Objective To evaluate the safety and efficacy of non-invasive positive pressure ventilation (NIPPV) combined with fiberoptic bronchoscopy(FB) on acute exacerbation of chronic obstructive puhmonary disease (AECOPD) patients with acute respiratory failure.
Methods A prospective study was conducted on the AECOPD patients with respiratory failure in respiratory intensive care unit of Tangdu Hospital of Fourth Military Medicine University from February 2010 to February 2011.They were randomly divided into a case group and a control group.The case group was administrated FB and lavage after one hour of NIPPV treatment.The control group was administrated NIPPV without FB and lavage.Other treatment regimen was the same in two groups.
Results There were 51 subjects recruited in the study, 25 subjects in the case group and 26 subjects in the control group.All variables at baseline were matched (P > 0.05).All variables improved after one hour of NIPPV before FB, without significant difference between two groups (P > 0.05).During the period of FB, heart rate in the case group was faster than that in the control group (P < 0.05), and other variables were not significantly different between two groups (P > 0.05).Both groups received NIPPV for one hour after FB, the variables including heart rate, respiratory rate, pH, PaO2, PaCO2 were statistically significant between two groups(P < 0.05).At the time of 24 hours after FB, the variables including mean arterial pressure, heart rate, respiratory rate, pH, PaO2 and PaCO2 in the case group were nearly recovered, and differences between two groups were significant (P < 0.05).The positive rate of sputum culture was significantly higher in the case group than that in the control group[88.0%(22/25) vs.58.6%(14/26)].Success rate in the case group were obviously superior to that in control group.The cases of failure, death and refusing in the case group were lower than those in the control group.Complications in two groups had no significant difference (P > 0.05).There was not serious complication such as hear arrest, hemoptysis and apnea during the process of NIPPV combined with early FB.
Conclusion It deserves to be used in clinic because of the safety, efficacy and feasible for most of AECOPD patients through NIPPV combined with early FB.
Citation：
JiangHua, NanYandong, LiChunmei, MaLijie, JinFaguang. Safety and Efficacy of Non-invasive Positive Pressure Ventilation Treatment Combined with Fiberoptic Bronchoscopy on AECOPD Patients with Acute Respiratory Failure. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(5): 484-489. doi: 10.7507/1671-6205.2014118
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Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
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- 1. 中华医学会呼吸病学分会.诊断性可弯曲支气管镜应用指南(2008年版).中华结核和呼吸杂志, 2008, 31:14-16.
- 2. 刘辉国, 张珍祥.纤维支气管镜在呼吸系统疾病中的诊断和治疗进展.实用诊断与治疗杂志, 2007, 21:561-563.
- 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(2013年修订版).中华结核和呼吸杂志, 2013, 36:255-264.
- 4. 王辰, 商鸣宇, 黄克武, 等.有创与无创序贯性机械通气治疗慢性阻塞性肺疾病所致严重急性呼吸衰竭的研究.中华结核和呼吸杂志, 2000, 23:212-216.
- 5. Kollef MH.The prevention of ventilator associated pneumonia.N Eng J Med, 1999, 340:627-634.
- 6. Kollef MH.Avoidance of tracheal intubation as a strategy to prevent ventilator associated pneumonia.Intensive Care Med, 1999, 25:553-555.
- 7. 曹志新, 王辰.无创正压通气在有创-无创序贯通气中的应用.国外医学呼吸系统分册, 2003, 23:228-229.
- 8. Zhu GF, Zhang W, Zong H, et al.Effectiveness and safety of noninvasive positive-pressure ventilation for severe hypercapnic encephalopathy due to acute exacerbation of chronic obstructive pulmonary disease:a prospective case-control study.Chin Med J (Engl), 2007, 120:2204-2209.
- 9. Meduri GU, Turner RE, Abou-Shala N, et al.Noninvasive mechanical ventilation via face mask:first-line intervention in patients with acute hypercapnic and hypoxemic acute respiratory failure.Chest, 1996, 109:179-193.
- 10. Adnet F, Racine SX, Lapostolle F, et al.Full reversal of hypercapnic coma by noninvasive positive pressure ventilation.Am J Emerg Med, 2001, 19:244-246.
- 11. Goldstein RA, Rohatgi PK, Bergofsky EH, et al.Clinical role of bronchoalveolar lavage in adults with pulmonary disease.Am Rev Respir Dis, 1990, 142:481-486.
- 12. Heunks LM, de Bruin CJ, van der Hoeven JG, et al.Non-invasive mechanical ventilation for diagnostic bronchoscopy using a new face mask:an observational feasibility study.Intensive Care Med, 2010, 36:143-147.
- 13. Scala R, Naldi M, Maccari U.Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia.Crit Care, 2010, 14:R80.
