Comparison of efficacy between sequential ventilation and conventional invasive mechanical ventilation in the treatment of pulmonary hypertension complicated with respiratory failure.

Am J Blood Res 2020;10(5):231-239 www.AJBlood.us /ISSN:2160-1992/AJBR0120001 Original Article Comparison of efficacy between sequential ventilation and conventional invasive mechanical ventilation in the treatment of pulmonary hypertension complicated with respiratory failure Yudan Zhu1*, Kongliang Ke1*, Zhi Dai3, Hongqin Tang2, Qiannan Xu2, Tinglin Guo1, Chongling Sang4 Departments of 1Respiratory and Critical Care Medicine, 2Intensive Care Unit, Naval Hospital of Eastern Theater of PLA, Zhoushan, Zhejiang Province, China; 3Department of Critical Care Medicine, 921 Hospital of Joint Logistics Support Force of PLA, Changsha, Hunan Province, China; 4Department of Respiratory, Air Force Hospital of Central Theater of PLA, Datong, Shanxi Province, China. *Equal contributors and co-first authors. Received August 10, 2020; Accepted September 14, 2020; Epub October 15, 2020; Published October 30, 2020 Abstract: Objective: Pulmonary hypertension (PAH) is a serious progressive and fatal pulmonary disease characterized by elevated pulmonary artery pressure. Mechanical sequential ventilation has been gradually applied in the treatment of patients with PAH complicated with RF, which can effectively reduce the incidence of VAP and better promote the recovery of respiratory function. This study is aimed to determine the efficacy of sequential ventilation and conventional invasive mechanical ventilation in the treatment of pulmonary hypertension (PAH) complicated with respiratory failure (RF). Methods: A total of 198 patients with both PAH and RF admitted to our hospital were enrolled. Among them, 102 patients were treated with sequential ventilation as a study group (stu group), and 96 patients were treated with conventional invasive mechanical ventilation as a control group (con group). Then the two groups were compared in efficacy and related indexes before and after treatment. Results: The stu group experienced significantly shorter invasive ventilation time, total mechanical ventilation time, and hospitalization time than the con group (all P<0.05), and showed a significantly lower complication rate than the con group (P<0.05). The reintubation rate, weaning failure rate, and ventilator-associated pneumonia (VAP) rate of the stu group were all significantly lower than those of the con group (all P<0.05), and the stu group showed significantly higher pondus hydrogenii (pH) and arterial partial pressure of oxygen (PaO2) and significantly lower arterial carbondioxide partial pressure (PaCO2) than the con group after treatment (all P<0.05). Additionally, after treatment, the level of brain natriuretic peptide (BNP) and pulmonary artery pressure in both groups declined significantly (P<0.05), and the decline of them in the stu group was more significant than that in the con group (P<0.05). Moreover, after treatment, endothelin (ET) and angiotensin II (Ang II) in both groups declined significantly, and the decline of them in the stu group was also more significant than that in the con group (P<0.05). Conclusion: Compared with conventional invasive mechanical ventilation, sequential ventilation can effectively minimize the treatment time of patients with PAH complicated with RF, reduce the incidences of adverse events and complications in them, and significantly improve the blood gas analysis indexes and BNP in them, so it is worthy of clinical promotion. Keywords: Sequential ventilation, conventional invasive mechanical ventilation, pulmonary hypertension, respiratory failure, brain natriuretic peptide Introduction Pulmonary hypertension (PAH) is a serious progressive and fatal pulmonary disease characterized by elevated pulmonary artery pressure [1]. It is featured by poor remodeling of small pulmonary artery, which results in increased pulmonary vascular resistance [2]. PAH may be idiopathic (IPAH) or familial, induced by drugs and toxins, and may also be related to many diseases including connective tissue disease (CTD), congenital heart disease (CHD), portal hypertension or schistosomiasis [3, 4]. The most common PAH includes IPAH (82.35%), and CTD-induced PAH (71.31%), and CHD-related PAH (60.26%) [5]. Patients with PAH usually suf- Sequential ventilation and conventional invasive mechanical ventilation on PAH fer from respiratory failure (RF), fatigue, and syncope meantime. The increase of right ventricular after load will increase the high risk of right ventricular failure and premature death [6]. Patients with PAH have impaired lung ventilation function, which will lead to hypoxia, and then give rise to RF [7]. Currently, PAH complicated with RF is mainly treated by mechanical ventilation, which establish an artificial airway for patients to control their lung infection to the maximum extent and relieve respiratory muscle fatigue, thus effectively improving their respiratory and pulmonary functions [8]. Conventional invasive mechanical ventilation can quickly restore the smooth of respiratory duct in patients with PAH complicated with RF, reduce the retention of CO2 in the lungs, and thus effectively alleviate clinical symptoms [9]. However, it is traumatic to patients, and it is difficult to tolerate due to long ventilation time, which easily brings about complications such as ventilator-associated pneumonia (VAP) and airway injury, resulting in unsatisfactory clinical efficacy [10]. As science and technology advance, mechanical sequential ventilation has been gradually applied in the treatment of patients with PAH complicated with RF, which can effectively reduce the incidence of VAP and better promote the recovery of respiratory function [11]. This study mainly determined the changes of BNP and pulmonary artery pressure of patients in two groups treated with different mechanical ventilation therapies to determine the efficacy of sequential ventilation and conventional invasive mechanical ventilation in treating PAH complicated with RF, with the goal of providing a theoretical basis for clinical treatment of PAH complicated with RF. Materials and methods General data A total of 198 patients with both PAH and RF admitted to our hospital were enrolled. Among them, 102 patients were treated with sequential ventilation as a study group (stu group), and 96 patients were treated with conventional invasive mechanical ventilation as a control group (con group). The stu group consisted of 68 males and 34 females, with an average age of (52.89±6.43) years, while the con group con- 232 sisted of 62 males and 34 females, with an average age of (53.02±6.57) years. The inclusion criteria of the study: Patients accompanied by family members at admission, patients with detailed clinicopathologic data, patients meeting the diagnostic criteria for PAH issued on the World Symposium on Pulmonary Hypertension [12], patients diagnosed as RF according to related examination of blood gas analysis (arterial partial pressure of oxygen (PaO2≤60 mmHg) and arterial carbondioxide partial pressur (...truncated)