Okuda Miyuki, Kashio Makoto, Tanaka Nobuya, Fujii Takashi, Okuda Yoshinari
Osaka Hospital, Neyagawakoen 2276-1, Neyagawa City, Osaka, 572-0854, Japan.
J Med Case Rep. 2012 Sep 10;6:284. doi: 10.1186/1752-1947-6-284.
We were able to treat a patient with acute exacerbation of chronic obstructive pulmonary disease who also suffered from sleep-disordered breathing by using the average volume-assured pressure support mode of a Respironics V60 Ventilator (Philips Respironics: United States). This allows a target tidal volume to be set based on automatic changes in inspiratory positive airway pressure. This removed the need to change the noninvasive positive pressure ventilation settings during the day and during sleep. The Respironics V60 Ventilator, in the average volume-assured pressure support mode, was attached to our patient and improved and stabilized his sleep-related hypoventilation by automatically adjusting force to within an acceptable range.
Our patient was a 74-year-old Japanese man who was hospitalized for treatment due to worsening of dyspnea and hypoxemia. He was diagnosed with acute exacerbation of chronic obstructive pulmonary disease and full-time biphasic positive airway pressure support ventilation was initiated. Our patient was temporarily provided with portable noninvasive positive pressure ventilation at night-time following an improvement in his condition, but his chronic obstructive pulmonary disease again worsened due to the recurrence of a respiratory infection. During the initial exacerbation, his tidal volume was significantly lower during sleep (378.9 ± 72.9mL) than while awake (446.5 ± 63.3mL). A ventilator that allows ventilation to be maintained by automatically adjusting the inspiratory force to within an acceptable range was attached in average volume-assured pressure support mode, improving his sleep-related hypoventilation, which is often associated with the use of the Respironics V60 Ventilator. Polysomnography performed while our patient was on noninvasive positive pressure ventilation revealed obstructive sleep apnea syndrome (apnea-hypopnea index = 14), suggesting that his chronic obstructive pulmonary disease was complicated by obstructive sleep apnea syndrome.
In cases such as this, in which patients with severe acute respiratory failure requiring full-time noninvasive positive pressure ventilation therapy also show sleep-disordered breathing, different ventilator settings must be used for waking and sleeping. On such occasions, the Respironics V60 Ventilator, which is equipped with an average volume-assured pressure support mode, may be useful in improving gas exchange and may achieve good patient compliance, because that mode allows ventilation to be maintained by automatically adjusting the inspiratory force to within an acceptable range whenever ventilation falls below target levels.
我们使用伟康V60呼吸机（飞利浦伟康：美国）的平均容量保证压力支持模式，成功治疗了一名患有慢性阻塞性肺疾病急性加重且伴有睡眠呼吸障碍的患者。这使得能够根据吸气气道正压的自动变化来设置目标潮气量。这消除了在白天和睡眠期间更改无创正压通气设置的必要性。在平均容量保证压力支持模式下，将伟康V60呼吸机连接到我们的患者身上，并通过自动将压力调整到可接受范围内，改善并稳定了他与睡眠相关的通气不足。
我们的患者是一名74岁的日本男性，因呼吸困难和低氧血症加重而住院治疗。他被诊断为慢性阻塞性肺疾病急性加重，并开始进行全时双相气道正压支持通气。在病情改善后，患者夜间临时接受了便携式无创正压通气，但由于呼吸道感染复发，他的慢性阻塞性肺疾病再次恶化。在初次加重期间，他睡眠时的潮气量（378.9±72.9mL）明显低于清醒时（446.5±63.3mL）。以平均容量保证压力支持模式连接了一台能够通过自动将吸气力调整到可接受范围内来维持通气的呼吸机，改善了他通常与使用伟康V60呼吸机相关的与睡眠相关的通气不足。在患者接受无创正压通气期间进行的多导睡眠图显示阻塞性睡眠呼吸暂停综合征（呼吸暂停低通气指数=14），提示他的慢性阻塞性肺疾病合并了阻塞性睡眠呼吸暂停综合征。
在这种情况下，对于需要全时无创正压通气治疗的严重急性呼吸衰竭患者同时伴有睡眠呼吸障碍，清醒和睡眠时必须使用不同的通气设置。在这种情况下，配备平均容量保证压力支持模式的伟康V60呼吸机可能有助于改善气体交换，并可能实现良好的患者依从性，因为该模式允许在通气低于目标水平时通过自动将吸气力调整到可接受范围内来维持通气。
