Objective To study the effect of noninvasive positive pressure ventilation (NPPV) in chronic obstructive pulmonary disease (COPD) patients with hypercapnic coma secondary to respiratory failure.Methods COPD patients with or without coma secondary to respiratory failure were both treated by bi-level positive airway pressure (BiPAP) ventilation on base of routine therapy.There were 32 cases in coma group and 42 cases in non-coma group.Such parameters as arterial blood gas (ABG)，Glasgow coma scale (GCS)，time of NPPV therapy，achievement ratio，and adverse effects were investigated.Results 30 patients in the coma group were improved after NPPV treatment (26 cases recovered consciousness treated by BiPAP in 2 hours，3 cases recovered between 3~8 hours，1 case recovered after 24 hours).The parameters of ABG，the tidal volume and the minute ventilation volume were improved after BiPAP.The time of effective therapy was (9±4) days in the coma group and (7±3) days in the non-coma group with no significant difference (Pgt;0.05).The achievement ratio was similar in two groups (93.75% vs 97.62%，Pgt;0.05).But the incidence of gastrointestinal tympanites reached to a higher level in the coma group (80.5%) than the non-coma group (10.6%).Conclusion COPD patients with hypercapnic coma secondary to respiratory failure isn’t the absolute contraindication of NPPV treatment.
Objective To observe the effects of peritoneal ventilation with pure oxygen in the rabbits with hypoxaemia and hypercapnia induced by mechanical controlled hypoventilation. Methods Sixteen rabbits were invasively ventilated after trachea incision. Hypoxaemia and hypercapnia were induced by hypoventilation which was implemented both by degrading ventilation parameters and respiratory depression induced by intravenous infusion of muscle relaxant. Then pure oxygen was insufflated into the peritoneal cavity and arterial blood gases were measured every 30 minutes for two hours. Results The PaO2 was ( 52. 50 ±3. 46) mmHg at baseline and increased to ( 76. 46 ±7. 79) mm Hg, ( 79. 62 ±9. 53) mm Hg,( 78. 54 ±7. 18) mmHg, and ( 81. 1 ±8. 3) mm Hg, respectively at 30, 60, 90, and 120 minutes after the peritoneal ventilation with pure oxgen( all P lt; 0. 05) . Meanwhile PaCO2 was ( 63. 84 ±9. 09) mm Hg at baseline and ( 59. 84 ±14. 22) mmHg, ( 59. 16 ±15. 5) mmHg, ( 60. 02 ±7. 07) mmHg, and ( 61. 38 ±6. 56) mm Hg, respectively at 30, 60, 90, and 120 minutes after the peritoneal ventilation with pure oxgen with no significant change( P gt;0. 05) . Conclusion Peritoneal ventilation can obviously improve hypoxaemia induced by mechanical controlled hypoventilation, whereas hypercapnia remains unchanged.
Continuous renal replacement therapy (CRRT) is a term of blood purification technique that can continuously remove the body's solute and water for 24 hours without any interruption throughout each day. It has several advantages such as hemodynamic stability, accurate capacity control, stable internal environment, and inflammatory regulation, which is especially suitable for patients with severe hemodynamic instability. In clinical practice, critically ill patients treated with CRRT are often associated with different types of acidosis, including metabolic acidosis, lactic acidosis, citrate acidosis, ketoacidosis and hypercapnic acidosis. Different types of acidosis can be treated in different ways. This paper reviews the CRRT for special types of acidosis.
With the extensive application of laparoscopy in clinical surgery, the advantages of laparoscopic surgery such as less intraoperative bleeding, small and beautiful incision, and rapid postoperative recovery become increasingly prominent. However, prolonged use of carbon dioxide (CO2) pneumoperitoneum or high CO2 pneumoperitoneum pressure during laparoscopic surgery may cause subcutaneous emphysema and hypercapnia, in severe cases which may affect the quality of recovery and prognosis of patients. The use of a protective ventilation strategy during laparoscopic surgery under general anesthesia, a mechanical ventilation model of controlled hyperventilation, can reduce or avoid the effects of hypercapnia caused by prolonged CO2 pneumoperitoneum or high CO2 pneumoperitoneum pressure. This article reviews the effects of laparoscopic CO2 pneumoperitoneum on patients, the application of controlled hyperventilation in laparoscopic surgery under general anesthesia and the effects of controlled hyperventilation on patients. The aim is to provide a theoretical basis for the safe and effective application of controlled hyperventilation in laparoscopic surgery.
Objective To explore the correlation between different ultrasound pulmonary artery systolic pressure (PASP) and high-resolution CT (HRCT) pulmonary artery width (PAD) in patients with chronic obstructive pulmonary disease (COPD). Methods A retrospective analysis was conducted on 473 patients with acute exacerbation of chronic obstructive pulmonary disease who were hospitalized in the First Hospital of Lanzhou University from January 2016 to December 2020. They were divided into four groups according to the degree of PASP elevation: PASP normal group: PASP≤36 mm Hg, 182 cases; mildly elevated group: PASP 37 to 50 mm Hg, 164 cases; moderately elevated group: PASP 51 to 70 mm Hg, 89 cases; severely elevated group: PASP>70 mm Hg, 38 cases. The PAD of chest HRCT and the width of the ascending aorta (AAD) on the same plane were measured, and the ratio of PAD to AAD (PAD/AAD) was calculated. The differences of PAD, AAD, PAD/AAD in different PASP groups of COPD were compared. The correlations between PASP, lung function, blood gas analysis and PAD, PAD/AAD were analyzed. Results With the decrease of FEV1%pred, FVC%pred, FEV1/FVC, PaO2 and SaO2 in the patients, PaCO2 increased, PASP gradually increased, PAD and PAD/AAD gradually increased. PAD and PAD/AAD were significantly different between the severely elevated PASP group and the other three groups, and there were significant differences between the moderately elevated group and the normal group, and between the moderately elevated group and the mildly elevated group. PASP and PaCO2 were positively correlated with PAD and PAD/AAD, and FEV1%pred, FVC%pred, FEV1/FVC, PaO2, SaO2 were negatively correlated with PAD and PAD/AAD. Multivariate logistic regression analysis showed that after adjusting for confounding factors, decreased FEV1%pred was an independent risk factor for PAD/AAD>1 in COPD patients. The receiver operating characteristic curve showed that the width of PAD and PAD/AAD had certain predictive value for PASP. Conclusions There is a significant positive correlation between different degrees of ultrasound PASP and PAD and PAD/AAD in patients with COPD. HRCT PAD has certain predictive value for PASP. The heavier the hypoxia and carbon dioxide retention, the worse the pulmonary ventilation function, the higher the pulmonary artery pressure, the greater the possibility of PAD and PAD/AAD.