The efficacy comparison of three weaning modes in the treatment of COPD with respiratory failure using invasive mechanical ventilation

Objective To compare the clinical therapeutic effect of three weaning modes[Glasgow coma scale( GCS),pulmonary infection control window,spontaneous breathing trial( SBT) ]in the treatment of chronic obstructive pulmonary disease( COPD) with respiratory failure using invasive mechanical ventilation. Methods A total of 120 COPD patients with respiratory failure were randomly divided into 3 groups according to weaning mode( n =40 each) : GCS group,pulmonary infection control window( PIC) group and SBT group. Invasive mechanical ventilation with synchronous intermittent mandatory ventilation( SIMV) plus pressure support ventilation( PSV)mode was given to all the patients. Extubating endotracheal tube and changing to non-invasive mechanical ventilation mode were carried out until weaning when reaching respectively undermentioned standards: reaching 15 points of GCS score,appearing of window period and being kept for 2 hours in GCS group; achieving pulmonary infection control window( pulmonary infection was obviously controlled) in PIC group; after SBT succeeded in SBT group.The ventilation and oxygenation indexes before ventilating,the time of received invasive mechanical ventilation,total mechanical ventilation time,total hospital stay time,re-intubation rate and the incidence of ventilator-associated pneumonia( VAP) were dynamically observed in three groups. Results The invasive ventilation time,the total mechanical ventilation time and the total hospital stay time in GCS group were all shorter than those in the other two groups( all P 0. 05). The invasive ventilation time,the total mechanical ventilation time and the total hospital stay time in PIC group were all shorter than those in SBT group( all P 0. 05). The incidences of VAP in GCS group and PIC group were all lower than that in SBT group( all P 0. 05),but there was no significant difference in the two groups( P 0. 05). There were no significant differences in the re-intubation rate and mortality rate among three groups( all P 0. 05). Conclusions The GCS weaning mode in the treatment of COPD patients with respiratory failure using invasive mechanical ventilation can decrease invasive ventilation time,total mechanical ventilation time,and hospital stay time and can reduce incidence of VAP,as well as improve the therapeutic effect.