Objective To evaluate the clinical efficacy of integrated treatment ( sequential noninvasive following invasive mechanical ventilation, bronchoscope suction, combined inhalation) in patients with acute respiratory failure induced by chronic obstructive pulmonary disease ( COPD) . Methods 59 elderly patients with COPD and acute respiratory failure in ICU fromJuly 2006 to July 2009 were enrolled in the study. The patients were randomized into three groups, ie. a non-invasive mechanical ventilation group ( NIV group) , a sequential non-invasive following invasive mechanical ventilation group ( SV group) , a integrated treatment group ( IT group) . APACHEⅡ score, clinical pulmonary infection score ( CPIS) ,arterial blood gas analysis, respiratory rate ( RR) , heart rate ( HR) , and mean artery blood pressure ( MAP)at 0 h, 3 h, 3 d, 12 d after treatment were recorded. Results With the extension of treatment time,APACHEⅡ score, CPIS score, RR, HR, PaCO2 , and white blood cells gradually reduced, while pH and PaO2 gradually increased in the three groups ( P lt;0. 05) . The differences in RR, HR, PaCO2 , and PaO2 at the time of 3 d and 12 d were significant between the three groups( P lt;0. 05) . The occurrence of pulmonary infection control ( PIC) window and ventilation associated pneumonia ( VAP) had no difference among the three groups( P gt;0. 05) . The duration of total mechanical ventilation, durations of ICU stay and hospital stay were shorter in SV group than those in NIV group( P lt;0. 05) . The duration of total mechanical ventilation,duration of invasive mechanical ventilation, durations of ICU stay and hospital stay were shorter in IT group than those in SV group( P lt;0. 05) . The incidence of VAP was higher in SV group than NIV group, but lower in IT group than SV group( P lt;0. 05) . Hospital mortality was lower in SV group than NIV group, and higher in IT group than SV group( P lt; 0. 05) . Conclusion In elderly COPD patients with acute respiratory failure, integrated treatment given early can reduce the duration of mechanical ventilation, the length of ICU and hospital stay, and decrease the morbidity of VAP and mortality.
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.