The Application Of Improved SBT Test And Continuous Noninvasive Ventilation Sequential Treatment In Using Invasive Ventilation For Respiratory Failure In Patients With Cardiac Insufficiency

Introduction:With the progress of the aging society,the use of invasiveventilation for respiratory failure in patients with cardiacinsufficiency had more and more be seen.Patients with congestiveheartfailure or (and) ischemic heart disease using invasive ventilationhad Longer ICU length of hospital stay and mechanical ventilation timesthan that other patients.Generally, Mechanical ventilation made negativeeffect to patients’hemodynamic with normal cardiac function.BecauseWith each inhale,chest positive pressure would reduce venous returnedblood volume. On the other hand, positive pressure ventilation couldimprove patients’cardiac pulmonary edema and had been used in clinicaltreatment for routine treatment. Although cardiac function would beimproved when making long-term mechanical ventilation, SBT test had changed the lung machinery mechanics and reduced pressure support andPEEP thus Leading to increased oxygen consumption and venous returnedblood volume,which made it easier for the weaning associated pulmonaryedema. At the same time, the strong evidence to support the use ofnoninvasive ventilation could largely prevent and treat acute cardiacpulmonary edema as well as reduce the weaning failure. Therefore themechanical ventilation combined clinical heart failure patients’SBTtest parameters setting need to make necessary adjustments and to assistcontinuous noninvasive ventilation sequential treatmentto increase thesuccess rate of weaning.Objective:1.To explore the success rate of improved SBT test in heart failurepatients with mechanical ventilation.2. Observe the efficacy ofcontinuous noninvasive ventilationsequential treatment in weaning and improvement of cardiac function.Method:1.Choose17Heart failure patients with mechanical ventilation whofailed standard SBT test use improved SBT test for self-reflection.Compare success ratebetween the two tests.2.When the improvement SBT test succeed,Pull out the endotrachealintubation and give continuous noninvasive ventilation sequentialtreatment.Then observe the weaning success rate. Results:1、All the17patients had passed improved SBT test.1hour after improvedSBT test,the physiological indexwerebetter than traditionalSBT.Theimprovement of HR and RR had remarkable statistical significance。2.In the end of expeirenment,there were12patients weaningsuccessfully,5patients failed。3、48hours after continuous noninvasive ventilation sequentialtreatment,2patients failed and3patients failed after72hours;48hoursweaning success rate were88.23%,72hours weaning success rate were70.58%4、In the15patients who passed48hours after continuous noninvasiveventilation sequential treatment,12patients’BNP had declined. In the12patients who passed72Hours treatment,10patients’BNP had declined.5、48and72hours after NIV treatment，The patients physiologicalindex were not significant deterioration and there were no statisticalsignificance compared with the physiological index of1hour afterimproved SBT test.Conclusion：1.Improved SBT test have a higher success rate and decannulation rate,which may be associated with better reduce the weaningassociatedpulmonary edema. 2.After pass the improved SBT test,respiratory failure in patientswith cardiac insufficiency have higher weaning success rate in usingcontinuous noninvasive ventilation sequential treatment,and cansignificantly improve cardiac function.