BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid er...BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid era,but direct head-to-head cost comparisons between the two modalities are not available in literature.AIM To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.METHODS A prospective observational single-center case control study including adult patients with ARF(PaO2/FiO2 ratio<300)admitted from January 1,2024 to December 31,2024 in medical intensive care unit(ICU)of a tertiary care hospital requiring either NIV or invasive ventilation.NIV and IMV groups were compared based on average length of ICU and hospital stay,mortality,net cost of ICU treatment,need for intubation and tracheostomy.RESULTS A total of 319 patients were included in the study(197 in NIV,122 in IMV group).Statistically significant difference in length of ICU stay(NIV group:5±3.25 days,IMV group:9±2.6 days;P<0.05)and mortality rate was seen(11%NIV vs 34%IMV;P<0.01).On multivariate analyses,mortality showed a stronger association with IMV[odds ratio(OR)=7.73;95%CI:3.12-19.18]as compared to ICU stay(OR=2.73;95%CI:2.15-3.48).A total of 33 patients(17%)in NIV group required intubation of which 3 were tracheostomized,while 14 patients(11%)in IMV group needed tracheostomy.The net average cost of ICU stay was₹83902 in NIV group while in IMV group,the net ICU cost was₹476216.The average cost of ICU stay was five times higher with IMV.CONCLUSION NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.展开更多
BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comp...BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.展开更多
BACKGROUND Noninvasive ventilation(NIV)reduces intubation rates,mortalities,and lengths of hospital and intensive care unit stays in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).He...BACKGROUND Noninvasive ventilation(NIV)reduces intubation rates,mortalities,and lengths of hospital and intensive care unit stays in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Helmet-based NIV is better tolerated than oronasal mask-based ventilation,and thus,allows NIV to be conducted for prolonged periods at higher pressures with minimal air leaks.CASE SUMMARY A 73-year-old man with a previous diagnosis of COPD stage 4 was admitted to our medical intensive care unit with chief complaints of cough,sputum,and dyspnea of several days’duration.For 10 mo,he had been on oxygen at home by day and had used an oronasal mask-based NIV at night.At intensive care unit admission,he breathed using respiratory accessory muscles.Hypercapnia and signs of infection were detected,and infiltration was observed in the right lower lung field by chest radiography.Thus,we diagnosed AECOPD by communityacquired pneumonia.After admission,respiratory distress steadily deteriorated and invasive mechanical ventilation became necessary.However,the patient refused this option,and thus,we selected helmet-based NIV as a salvage treatment.After 3 d of helmet-based NIV,his consciousness level and hypercapnia recovered to his pre-hospitalization level.CONCLUSION Helmet-based NIV could be considered as a salvage treatment when AECOPD patients refuse invasive mechanical ventilation and oronasal mask-based NIV is ineffective.展开更多
Objective: To establish the effectiveness of noninvasive ventilation in cancer children with acute respiratory failure. <br> Methods: The data of 33 cancer patients were obtained prospectively from six different...Objective: To establish the effectiveness of noninvasive ventilation in cancer children with acute respiratory failure. <br> Methods: The data of 33 cancer patients were obtained prospectively from six different pediatric intensive care units in Turkey between the years of 2012 and 2013. <br> Results: The diagnosis was leukemias in 25 (75.8%), lymphomas in 3 (9.1%) and other solid tumors in 5 (15.1%) patients. Pneumonia in 12 (36.3%) and sepsis in 15 (45.4%) patients were seen as the common reasons of respiratory failure. The mean PaO2/FiO2 ratios were (164.22 ± 37.24) and (126.80 ± 42.73) in noninvasive ventilation success and failure group, respectively. Noninvasive ventilation was successful in 18 (54.5%) patients. The failure group consisted of 15 patients required intubation. A total of 14 (42.4%) patients died. The clinical outcome in terms of success and failure was meaningful statistically (P = 0.0 00 1). <br> Conclusions: Our results could encourage the use of noninvasive ventilation in children with cancer who develop acute respiratory failure. It should be considered as a useful therapeutic approach to avoid endotracheal intubation.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 To characterize pediatric patients supported with continuous positive airway pressure and bilevel positive airway pressure(CPAP/BiPAP)or high-flow nasal cannula(HFNC)during interfacility transport(IFT).Meth...Background To characterize pediatric patients supported with continuous positive airway pressure and bilevel positive airway pressure(CPAP/BiPAP)or high-flow nasal cannula(HFNC)during interfacility transport(IFT).Methods A retrospective study with a provincial pediatric transport team from a tertiary hospital pediatric intensive care unit.Pediatric patients aged 28 days to<17 years,who required IFT between January 2017 and December 2018,were identified through a transport registry and were included in the study.Results A total of 118(26.7%)patients received CPAP/BIPAP or HFNC support for IFT.The most common respiratory diagnosis was bronchiolitis(46%).These patients were placed on respiratory support,31.4 minutes after the transport team’s arrival.None required intubation during their IFT,despite mean transport times of 163 minutes.Conclusions This study may provide important information for programs with large catchment areas,in which large distances and transport times should not be barriers to NIV implementation.展开更多
Objective:To investigate the change and relativity of noninvasive positive pressure ventilation(NIPPV)on the gene expression of ubiquitin system of skeletal muscle in patient with acute exacerbation of chronic obstruc...Objective:To investigate the change and relativity of noninvasive positive pressure ventilation(NIPPV)on the gene expression of ubiquitin system of skeletal muscle in patient with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:80 patients with AECOPD were divided into two groups based on whether the NIPPV treatment was given or not,38 cases in the study group and 42 in the control group.The blood gas analysis and pulmonary function were monitored and recorded before and 14 days after treatment.A skeletal muscle biopsy was performed 14 days after therapy.The mRNA expression of ribosomal protein S21(RPS21)and ubiquitin in skeletal muscle cell were measured by RT-PCR.Results:After 14 days treatment,the levels of PaCO_(2),PaO_(2),PH and FEV_(1)% in the NIPPV group improved much better than in the control group(p<.05).The gene expression of RPS21 and ubiquitin was obviously lower in the study group than in the control group(p<.05).The level of RPS21 was negatively related with PaO_(2),PH and FEV1%,and the level of ubiquitin was negatively related with PaO_(2) and FEV1%,but positively correlated with PaCO_(2).The area under the ROC curves of RPS21,ubiquitin,PaCO_(2) and FEV_(1)% were 0.771,0.885,0.821 and 0.734 respectively in the study group.The cut-off points were 103.978,8.128,45.350 and 51.350 respectively.The sensitivity evaluation of acid poisoning was 90.9%,and the specificities for each were 75%,75%,50% and 50%.Conclusions:NIPPV is effective for AECOPD patients through the gene expression of ubiquitin system of skeletal muscle.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 in...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 mortalityⅢ(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-Ⅲscores.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
Objective: To investigate the effect of extracorporeal diaphragmatic pacing combined with noninvasive ventilators on the respiratory function and prognosis of chronic obstructive pulmonary disease (COPD) patients. Met...Objective: To investigate the effect of extracorporeal diaphragmatic pacing combined with noninvasive ventilators on the respiratory function and prognosis of chronic obstructive pulmonary disease (COPD) patients. Methods: A total of 50 COPD patients were selected between January 2023 to December 2023 and randomly grouped into an observation group and a control group, with 25 cases. The observation group was given extracorporeal diaphragm pacing combined with a noninvasive ventilator, while the control group was given a conventional treatment mode. After the treatment, the results of each index in the two groups were compared. Results: Compared with the diaphragm function indexes of the two groups, the data of the observation group were more dominant (P < 0.05). The rehospitalization rate of the observation group was lower than that of the control group (P < 0.05). The COPD assessment test (CAT) and mMRC (Modified Medical Research Council) Dyspnoea scale scores after treatment between the two groups were significantly different (P < 0.05). Compared with the control group, the lung function indexes of the observation group were more dominant (P < 0.05). Conclusion: Extracorporeal diaphragmatic pacing combined with a noninvasive ventilator promoted the improvement of the patient’s prognosis and improved their respiratory function.展开更多
For the critically ill patients with COPD, in order to do a good job of nursing, the article investigates the application effect of nursing intervention on pressure sore caused by non-invasive positive pressure ventil...For the critically ill patients with COPD, in order to do a good job of nursing, the article investigates the application effect of nursing intervention on pressure sore caused by non-invasive positive pressure ventilation. 170 patients in our hospital were selected and the staffs were randomly divided into control group and observation group with equal number of cases. The nursing staff adopted conventional methods to carry out the nursing observation of the patients in the control group. On this basis, combined with the non-invasive positive pressure ventilation pressure sore nursing intervention model, the nursing research of the observation group was carried out. Then, the occurrence probability of pressure sore and nursing satisfaction of the patients in the two groups were compared. For the two groups of patients' nursing satisfaction, the observation group patients' nursing satisfaction was 97.65%, significantly higher than the control group 80.00%, while the observation group's pressure sore incidence rate was 2.35%, the control group's pressure sore incidence rate was 21.18%, data comparison, the observation group's pressure sore incidence rate was significantly lower, the difference between the groups was statistically significant (p < 0.05). It can be seen from this that in order to do a good job in the nursing of critically ill patients with COPD, it is extremely critical for the nursing staff to adopt the non-invasive positive pressure ventilation pressure sore nursing mode. On the basis of keeping close contact with the patients, the occurrence rate of pressure sores can be fundamentally reduced, and the nursing satisfaction of the patients can be comprehensively improved.展开更多
Objective: To investigate the efficacy, safety and nursing improvement of noninvasive positive pressure ventilation (NPPV) in high-risk patients with acute respiratory failure after cardiac surgery. Methods: From Sept...Objective: To investigate the efficacy, safety and nursing improvement of noninvasive positive pressure ventilation (NPPV) in high-risk patients with acute respiratory failure after cardiac surgery. Methods: From September 2018 to October 2019, high-risk patients who may develop acute respiratory failure after cardiac surgery were selected and randomly divided into non-invasive ventilation group and conventional treatment group (control group). The reintubation rate, tracheotomy rate, fatality rate, 24 h intake and output, respiratory rate, arterial blood gas PaO2 and PaCO2 were compared between the two groups of patients;at the same time, the patient comfort and mask leakage after improved nursing technology were compared. Results: The preoperative and intraoperative conditions of the two groups of patients were basically similar, but the reintubation rate, tracheotomy rate, fatality rate, and respiratory rate of the patients in the preventive application of NPPV group were significantly lower than those of the control group, and the 24 h input and output and arterial blood gas PaO2 were also excellent in the control group. Conclusion: NPPV used prophylactically in high-risk patients after cardiac surgery can significantly reduce the re-intubation rate, improve patient outcomes, and is markedly more effective than the conventional treatment group.展开更多
Objective: in this study, patients with severe pulmonary infection were treated with non-invasive positive pressure ventilation, so as to further control the development of the disease and improve pulmonary function i...Objective: in this study, patients with severe pulmonary infection were treated with non-invasive positive pressure ventilation, so as to further control the development of the disease and improve pulmonary function indexes. Methods: 80 cases of patients admitted to our hospital diagnosed with severe pulmonary infection were selected as the subjects of this study. The treatment time range was from January 2016 to December 2020. Patients in the control group were treated with conventional treatment measures, while the observation group was treated with non-invasive positive pressure ventilation, and the treatment results were compared. Results: in terms of treatment, the observation group had good curative effect, and the statistical results of oxygen partial pressure, carbon dioxide partial pressure and respiratory rate were different (P < 0.05). Meanwhile, in the comparison of the levels of CRP, TNF-α, IL-6 and IL-8 inflammatory cytokines, the data of the observation group were better than the control group, and the difference was statistically significant. Finally, the total effective rate of the observation group was 95.0%, while that of the control group was 87.5%, and the comparison was statistically significant. Conclusion: the use of non-invasive positive pressure ventilation program has good curative effect, and helps to improve the patients' qi and blood indexes and respiratory rate. At the same time, it helps to alleviate the inflammatory reaction, and patients' rehabilitation treatment is consolidated, which has the value of generalization.展开更多
This review, based on relevant published evidence and the authors` clinical experience, presents how to evaluate a patient with acute respiratory failure requiring ventilatory support. This patient must be carefully e...This review, based on relevant published evidence and the authors` clinical experience, presents how to evaluate a patient with acute respiratory failure requiring ventilatory support. This patient must be carefully evaluated by nurses, physiotherapists, respiratory care practitioners and physicians regarding the elucidation of the cause of the acute episode of respiratory failure by means of physical examination with the measurement of respiratory parameters and assessment of arterial blood gases analysis to make a correct respiratory diagnosis. After the initial evaluation, the patient must quickly receive adequate oxygen and ventilatory support that has to be carefully monitored until its discontinuation. When available, a noninvasive ventilation trial must be done in patients presenting desaturation during oxygen mask and or PaCO2 retention, especially in cases of cardiogenic pulmonary edema and severe exacerbation of chronic obstructive pulmonary disease. In cases of noninvasive ventilation trial-failure, endotracheal intubation and invasive protective mechanical ventilation must be promptly initiated. In severe ARDS patients, low tidal ventilation, higher PEEP levels, prone positioning and recruitment maneuvers with adequate PEEP titration should be used. Recently, new modes of ventilation should allow a better patient-ventilator interaction or synchrony permitting a sufficient unloading of respiratory muscles and increase patient comfort. Patients with chronic obstructive pulmonary disease may be considered for a trial for early extubation to noninvasive positive pressure ventilation in centers with extensive experience in noninvasive positive pressure ventilation.展开更多
BACKGROUND The optimal treatment for heart failure(HF)is a combination of appropriate medications.Controlling the disease using only medical therapy is difficult in patients with HF,severe hypercapnia,and desaturation...BACKGROUND The optimal treatment for heart failure(HF)is a combination of appropriate medications.Controlling the disease using only medical therapy is difficult in patients with HF,severe hypercapnia,and desaturation.These patients should first receive ventilator support followed by pulmonary rehabilitation(PR).CASE SUMMARY We report two cases in which arterial blood gas(ABG)improved and PR was possible with appropriate ventilator support.Two patients with extreme obesity complaining of worsening dyspnea–a 47-year-old woman and a 36-year-old man both diagnosed with HF–were hospitalized because of severe hypercapnia and hypoxia.Despite proper medical treatment,hypercapnia and desaturation resolved in neither case,and both patients were transferred to the rehabilitation department for PR.At the time of the first consultation,the patients were bedridden because of dyspnea.Oxygen demand was successfully reduced once noninvasive ventilation was initiated.As the patients’dyspnea gradually improved to the point where they could be weaned off the ventilator during the daytime,they started engaging in functional training and aerobic exercise.After 4 mo of followup,both patients were able to perform activities of daily living and maintain their lower body weight and normalized ABG levels.CONCLUSION Symptoms of patients with obesity and HF may improve once ABG levels are normalized through ventilator support and implementation of PR.展开更多
BACKGROUND Sleep-disordered breathing,including hypoventilation and obstructive sleep apnea,is often observed in Prader-Willi syndrome(PWS).Particularly in adolescence,scoliosis causes a progressive restrictive pulmon...BACKGROUND Sleep-disordered breathing,including hypoventilation and obstructive sleep apnea,is often observed in Prader-Willi syndrome(PWS).Particularly in adolescence,scoliosis causes a progressive restrictive pulmonary pattern,leading to hypoventilation,so timely corrective surgery is required.However,the effect is controversial.In addition,since mental retardation of PWS,patient effort-based respiratory tests may be less reliable.So far,no studies have accurately reported on the comparison of respiratory function before and after corrective surgery,and appropriate respiratory function measurement method in PWS.CASE SUMMARY We present two cases of adolescent PWS with typical characteristics,including obesity,mental retardation,and scoliosis.Two boys,aged 12 and 13,diagnosed with PWS,both underwent scoliosis correction surgery.Before and immediately after surgery,arterial blood tests showed no abnormalities and no respiratory symptoms occurred.However,after 6-7 mo,both patients complained of daytime sleepiness,difficulty sleeping at night,dyspnea on exertion,and showed cyanosis.Hypercapnia and hypoxia were confirmed by polysomnography and transcutaneous CO2 monitoring during sleep and were diagnosed with obstructive sleep apnea and alveolar hypoventilation.It was corrected by nighttime noninvasive ventilation application and normal findings of arterial blood gas were maintained after 6-8 mo follow-up.CONCLUSION Even after scoliosis surgery,“periodic”monitoring of respiratory failure with an“objective”test method is needed for timely respiratory support.展开更多
Leptospiroisis presents with a wide range of clinical symptoms, ranging from mild disease symptoms to life threatening complications. The clinical features and routine laboratory findings are not specific, and therefo...Leptospiroisis presents with a wide range of clinical symptoms, ranging from mild disease symptoms to life threatening complications. The clinical features and routine laboratory findings are not specific, and therefore a high index of suspicion must be maintained for the diagnosis. We documented a case of a patient, who presented with high grade fever, diarrhea, vomiting, had icterus on examination. Initial laboratory investigations revealed low platelet count, along with raised liver enzymes. IgM leptospirosis came positive and patients received broad spectrum antimicrobials and supportive fluid therapy. During admission, patient developed sudden onset breathlessness, which was diagnosed as acute respiratory distress syndrome after doing immediate arterial blood gases. The patient received noninvasive ventilation with positive airway pressure, from which the patient eventually recovered. Most of the cases of leptospirosis are uneventful with complete recovery. However, a minority of these cases may end with life threatening complications. A vaccine for human use is not available in most countries. Therefore, the prevention involves reducing exposure, either by avoiding situations that pose a risk of transmission or using protective clothing.展开更多
We aimed to investigate the risk factors and reason for initiation of high-flow nasal cannula (HFNC), its benefit on re-intubation rate, mortality, and length of stay (LOS) in the postoperative cardiac surgery patient...We aimed to investigate the risk factors and reason for initiation of high-flow nasal cannula (HFNC), its benefit on re-intubation rate, mortality, and length of stay (LOS) in the postoperative cardiac surgery patient in the ICU. Methods: In a retrospective and descriptive study, 200 patients, who underwent cardiac surgery, were randomly included, and screened for initiation of postoperative respiratory support. Demographic patient data and pre-operative patient measurements were sampled. Data concerning the P/F ratio at arrival- and post-extubation, LOS at ICU and overall mortality were sampled. A comparison of those variables was performed between patients with and without need of respiratory support. Results: HFNC was initiated in approximately 22.45% in 2018, and 25% in 2020, of the patients. Comparing both years didn’t reveal a significant rise, but we saw a quicker use of HFNC in 2020. The all-case re-intubation rate and mortality was approximately 3%. The body mass index (BMI) was the only correlation with a higher chance of initiation of HFNC. Other data like age, pre-operative renal- or left ventricle function didn’t show a correlation. Conclusion: In case of respiratory insufficiency in the postoperative cardiac surgery setting, HFNC is a worthy first line treatment option which is initiated if conventional oxygen therapy doesn’t suffice. The mortality was low, and the mean LOS was 4.38 days. If respiratory support was started with HFNC mean LOS rose to 8.35 days. The BMI seems to have a correlation with the development of respiratory failure, which confirms the latest recommendation to start preventive HFNC in the post-extubation cardiac surgery setting and which could be implemented in the daily practice.展开更多
Objective: to study the treatment of hypoxemia in patients with septic shock. Methods: 150 patients with septic shock treated in our hospital from January 2020 to July 2021 were divided into 3 groups according to the ...Objective: to study the treatment of hypoxemia in patients with septic shock. Methods: 150 patients with septic shock treated in our hospital from January 2020 to July 2021 were divided into 3 groups according to the severity of hypoxemia. All patients received comprehensive treatment, and the blood gas indexes of patients before and after treatment were compared;Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) before resuscitation, 1d and 7d after resuscitation. Results: compared with that before treatment, the above index levels of patients after treatment were significantly improved, P < 0.05. Conclusion: in the clinical treatment of patients with hypoxemia caused by concentration shock, comprehensive treatment methods, especially oxygen therapy, non-invasive intermittent positive pressure breathing therapy, fluid resuscitation therapy and hyperbaric oxygen chamber treatment, can quickly correct the hypoxemia of patients and reduce the body damage, which is worth learning from.展开更多
Background Although severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation （NPPV）, increasing clinical reports showed it was effective in patie...Background Although severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation （NPPV）, increasing clinical reports showed it was effective in patients with impaired consciousness and even coma secondary to acute respiratory failure, especially hypercapnic acute respiratory failure （HARF）. To further evaluate the effectiveness and safety of NPPV for severe hypercapnic encephalopathy, a prospective case-control study was conducted at a university respiratory intensive care unit （RICU） in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） during the past 3 years. Methods Forty-three of 68 consecutive AECOPD patients requiring ventilatory support for HARF were divided into 2 groups, which were carefully matched for age, sex, COPD course, tobacco use and previous hospitalization history, according to the severity of encephalopathy, 22 patients with Glasgow coma scale （GCS） 〈10 served as group A and 21 with GCS 〉10 as group B. Results Compared with group B, group A had a higher level of baseline arterial partial CO2 pressure （（102±27） mmHg vs （74±17） mmHg, P〈0.01）, lower levels of GCS （7.5±1.9 vs 12.2±1.8, P〈0.01）, arterial pH value （7.18±0.06 vs 7.28±0.07, P〈0.01） and partial 02 pressure/fraction of inspired 02 ratio （168±39 vs 189±33, P〈0.05）. The NPPV success rate and hospital mortality were 73% （16/22） and 14% （3/22） respectively in group A, which were comparable to those in group B （68% （15/21） and 14% （3/21） respectively, all P〉0.05）, but group A needed an average of 7 cmH20 higher of maximal pressure support during NPPV, and 4, 4 and 7 days longer of NPPV time, RICU stay and hospital stay respectively than group B （P〈0.05 or P〈0.01）. NPPV therapy failed in 12 patients （6 in each group） because of excessive airway secretions （7 patients）, hemodynamic instability （2）, worsening of dyspnea and deterioration of gas exchange （2）, and gastric content aspiration （1）. Conclusions Selected patients with severe hypercapnic encephalopathy secondary to HARF can be treated as effectively and safely with NPPV as awake patients with HARF due to AECOPD; a trial of NPPV should be instituted to reduce the need of endotracheal intubation in patients with severe hypercapnic encephalopathy who are otherwise good candidates for NPPV due to AECOPD.展开更多
Background This meta-analysis evaluated the effect of noninvasive, positive pressure ventilation on severe, stable chronic obstructive pulmonary disease （COPD）. Methods PUBMED, CNKI, Wanfang, EMBASE and the Cochrane...Background This meta-analysis evaluated the effect of noninvasive, positive pressure ventilation on severe, stable chronic obstructive pulmonary disease （COPD）. Methods PUBMED, CNKI, Wanfang, EMBASE and the Cochrane trials databases were searched. Randomized controlled trials of patients with severe, stable COPD and receiving noninvasive positive pressure ventilation, compared with sham ventilation or no ventilation, were reviewed. The mortality, physiological and health related parameters were pooled to yield odds ratio （OR）, weighted mean differences or standardized mean differences （SMD）, with 95% confidence interval （CI）. Results Eight parallel and three crossover randomized controlled trials met the inclusion criteria. Pooled analysis for parallel, randomized controlled trials showed noninvasive positive pressure ventilation： （1） Did not affect the 12- or 24-month mortality （OR 0.82, 95% Ch 0.48 to 1.41）; （2） Improved the arterial carbon dioxide tension （SMD -0.88, 95% Ch -1.43 to -0.34）; （3） Did not improve forced expiratory volume in one second （SMD 0.20, 95% CI： -0.06 to 0.46）, maximal inspiratory pressure （SMD 0.01, 95% Ch -0.28 to 0.29） or 6-minute walk distance （SMD 0.17, 95% Ch -0.16 to 0.50）; （4） Subgroup analysis showed noninvasive positive pressure ventilation improved the arterial carbon dioxide tension in hypercapnic patients. Pooled analysis for crossover randomized controlled trials did not show improvement in arterial blood gas or forced expiratory volume in one second with noninvasive positive pressure ventilation. Conclusions Noninvasive positive pressure ventilation improves the arterial carbon dioxide tension but does not improve the mortality, pulmonary function, or exercise tolerance and should be cautiously used in severe stable chronic obstructive pulmonary disease.展开更多
文摘BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid era,but direct head-to-head cost comparisons between the two modalities are not available in literature.AIM To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.METHODS A prospective observational single-center case control study including adult patients with ARF(PaO2/FiO2 ratio<300)admitted from January 1,2024 to December 31,2024 in medical intensive care unit(ICU)of a tertiary care hospital requiring either NIV or invasive ventilation.NIV and IMV groups were compared based on average length of ICU and hospital stay,mortality,net cost of ICU treatment,need for intubation and tracheostomy.RESULTS A total of 319 patients were included in the study(197 in NIV,122 in IMV group).Statistically significant difference in length of ICU stay(NIV group:5±3.25 days,IMV group:9±2.6 days;P<0.05)and mortality rate was seen(11%NIV vs 34%IMV;P<0.01).On multivariate analyses,mortality showed a stronger association with IMV[odds ratio(OR)=7.73;95%CI:3.12-19.18]as compared to ICU stay(OR=2.73;95%CI:2.15-3.48).A total of 33 patients(17%)in NIV group required intubation of which 3 were tracheostomized,while 14 patients(11%)in IMV group needed tracheostomy.The net average cost of ICU stay was₹83902 in NIV group while in IMV group,the net ICU cost was₹476216.The average cost of ICU stay was five times higher with IMV.CONCLUSION NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.
文摘BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.
文摘BACKGROUND Noninvasive ventilation(NIV)reduces intubation rates,mortalities,and lengths of hospital and intensive care unit stays in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Helmet-based NIV is better tolerated than oronasal mask-based ventilation,and thus,allows NIV to be conducted for prolonged periods at higher pressures with minimal air leaks.CASE SUMMARY A 73-year-old man with a previous diagnosis of COPD stage 4 was admitted to our medical intensive care unit with chief complaints of cough,sputum,and dyspnea of several days’duration.For 10 mo,he had been on oxygen at home by day and had used an oronasal mask-based NIV at night.At intensive care unit admission,he breathed using respiratory accessory muscles.Hypercapnia and signs of infection were detected,and infiltration was observed in the right lower lung field by chest radiography.Thus,we diagnosed AECOPD by communityacquired pneumonia.After admission,respiratory distress steadily deteriorated and invasive mechanical ventilation became necessary.However,the patient refused this option,and thus,we selected helmet-based NIV as a salvage treatment.After 3 d of helmet-based NIV,his consciousness level and hypercapnia recovered to his pre-hospitalization level.CONCLUSION Helmet-based NIV could be considered as a salvage treatment when AECOPD patients refuse invasive mechanical ventilation and oronasal mask-based NIV is ineffective.
文摘Objective: To establish the effectiveness of noninvasive ventilation in cancer children with acute respiratory failure. <br> Methods: The data of 33 cancer patients were obtained prospectively from six different pediatric intensive care units in Turkey between the years of 2012 and 2013. <br> Results: The diagnosis was leukemias in 25 (75.8%), lymphomas in 3 (9.1%) and other solid tumors in 5 (15.1%) patients. Pneumonia in 12 (36.3%) and sepsis in 15 (45.4%) patients were seen as the common reasons of respiratory failure. The mean PaO2/FiO2 ratios were (164.22 ± 37.24) and (126.80 ± 42.73) in noninvasive ventilation success and failure group, respectively. Noninvasive ventilation was successful in 18 (54.5%) patients. The failure group consisted of 15 patients required intubation. A total of 14 (42.4%) patients died. The clinical outcome in terms of success and failure was meaningful statistically (P = 0.0 00 1). <br> Conclusions: Our results could encourage the use of noninvasive ventilation in children with cancer who develop acute respiratory failure. It should be considered as a useful therapeutic approach to avoid endotracheal intubation.
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 To characterize pediatric patients supported with continuous positive airway pressure and bilevel positive airway pressure(CPAP/BiPAP)or high-flow nasal cannula(HFNC)during interfacility transport(IFT).Methods A retrospective study with a provincial pediatric transport team from a tertiary hospital pediatric intensive care unit.Pediatric patients aged 28 days to<17 years,who required IFT between January 2017 and December 2018,were identified through a transport registry and were included in the study.Results A total of 118(26.7%)patients received CPAP/BIPAP or HFNC support for IFT.The most common respiratory diagnosis was bronchiolitis(46%).These patients were placed on respiratory support,31.4 minutes after the transport team’s arrival.None required intubation during their IFT,despite mean transport times of 163 minutes.Conclusions This study may provide important information for programs with large catchment areas,in which large distances and transport times should not be barriers to NIV implementation.
文摘Objective:To investigate the change and relativity of noninvasive positive pressure ventilation(NIPPV)on the gene expression of ubiquitin system of skeletal muscle in patient with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:80 patients with AECOPD were divided into two groups based on whether the NIPPV treatment was given or not,38 cases in the study group and 42 in the control group.The blood gas analysis and pulmonary function were monitored and recorded before and 14 days after treatment.A skeletal muscle biopsy was performed 14 days after therapy.The mRNA expression of ribosomal protein S21(RPS21)and ubiquitin in skeletal muscle cell were measured by RT-PCR.Results:After 14 days treatment,the levels of PaCO_(2),PaO_(2),PH and FEV_(1)% in the NIPPV group improved much better than in the control group(p<.05).The gene expression of RPS21 and ubiquitin was obviously lower in the study group than in the control group(p<.05).The level of RPS21 was negatively related with PaO_(2),PH and FEV1%,and the level of ubiquitin was negatively related with PaO_(2) and FEV1%,but positively correlated with PaCO_(2).The area under the ROC curves of RPS21,ubiquitin,PaCO_(2) and FEV_(1)% were 0.771,0.885,0.821 and 0.734 respectively in the study group.The cut-off points were 103.978,8.128,45.350 and 51.350 respectively.The sensitivity evaluation of acid poisoning was 90.9%,and the specificities for each were 75%,75%,50% and 50%.Conclusions:NIPPV is effective for AECOPD patients through the gene expression of ubiquitin system of skeletal muscle.
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 mortalityⅢ(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-Ⅲscores.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.
文摘Objective: To investigate the effect of extracorporeal diaphragmatic pacing combined with noninvasive ventilators on the respiratory function and prognosis of chronic obstructive pulmonary disease (COPD) patients. Methods: A total of 50 COPD patients were selected between January 2023 to December 2023 and randomly grouped into an observation group and a control group, with 25 cases. The observation group was given extracorporeal diaphragm pacing combined with a noninvasive ventilator, while the control group was given a conventional treatment mode. After the treatment, the results of each index in the two groups were compared. Results: Compared with the diaphragm function indexes of the two groups, the data of the observation group were more dominant (P < 0.05). The rehospitalization rate of the observation group was lower than that of the control group (P < 0.05). The COPD assessment test (CAT) and mMRC (Modified Medical Research Council) Dyspnoea scale scores after treatment between the two groups were significantly different (P < 0.05). Compared with the control group, the lung function indexes of the observation group were more dominant (P < 0.05). Conclusion: Extracorporeal diaphragmatic pacing combined with a noninvasive ventilator promoted the improvement of the patient’s prognosis and improved their respiratory function.
文摘For the critically ill patients with COPD, in order to do a good job of nursing, the article investigates the application effect of nursing intervention on pressure sore caused by non-invasive positive pressure ventilation. 170 patients in our hospital were selected and the staffs were randomly divided into control group and observation group with equal number of cases. The nursing staff adopted conventional methods to carry out the nursing observation of the patients in the control group. On this basis, combined with the non-invasive positive pressure ventilation pressure sore nursing intervention model, the nursing research of the observation group was carried out. Then, the occurrence probability of pressure sore and nursing satisfaction of the patients in the two groups were compared. For the two groups of patients' nursing satisfaction, the observation group patients' nursing satisfaction was 97.65%, significantly higher than the control group 80.00%, while the observation group's pressure sore incidence rate was 2.35%, the control group's pressure sore incidence rate was 21.18%, data comparison, the observation group's pressure sore incidence rate was significantly lower, the difference between the groups was statistically significant (p < 0.05). It can be seen from this that in order to do a good job in the nursing of critically ill patients with COPD, it is extremely critical for the nursing staff to adopt the non-invasive positive pressure ventilation pressure sore nursing mode. On the basis of keeping close contact with the patients, the occurrence rate of pressure sores can be fundamentally reduced, and the nursing satisfaction of the patients can be comprehensively improved.
文摘Objective: To investigate the efficacy, safety and nursing improvement of noninvasive positive pressure ventilation (NPPV) in high-risk patients with acute respiratory failure after cardiac surgery. Methods: From September 2018 to October 2019, high-risk patients who may develop acute respiratory failure after cardiac surgery were selected and randomly divided into non-invasive ventilation group and conventional treatment group (control group). The reintubation rate, tracheotomy rate, fatality rate, 24 h intake and output, respiratory rate, arterial blood gas PaO2 and PaCO2 were compared between the two groups of patients;at the same time, the patient comfort and mask leakage after improved nursing technology were compared. Results: The preoperative and intraoperative conditions of the two groups of patients were basically similar, but the reintubation rate, tracheotomy rate, fatality rate, and respiratory rate of the patients in the preventive application of NPPV group were significantly lower than those of the control group, and the 24 h input and output and arterial blood gas PaO2 were also excellent in the control group. Conclusion: NPPV used prophylactically in high-risk patients after cardiac surgery can significantly reduce the re-intubation rate, improve patient outcomes, and is markedly more effective than the conventional treatment group.
文摘Objective: in this study, patients with severe pulmonary infection were treated with non-invasive positive pressure ventilation, so as to further control the development of the disease and improve pulmonary function indexes. Methods: 80 cases of patients admitted to our hospital diagnosed with severe pulmonary infection were selected as the subjects of this study. The treatment time range was from January 2016 to December 2020. Patients in the control group were treated with conventional treatment measures, while the observation group was treated with non-invasive positive pressure ventilation, and the treatment results were compared. Results: in terms of treatment, the observation group had good curative effect, and the statistical results of oxygen partial pressure, carbon dioxide partial pressure and respiratory rate were different (P < 0.05). Meanwhile, in the comparison of the levels of CRP, TNF-α, IL-6 and IL-8 inflammatory cytokines, the data of the observation group were better than the control group, and the difference was statistically significant. Finally, the total effective rate of the observation group was 95.0%, while that of the control group was 87.5%, and the comparison was statistically significant. Conclusion: the use of non-invasive positive pressure ventilation program has good curative effect, and helps to improve the patients' qi and blood indexes and respiratory rate. At the same time, it helps to alleviate the inflammatory reaction, and patients' rehabilitation treatment is consolidated, which has the value of generalization.
文摘This review, based on relevant published evidence and the authors` clinical experience, presents how to evaluate a patient with acute respiratory failure requiring ventilatory support. This patient must be carefully evaluated by nurses, physiotherapists, respiratory care practitioners and physicians regarding the elucidation of the cause of the acute episode of respiratory failure by means of physical examination with the measurement of respiratory parameters and assessment of arterial blood gases analysis to make a correct respiratory diagnosis. After the initial evaluation, the patient must quickly receive adequate oxygen and ventilatory support that has to be carefully monitored until its discontinuation. When available, a noninvasive ventilation trial must be done in patients presenting desaturation during oxygen mask and or PaCO2 retention, especially in cases of cardiogenic pulmonary edema and severe exacerbation of chronic obstructive pulmonary disease. In cases of noninvasive ventilation trial-failure, endotracheal intubation and invasive protective mechanical ventilation must be promptly initiated. In severe ARDS patients, low tidal ventilation, higher PEEP levels, prone positioning and recruitment maneuvers with adequate PEEP titration should be used. Recently, new modes of ventilation should allow a better patient-ventilator interaction or synchrony permitting a sufficient unloading of respiratory muscles and increase patient comfort. Patients with chronic obstructive pulmonary disease may be considered for a trial for early extubation to noninvasive positive pressure ventilation in centers with extensive experience in noninvasive positive pressure ventilation.
基金Supported by The“Research Base Construction Fund Support Program”funded by Jeonbuk National University in 2021.
文摘BACKGROUND The optimal treatment for heart failure(HF)is a combination of appropriate medications.Controlling the disease using only medical therapy is difficult in patients with HF,severe hypercapnia,and desaturation.These patients should first receive ventilator support followed by pulmonary rehabilitation(PR).CASE SUMMARY We report two cases in which arterial blood gas(ABG)improved and PR was possible with appropriate ventilator support.Two patients with extreme obesity complaining of worsening dyspnea–a 47-year-old woman and a 36-year-old man both diagnosed with HF–were hospitalized because of severe hypercapnia and hypoxia.Despite proper medical treatment,hypercapnia and desaturation resolved in neither case,and both patients were transferred to the rehabilitation department for PR.At the time of the first consultation,the patients were bedridden because of dyspnea.Oxygen demand was successfully reduced once noninvasive ventilation was initiated.As the patients’dyspnea gradually improved to the point where they could be weaned off the ventilator during the daytime,they started engaging in functional training and aerobic exercise.After 4 mo of followup,both patients were able to perform activities of daily living and maintain their lower body weight and normalized ABG levels.CONCLUSION Symptoms of patients with obesity and HF may improve once ABG levels are normalized through ventilator support and implementation of PR.
文摘BACKGROUND Sleep-disordered breathing,including hypoventilation and obstructive sleep apnea,is often observed in Prader-Willi syndrome(PWS).Particularly in adolescence,scoliosis causes a progressive restrictive pulmonary pattern,leading to hypoventilation,so timely corrective surgery is required.However,the effect is controversial.In addition,since mental retardation of PWS,patient effort-based respiratory tests may be less reliable.So far,no studies have accurately reported on the comparison of respiratory function before and after corrective surgery,and appropriate respiratory function measurement method in PWS.CASE SUMMARY We present two cases of adolescent PWS with typical characteristics,including obesity,mental retardation,and scoliosis.Two boys,aged 12 and 13,diagnosed with PWS,both underwent scoliosis correction surgery.Before and immediately after surgery,arterial blood tests showed no abnormalities and no respiratory symptoms occurred.However,after 6-7 mo,both patients complained of daytime sleepiness,difficulty sleeping at night,dyspnea on exertion,and showed cyanosis.Hypercapnia and hypoxia were confirmed by polysomnography and transcutaneous CO2 monitoring during sleep and were diagnosed with obstructive sleep apnea and alveolar hypoventilation.It was corrected by nighttime noninvasive ventilation application and normal findings of arterial blood gas were maintained after 6-8 mo follow-up.CONCLUSION Even after scoliosis surgery,“periodic”monitoring of respiratory failure with an“objective”test method is needed for timely respiratory support.
文摘Leptospiroisis presents with a wide range of clinical symptoms, ranging from mild disease symptoms to life threatening complications. The clinical features and routine laboratory findings are not specific, and therefore a high index of suspicion must be maintained for the diagnosis. We documented a case of a patient, who presented with high grade fever, diarrhea, vomiting, had icterus on examination. Initial laboratory investigations revealed low platelet count, along with raised liver enzymes. IgM leptospirosis came positive and patients received broad spectrum antimicrobials and supportive fluid therapy. During admission, patient developed sudden onset breathlessness, which was diagnosed as acute respiratory distress syndrome after doing immediate arterial blood gases. The patient received noninvasive ventilation with positive airway pressure, from which the patient eventually recovered. Most of the cases of leptospirosis are uneventful with complete recovery. However, a minority of these cases may end with life threatening complications. A vaccine for human use is not available in most countries. Therefore, the prevention involves reducing exposure, either by avoiding situations that pose a risk of transmission or using protective clothing.
文摘We aimed to investigate the risk factors and reason for initiation of high-flow nasal cannula (HFNC), its benefit on re-intubation rate, mortality, and length of stay (LOS) in the postoperative cardiac surgery patient in the ICU. Methods: In a retrospective and descriptive study, 200 patients, who underwent cardiac surgery, were randomly included, and screened for initiation of postoperative respiratory support. Demographic patient data and pre-operative patient measurements were sampled. Data concerning the P/F ratio at arrival- and post-extubation, LOS at ICU and overall mortality were sampled. A comparison of those variables was performed between patients with and without need of respiratory support. Results: HFNC was initiated in approximately 22.45% in 2018, and 25% in 2020, of the patients. Comparing both years didn’t reveal a significant rise, but we saw a quicker use of HFNC in 2020. The all-case re-intubation rate and mortality was approximately 3%. The body mass index (BMI) was the only correlation with a higher chance of initiation of HFNC. Other data like age, pre-operative renal- or left ventricle function didn’t show a correlation. Conclusion: In case of respiratory insufficiency in the postoperative cardiac surgery setting, HFNC is a worthy first line treatment option which is initiated if conventional oxygen therapy doesn’t suffice. The mortality was low, and the mean LOS was 4.38 days. If respiratory support was started with HFNC mean LOS rose to 8.35 days. The BMI seems to have a correlation with the development of respiratory failure, which confirms the latest recommendation to start preventive HFNC in the post-extubation cardiac surgery setting and which could be implemented in the daily practice.
文摘Objective: to study the treatment of hypoxemia in patients with septic shock. Methods: 150 patients with septic shock treated in our hospital from January 2020 to July 2021 were divided into 3 groups according to the severity of hypoxemia. All patients received comprehensive treatment, and the blood gas indexes of patients before and after treatment were compared;Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) before resuscitation, 1d and 7d after resuscitation. Results: compared with that before treatment, the above index levels of patients after treatment were significantly improved, P < 0.05. Conclusion: in the clinical treatment of patients with hypoxemia caused by concentration shock, comprehensive treatment methods, especially oxygen therapy, non-invasive intermittent positive pressure breathing therapy, fluid resuscitation therapy and hyperbaric oxygen chamber treatment, can quickly correct the hypoxemia of patients and reduce the body damage, which is worth learning from.
文摘Background Although severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation （NPPV）, increasing clinical reports showed it was effective in patients with impaired consciousness and even coma secondary to acute respiratory failure, especially hypercapnic acute respiratory failure （HARF）. To further evaluate the effectiveness and safety of NPPV for severe hypercapnic encephalopathy, a prospective case-control study was conducted at a university respiratory intensive care unit （RICU） in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） during the past 3 years. Methods Forty-three of 68 consecutive AECOPD patients requiring ventilatory support for HARF were divided into 2 groups, which were carefully matched for age, sex, COPD course, tobacco use and previous hospitalization history, according to the severity of encephalopathy, 22 patients with Glasgow coma scale （GCS） 〈10 served as group A and 21 with GCS 〉10 as group B. Results Compared with group B, group A had a higher level of baseline arterial partial CO2 pressure （（102±27） mmHg vs （74±17） mmHg, P〈0.01）, lower levels of GCS （7.5±1.9 vs 12.2±1.8, P〈0.01）, arterial pH value （7.18±0.06 vs 7.28±0.07, P〈0.01） and partial 02 pressure/fraction of inspired 02 ratio （168±39 vs 189±33, P〈0.05）. The NPPV success rate and hospital mortality were 73% （16/22） and 14% （3/22） respectively in group A, which were comparable to those in group B （68% （15/21） and 14% （3/21） respectively, all P〉0.05）, but group A needed an average of 7 cmH20 higher of maximal pressure support during NPPV, and 4, 4 and 7 days longer of NPPV time, RICU stay and hospital stay respectively than group B （P〈0.05 or P〈0.01）. NPPV therapy failed in 12 patients （6 in each group） because of excessive airway secretions （7 patients）, hemodynamic instability （2）, worsening of dyspnea and deterioration of gas exchange （2）, and gastric content aspiration （1）. Conclusions Selected patients with severe hypercapnic encephalopathy secondary to HARF can be treated as effectively and safely with NPPV as awake patients with HARF due to AECOPD; a trial of NPPV should be instituted to reduce the need of endotracheal intubation in patients with severe hypercapnic encephalopathy who are otherwise good candidates for NPPV due to AECOPD.
基金This study was supported by grants from the Natural Science Foundation of Jiangsu Province （No. BK2009318 and No. SBK201123521）, China Postdoctoral Science Foundation （No. 20100471844 and No. 201104792）, and Medical Technology Innovation Foundation of Nanjing Military Command （No. 09Z028）.
文摘Background This meta-analysis evaluated the effect of noninvasive, positive pressure ventilation on severe, stable chronic obstructive pulmonary disease （COPD）. Methods PUBMED, CNKI, Wanfang, EMBASE and the Cochrane trials databases were searched. Randomized controlled trials of patients with severe, stable COPD and receiving noninvasive positive pressure ventilation, compared with sham ventilation or no ventilation, were reviewed. The mortality, physiological and health related parameters were pooled to yield odds ratio （OR）, weighted mean differences or standardized mean differences （SMD）, with 95% confidence interval （CI）. Results Eight parallel and three crossover randomized controlled trials met the inclusion criteria. Pooled analysis for parallel, randomized controlled trials showed noninvasive positive pressure ventilation： （1） Did not affect the 12- or 24-month mortality （OR 0.82, 95% Ch 0.48 to 1.41）; （2） Improved the arterial carbon dioxide tension （SMD -0.88, 95% Ch -1.43 to -0.34）; （3） Did not improve forced expiratory volume in one second （SMD 0.20, 95% CI： -0.06 to 0.46）, maximal inspiratory pressure （SMD 0.01, 95% Ch -0.28 to 0.29） or 6-minute walk distance （SMD 0.17, 95% Ch -0.16 to 0.50）; （4） Subgroup analysis showed noninvasive positive pressure ventilation improved the arterial carbon dioxide tension in hypercapnic patients. Pooled analysis for crossover randomized controlled trials did not show improvement in arterial blood gas or forced expiratory volume in one second with noninvasive positive pressure ventilation. Conclusions Noninvasive positive pressure ventilation improves the arterial carbon dioxide tension but does not improve the mortality, pulmonary function, or exercise tolerance and should be cautiously used in severe stable chronic obstructive pulmonary disease.
