Clinical efficacy of mask continuous positive airway pressure mechanical ventilation in children with severe pneumonia

Objective: To investigate the clinical effects of the mask continuous positive airway pressure (CPAP) mechanical ventilation in children with severe pneumonia. Methods: A total of 100 cases of children with severe pneumonia were randomly divided into two groups, study group with 50 children and control group with 50 children. These 100 children were given comprehensive treatment measures: treatment of anti-infection, anti-respiratory failure, anti-heart failure (if necessary), relieving cough and reducing sputum, aerosol inhalation, limited fluid volume, nutrition support etc. Children in the study group were added mask continuous positive airway pressure mechanical ventilation (CPAP). Children in the control group were added ordinary mask oxygen inhalation. Investigated and checked the treatment effect in these two groups. Results: After treatment, SaO2, PaO2 in both two groups were showed significantly higher than before the treatment. PaO2 of the study group is obviously higher than the control group. The oxygen inhalation time of the study group was obviously lesser than the control group. The total effective rate of the study group was significantly higher than the control group which was 96.0% vs 66.0%. Conclusion: The mask continuous positive airway pressure (CPAP) mechanical ventilation can significantly improve the related symptoms and blood gas status of the children with severe pneumonia, shorten the oxygen inhalation time and had remarkable effect.

Risk factors for ventilator-associated pneumonia in trauma patients:A descriptive analysis

BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and 2013.Patients’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]vs.trauma room[TRI])and presence vs.absence of VAP.Multivariate regression analysis was performed to identify predictors of VAP.RESULTS:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 years.PHI group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of polytrauma.The overall mortality was 7.5%,and was not associated with intubation location or pneumonia rates.In the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP group.Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models.CONCLUSION:In trauma,the risk of developing VAP is multifactorial.However,the location of intubation and presence of chest injury could play an important role.

Effects of Tanreqing Injection on ICU Mortality among ICU Patients Receiving Mechanical Ventilation: Time-Dependent Cox Regression Analysis of A Large Registry

Objective To assess whether the use of Tanreqing(TRQ)Injection could show improvements in time to extubation,intensive care unit(ICU)mortality,ventilator-associated events(VAEs)and infection-related ventilator associated complication(IVAC)among patients receiving mechanical ventilation(MV).Methods A time-dependent cox-regression analysis was conducted using data from a well-established registry of healthcare-associated infections at ICUs in China.Patients receiving continuous MV for 3 days or more were included.A time-varying exposure definition was used for TRQ Injection,which were recorded on daily basis.The outcomes included time to extubation,ICU mortality,VAEs and IVAC.Time-dependent Cox models were used to compare the clinical outcomes between TRQ Injection and non-use,after controlling for the influence of comorbidities/conditions and other medications with both fixed and time-varying covariates.For the analyses of time to extubation and ICU mortality,Fine-Gray competing risk models were also used to measure competing risks and outcomes of interest.Results Overall,7,685 patients were included for the analyses of MV duration,and 7,273 patients for the analysis of ICU mortality.Compared to non-use,patients with TRQ Injection had a lower risk of ICU mortality(Hazards ratios(HR)0.761,95%CI,0.581–0.997),and was associated with a higher hazard for time to extubation(HR 1.105,95%CI,1.005–1.216),suggesting a beneficial effect on shortened time to extubation.No significant differences were observed between TRQ Injection and non-use regarding VAEs(HR 1.057,95%CI,0.912–1.225)and IVAC(HR 1.177,95%CI,0.929–1.491).The effect estimates were robust when using alternative statistic models,applying alternative inclusion and exclusion criteria,and handling missing data by alternative approaches.Conclusion Our findings suggested that the use of TRQ Injection might lower mortality and improve time to extubation among patients receiving MV,even after controlling for the factor that the use of TRQ changed over time.

Respiratory mechanics,ventilator-associated pneumonia and outcomes in intensive care unit

AIM To evaluate the predictive capability of respiratory mechanics for the development of ventilator-associated pneumonia (VAP) and mortality in the intensive care unit(ICU) of a hospital in southern Brazil. METHODS A cohort study was conducted between, involving a sample of 120 individuals. Static measurements of compliance and resistance of the respiratory system in pressure-controlled ventilation (PCV) and volumecontrolled ventilation(VCV) modes in the 1 st and 5 th days of hospitalization were performed to monitor respiratory mechanics. The severity of the patients' illness was quantified by the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ). The diagnosis of VAP was made based on clinical, radiological and laboratory parameters.RESULTS The significant associations found for the development of VAP were APACHE Ⅱ scores above the average(P = 0.016), duration of MV (P = 0.001) and ICU length of stay above the average(P = 0.003), male gender(P = 0.004), and worsening of respiratory resistance in PCV mode(P = 0.010). Age above the average(P < 0.001), low level of oxygenation on day 1(P = 0.003) and day 5 (P = 0.004) and low lung compliance during VCV on day 1 (P = 0.032) were associated with death as the outcome.CONCLUSION The worsening of airway resistance in PCV mode indicated the possibility of early diagnosis of VAP. Low lung compliance during VCV and low oxygenation index were death-related prognostic indicators.

Early versus late percutaneous dilational tracheostomy in critically ill patients anticipated requiring prolonged mechanical ventilation

Background Tracheostomy should be considered to replace endotracheal intubation in patients requiring prolonged mechanical ventilation （MV）. However, the optimal timing for tracheostomy is still a topic of debate. The present study aimed to investigate whether early percutaneous dilational tracheostomy （PDT） can reduce duration of MV, and to further verify whether early PDT can reduce sedative use, shorten intensive care unit （ICU） stay, decrease the incidence of ventilator associated pneumonia （VAP）, and increase successful weaning and ICU discharge rate. Methods A prospective, randomized controlled trial was carried out in a surgical ICU from July 2008 to June 2011 in adult patients anticipated requiring prolonged MV via endotracheal intubation. Patients meeting the inclusion criteria were randomly assigned to the early PDT group or the late PDT group on day 3 of MV. The patients in the early PDT group were tracheostomized with PDT on day 3 of MV. The patients in the late PDT group were tracheostomized with PDT on day 15 of MV if they still needed MV. The primary endpoint was ventilator-free days at day 28 after randomization. The secondary endpoints were sedation-free days, ICU-free days, successful weaning and ICU discharge rate, and incidence of VAP at day 28 after randomization. The cumulative 60-day incidence of death after randomization was also analyzed. Results Total 119 patients were randomized to either the early PDT group （n=58） or the late PDT group （n=61）. The ventilator-free days was significantly increased in the early PDT group than in the late PDT group （（9.57±5.64） vs. （7.38±6.17） days, P 〈0.05）. The sedation-free days and ICU-free days were also significantly increased in the early PDT group than in the late PDT group （20.84±2.35 vs. 17.05±2.30 days, P 〈0.05; and 8.0 （interquartile range （IQR）： 5.0-12.0） vs. 3.0 （IQR： 0-12.0） days, P 〈0.001 respectively）. The successful weaning and ICU discharge rate was significantly higher in early PDT group than in late PDT group （74.1% vs. 55.7%, P 〈0.05; and 67.2% vs. 47.5%, P 〈0.05 respectively）. VAP was observed in 17 patients （29.3%） in early PDT group and in 30 patients （49.2%） in late PDT group （P 〈0.05）. There was no significant difference between the two groups in the cumulative 60-day incidence of death after randomization （P=0.949）. Conclusions The early PDT resulted in more ventilator-free, sedation-free, and ICU-free days, higher successful weaning and ICU discharge rate, and lower incidence of VAP, but did not change the cumulative 60-day incidence of death in the patients＇ anticipated requiring prolonged mechanical ventilation.

Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria

BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation(MV).The emergence of multidrug resistant bacteria(MDRB)has become a public health problem,creating a new burden on medical care in hospitals,particularly for patients admitted to the intensive care unit(ICU).AIM To describe risk factors for ventilator-acquired pneumonia(VAP)in patients with cancer and to evaluate the impact of MDRB.METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City,which included all patients who were admitted to the ICU and required MV≥48 h.They were classified as those who developed VAP versus those who did not;pathogens isolated,including MDRB.Clinical evolution at 60-d was assessed.Descriptive analysis was carried out;comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.RESULTS Two hundred sixty-three patients were included in the study;mean age was 51.9 years;52.1%were male;68.4%had solid tumors.There were 32 episodes of VAP with a rate of 12.2%;11.5 episodes/1000 ventilation-days.The most frequent bacteria isolated were the following:Klebsiella spp.[n=9,four were Extended-Spectrum Beta-Lactamase(ESBL)producers,one was Carbapenem-resistant(CR)];Escherichia coli(n=5,one was ESBL),and Pseudomonas aeruginosa(n=8,two were CR).One Methicillin-susceptible Staphylococcus aureus was identified.In multivariate analysis,the sole risk factor associated for VAP was length of ICU stay(OR=1.1;95%CI:1.03-1.17;P=0.003).Sixty-day mortality was 53%in VAP and 43%without VAP(P=0.342).There was not higher mortality in those patients with MDRB.CONCLUSION This study highlights the high percentage of Gram-negative bacteria,which allows the initiation of empiric antibiotic coverage for these pathogens.In this retrospective,single center,observational study,MDRB VAP was not directly linked to increased mortality at 60 days.

Outcomes and risk factors of ventilator-associated pneumonia in neonates

Background:Ventilator-associated pneumonia (VAP) in neonates has been associated with high mortality and poor outcome.This study aimed to compare the incidence,risk factors,and outcomes of VAP and nonVAP conditions in neonates.Methods:We performed a prospective cohort study in a neonatal intensive care unit (NICU) in Thailand from January 2014 to December 2014.All neonatal patients who were ventilated more than 48 hours were enrolled.Results:There were 128 enrolled patients.The median (inter quartile range) gestational age and birthweight were 35 (30.2,37.8) weeks and 2380 (1323.8,3020.0) g.There were 17 VAP patients (19 episodes) and 111 non-VAP ones.The VAP rate was 13.3% or 10.1 per 1000 ventilator days.According to the multivariate analysis,a birthweight less than 750 g [adjusted odds ratio (aOR)=10.75,95% confidence interval (CI)=2.35-49.16;P=0.002] and sedative medication use (aOR=4.00,95% CI=1.23-12.50;P=0.021)were independent risk factors for VAP.Compared with the non-VAP group,the median difference in the VAP group yielded a significantly longer duration of NICU stay (18 days,P=0.001),total length of hospital stay (16 days,P=0.002) and higher hospital costs ($5113,P=0.001).The inhospital mortality rate in the VAP and non-VAP groups was 17.6% and 15.3% (P=0.73),respectively.Conclusions:A neonatal birthweight less than 750 g and sedative medication use were independent risk factors for VAP.Our VAP patients experienced a longer duration of both NICU and hospital stay,and incurred higher hospitalization costs.

Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics

BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance,alveolar capillary injury,pulmonary edema,refractory hypoxemia,and reduced lung compliance.Prolonged hypoxia can cause acid-base balance disorder,peripheral circulatory failure,blood-pressure reduction,arrhythmia,and other adverse consequences.AIM To investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory failure.METHODS We selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive Care Unit and divided them into sequential and regular groups according to a randomized trial,with each group comprising 54 patients.The sequential group received invasive and non-invasive sequential mechanical ventilation,whereas the regular group received invasive mechanical ventilation.Blood-gas parameters,hemodynamic parameters,respiratory mechanical parameters,inflammatory factors,and treatment outcomes were compared between the two groups before and after mechanical-ventilation treatment.RESULTS The arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24,48,and 72 h of treatment were higher than those of the conventional group(P<0.05).The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group(P<0.05).The pH value of the sequential group at 24 and 72 h of treatment,the central venous pressure value of the treatment at 24 h,and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group(P<0.05).The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group(P<0.05),the measured values of interleukin-6 and tumor necrosis factor-αin the sequential group at 72 h of treatment were lower than those in the conventional group(P<0.05),and the total time of mechanical ventilation in the sequential group was shorter than that in the conventional group,with a statistically significant difference(P<0.05).CONCLUSION Treating severe pneumonia complicated by respiratory failure with sequential mechanical ventilation is more effective in improving respiratory system compliance,reducing inflammatory response,maintaining hemodynamic stability,and improving patient blood-gas levels;however,from this study’s perspective,it cannot reduce patient mortality.

Subglottic Secretion Drainage for Preventing Ventilator Associated Pneumonia: A Meta-analysis

Objective： Ventilator associated pneumonia （VAP） has been shown to be associated with significant morbidity and mortality（ Chastre and Fagon, 2002; klompas, 2007） among mechanically venti- lated patients in the intensive care unit （ICU）, with the incidence ranging from 9% to 27% ; crude mortality ranges from 25% to 50%.1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage （SSD） on the incidence of ventilated associated pneumonia in adult ICU patients. Methods： Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases （December 30, 2010）. Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results： Ten RCTs with 2,314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk （RR） =0.52, 95% confidence interval （C/）： 0.42-0.64, P〈0.000 01]. When SSD was compared with the control groups, the overall RR for ICU mortality was 1.00 （95% CI, 0.84-1.19） and for hospital mortality was 0.95 （95% CI, 0. 80-1.13）. Overall, the subglottic drainage effect on the days of mechanical ventilation was -1.52 days （95% CI, -2.94 to -0.11） and on the ICU length of stay （LOS） was -0.81days （95% CI, -2.33 to -0.7）. Conclusions： In this meta-analysis, when an endotracheal tube （ETT） with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi- mately 50%. Time on mechanical ventilation （MV） and the ICU LOS may be reduced, but no reduction in ICU or hospital mortality has been observed in published trials,

Ventilator Associated Pneumonia in an Intensive Care Unit

The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mechanical ventilator for more than 3 days and without pulmonary infection on first admission were included in this study. In all cases, body temperature recordings, blood and urine culture, microbiological analyses of endotracheal aspirates, and chest X-rays were obtained and used to identify VAP. Apache II scores on admission, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were recorded. This study included 45 cases and 22 developed VAP (48%). The incidence of VAP was 25.34 per 1000 ventilator days. Univariate analyses showed that duration of mechanical ventilation, length of ICU stay, coma and tracheotomy were associated with the development of VAP. The mortality rate of cases with VAP (72.7%) was significantly higher than cases without VAP (39.1%). The most frequent microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae. In our study, VAP was a very common and important complication of mechanical ventilation and mortality was very high. To reduce mortality, minimize morbidity, shorten the length of stay, and reduce costs, defined risk factors for VAP should be recognized and an effective infection control program for the prevention of VAP should be implemented. Surveillance results should be evaluated regularly and necessary precautions should be taken.

肺超声指导下的体位管理在新生儿呼吸机相关性肺炎中的临床应用

目的探索肺超声指导下的体位管理在新生儿呼吸机相关性肺炎(VAP)中的临床效果。方法选取新生儿科收治的胎龄>32周且诊断为VAP的患儿50例为研究对象,采用随机数字表法分为肺超声指导下的体位管理组(观察组)和常规体位管理组(对照组)。比较两组患儿肺超声征象、实施方案后血气分析、氧合指数、肺超声评分、呼吸机使用情况、住院时间、并发症等情况。结果两组背部超声评分均较胸前或侧胸评分高,干预7 d后,观察组的胸前、侧胸及背部超声评分均较对照组降低,差异均有统计学意义(P<0.05);其中背部超声评分较胸前及侧胸评分高且变化明显,差异有统计学意义(P<0.05)。观察组在干预3、7 d的总超声评分均较对照组降低,差异有统计学意义(P<0.05);其中观察组干预7 d后的总超声评分较干预前(首次)显著降低(P<0.05)。观察组干预后第7天的氧合指数较干预前明显降低,且较对照组低,差异有统计学意义(P<0.05)。观察组与对照组在呼吸机使用时间差异有统计学意义(P<0.05)。结论肺超声可作为监测手段指导的新生儿VAP的体位管理,有助于缩短新生儿VAP患儿的呼吸机使用时间,值得临床推广应用。

改良成人经口气管插管机械通气患者口腔护理方法及应用

目的探讨改良成人经口气管插管机械通气患者口腔护理方法的应用效果。方法便利抽样选取2021年1月1日至2021年12月30日四川省人民医院神外监护室经口气管插管机械通气患者220例为对照组,口腔护理方法为冲洗+擦拭+吸痰管连接负压吸引;2022年1月1日至2022年12月30日经口气管插管机械通气患者163例为观察组,口腔护理方法为擦拭+冲洗+吸唾管连接负压吸引。比较两组患者口腔异味发生率、口腔污垢残留、操作时口腔内污液溢出及吸唾管/吸痰管滑出情况、呼吸机相关性肺炎发生率。结果两组患者呼吸机相关性肺炎发生率比较差异无统计学意义(P>0.05);两组口腔异味发生率、口腔污垢残留、操作时口腔内污液溢出及吸唾管/吸痰管滑出、操作耗时等比较,差异有统计学意义(P<0.05);100%操作人员愿意选择观察组的吸唾管连接负压吸引口腔护理废液(P<0.05)。结论改良成人经口气管插管机械通气患者口腔护理方法,能提高口腔护理质量、提高患者舒适度,节约成本、提高工作效率,有一定的推广应用价值。

呼吸机相关性肺炎病原菌分布特点及发病影响因素分析

目的:分析呼吸机相关性肺炎(ventilator associated pneumonia,VAP)患者的肺部病原菌分布情况,并探讨VAP发病的影响因素。方法:采用回顾性研究方法,选取2018年1月至2021年12月在山西医科大学第一医院及阳泉市第一人民医院接受机械通气治疗的1164例患者作为研究对象,均留取痰标本进行病原菌检测。收集研究对象一般资料(年龄、性别、住院时间、手术情况)、机械通气时长及次数、尿管和中心静脉导管留置时长及次数、抗菌药物使用时长及次数、痰标本的病原菌情况等信息。分析VAP患者肺部病原菌分布特点,并应用多因素logistic回归模型探究研究对象发生VAP的影响因素。结果:1164例研究对象中,171例(14.69%)发生VAP。171例VAP患者下呼吸道分泌物或气管插管终端分泌物中共检出378株病原菌,其中,革兰阴性菌298株(78.84%),革兰阳性菌66株(17.46%),真菌14株(3.70%);肺炎克雷伯菌、鲍曼不动杆菌是主要病原菌,分别占23.81%(90/378)、14.81%(56/378)。多因素logistic回归分析显示,手术[OR(95%CI)=2.506(1.640~3.828)]、住院时间≥14 d[OR(95%CI)=2.749(8.424~28.968)],以及留置尿管[OR(95%CI)=14.208(5.285~38.192)]均是接受通气治疗患者发生VAP的独立影响因素。结论:条件致病菌是造成机械通气治疗患者呼吸道感染的主要致病菌;对于实施手术、住院时间较长,以及留置尿管的患者,要警惕其发生VAP的风险。

风险等级防控护理对重症肺炎俯卧位通气治疗患者安全性与疗效的影响

目的 探究风险等级防控护理在重症肺炎俯卧位通气治疗患者中的临床应用效果。方法 抽选南通三院在2018年8月—2023年3月期间收治的81例重症肺炎俯卧位通气治疗患者作为观察对象,随机分为对照组和观察组,对照组40例实施常规重症监护室护理措施,观察组41例实施风险等级防控护理措施,于干预前、干预14 d后,对两组患者动脉血气、呼吸力学、临床指标及并发症发生情况进行分析对比。结果 干预前,两组患者动脉血气、呼吸力学等指标相比,差异不具有统计学意义(P>0.05);干预14 d后,两组动脉血气、呼吸力学指标高于干预前,且观察组在动脉血氧分压(PaO2)、肺总量(TLC)、动态顺应性(Cdyn)等指标高于对照组,气道峰值(PIP)低于对照组(P<0.05);观察组在机械通气时间、咳嗽、ICU治疗时间、平均住院时间均低于对照组(P<0.05);观察组在营养不良、呼吸机相关肺炎、呼吸衰竭、压力性损伤等并发症发生率低于对照组(P<0.05)。结论风险等级防控护理有助于改善重症肺炎俯卧位通气治疗患者动脉血气、呼吸力学等指标,缩短机械通气、ICU治疗、平均住院时间,降低机体各器官衰竭评分,减少并发症发生。

头孢曲松钠联合集束化管理措施对早期呼吸机相关肺炎的预防效果

目的观察头孢曲松钠(CRO)联合集束化管理措施(BM)对行机械通气(MV)的重症监护室(ICU)患者早期呼吸机相关肺炎(VAP)的预防效果。方法选择2022年5月至2023年4月首都医科大学附属北京同仁医院138例ICU行MV的患者。根据是否使用CRO分为CRO组和非CRO(NCRO)组,两组患者住院期间均实施BM。观察并比较两组患者早期VAP发生率、死亡率、机械通气时间、ICU住院时间和总住院时间。此外,比较干预前和干预后(第7 d)两组患者炎症指标[C-反应蛋白(CRP)、降钙素原(PCT)和白细胞计数(WBC)]的变化情况。结果CRO组患者早期VAP发生率低于NCRO组(P<0.05)。CRO组患者死亡率低于NCRO组,但差异无统计学意义(P>0.05)。CRO组患者机械通气时间、ICU住院时间和总住院时间均短于NCRO组(P<0.05)。治疗前两组患者的CRP水平、血清PCT水平和WBC差异无统计学意义(P>0.05)。与治疗前比较,CRO组和NCRO组血清CRP水平、血清PCT水平和WBC均显著下降(P<0.05)。此外,第7天,CRO组血清CRP水平、血清PCT水平和WBC低于NCRO组(P<0.05)。结论CRO联合BM可降低行MV的ICU患者早期VAP发生率,缩短MV时间、ICU住院时间和总住院时间,并降低机体炎症反应水平。

俯卧位机械通气对重症肺炎合并呼吸衰竭患者血气分析指标及疾病好转情况的影响

目的探究俯卧位机械通气对重症肺炎合并呼吸衰竭患者血气分析指标及疾病好转情况的影响。方法选取2018年6月至2021年6月中国人民解放军联勤保障部队第九六七医院接诊的82例重症肺炎合并呼吸衰竭患者作为研究对象,按照随机抽签法分为对照组与观察组,每组41例。两组均行常规对症治疗,对照组辅以仰卧位机械通气,观察组辅以俯卧位机械通气。比较两组疾病好转率、干预前后血气指标、机械通气时间及住院时间、并发症发生情况及干预前后急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分。结果干预7 d后,观察组疾病好转率高于对照组,差异有统计学意义(P<0.05)。干预7 d后,两组血液pH、血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))水平均高于干预前,动脉血二氧化碳分压(PaCO_(2))均低于干预前,且观察组血液pH、SaO_(2)、PaO_(2)高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。观察组机械通气时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义。干预7 d后,两组APACHE-Ⅱ评分均低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论俯卧位机械通气可提高重症肺炎呼吸衰竭患者疾病好转率,减轻病情严重程度,改善血气指标,缩短机械通气时间、住院时间,使其早日康复出院。

重症新型冠状病毒肺炎患者俯卧位喂养不耐受现状分析

目的:探讨重症新型冠状病毒肺炎患者俯卧位机械通气期间喂养不耐受现状,并分析其影响因素。方法:选择2022年10月—2023年3月收治的重症新型冠状病毒肺炎患者50例,通过医院电子病历系统收集患者临床资料,分析患者发生喂养不耐受现状,并采用Logistic回归分析其影响因素。结果:50例患者中喂养不耐受33例(66%)。Logistic回归分析结果显示,白蛋白<35 g/L、未使用胃动力药或益生菌、鼻胃管是患者发生喂养不耐受的影响因素(P<0.05)。结论:重症新型冠状病毒肺炎患者俯卧位机械通气期间喂养不耐受发生率较高,在肠内营养支持治疗期间要动态评估,积极纠正低蛋白血症,合理使用胃动力药或益生菌,选择合适的喂养途径,减少喂养不耐受的发生。

Ventilator-associated events: From surveillance to optimizing management

Mechanical ventilation(MV)is a life-support therapy that may predispose to morbid and lethal complications,with ventilator-associated pneumonia(VAP)being the most prevalent.In 2013,the Center for Disease Control(CDC)defined criteria for ventilator-associated events(VAE).Ten years later,a growing number of studies assessing or validating its clinical applicability and the potential benefits of its inclusion have been published.Surveillance with VAE criteria is retrospective and the focus is often on a subset of patients with higher thanlower severity.To date,it is estimated that around 30%of ventilated patients in the intensive care unit(ICU)develop VAE.While surveillance enhances the detection of infectious and non-infectious MV-related complicationsthat are severe enough to impact the patient’s outcomes,there are still many gaps in its classification and management.In this review,we provide an update by discussing VAE etiologies,epidemiology,and classification.Preventive strategies on optimizing ventilation,sedative and neuromuscular blockade therapy,and restrictivefluid management are warranted.An ideal VAE bundle is likely to minimize the period of intubation.We believethat it is time to progress from just surveillance to clinical care.Therefore,with this review,we have aimed toprovide a roadmap for future research on the subject.

低磷血症与老年重症肺炎预后相关性研究

目的 重症肺炎是引起老年人死亡的主要病因之一,而低磷血症在老年患者中发病率高且常被忽视,探究二者相关性为老年重症肺炎合并低磷血症者提供临床诊疗依据;方法 采用回顾性研究方法,按照入组标准及排除标准收集自2021年2月—2022年9月诊断为“重症肺炎”老年患者,共88例,按照不同血磷水平分为低磷血症组及血磷正常组,在不同组间对患者基础状况、预后情况进行比较。结果 低磷血症与患者预后情况密切相关,低磷血症组既往存在脑血管疾病史者较多(45.9%vs.22.2%,χ^(2)=4.42,P=0.03),低磷血症及血磷正常组相比死亡率、休克患者比例及机械通气(有创机械通气及无创机械通气)比例无明显差异,低磷血症组有创机械通气比例明显升高(36.1%vs.14.8%,χ^(2)=4.06,P=0.04),且在存活患者中,低磷血症组有创机械通气时间比血磷正常组延长[(7.70±2.94)d vs.(3.33±0.57)d,t=2.47,P=0.03],存活患者中低磷血症组住院费用比血磷正常组更高(3.48万元vs. 5.17万元,Z=2.85,P<0.02)。在不同病原学之间血磷水平无明显差异性。结论 血磷水平和老年重症肺炎患者预后有相关性,严重低磷血症可引起患者有创机械通气比例及通气时间延长,并引起患者住院费用增多。

多学科联合保护性管理策略与高侧卧位通气改善重症肺炎机械通气患者预后的临床研究

目的研究多学科联合保护性管理策略与高侧卧位通气改善重症肺炎机械通气患者预后的临床效果。方法将廊坊市人民医院重症医学科2021年5月至2023年7月收治的82例重症肺炎机械通气患者按随机数字表法分为对照组和研究组,每组41例。对照组采用常规机械通气,研究组采用多学科联合保护性管理策略联合高侧卧位通气,比较2组患者的氧合指数、血气分析指标、机械通气时间及住院时间、肺功能指标及心理状况。结果干预前2组患者氧合指数、血气分析指标、肺功能指标及心理状况比较,差异无统计学意义(P>0.05);干预后研究组患者氧合指数、血氧分压(PaO_(2))、最大呼气峰流速(PEF)、最大呼气中期流量(MMF)及FEV1/FVC(第1秒用力呼气容积/用力肺活量)高于对照组,差异有统计学意义(P<0.05);干预后研究组患者动脉血二氧化碳分压(PaCO_(2))、SAS、SDS评分低于对照组,差异有统计学意义(P<0.05);干预后研究组患者机械通气时间、住院时间短于对照组,差异有统计学意义(P<0.05)。结论多学科联合保护性管理策略联合高侧卧位通气能够有效改善重症肺炎患者的氧合指数、血气分析指标及心理状况,同时提高患者的肺功能,缩短患者的机械通气时间及住院时间,综合改善患者预后,值得临床推广。