Clinical Value Of Non-invasive Ventilation In Lateral Position In Acute Respiratory Failure

ObjectiveBy observing the change trend of arterial oxygen partial pressure（Pa O₂）,arterial carbon dioxide partial pressure（Pa CO₂）,oxygenation index（Pa O₂/Fi O₂）,pulse oxygen saturation（SPO₂）,average blood pressure（MAP）,heart rate（HR）,To study the value of lateral position non-invasive ventilation in patients with acute respiratory failure.MethodsA total of 30 patients with respiratory failure were randomly selected from December2017 to March 2019 in the emergency intensive care unit（EICU）in our hospital,including14 cases of AECOPD（46.67%）,13 cases of ACPE（43.33%）and 3 cases of CAP（10.00%）.On the basis of symptomatic support treatment,all patients were treated with non-invasive ventilation in lateral position under ST mode,followed by supine position ventilation for 1h,lateral position ventilation for 1 h and recovery of supine position ventilation for 1 h.The parameters of non-invasive ventilator remained unchanged during the whole process.The arterial blood pressure（Pa O₂）,the partial pressure of the arterial carbon dioxide（Pa CO₂）,the oxygenation index（Pa O₂/Fi O₂）were recorded by the blood gas analysis at the end of each position,and the parameters such as the pulse oxygen saturation（Sp O₂）,the mean blood pressure（MAP）,and the heart rate（HR）were recorded.Results（1）Pa O₂/Fi O₂ increased from（216.90±28.80）mm Hg to（250.61±22.80）mm Hg,after lateral position ventilation（p<0.001）,and Pa O₂/Fi O₂ decreased slightly to（248.60±31.37）mm Hg,after recovery of supine position.There was no significant difference between the two groups（p>0.05）,but it was significantly higher than that in the initial supine position（p<0.001）.（2）Pa O₂ increased from（76.30±11.79）mm Hg to（87.77±4.74）mm Hg after lateral position ventilation（p<0.001）,and Pa O₂ decreased slightly to（87.07±8.79）mm Hg,after recovery of supine position.The difference was not statistically significant（p>0.05）,but significantly increased compared with the initial supine position（p<0.001）.（3）After the initial supine position of Pa CO₂ was（49.60±3.84）mm Hg,it decreased to（45.33±3.70）mm Hg,after recovery of supine position and continued to decrease to（44.13±3.73）mm Hg,.There was significant difference in Pa CO₂ before and after the postural change（p>0.05）.（4）We considered that the increase of Pa O₂was more than 10 mm Hg as effective,and in the 30 patients in the study,there were 22 patients with lateral decubitus,the Pa O₂ elevation was more than 10 mm Hg,the effective rate was73.33%,and the Pa O₂ in 7 patients was less than 10 mm Hg,and Pa O₂ in 1 patient had a decrease.（5）Hemodynamic changes:there was no significant difference in HR and MAP after postural changes（p>0.05）.（6）In this study,2 patients felt slight pressure,one patient had red skin pressure,and two patients had mild numbness on the side of the limb.The symptoms improved quickly after the change of body position.ConclusionAccording to the results of this study,we can draw a conclusion:after lateral supine non-invasive ventilation in patients with acute respiratory failure,the indexes of Pa O₂,Pa O₂/Fi O₂ and other indexes were improved obviously,and the hemodynamic changes were not statistically significant.It is indicated that non-invasive ventilation in lateral position is safe and effective in the treatment of acute respiratory failure and can be applied in clinical practice.