The Application Of Pneumatic Extubation Window As Switching Point For Invasive-noninvasive Mechanical Ventilation In Treatment Of Chronic Obstructive Pulmonary Disease Combined With Pneumothorax

Objective:To evaluate the feasibility and curative effect of applicating invasive-noninvasive sequential mechanical ventilation in chronic obstructive pulmonary disease?COPD?complicated with respiratory failure and pneumothorax at the switch-point in pneumatic extubation window.Methods:30 patients with COPD complicated with pneumothorax treated with mechanical ventilation were involved in the study from 2015 to2017 and divided into two groups.12 patients were extubated at the switch-point in pneumatic extubation window following by noninvasive mechanical ventilation called experimental group,while the others were treated by exhaustive extubation in an empirical?Spontaneous breathing trail,SBT?called control group.The main clinical parameters observed were:the invasive mechanical ventilation time,the total mechanical ventilation time.The stay of RICU,total length of stay hospital,Hospitalization costs,pneumothorax treatment time;Prognostic indicators:The extubation success rate,re-intubation rate,out of RICU rate,discharge rate and 28-day mortality rate;Complication:the incidence of ventilator associated pneumonia?VAP?,incidence of pressure ulcer and pulmonary embolism;Closed thoracic drainage complications:Pneumothorax increase rate,Thoracic infection rate,Drainage tube withdrawal rate,Drainage tube plugging rate,Subcutaneous emphysema incidence.Cardiovascular parameters:HR,MAP,SBP,DBP and CVP were compared at 2h before and after extubation.Results:Above groups had similar clinical characteristics?P>0.05?.Invasive mechanical ventilation time?7.33±2.06d vs 11.78±5.78d?,P<0.05,The total mechanical ventilation time was?9.33±1.72d vs 14.11±5.36d?,respectively?P<0.01?,The stay of RICU was?9.83±2.82d vs 15.61±4.42d?,?P<0.01?,Total length of hospital stay?19.15±2.10d vs 29.31±4.80d?,?P<0.01?,Hospitalization costs?62683.81±9694.01 yuan vs 73474.11±13009.65 yuan?,P<0.05,Pneumothoracic treatment time?11.50±1.73d vs15.83±4.69d?,P<0.01;The rate of successful extubation?91.67%vs90.91%?,P>0.05,Reattachment rate?0%vs 10%?,P>0.05,Out of RICU rate?38.89%vs 83.33%?,P<0.05,Improvement rate of discharge?33.33%vs83.33%?,P<0.01,28-day mortality?16.67%vs 55.56%?P<0.05;The incidence of VAP?8.33%vs 61.11%?,P<0.01,The incidence of pressure sores?8.33%vs 22.22%?,P>0.05,The incidence of pulmonary embolism?0%vs 11.11%?,P>0.05;Pneumothorax increase rate?77.78%vs41.67%?,P<0.05;Thoracic infection rate?22.22%vs16.67%?,P>0.05,Drainage tube withdrawal rate?22.22%vs25%?,P>0.05,Drainage tube plugging rate?11.11%vs8.33%?,P>0.05,Subcutaneous emphysema incidence?66.67%vs 58.33%?,P>0.05.experimental group CVP?12.08±1.08cmH₂O vs 10.25±1.14cmH₂O?before and after extubation 2h,P<0.01,Control group CVP?13±1.51cmH₂O vs 9.27±1.53cm H₂O?,P<0.01.Conclusion:For patients with COPD complicated with respiratory failure and pneumothorax,choosing pneumatic extubation window as the switching point for early extubation and noninvasive ventilation can reduce invasive mechanical ventilation,reduce VAP incidence,shorten RICU stay,reduce hospital costs,moreover,be beneficial to the prognosis;the last but not the least,be conducted with clinical feasibility.