Objective To explore the efficacy of bi-level positive airway pressure ( BiPAP)ventilation plus plateau exhalation valve ( PEV) combined with respiratory stimulant for the treatment of pulmonary encephalopathy in patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD) . Methods 70 AECOPD patients with pulmonary encephalopathy were randomly divided into a control group and a treatment group. All patients received BiPAP ventilation and conventional therapy
including antimicrobial, bronchodilation, and expectorant treatment. In the treatment group, the BiPAP ventilator was connected to PEV additionally, and naloxone and nikethamide were administered for 3 days.Clinical symptoms, blood gas analysis, vital signs, gas leakage conditions, and adverse reactions were recorded. Results Heart rate, respiratory rate, PaCO2 , and APACHEⅡ score were more significantly lower,the time to recover consciousness was shoter, meanwhile PaO2 , SaO2 , pH, and glasgow coma scale were significantly higher in the treatment group compared with the control group( all P lt; 0. 01) . Two cases in the treatment group and 5 cases in the control group received tracheal intubation and invasive ventilation due to treatment failure. Two elderly patients in the control group died in hospital. Conclusion Noninvasive positive pressure ventilation plus PEV combined with respiratory stimulant can significantly improve symptoms, shorten the time to recover consciousness, reduce the rate of endotracheal intubation, and improve hypoxemia and hypercapnia rapidly in AECOPD patients with pulmonary encephalopathy.
Citation：
WANG Yong,FAN Yuanwei,ZHU Baoshan. Efficacy of Noninvasive Positive Pressure Ventilation Plus Plateau Exhalation Valve Combined with Respiratory Stimulant on Pulmonary Encephalopathy in Patients with Acute Exacerbation of COPD. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(4): 344-347. doi:
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- 1. Keenan SP, Sinuff T, Cook DJ, et al. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med, 2003 , 138: 861-870.
- 2. Hilbert G, Gruson D, Portel L, et al. Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency. Eur Respir J, 1998, 11 : 1349 -1353.
- 3. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南( 2007 年修订版) . 中华结核和呼吸杂志, 2007 ,30: 8-17.
- 4. Díaz GG, Alcaraz AC, Talavera JC, et al. Noninvasive positivepressure ventilation to treat hypercapnic coma secondary to respiratory failure. Chest, 2005, 127: 952 -960.
- 5. Plant PK, Owen JL, Parrott S, et al. Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial.BMJ, 2003, 326: 956 .
- 6. Confalonieri M, Garuti G, Cattaruzza MS, et al. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J, 2005, 25: 348-355 .
- 7. Schettino GP, Chatmongkolchart S, Hess DR, et al. Position of exhalation port and mask design affect CO2 rebreathing during noninvasive positive pressure ventilation. Crit Care Med, 2003, 31 :2178-2182.
