[Clinical analysis of complications after non- invasive positive pressure ventilation and an inquiry into the respiratory treatment strategy in patients with SARS].

Yang, Lei; Li, Fei; Li, Duo; Jia, Jian-guo; Yang, Peng; Sun, Jia-bang

OBJECTIVE To analyze the clinical data of severe acute respiratory syndrome (SARS) patients with pneumothorax and mediastinal emphysema occurring after the non-invasive positive pressure ventilation (NIPPV), and to inquire into relevant strategy in respiratory treatment in the SARS patients. METHODS Twenty-seven serious cases of SARS undergone NIPPV were analyzed retrospectively. RESULTS Pneumothorax and mediastinal emphysema occurred in 7 of 27 serious cases of SARS with NIPPV, and mediastinal emphysema occurred in 1 of 189 cases of SARS without mechanical ventilation (MV). The incidence of pneumothorax and mediastinal emphysema in serious cases of SARS with NIPPV was significantly higher (chi2=25.052, P<0.01) than that in cases of SARS without receiving MV. The peripheral blood oxygen saturation level was not changed significantly after reasonable adjustment of ventilation pressure and increase in oxygen concentration inhaled. Seven cases of pneumothorax and mediastinal emphysema improved gradually. CONCLUSION The incidence of pneumothorax and mediastinal emphysema in serious SARS patients with NIPPV is significantly higher than that in SARS patients without receiving MV. This might be related to SARS related pulmonary injuries, intensive cough and high mechanical ventilation pressure. The pneumothorax and mediastinal emphysema improve gradually in all cases after reasonable adjustment of mechanical ventilative pressure. So when NIPPV is used in the treatment of serious SARS patients to improve hypoxemia, optimized mechanical ventilative pressure should be acquired in order to avoid pneumothorax and mediastinal emphysema.