Analysis Of The Therapeutic Effect Of Non-invasive And Invasive Mechanical Ventilation On Mild And Moderate ARDS

Objectives The therapeutic effects of Noninvasive mechanical ventilation（NIV）and Invasive mechanical ventilation（IMV）on Acute respiratory distress syndrome（ARDS）were analyzed by case-control study,and some clinical basis was provided for the selection of appropriate ventilation mode for mild and moderate ARDS patients;At the same time,we analyzed the patients with NIV failure to explore the risk factors for NIV failure.Methods The Intensive Care Unit（ICU）of the Northern China University of tech nology in January 2015-2020 was required to collect records of adults with mechan ical ventilation of the mild and moderate ARDS.After various mechanical ventilati on modes,the group of IMV,the group of NIV success,and the group of NIV fai lure formed them.We needed to compare the NIV success and IMV group of pati ents with Age,Gender,Body Mass Index（BMI）,Acute Physiology and Chronic He alth EvaluationⅡ（APACHEⅡ）Score;and the Arterial blood gas results from pati ents in the NIV successful group and IMV group were need to compare before（T₀）and after mechanical ventilation at 6h（T₁）,12h（T₂）,24h（T₃）,36h（T₄）,48h（T₅）and 72h（T₆）,Including PH,oxygen diffusion of arterial blood,oxygen stratification in arterial blood,carbon dioxide in arterial blood,degree of oxygen saturation in ar terial blood.The incidence of respiratory pneumonia（VAP）was compared between the NIV success group and the IMV group.The mortality rate and duration of stay（LOS）of patients in the NIV success group,the NIV failure group and the IMV g roup were analyzed.For the NIV error group,binary logistic regression was used to investigate the risk factors of an NIV error.Results There are no significant differences in gender,age,APACHEⅡ score and BMI between the NIV successful group and the IMV group（P>0.05）.In IMV group,p H,PaO₂,PaO₂/FiO₂ and SaO₂ at T₁-T₆ are higher than those at T₀,and Pa CO₂ is lower than those at T₀,and they are statistic difference（P<0.05）.In the NIV successful group,p H,PaO₂,PaO₂/FiO₂ and SaO₂ at T₁-T₆are higher than those at T₀,and Pa CO₂ is lower than those at T₀,with statistical significance（P<0.05）.At T₀,there were no significant differences in p H,PaO₂,PaO₂/FiO₂,SaO₂ and Pa CO₂between IMV group and NIV successful group（P>0.05）.At T₁,there are no significant differences in p H,PaO₂ and Pa CO₂between the two groups（P<0.05）.PaO₂/FiO₂ and SaO₂in IMV group are higher than those in the NIV successful group,and they are statistic difference（P<0.05）.At T₂-T₆,p H,PaO₂,PaO₂/FiO₂and SaO₂ in IMV group are higher than those in NIV successful group,and Pa CO₂ is lower than those in NIV successful group,and they are statistic difference（P<0.05）.The discrepancy is significant with statistics science,and the incidence of ventilator-associated pneumonia in the NIV successful group are lower than that in the NIV group（P<0.05）.There is no significant discrepancy in the mortality and length of stay between the IMV group and the non-invasive ventilation failure group（P>0.05）.The in-hospital mortality and LOS in the NIV success group are lower than those in the NIV failure group and the IMV group,and they are statistic difference（P<0.05）.In univariate analysis of NIV failure,there are no significant differences in gender,BMI,etiology,treatment PH,Pa CO₂ and SaO₂ between the successful and failed NIV groups（P>0.05）.The age and APACHEⅡ score of the successful group are lower than those of the failed group,and it is statistic difference（P<0.05）.PaO₂ and PaO₂/FiO₂ in the NIV success group are higher than those in the failure group,and they are statistic difference（P<0.05）.Binary Logistic regression shows that APACHEⅡ score is an independent risk factor for NIV failure,with statistical significance（P<0.05）.Conclusions Both NIV and IMV can improve the oxygenation of mild and moderate ARDS patients,but NIV can significantly reduce the in-hospital mortality,shorten the length of hospital stay,and reduce the incidence of ventilator-associated pneumonia.APACHEⅡ score is an independent risk factor for failure in NIV,and patients with higher APACHEⅡ scores should avoid to NIV.There is a possibility of failure of NIV,so close monitoring and standardized nursing should be carried out during the use.If the condition does not improve or even deteriorate that,endotracheal intubation should be carried out in time.Figure 5;Table13;Reference 157...