ObjectiveTo assess the mortality, acute exacerbations, exercise capacity, symptoms and significant physiological parameters (lung function, respiratory muscle function and gas exchange) of patients with severe stable chronic obstructive pulmonary disease (COPD) with respiratory failure treated by noninvasive positive pressure ventilation (NPPV).MethodsA meta-analysis of randomized controlled trials was carried out by searching PubMed, Cochrane library, Embase, OVID, Chinese Biomedical Literature Database and the bibliographies of the retrieved articles up to February 2017. Studies of patients with severe stable COPD with respiratory failure receiving long-term noninvasive positive pressure ventilation and comparison with oxygen therapy were conducted, and at least one of the following parameters were reviewed: frequency of acute exacerbations, mortality, lung function, respiratory muscle function, gas exchange, 6-minute walk test.ResultsSix studies with 695 subjects met the inclusion criteria and were analyzed. The PaCO2 was significantly decreased in patients who received long-term NPPV. No significant difference was found between long-term NPPV and oxygen therapy in mortality, frequency of acute exacerbations, gas exchange, lung function, respiratory muscle function and exercise capacity. The subgroup analysis showed that NPPV improves survival of patients when it is targeted at greatly reducing hypercapnia.ConclusionCurrent evidence suggests that there is no significant improvement by application of NPPV on severe stable COPD with respiratory failure patients, but NPPV may reduce patients’ mortality with the aim of reducing hypercapnia.
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.
Objective To explore the effects of enteral tube feeding on moderate AECOPD patients who underwent noninvasive positive pressure ventilation ( NPPV) . Methods Sixty moderate AECOPD patients with NPPV admitted from January 2009 to April 2011 were recruited for the study. They were randomly divided into an enteral tube feeding group (n=30) received enteral tube feeding therapy, and an oral feeding group (n=30) received oral feeding therapy. Everyday nutrition intake and accumulative total nutrition intake in 7 days, plasma level of prealbumin and transferrin, success rate of weaning, duration of mechanical ventilation, length of ICU stay, rate of trachea cannula, and mortality rate in 28 days were compared between the two groups. Results Compared with the oral feeding group, the everyday nutrition intake and accumulative total nutrition intake in 7 days obviously increased (Plt;0.05) , while the plasma prealbumin [ ( 258.4 ±16.5) mg/L vs. (146.7±21.6) mg/L] and transferrin [ ( 2.8 ±0.6) g/L vs. ( 1.7 ±0.3) g/L] also increased significantly after 7 days in the enteral tube feeding group( Plt;0.05) . The success rate of weaning ( 83.3% vs. 70.0%) , the duration of mechanical ventilation [ 5. 6( 3. 2-8. 6) days vs. 8. 4( 4. 1-12. 3) days] , the length of ICU stay [ 9. 2( 7. 4-11. 8) days vs. 13. 6( 8.3-17. 2) days] , the rate of trachea cannula ( 16. 6% vs. 30. 0% ) , the mortality rate in 28 days ( 3. 3% vs. 10. 0% ) all had significant differences between the enteral tube feeding group and the oral feeding group. Conclusions For moderate AECOPD patients with NPPV, enteral tube feeding can obviously improve the condition of nutrition and increase the success rate of weaning, shorten the mechanical ventilation time and the mean stay in ICU, decrease the rate of trachea cannula and mortality rate in 28 days. Thus enteral tube feeding should be preferred for moderate AECOPD patients with NPPV.
ObjectiveTo investigate the application value of noninvasive ventilation (NIV) performed in patients with unplanned extubation (UE) in intensive care unit (ICU).MethodsThis was a retrospective analysis. The clinical data, application of NIV, reintubation rate and prognosis of UE patients in the ICU of this hospital from January 2014 to December 2018 were reviewed, and the patients were assigned to the control group or the NIV group according to the application of NIV after UE. The data between the two groups were compared and the application effects of NIV in UE patients were evaluated.ResultsA total of 66 UE patients were enrolled in this study, including 44 males and 22 females and with an average age of (64.2±16.1) years. Out of them, 41 patients (62.1%) used nasal catheter or mask for oxygenation as the control group, 25 patients (37.9%) used NIV as the NIV group. The Acute Physiology andChronic Health EvaluationⅡ score of the control group and the NIV group were (18.6±7.7) vs. (14.8±6.3), P=0.043. The causes of respiratory failure in the control group and the NIV group were as follows: pneumonia 16 patients (39.0%) vs. 7 patients (28.0%), postoperative respiratory failure 7 patients (17.1%) vs. 8 patients (32.0%), chronic obstructive pulmonary disease 8 patients (19.5%) vs. 6 patients (24.0%), others 5 patients (12.2%) vs. 4 patients (16.0%), heart failure 3 patients (7.3%) vs. 0 patients (0%), nervous system diseases 2 (4.9%) vs. 0 patients (0%), which showed no significant difference between the two groups. Mechanical ventilation time before UE were (12.5±19.8) vs (12.7±15.2) d (P=0.966), PaO2 of the control group and the NIV group before UE was (114.9±37.4) vs. (114.4±46.3)mm Hg (P=0.964), and oxygenation index was (267.1±82.0) vs. (257.4±80.0)mm Hg (P=0.614). Reintubation rate was 65.9% in the control group and 24.0% in the NIV group (P=0.001). The duration of mechanical ventilation was (23.9±26.0) vs. (21.8±26.0)d (P=0.754), the length of stay in ICU was (34.4±36.6) vs. (28.5±25.8)d (P=0.48). The total mortality rate in this study was 19.7%. The mortality rate in the control group and NIV group were 22.0% and 16.0% (P=0.555).ConclusionPatients with UE in ICU may consider using NIV to avoid reintubation.
Most of the existing near-infrared noninvasive blood glucose detection models focus on the relationship between near-infrared absorbance and blood glucose concentration, but do not consider the impact of human physiological state on blood glucose concentration. In order to improve the performance of prediction model, particle swarm optimization (PSO) algorithm was used to train the structure paramters of back propagation (BP) neural network. Moreover, systolic blood pressure, pulse rate, body temperature and 1 550 nm absorbance were introduced as input variables of blood glucose concentration prediction model, and BP neural network was used as prediction model. In order to solve the problem that traditional BP neural network is easy to fall into local optimization, a hybrid model based on PSO-BP was introduced in this paper. The results showed that the prediction effect of PSO-BP model was better than that of traditional BP neural network. The prediction root mean square error and correlation coefficient of ten-fold cross-validation were 0.95 mmol/L and 0.74, respectively. The Clarke error grid analysis results showed that the proportion of model prediction results falling into region A was 84.39%, and the proportion falling into region B was 15.61%, which met the clinical requirements. The model can quickly measure the blood glucose concentration of the subject, and has relatively high accuracy.
Objective Sedation and/or analgesia is often applied during noninvasive positive pressure ventilation (NIPPV) to make patients comfortable, and thus improve the synchronization between patients and ventilator. Nevertheless, the effect of sedation and/or analgesia on the clinical outcome of the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation remains controversial. Methods A retrospective study was conducted on patients with AECOPD who received NIPPV after extubation in seven intensive care units in West China Hospital, Sichuan University between December 2013 and December 2017 . A logistic regression model was used to analyze the association between the use of sedation and/or analgesia and clinical outcomes including rate of NIPPV failure (defined as the need for reintubation and mechanical ventilation), hospital mortality, and length of intensive care unit stay after extubation. Results A total of 193 patients were included in the analysis, and 62 cases of these patients received sedation and/or analgesia during NIPPV. The usage of sedation and/or analgesia could result in failure of NIPPV (adjusted odd ratio [OR] 0.10, 95% confidence interval [CI] 0.02 - 0.52, P=0.006) and death (adjusted OR=0.13, 95%CI 0.04 - 0.42, P=0.001). Additionally, intensive care unit stay after extubation was longer in the patients who did not receive sedation and/or analgesia than those who did (11.02 d vs. 6.10 d, P< 0.01). Conclusion The usage of sedation and/or analgesia during NIPPV can decrease both the rate of NIPPV failure and hospital mortality in AECOPD patients after extubation.
Objective To investigate the influence of pulmonary infection on noninvasive ventilation ( NIV) therapy in hypercapnic acute respiratory failure ( ARF) due to acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) , and evaluate the predictive value of simplified version of clinical pulmonary infection score ( CPIS) for the efficacy of NIV therapy in ARF patients with AECOPD. Methods Eighty-four patients with ARF due to AECOPD were treated by NIV, and were divided into a successful group and an unsuccessful group by the therapeutic effect of NIV. The CPIS and simplified version of CPIS between two groups was compared. The predictive value of simplified version of CPIS for the efficacy of NIV wasevaluated using ROC curve analysis. Results The CPIS and the simplified version of CPIS of the successful treatment group ( 4. 0 ±2. 8, 3. 2 ±2. 4) were lower than those of the unsuccessful group ( 8. 0 ±2. 1, 7. 2 ±1. 8) significantly ( P =0. 006, 0. 007) . The area under ROC curve ( AUC) of CPIS and simplified version of CPIS were 0. 884 and 0. 914 respectively, the cut oint of CPIS and simplified version of CPIS were 6 ( sensitivity of 78. 0% , specificity of 91. 2% ) and 5 ( sensitivity of 80. 0% , specificity of 91. 2% ) respectively. Conclusions The level of pulmonary infection is an important influencing factor on the therapeutic effect of NIV in patients with ARF due to AECOPD. Simplified version of CPIS is a helpful predictor for the effect of NIV on ARF of AECOPD.
ObjectiveTo investigate the feasibility of electroencephalography (EEG) power spectrum analysis monitoring noninvasive intracranial pressure (ICP).
MethodsBetween September 2008 and May 2009, the EEG signals were recorded in 62 patients (70 cases/times) with central nervous system (CNS). By using self-designed software, EEG power spectrum analysis was conducted and pressure index (PI) was calculated automatically. ICP was measured by lumbar puncture (LP).
ResultsThe mean ICP was (239.74±116.25) mm H2O (70-500 mm H2O, 1 mm H2O=0.009 8 kPa), and 52.9% of patients had increased ICP. The mean PI was 0.29±0.20 (0.02-0.85). The Spearman rank test showed that there was a significant negative correlation between PI and ICP (rs=-0.849, P<0.01). The data from the patients with diffuse lesions of CNS and focal lesions were analyzed separately; the results showed there were significant negative correlations between PI and ICP in both groups (rs=-0.815, -0.912; P<0.01).
ConclusionThe PI obtained from EEG analysis is correlated with ICP. Analysis of specific parameters from EEG power spectrum might reflect the ICP. Further research should be carried out.
Objective To evaluate the efficiency and associated factors of noninvasive positive pressure ventilation( NPPV) in the treatment of acute lung injury( ALI) and acute respiratory distress syndrome( ARDS) .Methods Twenty-eight patients who fulfilled the criteria for ALI/ARDS were enrolled in the study. The patients were randomized to receive either noninvasive positive pressure ventilation( NPPV group) or oxygen therapy through a Venturi mask( control group) . All patients were closely observed and evaluated during observation period in order to determine if the patients meet the preset intubation criteria and the associated risk factors. Results The success rate in avoiding intubation in the NPPV group was 66. 7%( 10/15) , which was significantly lower than that in the control group ( 33. 3% vs. 86. 4% , P = 0. 009) . However, there was no significant difference in the mortality between two groups( 7. 7% vs.27. 3% , P =0. 300) . The incidence rates of pulmonary bacteria infection and multiple organ damage were significantly lower in the NPPV success subgroup as compared with the NPPV failure group( 2 /10 vs. 4/5, P =0. 01;1 /10 vs. 3/5, P = 0. 03) . Correlation analysis showed that failure of NPPV was significantly associated with pulmonary bacterial infection and multiple organ damage( r=0. 58, P lt;0. 05; r =0. 53, P lt;0. 05) . Logistic stepwise regression analysis showed that pulmonary bacterial infection was an independent risk factor associated with failure of NPPV( r2 =0. 33, P =0. 024) . In the success subgroup, respiratory rate significantly decreased( 29 ±4 breaths /min vs. 33 ±5 breaths /min, P lt; 0. 05) and PaO2 /FiO2 significantly increased ( 191 ±63 mmHg vs. 147 ±55 mmHg, P lt;0. 05) at the time of 24 hours after NPPV treatment as compared with baseline. There were no significant change after NPPV treatment in heart rate, APACHEⅡ score, pH and PaCO2 ( all P gt;0. 05) . On the other hand in the failure subgroup, after 24 hours NPPV treatment, respiratory rate significantly increased( 40 ±3 breaths /min vs. 33 ±3 breaths /min, P lt;0. 05) and PaO2 /FiO2 showed a tendency to decline( 98 ±16 mmHg vs. 123 ±34 mmHg, P gt; 0. 05) . Conclusions In selected patients, NPPV is an effective and safe intervention for ALI/ARDS with improvement of pulmonary oxygenation and decrease of intubation rate. The results of current study support the use of NPPV in ALI/ARDS as the firstline choice of early intervention with mechanical ventilation.
Objective To investigate the effectiveness of noninvasive positive pressure ventilation( NPPV) in acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) complicated with severe type Ⅱ respiratory failure.Methods 37 patients who were admitted fromJanuary 2008 to June 2009 due to AECOPD complicated with severe type Ⅱ respiratory failure and had received NPPV therapy were enrolled as a NPPV group. Another similar 42 cases who had not received NPPV therapy served as control. All subjects received standard medication therapy according to the guideline. Arterial blood gases before and after treatment, the duration of hospitalization and intubation rate were observed. Results The arterial pH, PaO2 ,and PaCO2 improved significantly after treatment as compared with baseline in both groups ( P lt; 0. 05) .Compared with the control group, the average duration of hospitalization was significantly shorter ( 10 ±5 vs.19 ±4 days, P lt;0. 05) and the intubation rate was significantly lower ( 2. 7% vs. 16. 7% , P lt;0. 05) in the NPPV group. Conclusion The use of NPPV in AECOPD patients complicated with severe type Ⅱ respiratory failure is effective in improving arterial blood gases, reducing the duration of hospitalization and intubation rate.
