ObjectiveTo analyze hospitalized patients of respiratory diseases with mechanical ventilation (MV). MethodsHospitalized patients with or without MV were enrolled into the current study from January 2010 to December 2014. Patients' characteristics including age and sex, type of illness and costs of hospital treatment were retrospectively analyzed. ResultsA total of 9,539 patients were hospitalized into Department of Respiratory Medicine, The General Hospital of Shenyang Military Area Command in the past 5 years. Of them, 1,531 (16.0%) patients were treated with MV, 764 of the 1,531 (49.9%) patients received non-invasive mechanical ventilation (NIMV), 135 of the 1,531 (8.8%) received invasive mechanical ventilation (IMV), and 632 of the 1,531 (41.3%) received NIMV plus IMV. The percentage of patients older than 65 years in the three groups as above were 71.3%, 63.0% and 72.2%, significantly higher than the Non-MV group's 47.7% (P<0.05); the percentage of males were 52.7%, 82.2% and 63.3% respectively, the later two groups was significantly higher than the Non-MV group's 59.2% (P<0.05); the percentage of ICU admission were 67.0%, 70.4% and 82.8%, significantly higher than the Non-MV group's 24.0% (P<0.05); the percentage of type Ⅰ respiratory failure were 12.4%, 29.6% and 12.4%, the later two groups was significantly higher than the Non-MV group's 13.2% (P<0.05); the percentage of type Ⅱ respiratory failure were 76.6%, 17.8% and 47.0%, all were significantly higher than the Non-MV group's 7.6% (P<0.05). Twenty-one kinds of common co-morbidities for respiratory hospitalized patients were analyzed and it was found that MV patients were likely to have more co-morbidities. Compared to Non-MV group, IMV group had more co-morbidities of type Ⅰ or type Ⅱ respiratory failure caused by pneumonia, bronchiectasis and other infectious diseases and concomitant with hypoalbuminemia, gastrointestinal bleeding and liver and kidney dysfunction and cerebrovascular disease, with statistically significant differences (P<0.05); NIMV group had more co-morbidities of type Ⅱ respiratory failure caused by chronic bronchitis, emphysema, pulmonary heart disease and other chronic airway diseases, and concomitant with coronary heart disease, heart failure, cerebrovascular disease and renal dysfunction, with statistically significant differences (P<0.05); the co-morbidity spectrum of NIMV plus IMV group was between those of IMV and NIMV groups, but more similar to that of IMV group. The high risk factors for IMV were pneumonia, hypoalbuminemia, gastrointestinal bleeding, and cerebrovascular disease; for NIMV were chronic bronchitis, emphysema, pulmonary heart disease, type Ⅱ respiratory failure and cardiac dysfunction. Cost analysis showed that average cost of Non-MV, NIMV, IMV, and NIMV plus IMV patients were 16 359 yuan, 31 872 yuan, 66 924 yuan, and 98 648 yuan respectively, in which the expense of NIMV plus IMV patients was vastest. ConclusionsHospitalized patients receiving MV therapy tend to be older, stay in ICU, complicated with respiratory failure and multiple co-morbidities. Respiratory failure by chronic obstructive airways disease is more often treated with NIMV, but respiratory failure by lung infection often need IMV.
During the new coronavirus disease 2019 (COVID-19) pandemic, there has been controversy over whether emergency surgical management should be performed or not in the patients with COVID-19. Stanford type A aortic dissection is a very urgent life-threatening disease, and guidelines recommend surgical treatment for patients with type A aortic dissection in the first instance. However, intraoperative extracorporeal circulation can be fatal to patients recovering from COVID-19. During the pandemic, extracorporeal membrane oxygenation (ECMO) has played an important role in supporting COVID-19 patients with acute respiratory failure. This article reports a successful V-V ECMO treatment for a Stanford type A aortic dissection patient, who suffered respiratory failure caused by COVID-19 after emergency surgery.
ObjectiveTo evaluate the effects of home mechanical ventilation (HMV) for stable chronic obstructive pulmonary disease (COPD) patients with respiratory failure in Tongzhou district of Beijing city. MethodsTwenty stable COPD patients with respiratory failure were included in the study.During the one-year follow-up period,4 patients died and 1 withdrew and 15 patients finished the follow-up.The patients was followed up by telephone each month and guided in drug administration,HMV,and rehabilitation therapy.At the beginning of the study and one year later,the patients were interviewed and accessed on the general data,nutritional status,COPD assessment test (CAT),Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,and arterial blood gas analysis. ResultsAt the end of one-year follow-up,nutrition index,CAT,Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,pH,and PaO2 did not change significantly (P>0.05),while PaCO2 decreased significantly compared with those at the beginning of the study (P<0.05).Compared with the past year,the times of hospitalization due to acute exacerbation of COPD was significantly reduced during the follow-up year (P<0.05). ConclusionHMV can ameliorate carbon dioxide retention and reduce times of hospitalization due to acute exacerbation of COPD for COPD patients with respiratory failure.
ObjectiveTo explore the risk factors for postoperative respiratory failure (RF) in patients with esophageal cancer, construct a predictive model based on the least absolute shrinkage and selection operator (LASSO)-logistic regression, and visualize the constructed model. MethodsA retrospective analysis was conducted on patients with esophageal cancer who underwent surgical treatment in the Department of Thoracic Surgery, Sun Yat-sen University Cancer Center Gansu Hospital from 2020 to 2023. Patients were divided into a RF group and a non-RF (NRF) group according to whether RF occurred after surgery. Clinical data of the two groups were collected, and LASSO-logistic regression was used to optimize feature selection and construct the predictive model. The model was internally validated by repeated sampling 1000 times based on the Bootstrap method. ResultsA total of 217 patients were included, among which 24 were in the RF group, including 22 males and 2 females, with an average age of (63.33±9.10) years; 193 were in the NRF group, including 161 males and 32 females, with an average age of (62.14±8.44) years. LASSO-logistic regression analysis showed that the percentage of forced expiratory volume in one second/forced vital capacity (FEV1/FVC) to predicted value (FEV1/FVC%pred) [OR=0.944, 95%CI (0.897, 0.993), P=0.026], postoperative anastomotic fistula [OR=4.106, 95%CI (1.457, 11.575), P=0.008], and postoperative lung infection [OR=3.776, 95%CI (1.373, 10.388), P=0.010] were risk factors for postoperative RF in patients with esophageal cancer. Based on the above risk factors, a predictive model was constructed, with an area under the receiver operating characteristic curve of 0.819 [95%CI (0.737, 0.901)]. The Hosmer-Lemeshow test for the calibration curve showed that the model had good goodness of fit (P=0.527). The decision curve showed that the model had good clinical net benefit when the threshold probability was between 5% and 50%. Conclusion FEV1/FVC%pred, postoperative anastomotic fistula, and postoperative lung infection are risk factors for postoperative RF in patients with esophageal cancer. The predictive model constructed based on LASSO-logistic regression analysis is expected to help medical staff screen high-risk patients for early individualized intervention.
ObjectiveTo observe the clinical efficacy of invasive-noninvasive sequential mechanical ventilation in the treatment of chronic obstructive pulmonary disease (COPD) complicated by type Ⅱ respiratory failure. MethodsA total of 100 patients with COPD complicated with type Ⅱ respiratory failure from March 2013 to April 2014 were randomly divided into control group and study group (with 50 patients in each). While the control group was given continuous invasive ventilation treatment, the study group was treated with invasive-noninvasive sequential ventilation. The ventilation time, Intensive Care Unit (ICU) monitoring and hospitalization time, the serum concentrations of C-reactioin protein (CRP) before and after treatment and the ventilator associated pneumonia (VAP) and hospital mortality rate were observed and compared between the two groups. ResultsFor patients in the study group, ICU monitoring time, ventilation time and hospitalization time were (9.4±8.1), (10.3±5.8), and (14.7±8.2) days, respectively, significantly shorter than those in the control group[(17.5±10.8), (15.2±7.7), and (22.8±7.4) days] (P<0.05). The incidence of VAP and nosocomial VAP mortality in the study group were 4.0% and 2.0% respectively, which were significantly lower than those in the control group (22.0% and 20.0%), and the differences were statistically significant (P<0.05). ConclusionIn the clinical treatment of COPD patients with type Ⅱ respiratory failure, invasive-noninvasive sequential ventilation treatment is effective in shortening the duration of ventilation and hospitalization time, controlling the incidence of VAP, and reducing the mortality rate, which is worthy of clinical popularization.
Abstract： Objective To analyze risk factors associated with postoperative respiratory failure in patients with valvular surgery. Methods Between January 2001 and November 2010, clinical data of 618 patients with 339 males and 279 fameles at age of 10-74（44.01±13.95）years,undergoing valvular operations were investigated retrospectively. We divided the patients into two groups according to the presence （74 patients）or absence（544 patients）of postoperative respiratory failure. Its risk factors were evaluated by univariate and multivariate logistic regression analysis. Results The hospital mortality rate of valvular surgery was 6.1%（38/618）.The morbidity rate of respiratory failure was 12.0%（74/618） with hospital mortality rate at 17.6%（13/74） which was significantly higher than those patients without postoperative respiratory failure at 4.6%（25/544, χ2=18.994, P=0.000）. Univariate analysis showed age＞ 65 years（P=0.005）, New York Heart Association（NYHA）classⅣ（P=0.014）, election fraction＜ 50.0%（P=0.003）, cardiopulmonary bypass time＞ 3 h（P=0.001）, aortic cross clamping time＞ 2 h（P=0.008）, concomitant operation（ valvular operation with coronary artery bypass grafting, Bentall or radiofrequency ablation maze operation（P=0.000）, reoperation（P=0.012）, postoperative complications （P=0.000）, and blood transfusion＞ 2 000 ml（P=0.000） were important risk factors for postoperative respiratory failure. Multivariate logistic regression showed that concomitant operation（P=0.003）, reoperation（P=0.010）, postoperative complications（P=0.000）, and blood transfusion＞2 000 ml（P=0.012）were significant independent predictive risk factors. Conclusion This study suggest that patients with predictive risk factors of postoperative respiratory failure need more carefully treated. The morbidity of these patients would be reduced through improving perioperative management, shortening cardiopulmonary bypass time and reducing postoperative complications.
ObjectiveTo explore the role of nutritional support in adjuvant therapy for respiratory failure. MethodsWe took 72 patients with respiratory failure who were treated in our hospital from August 2011 to January 2013 as the research objects. They were divided into two groups:control group and trial group, with 36 patients in each group. The division of the groups was in accordance with the state food and drug administration clinical trial institution ethics committee standard operating procedures. In the control group, 36 patients were provided with regular treatments according to their condition, like maintaining the respiratory tract unobstructed, oxygen therapy, mechanical ventilation and anti-infection. In the trial group, we offered nutritional support in addition to the normal treatment. Consecutive 20 days was a course of treatment. After four courses, we inspected and put down two groups' respective clinical features, and made a contrast of their treatment conditions. We analyzed the treatments through observational indexes including assessment of eutrophication, treatment efficiency, pulmonary function and arterial blood gases. ResultsBoth groups had obvious therapeutic effects. The observational indexes in the trial group were better than those in the control group. The total effective rate was 91.7% in the trail group after treatment, significantly higher than that in the control group (66.7%) (χ2=8.692, P=0.003); the lung capacity, the ventilation flow ratio and arterial blood gas analysis values in the trial group was better than those in the control group. ConclusionThe effect of the nutritional support for the respiratory failure treatment is much better than the regular treatment. The total effective rate is improved while the death rate is lower than before and the patients recover quickly.
Objective To study the effect of noninvasive positive pressure ventilation (NPPV) in chronic obstructive pulmonary disease (COPD) patients with hypercapnic coma secondary to respiratory failure.Methods COPD patients with or without coma secondary to respiratory failure were both treated by bi-level positive airway pressure (BiPAP) ventilation on base of routine therapy.There were 32 cases in coma group and 42 cases in non-coma group.Such parameters as arterial blood gas (ABG)，Glasgow coma scale (GCS)，time of NPPV therapy，achievement ratio，and adverse effects were investigated.Results 30 patients in the coma group were improved after NPPV treatment (26 cases recovered consciousness treated by BiPAP in 2 hours，3 cases recovered between 3~8 hours，1 case recovered after 24 hours).The parameters of ABG，the tidal volume and the minute ventilation volume were improved after BiPAP.The time of effective therapy was (9±4) days in the coma group and (7±3) days in the non-coma group with no significant difference (Pgt;0.05).The achievement ratio was similar in two groups (93.75% vs 97.62%，Pgt;0.05).But the incidence of gastrointestinal tympanites reached to a higher level in the coma group (80.5%) than the non-coma group (10.6%).Conclusion COPD patients with hypercapnic coma secondary to respiratory failure isn’t the absolute contraindication of NPPV treatment.