Without the need for noninvasive ventilator for patients with tracheotomy or tracheal intubation, the operation is simple, easily accepted b
Without the need for noninvasive ventilator for patients with tracheotomy or tracheal intubation, the operation is simple, easily accepted by patients, and complications of airway injury and ventilator-associated pneumonia less, not only widely used in the treatment of hospitalized patients with acute or chronic respiratory failure, the family condition is relatively stable in the clinic application of more and more. The family needs to use noninvasive ventilation in the treatment of diseases including obstructive sleep apnea hypopnea syndrome (OSAHS), heart failure, chronic obstructive pulmonary disease (COPD) respiratory failure, obesity hypoventilation syndrome and neuromuscular diseases. How to choose the appropriate non-invasive ventilator and ventilation mode to ensure the efficacy and safety of the treatment has been the concern of the majority of clinicians and patients. The ventilator is not the general household appliances, the use of service providers need to provide continuous technical support and maintenance, but also need to follow up and adjust the clinician. This paper discusses the types and characteristics of non-invasive ventilator used in different diseases, in order to be helpful to the patients who need to choose the home ventilator.
For different diseases, although the therapeutic effect of noninvasive ventilation in different types of overlap with certain (that is, sometimes the same type of ventilator may be used for patients with different diseases, and vice versa), but the pathogenesis and treatment of each disease based on different for noninvasive ventilator type selection requirements or different requirements. The type and severity of the disease is an important basis for the selection of different types of ventilators and the efficacy and safety.
1. Sleep disordered breathing
So far, continuous positive airway pressure (CPAP) ventilation is still the first choice for the treatment of obstructive sleep apnea hypopnea syndrome guidelines recommend, provide a constant pressure in the process of respiration, maintain upper airway especially expiratory phase open, divided into fixed pressure CPAP (Fixed-CPAP) and automatic voltage CPAP (Auto-CPAP) two types. CPAP up to OSAHS, can effectively eliminate sleep apnea and low ventilation, avoid hypoxia damage, improve sleep quality in patients with daytime sleepiness, reduce the risk of complications such as cardiovascular disease. Other diseases, such as overlap syndrome (COPD and OSAHS two diseases) and chronic heart failure associated with respiratory and respiratory problems, patients may benefit from. The treatment of Fixed-CPAP needs to be monitored by polysomnography in the sleep laboratory. The titration goal is to determine an optimal pressure to eliminate or reduce apnea, hypopnea, snoring, and respiratory effort related arousal, and the quality criteria of titration. Determination of the optimum pressure by titration as a basis for the pressure setting of a domestic CPAP respirator. Fixed-CPAP non-invasive respiratory effects, cheap, is currently used for the treatment of the most common types of OSAHS. Auto-CPAP is a CPAP device that automatically titrate pressure to work. The automatic degree and variation of perception of airway obstruction, automatically adjust the pressure to open the airway, and Auto-CPAP to a certain extent overcomes the shortcomings of CPAP, reducing the artificial pressure titration needs, but it is important to note that Auto-CPAP does not completely replace the manual pressure titration. No matter what kind of ventilator treatment process still need a professional doctor or respiratory therapist according to the condition and the use of results to adjust. However, some studies have shown that OSAHS has no advantage over traditional fixed CPAP and is more expensive. The American Sleep Association does not recommend routine Auto-CPAP for the diagnosis and treatment of OSAHS caused by cardiovascular disease is not recommended for the treatment of other non obstructive sleep disorders or other causes of nocturnal hypoxemia. If obstructive sleep apnea in patients with long duration of illness, often with central sleep apnea or pressure titration pressure is too high, difficult to tolerate, can choose the bi level positive airway pressure (BiPAP) ventilator, and need to have a backup frequency, if the economic conditions allow the best solution is to have the ASV mode of ventilator. The central sleep apnea is the "brain" of the commander absquatulate, issued instructions causing intermittent breathing intermittent respiratory airflow, it cannot use the continuous positive airway pressure (CPAP) ventilation, and to adopt positive pressure ventilation with pressure support mode - bi level airway (BiPAP), which can be divided into S/T ASV (Adaptive Servo ventilation), etc..
2, chronic obstructive pulmonary disease with respiratory failure
Chronic obstructive pulmonary disease in advanced disease or acute exacerbation occurs after respiratory failure, it requires bi level positive airway pressure (BiPAP) to assist patients through breathing, expiratory pressure against endogenous PEEP, reduce intrapulmonary gas retention, help air into the lungs and suction pressure, relieve dyspnea, discharge the body of excess carbon dioxide. Compared with CPAP, BiPAP is more widely used, not only can be used for the treatment of chronic obstructive pulmonary disease, but also can be used for alveolar hypoventilation (that is, during the day there is an increase in blood carbon dioxide) and other chronic respiratory diseases. BiPAP was divided into two modes: no standby control ventilation frequency (BiPAP-S) and standby control ventilation frequency (BiPAP-S/T). The suction pressure of BiPAP can provide a higher expiratory pressure (IPAP) and low (EPAP), IPAP and EPAP difference to maintain effective ventilation (adequate tidal volume and minute ventilation) and reduce the blood carbon dioxide is crucial. BiPAP also used to profile pleural diseases caused by restrictive ventilation dysfunction and severe stable COPD, obesity hypoventilation syndrome after the treatment of CPAP still residual alveolar hypoventilation (i.e. daytime blood carbon dioxide increases) and with central sleep apnea syndrome and (or) Chen Shi's breathing in patients with chronic heart failure. For respiratory instability, with central sleep apnea or Cheyne Stokes respiration patients should use ventilator with BiPAP-S/T mode, in order to ensure the safety and efficacy, but the best way or mode of ASV breathing machine.
3, heart failure
Noninvasive ventilation is a safe and effective method for the treatment of cardiac insufficiency. It has sufficient evidence of evidence-based medicine, and has been written into textbooks. Positive pressure ventilation can increase the intrathoracic pressure to reduce the amount of blood back to play a diuretic and similar effects, but there is no side effects of electrolyte disturbances, but also can reduce the burden on the heart. For most patients with heart failure, suitable for continuous positive airway pressure (CPAP), do not need too much pressure to achieve the desired results. Due to obstructive sleep apnea incidence in patients with cardiovascular disease is much higher than that of normal people, we will encounter a lot of heart failure in patients with obstructive sleep apnea patients, will also have a lot of patients with central sleep apnea, although the latter by oxygen have a certain degree of improvement, but most require non-invasive ventilation treatment and, unlike other central respiratory pause to bi level positive pressure ventilation in patients with CHF, most of the central sleep apnea by continuous positive airway pressure (CPAP) in the correct, do not recommend continuous airway pressure automatic regulation of positive pressure ventilation (auto-CPAP). Adaptive Servo ventilation (ASV) to the treatment of heart failure and central sleep apnea syndrome and (or) Chen Shi's invalid breathing in patients treated with CPAP, but according to a new study, not recommended for severe heart failure (ejection fraction less than 0.45 of patients). ASV can also be used for the treatment of complex sleep apnea syndrome and mixed sleep apnea syndrome. ASV usually set a EPAP sufficient to overcome the obstructive sleep apnea, and then automatically adjust the support pressure of each breath in the previously set range so that the amount of ventilation can reach 90% of the patient's recent average ventilation. The advantage of ASV is that it can stabilize the breath and avoid the reduction of carbon dioxide in the central nervous system caused by the excessive support pressure.
4, neuromuscular disease
In some countries in Europe, the number of patients suffering from neuromuscular disorders can be as high as 1/3, while in our country is much less. We have a lot of work to do about respiratory failure in patients with neuromuscular disorders. Early noninvasive ventilation can delay the respiratory muscle failure, sputum retention ability of patients, reduce the risk of pneumonia. Should choose the bi level positive airway pressure ventilation, according to the patient's muscle strength and tidal volume, carefully adjust the suction pressure (IPAP), to obtain the best effect. In recent years the target tidal volume or alveolar ventilation mode can occur in patients with inspiratory efforts, adapt to the changes in airway resistance, lung or chest, according to the preset tidal volume (usually 6-8ml/kg standard weight) to adjust the pressure, so as to ensure enough tidal volume is relatively stable, the disease deterioration such as acute exacerbation of COPD and progress during the period of neuromuscular diseases, the machine can adapt to the condition changes in a timely manner to increase the support pressure support ventilation capacity, thus ensuring the curative effect. Katie and the Thai company developed with high frequency function of the ventilator for such patients can promote the excretion of sputum, has a special advantage.
After wearing the respirator must be checked according to the condition of the ventilator parameters, and timely adjustment, in order to achieve the best treatment effect. As a department of respiration doctor, the last thing you want to see is that the patient will soon be hospitalized again because of respiratory failure. Resmed provides remote monitoring and management functions in Australia New ventilator, but unfortunately currently does not give the market outside Australia Rui Simai provides the remote service. Let us Chinese proud is, by the first batch of thousands of people plan our home remote monitoring function expert Dr. Sun Jianguo Katie created the Thai company as early as the end of 2012 that launched the Lotus Series ventilator provides, so that our domestic patients have more choices. So how to improve the communication between doctors and patients, and how to strengthen the management? In order to give more patients to provide individualized service of Qilu Hospital of Shandong University established a respiratory networking platform Internet and mobile phone application development, provide the account number for each patient in the mobile phone application using OTG card reader to read data on the SD card upload ventilator, the doctor will upload the data analysis report, the patient can automatically receive and read in the mobile phone terminal the report, if the doctor thinks that the need to adjust the parameters, can change the configuration file to breathe things, patients can automatically configure the new mobile phone application downloads to the ventilator parameters. In short, regardless of the traditional treatment or advanced Internet of things, we have to do between doctors and patients with a total of breathing.