Clinical application of incremental PEEP under pressure control in initial invasive mechanical ventilation of patients with AECOPD combined with respiratory failure

Abstract

Objective \nTo investigate the clinical application of incremental positive end expiratory pressure (PEEP) under pressure control in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)combined with respiratory failure in initial invasive mechanical ventilation. \n \n \nMethods \nSeventy-eight AECOPD patients who were given invasive mechanical ventilation in Binzhou Central Hospital from March 2015 to February 2017 were selected as research objects. And they were divided into control group (40 cases) and observation group (38 cases) by random number table method. The exogenous PEEP (PEEPe) of control group was set to 0.8 endogenous PEEP (0.8 PEEPi), while the parameters of observation group were set up to 0, 2 cmH2O (1 cmH2O=0.098 kPa), 3 cmH2O, and 0.8 PEEPi at 0, 1, 2 and 3 hours after invasive mechanical ventilation, respectively. The airway peak pressure (Ppeak), mean airway pressure (Pmean), exhaled tidal volume (Vte), arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), pulse oxygen saturation (SpO2) and upper machine efficiency were compared between the two groups 1, 2, and 3 hours after invasive mechanical ventilation. \n \n \nResults \nAt 1 hour and 2 hours after ventilation, the Ppeak and Pmean in observation group were significantly lower than those in control group, and the Vte was significantly higher than that in control group (P 0.05). At 3 hours after ventilation, Ppeak, Pmean and PaCO2 were significantly lower than those in control group, however, Vte, PaO2 and SpO2 were significantly higher than those in control group (P<0.05). The independent sample chi-square test showed that the effective rate in observation group was 86.8% (33/38), and it was 65.0%(26/40) in control group, and the difference was statistically significant (P=0.025). \n \n \nConclusions \nThe incremental PEEP is suitable for AECOPD patients with initial mechanical ventilation. Sometimes, the PEEP should be set up to 0 in initial mechanical ventilation of AECOPD patients. \n \n \nKey words: \nChronic obstructive pulmonary disease;\xa0Positive end expiratory pressure, incremental;\xa0Invasive mechanical ventilation