Objective To explore the effect of budesonide nebulization in the treatment of mechanically ventilated patients with chronic obstructive pulmonary disease(COPD).Methods A total of 25 intubated and ventilated COPD patients complicated with respiratory failure was randomly divided into two groups.The control group consisted of 12 patients received salbutamol nebulization on the routine treatment.The budesonide group consisted of 13 patients received budesonide plus salbutamol nebulization on the routine treatment.Variables such as tumor necrosis factor-α(TNF-α) and interleukin-8(IL-8) in the bronchoalveolar lavage fluid(BALF) ， incidence of ventilation-associated lung injury(VALI) ， days of mechanical ventilation ，， days of hospitalization and survival rate were measured and compared.Results The survival rate and incidence of VALI were not different significantly between the two groups.However ， the levels of TNF-α and IL-8 in BALF of the control patients were significantly lower than those in the budesonide group[ （ 1.2±0.2 ） mg/L vs （ 1.5±0.4 ） mg/L ，（ 85.7±26.5 ）（ 125.6±30.4 ）， both Plt;0.05).And the days of mechanical ventilation and hospitalization were statistically shorter in the budesonide group compared with the control group[ (7.2±2.5 ） d vs （ 10.5±6.2 ） d ， (10.5±4.7 ） d vs (15.8±6.6 ） d ， both Plt;0.05].Conclusion Our data suggest that nebulization of budesonide can suppressed the pulmonary inflammation and decreased days of the mechanical ventilation and hospitalization in mechanically ventilated COPD patients.
Objective To investigate the safety of high fraction of inspired oxygen (FiO2)during noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)and carbon dioxide (CO2)retention. Methods Fifty-six AECOPD patients with CO2 retention admitted between March 2013 and August 2015 were recruited in the study.All patients received noninvasive ventilation treatment with FiO2<0.5.After stabilization of acute respiratory crisis,FiO2 was increased to 1.0 and lasted for 40 minutes.The changes of tidal volume,respiratory frequency,minute volume,Glasgow coma score,arterial blood gas and SpO2 were observed before and after the FiO2 reset. Results The mean PaO2 increased from (83±14)mm Hg to (165±41)mm Hg and the mean SpO2 increased from (92.4±3.1)% to (97.8±1.9)% significantly (both P<0.001).The mean PaCO2 did not changed obviously from (72±15)mm Hg to (72±14)mm Hg (P=0.438).There were also no significant changes in any of the other parameters. Conclusion During noninvasive ventilation with an FiO2 sufficient to maintain a normal PaO2,an increase in FiO2 does not further increase PaCO2 level in AECOPD patients with CO2 retention.