Search

Objective: To assess the efficacy and safety of high-flow nasal cannula oxygen therapy in treating moderate hypercapnic respiratory failure in patients who cannot tolerate or have contraindications to noninvasive mechanical ventilation. Methods: A prospective observational 13-month study involving subjects admitted to an intensive care unit with or developing moderate hypercapnic respiratory failure. Clinical and gas exchange parameters were recorded at regular intervals during the first 24 hours. The endpoints were a oxygen saturation between 88 and 92% along with a reduction in breathing effort (respiratory rate) and pH normalization (= 7.35). Subjects were considered nonresponders if they required ventilatory support. Results: Thirty subjects were treated with high-flow nasal cannula oxygen therapy. They consisted of a mixed population with chronic obstructive pulmonary disease exacerbation, acute cardiogenic pulmonary edema, and postoperative and postextubation respiratory failure. A nonsignificant improvement was observed in respiratory rate (28.0 ± 0.9 versus 24.3 ± 1.5, p = 0.22), which was apparent in the first four hours of treatment. The pH improved, although normal levels were only reached after 24 hours on highflow nasal cannula therapy (7.28 ± 0.02 versus 7.37 ± 0.01, p = 0.02). The rate of nonresponders was 13.3% (4 subjects), of whom one needed and accepted noninvasive mechanical ventilation and three required intubation. Intensive care unit mortality was 3.3% (1 subject), and a patient died after discharge to the ward (hospital mortality of 6.6%). Conclusion: High-flow nasal cannula oxygen therapy is effective for moderate hypercapnic respiratory failure as it helps normalize clinical and gas exchange levels with an acceptable rate of nonresponders who require ventilatory support. [ABSTRACT FROM AUTHOR]

Objective To compare the effects of noninvasive ventilation combined with different timing for giving the oxygen atomizing inhalation in the treatment of the patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicating type II respiratory failure. Methods Totally 60 patients with AECOPD complicating type Ⅱ respiratory failure admitted to the respiration department of the Second Affiliated Hospital of Chongqing Medical University from January to December 2015 were randomly divided into the observation group and control group,30 cases in each group. The observation group was given the oxygen atomizing inhalation combined with noninvasive ventilation at the same time,while the control group was given oxygen atomizing inhalation in the interval of noninvasive ventilation. The clinical efficacy and improvement of relevant indicators were observed in two groups. Results The total effective rate,p H value,arterial oxygen partial pressure,arterial carbon dioxide partial pressure,heart rate,respiratory rate,forced expiratory volume in one second(FEV1) and 6 min walking test in the observation group were 93.3%(28/30),7.40 ±0.06,(82.93 ±12.36)mm Hg,(62.00 ±6.92)mm Hg,(92.50 ±5.40)beats/min,(16.00±3.00)times/min,(3.20±0.50)V/L and(260.00±30.00)m,which were significantly better than 56.7%(17/30),7.38±0.14,(79.75±12.76)mm Hg,(65.03±8.90)mm Hg,(95.60±7.70)beats/min,(20.00±4.00)times/min,(2.90±0.50)V/L and(240.00±25.00)min the control group,the differences were statistically significant(P0.05). Conclusion Noninvasive ventilation combine with drug atomizing inhalation has a significant effect for treating AECOPD complicating type Ⅱ respiratory failure. [ABSTRACT FROM AUTHOR]

We describe the initial--and successful--use of the TandemHeart System's catheters to provide extracorporeal membrane oxygenation (ECMO), in 2 patients. In 1 patient, who was experiencing severe primary respiratory failure, the catheters provided a standard venovenous ECMO circuit. In the other patient, who had severe, acute pulmonary hypertension and right-heart failure, the catheters enabled a novel right atrial-to-left atrial circuit for ECMO. We discuss the potential of the TandemHeart System's catheters to provide novel and possibly superior vascular routes for the delivery of ECMO in different types of cardiopulmonary failure. [ABSTRACT FROM AUTHOR]

Herein, we describe the case of a 60-year-old man with severe nonischemic cardiomyopathy and hypervolemia. By means of venoarterial extracorporeal membrane oxygenation at the bedside, along with hemoconcentration, the patient was resuscitated from severe cardiogenic shock and normal blood volume was restored. Within 24 hours, he was able to undergo a high-risk aortic valve replacement for severe aortic stenosis, with a successful outcome. To our knowledge, this is the first reported case in which hemoconcentration with extracorporeal membrane oxygenation has been used to support a patient with severe hypervolemia. [ABSTRACT FROM AUTHOR]