Objective To systematically evaluate the risk factors for secondary respiratory failure (RF) on chronic obstructive pulmonary disease (COPD), so as to provide evidence for formulating prevention and control strategies. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP databases and SinoMed were searched for articles published from the dates of establishment of databases to August 2021. To collect the relevant case-control studies or cohort studies on the risk factors of secondary RF in patients with COPD. The patients were divided into two groups, RF group and non RF group. Meta-analysis was carried out with RevMan 5.3 software after selecting literature, extracting data and evaluating quality according to inclusion and exclusion criteria. Results A total of 16 case-control studies involving 2 417 patients were included. There were 856 cases in RF group and 1 561 cases in non RF group. The results of meta-analysis showed that age [mean difference (MD)=0.58 years, 95% confidence interval (CI) (0.18, 0.97) years, P=0.004], number of acute attacks per year [MD=2.68 times, 95%CI (2.58, 2.78) times, P<0.001], number of acute attacks per year over 3 [odds ratio (OR)=3.37, 95%CI (2.40, 4.73), P<0.001], serum albumin level [MD=−2.93 g/L, 95%CI (−3.92, −1.94), P<0.001], serum uric acid [MD= −59.91 mmol/L, 95%CI (−66.57, −53.25) mmol/L, P<0.001], nosocomial infection [OR=4.53, 95%CI (3.44, 5.98), P<0.001], no-inhaled glucocorticoid [OR=3.63, 95%CI (2.95, 4.48), P<0.001], acid-base imbalance [OR=13.22, 95%CI (10.14, 17.23), P<0.001], COPD very serious [OR=1.82, 95%CI (1.50, 2.21), P<0.001], cardiovascular disease [OR=2.73, 95%CI (1.99, 3.74), P<0.001], kidney disease [OR=3.62, 95%CI (2.67, 4.90), P<0.001] were risk factors for RF in COPD. Sensitivity analysis showed that the results of meta-analysis were stable. Conclusion According to the results of meta-analysis, the risk factors of secondary RF in COPD can be identified in time and preventive measures can be taken to effectively reduce the incidence of aspiration failure and improve the prognosis and outcome of patients.
Objective To observe the effects of peritoneal ventilation with pure oxygen in the rabbits with hypoxaemia and hypercapnia induced by mechanical controlled hypoventilation. Methods Sixteen rabbits were invasively ventilated after trachea incision. Hypoxaemia and hypercapnia were induced by hypoventilation which was implemented both by degrading ventilation parameters and respiratory depression induced by intravenous infusion of muscle relaxant. Then pure oxygen was insufflated into the peritoneal cavity and arterial blood gases were measured every 30 minutes for two hours. Results The PaO2 was ( 52. 50 ±3. 46) mmHg at baseline and increased to ( 76. 46 ±7. 79) mm Hg, ( 79. 62 ±9. 53) mm Hg,( 78. 54 ±7. 18) mmHg, and ( 81. 1 ±8. 3) mm Hg, respectively at 30, 60, 90, and 120 minutes after the peritoneal ventilation with pure oxgen( all P lt; 0. 05) . Meanwhile PaCO2 was ( 63. 84 ±9. 09) mm Hg at baseline and ( 59. 84 ±14. 22) mmHg, ( 59. 16 ±15. 5) mmHg, ( 60. 02 ±7. 07) mmHg, and ( 61. 38 ±6. 56) mm Hg, respectively at 30, 60, 90, and 120 minutes after the peritoneal ventilation with pure oxgen with no significant change( P gt;0. 05) . Conclusion Peritoneal ventilation can obviously improve hypoxaemia induced by mechanical controlled hypoventilation, whereas hypercapnia remains unchanged.
Objective To investigate the therapeutic effects of thyroid hormone replacement on critically ill COPD patients with low serum thyroid hormone. Methods Sixty-seven critically ill patients with acute exacerbation of COPD ( AECOPD) , and complicated with respiratory and/ or heart failure and low serum thyroid hormone, admitted from July 2008 to June 2011, were recruited for the study. They were randomly divided into an intervention group ( n = 34) and a control group ( n = 33) . The control group received conventional treatment and the intervention group received conventional treatment plus additional thyroid hormone replacement therapy. Results Compared with the control group, the overall efficacy of the intervention group was not significantly different ( 88. 2% vs. 81. 8% , P gt; 0. 05) , while average effective time was significantly shorter [ ( 9. 6 ±2. 5) d vs. ( 12. 3 ±2. 8) d, P lt; 0. 05] . The post-treatment serum FT3 , FT4 , TT4 , and h-TSH levels were significantly higher in the intervention group than those in the control group, and significantly higher than baseline ( P lt;0. 05) . Conclusions For AECOPD patients complicated with respiratory and/or heart failure and low serum thyroid hormone, thyroid hormone supplement at low dosage will help to improve serumthyroid hormone level, and promote early recovery.
【Abstract】 Objective To analyze the lung pathological features of type A H1N1 influenza and respiratory failure. Methods The data of imaging and aspiration lung biopsy of five patients with type A H1N1 influenza and respiratory filure since October 2009 were retrospectively analyzed. Results Common clinical manifestations of patients with type A H1N1 influenza and respiratory failure were rapid progress of illness after common cold-like symptoms with high fever, dyspnea, severe hypoxemia, large amounts of bloody sputum, wet rales over both lungs, and with other organs involved or even septic shock. Early lung pathological features were inflammatory exudate in alveoli and lung interstitium, infiltration of inflammatory cells, and extensive hemorrhage. Middle and late pathological features were hyperplasia of alveolar epithelial,disconnection of alveolar septa, replaced of alveolar spaces by fibrosis. Conclusions The pathology of patients with type A H1N1 influenza and respiratory failure is similiar with ARDS. Development of treatment strategies targeted to pathological characteristics of ARDS caused by type A H1N1 influenza is of greatsignificance for effective and timely treatment.
Objective To estimate the feasibility and efficacy of respiratory function score ( RFS)guided ventilator weaning in mechanical ventilated patients with respiratory failure. Methods By a prospective control study,136 patients with acute respiratory failure who had received endotracheal intubation and mechanical ventilation from January 2010 to May 2012 were randomly divided into three group, ie. a RFS-guided 3-4 group ( n=60) , a RFS-guided 5-6 group ( n = 51) , and a traditional group ( n =25) . TheRFS-guided groups underwent ventilator weaning by guidance of RFS 3-4 and 5-6 respectively. The traditional group underwent ventilator weaning by ordinary way. The ventilation and oxygenation index, RFS,direct weaning success rate, total weaning success rate, total mechanical ventilation time, re-intubation rate,and ventilator-associated pneumonia ( VAP) incidence rate were observed.Results The direct weaning success rate in the RFS-guided 3-4 group, the RFS-guided 5-6 group, and the traditional group was 98. 3%( 59/60) , 82. 4% ( 42 /51) , and 100% ( 25 /25) , respectively. The total duration of mechanical ventilation was ( 5. 2 ±2. 5) days, ( 5. 0 ±3. 0) days, and( 7. 5 ±3. 5) days, respectively. the re-intubation rate was 0( 0 /60) , 1. 9% ( 1 /51) , and 0 ( 0/25) , respectively. VAP incidence rate was 11. 7% ( 7/60) , 13. 7%( 7 /51) and 24% ( 6 /25) , respectively. Compared with the traditional group, the direct weaning success rate and total weaning success rate in the RFS-guided 3-4 group were not significant different( P gt;0. 05) , while the total mechanical ventilation time and VAP incidence rate were significantly lower ( P lt; 0. 05) . Compared with the traditional group, the direct weaning success rate and total mechanical ventilation time in the RFSguided 5-6 group were significantly lower ( P lt;0. 05) , but the total weaning success rate was not significantly different ( P gt;0. 05) . Compared with the RFS-guided 5-6 group, the directweaning success rate in the RFSguided 3-4 group was significantly increased. Conclusions Mechanical ventilator weaning of patients with respiratory failure under RFS guidance is safe and feasible. RFS 3-4 guided ventilator weaning can significantly improve the therapeutic effect.
Objective To explore the prognostic value of early lactate clearance rate in patients with respiratory failure.Methods 117 patients with respiratory failure and elevated blood lactate, admitted into respiratory intensive care unit( RICU) between January 2010 and December 2011, were retrospectively analyzed. Arterial lactate and arterial blood gas were measured before and 12h, 24h, 48h, and 72h after treatment. Then12h lactate clearance rate was calculated. The acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) score was evaluated before and after 12h treatment. The mortality were compared between subgroups with different lactate normalization time( lt;24 h, 24 ～48 h, 48 ～72 h, and gt;72h, respectively) . The clinical data was compared between subgroups with different prognosis ( survival or non-survival ) and between subgroups with different lactate clearance rate( ≥10% as high lactate clearance rate, lt;10% as low lactate clearance rate) . Results The mortality of the patients with lactate normalization time in less 24 hours was significantly lower than that of the patients with lactate normalization time more than 72 hours ( 5. 3% vs. 89. 2% , P lt; 0. 001) . The 12 hour lactate clearance rate of the survival group was significantly higher than that of the non-survival group [ ( 43. 6 ±26. 8) % vs. ( 12. 3 ±39. 1) % , P lt;0. 01] . The mortality of the patients with high lactate clearance rate was significantly lower than that of the patients with lowlactate clearance rate( 25. 8% vs. 71. 4% , P lt;0. 01) . Conclusion Early lactate clearance rate can be used as a marker for prognosis of patients with respiratory failure.
ObjectiveTo analyze the main causes and management of respiratory failure after surgery for esophageal cancer. MethodsWe retrospectively collected and analyzed the clinical data of 27 patients with respiratory failure after surgery for esophageal cancer in our hospital between January 2005 and December 2012. ResultsOf the 27 patients with respiratory failure after surgery for esophageal cancer, 23 were at advanced age, and 15 had moderately to severely impaired pulmonary function before surgery. After surgery, 19 suffered severe pulmonary infection, 8 yielded complications such as anastomotic leak, gastropleural fistula chylothorax, and postoperative bleeding. ConclusionPulmonary infections and surgical complications are the major and direct causes of respiratory failure after surgery for esophageal cancer. For high-risk patients at advanced age with impaired pulmonary function, enhancing perioperative airway management and improving surgical operation can decrease incidence of respiratory failure effectively.
ObjectiveTo investigate the relationship between chronic obstructive pulmonary disease (COPD) and respiratory failure in patients with upper gastrointestinal bleeding and recent prognosis. MethodsWe retrospectively analyzed the clinical data of 73 patients with COPD and respiratory failure treated from February 2009 to May 2011. The patients were assigned to the observing group (n=33) and control group (n=40). General characteristics, improvement rates, mortality rates, lengths of hospital stay, endotracheal tube rates and arrhythmia rates were compared between the two groups. ResultsAge, sex, and medical history of the patients were similar in both groups (P>0.05). Compared with the control group, the improvement rate was lower (P<0.001), the mortality rate (P<0.001), length of hospital stay (P<0.001), endotracheal tube rate (P<0.05) and arrhythmia rate (P<0.05) were all higher in the observing group after treatment. ConclusionUpper gastrointestinal bleeding is a high risk factor for short-term prognosis patients with COPD and respiratory failure.
ObjectiveTo compare the therapeutic effects of invasive-high-flow oxygen therapy (HFNC) and invasive-non-invasive ventilation (NIV) sequential strategies on severe respiratory failure caused by chronic obstructive pulmonary disease (COPD), and explore the feasibility of HFNC after extubation from invasive ventilation for COPD patients with severe respiratory failure.MethodsFrom October 2017 to October 2019, COPD patients with type Ⅱ respiratory failure who received invasive ventilation were randomly assigned to a HFNC group and a NIV group at 1: 1 in intensive care unit (ICU), when pulmonary infection control window appeared after treatments. The patients in the HFNC group received HFNC, while the patients in the NIV group received NIV after extubation. The primary endpoint was treatment failure rate. The secondary endpoints were blood gas analysis and vital signs at 1 hour, 24 hours, and 48 hours after extubation, total respiratory support time after extubation, daily airway care interventions, comfort scores, and incidence of nasal and facial skin lesions, ICU length of stay, total length of stay and 28-day mortality after extubation.ResultsOne hundred and twelve patients were randomly assigned to the HFNC group and the NIV group. After secondary exclusion, 53 patients and 52 patients in the HFNC group and the NIV group were included in the analysis respectively. The treatment failure rate in the HFNC group was 22.6%, which was lower than the 28.8% in the NIV group. The risk difference of the failure rate between the two groups was –6.2% (95%CI –22.47 - 10.43, P=0.509), which was significantly lower than the non-inferior effect of 9%. Analysis of the causes of treatment failure showed that treatment intolerance in the HFNC group was significantly lower than that in the NIV group, with a risk difference of –38.4% (95%CI –62.5 - –3.6, P=0.043). One hour after extubation, the respiratory rate of both groups increased higher than the baseline level before extubation (P<0.05). 24 hours after extubation, the respiratory rate in the HFNC group decreased to the baseline level, but the respiratory rate in the NIV group was still higher than the baseline level, and the respiratory rate in the HFNC group was lower than that in the NIV group [(19.1±3.8) vs. (21.7±4.5) times per minute, P<0.05]. 48 hours after extubation, the respiratory rates in the two groups were not significantly different from their baseline levels. The average daily airway care intervention in the NIV group was 9 (5 - 12) times, which was significantly higher than the 5 (4 - 7) times in the HFNC group (P=0.006). The comfort score of the HFNC group was significantly higher than that of the NIV group (8.6±3.2 vs. 5.7±2.8, P= 0.022), while the incidence of nasal and facial skin lesions in the HFNC group was significantly lower than that in the NIV group (0 vs. 9.6%, P=0.027). There was no significant difference in dyspnea score, length of stay and 28-day mortality between the two groups.ConclusionsThe efficacy of invasive-HFNC sequential treatment on COPD with severe respiratory failure is not inferior to that of invasive-NIV sequential strategy. The two groups have similar treatment failure rates, and HFNC has better comfort and treatment tolerance.
ObjectiveTo analyze the treatment effect of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with respiratory failure.MethodsA review of randomized controlled trials with meta-analysis performed by searching databases of PubMed, the Cochrane Library, Embase, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and WanFang data. Randomized controlled trials by using sequential noninvasive following invasive mechanical ventilation in COPD patients with respiratory failure were eligible for inclusion.ResultsEleven trials were included, involving 553 COPD patients with respiratory failure. Meta-analysis showed that sequential noninvasive following invasive mechanical ventilation reduced the mortality rate [RR=0.37, 95%CI(0.22 to 0.61), P=0.000 1], the incidence of ventilator-associated pneumonia (VAP) [RR=0.20, 95%CI(0.13 to 0.32), P<0.000 01], reintubation rate [RR=0.40, 95%CI(0.23 to 0.68), P=0.0008]; it also decreased the duration of invasive mechanical ventilation [MD=–10.47, 95%CI(–13.80 to –7.14), P<0.000 01] and duration of mechanical ventilation [MD=–4.54, 95%CI(–7.01 to –2.06), P=0.000 3], which also shortened the lengths of stay in an intensive care unit (ICU) [MD=–8.75, 95%CI(–13.49 to –4.01), P=0.000 3], as well as length of hospital stay [MD=–9.11, 95%CI(–11.68 to –6.55), P<0.000 01］.ConclusionSequential noninvasive following invasive mechanical ventilation can significantly reduce the incidence of VAP, the duration of invasive mechanical ventilation, the length of hospital stay in COPD patients with respiratory failure, and reduce the mortality, reintubation rate, the duration of mechanical ventilation and the length of ICU stay as well.