A comparative study of effectiveness of biphasic positive airway pressure，VV+，assist-control ventilation and pressure support ventilation on acute respiratory failure of chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 XU Xiyuan , YANG Jingping , SUN Dejun

Department of Respiratory and Critical Care Medicine，The Third Affiliated Hospital of Inner Mongolia Medical College.Baotou，Inner Mongolia，014010，ChinaCorresponding author：XU Xi-yuan，E-mail：yaoyikai@sina.com;

Corresponding author：

XU Xiyuan, Email: yaoyikai@sina.com

Keywords：

Chronic obstructive pulmonary disease; Respiratory failure; Mechanical ventilation; Biphasic positive airway pressure; Volume ventilation plus; Respiratory mechanics

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Objective To investigate the therapeutic effects of biphasic positive airway pressure (Bilevel) ventilation and volume ventilation plus [VV+，including volume control plus (VC+) and volume support (VS)] on respiratory failure in patients with chronic obstructive pulmonary disease (COPD).Methods 63 patients with COPD complicated by acute respiratory failure were intubated and underwent mechanical ventilation for at least 24 hours.At the first patients were underwent assist-control (A/C) ventilation for 2 to 4 hours to obtain the suitable basic ventilatory parameters.Meanwhile，the hemodynamics and oxygen dynamic parameters were measured.Then the patients were randomly allocated to three groups with 21 patients in each group and the ventilation mode was switched to Bilevel，VC+ and A/C mode correspondingly.The setting parameter was identical in three modes.In the process of weaning，patients in Bilevel group were ventilated with Bilevel and pressure support ventilation (PSV) mode at each pressure level，and subdivided into Bilevel and PSV 1 group accordingly.In VC+ group，the mode was switched to VS and PSV mode and subdivided into VC+ group and PSV 2 group,respectively.Every mode was run for 30 minutes while the ventilation function，blood gas exchange and lung mechanics index were measured.Results In the initial stage，the airway peak pressure (PIP) of Bilevel and VC+ mode obviously decreased，and the respiratory compliance was higher compared to the A/C mode. The effectiveness of Bilevel and A/C was equivalent in improving alveolar ventilation and oxygenation.The difference in the change of circulation function and blood gas between the two groups were not significant (P gt;0.05).In the process of weaning，the effectiveness of Bilevel and VV+ was equal to PSV.The changes of breathing mode and blood gas between the two groups had no significant differences.Conclusions Bilevel and VV+ mode ventilation can be used in the whole mechanical ventilation for acute respiratory failure due to COPD with lower PIP，higher respiratory compliance compared to A/C model and similar performance as PSV during mechanical ventilation withdrawn.

Citation： XU Xiyuan,YANG Jingping,SUN Dejun. A comparative study of effectiveness of biphasic positive airway pressure，VV+，assist-control ventilation and pressure support ventilation on acute respiratory failure of chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2007, 6(1): 27-32. doi: Copy

1.	朱蕾.有创-无创“序贯”机械通气治疗慢性阻塞性肺疾病呼吸衰竭.中国呼吸与危重监护杂志，2003，2：198-199.
2.	Hormann C，Baum M，Putensen C，et al.Biphasic positive airnay pressure (BiPAP)-a new mode of ventilatory support.Eur J Anaesthesiol，1994，11：37-42.
3.	李振华，郑欲知.两种新的机械通气方法——VC+和VS的临床应用比较.医疗信息技术，2004，19：46-47.
4.	李振华，郑欲知.机械通气的双重控制模式.医疗卫生装备，2004，8：51-52.
5.	俞森洋.机械通气新模式（二）：双重控制模式.中国医疗器械信息，2004，10：60-63.
6.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南.中华内科杂志，2002，41：640-646.
7.	Flick GR，Bellamy PE，Simmons DH.Diaphragmatic contraction during assisted mechanical ventilation.Chest，1989，96：130-135.
8.	Fernandez R，Mendez M，Younes M.Effect of ventilator flow rate on respiratory timing in normal humans.Am J Respir Crit Care Med，1999，159：710-719.
9.	Chiumello D，Peloxio P，Croci M，et al.The effects of pressurization rate on breathing pattern，work of breathing，gas exchange and patient comfort in pressure support ventilation.Eur Respir J，2001，18：107-114.
10.	陈宇清，周新，赵冰清，等.容积保证压力支持通气时不同水平恒定供气流量对呼吸衰竭患者肺力学的影响.中华急诊医学杂志，2005，14：16-20.
11.	周新，陈宇清.机械通气模式的研究进展.中国呼吸与危重监护杂志，2004，3：136-139.
12.	GarciaRioFC，PradosED，Tejedor，et al.Breathing patternand central ventilatory drivein midland moder ategene ralized my sthenia gravis.Thorax，1994，49：703-706.
13.	王佰顺，苑水珍.PRVC和VS通气模式的比较.中国医学装备，2005，2：41-42.
14.	Grasso S，Puntillo F，Mascia L，et al.Compensation for increase in respiratory workload during mechanical ventilation：Pressure-support versus proportional-assist ventilation.Am J Respir Crit Care Med，2000，161：819-826.
15.	Baum M，Benzer H，Putensen C，et al.Biphasic positive airway pressure （BiPAP） a new form augmented ventilation.Anaesthesist，1989，38：452-458.
16.	Rathgeber J，Schorn B，Falk V，et al.The influence of controlled mandatory ventilation（CMV），intermittent mandatory ventilation（IMV） and biphasic intermittent positive airway pressure（BIPAP） on duration of intubation and consumption of analgesics and sedatives.A prospective analysis in 596 patients following adult cardiac surgery.Eur J Anaesthesiol，1997，14：576-582.
17.	王辰，商鸣宇，黄克武，等.有创与无创序惯性机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的研究.中华结核和呼吸杂志，2000，23：212-216.
18.	Staudinger T，Kordova H，Roggla M，et al.Comparison of oxygen cost of breathing with pressure-support ventilation and biphasic intermittent positive airway pressure ventilation.Crit Care Med，1998，26：1518-1522.

1. 朱蕾.有创-无创“序贯”机械通气治疗慢性阻塞性肺疾病呼吸衰竭.中国呼吸与危重监护杂志，2003，2：198-199.
2. Hormann C，Baum M，Putensen C，et al.Biphasic positive airnay pressure (BiPAP)-a new mode of ventilatory support.Eur J Anaesthesiol，1994，11：37-42.
3. 李振华，郑欲知.两种新的机械通气方法——VC+和VS的临床应用比较.医疗信息技术，2004，19：46-47.
4. 李振华，郑欲知.机械通气的双重控制模式.医疗卫生装备，2004，8：51-52.
5. 俞森洋.机械通气新模式（二）：双重控制模式.中国医疗器械信息，2004，10：60-63.
6. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南.中华内科杂志，2002，41：640-646.
7. Flick GR，Bellamy PE，Simmons DH.Diaphragmatic contraction during assisted mechanical ventilation.Chest，1989，96：130-135.
8. Fernandez R，Mendez M，Younes M.Effect of ventilator flow rate on respiratory timing in normal humans.Am J Respir Crit Care Med，1999，159：710-719.
9. Chiumello D，Peloxio P，Croci M，et al.The effects of pressurization rate on breathing pattern，work of breathing，gas exchange and patient comfort in pressure support ventilation.Eur Respir J，2001，18：107-114.
10. 陈宇清，周新，赵冰清，等.容积保证压力支持通气时不同水平恒定供气流量对呼吸衰竭患者肺力学的影响.中华急诊医学杂志，2005，14：16-20.
11. 周新，陈宇清.机械通气模式的研究进展.中国呼吸与危重监护杂志，2004，3：136-139.
12. GarciaRioFC，PradosED，Tejedor，et al.Breathing patternand central ventilatory drivein midland moder ategene ralized my sthenia gravis.Thorax，1994，49：703-706.
13. 王佰顺，苑水珍.PRVC和VS通气模式的比较.中国医学装备，2005，2：41-42.
14. Grasso S，Puntillo F，Mascia L，et al.Compensation for increase in respiratory workload during mechanical ventilation：Pressure-support versus proportional-assist ventilation.Am J Respir Crit Care Med，2000，161：819-826.
15. Baum M，Benzer H，Putensen C，et al.Biphasic positive airway pressure （BiPAP） a new form augmented ventilation.Anaesthesist，1989，38：452-458.
16. Rathgeber J，Schorn B，Falk V，et al.The influence of controlled mandatory ventilation（CMV），intermittent mandatory ventilation（IMV） and biphasic intermittent positive airway pressure（BIPAP） on duration of intubation and consumption of analgesics and sedatives.A prospective analysis in 596 patients following adult cardiac surgery.Eur J Anaesthesiol，1997，14：576-582.
17. 王辰，商鸣宇，黄克武，等.有创与无创序惯性机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的研究.中华结核和呼吸杂志，2000，23：212-216.
18. Staudinger T，Kordova H，Roggla M，et al.Comparison of oxygen cost of breathing with pressure-support ventilation and biphasic intermittent positive airway pressure ventilation.Crit Care Med，1998，26：1518-1522.

Chinese Journal of Respiratory and Critical Care Medicine

A comparative study of effectiveness of biphasic positive airway pressure，VV+，assist-control ventilation and pressure support ventilation on acute respiratory failure of chronic obstructive pulmonary disease

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