Objective To systematically review the efficacy of noninvasive positive pressure ventilation (NPPV) by helmet in adults with acute respiratory failure. Methods Randomized controlled trials (RCTs) or cohort studies about noninvasive positive pressure ventilation (NPPV) by helmet in adults with acute respiratory failure were retrieved in PubMed, The Cochrane Library (Issue 11, 2016), Web of Science, EMbase, CBM, CNKI and WanFang Data databases from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Stata 12.0 software was then used to perform meta-analysis. Results A total of eight studies were included. The results of meta-analysis showed that, NPPV by helmet could significantly reduce the carbon dioxide partial pressure (cohort study: SMD=–0.46, 95%CI –0.75 to –0.18, P=0.001), tracheal intubation rate (RCT: OR=0.36, 95%CI 0.17 to 0.77, P=0.008) and hospital mortality (RCT: OR=0.48, 95%CI 0.24 to 0.98, P=0.044), improve the positive end expiratory pressure (RCT: SMD=1.27, 95%CI 0.87 to 1.67, P<0.05) and respiratory status (RCT: SMD=–0.45, 95%CI –0.81 to –0.08,P=0.017). There was no significant difference in the duration of NPPV(cohort study: OR=–0.20, 95%CI –0.50 to 0.09, P=0.177; RCT: OR=–0.24, 95%CI –0.86 to 0.38, P=0.445). Conclusion NPPV by helmet can reduce the carbon dioxide partial pressure, tracheal intubation rate, hospital mortality and improve the positive end expiratory pressure, respiratory status. But the effects in the duration of NPPV and oxygenation index are uncertain. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo investigate the value of noninvasive positive pressure ventilation in patients with high risk of weaning induced pulmonary oedema.MethodsFrom June 2018 to June 2019, 63 patients with mechanical ventilation in the Department of Critical Care Medicine of the First Hospital of Lanzhou University were enrolled. Randomized digital table method was randomly divided into two groups and the resulting random number assignment was hidden in opaque envelopes, the experimental group received non-invasive positive pressure ventilation (n=32), and the control group received mask oxygen therapy ventilation (n=31). The heart rate, respiratory rate, means arterial pressure, hypoxemia, reintubation, blood gas analysis and other indicators were compared between the two groups after 2 hours of weaning. The length of hospital stay, mortality and complications were compared between the two groups.ResultsAfter 2 hours of weaning, the heart rate and respiratory rate were significantly lower in the non-invasive positive pressure ventilation group than in the mask group (P<0.05). There was no difference in mean arterial pressure between the two groups of patients, which was not statistically significant (P>0.05). The incidence of hypoxemia, laryngeal edema and reintubation in the noninvasive positive pressure ventilation group was significantly lower than that in the mask group, which was statistically significant (P<0.05), and the blood gas analysis index was better than the mask group (P<0.05). The non-invasive positive pressure ventilation group was significantly shorter than the mask group in the length of hospital stay and intensive care unit (P<0.05). The hospital mortality rate in 28 days was lower than that in the mask group (P<0.05), but there was no difference in tracheotomy, pneumothorax and subcutaneous emphysema between the two groups (P>0.05).ConclusionsNoninvasive positive pressure ventilation can effectively prevent hypoxemia, laryngeal edema, and re-intubation in patients at high risk of withdrawal related pulmonary edema. It can also shorten the length of hospital stay, which is worth clinical attention and promotion.
ObjectiveTo evaluate the effect of airway pressure release ventilation (APRV) on the hospital mortality of patients with acute respiratory distress syndrome (ARDS) by using cumulative meta-analysis. MethodsThe PubMed, Web of Science, Cochrane Library, WanFang Data, CNKI, and VIP databases were electronically searched to collect randomized controlled trials (RCTs) related to the objective from inception to June 30, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A cumulative meta-analysis was then performed by using StataSE 12.0 software. ResultsA total of 9 RCTs involving 533 patients were included. The results of meta-analysis showed that APRV could reduce the hospital mortality of patients with ARDS (RR=0.70, 95%CI 0.54 to 0.91, P<0.01) compared with traditional mechanical ventilation. ConclusionCurrent evidence shows that APRV can reduce the hospital mortality of patients with ARDS. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectivesTo investigate the effect of prone position ventilation (PPV) on patients with acute respiratory distress syndrome (ARDS).MethodsPatients with ARDS who received PPV treatment in the this hospital were enrolled from January 1, 2017 to December 31, 2017. The changes in heart rate, respiratory mechanics and blood gas index before and after PPV in patients, the inhaled oxygen concentration (FiO2), oxygenation index (PaO2/FiO2), pressure sore and other related complications were observed and compared in patients before and after PPV.ResultsA total of 28 patients with ARDS were registered, including 21 males and 7 females. Fourteen patients were complicated with chronic obstructive pulmonary disease (COPD) and 20 were dead in 28 days. After PPV, the peak pressure and plateau pressure decreased significantly, PaO2 and SaO2 increased significantly, system compliance improved considerably but PaCO2 did not change. There was no significant difference in the changes of heart reat, respiratory rate, minute volume, tidal volume and positive end-expiratory pressure between before and after PPV. FiO2 decreased significantly, PaO2/FiO2 increased significantly, and pressure sore increased significantly on day 1 post-PPV in comparison to pre-PPV and on day 7 post-PPV in comparison to day 1 post-PPV. A total of 13 unplanned extubation occurred during the entire PPV procedure, 9 of them were gastric tube slipping, 2 were urethral catheter slipping, 1 was tracheal tube slipping, and 1 was deep venous catheter slipping. There were 17 cases of artificial airway obstruction, 7 cases of hypotension, 3 cases of arrhythmia, and 4 cases of keratitis. In the subgroup analysis, the age of the patients complicated with COPD was significantly higher, but there was no difference in additional baseline data and the survival rate.ConclusionPPV can significantly improve the patient's respiratory status, especially oxygenation and respiratory mechanics, but PPV can increase the incidence of complications such as pressure sore, and PPV does not improve the prognosis.
ObjectiveTo design a ventilator humidifier that can ensure water level and infuse fluid automatically, and evaluate its application effect in patients with mechanical ventilation.MethodsThirty-eight patients who received mechanical ventilation in ICU from March to June in 2019 were included. According to the order of admission, they were divided into a study group with 18 patients and a control group with 20 patients. Different ventilator humidifiers were used. The study group used self-designed ventilator humidifier, and the control group used the MR370 humidifier. The cases of sputum viscosity with Ⅲ degree after 48 hours’ mechanical ventilation, the times of fluid infusion and the total amount of fluid infusion were compared. The times of pouring out condensate water and the total amount of pouring out condensate water in 24 hours were also compared.ResultsThe times of infusing liquid in the study group in 24 hours was less than that in the control group (3.3±0.5 vs. 11.2±1.7, P<0.01), but the other indicators were not statistically significant between the two groups (all P>0.05).ConclusionsThe self-designed ventilator humidifier can be used for patients with mechanical ventilation, which can keep the water level at the water line all the time and is beneficial to humidification treatment. It can reduce the times of fluid infusion and nurses' workload.