Analysis of the therapeutic effect and influencing factors of noninvasive mechanical ventilation mode based on target tidal volume in patients with chronic obstructive pulmonary disease with type Ⅱ respiratory failure

DU Yujing; NIE Qingrong; LIU Qimeng; AN Mengqiao; LUO Hailun; ZHANG Lei

doi:10.3969/j.issn.1674-3245.2025.05.011

Abstract：Objective Noninvasive mechanical ventilation(NIV)mode is an important therapeutic tool for treating patients with chronic obstructive pulmonary disease(COPD)with type Ⅱ respiratory failure.Target tidal volume,as a key parameter of mechanical ventilation,is closely related to the therapeutic effect and complications of NIV.The aim of this study was to compare the efficacy,complications and life indications.According to whether complications occurred after treatment,106 patients were further divided into complication group(24 cases)and non-complication group(82 cases).The data before admission were collected and analyzed.Methods This study is a phased study.First,106 COPD patients with respiratory failure were prospectively included,and they were divided into groups A and B with small[ideal body weight×(8～11)ml/kg]and large[ideal body weight×(12～15)ml/kg]target tidal volumes to compare the difference between efficacy and life indications.Furthermore,106 patients were further divided into 2 groups according to the occurrence of complications during the study,and the relationship between target tidal volume and the occurrence of complications was analyzed by univariate and Cox proportional risk model.Results The treatment success in group A was 88.68%,which was significantly higher than 69.81%in group B(χ2=4.476,P=0.034).A total of 24 cases in 106 patients had complications,including 8 cases in group A,accounting for 15.09%,significantly lower than 16 patients in group B,accounting for 30.19%(P<0.05),complications were classified as the complication group,and patients without complications were included in the untreated group for subsequent studies.The pH and PaO2 were significantly higher in group A than in group B after 12 h and 1 d of treatment in patients in groups A and B(t=5.657,5.479,3.868,2.365,P<0.05),while PaCO2 and heart rate were significantly lower than those in group B(t=3.930,3.732,2.158,3.118,P<0.05).There was a total of 24 cases(22.64%)of patients in the complication group in the 106 patients,and non 82 cases(77.36%)in the non-complication group.The risk of complications increased with age,male number percentage,target tidal volume,duration of mechanical ventilation,pre-treatment PaCO2、pre-treatment CRP,WBC,and decrease in pre-treatment PaO2(t=4.257、6.639、2.130、6.530、5.995、3.127、7.184、3.994,P<0.05).Univariate analysis showed that the occurrence of complications was closely associated with age>66.75 years,target tidal volume>645.64 mL,pretreatment PaO2≤55.27 mmHg,pretreatment PaCO2>74.67 mmHg,and pretreatment CRP>71.17 mg/L(HR=1.724、1.436、1.736、1.427、1.743,P<0.05).Cox regression analysis model was adjusted to find that with the increase of target tidal volume increased,the patients'risk of complications significantly increased(non-complicated group as a reference;HR in the complicated group,95%CI:1.012,1.001～1.254,P=0.000);after further adjusting for the confounders of age,PaO2,PaCO2,CRP,etc.,the non-complicated group was still at a significantly elevated risk of complications compared with the complicated group(HR=1.615,95%CI:1.042～1.875,P=0.034).Conclusion NIV at small target tidal volume has higher efficacy in patients with COPD with type Ⅱ respiratory failure,and the risk of NIV complications is increased in patients with advanced age,high target tidal volume,low PaO2,high PaCO2,and high CRP,and there is a positive correlation between target tidal volume and NIV complications in patients with COPD with type II respiratory failure.