The value of application noninvasive positive pressure ventilation in patients with high risk of weaning induced pulmonary oedema_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YUE Weigang , ZHANG Yin , JIANG Youfei , YUAN Peng , FEN Xin , YIN Ruiyuan , ZHANG Zhigang ,  LI Bin

Department of Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P. R. China;

Corresponding author：

LI Bin, Email: lynd001@163.com

Keywords：

Noninvasive positive pressure ventilation; Weaning induced pulmonary oedema; High risk patients

DOI：

10.7507/1671-6205.201909055

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Objective To investigate the value of noninvasive positive pressure ventilation in patients with high risk of weaning induced pulmonary oedema.Methods From June 2018 to June 2019, 63 patients with mechanical ventilation in the Department of Critical Care Medicine of the First Hospital of Lanzhou University were enrolled. Randomized digital table method was randomly divided into two groups and the resulting random number assignment was hidden in opaque envelopes, the experimental group received non-invasive positive pressure ventilation (n=32), and the control group received mask oxygen therapy ventilation (n=31). The heart rate, respiratory rate, means arterial pressure, hypoxemia, reintubation, blood gas analysis and other indicators were compared between the two groups after 2 hours of weaning. The length of hospital stay, mortality and complications were compared between the two groups.Results After 2 hours of weaning, the heart rate and respiratory rate were significantly lower in the non-invasive positive pressure ventilation group than in the mask group (P<0.05). There was no difference in mean arterial pressure between the two groups of patients, which was not statistically significant (P>0.05). The incidence of hypoxemia, laryngeal edema and reintubation in the noninvasive positive pressure ventilation group was significantly lower than that in the mask group, which was statistically significant (P<0.05), and the blood gas analysis index was better than the mask group (P<0.05). The non-invasive positive pressure ventilation group was significantly shorter than the mask group in the length of hospital stay and intensive care unit (P<0.05). The hospital mortality rate in 28 days was lower than that in the mask group (P<0.05), but there was no difference in tracheotomy, pneumothorax and subcutaneous emphysema between the two groups (P>0.05).Conclusions Noninvasive positive pressure ventilation can effectively prevent hypoxemia, laryngeal edema, and re-intubation in patients at high risk of withdrawal related pulmonary edema. It can also shorten the length of hospital stay, which is worth clinical attention and promotion.

Citation： YUE Weigang, ZHANG Yin, JIANG Youfei, YUAN Peng, FEN Xin, YIN Ruiyuan, ZHANG Zhigang, LI Bin. The value of application noninvasive positive pressure ventilation in patients with high risk of weaning induced pulmonary oedema. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(2): 114-117. doi: 10.7507/1671-6205.201909055 Copy

1.	白珀, 张睢扬. 呼吸衰竭合并心衰患者脱机相关性肺水肿的研究进展. 中华肺部疾病杂志(电子版), 2014, 7(3): 88-89.
2.	Kitajima T, Marumo S, Shima H, et al. Clinical impact of episodic nocturnal hypercapnia and its treatment with noninvasive positive pressure ventilation in patients with stable advanced COPD. Int J Chron Obstruct Pulmon Dis, 2018, 13: 843-853.
3.	Dres M, Teboul JL, Monnet X. Weaning the cardiac patient from mechanical ventilation. Curr Opin Crit Care, 2014, 20(5): 493-498.
4.	Yamaga S, Ohshimo S, Shime N. Is lung ultrasonography really useful for diagnosing weaning-induced pulmonary oedema?. Intensive Care Med, 2019, 45(9): 1329.
5.	Ferré A, Guillot M, Lichtenstein D, et al. Lung ultrasound allows the diagnosis of weaning-induced pulmonary oedema. Intensive Care Med, 2019, 45(5): 601-608.
6.	Goudelin M, Evrard B, Vignon P. Left ventricular overloading is the leading mechanism in extubation failure of patients at high-risk of weaning-induced pulmonary edema. Intensive Care Med, 2020, 46(10): 1962-1964.
7.	Potts JM. Noninvasive positive pressure ventilation: effect on mortality in acute cardiogenic pulmonary edema: a pragmatic meta-analysis. Pol Arch Med Wewn, 2009, 119(6): 349-353.
8.	Vignon P. Cardiovascular failure and weaning. Ann Transl Med, 2018, 6(18): 354.
9.	Liu J, Shen F, Teboul JL, et al. Cardiac dysfunction induced by weaning from mechanical ventilation: incidence, risk factors, and effects of fluid removal. Crit Care, 2016, 20(1): 369.
10.	Goudelin M, Champy P, Amiel JB. Left ventricular overloading identified by critical care echocardiography is key in weaning-induced pulmonary edema. Intensive Care Med, 2020, 6(7): 1371-1381.
11.	Dres M, Teboul JL, Anguel N, et al. Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema. Crit Care Med, 2014, 42(8): 1882-1889.
12.	Chen PK, Shih CC, Lin FC, et al. Prolonged use of noninvasive positive pressure ventilation after extubation among patients in the intensive care unit following cardiac surgery: The predictors and its impact on patient outcome. Sci Rep, 2019, 9(1): 9539.
13.	Sanfilippo F, Santonocito C, Burgio G, et al. The importance of diastolic dysfunction in the development of weaning-induced pulmonary oedema. Crit Care, 2017, 21(1): 29.
14.	Gedeon M, Gomes S, Roy K, et al. Use of noninvasive positive pressure ventilation in patients with severe obesity undergoing esophagogastroduodenoscopy: a randomized controlled trial. Surg Obes Relat Dis, 2019, 15(9): 1589-1594.
15.	Anguel N, Monnet X, Osman D. Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema. Intensive Care Med, 2008, 34(7): 1231-1238.

1. 白珀, 张睢扬. 呼吸衰竭合并心衰患者脱机相关性肺水肿的研究进展. 中华肺部疾病杂志(电子版), 2014, 7(3): 88-89.
2. Kitajima T, Marumo S, Shima H, et al. Clinical impact of episodic nocturnal hypercapnia and its treatment with noninvasive positive pressure ventilation in patients with stable advanced COPD. Int J Chron Obstruct Pulmon Dis, 2018, 13: 843-853.
3. Dres M, Teboul JL, Monnet X. Weaning the cardiac patient from mechanical ventilation. Curr Opin Crit Care, 2014, 20(5): 493-498.
4. Yamaga S, Ohshimo S, Shime N. Is lung ultrasonography really useful for diagnosing weaning-induced pulmonary oedema?. Intensive Care Med, 2019, 45(9): 1329.
5. Ferré A, Guillot M, Lichtenstein D, et al. Lung ultrasound allows the diagnosis of weaning-induced pulmonary oedema. Intensive Care Med, 2019, 45(5): 601-608.
6. Goudelin M, Evrard B, Vignon P. Left ventricular overloading is the leading mechanism in extubation failure of patients at high-risk of weaning-induced pulmonary edema. Intensive Care Med, 2020, 46(10): 1962-1964.
7. Potts JM. Noninvasive positive pressure ventilation: effect on mortality in acute cardiogenic pulmonary edema: a pragmatic meta-analysis. Pol Arch Med Wewn, 2009, 119(6): 349-353.
8. Vignon P. Cardiovascular failure and weaning. Ann Transl Med, 2018, 6(18): 354.
9. Liu J, Shen F, Teboul JL, et al. Cardiac dysfunction induced by weaning from mechanical ventilation: incidence, risk factors, and effects of fluid removal. Crit Care, 2016, 20(1): 369.
10. Goudelin M, Champy P, Amiel JB. Left ventricular overloading identified by critical care echocardiography is key in weaning-induced pulmonary edema. Intensive Care Med, 2020, 6(7): 1371-1381.
11. Dres M, Teboul JL, Anguel N, et al. Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema. Crit Care Med, 2014, 42(8): 1882-1889.
12. Chen PK, Shih CC, Lin FC, et al. Prolonged use of noninvasive positive pressure ventilation after extubation among patients in the intensive care unit following cardiac surgery: The predictors and its impact on patient outcome. Sci Rep, 2019, 9(1): 9539.
13. Sanfilippo F, Santonocito C, Burgio G, et al. The importance of diastolic dysfunction in the development of weaning-induced pulmonary oedema. Crit Care, 2017, 21(1): 29.
14. Gedeon M, Gomes S, Roy K, et al. Use of noninvasive positive pressure ventilation in patients with severe obesity undergoing esophagogastroduodenoscopy: a randomized controlled trial. Surg Obes Relat Dis, 2019, 15(9): 1589-1594.
15. Anguel N, Monnet X, Osman D. Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema. Intensive Care Med, 2008, 34(7): 1231-1238.

Chinese Journal of Respiratory and Critical Care Medicine

The value of application noninvasive positive pressure ventilation in patients with high risk of weaning induced pulmonary oedema

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