Study on the treatment of mechanical ventilation in patients with respiratory failure by disposable nasal (facial) cover

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Guo Zhongliang 1 Liang Yongjie 1 Cai Yingyun 2 Wang Ailing 1 2 button cells Wang Shu 1abstractObjective to investigate the efficacy, safety

Content

Guo Zhongliang 1 Liang Yongjie 1 Cai Yingyun 2 Wang Ailing 1 2 button cells Wang Shu 1

abstract

Objective to investigate the efficacy, safety and feasibility of the disposable nasal (facial) mask in the treatment of patients with respiratory failure. Methods 42 cases of patients with respiratory failure by mechanical ventilation, according to the nasal (facial) type were randomly divided into disposable mask group (21 cases) and normal group (21 cases), using pressure support ventilation (PSV) + positive end expiratory pressure (PEEP) mode of mechanical ventilation. The results of mechanical ventilation before all patients had hypoxemia in patients with COPD to a certain extent, accompanied by carbon dioxide retention, mechanical ventilation after hypoxia and ventilation disorder significantly improved, the end of most of the patients after treatment of the symptoms of hypoxia and carbon dioxide retention corrected. Two groups of general situation and the results of blood gas analysis showed no significant difference; two kinds of mask with leakproof similarity; disposable in group 2h after ventilation than ordinary group appear not adapt to the proportion decreased significantly (2 and 8), P< 0.05; in the course of treatment group was significantly lower than ordinary disposable group group bloating and local adverse reaction rate (2 and 8), P< 0.05. Conclusion nasal (facial) mask mechanical ventilation can effectively correct hypoxia and improve ventilation; disposable nasal (facial) cover has a good gas leak, it is not easy to appear flatulence and local adverse reactions in the treatment, has a high clinical value.

Key words: respiratory failure; mechanical ventilation; nasal mask

Department of respiration, Dongfang Hospital, Shanghai 1, China

2 Zhongshan Hospital Affiliated to Shanghai Medical University

Application of Autoquitting or Face Mask Mechanical Ventilation in the Treatment of Respiratory Failure during Oranasal Nasl

GUO Zhongliang, LIANG Yongjie, NIU Shanfu, CAI Yingyun, et al. of Respiratory Disease, East Hospital, Shanghai 200120, China, Department

Abstract

Objective To Evaluate the application and efficacy of autoquitting nasal or oranasal face mask during mechanical ventilation (MV) in the treatment of respiratory failure. Methods treated with mechanical ventilation 42 Patients were separated into two groups: autoquitting group (21 patients) and conventional group (21 patients). All patients were treated with pressure support ventilation & positive end expiratory pressure ventilation (PSV +PEEP). The former patients used autoquitting nasal or oranasal face mask during MV the later patients used conventional; nasal or oranasal face mask during MV. Results there were no significant difference in clinic characteristics and gas exchange and at the time before MV between the two groups. A Si Gnificantly improvement were found during MV in both groups. Most of the patients in both groups were successfully weaned with nearly normal arterial oxygen and carbon dioxide pressure. The masks of Both types had the same characteristics of air inescape. There were in the autoquitting group 2 patients and 8 patients in the conventional group with inadaptation after 2 hours MV; the incidence of complications was 2/21 vs 8/21, P< 0.05, respectively. Conclusions mask; mechanical ventilation could obviously ameliorate hypoxygen and improve ventilation in patients with respiratory failure autoquitting nasal or oranasal face; mask during mechanical ventilation (MV) had the characteristics of air inescape patients taken with autoquitting nasal; Or oranasal mask had incidence of lower face complications.

Key words Respiratory failure; Mechanical ventilation; Nasal mask with the development of sensor technology and computer intelligent analysis technology, noninvasive ventilation (NIV) in modern medicine, especially in emergency and has been applied widely in medicine. With the traditional ventilation, reduce the complications of endotracheal intubation and tracheotomy, ventilator associated pneumonia (ventilator associated, pneumonia, VAP) incidence rate, shorten the hospitalization time, cost saving [1-4]. But the traditional nasal or nasal (facial) cover and surface consistent differences affect breathing gas leakage caused by the effective pressure pressure support, long time compression of nasal facial soft tissue can cause ischemia, erosion, also some patients because of nasal or nasal (facial) cover material to produce allergic dermatitis. At the same time due to local compression can also affect the compliance of patients. To this end, we use the disposable silica gel mask ventilation nose (face) cover to replace the traditional nose (face) cover to explore its

Safety, efficacy and feasibility of noninvasive ventilation, and evaluate its application value.

Objects and methods

Case selection

From July 1998 to May 2000, 42 patients with respiratory failure were admitted to our hospital respiratory care unit (RICU). Age 24-91 (61 + 16), including male, female in 34 cases, 8 cases. Including 26 cases of chronic obstructive pulmonary disease (COPD), 4 cases of bronchial asthma, 2 cases of obesity hypoventilation associated with obstructive sleep apnea syndrome, 1 cases of myasthenia gravis, refractory heart failure and 1 cases of coronary artery bypass surgery, 8 cases of acute respiratory distress syndrome (ARDS) (including 5 cases 3 cases of infection, trauma or surgery). According to the nasal (facial) mask ventilation time were randomly divided into two groups, disposable group (21 cases) using disposable ZS-MZ-A (B) type silicone mask ventilation by nasal (facial) cover (Zhongshan medical Technical Developing Company), normal group (21 cases) with clinical common nasal (facial) cover (Shanghai ocean Industrial Co. Ltd. to provide).

Two, treatment

Application of Evita II, Bear1000 and Bird8400STi respirator. All patients were treated with mechanical ventilation (PSV) + positive end expiratory pressure (PEEP). Patient mobilization before ventilation patients adhere to the use of nasal (facial mask), part of the not very good with or more fidgety patients can be used as a simple breathing bag with the patient breathing mask pressure ventilation, waiting for the relief of symptoms after ventilator assisted ventilation. Support pressure from an early age, generally 8-10cmH2O (1 cmH2O=0.098kPa), gradually increased. The capacity of auxiliary control mode (SIMV) determination of tidal volume in the tidal volume in 450~500ml, record the tidal volume and set tidal volume (Vte/Vti) in order to understand the nasal (facial) cover and surface fit or leak rate. According to the patient's condition, ventilation, blood gas analysis results and tolerance to adjust the oxygen concentration (FiO2), PSV and PEEP levels, until the patient can be stable breathing machine. The effective ventilation time, active treatment of primary disease nutritional support, correct water and electrolyte balance, antispasmodic and anti infection. The general condition, blood gas analysis, oxygenation index (PaO2/FiO2), chest X-ray, PSV and PEEP levels, and the tolerance and adverse reaction of the nose (face) were recorded in the ventilation process.

Three, statistical analysis

Paired t test and X2 test.

Result

First, the general situation before mechanical ventilation

There were no significant differences between the two groups in age, gender, heart rate, systolic blood pressure, respiratory rate, peripheral white blood cells and body temperature (Table 1); analysis results of the two groups before ventilation and arterial blood gas (pH, PaO2 and PaCO2) had no significant difference (Table 3). The basic situation of the two groups was comparable.

Two, mechanical ventilation and adverse reactions

See table 2. Two groups of patients were given PSVPEEP ventilation mode. The Vte/Vti values measured by the CIMV model in the two groups were similar, indicating that they had similar leak proof performance. There was no significant difference in the level of PSV and PEEP between the two groups in the treatment of NIV, and the total time of receiving NIV treatment was 7.9 + / - 2.7 days and 7 + / - 3.7 days, P>, respectively. The results showed that the treatment time was similar in the two groups. Except two, disposable 2h after mechanical ventilation was tolerated by nasal (facial) mask mechanical ventilation, but the normal group had 8 cases after 2H is still not adapt, suggesting that disposable masks with good comfort, so that patients have good compliance. In the course of treatment, disposable group had 2 cases due to bloating was respectively in third and seventh days to tracheal intubation and mechanical ventilation, there were no nose erosion or skin allergy; normal group had 4 cases of obvious flatulence and eventually to tracheal intubation, 3 cases with varying degrees nose erosion, 1 cases of contact parts contact dermatitis, adverse reactions were significantly higher than that of disposable group (P< 0.05).

Three, arterial blood gas changes and prognosis

See table 3. Mechanical ventilation before all patients had hypoxemia in different degrees, oxygenation index (OI) decreased in COPD and asthma are serious carbon dioxide (CO2) retention, other levels of PaCO2 were decreased or normal; 1 days after hypoxia mask ventilation and CO2 retention symptoms improvement, increase of OI (P< 0.05) NIV; after the end of treatment in patients with hypoxia and CO2 retention symptoms were corrected and (P< 0.05). Disposable group 19 cases (90%) patients treated with NIV successful weaning, 1 cases died after tracheal intubation was normal; group 15 cases (71%) treated with NIV successful weaning, 6 cases with complications to tracheal intubation, including 3 cases of death.

discuss

Since the continuous positive airway pressure (CPAP) in the successful application of chronic lung disease and acute hypoxic respiratory failure, noninvasive mechanical ventilation (NIV) is a respiratory failure in patients with first-line treatment, create favorable conditions for the timely rescue, respiratory failure prevention and rehabilitation. NIV is more and more applied to the exacerbation of chronic obstructive pulmonary disease (COPD), severe asthma, neuromuscular and chest wall disorders due to respiratory failure and sleep apnea syndrome, refractory heart failure, acute respiratory distress syndrome (ARDS) and prevention of postoperative rehabilitation treatment such as failure to rescue or call [with 1-5]. In our study we found that nasal (facial) mask mechanical ventilation can effectively correct hypoxia and improve ventilation, the vast majority of patients with nasal (facial) mask mechanical ventilation after successful weaning, the treatment effect is obvious. Due to the use of nasal mask or mask ventilation, in order to ensure the effect of ventilation, should be applied to patients and their bedside nurses before and after the patient to explain the working principle of the ventilator and the use of the notes. Ventilation can occur in the early stages of poor tolerance or poor ventilation effect, common reasons are: the poor airway control, such as the pipeline system is not well connected, the nose or face mask wearing loose, patient and / or nasal due to physiological or pathological on can not match with the nose or face mask, with nasal mask patients closed with breathing and nasal resistance is poor; the active air machine does not adapt, and the initial pressure is too large or too small, the inhaled gas humidification or pre heating on the insufficient; sputum inconvenience and / or difficult; because of the psychological burden of language communication barriers or mood changes, some patients can appear irritability uneasy; improper regulation of the ventilation function deterioration of breathing pattern and respiratory parameters; the long-term hypoxia and dyspnea in patients with mechanical ventilation after the lifting of the endogenous stimulation, can turn Sleep and respiratory depression. Therefore, in the treatment of nasal (face) mechanical ventilation, we should observe the changes of the condition and the ventilation condition, so as to take corresponding measures in time.

Because of the long time of non-invasive mechanical ventilation, it is very important to choose the appropriate nose (face) cover. The traditional nasal (facial) cover the use of polymeric materials to be ordinary, inflatable balloon in the nose and cheek contact surface, to improve the contact surface and reduce leakage. The nasal (facial) cover facial sustained compression in breathing, nasal ventilation effect of facial soft tissue, a long time can cause nasal facial soft tissue ischemia, erosion, and some patients with contact dermatitis, a few patients of polymeric material allergy and allergic dermatitis. Some nasal (facial) cover and surface difference with that of the influence of the leakage caused by pressure support. A new disposable nasal (facial) cover at the contact surface by silica gel mask to replace the traditional airbag with ventilator inspiratory give positive airway pressure to strengthen its contact with the nose and face, and according to the positive airway pressure level contact pressure is appropriate, it has anti leakage function; at the same time, on the exhale with the decline of positive airway pressure and lower its nose and face of oppression, so as to improve the air condition pressure parts, to avoid compression of soft tissue ischemia and erosion. Due to the use of silicone materials, rarely cause allergic dermatitis. We adopt the randomized controlled way compared with disposable nasal (facial) cover and the common nasal (facial) cover applications in mechanical ventilation, found disposable patients with good gas leak, the process in the treatment of abdominal distention, contact dermatitis, allergic dermatitis and local soft tissue erosion rate of complications was lower than that of the normal nasal (facial) cover group.

In short, nasal (facial) mask mechanical ventilation can effectively correct hypoxia and improve ventilation; disposable nasal (facial) cover has a good gas leak, it is not easy to appear on the abdominal distension, contact dermatitis, allergic dermatitis and skin erosion and other complications in the treatment process, has high clinical promotion value.

Reference:

1.Brochard L, Mancebo J, Williams AJ, et al. ventilation Acute of chronic pulmonary disease. Engl J Med, 1995, 333:817-822., exacerbations, Noninvasive, obstructive, N

2.Meduri GU, Cook TR, Turner RE, et al. positive ventilation status asthmaticus in, Chest, 1996, 110:767-774., pressure, Noninvasive

3.Pollack CV, Torres MT, Alexander L. study the of positive airway respiratory support the emergency department. Ann Emerg Med, 1996, 27:189-192., of, use, pressure, in, bilevel

4.Nourdine K, Combes P, Carton M Jr, et al. noninvasive reduce the nosocomial infection risk A clinisal survey. Intensive Care Med, 1999,25:567-573., ICU, Does, prospective

5 Zhu Lei, Niu Xin, Li Shanqun, et al. Treatment of acute respiratory distress syndrome (23:225-227.) by nasal and facial mask ventilation. Chinese Journal of tuberculosis and respiratory diseases, 2000

Table 1 Comparison of the basic situation between the two groups before and after mechanical ventilation (s)

group

The number of cases

Age

(years old)

Gender

(male / female)

Respiratory frequency

(BPM)

heart rate

(BPM)

Arterial systolic pressure

(mmHg)

Previous NIV treatment cases

temperature

(c)

Peripheral blood leukocytes

(mm / mm 3)

Disposable group

Twenty-one

62 + 19

17/4

32 + 11

108 + 18

125 + 23

Three

37.3 + 0.6

9800 + 4131

Ordinary group

Twenty-one

60 + 17

17/4

30 + 13

110 + 24

121 + 19

Two

37.5 + 0.5

9500 + 3956

The value of P

> 0.05

> 0.05

> 0.05

> 0.05

> 0.05

> 0.05

> 0.05

> 0.05

> 0.05

Note: 1 mmHg=0.133kPa

Table 2 Comparison of mechanical ventilation between the two groups (+ s)

group

Vte/Vti

PSV level

(cmH2O)

PEEP level

(cmH2O)

2H nasal (face) mask adaptation number

Total NIV treatment time

Adverse reaction cases

Disposable group

0.67 + 0.10

17 + 9

3.6 + 0.6

21/23

5.3 + 2.7

Two

Ordinary group

0.65 + 0.13

18 + 8

3.6 + 0.5

15/23

4.8 + 3.7

Eight

The value of P

> 0.05

> 0.05

> 0.05

< 0.05

> 0.05

< 0.05

Table 3 changes of blood gas analysis before and after mechanical ventilation in group (+ s)

group

Before ventilation

Ventilation for 1 days

End ventilation

PH value

OI

(mmHg)

PaCO2

(mmHg)

PH value

OI

(mmHg)

PaCO2

(mmHg)

PH value

OI

(mmHg)

PaCO2

(mmHg)

Disposable group

7.29 + 0.17

207 + 65

77 + 25

7.31 + 0.14*

275 + 65**

63 + 19*

7.35 + 0.12**

347 + 56**

52 + 15**

Ordinary group

7.27 + 0.20

195 + 73

75 + 27

7.32 + 0.12*

265 + 73**

65 + 25*

7.34 + 0.09**

335 + 67**

48 + 18**

The value of P

> 0.05

> 0.05

> 0.05

> 0.05

> 0.05

> 0.05

> 0.05

> 0.05

> 0.05

Note: compared with before ventilation, *P< 0.05; **P<

 

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