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 observe the clinical efficacy of invasive-noninvasive sequential mechanical ventilation in the treatment of chronic obstructive pulmonary disease (COPD) complicated by type Ⅱ respiratory failure.
MethodsA total of 100 patients with COPD complicated with type Ⅱ respiratory failure from March 2013 to April 2014 were randomly divided into control group and study group (with 50 patients in each). While the control group was given continuous invasive ventilation treatment, the study group was treated with invasive-noninvasive sequential ventilation. The ventilation time, Intensive Care Unit (ICU) monitoring and hospitalization time, the serum concentrations of C-reactioin protein (CRP) before and after treatment and the ventilator associated pneumonia (VAP) and hospital mortality rate were observed and compared between the two groups.
ResultsFor patients in the study group, ICU monitoring time, ventilation time and hospitalization time were (9.4±8.1), (10.3±5.8), and (14.7±8.2) days, respectively, significantly shorter than those in the control group[(17.5±10.8), (15.2±7.7), and (22.8±7.4) days] (P<0.05). The incidence of VAP and nosocomial VAP mortality in the study group were 4.0% and 2.0% respectively, which were significantly lower than those in the control group (22.0% and 20.0%), and the differences were statistically significant (P<0.05).
ConclusionIn the clinical treatment of COPD patients with type Ⅱ respiratory failure, invasive-noninvasive sequential ventilation treatment is effective in shortening the duration of ventilation and hospitalization time, controlling the incidence of VAP, and reducing the mortality rate, which is worthy of clinical popularization.
Objective To investigate the clinical characteristics of acute myocardial infarction ( AMI) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods Clinical data of 16 elderly patients with AECOPD and AMI from may 2007 to December 2009 were reviewed. Meanwhile, 128 elderly AECOPD patients without AMI were analyzed as control. Results Neither the AMI group nor the control group had typical precordial pain, conscious disturbance, andhypotension. Compared with the control group, the main symptoms of the AMI group were worsening of chest tightness and dyspnea( 16 /16 vs. 4/128, P lt;0. 01) ,most of which accompanying fever( 11/16 vs. 6/128, P lt;0. 05) and anorexia ( 10/16 vs. 23 /128, P lt; 0. 05) . The incidence of patches-like shadow on chest X-rayincreased ( 16 /16 vs. 62/128, P lt;0. 05) , PaO2 ( mm Hg) decreased ( 43. 72 ±3. 64 vs. 82. 26 ±11. 41, P lt;0. 001) , the red blood cell count ( ×1012 /L) increased ( 6. 43 ±0. 42 vs. 4. 11 ±1. 24, P lt; 0. 05) , the concentration of total cholesterol ( mmol /L) increased ( 6. 51 ±0. 84 vs. 3. 93 ±1. 14, P lt; 0. 05) , the needfor invasive mechanical ventilation increased ( 13/16 vs. 11 /128, P lt; 0. 05) , the days in hospital were prolonged ( 35 ±13 vs. 11 ±3, P lt; 0. 01) , the cost ( 1000 RMB) increased( 32 ±11 vs. 7. 6 ±2. 8, P lt;0. 01) , and the mortality also increased ( 2/16 vs. 3 /128, P lt;0. 01) . Conclusion AMI should be alerted in the case of sudden exacerbation of chest tightness and dyspnea in elderly patients with AECOPD.
ObjectiveTo explore the risk factors for postoperative respiratory failure (RF) in patients with esophageal cancer, construct a predictive model based on the least absolute shrinkage and selection operator (LASSO)-logistic regression, and visualize the constructed model. MethodsA retrospective analysis was conducted on patients with esophageal cancer who underwent surgical treatment in the Department of Thoracic Surgery, Sun Yat-sen University Cancer Center Gansu Hospital from 2020 to 2023. Patients were divided into a RF group and a non-RF (NRF) group according to whether RF occurred after surgery. Clinical data of the two groups were collected, and LASSO-logistic regression was used to optimize feature selection and construct the predictive model. The model was internally validated by repeated sampling 1000 times based on the Bootstrap method. ResultsA total of 217 patients were included, among which 24 were in the RF group, including 22 males and 2 females, with an average age of (63.33±9.10) years; 193 were in the NRF group, including 161 males and 32 females, with an average age of (62.14±8.44) years. LASSO-logistic regression analysis showed that the percentage of forced expiratory volume in one second/forced vital capacity (FEV1/FVC) to predicted value (FEV1/FVC%pred) [OR=0.944, 95%CI (0.897, 0.993), P=0.026], postoperative anastomotic fistula [OR=4.106, 95%CI (1.457, 11.575), P=0.008], and postoperative lung infection [OR=3.776, 95%CI (1.373, 10.388), P=0.010] were risk factors for postoperative RF in patients with esophageal cancer. Based on the above risk factors, a predictive model was constructed, with an area under the receiver operating characteristic curve of 0.819 [95%CI (0.737, 0.901)]. The Hosmer-Lemeshow test for the calibration curve showed that the model had good goodness of fit (P=0.527). The decision curve showed that the model had good clinical net benefit when the threshold probability was between 5% and 50%. Conclusion FEV1/FVC%pred, postoperative anastomotic fistula, and postoperative lung infection are risk factors for postoperative RF in patients with esophageal cancer. The predictive model constructed based on LASSO-logistic regression analysis is expected to help medical staff screen high-risk patients for early individualized intervention.
ObjectiveTo analyze the main causes and management of respiratory failure after surgery for esophageal cancer.
MethodsWe retrospectively collected and analyzed the clinical data of 27 patients with respiratory failure after surgery for esophageal cancer in our hospital between January 2005 and December 2012.
ResultsOf the 27 patients with respiratory failure after surgery for esophageal cancer, 23 were at advanced age, and 15 had moderately to severely impaired pulmonary function before surgery. After surgery, 19 suffered severe pulmonary infection, 8 yielded complications such as anastomotic leak, gastropleural fistula chylothorax, and postoperative bleeding.
ConclusionPulmonary infections and surgical complications are the major and direct causes of respiratory failure after surgery for esophageal cancer. For high-risk patients at advanced age with impaired pulmonary function, enhancing perioperative airway management and improving surgical operation can decrease incidence of respiratory failure effectively.
Objective To study the clinical feasibility of invasive mechanical ventilation with bilevel positive airway pressure（BiPAP） non-invasive ventilator in the stable patients needing prolonged mechanical ventilation.Methods Eleven patients with respiratory failure admitted in intensive care unit（ICU）of our department，who needed prolonged mechanical ventilation，between Jun 2004 and Nov 2007 were enrolled in the study and followed until death or Jan 2008.The arterial blood gas analysis data，length of stay(LOS)，LOS after changing to BiPAP non-invasive ventilator（Synchrony，Harmony，RESPIRONICS，VPAP III ST-A，RESMED），survival time after discharge(or fulfilled the discharge standards) were reviewed retrospectively.Results The settings of inspiratory pressure，expiratory pressure and respiratory rate of non-invasive ventilation were 21.3 (16-26) cm H2O，4 cm H2O，and 16 min-1，respectively.The LOS (or up to the discharge standard) was (91.5±50.2) days.The LOS (or up to the discharge standard) after changing to BiPAP ventilator was (23.5±12.2) days.The mean survival time after discharge (or up to the discharge standard) was (353.1±296.5) days.Four patients were still alive up to the end of the study.The arterial pH，PaCO2，PaO2，and SaO2 were not significant different before and after changing to BiPAP ventilator.Conclusion The mechanical ventilation with BiPAP non-invasive ventilator via tracheotomy tube is an alternative choice for stable patients needing prolonged mechanical ventilation.
Objective To explore the effect of respiratory training based on mechanical vibration-assisted sputum expulsion on arterial blood gases in patients with chronic obstructive pulmonary type 2 respiratory failure and clinical efficacy observation. Methods 105 patients with chronic obstructive pulmonary disease combined with type 2 respiratory failure who were hospitalized in our hospital from November 2019 to February 2023 were selected as study subjects. They were randomly numbered and divided into experimental and control groups according to the order of admission, and 3 patients withdrew from the study cohort due to their own reasons, and 51 cases each of the experimental and control groups were finally included. Patients in the control group were given conventional treatment and lung function exercise, while the experimental group was given respiratory training with mechanical vibration-assisted sputum expulsion. Lung function and blood gas analysis indexes were measured before and 2 weeks after treatment to evaluate the clinical efficacy and incidence of adverse events in the two groups. Results After the treatment, pulmonary function indexes such as PEF, FVC, FEV1 and FEV1/FVC, and blood gas analysis indexes such as PaO2, PaCO2 of the experimental group and daily sputum excretion improved significantly compared with those of the pre-treatment and control groups (P<0.05). The total clinical efficacy rate of the patients in the experimental group was significantly higher than that of the control group (P<0.05), and the incidence of adverse events was lower than that of the control group, but the difference was not statistically significant (P>0.05). Conclusion Respiratory training based on mechanical vibration-assisted sputum expectoration can help improve the lung function and blood gas level of patients with chronic obstructive pulmonary disease combined with type 2 respiratory failure, and it has a certain clinical value in promoting the rehabilitation and prognosis of patients.
