Prevention of ventilator-associated pneumonia with inhaled antibiotics

The direct delivery of inhaled antibiotics to the respiratory tract has been a subject of enduring interest among medical practitioners and researchers due to the associated favorable pharmacokinetics.This interest has been particularly pronounced in the context of critically illpatients,wherehealthcare-associatedpulmonary infections represent a significant challenge,driving continued exploration of inhaled antibiotics for intubated patients.Recent high-level evidence has shown a very promising application in the field of ventilator-associated pneumonia (VAP) prevention.^([1]).

Observation on the Effect of Non-Invasive Ventilator Combined with Conventional Therapy in the Treatment of Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

Objective:To explore the clinical effect of a non-invasive ventilator combined with conventional therapy in the treatment of patients with chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:68 patients with COPD combined with respiratory failure treated in our hospital from September 2021 to October 2023 were selected as the research subjects.Using the random number table method,they were divided into a control group and an experimental group of 34 cases each.The control group received conventional symptomatic treatment,and the experimental group received non-invasive ventilator treatment based on the control group.The clinical effects,blood gas indicators(partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),arterial oxygen saturation(SaO_(2))),lung function(forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),6 min walking distance),complications,and inflammatory factor levels(c-reactive protein(CRP),interleukin-6(IL-6),neutrophil-to-lymphocyte ratio(NLR))of the two groups of patients were observed.Results:(1)The clinical efficacy of the patients in the experimental group(33/97.06%)was more significant as compared with the control group(25/73.53%)(P<0.05);(2)After treatment,the clinical efficacy of the two groups of patients in terms of FEV1,FEV1/FVC,6-minute walking distance,PaO_(2)and SaO_(2)all increased in the experimental group as compared to that of the control group(P<0.05);(3)After treatment,the PaCO_(2),CRP,IL-6,and NLR of the two groups of patients decreased,and the decrease in the experimental group was higher than that of the control group(P<0.05);(4)The patients’complication rate in the experimental group(2/5.88%)was lower as compared to that of the control group(9/26.46%)(P<0.05).Conclusion:Non-invasive ventilators combined with conventional therapy achieved good clinical results in treating patients with COPD and respiratory failure.

Comparison of the Use of Conventional and Antibiotic-Coated Tracheal Tubes and EVAC on the Incidence of Ventilator-Associated Pneumonia (VAP)

Ventilator-associated pneumonia (VAP) is one of the most important hospital infections in hospitalized patients, which is associated with increased mortality and patient costs. The tracheal tube itself seems to be a major risk factor for VAP. Contaminated secretions pass through the endotracheal tube and reach the lungs. Also, bacteria form a bacterial biofilm on the tracheal tube and are transferred from there to the lungs. Different tracheal tube designs have been produced to overcome these cases. The purpose of this study is to investigate the effect of an Evac tracheal tube covered with antibiotics and normal on the incidence of pneumonia caused by the ventilator. Research method: 180 patients were randomly intubated in three groups of 60 people with three types of tracheal tubes, Evac and Bactiguard. Clinical examinations, endotracheal tube aspiration culture, and chest radiography were obtained from the patients and the incidence of VAP was calculated based on the CPIS standard. The relationship between the type of endotracheal tube and the incidence of VAP and the length of stay in the intensive care unit (ICU) and being discharged alive from the ICU were investigated. Findings and conclusions: The average incidence of VAP for the group of patients intubated with a conventional tracheal tube was 50%, EVAC was 45% and Bactiguard was 40%. The results showed that there is no significant relationship between the incidence of ventilator-induced pneumonia and the type of tracheal tube. The incidence of ventilator-induced pneumonia was not significantly reduced by suctioning subglottic secretions and Bactiguard tracheal tubes. It seems that using one method alone is not effective in reducing ventilator-induced pneumonia.

Evaluating the Effectiveness of Emergency Ventilator Treatment for Severe Acute Left Ventricular Heart Failure

Objective:To evaluate the efficacy of emergency ventilator therapy in severe acute left heart failure.Methods:A total of 75 patients with severe acute left ventricular heart failure who were admitted to the hospital from July 2020 to July 2023 were randomly divided into two groups.Group A received additional emergency ventilator treatment,and group B received conventional treatment.The efficacy was compared.Results:The curative effect of patients with severe acute left heart failure in group A was higher than that in group B(P<0.05);all blood gas indicators in group A were better than those in group B(P<0.05);all vital signs indicators in group A were better than those in group B(P<0.05);group A was more satisfied with the treatment of severe acute left ventricular heart failure than group B(P<0.05).Conclusion:Patients with severe acute left heart failure who receive emergency ventilator treatment can stabilize vital signs,improve blood oxygen supply,and enhance curative effect.

Importance of proper ventilator support and pulmonary rehabilitation in obese patients with heart failure:Two case reports

BACKGROUND The optimal treatment for heart failure(HF)is a combination of appropriate medications.Controlling the disease using only medical therapy is difficult in patients with HF,severe hypercapnia,and desaturation.These patients should first receive ventilator support followed by pulmonary rehabilitation(PR).CASE SUMMARY We report two cases in which arterial blood gas(ABG)improved and PR was possible with appropriate ventilator support.Two patients with extreme obesity complaining of worsening dyspnea–a 47-year-old woman and a 36-year-old man both diagnosed with HF–were hospitalized because of severe hypercapnia and hypoxia.Despite proper medical treatment,hypercapnia and desaturation resolved in neither case,and both patients were transferred to the rehabilitation department for PR.At the time of the first consultation,the patients were bedridden because of dyspnea.Oxygen demand was successfully reduced once noninvasive ventilation was initiated.As the patients’dyspnea gradually improved to the point where they could be weaned off the ventilator during the daytime,they started engaging in functional training and aerobic exercise.After 4 mo of followup,both patients were able to perform activities of daily living and maintain their lower body weight and normalized ABG levels.CONCLUSION Symptoms of patients with obesity and HF may improve once ABG levels are normalized through ventilator support and implementation of PR.

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.

Individualized Design of the Ventilator Mask based on the Residual Concentration of CO2

OSAHS(Obstructive Sleep Apnea Hypopnea Syndrome)is a respiratory disease mainly characterized by limited and repeated pauses of breathing in sleep.Currently,the optimal treatment is to apply CPAP(Continuous Positive Airway Pressure)ventilation on the upper airway of the patient through a household respiratory machine.However,if the ventilator mask is designed improperly,it might cause the residue and repeated inhalation of CO2,which will exert an adverse impact on the therapeutic effect.Present research numerically analyzed the CO2 transportation inside a commercial ventilator mask(Mirage SoftGel,ResMed,Australia)based on the reconstructed 3D numerical model of a volunteer's face and performed the improved design of the ventilator mask in terms of the CO2 residual concentration below the nostrils.The fluid dynamic analyses showed that at the end time of expiratory,the CO2 residual concentration below the nostrils is close to 4%.To improve the therapeutic effect,we changed the position of the exhaust holes and found that by moving the exhaust holes to the bottom of the ventilator mask,the CO2 residual concentration below the nostrils would be reduced to no more than 1%.This study established a near physiological computational model and provided a new method for the individualized design of the commercial ventilator mask.

Ventilator associated pneumonia following liver transplantation:Etiology,risk factors and outcome

AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria. RESULTS: VAP occurred in 18(7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation(MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae(79%). Univariate logistic analysis showed that model for end-stage liver disease(MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariateanalysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP. CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.

Expiratory flow-limitation in mechanically ventilated patients: A risk for ventilator-induced lung injury?

Expiratory flow limitation(EFL), that is the inability of expiratory flow to increase in spite of an increase of the driving pressure, is a common and unrecognized occurrence during mechanical ventilation in a variety of intensive care unit conditions. Recent evidence suggests that the presence of EFL is associated with an increase in mortality, at least in acute respiratory distress syndrome(ARDS) patients, and in pulmonary complications in patients undergoing surgery. EFL is a major cause of intrinsic positive end-expiratory pressure(PEEPi), which in ARDS patients is heterogeneously distributed, with a consequent increase of ventilation/perfusion mismatch and reduction of arterial oxygenation. Airway collapse is frequently concomitant to the presence of EFL.When airways close and reopen during tidal ventilation, abnormally high stresses are generated that can damage the bronchiolar epithelium and uncouple small airways from the alveolar septa, possibly generating the small airways abnormalities detected at autopsy in ARDS. Finally, the high stresses and airway distortion generated downstream the choke points may contribute to parenchymal injury, but this possibility is still unproven. PEEP application can abolish EFL, decrease PEEPi heterogeneity, and limit recruitment/derecruitment.Whether increasing PEEP up to EFL disappearance is a useful criterion for PEEP titration can only be determined by future studies.

From hardware store to hospital:a COVID-19-inspired,cost-effective,open-source,in vivo-validated ventilator for use in resource-scarce regions

Resource-scarce regions with serious COVID-19 outbreaks do not have enough ventilators to support critically ill patients,and these shortages are especially devastating in developing countries.To help alleviate this strain,we have designed and tested the accessible low-barrier in vivo-validated economical ventilator(ALIVE Vent),a COVID-19-inspired,cost-effective,open-source,in vivo-validated solution made from commercially available components.The ALIVE Vent operates using compressed oxygen and air to drive inspiration,while two solenoid valves ensure one-way flow and precise cycle timing.The device was functionally tested and profiled using a variable resistance and compliance artificial lung and validated in anesthetized large animals.Our functional test results revealed its effective operation under a wide variety of ventilation conditions defined by the American Association of Respiratory Care guidelines for ventilator stockpiling.The large animal test showed that our ventilator performed similarly if not better than a standard ventilator in maintaining optimal ventilation status.The FiO2,respiratory rate,inspiratory to expiratory time ratio,positive-end expiratory pressure,and peak inspiratory pressure were successfully maintained within normal,clinically validated ranges,and the animals were recovered without any complications.In regions with limited access to ventilators,the ALIVE Vent can help alleviate shortages,and we have ensured that all used materials are publicly available.While this pandemic has elucidated enormous global inequalities in healthcare,innovative,cost-effective solutions aimed at reducing socio-economic barriers,such as the ALIVE Vent,can help enable access to prompt healthcare and life saving technology on a global scale and beyond COVID-19.

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,

Application of non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure in ICU

Objective:To observe the application effect of non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure in ICU.Methods:A total of 80 patients with acute heart failure merged with respiratory failure who were admitted in ICU from January, 2015 to January, 2016 were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the two groups were given routine treatments after admission. On this basis, the patients in the observation group were given non-invasive ventilator. The patients in the control group were given continuous low flow oxygen inhalation. PaO2, pH, PaCO2, SaO2, and PaO2/FiO2 before and after treatment between the two groups were compared. The serum NT-pro BNP and cTnI levels before treatment, 24 h and 48 h after treatment in the two groups were compared.Results:The comparison of PaO2, pH, PaCO2, SaO2, and PaO2/FiO2 before treatment between the two groups was not statistically significant. PaO2, pH, SaO2, and PaO2/FiO2 after treatment in the two groups were significantly elevated, while PaCO2 was significantly reduced when compared with before treatment. PaO2, pH, SaO2, and PaO2/FiO2 after treatment in the observation group were significantly higher than those in the control group, while PaCO2 was significantly lower than that in the control group. The comparison of NT-pro BNP and cTnI levels before treatment between the two groups was not statistically significant. NT-pro BNP and cTnI levels 12 h and 24 h after treatment in the two groups were significantly elevated when compared with before treatment. NT-pro BNP and cTnI levels 12 h and 24 h after treatment in the observation group were significantly lower than those in the control group.Conclusions:Non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure can effectively improve the ventilation function, reduce NT-pro BNP and cTnI levels, and is of great significance in enhancing the rescued effect.

Respiratory evaluation of patients requiring ventilator support due to acute respiratory failure

This review, based on relevant published evidence and the authors` clinical experience, presents how to evaluate a patient with acute respiratory failure requiring ventilatory support. This patient must be carefully evaluated by nurses, physiotherapists, respiratory care practitioners and physicians regarding the elucidation of the cause of the acute episode of respiratory failure by means of physical examination with the measurement of respiratory parameters and assessment of arterial blood gases analysis to make a correct respiratory diagnosis. After the initial evaluation, the patient must quickly receive adequate oxygen and ventilatory support that has to be carefully monitored until its discontinuation. When available, a noninvasive ventilation trial must be done in patients presenting desaturation during oxygen mask and or PaCO2 retention, especially in cases of cardiogenic pulmonary edema and severe exacerbation of chronic obstructive pulmonary disease. In cases of noninvasive ventilation trial-failure, endotracheal intubation and invasive protective mechanical ventilation must be promptly initiated. In severe ARDS patients, low tidal ventilation, higher PEEP levels, prone positioning and recruitment maneuvers with adequate PEEP titration should be used. Recently, new modes of ventilation should allow a better patient-ventilator interaction or synchrony permitting a sufficient unloading of respiratory muscles and increase patient comfort. Patients with chronic obstructive pulmonary disease may be considered for a trial for early extubation to noninvasive positive pressure ventilation in centers with extensive experience in noninvasive positive pressure ventilation.

Effect of Shenqi Fuzheng Injection and naloxone and BiPAP ventilator on serum inflammatory factors, immune function and blood gas analysis indexes in patients with AECOPD with type Ⅱ respiratory failure

Objective: To investigate the effect of Shenqi Fuzheng Injection combined with naloxone and BiPAP ventilator on serum inflammatory factors, immune function and blood gas analysis indexes in treatment of AECOPD with type Ⅱ respiratory failure. Methods: A total of 82 patients with AECOPD and type Ⅱ respiratory failure were divided into control group (n=40) and observation group (n=42) according to random data table, patients in the control group received naloxone and BiPAP ventilator therapy, and observation group patients were treated with Shenqi Fuzheng Injection on the basis of control group. The levels of serum inflammatory factors, immune function and blood gas analysis indexes were compared between the two groups before and after treatment. Results: There were no significant difference in levels of CRP, TNF-α, IL-6, CD3+, CD4+, CD8+, CD4+/CD8+, PaO2, PaCO2, SaO2 and pH before and after treatment in the two groups. After treatment, the levels of CRP, TNF-α, IL-6, CD8+and PaCO2 in two groups were significantly lower than those in same group before treatment, moreover observation group was significantly lower than control group;and levels of CRP, TNF-α, IL-6, CD8+ and PaCO2 in the observation group was significantly lower than those of the control group, the difference was statistically significant;When compared with the group before treatment, CD3+, CD4+, CD4+/CD8+, PaO2, SaO2 and pH levels of both groups after treatment were significantly increased, and the level of each index of observation group after treatment were significantly higher than the control group, the difference was statistically significant. Conclusion: The clinical effect of Shenqi Fuzheng Injection Combined with naloxone and BiPAP ventilator in treatment of AECOPD with type II respiratory failure is significant, can effectively reduce the body's inflammatory reaction, improve immune function, regulate blood gas analysis index, with a certain clinical value.

An Analysis of Nursing Factors Affecting Flatulence in Patients with Non-Invasive Ventilator Assisted Therapy

Objective:To analyze the factors of flatulence in patients treated with non-invasive ventilator and summarize practical and effective nursing measures.Methods:From July 2020 to June 2021,40 patients who complained of flatulence after using non-invasive ventilator were analyzed.Results:20 cases of abdominal distension were caused by the habit of breathing with their mouth open,10 cases of abdominal distention were caused by liking to eat soup,10 cases of abdominal distention were caused by long-term bed-in-bed activity reduced gastrointestinal peristalsis constipation.Conclusion:We should investigate the causes causing gastrointestinal flatulence with the use of non-invasive ventilators,intervene in advance,boost patient comfort,collaborate with therapy,and improve the therapeutic result.

Case Analysis of a Pump-Driven Heat Pipe Heat Recovery Ventilator in an Existing Experiment Building

The building energy consumption is an important part among the total society energy consumption,in which the energy consumption for air conditioning occupies almost 70%.The energy consumption of the air conditioning system for fresh air handling can be saved effectively when the exhaust air energy could be recovered to preheat or precool the fresh air.Considering the install locations requirements on field,the pump-driven heat pipes(PHP)were developed as heat recovery ventilators(HRVs)and used in an existing experiment building in Beijing Urban.The thermal performance of the PHP HRVs was tested in real operation time periods under winter running mode.Both the power and heat consumption of the modular air handling units with and without HRVs were monitored and obtained,as well as the hourly power and heat consumption.The energy savings of HRVs were analyzed.The results indicate that the PHP HRVs can work steadily and meet the energy recovery need well.The temperature effectiveness of the HRVs can be kept from 60%to 70%.The test total energy saving rate was 24.48%,and the average hourly heat consumption reduced by 28.54%.The daily energy consumption can be saved by 118 kWh,and the energy savings can reach to 9440 kWh for a whole winter.

The Observation on Risk of Ventilator Failure Weaning by Ultrasound bedside Monitoring of Inferior Vena Cava and Lung B Line

Objective: This study was designed to investigate risk of ventilator weaning by ultrasound bedside monitoring of the width of inferior vena cava (IVC) and the number of lung B-lines (B-lines). Methods: This study was conducted on 106 patients from January 2019 to January 2020 who had mechanical ventilation for more than 48 hours in an emergency care unit. They were clinically stable and had the criteria for weaning from the ventilator. Before Spontaneous Breathing Test (SBT) and 30 min or 120 min after SBT, the width of IVC and the number of B-lines in patients were monitored via bedside ultrasound. There were 87 cases of successful weaning as a control group and 19 cases of ventilator failure weaning as a study group. Changes of the width of IVC and the number of B-lines were compared in the different stages of SBT. Results: A total of 106 patients were included in this study. There were 87 cases of ventilator successful weaning and 19 cases failure weaning. The weaning success rate was 82.08%. The width of IVC and the number of B-lines in the study group were higher than those in the control group in same stage of SBT, the difference was statistically significant (P < 0.05), and which increased significantly with time. There was no significant difference in the width of IVC and the number of B-lines on the different stage of SBT in the control group (P > 0.05), and significant difference in the study group. Conclusion: The width of IVC and the number of B-lines monitored by bedside ultrasound can assess the risk of ventilator weaning, it may be caused by cardiopulmonary interaction.

Indoor Air Quality Measurement with the Installation of a Rooftop Turbine Ventilator

The present paper presents a numerical analysis of the difference in comfort level inside a room of a residential building when roof top turbine ventilator is installed. This analysis simulates various comfort factors which includes the indoor air movement, room temperature, Predicted Mean Vote (PMV) and Predicted Percentage of Dissatisfied (PPD). Various test cases of ventilator exhaust rate were examined. The results showed that general comfort satisfying international standards in building can be achieved. This study also presents a qualitative and quantitative study of indoor air temperature and overall indoor air flow pattern. A promising conclusion that can be drawn from this study is that wind driven ventilators can play an important role in the design of a cost effective and energy efficient ventilation system inside a building.

Ventilator performance evaluation system based on virtual instruments

A virtual instrument system is proposed to test the performance parameters of local-ventilator installed under coal mines,which can do ventilator parameter acquisition automatically,as well as plot and analyze the ventilator performance curve.The whole system is designed using the virtual instrument technology combined with network technology based on Labview platform.Experimental results show that it can monitor and evaluate ventilator’s performance parameters automatically and efficiently,which provides critical information for ventilator safety under coal mine.