Non invasive CPAP ventilation in a dog with cardiogenic pulmonary oedema.
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Acute pulmonary edema
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目的 探讨重症急性心源性肺水肿的早期有创机械通气的疗效.方法25例重症急性心源性肺水肿患者进行早期有创机械通气,记录血氧的改善,心率、呼吸频率的变化及不良反应的发生率.结果在通气后半小时低氧血症已明显改善,心率明显下降.在机械通气期间无一例死亡,所有病例均能在短时间内成功脱机,严重的心律失常、气压伤、呼吸机相关性肺炎发生率低.结论对重症急性心源性肺水肿的患者,早期应用有创机械通气治疗是一种更为积极主动的治疗手段,能显著降低心室纤颤、心跳骤停、窒息等严重并发症的发生率。
Acute pulmonary edema
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Pulmonary oedema
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Positive airway pressure
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Acute cardiogenic pulmonary edema is a common cause of acute respiratory failure; however, with appropriate management few patients require intubation and mechanical ventilation. The explosive onset of dyspnea with typical clinical and radiographic findings differentiates patients with cardiogenic pulmonary edema from those with chronic congestive heart failure who present with slowly increasing dyspnea, fatigue, and peripheral edema. The predominant pathophysiologic problem is diastolic heart failure, and although many patients have coexistent systolic heart failure, this problem rarely dominates the clinical presentation. Management must concurrently aim to decrease left ventricular diastolic pressure (primarily by decreasing central blood volume), promote coronary blood flow, and correct the acute respiratory failure. The action of nitroglycerin (initially sublingually and then by intravenous infusion) combines venodilatation, reduction of left ventricular afterload, and correction of myocardial ischemia. Although parenteral furosemide is almost universally administered, both as a venodilator and a potent diuretic, it may acutely raise the pulmonary artery occlusion pressure and lower cardiac output in patients with chronic congestive heart failure. Mask continuous positive airway pressure has been shown to dramatically reduce the need for intubation and mechanical ventilation in patients with severe acute respiratory failure; this technique is well tolerated and is usually required for less than 10 hours. Beneficial effects as compared with oxygen therapy include quicker correction of hypoxemia and reduction in respiratory work, left ventricular preload, and left ventricular afterload. In patients for whom systolic dysfunction is the dominant feature, mechanical ventilation, positive inotropic agents, and left ventricular assist devices may be needed.
Afterload
Preload
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Acute pulmonary edema
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Objective :To summarize the clinical efficacy of patients with severe acute cardiogenic pulmonary edema treated by mechanical ventilation. Methods :The clinical data of 40 patients with severe acute cardiogenic pulmonary edema treated by mechanical ventilation were retrospectively analyzed from Jan 2010 to Dec 2014. Results :The condition improved rate of the patients was 87.5%(35 / 40), with an average recovery time of(7.5 ±0.9) h. 4cases died, the cause of death were all a large area of myocardial infarction complicated with cardiogenic shock. The p H,Pa O2,Sa O2 of patients were significantly increased after treatment(P 0.05). While PaCO2, heart rate, respiratory rate, systolic pressure, diastolic pressure were decreased significantly,all P 0.05. Conclusion :Mechanical ventilation contributes to the improvement of hypoxia symptoms of patients with severe acute cardiogenic pulmonary edema and improve their cardiac function.
Pulmonary wedge pressure
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