Driving pressure in mechanical ventilation:A review

Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.

Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed rapidly in the field of critical care in recent years.Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator.Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into a successful ventilation group(68 cases)and a failed ventilation group(26 cases)according to the outcome of ventilation.The clinical data of patients with successful and failed noninvasive ventilation were compared,and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.RESULTS There were no significant differences in gender,age,body mass index,complications,systolic pressure,heart rate,mean arterial pressure,respiratory rate,oxygen saturation,partial pressure of oxygen,oxygenation index,or time of inspiration between patients with successful and failed mechanical ventilation(P>0.05).The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide(PaCO_(2))than those with failed treatment,while potential of hydrogen(pH),diaphragm thickening fraction(DTF),diaphragm activity,and diaphragm movement time were significantly higher than those with failed treatment(P<0.05).pH[odds ratio(OR)=0.005,P<0.05],PaCO_(2)(OR=0.430,P<0.05),and DTF(OR=0.570,P<0.05)were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.

Brain protective effect of dexmedetomidine vs propofol for sedation during prolonged mechanical ventilation in non-brain injured patients

BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical ventilation.AIM To compare the neuroprotective effects of dexmedetomidine and propofol for sedation during prolonged mechanical ventilation in patients without brain injury.METHODS Patients who underwent mechanical ventilation for>72 h were randomly assigned to receive sedation with dexmedetomidine or propofol.The Richmond Agitation and Sedation Scale(RASS)was used to evaluate sedation effects,with a target range of-3 to 0.The primary outcomes were serum levels of S100-βand neuron-specific enolase(NSE)every 24 h.The secondary outcomes were remifentanil dosage,the proportion of patients requiring rescue sedation,and the time and frequency of RASS scores within the target range.RESULTS A total of 52 and 63 patients were allocated to the dexmedetomidine group and propofol group,respectively.Baseline data were comparable between groups.No significant differences were identified between groups within the median duration of study drug infusion[52.0(IQR:36.0-73.5)h vs 53.0(IQR:37.0-72.0)h,P=0.958],the median dose of remifentanil[4.5(IQR:4.0-5.0)μg/kg/h vs 4.6(IQR:4.0-5.0)μg/kg/h,P=0.395],the median percentage of time in the target RASS range without rescue sedation[85.6%(IQR:65.8%-96.6%)vs 86.7%(IQR:72.3%-95.3),P=0.592],and the median frequency within the target RASS range without rescue sedation[72.2%(60.8%-91.7%)vs 73.3%(60.0%-100.0%),P=0.880].The proportion of patients in the dexmedetomidine group who required rescue sedation was higher than in the propofol group with statistical significance(69.2%vs 50.8%,P=0.045).Serum S100-βand NSE levels in the propofol group were higher than in the dexmedetomidine group with statistical significance during the first six and five days of mechanical ventilation,respectively(all P<0.05).CONCLUSION Dexmedetomidine demonstrated stronger protective effects on the brain compared to propofol for long-term mechanical ventilation in patients without brain injury.

Clinical prediction scores predicting weaning failure from invasive mechanical ventilation:Role and limitations

Invasive mechanical ventilation(IMV)has become integral to modern-day critical care.Even though critically ill patients frequently require IMV support,weaning from IMV remains an arduous task,with the reported weaning failure(WF)rates being as high as 50%.Optimizing the timing for weaning may aid in reducing time spent on the ventilator,associated adverse effects,patient discomfort,and medical care costs.Since weaning is a complex process and WF is often multifactorial,several weaning scores have been developed to predict WF and aid decision-making.These scores are based on the patient's physiological and ventilatory parameters,but each has limitations.This review highlights the current role and limitations of the various clinical prediction scores available to predict WF.

Impact of Sedation Protocols on Elderly Patients Undergoing Mechanical Ventilation and Off-Line Weaning

The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.

Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stagesⅢb-Ⅴchronic kidney disease?

BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and COVID-19.METHODS We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-ⅤCKD.The primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no MV.Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables.Cutoffs for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/L.RESULTS 290 were screened,and 118 met the inclusion criteria.CRP,D-dimer,and ferritin were significantly different among the three groups.On univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P<0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD patients.The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-ⅤCKD.This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

Effects of ultrasound monitoring of gastric residual volume on feeding complications,caloric intake and prognosis of patients with severe mechanical ventilation

BACKGROUND Monitoring of gastric residual is an important approach for assessing gastric emptying in patients with mechanical ventilation.By monitoring gastric contents,the enteral nutrition scheme can be adjusted in time to ensure feeding safety.AIM To investigate the effects of ultrasound monitoring on the incidence of feeding complications,daily caloric intake and prognosis of patients with severe mechanical ventilation.To analyze the clinical significance of ultrasound monitoring of gastric residual volume(GRV)up to 250 mL to provide a theoretical basis for clinical practice.METHODS Patients admitted to the department of emergency medicine of the Affiliated Hospital of Nantong University from January 2018 to June 2022 who received invasive mechanical ventilation and continuous enteral nutrition support within 24-48 h after admission were enrolled in this study.Medical records for patients within 7 d of hospitalization were retrospectively analyzed to compare the incidence of feeding complications,daily caloric intake and clinical prognosis between patients with gastric residual≥250 mL and<250 mL,as monitored by ultrasound on the third day.RESULTS A total of 513 patients were enrolled in this study.Incidences of abdominal distension,diarrhea,and vomiting in the<250 mL and≥250 mL groups were:18.4%vs 21.0%,23.9%vs 32.3%and 4.0%vs 6.5%,respectively;mortality rates were 20.8%vs 22.65%;mechanical ventilation durations were 18.30 d vs 17.56 d while lengths of stay in the intensive care units(ICU)were 19.87 d vs 19.19±5.19 d.Differences in the above factors between groups were not significant.Gastric residual≥250 mL was not an independent risk factor for death and prolonged ICU stay.However,target feeding time of patients in the≥250 mL group was longer than that of patients in the≥250 mL group,and caloric intake(22.0,23.6,24.8,25.3 kcal/kg/d)for patients in the≥250 mL group from the 4^(th) day to the 7^(th) day of hospitalization was lower than that of patients in the≥250 mL group(23.2,24.8,25.7,25.8 kcal/kg/d).On the 4^(th) day(Z=4.324,P=0.013),on the 5^(th) day(Z=3.376,P=0.033),while on the 6^(th) day(Z=3.098,P=0.04),the differences were statistically significant.CONCLUSION The use of ultrasound to monitor GRV and undertaking clinical interventions when the monitoring value is≥250 mL has no significant effects on incidences of feeding complications and clinical prognostic outcomes,however,it significantly prolongs the time to reach target feeding,reduces the daily intake of calories during ICU hospitalization,and increases the risk of insufficient nutrition of patients.The accuracy and necessity of monitoring gastric remnants and monitoring frequencies should be investigated further.

Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation

BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.

Effects of early rehabilitation therapy on patients with mechanical ventilation

BACKGROUND: For patients in intensive care unit(ICU), mechanical ventilation is an effective treatment to survive from acute illness and improve survival rates. However, long periods of bed rest and restricted physical activity can result in side effects. This study aimed to investigate the feasibility of early rehabilitation therapy in patients with mechanical ventilation.METHODS: A randomized controlled trial was carried out. Sixty patients, with tracheal intubation or tracheostomy more than 48 hours and less than 72 hours, were admitted to the ICU of the Affiliated Hospital of Medical College, Qingdao University, from May 2010 to May 2012. These patients were randomly divided into a rehabilitation group and a control group. In the rehabilitation group, rehabilitation therapy was performed twice daily, and the training time and intensity were adjusted according to the condition of the patients. Early rehabilitation therapy included heading up actively, transferring from the supine position to sitting position, sitting at the edge of the bed, sitting in chair, transferring from sitting to standing, and ambulating bedside. The patient's body mass index, days to first out of bed, duration of mechanical ventilation, length of ICU stay, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality of patients were all compared between the rehabilitation group and the control group. The differences between the two groups were compared using Student's t test.RESULTS: There was no significant difference in body mass index, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality between the rehabilitation group and the control group(P>0.05). Patients in the rehabilitation group had shorter days to first out of bed(3.8±1.2 d vs. 7.3±2.8 d; P=0.00), duration of mechanical ventilation(5.6±2.1 d vs. 12.7±4.1 d; P=0.005) and length of ICU stay(12.7±4.1 d vs. 15.2±4.5 d; P=0.01) compared with the control group.CONCLUSION: Early rehabilitation therapy was feasible and effective in improving the outcomes of patients with mechanical ventilation.

Intensivists’response to hyperoxemia in mechanical ventilation patients:The status quo and related factors

BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in intensive care unit(ICU)patients.METHODS:We retrospectively screened the medical records of adult patients(age≥18 years)who required mechanical ventilation(MV)≥24 hours from January 1,2018,to December 31,2018.All arterial blood gas(ABG)tested during MV was retrieved,and MV settings were recorded.The median arterial partial pressure of oxygen(PaO2)>120 mmHg(1 mmHg=0.133 kPa)was defined as mild to moderate hyperoxemia,and PaO2>300 mmHg as extreme hyperoxemia.Intensivists’response to hyperoxemia was assessed based on the reduction of fraction of inspired oxygen(FiO2)within one hour after hyperoxemia was recorded.Multivariable logistic regression analysis was performed to determine the independent factors associated with the intensivists’response to hyperoxemia.RESULTS:A total of 592 patients were fi nally analyzed.The median Acute Physiology and Chronic Health Evaluation II(APACHE II)score was 21(15-26).The PaO2,arterial oxygen saturation(SaO2),FiO2,and positive end expiratory pressure(PEEP)were 96.4(74.0-126.0)mmHg,97.8%(95.2%-99.1%),0.4(0.4-0.5),and 5(3-6)cmH2O,respectively.Totally 174(29.39%)patients had PaO2>120 mmHg,and 19(3.21%)patients had extreme hyperoxemia at PaO2>300 mmHg.In cases of mild to moderate hyperoxemia with FiO2≤0.4,only 13(2.20%)patients had a decrease in FiO2 within one hour.The multivariable logistic regression analysis showed that a positive response was independently associated with FiO2(odds ratio[OR]1.09,95%confi dence interval[CI]1.06-1.12,P<0.001),PaO2(OR 1.01,95%CI 1.00-1.01,P=0.002),and working shifts(OR 5.09,95%CI 1.87-13.80,P=0.001).CONCLUSIONS:Hyperoxemia occurs frequently and is neglected in most cases,particularly when mild to moderate hyperoxemia,hyperoxemia with lower FiO2,hyperoxemia during night and middle-night shifts,or FiO2 less likely to be decreased.Patients may be at a risk of oxygen toxicity because of the liberal oxygen strategy.Therefore,further research is needed to improve oxygen management for patients with MV in the ICUs.

Evaluation of progressive early rehabilitation training mode in intensive care unit patients with mechanical ventilation

BACKGROUND Mechanical ventilation is a common resuscitation method in the intensive care unit(ICU).Unfortunately,this treatment process prolongs the ICU stay of patients with an increased incidence of delirium,which ultimately affects the prognosis.AIM To evaluate the effect of progressive early rehabilitation training on treatment and prognosis of patients with mechanical ventilation in ICU.METHODS The convenience sampling method selected 190 patients with mechanical ventilation admitted to the Fourth Hospital of Hebei Medical University from March 2020 to March 2021.According to the random number table method,they were divided into the control and intervention groups.The control group received routine nursing and rehabilitation measures,whereas the intervention group received progressive early rehabilitation training.In addition,the incidence and duration of delirium were compared for the two groups along with mechanical ventilation time,ICU hospitalization time,functional independence measure(FIM)score,Barthel index,and the incidence of complications(deep venous thrombosis,pressure sores,and acquired muscle weakness).RESULTS In the intervention group,the incidence of delirium was significantly lower than in the control group(28%vs 52%,P<0.001).In the intervention group,the duration of delirium,mechanical ventilation time,and ICU stay were shorter than in the control group(P<0.001).The FIM and Barthel index scores were significantly higher in the intervention group than the control group(P<0.001).The total incidence of complications in the intervention group was 3.15%,which was lower than 17.89%in the control group(P<0.001).CONCLUSION Progressive early rehabilitation training reduced the incidence of delirium and complications in ICU patients with mechanical ventilation,which improved prognosis and quality of life.

Unsteady temperature field of surrounding rock mass in high geothermal roadway during mechanical ventilation

To explore the spatial-temporal evolution law of rock mass temperature in high geothermal roadway during mechar^ical ventilation, a series of experiments were conducted based on the physical simulation test system of thermal and humid environment in high geothermal roadway, which is a method independently developed by China University of Mining and Technology. The results indicate that during ventilation, the disturbed region of the temperature extends gradually from shallow area to deep area in the surrounding rock mass of the roadway. Meanwhile, the temperature increases as the exponential function from shallow area to deep, with steady decrease of the temperature gradient and heat flux. As the ventilation proceeds, the relationship between dimensionless temperature and dimensionless time approximately meets Hill function.

Effect of glucocorticoid on MIP-1α and NF-кb expressing in the lung of rats undergoing mechanical ventilation with a high tidal volume

BACKGROUND： Ventilator induced lung injury （VILI） is a serious complication in the treatment of mechanical ventilating patients, and it is also the main cause that results in exacerbation or death of patients. In this study, we produced VILI models by using glucocorticoid in rats with high tidal volume mechanical ventilation, and observed the content of macrophage inflammatory protein-1α （MIP-1α） in plasma and bronchoalveolar lavage fluid （BALF） and the expression of MIP-1α mRNA and nuclear factor-kappa B （NF-кB） p65 mRNA in the lung so as to explore the role of glucocorticoid in mechanical ventilation.METHODS： Thirty-two healthy Wistar rats were randomly divided into a control group, a ventilator induced lung injury （VILI） group, a dexamethasone （DEX） group and a budesonide （BUD） group. The content of MIP-1a in plasma and BALF was measured with ELISA and the level of MIP-1α mRNA and NF-кBp65 mRNA expressing in the lung of rats were detected by RT-PCR. The data were expressed as mean±SD and were compared between the groups.RESULTS： The content of MIP-1α in plasma and BALF and the level of MIP-1α mRNA and NF-кBp65 mRNA in the lung in the DEX and BUD groups were signifi cantly lower than those in the VILI group （P〈0.001）. Although the content of MIP-1α in plasma and BALF and the level of MIP-1α mRNA and NF-кBp65 mRNA in the lung in the BUD group were higher than those in the DEX group, there were no signifi cant differences between them （P〉0.05）.CONCLUSIONS： Glucocorticoid could down-regulate the expression of MIP-1α by inhibiting the activity of NF-кB in the lung and may exert preventive and therapeutic effects on VILI to some extent. The effect of local use of glucocorticoid against VILI is similar to that of systemic use, but there is lesser adverse reaction.

Univariate Risk Factors for Prolonged Mechanical Ventilation in Patients Undergoing Prosthetic Heart Valves Replacement Surgery

Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery （combined surgery） from January 1998 to January 2004 at Union Hospital were retrospectively reviewed. Univariate logistic regression analyses were conducted to identity risk factors for prolonged mechanical ventilation. The results showed that prolonged cardiopulmonary bypass duration, prolonged aortic cross clamp time and low ejection fraction less than 50 percent （50 %） were found to be independent predictors for prolonged mechanical ventilation. Meanwhile age, weight, and preoperative hospital stay （days） were not found to be associated with prolonged mechanical ventilation. It was concluded that. for age and weight, this might be due to the lower number of old age patients （70 years and above） included in our study and genetic body structure of majority Chinese population that favor them to be in normal weight, respectively.

Structured Graded Lung Rehabilitation for Children with Mechanical Ventilation

Lung rehabilitation is safe and feasible,and it has positive benefits in weaning the machine as soon as possible,shortening the time of hospitalization and improving the prognosis of children with mechanical ventilation.However,at present,the traditional medical concept is deep-rooted,and doctors'understanding of early rehabilitation is inadequate.It is necessary to make in-depth exploration in the relevant guidelines and expert consensus to formulate standardized early rehabilitation diagnosis and treatment procedures and standards for mechanically ventilated children.In the paper,a structured graded lung rehabilitation program is constructed for children with mechanical ventilation to improve their respiratory function,shorten the time of mechanical ventilation and pediatric intensive care unit(PICU)hospitalization,and reduce their anxiety,based on the principal component analysis of functional pneumonia data.Scientific evaluation and dynamic monitoring ensure the safety of the implementation of the program and promote the prognosis and prognosis of the disease.The proposed lung reha-bilitation program provides a reference basis for the formulation of lung rehabilitation guidelines for children with mechanical ventilation.And It has important reference significance for clinical pulmonary rehabilitation to alleviate the concerns of clinicians and lay the foundation for the large-scale promotion of early lung rehabilitation.

Mechanical Ventilation Outcomes at the NICU at EL-Zahraa University Hospital

Background: Mechanical ventilation (MV) is one of the most common therapies in the neonatal Intensive Care Unit (NICU) and is associated with increased morbidity and mortality. MV is a complex and highly specialized area in neonatology that has several complications related to different modes, techniques, and devices. Aim of the Study: To detect the causes of morbidity and mortality in mechanically ventilated neonates and to correlate the neonatal morbidity and mortality with gestational age, birth weight and duration of MV. Patients and Methods: This prospective observation analytical study was carried out on 110 neonates who were admitted to NICU at Al-Zahraa university hospital on MV during the period from March 2019 to March 2020. All neonates were followed up till the time of discharge with record of any complications during mechanical ventilation. Detailed medical history, examination to detect indication of MV and laboratory, radiological investigations were recorded. As regard the general characterization of studied neonates, 64 (58.2%) were males while the rest 46 (41.8%) were females, 50 (45.4%) were full term (37 - 42 wks), 42 (38.18%) were early preterm (28 - 33 wks), 18 (16.3%) were late preterm (34 - 42 wks). Results: Among (110 mechanically ventilated neonates, 58.2% were males, 41.8% were females. The most common indication for MV in the studied cases was respiratory distress syndrome (RDS) in 30% neonates. Ventilator associated pnemonia and Devices associated infection were the most common complications related to MV (19.1% and 11.8% respectively). While septic shock and multiorgan failure were the most common complications related to the underlying disease (24%). There is a significant negative association between gestational age, birth weight and mortality in mechanically ventilated neonates. the overall recovery was 59.1% among studied neonates. Conclusion: Respiratory disorders were the commonest indication of MV in NICU mostly RDS. Ventilator associated pneumonia and devices associated infection are common complications. Preterm and low birth weight neonates are vulnerable group for need of mechanical ventilation.

Retrospective analysis of influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients

BACKGROUND The novel coronavirus disease 2019(COVID-19)has spread widely around the world with strong infectivity,rapid mutation and a high mortality rate.Mechanical ventilation has been included in the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia(Trial Version 8)as an important treatment for severe and critical COVID-19 patients,but its clinical efficacy in COVID-19 patients is various.Therefore,it is necessary to study the influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients.AIM The aim of this study was to determine the influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients.METHODS A total of 27 severe and critical COVID-19 patients were enrolled in this study and treated with mechanical ventilation at the Optical Valley Campus of Hubei Maternal and Child Health Care Hospital(Wuhan,Hubei Province)from February 20,2020 to April 5,2020.According to the final treatment outcomes,the patients were divided into the“effective group”and“death group.”The clinical data of the two groups,such as the treatment process and final outcome,were retrospectively analyzed in order to determine the specific curative effects on the two groups and the reasons for the differences in such curative effects,as well as to explore the factors related to death.RESULTS This study enrolled 27 severe and critical COVID-19 patients,including 17 males(63.0%)and 10 females(37.0%).Their ages were 74.41±11.73-years-old,and 19 patients(70.4%)were over 70-years-old.Severe COVID-19 patients over 70-yearsold who were treated with mechanical ventilation died in 14 cases(82.4%);thus,this was the peak age.A total of 17 patients died of basic disease,16 of whom had more than two basic diseases.The basic diseases were hypertension,diabetes,and cardiovascular and cerebrovascular diseases.At the same time,13 patients(76.5%)died from an abnormal increase in blood glucose.Among them,eight had diabetes before contracting COVID-19 and five had a stress-induced increase in blood glucose after contracting COVID-19.Diabetic ketoacidosis occurred in one case.The use of tocilizumab may be a double-edged sword that carries a certain risk in clinical usage.Among the patients who died,16(94.1%)went into septic shock at the end.There were significant differences in the degree of infection,cardiac and renal function,and blood glucose between the death group and effective group.CONCLUSION Age,blood glucose,cardiac and renal function,and inflammatory reaction are important indicators of poor prognosis for mechanical ventilation in severe and critical COVID-19 patients.

Effectiveness of daily interruption of sedation in sedated patients with mechanical ventilation in ICU: A systematic review

Purpose:To evaluate the effectiveness of daily sedation interruption in patients with mechanical ventilation in intensive care unit(ICU).Methods:The randomized controlled trials(RCTs)on the application of daily interruption of sedation in sedated patients with mechanical ventilation in ICU were collected through databases including Cochrane library,MEDLINE,Web of Knowledge,Embase,CNKI,CBM and VIP Data.Two reviewers independently assessed the quality of studies and extracted the data.Meta-analysis was conducted on the included studies.Results:Eight RCTs involving 757 patients were included.The daily sedation interruptions could shorten the duration of mechanical ventilation(Z=5.36,p<0.0001),length of stay(Z=2.93,p=0.003<0.05)and reduce the rate of tracheotomy(Z=3.97,p<0.00001)in these patients.Additionally,daily sedation interruption was not associated with increased rate of unplanned extubation by the patients(Z=0.53,p=0.6<0.05).Conclusion:The application of daily interruption of sedation in patients with mechanical ventilation in ICU is safe and effective.

Risk factors of mortality and severe disability in the patients with cerebrovascular diseases treated with perioperative mechanical ventilation

BACKGROUND The prognosis of cerebrovascular diseases treated with mechanical ventilation during perioperative has not been clearly reported.AIM To analyze mortality and functional disability and to determine predictors of unfavorable outcome in the patients with cerebrovascular diseases treated with mechanical ventilation.METHODS A retrospective follow-up study of 111 cerebrovascular disease patients who underwent mechanical ventilation during the perioperative period in the First Hospital of Jilin University from June 2016 to June 2019 was performed.Main measurements were mortality and functional outcome in-hospital and after 3-month follow-up.According to the modified rankin scale(mRS),the functional outcome was divided into three groups:Good recovery(mRS≤3),severe disability(mRS=4 or 5)and death(mRS=6).Univariate analysis was used to compare the differences between three functional outcomes.Multivariate logistic regression analysis was used to for risk factors of mortality and severe disability.RESULTS The average age of 111 patients was 56.46±12.53 years,59(53.15%)were males.The mortality of in-hospital and 3-month follow-up were 36.9% and 45.0%,respectively.Of 71 discharged patients,46.47% were seriously disabled and 12.67% died after three months follow-up.Univariate analysis showed that preoperative glasgow coma scale,operation start time and ventilation reasons had statistically significant differences in different functional outcomes.Multiple logistic regression analysis showed that the cause of ventilation was related to the death and poor prognosis of patients with cerebrovascular diseases.Compared with brainstem compression,the risk of death or severe disability of pulmonary disease,status epilepticus,impaired respiratory center function,and shock were 0.096(95%CI:0.028-0.328),0.026(95%CI:0.004-0.163),0.095(95%CI:0.013-0.709),0.095(95%CI:0.020-0.444),respectively.CONCLUSION The survival rate and prognostic outcomes of patients with cerebrovascular diseases treated with mechanical ventilation during the perioperative period were poor.The reason for mechanical ventilation was a statistically significant predictor for mortality and severe disability.

Effect of ephedrine hydrochloride on regulation of body fluid metabolism and AQP1 and AQP2 in a rabbit model of mechanical ventilation

Objective:Ephedrine hydrochloride(EH)is a major component from Ephedra sinica STAPF,which is used as a traditional Chinese herbal medicine.This study was designed to investigate the effect of EH on water metabolism and further explore the relevant signaling pathway of body fluid regulation in“lung governing regulation of water passage”using a rabbit model of mechanical ventilation.The molecular mechanism of the EH effect in the kidney was also investigated.Methods:Rabbits were randomly divided into a control group,model group,EH group,and dexmedetomidine hydrochloride(DH)group.Urine volume was measured by the intubation method and pathologic changes in lung and renal tissue were measured by hematoxylin and eosin staining.Nitric oxide(NO)production in lung,serum,and kidney were analyzed using chemical methods.An ELISA was used to analyze angiotensin II(Ang II),antidiuretic hormone(ADH),prostaglandin E2(PGE2),atrial natriuretic peptide(ANP),and endothelin-1(ET-1)levels in the lung,serum,and kidney.Aquaporin-1(AQP1)and aquaporin-2(AQP2)mRNA and protein expression in the kidney was determined using qRT-PCR and immunohistochemistry.Results:EH significantly inhibited the decrease in the total urine volume in the third and fourth stages,and displayed significant regulatory effects on NO,Ang II,ADH,PGE2,ANP,and ET-1 in serum,lung,and renal tissues compared with the model group.In the kidney,AQP1 and AQP2 mRNA and protein expression in the EH group were remarkably downregulated compared with the model group.Conclusion:EH exerted a regulatory effect on water metabolism by diffusing the lung and increased urine volume in the rabbit model,which was consistent with the decrease in kidney AQP1 and AQP2 expression levels that led to an increase in urine volume.EH could assist with DH to exert a protective effect on the clinical application of mechanical ventilation.