Objective To investigate the influence of two different mechanical ventilation modes of bi-level positive airway pressure ventilation(BIPAP)and synchronized intermittent ventilation (SIMV)on the respiratory function and clinical curative effect in children patients with severe hand foot and mouth disease(HFMD)complicating neurogenic pulmonary edema.Methods Thirty children patients with severe HFMD complicating neurogenic pulmonary edema receiving mechanical ventilation were divided into the SIMV group (control group)and BIPAP group (experimental group).The lung protective ventilation strategy was applied in both groups.After 30 min use of SIMV and positive end expiratory pressure (PEEP)ventilation,the experimental group changed to use the BIPAP ventilation mode,while the control group still used the initial parameters.The airway peak pressure,alveolar plat-form (Pplat)pressure,lung compliance,pH value,arterial blood CO2 partial pressure (PaCO2 )and oxygenation index (PaO2/FiO2 )at 0 h (baseline value),24,48,72 h after mechanical ventilation were monitored.Besides,the duration of mechanical ventila-tion,28 d mortality rate and the length of ICU stay were observed.Results Thirty children patients smoothly spent their acute re-spiratory failure period.One case in each group during the later period of treatment was transferred to the other hospital for contin-uous therapy.Among them the transferred case in the control group finally died due to give up treatment.The rest 28 cases all were cured and discharged from hospital.The 28 d mortality rates in the two groups were 6.67% and 0% respectively,with no statistical difference (P >0.05).Compared with the control group,the airway peak pressure,Pplat and PaCO2 after mechanical ventilation for 24,48,72 h in the experimental group were significantly decreased(P <0.05);the lung compliance and PaO2/ FiO2 improvement was significantly higher than that in the control group(P <0.05);meanwhile the duration of mechanical ventilation and the length of ICU stay in the experimental group were shorter than those in the control group (P <0.05).Conclusion The BIPAP mode used in the mechanical ventilation therapy of the children patients with severe HFMD complicating neurogenic pulmonary edema can pro-vide better effective ventilation,improve oxygenation and respiratory function,and shorten the duration of mechanical ventilation.

Objective To explore the effect of different method in preventing broncho-pulmonary dysplasia(BPD) in very low birth weight infants(VLBWI) during mechanical ventilation.Methods The gestational age of 71 infants with VLBWI was (30?2) weeks and the average weight was (1235.2?160.6)g.The infants were randomly divided into three groups,they received different therapeutic regimens during mechanical ventilation:32 cases were treated with permissive hypercapnia(PHC) ventilation in group Ⅰ;20 cases were treated by intratracheal instillation of pulmonary surfactant(PS) in group Ⅱ;19 cases were treated by inhalation of becotide(beclomethasone dipropionate,BDP) in group Ⅲ.The ventilator settings,blood gas analysis,clinical symptoms and therapeutic effect were statistically analyzed and compared.Results The peak inspiratory pressure(PIP) and ventilation rate(VR) of ventilator parameter were (18.3?1.6)cmH_2O and (35?5)bpm in group Ⅰ,there was significantly lower than that in group Ⅱ and group Ⅲ(P0.05).The incidence of BPD was 16%(5/32) in group Ⅰ,5%(1/20) in group Ⅱ and 5%(1/19) in group Ⅲ;The mortality rate of PHC group(group Ⅰ) was 6%(2/32) and 5%(1/20) in group Ⅱ.Conclusion The application of permissive hypercapnia,intracheal instillation of pumlonary surfactant and inhalation of becotide all can prevent effectively the occurrence of severe broncho-pulmonary dysplasia in VLBWI during mechanical ventilation.