Application of invasive-noninvasive sequential mechanical ventilation in chromic obstructive pulmonary dis-ease patients with respiratory failure by investigating the appearance of respiratory pump failure improved window

doi:10.3969/j.issn.1674-3806.2014.08.03

Abstract：Objective To evaluate the application of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease ( COPD) patients with severe respiratory failure by investigating the appearance of respiratory pump failure improved window ( RPFIW) .Methods COPD patients with severe respira-tory failure receiving invasive mechanical ventilation ( MV) were involved in the study .When the RPFIW appeared by the antibiotic and comprehensive therapy ,106 cases were randomized into invasive-noninvasive sequential mechanical ventilation group and control group .The early extubation was conducted and followed by noninvasive mechanical ven -tilation via facial mask immediately in the sequential mechanical ventilation group .Conventional invasive mechanical ventilation was used as the weaning technique in the control group .The incidence of ventilator-associated pneumonia (VAP),incidence of reintubation and mortality,the duration of invasive mechanical ventilation and days in ICU were analyzed and compared .Results There were 52 cases in the sequential mechanical ventilation group ,54 cases in the control group.In the sequential mechanical ventilation group ,the duration of invasive mechanical ventilation was (3.9 ± 1.5)d,while the duration was(15.5 ±6.1)d in the control group (P<0.05).The durations of ICU stay was(4.9 ± 1.8 ) d in the sequential mechanical ventilation group , ( 20.3 ±5.5 ) d in the control group ( P<0.05 ) .The inci-dence of VAP was 15.38%(8/52) in the sequential mechanical ventilation group ,35.19%(19/54) in the control group respectively ( P <0.05 ) .Hospital mortality was 11.54%( 6/52 ) in the sequential mechanical ventilation group,and 27.78%(15/54) in the control group (P<0.05).The incidence of reintubation was 19.23%(10/52) in the sequential mechanical ventilation group ,16.67%( 9/54 ) in the control group ( P>0.05 ) .Conclusion In those COPD patients requiring invasive mechanical ventilation with severe respiratory failure due to respiratory pump failure,sequential noninvasive following invasive mechanical ventilation at the appearance of respiratory pump failure improved window might significantly reduce duration of invasive mechanical ventilation ,and days in ICU stay ,and de-crease the occurrence of VAP and hospital mortality .