Objective To investigate the effects of different inspiratory rise time during noninvasive positive pressure ventilation ( NPPV) on work of breathing in patients with acute exacerbation of chronic obstructive pulmonary disease ( COPD) . Methods Eleven patients with acute exacerbation of COPD received different inspiratory rise time ( 0. 1sec, 0. 3sec, 0. 5sec) during NPPV. The changes of inspiratory muscle effort and breathing pattern of the patients were observed. Results The average respiratory rate,minute ventilation, and tidal volume were higher during NPPV compared with spontaneous breathing. But the changes of average minute ventilation and tidal volume were not significant ( P gt; 0. 05) . The pressure time product ( PTP) , transdiaphragmatic pressure ( Pdi) , and work of breathing of inspiratory muscle reduced significantly during different inspiratory rise time as compared with spontaneous breathing ( P lt;0. 01) . PTP,Pdi, and work of breathing reduced 59. 2% , 62. 7% , and 49% respectively when inspiratory rise time was 0. 1sec. They reduced more significantly during inspiratory rise time of 0. 1sec. Conclusions The present study confirms NPPV can unload inspiratory muscles in patients with acute exacerbation of COPD. It is more effective to reduce inspiratory load when inspiratory rise time is set at 0. 1sec while the patients feel most comfortable.
ObjectiveTo analyze the benefits of lung transplantation in the treatment of interstitial lung disease (ILD) and investigate its prognostic factors.MethodsThe clinical data of patients diagnosed with ILD and meet the lung transplantation criteria were retrospectively analyzed from January 2012 to December 2017 in the First Affiliated Hospital of Guangzhou Medical University. A total of 111 patients, 88 males and 23 females, aged (58.3±11.4) years old, were divided into lung transplantation group and non-lung transplantation group. Clinical data and prognosis of the two groups were compared and the factors affecting the prognosis of lung transplantation were analyzed with relevant literatures. Results There were 56 patients in lung transplantation group and 55 patients in non-lung transplantation group. The mainly underlying disease of both groups were idiopathic pulmonary fibrosis (IPF). There was no significant difference in age, body mass index, arterial partial pressure of oxygen, percentage of forced vital capacity in the estimated value, percentage of diffusing capacity of the lung for carbon monoxide in the estimated value, six-minute walk distance between the two groups (P>0.05). The pulmonary arterial hypertension and arterial partial pressure of carbondioxide were higher in lung transplantation group than non-transplantation group (P<0.05). The 1-year survival rate in the lung transplantation group was significantly higher than that in the non-lung transplantation group: 77.4% vs. 32.7% (P<0.01). COX regression analysis showed that preoperative ventilator dependence, serum creatinine, bilirubin, pulmonary artery pressure, and procedures (single lung vs. double lung) had no significant effect on the prognosis of lung transplantation; age and preoperative diabetes mellitus were risk factors for the prognosis of lung transplantation.ConclusionsLung transplantation can significantly improve the prognosis of patients with ILD who are refractory to medicine therapy. IPF patients should be advised to consider lung transplantation as soon as possible. Age and preoperative diabetes mellitus are risk factors for the prognosis of lung transplantation.
