Extremely severe respiratory failure complicated by lactic acidosis

A case of a 48-year male patient with chronic cor pulmonale is presented. Exacerbation of the chronic respiratory failure was caused by pneumonia. The patient was treated with artificial ventilation for 22 days and stimulating aggressive antibacterial therapy. An improvement was achieved. Indications to the use of respirator in the exacerbated chronic respiratory failure have been discussed together with problem of the potential reversibility of the cause, gas and lactic acidosis and an important clinical problem of the respiratory muscles exhaustion.     

机械通气患者人工气道管理技术进展

机械通气技术在严重急慢性呼吸衰竭的患者抢救治疗中广泛应用,人工气道管理技术方法在机械通气过程中显示十分重要作用,有效的气道管理技术方法可减少机械通气过程中一些并发症如呼吸机相关性肺炎等。结合临床应用机械通气技术体会,本文主要对人工气道管理技术方法总结分析。     

Netilmicin in the treatment of bacterial respiratory tract infections

Netilmicin - a semisynthetic aminoglycoside - was administered to 33 patients with the acute or chronic lower respiratory tract or pulmonary infections in a daily dose of 5 mg/kg body weight for 10 days. A principle criterium of patients classification to netilmicin therapy were sensitive bacterial strains either in sputum or in BAL liquid. A significant clinical improvement was noted in 88% of the treated patients. However, elimination of pathogens from the sputum was achieved only in 52% of these patients. No improvement was observed in 4% of the treated patients. No adverse reactions were noted. Netilmicin proved safe and effective antibacterial agent in patients with respiratory infections.     

经鼻盲探气管插管在抢救呼吸衰竭病人中的应用

目的比较经鼻盲探气管插管和气管切开在抢救呼吸衰竭病人的治疗效果。方法回顾性对比分析同期ICU住院病人采用经鼻盲探气管插管或气管切开建立人工气道后的病情转归,使用呼吸机后血气纠正时间,使用呼吸机时间,留置气管导管时间,平均住院时间及操作并发症。结果经鼻盲探气管插管组拔管率42.9%(9/21例),拔管成功率100%(9/9例);气管切开组拔管率60.7%(17/28例),拔管成功率76.5%(13/17例),两组间比较无显著性差异(P<0.05)。使用呼吸机后血气纠正时间无明显差别,但经鼻盲探气管插管组使用呼吸机时间,留置气管导管时间,平均住院时间均短于气管切开组(P<0.05)。气管切开组操作导致的并发症发生率46.4%(13/28例),而经鼻盲探气管插管组操作导致的并发症发生率23.8%(5/21例),明显少于前者(P<0.01)。结论经鼻盲探气管插管操作简便、实用,能减少并发症,缩短使用呼吸机时间,留置气管导管时间及住院时间,在抢救呼吸衰竭病人中较气管切开术有更好的临床应用价值。     

喉罩与气管插管在呼吸衰竭患者院前和急诊急救中的应用效果比较

目的:探讨喉罩与气管插管在呼吸衰竭患者院前和急诊急救中的应用效果。方法:选择2016年1月至2018年5月由中国人民解放军第174医院急诊医学科出诊抢救的呼吸衰竭患者92例,所有患者根据通气方法的不同分为A组和B组。其中A组使用喉罩人工通气方法进行急救,共有47例,而B组则使用气管插管人工通气方法进行急救,共有45例,比较两组患者治疗前与治疗1 h后呼吸频率(RR)、心率(HR)以及血氧饱和度(SpO_2)等生命体征指标,对比喉罩与气管插管置入时间、一次性成功率、心肺复苏成功率情况,记录两组并发症发生情况。结果:两组患者治疗前HR、RR以及SpO_2比较差异无统计学意义(P0.05),两组患者治疗1 h后HR、RR均较治疗前降低,SpO_2较治疗前升高(P0.05),两组患者治疗1h后HR、RR以及SpO_2比较差异无统计学意义(P0.05)。A组的喉罩插管置入时间明显短于B组的气管插管置入时间,且A组插管一次性成功率明显高于B组,两组比较差异具有统计学意义(P0.05),而两组心肺复苏成功率比较差异无统计学意义(P0.05)。A组并发症发生率为2.13%(1/47),低于B组的并发症发生率13.33%(6/45),差异具有统计学意义(P0.05)。结论:喉罩通气与气管插管通气效果基本一致,但其操作更简单更安全,可缩短插管置入时间,提高一次性成功率,争取抢救时间。     

Noninvasive positive-pressure ventilation in acute respiratory failure

Noninvasive positive-pressure ventilation is a type of mechanical ventilation that does not require an artificial airway. Studies published in the 1990s that evaluated the efficacy of this technique for the treatment of diseases as chronic obstructive pulmonary disease, congestive heart failure and acute respiratory failure have generalized its use in recent years. Important issues include the selection of the ventilation interface and the type of ventilator. Currently available interfaces include nasal, oronasal and facial masks, mouthpieces and helmets. Comparisons of the available interfaces have not shown one to be clearly superior. Both critical care ventilators and portable ventilators can be used for noninvasive positive-pressure ventilation; however, the choice of ventilator type depends on the patient''s condition and therapeutic requirements and on the expertise of the attending staff and the location of care. The best results (decreased need for intubation and decreased mortality) have been reported among patients with exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary edema.Noninvasive positive-pressure ventilation is the delivery of mechanical ventilation to patients with respiratory failure without the requirement of an artificial airway. The key change that led to the recent increase in the use of this technique occurred in the early 1980s with the introduction of the nasal continuous positive airway pressure mask for the treatment of obstructive sleep apnea. Studies published in the 1990s that evaluated the efficacy of noninvasive positive-pressure ventilation for treatment of diseases such as chronic obstructive pulmonary disease, congestive heart failure and acute respiratory failure have generalized its use in recent years.¹ In 1998, an international study on the use of mechanical ventilation found that 5% of patients admitted to intensive care units received noninvasive positive-pressure ventilation.²Noninvasive positive-pressure ventilation includes various techniques for augmenting alveolar ventilation without an endotracheal airway. The clinical application of noninvasive ventilation by use of continuous positive airway pressure alone is referred to as “mask CPAP,” and noninvasive ventilation by use of intermittent positive-pressure ventilation with or without continuous positive airway pressure is called noninvasive positive-pressure ventilation.     

Respiratory failure treated at the intensive care unit "R" of the Internal Disease Clinic of the Institute of Tuberculosis and Pulmonary Diseases (1986-1987)

A picture and clinical course of the acute and exacerbated chronic respiratory failure have been analysed. An analysis embraced a group of 49 patients, i.e. 16 percent of all patients treated at the Intensive Care Unit. Four subgroups were distinguished depending on the etiology of the disease in which infectious, thrombo-embolic, circulatory or toxic factors caused respiratory failure. An emphasis is on the prevalence of the infectious etiology of disease being noted in 65% of patients. Acute respiratory failure was observed in 37% of patients whereas exacerbation of the chronic respiratory failure in 63%. Complete respiration distress was noted in 55% of cases and partial respiratory failure in the remaining 45%. Gasometric differences characteristic for each subgroup of the patients have also been analysed. 41% of the patients died. The highest mortality rate was seen in pulmonary embolism complicating various pulmonary diseases. Sudden cardiac arrest, shock and not compensated acidosis have been most unfavourable factors in the prognosis.     

Results of treating acute myeloblastic leukemia in patients over 60 years of age

An efficiency of the acute myeloblastic leukemia therapy has been assessed in 79 patients aged over 60 years. Twenty six patients out of this group have been treated with usual or reduced doses of doxorubicin and cytarabine (ADR-Ara-C) 35--low doses of cytarabine (LD Ara-C), 11-6-mercaptopurine (6 MP), and 7 patients died before chemotherapy. Complete remission in group treated with ADR-Ara-C was achieved in 23% of patients while partial remission in 42%. Median survival in this group was 5.8 months (range from 0.5 to 16 months). Percentage of the complete remissions in the group treated with LD-Ara-C was 6%, and partial remissions 40%. Median survival was 4.7 months (range from 0.5 to 14.2 months). Partial remission in 5 out of 11 patients treated with 6 MP (36%) and no complete remissions were noted. Median survival was 3.9 months. Therapy with ADR-Ara-C produced marked leucopenia and thrombocytopenia in the majority of treated patients. Vomiting, hemorrhagic complications, and bacterial infections have also been noted. These adverse reactions have been less frequent in patients treated with LD-Ara-C, and 6 MP. Ten patients (38%) treated with ADR-Ara-C and 7 patients treated with LD-Ara-C died during remission inducing therapy.     

Low Testosterone Levels are Frequent in Patients with Acute Respiratory Failure and Are Associated with Poor Outcomes

ObjectiveLow testosterone level is a common finding in critically ill patients with trauma, shock, and sepsis. However, its prevalence and outcomes in patients with primary acute respiratory failure is unknown; low testosterone could contribute to respiratory muscle weakness and further compromise ventilation in these patients.MethodsWe aimed to determine the prevalence, severity, and effects of hypotestosteronemia in patients with acute respiratory failure in a 16-bed single academic center medical intensive care unit (ICU). We studied 30 men who required mechanical ventilation for ≥ 24 hours for a primary diagnosis of acute respiratory failure. Blood samples were drawn on ICU day 1 and day 3 to measure serum levels of total and free testosterone.ResultsHypotestosteronemia (level below the lower reference limit) was present on day 1 in 93.1% (total testosterone) and 76.7% (free testosterone) of patients and on day 3 in 94.4% (total testosterone) and 100% (free testosterone) of patients. Sex hormone–binding globulin, dehydroepiandrosterone sulfate, follicle-stimulating hormone, luteinizing hormone, and thyroid function levels were all within stated reference ranges. Total and free testosterone levels correlated inversely with ventilator days and ICU length of stay.ConclusionHypotestosteronemia is common in mechanically ventilated patients with primary acute respiratory failure and may contribute to longer ICU stay. Further studies are needed to determine the effect of testosterone replacement on short- and long-term outcomes in these patients. (Endocr Pract. 2014;20:1057-1063)     

5. New approaches to the management of flail chest.

Although continuous positive-pressure ventilation (internal pneumatic fixation) was a great advance in the treatment of flail chest and is now the standard treatment of this condition, early and late complications related to tracheostomy and long-term ventilation are associated with this method. These complications can be avoided by use of three recently adopted techniques--expectant therapy, intermittent mandatory ventilation with positive end-expiratory pressure, and early surgical stabilization of fractures. All patients should continue to be treated in intensive care units so that impending respiratory failure can be identified and treated. These newer forms of therapy not only have the advantages of avoiding complications inherent in tracheostomy and prolonged ventilation, but also decrease the length of hospital stay and expense of treatment.     

Significance of Legionella pneumophila in human respiratory pathology

The etiological structure of acute pneumonia and acute respiratory diseases was studied with a view to establishing the proportion of L. pneumophila among other causative agents of such diseases. A total of 299 patients were examined over time. The etiological diagnosis based on the data of serological examination was made in 70.6% of the patients with acute pneumonia and in 65% of the patients with acute respiratory viral infections and influenza. In the etiology of pneumonia, the leading role was found to belong to influenza A (H3N2) and B viruses, as well as to adenovirus, while in the etiology of acute respiratory viral infections and influenza, to influenza B virus, adenovirus and Mycoplasma pneumoniae. The importance of L. pneumophila in the etiology of acute pneumonia and acute respiratory diseases was shown. The proportion of L. pneumophila proved to be, on the average, 9.9% in acute pneumonia and 9.8% in acute respiratory diseases. L. pneumophila occurred most frequently in mixed infections in combination with adenovirus and influenza B virus. Diseases of Legionella etiology were found to have a seasonal character, occurring mostly in winter and spring.     

急性心力衰竭应用BiPAP 呼吸机疗效分析

目的:分析急性心力衰竭(AHF)患者应用双水平正压通气(BiPAP)呼吸机治疗的效应。方法:95例急性左心衰竭患者随机分为:A组(应用BiPAP呼吸机治疗)43例和B组(对照组,常规治疗)52例。A组在常规药物治疗的基础上,每天应用BiPAP呼吸机无创通气12～24小时,全部用鼻罩;B组仅应用常规药物治疗。疗程均为5天。观察两组治疗前后临床疗效、B型利钠肽(BNP)、血气分析及心功能的变化。结果:显效率:BiPAP组69.8%,对照组46.2%,两组有显著差异(P<0.05)。两组心功能、BNP、血气分析,治疗后与治疗前相比均有显著差异(P<0.05),治疗后BiPAP组与对照组间比较有显著差异(P<0.05)。结论:BiPAP呼吸机能改善急性左心衰竭患者的症状、血气结果及心功能,还能降低BNP。     

老年重症肺炎患者机械通气后短期预后的相关影响因素分析

目的：探讨分析该疾病患者短期预后的相关影响因素。方法：对120例老年重症肺炎机械通气患者的临床资料进行回顾性分析,采用Logistic回归分析法,对老年重症肺炎患者的机械通气后的病死率与并发症的相关因素进行分析。结果：病死率为29．17％,经回归分析后,病死率与心力衰竭、电解质紊乱与酸碱失衡、肝功能衰竭以及呼吸衰竭等因素有关（P〈0．05）;而与循环衰竭、胃肠损害（消化道出血异常）以及气胸等因素无关（P〉0．05）;影响患者短期预后的独立预测因素包括：高急性生理与慢性健康评分（APACHEII）、高急性生理学评分（APS）、低格拉斯哥昏迷（GCS）评分以及低白蛋白水平。结论：老年重症肺炎患者机械通气后,能够引起心力衰竭等症状,影响患者短期预后情况的重要因素。     

NCPAP在治疗新生儿急性呼吸衰竭中的应用价值

目的：探讨鼻塞持续正压通气(NCPAP)治疗新生儿急性呼吸衰竭的临床应用价值。方法：选取我院2008 年2 月至2014 年5 月接收确诊的新生儿急性呼吸衰竭98 例，根据治疗方法不同均分为对照组和治疗组，每组49 例，对照组采用持续头罩吸氧治 疗，治疗组采用鼻塞持续正压无创通气治疗，对比分析两组患儿的治疗效果。结果：治疗24 h 后，治疗组患儿的呼吸、心率、PaO2和 PaCO2临床指标改善程度要高于对照组(P<0.05)，且治疗组的治愈率高于对照组(89.4 %>67.4 %，X2=3.671，P<0.05)，同时并发症的 发生率低于对照组(P<0.05)。结论：NCPAP 能够有效地治疗新生儿急性呼吸衰竭，同时减少并发症的发生，值得临床进一步推广与 应用。     

机械通气对ICU肺动脉高压伴呼吸衰竭患者血浆脑钠肽水平的影响

目的探讨机械通气对ICU肺动脉高压伴呼吸衰竭患者血浆脑钠肽水平的影响。方法随机抽取86例ICU肺动脉高压伴呼吸衰竭患者分为两组,观察组43例患者应用面罩呼吸机予以辅助呼吸治疗,对照组43例患者行气管插管呼吸机辅助治疗,并对两组患者治疗前后脑钠肽、肺动脉压水平以及并发症发生率进行比较分析。结果治疗后,观察组脑钠肽、肺动脉压力均高于对照组(均P0.01);观察组并发症发生率为6.98%,低于对照组的23.26%(P0.05)。结论 ICU肺动脉高压伴呼吸衰竭患者行气管插管机械通气治疗的临床效果肯定。     

Guillain-Barré syndrome: rehabilitation outcome and recent developments.

Guillain-Barré syndrome is the most common polyneuropathy causing major disability and respiratory failure. Respiratory complications are the main cause of death. Improved respiratory care and new treatment strategies such as plasmaphoresis and immunoglobulin have been shown to improve outcome. We studied the course and outcome of 37 patients with Guillain-Barré syndrome who were admitted to a rehabilitation and respiratory care facility over a 10-year period. There were 21 males and 16 females with a mean age of 62+/-3 years. Fourteen patients developed respiratory failure requiring endotracheal intubation and mechanical ventilation. The mean duration of mechanical ventilation was 38+/-10 days. All patients were successfully liberated from the ventilator. However, 83 percent of the patients were moderately to severely disabled at the time of discharge. Thirteen out of 37 (35 percent) developed long-term disability. None of the patients died over the period of follow-up. These results indicate that early recognition and treatment of respiratory complications in Guillain-Barré syndrome could reduce the morbidity and mortality of this condition.     

Results of ciprofloxacin therapy in urinary and respiratory tract infections

Ciprofloxacin was administered to 218 patients with various urinary and respiratory tracts infections, including 142 patients with urinary tract infections and 76 patients with respiratory tract infections. Bacteriological tests and routine laboratory tests were performed thrice (before, during and after therapy) in all patients. Ciprofloxacin was administered orally in daily dose of 500 mg for 10 days. Daily dose was increased to 1000 mg in 23 patients with severe respiratory tract infections. Satisfactory results (recovery or regression of the symptoms of exacerbated chronic disease) were achieved in 185 patients (84.9%) and no effect in 10 patients (4.6%). Significant improvement or transient improvement were noted in 23 patients (10.5%).     

Thrombolytic therapy in arterial thrombosis producing acute ischemia of the lower limbs]

Efficiency of the thrombolytic therapy in the acute arterial thrombosis (producing an acute ischemia of the lower limbs) with streptokinase has been assessed in 35 patients treated in the selected departments of vascular surgery in Poland. Complete recovery has been noted in 9 patients (25.7%) in whom limb functioning with detectable peripheral pulse have been restored. An improvement has been achieved in 12 (34.3%) patients and moderate result in 4 (11.4%) patients. The limb has been amputated in 7 (20%) patients, and 3 patients (8.6%) died. Similar results have been observed in case of ischemia of duration period below 12 hours, between 12 and 24 hours, and between 24 and 72 hours. The results have been worse when thrombolytic therapy was introduced after 72 hours.     

经鼻高流量湿化氧疗与无创正压通气在改善AECOPD患者二氧化碳潴留临床疗效的比较

目的:经鼻高流量氧疗(HFNC)已广泛应用于缺氧性呼吸衰竭患者的治疗。本研究分析了HFNC治疗对慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的治疗效果。方法:本研究前瞻性观察分析了2017年1月至2019年1月入住我院呼吸科和重症医学科,诊断为AECOPD且合并有中度II型呼吸衰竭(血气分析PaO₂/Fi O2<200 mm Hg,PaCO₂>45 mm Hg,pH7.25~7.35)的患者44例,随机平均分为两组,参照组22例患者采纳无创正压通气(NIV)技术治疗,实验组22例患者予以HFNC治疗。观察两组患者治疗效果(治疗失败改为有创通气、28天死亡率)、血气分析对比血pH、PaCO₂、PaO₂。结果:HFNC组患者(22例,平均年龄73岁,男性占63.6%)同NIV组患者(22例,平均年龄77岁,男性占54.5%)相比,血pH、PaCO₂、PaO₂等血气分析指标两组无显著统计学差异。治疗失败率分别为22.7%(5/22)和27.2%(6/22),P=0.857。28天死亡率无统计学差异(HFNC组为13.6%,NIV组为18.2%,P=0.845)。结论:在AECOPD合并Ⅱ型呼吸衰竭的患者中,HFNC在改善氧合缓解CO2潴留方面具有同NIV相似的效应,因其具有更好的舒适性和耐受性,可成为NIV的有益补充。     

经鼻面罩BiPAP正压通气治疗重症支气管哮喘合并Ⅱ型呼吸衰竭的临床观察

目的观察经鼻面罩BiPAP无创正压通气治疗重症支气管哮喘合并Ⅱ型呼吸衰竭的临床效果。方法观察患者行呼吸机治疗前,治疗后4、12、24、48h的临床症状及血气分析。结果治疗后患者的临床症状、血气分析（pH、PaCO2、PaO2）均有显著改善,且无严重并发症发生。结论 BiPAP无创正压通气有助于呼吸改善,正确有效的护理措施对保证通气治疗的效果、减少并发症具有重要意义。