Objective To investigate the effects of noninvasive positive pressure ventilation (NPPV) on patients with acute left heart failure. Methods Twenty patients with acute left heart failure diagnosed between September 2013 and July 2014 were randomized into treatment group (n=10) and control group (n=10). Both groups used conventional sedations, diuretics and drugs that strengthened the heart and dilated the vessels, while early use of NPPV was applied in the experimental group. Arterial blood gas analysis [pH value, pressure of arterial carbon dioxide (PaCO2), and pressure of arterial oxygen (PaO2)], heart rate (HR), respiration, duration of Intensive Care Unit (ICU) stay and invasive mechanical ventilation, duration of overall mechanical ventilation, and success case numbers before and two hours after treatment were observed and analyzed. Results For the control group, two hours after treatment, PaO2 was (67.0±8.5) mm Hg (1 mm Hg=0.133 kPa), HR was (124±10) times/min, Respiration was (34±4) times/min, the duration of ICU stay was (6.0±1.1) days, invasive ventilation was for (32.0±3.1) hours, and the total time of mechanical ventilation was (32.0±3.1) hours. Those indexes for the treatment group two hours after treatment were: PaO2, (82.3±8.9) mm Hg; HR, (98±11) times/min; respiration, (24±4) times/min; the duration of ICU stay, (4.0±0.8) days; invasive ventilation time, (16.0±1.3) hours; the total time of mechanical ventilation, (26.0±1.8) hours. All the differences for each index between the two groups were statistically significant (P < 0.05). Conclusion Early application of NPPV can rapidly relieve clinical symptoms and reduce the medical cost for patients with acute left heart failure.
ObjectiveTo investigate the effect of recruitment maneuver (RM) following fibrobronchoscopy in invasively mechanically ventilated (IMV) patients with excessive airway secretions or foreign body aspiration. MethodsFrom September 2012 to July 2014, 200 eligible patients were randomly assigned to intervention group (n=100) and control group (n=100) . Airway clearance by fibrobronchoscopy was conducted in both the two groups, but RM was subsequently performed only in the intervention group. Outcome measurements included oxygenation index, partial pressure of carbon dioxide (PaCO2), heart rate (HR), air way resistance (Raw) and dynamic lung compliance (Cdyn) before and 2 hours after treatment, and duration of IMV and Intensive Care Unit (ICU) stay were also analyzed. ResultsAfter treatment with fibrobronchoscopy, oxygenation index [intervention vs. control: (291.14±38.49) vs. (241.39± 35.62) mm Hg (1 mm Hg=0.133 kPa)], PaCO2 [(41.65±7.73) vs. (38.87±7.97) mm Hg] and Cdyn [(48.94±11.21) vs. (39.59±10.98) mL/cm H2O (1 cm H2O=0.098 kPa) ] were significantly increased, while HR [(95.41±20.59) , vs. (106.47±19.11) beats/min] and Raw [(17.87±8.32) vs. (23.98±7.88) cm H2O/(L·s)] were significantly decreased in both groups (P ＜ 0.01) . Duration of IMV and ICU stay in the intervention group were (15.72±6.42) and (19.85±8.12) days respectively, while in the control group were (20.49±7.21) and (27.87±10.33) days. Compared with the control group, patients in the intervention group had lower Raw, duration of IMV and ICU stay, and higher Cdyn, oxygenation index, and PaCO2 (P ＜ 0.01) , but no significant difference was found in HR (P ＞ 0.05) . ConclusionIn mechanically ventilated patients with excessive airway secretion or foreign body aspiration, recruitment maneuver following fibrobronchoscopy is of great clinical importance, due to the decrease of the duration of mechanical ventilation and ICU stay by re-inflating the collapsing alveoli, improving pulmonary ventilation and gas exchange, lung compliance and diffusion capacity.