Du Ling-ling, Han Hao, Zhang Xiao-jun, Wei Ling
Department of Respiratory Disease, People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009 Jul;21(7):394-6.
To evaluate the feasibility and the efficacy of sequential non-invasive mechanical ventilation (MV) following short-term invasive MV in the treatment of acute respiratory distress syndrome (ARDS) consequent to pulmonary diseases in the elderly patients.
Thirty-two elderly patients of ARDS were enrolled and grouped into two groups (sequential therapy group and control group) randomly (16 cases in each group). Both groups with tracheal intubation received the following ventilation modality in the first 24 hours: control/assistant-control+positive end expiratory pressure (PEEP)+sustained inflation (SI), and when the patients' conditions were relieved, the ventilation modality was switched to synchronized intermittent mandatory ventilation (SIMV)+pressure support ventilation (PSV)+PEEP. When "ARDS-controlled window" appeared, the ventilation mobility was switched to oronasal face continuous positive airway pressure (CPAP), followed by CPAP until weaning; the control group was weaned with SIMV+PSV+PEEP. The parameters including ventilation and oxygenation, ventilation duration, ventilation-associated pneumonia (VAP), duration of respiratory intensive care unit (RICU) stay were serially determined.
Both groups had the similar baseline clinical characteristics (all P>0.05). The patients in the sequential therapy group showed shorter MV duration [(4.6+/-1.0) days], total duration of ventilation support [(12.7+/-4.0) days] and RICU stay duration [(16+/-7) days], and lower VAP incidence rate [6.25% (1/16)] and mortality rate [25.00% (4/16)] compared with control subjects [(21.9+/-9.0) days, (21.9+/-9.0) days, (29+/-13) days, 75.00% (12/16), 56.25% (9/16), respectively, P<0.05 or P<0.01].
Early extubation followed by non-invasive ventilation might decrease the total duration of ventilation support, the risks of VAP and duration of RICU stay.
评估老年肺部疾病所致急性呼吸窘迫综合征（ARDS）患者短期有创机械通气（MV）后序贯无创机械通气的可行性及疗效。
选取32例老年ARDS患者，随机分为两组（序贯治疗组和对照组），每组16例。两组气管插管患者在前24小时均采用以下通气模式：控制/辅助控制+呼气末正压（PEEP）+持续气道内正压通气（SI），待患者病情缓解后，通气模式切换为同步间歇指令通气（SIMV）+压力支持通气（PSV）+PEEP。当出现“ARDS控制窗”时，通气模式切换为口鼻面罩持续气道正压通气（CPAP），随后持续使用CPAP直至脱机；对照组采用SIMV+PSV+PEEP脱机。连续测定通气和氧合参数、通气时间、呼吸机相关性肺炎（VAP）、入住呼吸重症监护病房（RICU）时间。
两组基线临床特征相似（均P>0.05）。与对照组相比，序贯治疗组患者的机械通气时间[（4.6±1.0）天]、通气支持总时间[（12.7±4.0）天]和RICU住院时间[（16±7）天]更短，VAP发生率[6.25%（1/16）]和死亡率[25.00%（4/16）]更低，对照组分别为[（21.9±9.0）天、（21.9±9.0）天、（29±13）天、75.00%（12/16）、56.25%（9/16），P<0.05或P<0.01]。
早期拔管后序贯无创通气可能会缩短通气支持总时间、降低VAP风险及RICU住院时间。
