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  Česky / Czech version Anest. intenziv. Med., 16, 2005, č. 4, s. 284–290.
 
A comparison of the effectiveness of continuous positive airway pressure and high-frequency jet ventilation applied by naso-oral mask in patients treated for pulmonary oedema 
Čandík P., Drbjáková E., Lakatoš I., Toya P., Šalantay J., Čičatko P. 

Oddelenie anestéziológie a intenzívnej medicíny NsP Vranov nad Topľou, Slovenská republika
 


Summary:

       Objective: Comparison of continuous positive airway pressure (CPAP) and high-frequency jet ventilation applied by naso-oral mask (HFJV-M) in patients treated for cardiogenic pulmonary oedema (PO). Design: Retrospective study. Setting:Department of Anaesthesia and Intensive Care Medicine. Material and Methods: A group of 196 patients admitted for PO were stratified to 3 subgroups in accordance with the seriousness of the PO. The decrease in spontaneous respiratory rate, oxygenation, length of ventilatory sup- port and length of stay in the ICU were used as indicators of treatment effectiveness (CPAP in 64 patients and HFJV-M in 132 patients) while pharmacotherapy, mean airway pressure and FiO2 values remained very similar. The results were analysed using Student’s T-test. Results: There were no statistically significant differences in the studied parameters between CPAP and HFJV-M in the subgroup with mild PO (subgroup 1). In the subgroups with more severe PO (subgroups 2 and 3) there were statistically significant differences in the decrease of spontaneous respiratory rate from 25-33 bpm to 18-22 bpm (P < 0.01) in the first 3 hours of ventilatory support in favour of patients ventilated by HFJV-M. Similarly, there was a statistically significant difference in the rate of improvement of PaO2, pH and PaO2/FiO2 index (P < 0.01) main- ly during the first 2 hours of therapy again in favour of HFJV-M. There was no significant difference in the change of PaCO2 between the two treatments. The length of required ventilatory support was 10.9 vs. 6.8 hours (CPAP vs. HFJV-M). The average length of stay in the ICU was 2.7 vs. 2.0 days, which is statistically significant (P < 0.01 vs. P < 0.05). Only 8.2% of patients participating in the study ultimately required tracheal intubation and conventi- onal mechanical ventilation. Conclusion: HFJV-M is more effective than CPAP during the first 2-5 hours of therapy. The application of HFJV-M significantly shortens the length of required ventilatory support and the length of stay in the ICU. The overall inci- dence of tracheal intubation was low at 8.2 %.

        Key words: Non-invasive ventilation – CPAP – HFJV-M – pulmonary oedema
       

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