BACKGROUND A critically ill coronavirus disease 2019(COVID-19)patient complicated by acute respiratory distress syndrome is reported.The patient survived following treatment with awake veno-venous extracorporeal membr...BACKGROUND A critically ill coronavirus disease 2019(COVID-19)patient complicated by acute respiratory distress syndrome is reported.The patient survived following treatment with awake veno-venous extracorporeal membrane oxygenation(ECMO).CASE SUMMARY A 53-year-old male patient attended our hospital following a cough for 11 d and fever for 9 d.According to his computed tomography(CT)scan and real-time reverse transcription–polymerase chain reaction assay of a throat swab,nucleic acid was positive,confirming that he had COVID-19.He was subsequently transferred to the intensive care unit due to respiratory failure.The patient received antiviral drugs,a small dose of glucocorticoid,and respiratory support,including mechanical ventilation,but the treatment effect was poor.On the 28th day after admission,veno-venous ECMO and prone position ventilation(PPV)were performed,combined with awake ECMO and other comprehensive rehabilitation measures.On the 17th day of ECMO,the patient started to improve and his chest CT and lung compliance improved.ECMO was discontinued after 27 days,and mechanical ventilation was also discontinued after 9 days.The patient was then transferred to the rehabilitation department.CONCLUSION COVID-19 can damage lung tissues and cause evident inflammatory exudation,thus affecting oxygenation function.Awake ECMO,PPV,and comprehensive rehabilitation are effective in patients with critical COVID-19 and respiratory failure.展开更多
Background Since the beginning of the coronavirus disease 2019(COVID-19)pandemic,prone positioning has been widely applied for non-intubated,spontaneously breathing patients.However,the efficacy and safety of prone po...Background Since the beginning of the coronavirus disease 2019(COVID-19)pandemic,prone positioning has been widely applied for non-intubated,spontaneously breathing patients.However,the efficacy and safety of prone positioning in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure remain unclear.We aimed to systematically analyze the outcomes associated with awake prone positioning(APP).Methods We conducted a systematic literature search of PubMed/MEDLINE,Cochrane Library,Embase,and Web of Science from January 1,2020,to June 3,2022.This study included adult patients with acute respiratory failure caused by COVID-19.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines were followed,and the study quality was assessed using the Cochrane risk-of-bias tool.The primary outcome was the reported cumulative intubation risk across randomized controlled trials(RCTs),and the effect estimates were calculated as risk ratios(RRs;95%confidence interval[CI]).Results A total of 495 studies were identified,of which 10 fulfilled the selection criteria,and 2294 patients were included.In comparison to supine positioning,APP significantly reduced the need for intubation in the overall population(RR=0.84,95%CI:0.74–0.95).The two groups showed no significant differences in the incidence of adverse events(RR=1.16,95%CI:0.48–2.76).The meta-analysis revealed no difference in mortality between the groups(RR=0.93,95%CI:0.77–1.11).Conclusions APP was safe and reduced the need for intubation in patients with respiratory failure associated with COVID-19.However,it did not significantly reduce mortality in comparison to usual care without prone positioning.展开更多
Introduction:Awake fiberoptic bronchoscopy has long been considered the criterion standard for the management of difficult airways because of large thyroid malignancies.After an unsuccessful attempt to intubate with a...Introduction:Awake fiberoptic bronchoscopy has long been considered the criterion standard for the management of difficult airways because of large thyroid malignancies.After an unsuccessful attempt to intubate with a fiberoptic bronchoscope in the supine position,the decision to switch to the left lateral position was made.We present this case to propose the utilization of the lateral position for awake intubation.Case presentation:We report a rare case of a patient with a large papillary carcinoma of the thyroid planned for surgical excision.The patient presented to our hospital with complaints of difficulty breathing while lying down in the supine position and oozing blood from the necrotic tissue.The breathing difficulties subsided in the lateral position.Conclusion:We demonstrated how the left lateral position with an adjunct maneuver facilitates intubation in large thyroid malignancies.展开更多
目的探讨早期清醒俯卧位在轻中度急性呼吸窘迫综合征(ARDS)患者中的应用效果,并分析影响俯卧位结局的相关因素。方法采用前瞻性队列研究方法,选择2020年1月至2023年6月颍上县人民医院急诊科收治的轻中度ARDS患者作为研究对象,根据俯卧...目的探讨早期清醒俯卧位在轻中度急性呼吸窘迫综合征(ARDS)患者中的应用效果,并分析影响俯卧位结局的相关因素。方法采用前瞻性队列研究方法,选择2020年1月至2023年6月颍上县人民医院急诊科收治的轻中度ARDS患者作为研究对象,根据俯卧位耐受测试结果将患者分为清醒俯卧位组和非俯卧位组。所有患者均按照常规方法给予经鼻高流量氧疗(HFNC);清醒俯卧位组患者在常规治疗的基础上,于入科12 h内接受俯卧位治疗,可分多次进行,至少每日1次,每次至少2 h,为尽量长时间俯卧位,允许患者进行活动或保持身体小角度侧俯。记录入科0、24、48、72 h氧合指数(PaO_(2)/FiO_(2))变化,重症监护病房(ICU)转入率,无创通气(NIV)使用率和使用时间,总住院时间,以及俯卧位患者每日俯卧位时间和俯卧位2 h ROX指数〔脉搏血氧饱和度/吸入氧浓度(SpO_(2)/FiO_(2))与呼吸频率(RR)比值〕。以HFNC顺利停机定义为俯卧位成功,以患者改用NIV或转入ICU治疗定义为俯卧位失败,进行亚组分析,采用二元多因素Logistic回归分析筛选早期清醒俯卧位结局的影响因素。结果最终共纳入107例患者,清醒俯卧位组61例,非俯卧位组46例。两组患者PaO_(2)/FiO_(2)均随入科时间延长逐渐升高;清醒俯卧位组PaO_(2)/FiO_(2)入科24 h即较0 h明显升高〔mmHg(1 mmHg≈0.133 kPa):191.94±17.86比179.24±29.27,P<0.05〕,非俯卧位组72 h时才较0 h出现统计学差异(mmHg:198.24±17.99比181.24±16.62,P<0.05),且清醒俯卧位组入科48 h和72 h PaO_(2)/FiO_(2)均明显高于非俯卧位组。清醒俯卧位组患者NIV使用率明显低于非俯卧位组〔36.1%(22/61)比56.5%(26/46),P<0.05〕;Kaplan-Meier曲线分析进一步证实,清醒俯卧位组患者NIV使用时间更晚,且累积NIV使用率明显低于非俯卧位组(Log-Rank检验:χ^(2)=5.402,P=0.020)。与非俯卧位组比较,清醒俯卧位组ICU转入率明显降低〔11.5%(7/61)比28.3%(13/46),P<0.05〕,HFNC时间、NIV时间、总住院时间明显缩短〔HFNC时间(d):5.71±1.45比7.24±3.36,NIV时间(d):3.27±1.28比4.40±1.47,总住院时间(d):11(7,13)比14(10,19),均P<0.05〕。61例清醒俯卧位患者中,俯卧位成功39例,失败22例。与成功组比较,失败组体质量指数(BMI)更高(kg/m^(2):26.61±4.70比22.91±5.50,P<0.05),PaO_(2)/FiO_(2)、无症状低氧血症比例及俯卧位2 h ROX指数更低〔PaO_(2)/FiO_(2)(mmHg):163.73±24.73比185.69±28.87,无症状低氧血症比例:18.2%(4/22)比46.2%(18/39),俯卧位2 h ROX指数:5.75±1.18比7.21±1.45,均P<0.05〕,每日俯卧位时间更短(h:5.87±2.85比8.05±1.99,P<0.05);二元多因素Logistic回归分析显示,上述因素均为清醒俯卧位结局的影响因素(均P<0.05),其中BMI〔优势比(OR)=1.447,95%可信区间(95%CI)为1.105~2.063〕、非无症状低氧血症(OR=13.274,95%CI为1.548~117.390)为俯卧位失败的危险因素,PaO_(2)/FiO_(2)(OR=0.831,95%CI为0.770~0.907)、每日俯卧位时间(OR=0.482,95%CI为0.236~0.924)、俯卧位2 h ROX指数(OR=0.381,95%CI为0.169~0.861)为保护因素。结论应用HFNC支持的轻中度ARDS患者进行早期清醒俯卧位安全可行,减少了NIV的使用率及使用时间,降低了ICU转入率,缩短了住院时间;较高的BMI和非无症状低氧血症是俯卧位失败的危险因素,较高的PaO_(2)/FiO_(2)和俯卧位2 h ROX指数(即患者对俯卧位的反应性较好)及每日长时间俯卧位可以提高俯卧位成功率。展开更多
文摘BACKGROUND A critically ill coronavirus disease 2019(COVID-19)patient complicated by acute respiratory distress syndrome is reported.The patient survived following treatment with awake veno-venous extracorporeal membrane oxygenation(ECMO).CASE SUMMARY A 53-year-old male patient attended our hospital following a cough for 11 d and fever for 9 d.According to his computed tomography(CT)scan and real-time reverse transcription–polymerase chain reaction assay of a throat swab,nucleic acid was positive,confirming that he had COVID-19.He was subsequently transferred to the intensive care unit due to respiratory failure.The patient received antiviral drugs,a small dose of glucocorticoid,and respiratory support,including mechanical ventilation,but the treatment effect was poor.On the 28th day after admission,veno-venous ECMO and prone position ventilation(PPV)were performed,combined with awake ECMO and other comprehensive rehabilitation measures.On the 17th day of ECMO,the patient started to improve and his chest CT and lung compliance improved.ECMO was discontinued after 27 days,and mechanical ventilation was also discontinued after 9 days.The patient was then transferred to the rehabilitation department.CONCLUSION COVID-19 can damage lung tissues and cause evident inflammatory exudation,thus affecting oxygenation function.Awake ECMO,PPV,and comprehensive rehabilitation are effective in patients with critical COVID-19 and respiratory failure.
基金supported by the Clinical Research Plan of SHDC (grant number:SHDC2020CR2013A)the Clinical Research Plan of SHDC (grant number:SHDC2020CR5010-003).
文摘Background Since the beginning of the coronavirus disease 2019(COVID-19)pandemic,prone positioning has been widely applied for non-intubated,spontaneously breathing patients.However,the efficacy and safety of prone positioning in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure remain unclear.We aimed to systematically analyze the outcomes associated with awake prone positioning(APP).Methods We conducted a systematic literature search of PubMed/MEDLINE,Cochrane Library,Embase,and Web of Science from January 1,2020,to June 3,2022.This study included adult patients with acute respiratory failure caused by COVID-19.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines were followed,and the study quality was assessed using the Cochrane risk-of-bias tool.The primary outcome was the reported cumulative intubation risk across randomized controlled trials(RCTs),and the effect estimates were calculated as risk ratios(RRs;95%confidence interval[CI]).Results A total of 495 studies were identified,of which 10 fulfilled the selection criteria,and 2294 patients were included.In comparison to supine positioning,APP significantly reduced the need for intubation in the overall population(RR=0.84,95%CI:0.74–0.95).The two groups showed no significant differences in the incidence of adverse events(RR=1.16,95%CI:0.48–2.76).The meta-analysis revealed no difference in mortality between the groups(RR=0.93,95%CI:0.77–1.11).Conclusions APP was safe and reduced the need for intubation in patients with respiratory failure associated with COVID-19.However,it did not significantly reduce mortality in comparison to usual care without prone positioning.
文摘Introduction:Awake fiberoptic bronchoscopy has long been considered the criterion standard for the management of difficult airways because of large thyroid malignancies.After an unsuccessful attempt to intubate with a fiberoptic bronchoscope in the supine position,the decision to switch to the left lateral position was made.We present this case to propose the utilization of the lateral position for awake intubation.Case presentation:We report a rare case of a patient with a large papillary carcinoma of the thyroid planned for surgical excision.The patient presented to our hospital with complaints of difficulty breathing while lying down in the supine position and oozing blood from the necrotic tissue.The breathing difficulties subsided in the lateral position.Conclusion:We demonstrated how the left lateral position with an adjunct maneuver facilitates intubation in large thyroid malignancies.
文摘目的探讨早期清醒俯卧位在轻中度急性呼吸窘迫综合征(ARDS)患者中的应用效果,并分析影响俯卧位结局的相关因素。方法采用前瞻性队列研究方法,选择2020年1月至2023年6月颍上县人民医院急诊科收治的轻中度ARDS患者作为研究对象,根据俯卧位耐受测试结果将患者分为清醒俯卧位组和非俯卧位组。所有患者均按照常规方法给予经鼻高流量氧疗(HFNC);清醒俯卧位组患者在常规治疗的基础上,于入科12 h内接受俯卧位治疗,可分多次进行,至少每日1次,每次至少2 h,为尽量长时间俯卧位,允许患者进行活动或保持身体小角度侧俯。记录入科0、24、48、72 h氧合指数(PaO_(2)/FiO_(2))变化,重症监护病房(ICU)转入率,无创通气(NIV)使用率和使用时间,总住院时间,以及俯卧位患者每日俯卧位时间和俯卧位2 h ROX指数〔脉搏血氧饱和度/吸入氧浓度(SpO_(2)/FiO_(2))与呼吸频率(RR)比值〕。以HFNC顺利停机定义为俯卧位成功,以患者改用NIV或转入ICU治疗定义为俯卧位失败,进行亚组分析,采用二元多因素Logistic回归分析筛选早期清醒俯卧位结局的影响因素。结果最终共纳入107例患者,清醒俯卧位组61例,非俯卧位组46例。两组患者PaO_(2)/FiO_(2)均随入科时间延长逐渐升高;清醒俯卧位组PaO_(2)/FiO_(2)入科24 h即较0 h明显升高〔mmHg(1 mmHg≈0.133 kPa):191.94±17.86比179.24±29.27,P<0.05〕,非俯卧位组72 h时才较0 h出现统计学差异(mmHg:198.24±17.99比181.24±16.62,P<0.05),且清醒俯卧位组入科48 h和72 h PaO_(2)/FiO_(2)均明显高于非俯卧位组。清醒俯卧位组患者NIV使用率明显低于非俯卧位组〔36.1%(22/61)比56.5%(26/46),P<0.05〕;Kaplan-Meier曲线分析进一步证实,清醒俯卧位组患者NIV使用时间更晚,且累积NIV使用率明显低于非俯卧位组(Log-Rank检验:χ^(2)=5.402,P=0.020)。与非俯卧位组比较,清醒俯卧位组ICU转入率明显降低〔11.5%(7/61)比28.3%(13/46),P<0.05〕,HFNC时间、NIV时间、总住院时间明显缩短〔HFNC时间(d):5.71±1.45比7.24±3.36,NIV时间(d):3.27±1.28比4.40±1.47,总住院时间(d):11(7,13)比14(10,19),均P<0.05〕。61例清醒俯卧位患者中,俯卧位成功39例,失败22例。与成功组比较,失败组体质量指数(BMI)更高(kg/m^(2):26.61±4.70比22.91±5.50,P<0.05),PaO_(2)/FiO_(2)、无症状低氧血症比例及俯卧位2 h ROX指数更低〔PaO_(2)/FiO_(2)(mmHg):163.73±24.73比185.69±28.87,无症状低氧血症比例:18.2%(4/22)比46.2%(18/39),俯卧位2 h ROX指数:5.75±1.18比7.21±1.45,均P<0.05〕,每日俯卧位时间更短(h:5.87±2.85比8.05±1.99,P<0.05);二元多因素Logistic回归分析显示,上述因素均为清醒俯卧位结局的影响因素(均P<0.05),其中BMI〔优势比(OR)=1.447,95%可信区间(95%CI)为1.105~2.063〕、非无症状低氧血症(OR=13.274,95%CI为1.548~117.390)为俯卧位失败的危险因素,PaO_(2)/FiO_(2)(OR=0.831,95%CI为0.770~0.907)、每日俯卧位时间(OR=0.482,95%CI为0.236~0.924)、俯卧位2 h ROX指数(OR=0.381,95%CI为0.169~0.861)为保护因素。结论应用HFNC支持的轻中度ARDS患者进行早期清醒俯卧位安全可行,减少了NIV的使用率及使用时间,降低了ICU转入率,缩短了住院时间;较高的BMI和非无症状低氧血症是俯卧位失败的危险因素,较高的PaO_(2)/FiO_(2)和俯卧位2 h ROX指数(即患者对俯卧位的反应性较好)及每日长时间俯卧位可以提高俯卧位成功率。
