Wang Chen, Shang Mingyu, Huang Kewu, Tong Zhaohui, Kong Weimin, Jiang Chaomei, Dai Huaping, Zhang Hongyu, Weng Xinzhi
Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing 100020, China.
Chin Med J (Engl). 2003 Jan;116(1):39-43.
To estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation (MV) in chronic obstructive pulmonary disease (COPD) with exacerbated hypercapnic respiratory failure.
Twenty-two intubated COPD patients with severe hypercapnic respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. At the time of pulmonary infection control window (PIC window) appeared, when pulmonary infection had been significantly controlled (resolution of fever and decrease in purulent sputum, radiographic infiltrations, and leukocytosis) after the antibiotic and the comprehensive therapy, the early extubation was conducted and followed by non-invasive MV via facial mask immediately in 11 cases (study group). Other 11 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were recruited as control group.
All patients had similar clinical characteristics and gas exchange before treatment, as well as the initiating time and all indices at the time of the PIC window. For study group and control group, the duration of invasive MV was (7.1 +/- 2.9) vs (23.0 +/- 14.0) days, respectively, P < 0.01. The total duration of ventilatory support was (13 +/- 7) vs (23 +/- 14) days, respectively, P < 0.05. The incidence of ventilator associated pneumonia (VAP) were 0/11 vs 6/11, respectively, P < 0.01. The duration of intensive care unit (ICU) stay was (13 +/- 7) vs (26 +/- 14) days, respectively, P < 0.05.
In COPD patients requiring intubation and MV for pulmonary infection and hypercapnic respiratory failure, early extubation followed by non-invasive MV initiated at the point of PIC window significantly decreases the invasive and total durations of ventilatory support, the risk of VAP, and the duration of ICU stay.
评估早期拔管及序贯无创机械通气在慢性阻塞性肺疾病（COPD）合并高碳酸血症性呼吸衰竭急性加重期的可行性及疗效。
本研究纳入22例因肺部感染（肺炎或化脓性支气管炎）导致严重高碳酸血症性呼吸衰竭并已行气管插管的COPD患者。在出现肺部感染控制窗（PIC窗）时，即经抗生素及综合治疗后肺部感染已得到显著控制（发热消退、脓性痰减少、影像学浸润及白细胞增多情况改善），对11例患者（研究组）进行早期拔管，并立即通过面罩给予无创机械通气。另外11例具有相似临床特征、在PIC窗后继续接受有创机械通气的COPD患者作为对照组。
所有患者治疗前的临床特征及气体交换情况、PIC窗出现的起始时间及各项指标均相似。研究组和对照组有创机械通气时间分别为（7.1±2.9）天和（23.0±14.0）天，P<0.01。通气支持总时间分别为（13±7）天和（23±14）天，P<0.05。呼吸机相关性肺炎（VAP）发生率分别为0/11和6/11，P<0.01。重症监护病房（ICU）住院时间分别为（13±7）天和（26±14）天，P<0.05。
对于因肺部感染和高碳酸血症性呼吸衰竭而需要气管插管及机械通气的COPD患者，在PIC窗时进行早期拔管并序贯无创机械通气可显著缩短有创及通气支持总时间、降低VAP风险及ICU住院时间。
