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Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study

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chinese Medical Journal 2005年第19期118卷 1589-1594页

作者： Wang, C Zhan, QY Cao, ZX Wei, LQ Cheng, ZZ Liu, S Zhang, JL Chen, RC Luo, Q Niu, SF Zhu, L Wu, DW Fang, BM Wu, TH Wang, CZ Liu, YN collaborating research group for noninvasive mechanical ventilation of chinese respiratory society

Background Early withdraw from invasive mechanical ventilation （MV） followed by noninvasive MV is a new strategy for changing modes of treatment. This study was conducted to estimate the feasibility and the efficacy of early extubation and sequential noninvasive MV commenced at beginning of pulmonary infection control window in patients with exacerbated hypercapnic respiratory failure caused by chronic obstructive pulmonary diseases （ C OPD ）. Methods A prospective, randomized controlled study was conducted in eleven teaching hospitals＇ respiratory or medical intensive care units in China. Ninety intubated COPD patients with severe hypercapnic respiratory failure triggered by pulmonary infection （pneumonia or purulent bronchitis） were involved in the study. When the pulmonary infection had been controlled by antibiotics and comprehensive therapy, the “pulmonary infection control window （PIC window）” has been reached. Each case was randomly assigned to study group （extubation and noninvasive MV via facial mask immediately） or control group （ invasive MV was received continuously after PIC window by using conventional weaning technique）. Results Study group （n = 47 ） and control group （n = 43 ） had similar clinical characteristics initially and at the time of PIC window. Compared with control group, study group had shorter duration of invasive MV [ （6. 4±4. 4） days vs （ 11.3±6. 2） days, P =0. 0001, lower rate of ventilator associated pneumonia （VAP）（3/47 vs 12/43, P=0.014）, fewer days in ICU [（12 ＋8） days vs 16 ＋ 11） days, P =0.047] and lower hospital mortality （ 1/47 vs 7/43, P =0. 025）. Conclusions In COPD patients requiring intubation and lnvasive MV for hypercapnic respiratory failure, which is exacerbated by pulmonary infection, early extubation followed by noninvasive MV initiated at the start of PIC window may decrease significantly the duration of invasive MV, the risk of VAP and hospital mortality.

关键词： chronic obstructive pulmonary disease acute exacerbation . noninvasive positive pressureventilation . invasive positive pressure ventilation . ventilator weaning

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Pulmonary infection control window as a switching point for consequential ventilation: an encouraging finding in treatment of acute respiratory failure of chronic obstructive pulmonary disease

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chinese Medical Journal 2005年第19期118卷 1587-1588页

作者： ZHANG Xi-long Department of respiratory Medicine First Affiliated Hospital ofNanjing Medical University Nanjing 210029 China

I read with great interest the article by collaborating research group for noninvasivemechanical ventilation of chinese respiratory society. 1 Based on the concept mentioned in this paper, I have found that it is really an encouraging new finding in the field of clinical application of mechanical ventilation and treatment of acute respiratory failure （ARF） of chronic obstructive pulmonary disease （COPD）.

关键词： noninvasive ventilation mechanical ventilation

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