Clinical Analysis Of Noninvasive Positive Pressure Ventilation In Aecopd Patients With Sever Type Ⅱ Respiratory Failure

Objective To investigate the therapeutic value of noninvasive positivepressure ventilation(NPPV) in acute exacerbation of chronic obstructivepulmonary disease （AECOPD） patients complicated with sever typeⅡrespiratory failur（ePaCO2≥80mmHg）.Methods61AECOPDpatientswith sever type Ⅱrespiratory failure (average PaCO2of these patients beforeNPPV therapy was94.79±14.24mmHg) who had received NPPV therapywere retrospectively evaluated. Respironics Vision （BiPAP） ventilatorproduced by Philips company or Savina ventilator produced by Dragercompany was used for noninvasive mechanical ventilation usingCPAP+ASB mode. Meanwhile all these patients had receivedcomprehensive treatment such as anti-infection. Clinical data such as vitalsigns and arterial blood gas analysis during the treatment were collected andevaluated. Result55patients (mean PaCO2before NPPV therapy was93.91±16.83mmHg) recovered from respiratory failure after NPPV therapy，but6patients (mean PaCO2before NPPV therapy was102.83±20.46mmHg)needed to switch to invasive mechanical ventilation. The mean PaCO2and pH value in artery blood gas analysis of all61patients were significantlyimproved through NPPV therapy(mean PaCO2before NPPV was94.79±14.24mmHg compared with64.64±16.14mmHg after NPPV, andmean pH before and after NPPV were:7.24±0.060vs.7.37±0.055,respectively, P＜0.05)， but PaO2and Oxygenation index were notimproved(mean PaO2before NPPV was77.80±19.91mmHg compared with82.00±17.31mmHg after NPPV, and mean Oxygenation index before andafter NPPV were:224.83±90.54mmHg vs.243.29±83.60mmHg, P>0.05).By comparing data between NPPV successful and unsuccessful group, pH7.25may be a cut-point to predict the out-come of NPPV therapy inAECOPD patients complicated with sever type Ⅱrespiratoryfailure.Conclusion NPPV is a safe and effective therapeutic method formost AECOPD patients with sever type Ⅱrespiratory failure, however forthe patient whose pH<7.25, NPPV should be utilized more cautiously andother indicator need be found to more exactly determine the indications ofNPPV.