Observation of lateral position ventilation in invasive ventilation of patients with acute exacerbations of chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Xiaoyi ,  LIU Hui

Department of Critical Care Medicine, Central Hospital of Dazhou, Dazhou, Sichuan 635000, P. R. China;

Corresponding author：

LIU Hui, Email: 756904123@qq.com

Keywords：

Acute exacerbations of chronic obstructive pulmonary disease; Invasive mechanical ventilation; Lateral position ventilation; Fibrobronchoscopy; Invasive-noninvasive sequential ventilation; Difficult weaning

DOI：

10.7507/1671-6205.201612048

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Objective To investigate the clinical significance of lateral position ventilation in the treatment of invasive ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods From October 2014 to December 2016, 60 eligible patients with AECOPD who meeting the inclusion criteria were randomly assigned to an intervention group (n=30) or a control group (n=30). Expectorant, antiasthmatic, anti-infective, invasive ventilation, bronchoscopy, analgesic sedation, invasive-noninvasive sequential ventilation, nutritional support, intensive care and other treatment were conducted in two groups, but lateral position ventilation was subsequently performed in the intervention group and the control group used half lateral position. Outcome measurements included pH, PaO₂/FiO₂, arterial partial pressure of carbon dioxide (PaCO₂), heart rate (HR), respiratory rate (R) and air way resistance (Raw) before and one day after invasive ventilation, and duration of control of pulmonary infection (PIC), invasive mechanic ventilation (IMV), mechanic ventilation (MV) and intensive care unit (ICU) stay. Results Compared with before ventilation, the levels of PaO₂/FiO₂, PaCO₂, HR, R and Raw were significantly changed in two groups after ventilation (P<0.05). One day later after ventilation, pH [interventionvs. control: (7.43±0.07) vs. (7.37±0.11)], PaO₂/FiO₂[(253.52±65.33) mm Hg (1 mm Hg=0.133 kPa) vs. (215.46±58.72) mm Hg] and PaCO₂ [(52.45±7.15) mm Hg vs. (59.39±8.44) mm Hg] were statistically significant (P<0.05), but no significant difference was found in HR, R or Raw between two groups (P>0.05). Compared with the control group, PIC [(3.7±1.4) daysvs. (5.3±2.2) days], IMV [(4.0±1.5) days vs. (6.1±3.0) days], MV [(4.7±2.0) days vs. (7.3±3.7) days] and ICU stay [(6.2±2.1) days vs. (8.5±4.2) days] were significantly decreased (P<0.05) in the intervention group. Conclusions In AECOPD patients, invasive ventilation using lateral position ventilation can significantly improve arterial blood gas index, decrease Raw, shorten the time of PIC, IMV, MV and ICU stay.

Citation： LIU Xiaoyi, LIU Hui. Observation of lateral position ventilation in invasive ventilation of patients with acute exacerbations of chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(6): 540-544. doi: 10.7507/1671-6205.201612048 Copy

1.	慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组. 慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014 年修订版). 国际呼吸杂志, 2014, 34(1): 1-11.
2.	Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
3.	成人慢性气道疾病雾化吸入治疗专家组. 成人慢性气道疾病雾化吸入治疗专家共识. 中国呼吸与危重监护杂志, 2012, 11(2): 105-110.
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5.	有创-无创序贯机械通气多中心研究协作组. 以肺部感染控制窗为切换点行有创与无创序贯机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的随机对照研究. 中华结核和呼吸杂志, 2006, 29(1): 14-18.
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9.	于湘友, 潘鹏飞, 拜合提尼沙•吐尔地. 侧卧位通气对急性呼吸窘迫综合征患者肺容积合氧合的影响. 中国呼吸与危重监护杂志, 2009, 8(6): 555-557.
10.	于湘友, 杨春波, 王毅. 侧卧位通气治疗肺内/肺外源性急性呼吸窘迫综合征的对比观察. 中华急诊医学杂志, 2012, 21(3): 249-251.
11.	龙勇, 姜英, 李长罗. 侧卧位机械通气对胸外伤急性呼吸衰竭患者血氧及循环的影响. 中国当代医药, 2016, 23(17): 29-31.
12.	王泠. 2014 版国际《压疮预防和治疗: 临床实践指南》解读. 中国护理管理, 2016, 16(5): 577-580.
13.	章敬玉, 邓桂胜, 吴刚. PIC 窗指导下序贯机械通气在慢性阻塞性肺疾病急性加重患者治疗中的应用. 山东医药, 2016, 56(38): 50-52.
14.	Duan J, Guo S, Han X, et al. Dual-mode weaning strategy for difficult-weaning tracheotomy patients: a feasibility study. Anesth Analg, 2012, 115(3): 597-604.
15.	Perera PN, Armstrong EP, Sherrill DL, et al. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD, 2012, 9(2): 131-141.
16.	Ban A, Ismail A, Harun R, et al. Impact of clinical pathway on clinical outcomes in the management of COPD exacerbation. BMC Pulm Med, 2012, 12: 27.
17.	Brightling CE. Biomarkers that predict and guide therapy for exacerbations of chronic obstructive pulmonary disease. Ann Am Thorac Soc, 2013, 10 Suppl: S214-S219.
18.	Diamantea F, Kostikas K, Bartziokas K, et al. Prediction of hospitalization stay in COPD exacerbations: the AECOPD-F score. Respir Care, 2014, 59(11): 1679-1686.
19.	刘小毅, 郑祥德, 刘慧. 肺复张策略在有创通气患者行纤维支气管镜治疗后的对比研究. 华西医学, 2016, 31(5): 863-866.
20.	权红丽, 冯思芳, 白智庆. 机械振动排痰在 AECOPD 机械通气患者中的应用及效果观察. 中国急救医学, 2015, 35(z2): 324-325.

1. 慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组. 慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014 年修订版). 国际呼吸杂志, 2014, 34(1): 1-11.
2. Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
3. 成人慢性气道疾病雾化吸入治疗专家组. 成人慢性气道疾病雾化吸入治疗专家共识. 中国呼吸与危重监护杂志, 2012, 11(2): 105-110.
4. 中华医学会重症医学分会. 慢性阻塞性肺疾病急性加重患者的机械通气指南(2007). 中国危重病急救医学, 2007, 19(9): 513-518.
5. 有创-无创序贯机械通气多中心研究协作组. 以肺部感染控制窗为切换点行有创与无创序贯机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的随机对照研究. 中华结核和呼吸杂志, 2006, 29(1): 14-18.
6. Mallia P, Singanayagam A, Johnston SL. Virus-bacteria interactions in COPD exacerbations. Eur Respir Monogr, 2013, 60: 76-83.
7. Mackay AJ, Hurst JR. COPD exacerbations: causes, prevention, and treatment. Med Clin North Am, 2012, 96(4): 789-809.
8. 梁丽, 李礼娟. 机械通气患者大于 80° 侧卧位的通气效果观察. 医学理论与实践, 2015, 28(11): 1523-1524.
9. 于湘友, 潘鹏飞, 拜合提尼沙•吐尔地. 侧卧位通气对急性呼吸窘迫综合征患者肺容积合氧合的影响. 中国呼吸与危重监护杂志, 2009, 8(6): 555-557.
10. 于湘友, 杨春波, 王毅. 侧卧位通气治疗肺内/肺外源性急性呼吸窘迫综合征的对比观察. 中华急诊医学杂志, 2012, 21(3): 249-251.
11. 龙勇, 姜英, 李长罗. 侧卧位机械通气对胸外伤急性呼吸衰竭患者血氧及循环的影响. 中国当代医药, 2016, 23(17): 29-31.
12. 王泠. 2014 版国际《压疮预防和治疗: 临床实践指南》解读. 中国护理管理, 2016, 16(5): 577-580.
13. 章敬玉, 邓桂胜, 吴刚. PIC 窗指导下序贯机械通气在慢性阻塞性肺疾病急性加重患者治疗中的应用. 山东医药, 2016, 56(38): 50-52.
14. Duan J, Guo S, Han X, et al. Dual-mode weaning strategy for difficult-weaning tracheotomy patients: a feasibility study. Anesth Analg, 2012, 115(3): 597-604.
15. Perera PN, Armstrong EP, Sherrill DL, et al. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD, 2012, 9(2): 131-141.
16. Ban A, Ismail A, Harun R, et al. Impact of clinical pathway on clinical outcomes in the management of COPD exacerbation. BMC Pulm Med, 2012, 12: 27.
17. Brightling CE. Biomarkers that predict and guide therapy for exacerbations of chronic obstructive pulmonary disease. Ann Am Thorac Soc, 2013, 10 Suppl: S214-S219.
18. Diamantea F, Kostikas K, Bartziokas K, et al. Prediction of hospitalization stay in COPD exacerbations: the AECOPD-F score. Respir Care, 2014, 59(11): 1679-1686.
19. 刘小毅, 郑祥德, 刘慧. 肺复张策略在有创通气患者行纤维支气管镜治疗后的对比研究. 华西医学, 2016, 31(5): 863-866.
20. 权红丽, 冯思芳, 白智庆. 机械振动排痰在 AECOPD 机械通气患者中的应用及效果观察. 中国急救医学, 2015, 35(z2): 324-325.

Chinese Journal of Respiratory and Critical Care Medicine

Observation of lateral position ventilation in invasive ventilation of patients with acute exacerbations of chronic obstructive pulmonary disease

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