Application Of Sequential Noninvasive Following Invasive Mechanical Ventilation In AECOPD Patients With Severe Type Ⅱ Respiratory Failure In Weaning From Mechanical Ventilation

Objective:1.Investigating the Application of sequential noninvasive following invasive mechanical ventilation in AECOPD patients with severe type Ⅱ respiratory failure in Weaning from mechanical ventilation, and evaluating the difference of application of spontaneous breathing trials (SBT) and pulmonary infection control window(PIC-W) as invasive-non-invasive sequential treatment of the point on the successfully guidance to wean.Methods:1.Give the sequential noninvasive following invasive mechanical ventilation insisted48h to the31paients that pass the SBT trail and extubated from invasive positive pressure ventilation(IPPV),who were AECOPD patients with severe type Ⅱ respiratory failure that stay at the ICU of our hospital from March2010to March2012,and weaning is considered successful that48hours after non-invasive ventilator (NIV) assisted ventilation. Evaluating the difference of application of spontaneous breathing trials (SBT) and pulmonary infection control window(PIC-W) as invasive-non-invasive sequential treatment of the point on the successfully guidance to wean.RESULT:1.It is a high rate of90.3%to the patients who are AECOPD with severe type Ⅱ respiratory failure successfully wean when sequential noninvasive following invasive mechanical ventilation therapy after extubation48hours.2.In the patients who are AECOPD with severe type Ⅱ respiratory failure,70.6%of them passed the SBT trail in the first time.In the patients who passed SBT trail,successful weaning rate is96.0%,while Patients who failed SBT experiments, successful weaning rate is66.7%.3.There was no significant difference that SBT trail and PIC window as invasive-non-invasive sequential treatment of the point on the sluccessful guidance to wean in the patient who are COPD with severe type Ⅱ respiratory failure (P>0.05).4.In the PIC window,82.6%of the patient passed SBT trail,which is high that42.8%of the patient passed SBT trail out of the PIC window.In the patient who passed the SBT trail,76.0%falls within the PIC window,while66.7%of patient fail the SBT trail out of the PIC windows.5.It was significantly improved of arterial blood gas analysis(ph、PaCO2, PaO2)compared with hospital admission when patients meet the SBT trail(P<0.05), white blood cell count, neutrophil percentage than the admission decreased significantly (P>0.05); it was significantly improved of arterial blood gas analysis(ph、PaCO2, PaO2)compared with hospital admission when in the PIC window,white blood cell count decreased significantly (P>0.05) percentage of neutrophils decreased significantly (P<0.05); it was no significant difference of arterial blood gas analysis(ph、PaCO2, PaO2)、white blood cell count, neutrophil percentage between the SBT trail and PIC-window (P>0.05).Conclusion:1.It is a high rate to the patients who are AECOPD with severe type Ⅱ respiratory failure successfully wean when sequential noninvasive following invasive mechanical ventilation therapy after extubation48hours.2.There was no significant difference that SBT trail and PIC window as invasive-non-invasive sequential treatment of the point on the sluccessful guidance to wean in the patient who are COPD with severe type Ⅱ respiratory failure3.SBT trail have a higher successful passing rate in PIC window, suggesting that SBT trail and PIC window, can be as invasive-non-invasive sequential treatment point guiding weaning to thepatient who are AECOPD with severe type Ⅱ respiratory failure.