The Effects Of Sequential Mechanical Ventilation On Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

ObjectiveThe clinical effects of sequential mechanical ventilation on patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）were observed and analyzed by using pulmonary infection control window combined with autonomic respiratory test as the switching time.MethodThis study is a retrospective analysis.The patients who were admitted to the affiliated Hospital of Yan’an University from 2014 to 2018 due to acute exacerbation of chronic obstructive pulmonary disease were divided into invasive group and sequential group according to different ways of withdrawal.All patients were treated according to the criteria for diagnosis and treatment of chronic obstructive pulmonary disease,followed by orotracheal intubation.The initial preset volume assisted/controlled（A/C）mode was used at the beginning,and then gradually transitioned to SIMV+PSV mode.According to the patient’s condition,the parameters of ventilator were adjusted in time to ensure that the patient’s SPO₂ was above 90%and the vital signs were stable.In the invasive group,after continuous invasive ventilation to weaning,using SIMV+PSV mode,the breath rate frequency was gradually adjusted at 4⁸ times/min,PSV at 6⁸ cm H₂O,remain SPO₂>90%,and PaO₂ at 45⁵5 mmHg or level of stable phase of COPD,After stabilizing for 2h,the tube was pulled out,and the nasal duct or mask was used to oxygen therapy.In the sequential group,extubation after the pulmonary infection control window was achieved and the spontaneous breathing trail was successful,switch to Non-Invasive Ventilation with face mask.The ventilation mode was changed to BiPAP non-invasive mechanical ventilation when inspiratory pressure reduced to 5cm H₂O,the patient can breathe autonomously and then evacuate the non-invasive ventilator.All patients were given proper sedation during mechanical ventilation,ensure airway humidification,the smooth drainage of sputum fluid,the nutritional supply of patients,and do whatever we can to prevent the occurrence of complications related to mechanical ventilation.The general data of all patients（sex,age,course of disease,APACHEⅡscore,blood gas index,complications）,blood gas indexes after 24 hours mechanical ventilation,time to switching were collected.The blood gas indexes and clinical indexes at the end of treatment（invasive mechanical ventilation time,total mechanical ventilation time,length of hospitalization,incidence of VAP,re-intubated rate,weaning failure rate,death rate,improvement rate）were measured after weaning 2 hours.SPSS19.0 software was used for statistical analysis,paired t-test was used for intra-group comparison,t-test,chi-square test for inter-group comparison,p<0.05.The difference was statistically significant.Result1.General data:according to inclusion criteria and exclusion criteria,146 patients were included,including 71 patients in invasive group and 75 patients in sequential group.There was no significant difference in general data and severity of disease between the two groups（p>0.05）.2.Results:there was significant difference in blood gas index within the two groups before and after 48 hours of mechanical ventilation（p<0.05）,but there was no significant difference between the two groups（p>0.05）.There was significant difference in blood gas index within the two groups before and weaning after 2 hours（p<0.05）,but there was no significant difference between the two groups（p>0.05）.3.Clinical indexes:there was no significant difference in the time of reaching switching opportunity between the two groups.The time of invasive mechanical ventilation,the time of total mechanical ventilation and the length of hospitalization were significantly different between the two groups（p<0.05）.4.Incidence of complications:there was a significant difference in the incidence of VAP between the two groups（p<0.05）.There was no significant difference in improvement rate,receptacle rate,mortality rate and weaning failure rate（p>0.05）.Conclusion1.The effect of sequential mechanical ventilation in the treatment of acute exacerbation of chronic obstructive lung was same with that of invasive mechanical ventilation.2.Compared with pulmonary infection control window,combine pulmonary infection control window with spontaneous breathing test as switching opportunity can significantly reduce the incidence of ventilator-related complications,improve the success rate of the first weaning,and improve the prognosis of the patients,which is worth popularizing.