Establishment of noninvasive artificial ventilation in patients with sever lung edema

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1. Positive pressure ventilation (Nasal continuous positive airway pressure)(Study 1) Thirty patients with respiratory failure due to severe cardiogenic puylmonary edema were assigned to two groups : received oxygen plus nasal CPAP (CPAP group), and received only oxygen by face mask (oxygen group). The heart rate and the mean pulmonary artery pressure decreased significantly in the CPAP group. The PaO2/FiO2 ratio increased in the CPAP group (163±70 to 332±104, p<0.01) after 6 hr. There was a significant correlation between the arterial plasma ET-1 concentrations and mean pulmonary artery pressure, and Pao2/FIo2.(Study 2) Tenty-two consecutive patients were assigned at random to either of the following two groups : received oxygen plus CPAP delivered by a nasal mask (CPAP group), and received only oxygen through face mask (oxygen group). Two patients (18%) in the CPAP group and 8 patients (73%) in the oxygen group required mechanical ventilation with endotracheal intubation (p=0.03). Th … More e hospital mortality rate in the CPAP group (9%) was significantly lower than the oxygen group (64%, p=0.02). The pulmonary artery wedge pressure, mean pulmonary artery pressure, and heart rate significantly decreased in the CPAP. The PaO2/FiO2 ratio significantly increased in the intubation group. Arterial plasma endothelin-1 concentrations decreased significantly earlier in the CPAP group than in the oxygen group (p<0.05). Nasal CPAP lead to an early improvement in oxygenation and hemodynamics, and decreased the mortality rate. Early and active respiratory management is recommended in patients with pulmonary edema.2. Negative pressure ventilation (External high-frequency oscillation)(Study 1) Seven patients with postoperative hypercapnia following upper abdominal surgery were ventilated with EHFO. PaCO2 significantly decreased. PaO2 significantly increased. The FEV1 and FVC significantly increased. EHFO is an effective method of gas exchange which is associated with earlier return to preoperative lung function.(Study 2) Twelve patients were ventilated with EHFO combined with PSV. Significant increases were noted in cardiac index and stroke volume index without changes in pulmonary artery wedge pressure. PaO2/FiO2 and PaCO2. Breath sounds could be hard well throughout the lung fields after institution of EHFO. As a method of ventilation for patients with acute respiratory failure, EHFO combined with PSV may have potential advantages over conventional mechanical ventilation when drainage of secretions is facilitated. Beneficial effects of EHFO may appear after several hours. Less