Safety and Efficacy of Non-invasive Positive Pressure Ventilation Treatment Combined with Fiberoptic Bronchoscopy on AECOPD Patients with Acute Respiratory Failure_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

JiangHua ,  NanYandong , LiChunmei , MaLijie , JinFaguang

Department of Respiratory and Critical Care Medicine, Tangdu HospitaI, Fourth MiIitary Medical University, Xi'an, Shanxi, 710038, China;

Corresponding?author：

NanYandong, Email: nanyandong2008@163.com

Keywords：

Acute exacerbation of chronic obstructive pulmonary disease; Non-invasive positive pressure ventilation; Fiberoptic bronchoscopy; Acute respiratory failure

DOI：

10.7507/1671-6205.2014118

Video：

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Objective To evaluate the safety and efficacy of non-invasive positive pressure ventilation (NIPPV) combined with fiberoptic bronchoscopy(FB) on acute exacerbation of chronic obstructive puhmonary disease (AECOPD) patients with acute respiratory failure. Methods A prospective study was conducted on the AECOPD patients with respiratory failure in respiratory intensive care unit of Tangdu Hospital of Fourth Military Medicine University from February 2010 to February 2011.They were randomly divided into a case group and a control group.The case group was administrated FB and lavage after one hour of NIPPV treatment.The control group was administrated NIPPV without FB and lavage.Other treatment regimen was the same in two groups. Results There were 51 subjects recruited in the study, 25 subjects in the case group and 26 subjects in the control group.All variables at baseline were matched (P > 0.05).All variables improved after one hour of NIPPV before FB, without significant difference between two groups (P > 0.05).During the period of FB, heart rate in the case group was faster than that in the control group (P < 0.05), and other variables were not significantly different between two groups (P > 0.05).Both groups received NIPPV for one hour after FB, the variables including heart rate, respiratory rate, pH, PaO₂, PaCO₂ were statistically significant between two groups(P < 0.05).At the time of 24 hours after FB, the variables including mean arterial pressure, heart rate, respiratory rate, pH, PaO₂ and PaCO₂ in the case group were nearly recovered, and differences between two groups were significant (P < 0.05).The positive rate of sputum culture was significantly higher in the case group than that in the control group[88.0%(22/25) vs.58.6%(14/26)].Success rate in the case group were obviously superior to that in control group.The cases of failure, death and refusing in the case group were lower than those in the control group.Complications in two groups had no significant difference (P > 0.05).There was not serious complication such as hear arrest, hemoptysis and apnea during the process of NIPPV combined with early FB. Conclusion It deserves to be used in clinic because of the safety, efficacy and feasible for most of AECOPD patients through NIPPV combined with early FB.

Citation： JiangHua, NanYandong, LiChunmei, MaLijie, JinFaguang. Safety and Efficacy of Non-invasive Positive Pressure Ventilation Treatment Combined with Fiberoptic Bronchoscopy on AECOPD Patients with Acute Respiratory Failure. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(5): 484-489. doi: 10.7507/1671-6205.2014118 Copy

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9.	Meduri GU, Turner RE, Abou-Shala N, et al.Noninvasive mechanical ventilation via face mask:first-line intervention in patients with acute hypercapnic and hypoxemic acute respiratory failure.Chest, 1996, 109:179-193.
10.	Adnet F, Racine SX, Lapostolle F, et al.Full reversal of hypercapnic coma by noninvasive positive pressure ventilation.Am J Emerg Med, 2001, 19:244-246.
11.	Goldstein RA, Rohatgi PK, Bergofsky EH, et al.Clinical role of bronchoalveolar lavage in adults with pulmonary disease.Am Rev Respir Dis, 1990, 142:481-486.
12.	Heunks LM, de Bruin CJ, van der Hoeven JG, et al.Non-invasive mechanical ventilation for diagnostic bronchoscopy using a new face mask:an observational feasibility study.Intensive Care Med, 2010, 36:143-147.
13.	Scala R, Naldi M, Maccari U.Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia.Crit Care, 2010, 14:R80.

1. 中華醫學會呼吸病學分會.診斷性可彎曲支氣管鏡應用指南(2008年版).中華結核和呼吸雜志, 2008, 31:14-16.
2. 劉輝國, 張珍祥.纖維支氣管鏡在呼吸系統疾病中的診斷和治療進展.實用診斷與治療雜志, 2007, 21:561-563.
3. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組.慢性阻塞性肺疾病診治指南(2013年修訂版).中華結核和呼吸雜志, 2013, 36:255-264.
4. 王辰, 商鳴宇, 黃克武, 等.有創與無創序貫性機械通氣治療慢性阻塞性肺疾病所致嚴重急性呼吸衰竭的研究.中華結核和呼吸雜志, 2000, 23:212-216.
5. Kollef MH.The prevention of ventilator associated pneumonia.N Eng J Med, 1999, 340:627-634.
6. Kollef MH.Avoidance of tracheal intubation as a strategy to prevent ventilator associated pneumonia.Intensive Care Med, 1999, 25:553-555.
7. 曹志新, 王辰.無創正壓通氣在有創-無創序貫通氣中的應用.國外醫學呼吸系統分冊, 2003, 23:228-229.
8. Zhu GF, Zhang W, Zong H, et al.Effectiveness and safety of noninvasive positive-pressure ventilation for severe hypercapnic encephalopathy due to acute exacerbation of chronic obstructive pulmonary disease:a prospective case-control study.Chin Med J (Engl), 2007, 120:2204-2209.
9. Meduri GU, Turner RE, Abou-Shala N, et al.Noninvasive mechanical ventilation via face mask:first-line intervention in patients with acute hypercapnic and hypoxemic acute respiratory failure.Chest, 1996, 109:179-193.
10. Adnet F, Racine SX, Lapostolle F, et al.Full reversal of hypercapnic coma by noninvasive positive pressure ventilation.Am J Emerg Med, 2001, 19:244-246.
11. Goldstein RA, Rohatgi PK, Bergofsky EH, et al.Clinical role of bronchoalveolar lavage in adults with pulmonary disease.Am Rev Respir Dis, 1990, 142:481-486.
12. Heunks LM, de Bruin CJ, van der Hoeven JG, et al.Non-invasive mechanical ventilation for diagnostic bronchoscopy using a new face mask:an observational feasibility study.Intensive Care Med, 2010, 36:143-147.
13. Scala R, Naldi M, Maccari U.Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia.Crit Care, 2010, 14:R80.

Chinese Journal of Respiratory and Critical Care Medicine

Safety and Efficacy of Non-invasive Positive Pressure Ventilation Treatment Combined with Fiberoptic Bronchoscopy on AECOPD Patients with Acute Respiratory Failure

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