities (E/A ratio), deceleration time (DT) and atrial filling fraction (AFF) of transmitral flow, systolic fraction of forward pulmonary venous flow (SFpvf), and mitral regurgitation were quantified by echo-Doppler. RESULTS: Patients with pulmonary hypertension had greater left atrial systolic and diastolic dysfunction, more left ventricular diastolic abnormalities, and greater hemodynamic impairment. The correlations between systolic left ventricular indices, mitral regurgitation, and sPAP were generally poor. Among invasive and non-invasive measurements, PWP (r = 0.89, p < 0.0001) and SFpvf (r = -0.68, p < 0.0001) showed the strongest correlation with sPAP. When we compared all patients with those without mitral regurgitation, the correlations between E/A ratio (r = 0.56 vs r = 0. 74, p < 0.002), SFpvf (r = -0.68 vs r = -0.84, p < 0.03), and systolic pulmonary artery pressure were significantly stronger. Multivariate analysis revealed that PWP was the strongest invasive independent predictor of systolic pulmonary artery pressure in patients with (R(2) = 0.87, p < 0.0001) and without (R(2) = 0.90, p < 0.0001) mitral regurgitation. A PWP > or= 18 mm Hg (odds ratio [95% CL], 142 (41-570) was strongly associated with systolic pulmonary hypertension. Among non-invasive variables DT, SFpvf, and AFF were identified as independent predictors of sPAP in patients with (R(2) = 0.56, p < 0.0001) and without (R(2) = 0.78, p < 0.0001) mitral regurgitation. A DT < 130 (odds ratio [95% CL], 3.5 (1.3-8.5), SFfvp < 40% (odds ratio [95% CL], 333 (41-1,007), and AFF < 30% (odds ratio [95% CL], 2 (1.3-7) most strongly predicted systolic pulmonary hypertension. CONCLUSIONS: The results of this study indicate that in patients with chronic heart failure, venous pulmonary congestion is an important determinant of systolic pulmonary artery hypertension. Hemodynamic and Doppler determinants showed similar predictive power in identifying systolic pulmonary artery hypertension.     

Long term non-invasive ventilation in the community for patients with musculoskeletal disorders: 46 year experience and review

BACKGROUND—A study wasundertaken to assess the long term physiological and clinical outcomein 79 patients with musculoskeletal disorders (73 neuromuscular, six ofthe chest wall) who received non-invasive ventilation for chronicrespiratory failure over a period of 46years.
METHODS—Vital capacity(VC) and carbon dioxide tension (PCO₂) beforeand after initiation of ventilation, type and duration of ventilatory assistance, the need for tracheostomy, and mortality wereretrospectively studied in 48 patients who were managed withmouth/nasal intermittent positive pressure ventilation (M/NIPPV) and 31 who received body ventilation. The two largest groups analysed were 45 patients with poliomyelitis and 15 with Duchenne's muscular dystrophy. Twenty five patients with poliomyelitis received body ventilation (fora mean of 290 months) and 20 were supported by M/NIPPV (mean 38 months). All 15 patients with Duchenne's muscular dystrophy wereventilated by NIPPV (mean 22months).
RESULTS—Fourteenpatients with poliomyelitis on body ventilation (56%) but only one onM/NIPPV, and 10 of 15 patients (67%) with Duchenne's musculardystrophy eventually received tracheostomies for ventilatory support.Five patients with other neuromuscular disorders required tracheostomies. Twenty of 29 tracheostomies (69%) were provided because of progressive disease and hypercarbia which could not becontrolled by non-invasive ventilation; the remaining nine were placedbecause of bulbar dysfunction and aspiration related complications.Nine of 10 deaths occurred in patients on body ventilation (six withpoliomyelitis), although the causes of death were varied and notnecessarily related to respiratory complications. A proportionatelygreater number of patients on M/NIPPV (67%) reported positive outcomes(improved sense of wellbeing and independence) than did those on bodyventilation (29%, p<0.01). However, other than tracheostomies anddeaths, negative outcomes in the form of machine/interface discomfortand self-discontinuation of ventilation also occurred at a rate 2.3 times higher than in the group who received body ventilation. None ofthe six patients with chest wall disorders (all on M/NIPPV) requiredtracheostomy or died. Hospital admission rates increased nearlyeightfold in patients receiving body ventilation (all poliomyelitispatients) compared with before ventilation (p<0.01) while in thosesupported by M/NIPPV they were reduced by 36%.
CONCLUSIONS—Non-invasiveventilation (NIV) in the community over prolonged periods is a feasiblealthough variably tolerated form of management in patients withneuromuscular disorders. While patients who received body ventilationwere followed the longest (mean 24 years), the need for tracheostomyand deaths occurred more often in this group (most commonly in thepoliomyelitis patients). Despite a number of discomforts associatedwith M/NIPPV, a larger proportion of patients experienced improvedwellbeing, independence, and ability to perform daily activities.

     

氧气与空气雾化对无创通气治疗慢性阻塞性肺疾病急性加重患者的效果比较

目的 比较慢性阻塞性肺疾病急性加重患者无创机械通气同时雾化吸入时,不同雾化驱动气体对患者雾化过程中二氧化碳分压动态变化及治疗效果的影响。方法 将64例慢性阻塞性肺疾病急性加重患者随机分为氧气组和空气组各32例。氧气组在无创机械通气的同时进行氧气驱动雾化吸入治疗,空气组进行空气驱动雾化吸入。记录雾化0 min、5 min、10 min、15 min,雾化结束5 min、10 min、15 min的患者经皮二氧化碳分压。记录治疗前、治疗第4天、治疗第7天动脉血气分析、CAT评分、痰液症状积分。结果 两组各30例完成研究。两组雾化不同时间经皮二氧化碳分压比较,组间、时间及交互效应存在统计学差异(均P<0.05)。两组患者治疗后PaCO₂、pH值、CAT评分、痰液症状积分均有改善,其中PaCO₂在治疗第7天组间比较有统计学意义(P<0.05)。结论 两种雾化驱动气体均能取得良好的治疗效果。氧气组能够使雾化过程中经皮二氧化碳分压维持相对稳定。而空气组能够降低雾化过程中经皮二氧化碳分压,适用于慢性阻塞性肺疾病急性加重伴有严重CO_2<...     

慢性阻塞性肺疾病急性加重机械通气患者序贯HFNC与NPPV的疗效比较

目的:比较慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease, AECOPD）患者以肺部感染控制窗（pulmonary infection control window, PIC-W）为切换点序贯经鼻高流量湿化氧疗（high-...     

呼吸衰竭患者保留气管套管行有创-无创序贯通气的护理

目的总结呼吸衰竭患者保留气管套管行有创-无创序贯通气的护理方法。方法对26例呼吸衰竭行气管切开患者保留气管套管行有创-无创呼吸序贯通气,同时加强心理护理、气道护理、封堵套管的护理等。结果患者总的机械通气时间为(8.90±7.65)d,有创通气时间为(3.40±0.23)d,撤机成功率为80.77%。序贯通气期间患者的呼吸频率维持在12~25次/min,动脉血气为pH 7.35±0.38、PaCO2(7.57±1.29)kPa、PaO2(10.64±1.26)kPa;呼吸机相关性肺炎发生率15.38%,2例撤机后再次行有创机械通气,死亡1例。结论对保留气管套管患者实施有创-无创序贯通气,提供正确规范化的护理措施,是成功撤机的必要保障。     

无创正压通气治疗老年COPD合并呼吸衰竭患者的临床疗效观察

目的：探讨无创正压通气治疗老年COPD合并呼吸衰竭患者的临床效果。方法选取我院收治的老年COPD并合并有呼吸衰竭的患者60例,随机分为A组与B组,B组患者行鼻导管持续低流量吸氧和常规药物治疗,A组患者在B组基础上增加机械通气面罩正压通气。比较两组患者血气分析结果、病死率、治疗周期和治疗后肺功能指标间的差异。结果 A组患者血气分析指标和治疗后肺功能指标显著优于B组（ P＜0.05）,病死率显著低于B组（P＜0.05）,治疗周期显著短于B组（P＜0.05）。结论无创正压通气可以有效提高老年COPD并发呼吸衰竭患者的临床治疗效果。     

Treatment of acute respiratory failure by prolonged non-invasive ventilation in a child

Purpose

To evaluate the feasibility and the efficacy of non-invasive ventilation (NIV) by nasal mask in a paediatric patient.

Clinical features

A four-year-old girl with acute lymphocytic leukaemia (ALL L₁ pre-pre B) complicated by acute respiratory failure was treated with NIV On admission she exhibited hyperpyrexia (40C), pancytopaenia and severe hypoxia with hypocapnia (PaO₂ = 45 minHg; PaCO₂ = 28.2 mmHg; pH = 7.30; SpO₂ = 76%; ABE = ?7.3 mmol · L^?1. With NIV, PaO₂ improved (PaO₂ = 78 ± 8 mmHg; SpO₂ = 86 ± 2; PaCO₂ = 39 ± 2) throughout the first day. Treatment was continued for six days until the patient was discharged. No complications were recorded.

Conclusion

Non-invasive ventilation by nasal mask may represent a choice in the treatment of acute respiratory failure of parenchymal origin in paediatric haematological patients.