[Randomized control study of sequential non-invasive following short-term invasive mechanical ventilation in the treatment of acute respiratory distress syndrome as a result of existing pulmonary diseases in elderly patients].

OBJECTIVE: To evaluate the feasibility and the efficacy of sequential non-invasive mechanical ventilation (MV) following short-term invasive MV in the treatment of acute respiratory distress syndrome (ARDS) consequent to pulmonary diseases in the elderly patients.

METHODS: Thirty-two elderly patients of ARDS were enrolled and grouped into two groups (sequential therapy group and control group) randomly (16 cases in each group). Both groups with tracheal intubation received the following ventilation modality in the first 24 hours: control/assistant-control+positive end expiratory pressure (PEEP)+sustained inflation (SI), and when the patients' conditions were relieved, the ventilation modality was switched to synchronized intermittent mandatory ventilation (SIMV)+pressure support ventilation (PSV)+PEEP. When "ARDS-controlled window" appeared, the ventilation mobility was switched to oronasal face continuous positive airway pressure (CPAP), followed by CPAP until weaning; the control group was weaned with SIMV+PSV+PEEP. The parameters including ventilation and oxygenation, ventilation duration, ventilation-associated pneumonia (VAP), duration of respiratory intensive care unit (RICU) stay were serially determined.

RESULTS: Both groups had the similar baseline clinical characteristics (all P>0.05). The patients in the sequential therapy group showed shorter MV duration [(4.6+/-1.0) days], total duration of ventilation support [(12.7+/-4.0) days] and RICU stay duration [(16+/-7) days], and lower VAP incidence rate [6.25% (1/16)] and mortality rate [25.00% (4/16)] compared with control subjects [(21.9+/-9.0) days, (21.9+/-9.0) days, (29+/-13) days, 75.00% (12/16), 56.25% (9/16), respectively, P<0.05 or P<0.01].

CONCLUSION: Early extubation followed by non-invasive ventilation might decrease the total duration of ventilation support, the risks of VAP and duration of RICU stay.