Observation of lateral position ventilation in invasive ventilation of patients with acute exacerbations of chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Xiaoyi ,  LIU Hui

Department of Critical Care Medicine, Central Hospital of Dazhou, Dazhou, Sichuan 635000, P. R. China;

Corresponding?author：

LIU Hui, Email: 756904123@qq.com

Keywords：

Acute exacerbations of chronic obstructive pulmonary disease; Invasive mechanical ventilation; Lateral position ventilation; Fibrobronchoscopy; Invasive-noninvasive sequential ventilation; Difficult weaning

DOI：

10.7507/1671-6205.201612048

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Objective To investigate the clinical significance of lateral position ventilation in the treatment of invasive ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods From October 2014 to December 2016, 60 eligible patients with AECOPD who meeting the inclusion criteria were randomly assigned to an intervention group (n=30) or a control group (n=30). Expectorant, antiasthmatic, anti-infective, invasive ventilation, bronchoscopy, analgesic sedation, invasive-noninvasive sequential ventilation, nutritional support, intensive care and other treatment were conducted in two groups, but lateral position ventilation was subsequently performed in the intervention group and the control group used half lateral position. Outcome measurements included pH, PaO₂/FiO₂, arterial partial pressure of carbon dioxide (PaCO₂), heart rate (HR), respiratory rate (R) and air way resistance (Raw) before and one day after invasive ventilation, and duration of control of pulmonary infection (PIC), invasive mechanic ventilation (IMV), mechanic ventilation (MV) and intensive care unit (ICU) stay. Results Compared with before ventilation, the levels of PaO₂/FiO₂, PaCO₂, HR, R and Raw were significantly changed in two groups after ventilation (P<0.05). One day later after ventilation, pH [interventionvs. control: (7.43±0.07) vs. (7.37±0.11)], PaO₂/FiO₂[(253.52±65.33) mm Hg (1 mm Hg=0.133 kPa) vs. (215.46±58.72) mm Hg] and PaCO₂ [(52.45±7.15) mm Hg vs. (59.39±8.44) mm Hg] were statistically significant (P<0.05), but no significant difference was found in HR, R or Raw between two groups (P>0.05). Compared with the control group, PIC [(3.7±1.4) daysvs. (5.3±2.2) days], IMV [(4.0±1.5) days vs. (6.1±3.0) days], MV [(4.7±2.0) days vs. (7.3±3.7) days] and ICU stay [(6.2±2.1) days vs. (8.5±4.2) days] were significantly decreased (P<0.05) in the intervention group. Conclusions In AECOPD patients, invasive ventilation using lateral position ventilation can significantly improve arterial blood gas index, decrease Raw, shorten the time of PIC, IMV, MV and ICU stay.

Citation： LIU Xiaoyi, LIU Hui. Observation of lateral position ventilation in invasive ventilation of patients with acute exacerbations of chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(6): 540-544. doi: 10.7507/1671-6205.201612048 Copy

1.	慢性阻塞性肺疾病急性加重(AECOPD)診治專家組. 慢性阻塞性肺疾病急性加重(AECOPD)診治中國專家共識(2014 年修訂版). 國際呼吸雜志, 2014, 34(1): 1-11.
2.	Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
3.	成人慢性氣道疾病霧化吸入治療專家組. 成人慢性氣道疾病霧化吸入治療專家共識. 中國呼吸與危重監護雜志, 2012, 11(2): 105-110.
4.	中華醫學會重癥醫學分會. 慢性阻塞性肺疾病急性加重患者的機械通氣指南(2007). 中國危重病急救醫學, 2007, 19(9): 513-518.
5.	有創-無創序貫機械通氣多中心研究協作組. 以肺部感染控制窗為切換點行有創與無創序貫機械通氣治療慢性阻塞性肺疾病所致嚴重呼吸衰竭的隨機對照研究. 中華結核和呼吸雜志, 2006, 29(1): 14-18.
6.	Mallia P, Singanayagam A, Johnston SL. Virus-bacteria interactions in COPD exacerbations. Eur Respir Monogr, 2013, 60: 76-83.
7.	Mackay AJ, Hurst JR. COPD exacerbations: causes, prevention, and treatment. Med Clin North Am, 2012, 96(4): 789-809.
8.	梁麗, 李禮娟. 機械通氣患者大于 80° 側臥位的通氣效果觀察. 醫學理論與實踐, 2015, 28(11): 1523-1524.
9.	于湘友, 潘鵬飛, 拜合提尼沙?吐爾地. 側臥位通氣對急性呼吸窘迫綜合征患者肺容積合氧合的影響. 中國呼吸與危重監護雜志, 2009, 8(6): 555-557.
10.	于湘友, 楊春波, 王毅. 側臥位通氣治療肺內/肺外源性急性呼吸窘迫綜合征的對比觀察. 中華急診醫學雜志, 2012, 21(3): 249-251.
11.	龍勇, 姜英, 李長羅. 側臥位機械通氣對胸外傷急性呼吸衰竭患者血氧及循環的影響. 中國當代醫藥, 2016, 23(17): 29-31.
12.	王泠. 2014 版國際《壓瘡預防和治療: 臨床實踐指南》解讀. 中國護理管理, 2016, 16(5): 577-580.
13.	章敬玉, 鄧桂勝, 吳剛. PIC 窗指導下序貫機械通氣在慢性阻塞性肺疾病急性加重患者治療中的應用. 山東醫藥, 2016, 56(38): 50-52.
14.	Duan J, Guo S, Han X, et al. Dual-mode weaning strategy for difficult-weaning tracheotomy patients: a feasibility study. Anesth Analg, 2012, 115(3): 597-604.
15.	Perera PN, Armstrong EP, Sherrill DL, et al. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD, 2012, 9(2): 131-141.
16.	Ban A, Ismail A, Harun R, et al. Impact of clinical pathway on clinical outcomes in the management of COPD exacerbation. BMC Pulm Med, 2012, 12: 27.
17.	Brightling CE. Biomarkers that predict and guide therapy for exacerbations of chronic obstructive pulmonary disease. Ann Am Thorac Soc, 2013, 10 Suppl: S214-S219.
18.	Diamantea F, Kostikas K, Bartziokas K, et al. Prediction of hospitalization stay in COPD exacerbations: the AECOPD-F score. Respir Care, 2014, 59(11): 1679-1686.
19.	劉小毅, 鄭祥德, 劉慧. 肺復張策略在有創通氣患者行纖維支氣管鏡治療后的對比研究. 華西醫學, 2016, 31(5): 863-866.
20.	權紅麗, 馮思芳, 白智慶. 機械振動排痰在 AECOPD 機械通氣患者中的應用及效果觀察. 中國急救醫學, 2015, 35(z2): 324-325.

1. 慢性阻塞性肺疾病急性加重(AECOPD)診治專家組. 慢性阻塞性肺疾病急性加重(AECOPD)診治中國專家共識(2014 年修訂版). 國際呼吸雜志, 2014, 34(1): 1-11.
2. Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
3. 成人慢性氣道疾病霧化吸入治療專家組. 成人慢性氣道疾病霧化吸入治療專家共識. 中國呼吸與危重監護雜志, 2012, 11(2): 105-110.
4. 中華醫學會重癥醫學分會. 慢性阻塞性肺疾病急性加重患者的機械通氣指南(2007). 中國危重病急救醫學, 2007, 19(9): 513-518.
5. 有創-無創序貫機械通氣多中心研究協作組. 以肺部感染控制窗為切換點行有創與無創序貫機械通氣治療慢性阻塞性肺疾病所致嚴重呼吸衰竭的隨機對照研究. 中華結核和呼吸雜志, 2006, 29(1): 14-18.
6. Mallia P, Singanayagam A, Johnston SL. Virus-bacteria interactions in COPD exacerbations. Eur Respir Monogr, 2013, 60: 76-83.
7. Mackay AJ, Hurst JR. COPD exacerbations: causes, prevention, and treatment. Med Clin North Am, 2012, 96(4): 789-809.
8. 梁麗, 李禮娟. 機械通氣患者大于 80° 側臥位的通氣效果觀察. 醫學理論與實踐, 2015, 28(11): 1523-1524.
9. 于湘友, 潘鵬飛, 拜合提尼沙?吐爾地. 側臥位通氣對急性呼吸窘迫綜合征患者肺容積合氧合的影響. 中國呼吸與危重監護雜志, 2009, 8(6): 555-557.
10. 于湘友, 楊春波, 王毅. 側臥位通氣治療肺內/肺外源性急性呼吸窘迫綜合征的對比觀察. 中華急診醫學雜志, 2012, 21(3): 249-251.
11. 龍勇, 姜英, 李長羅. 側臥位機械通氣對胸外傷急性呼吸衰竭患者血氧及循環的影響. 中國當代醫藥, 2016, 23(17): 29-31.
12. 王泠. 2014 版國際《壓瘡預防和治療: 臨床實踐指南》解讀. 中國護理管理, 2016, 16(5): 577-580.
13. 章敬玉, 鄧桂勝, 吳剛. PIC 窗指導下序貫機械通氣在慢性阻塞性肺疾病急性加重患者治療中的應用. 山東醫藥, 2016, 56(38): 50-52.
14. Duan J, Guo S, Han X, et al. Dual-mode weaning strategy for difficult-weaning tracheotomy patients: a feasibility study. Anesth Analg, 2012, 115(3): 597-604.
15. Perera PN, Armstrong EP, Sherrill DL, et al. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD, 2012, 9(2): 131-141.
16. Ban A, Ismail A, Harun R, et al. Impact of clinical pathway on clinical outcomes in the management of COPD exacerbation. BMC Pulm Med, 2012, 12: 27.
17. Brightling CE. Biomarkers that predict and guide therapy for exacerbations of chronic obstructive pulmonary disease. Ann Am Thorac Soc, 2013, 10 Suppl: S214-S219.
18. Diamantea F, Kostikas K, Bartziokas K, et al. Prediction of hospitalization stay in COPD exacerbations: the AECOPD-F score. Respir Care, 2014, 59(11): 1679-1686.
19. 劉小毅, 鄭祥德, 劉慧. 肺復張策略在有創通氣患者行纖維支氣管鏡治療后的對比研究. 華西醫學, 2016, 31(5): 863-866.
20. 權紅麗, 馮思芳, 白智慶. 機械振動排痰在 AECOPD 機械通氣患者中的應用及效果觀察. 中國急救醫學, 2015, 35(z2): 324-325.

Chinese Journal of Respiratory and Critical Care Medicine

Observation of lateral position ventilation in invasive ventilation of patients with acute exacerbations of chronic obstructive pulmonary disease

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