Non-invasive ventilation after surgery

After surgery, hypoxemia and/or acute respiratory failure (ARF) mainly develop following abdominal and/or thoracic surgery. Anesthesia, postoperative pain and surgery will induce respiratory modifications: hypoxemia, pulmonary volumes decrease and atelectasis associated to a restrictif syndrome and a diaphragm dysfunction. Maintenance of adequate oxygenation in the postoperative period is of major importance, especially when pulmonary complications such as ARF occur. Although invasive endotracheal mechanical ventilation has remained the cornerstone of ventilatory strategy for many years for severe acute respiratory failure, several studies have shown that mortality associated with pulmonary disease is largely related to complications of postoperative reintubation and mechanical ventilation. Therefore, major objectives for anesthesiologists and surgeons are first to prevent the occurrence of postoperative complications and second if ARF occurs is to ensure oxygen administration and carbon dioxide CO₂ removal while avoiding intubation. Non-invasive ventilation (NIV) does not require endotracheal tube or tracheotomy and its use is well established to prevent ARF occurrence (prophylactic treatment) or to treat ARF to avoid reintubation (curative treatment). Studies shows that patient-related risk factors, such as chronic obstructive pulmonary disease (COPD), age older than 60 years, American Society of Anesthesiologists ASA class of II or higher, obesity, functional dependence, and congestive heart failure, increase the risk for postoperative pulmonary complications. Rationale for postoperative NIV use is the same as the post-extubation NIV use plus the specificities due to the respiratory modifications induced by the surgery and anesthesia. Postoperative NIV improves gas exchange, decreases work of breathing and reduces atelectasis. The aims of this article are (1) to review the main respiratory modifications induced by surgery and anesthesia which justify postoperative NIV use (2) to offer some recommendations to apply safely postoperative NIV and (3) to present the main results obtained with preventive and curative NIV in a surgical context.     

BDNF plasma levels after antidepressant treatment with sertraline and transcranial direct current stimulation: Results from a factorial,randomized, sham-controlled trial

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation intervention that modifies cortical excitability according to the stimulation parameters. Preclinical and clinical studies in healthy volunteers suggest that tDCS induces neuroplastic alterations of cortical excitability, which might explain its clinical effects in major depressive disorder (MDD). We therefore examined whether tDCS, as compared to the antidepressant sertraline, increases plasma brain-derived neurotrophic factor (BDNF) levels, a neurotrophin associated with neuroplasticity. Patients (n=73) with major depressive disorder were randomized to active/sham tDCS and sertraline/placebo (four groups) in this 6-week, double-blind, placebo-controlled trial. We measured BDNF plasma levels at baseline and endpoint, observing no significant changes of BDNF levels after treatment. In addition, no significant changes were observed in responders and non-responders as well as no relationships between BDNF levels and clinical and psychopathological variables related to depression. Thus, in one of the few placebo-controlled trials evaluating BDNF changes over an antidepressant treatment course, we did not observe BDNF increase regardless of clinical improvement in depressed patients. Regarding tDCS, BDNF plasma levels might not be a good candidate biomarker to evaluate depression improvement or be a predictor of response in patients treated with tDCS, as our results showed that BDNF increase was not necessary to induce clinical response. Finally, our findings do not support a relationship between BDNF and improvement of depression.     

急诊抢救重症哮喘合并呼吸衰竭32例临床效果分析

目的：探讨急诊无创机械通气在抢救重症哮喘合并呼吸衰竭中的应用价值。方法将2012年9月~2013年9月本院收治的32例重症哮喘合并呼吸衰竭患者分为试验组（17例,常规治疗基础上再加用无创机械通气）和对照组（15例,仅给予常规治疗）,比较两组治疗前后血pH、动脉血氧分压（Pa02）、动脉血二氧化碳分压（PaC02）改变及哮喘缓解率。结果①治疗12 h后,试验组哮喘缓解率达到64.71%,明显高于对照组46.67%（P〈0.05）;②经治疗12 h后,两组患者血pH、Pa02、PaC02均得到不同程度的改善,但试验组较对照组改善更为显著,差异有统计学意义（P〈0.05）。结论无创机械通气用于急诊抢救重症哮喘合并呼吸衰竭效果显著,值得临床推广应用。     

人性化护理干预在慢性阻塞性肺疾病合并心力衰竭无创正压通气治疗中的应用效果

目的探讨人性化护理干预在慢性阻塞性肺疾病合并心力衰竭无创正压通气治疗中的应用效果。方法选取本院2011年1月～2013年6月收治的慢性阻塞性肺疾病合并心力衰竭患者104例为研究对象,随机分为观察组与对照组,各52例,均给予无创正压通气治疗,其中对照组采取常规护理干预,观察组采取人性化护理干预,比较两组的住院时间、HAMD评分及护理服务满意度。结果观察组的住院时间明显短于对照组,HAMD评分明显低于对照组,护理服务满意度明显高于对照组,两组比较差异有统计学意义（P〈0.05）。结论人性化护理干预应用于接受无创正压通气治疗的慢性阻塞性肺疾病合并心力衰竭患者,对改善患者不良情绪、加快康复进程、降低并发症发生率、提升护理服务质量有明显的促进作用,值得临床推广应用。     

无创通气治疗慢性阻塞性肺疾病合并重症呼吸衰竭的效果观察

目的：探讨无创通气治疗慢性阻塞性肺疾病（COPD）合并重症呼吸衰竭的临床效果。方法抽取2011年12月~2013年12月在本院治疗的COPD急性发作合并呼吸衰竭患者72例,随机分为观察组与对照组,每组36例。对照组采用吸氧、药物治疗等常规对症支持治疗,观察组在对照组的基础上给予无创正压通气治疗,比较两组患者的血气分析结果、不良发应发生率。结果治疗3 d后,两组患者的pH、PaO2、PaCO2等均明显改善,观察组的改善情况明显优于对照组（P〈0.05）;观察组的不良反应发生率为13.8%,对照组为11.1%,两组比较,差异无统计学意义（P〉0.05）。结论无创通气治疗COPD合并重症呼吸衰竭能快速缓解患者的临床症状,提高PaO2,降低PaCO2,提高患者的生存质量,值得临床推广。     

无创胚胎染色体筛查在染色体非整倍体检测中的应用效果

目的 探讨无创胚胎染色体筛查技术（NICS）在染色体非整倍体检测中的应用效果。方法 收集2017年5月至2019年5月在安徽省妇幼保健院生殖中心拟行体外受精-胚胎移植的364例患者的囊胚培养液,并行NICS筛查。对单囊胚移植且临床确认妊娠的46例患者,根据其妊娠结局不同行不同染色体检查方法：对12例流产的患者行流产组织染色体检查,并以该检查结果<为金标准,计算NICS的灵敏度和特异度;对继续妊娠的34例患者行外周血无创产前遗传学筛查（NIPS）,比较NICS结果与NIPS筛查结果的差异。结果 12例流产的患者样本中,流产组织染色体检查与NICS检查为染色体非整倍体者均为3例,NICS筛查的灵敏度为100%;在流产组织染色体检查为整倍体的9例样本中,对应的NICS检出2例为非整倍体,其特异度为77.78%,两种筛查方法的一致性分析Kappa值为0.64。继续妊娠的34例患者样本中,NIPS筛查均未检出13、18、21号染色体为非整倍体胚胎,NICS对这3条染色体的筛查结果与NIPS一致。结论 NICS筛查染色体非整倍体有较好的灵敏度,但假阳性率偏高,需进一步技术优化以提高特异性。     

Síndrome de obesidad-hipoventilación: situación hemodinámica basal e impacto de la ventilación no invasiva

IntroductionObesity-hypoventilation syndrome (OHS) is a risk factor for heart failure (HF). Some studies associate the use of non-invasive ventilation (NIV) with changes in hemodynamic parameters. Our objective was to describe the hemodynamic status of a group of patients with OHS and to study the effect of NIV.Patients and methodsPatients with stable OHS treated with NIV were included in this cross-sectional repeated measurements study. Hemodynamics were measured by bioimpedance: 30 minutes at baseline and another 30 minutes on NIV. Cardiac output (CO), cardiac index, and systolic volume were measured. The CO calculated for each patient expressed as a percentage of the lower limit of normal (LLN) was taken as reference, and 2 groups were formed: patients without HF and normal CO (≥ 100% of LLN) and patients with HF and low CO (< 100% of LLN). The Mann-Whitney U test was used to compare independent variables and the Wilcoxon test was used for paired variables, with significance set at P<.05.ResultsThe final sample comprised 36 patients, aged 66 (± 8) years, 19 (52%) men. In 17 (46%) patients, HF was detected with a CO of 3.7 l/min (66%) compared to the group without HF, whose CO was 7 l/min (107%). After NIV, patients with HF showed improvement in CO (4.5 l/min (77%), P=.009, while the non-HF group remained unchanged, with CO 6.8 l/min (104%), P=.2.ConclusionA total of 46% of patients with stable OHS present HF; NIV improves hemodynamics and does not affect patients with normal CO.     

Effects of two non-invasive continuous positive pressure devices on the acoustic environment of preterm infants

BackgroundTwo non-invasive ventilation strategies, Bubble Continuous Positive Airway Pressure (Bubble CPAP) and standard nasal Continuous Positive Airway Pressure (nasal-CPAP), are commonly used to treat preterm infants in the NICU, differentially impacting their auditory environment and contributing to noise exposure above recommended safe levels.AimTo compare differences in sound exposure for preterm infants receiving two types of non-invasive CPAP.MethodProspective observational study of 108 preterm infants, receiving either Bubble-CPAP or nasal-CPAP, using repeated measures of sound exposure in single-patient rooms and semi-private bays.ResultsAnalyses with repeated measures demonstrated that both types of CPAP increase noise levels above the background of the NICU, and that non-invasive nasal-CPAP produces higher noise pollution compared to Bubble CPAP, regardless of the room type.ConclusionWhile CPAP is a necessary treatment for many preterm infants, cumulative noise exposure in extremely preterm infants may also be a care consideration.     

自制无创面罩垫对面型瘦小患者无创正压通气的改善作用及预后效果的影响

目的研究自制无创面罩垫对面型瘦小患者无创正压通气的改善作用及预后效果影响。方法选取2016年2月至2018年2月于佛山市第五人民医院接受无创正压通气治疗的面型瘦小患者80例,以随机抽签法分成实验组与对照组,各40例。对照组予以传统呼吸机面罩行无创正压通气,实验组在对照组的基础上加用自制无创面罩垫行无创正压通气。比较两组治疗前后血气分析指标水平、舒适度情况、面罩漏气、破损情况、压疮发生率、满意度情况。结果治疗后实验组PaO2水平显著高于对照组,而PaCO2水平显著低于对照组,实验组患者的舒适度显著高于对照组,实验组患者面罩漏气、破损情况及压疮发生率均显著低于对照组,实验组满意度显著高于对照组,差异均有统计学意义(均P<0.05)。结论自制无创面罩垫应用于无创正压通气治疗的面型瘦小患者中效果明显,有利于改善患者的血气分析状况,缓解传统呼吸机面罩所造成的不适症状,同时有利于降低面罩漏气、破损以及压疮发生风险,提高满意度。