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 pulmon...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.展开更多
Objective:To compare the survival and length of stay of invasive ventilation(IV)with those of non-invasive ventilation(NIV)in patients with COVID-19 acute respiratory distress syndrome in a single hospital from May 20...Objective:To compare the survival and length of stay of invasive ventilation(IV)with those of non-invasive ventilation(NIV)in patients with COVID-19 acute respiratory distress syndrome in a single hospital from May 2020 to March 2021.Methods:After obtaining approval from the Hospital Director,the data of COVID-19 patients including demographics,type of respiratory support(non-invasive ventilation or invasive ventilation),duration of ventilation,length of stay,discharge,and death were collected and analyzed.Results:Out of the 152 patients identified,134 patients were analyzed.The median intubation days were 10.0(Q1:3.5,Q3:13.5)in the IV group and 0.0(Q1:0.0,Q3:0.0)days in the NIV-only group.Out of the 101 patients who received NIV,43 patients were subsequently intubated due to failure of NIV.Of the 63 patients(47.01%)who died,22(66.66%)were from the IV group and 40(92.02%)were from the NIV-followed-by-intubation group,and 1(1.72%)were from the NIV-only group.Multivariate analysis showed that the presence of a respiratory comorbidity(OR=16.56,95%CI=1.56-175.48,P=0.02)was an independent predictor of survival.Conclusions:Respiratory co-morbidity is a significant adverse predictor of survival outcome.The decision on the type of respiratory support should be made on a patient-to-patient basis.展开更多
Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical vent...Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease.Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database.Intubation rate,mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions(NIV Hospita1)were compared against 13 hospitals using solely invasive ventilation(IMV Hospitals).Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups.Results Both hospital groups had comparable demographics and clinical profiles,but NIV Hospital(42 patients)had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement.Compared to IMV Hospitals(451 patients).NIV Hospital had lower adjusted odds ratios for intubation(0.36,95%C10.164-0.791,P=0.011)and death(0.235.95%C10.077-0.716,P=0.O 11),and improved earlier after pulsed steroid rescue.There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation,non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.展开更多
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...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.展开更多
Objective:To describe the strategies and outcomes of mechanical ventilation in a poorly equipped facility.Methods:This retrospective descriptive study included patients with COVID-19 who were admitted to the intensive...Objective:To describe the strategies and outcomes of mechanical ventilation in a poorly equipped facility.Methods:This retrospective descriptive study included patients with COVID-19 who were admitted to the intensive care unit(ICU)and mechanically ventilated between September 1,2020,and May 31,2021.Data were collected from medical records and databases.Results:54 Patients aged(62.9±13.3)years were included.Among these cases,79.6%had at least one comorbidity.On admission,all patients had hypoxia.The median peripheral oxygen saturation in room air was 76%(61%,83%).Non-invasive ventilation(NIV)was performed in 75.9%of the patients,and invasive mechanical ventilation(IMV)in 68.5%.IMV was performed on patients due to severe coma(8.1%),failure of standard oxygen therapy(27.0%),and failure of NIV(64.9%).An arterial blood gas test was performed in 14.8%of the patients.NIV failed in 90.2%of cases and succeeded in 9.8%.IMV was successful in 5.4%of cases,vs.94.6%of mortality.The overall mortality rate of patients on ventilation in the ICU was 88.9%.The causes of death included severe respiratory distress syndrome(85.2%),multiple organ failure(14.8%),and pulmonary embolism(13.0%).Conclusions:The ventilation management of COVID-19 patients in the ICU with NIV and IMV in a scarce resource setting is associated with a high mortality rate.Shortcomings are identified in ventilation strategies,protocols,and monitoring.Required improvements were also proposed.展开更多
文摘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.
文摘Objective:To compare the survival and length of stay of invasive ventilation(IV)with those of non-invasive ventilation(NIV)in patients with COVID-19 acute respiratory distress syndrome in a single hospital from May 2020 to March 2021.Methods:After obtaining approval from the Hospital Director,the data of COVID-19 patients including demographics,type of respiratory support(non-invasive ventilation or invasive ventilation),duration of ventilation,length of stay,discharge,and death were collected and analyzed.Results:Out of the 152 patients identified,134 patients were analyzed.The median intubation days were 10.0(Q1:3.5,Q3:13.5)in the IV group and 0.0(Q1:0.0,Q3:0.0)days in the NIV-only group.Out of the 101 patients who received NIV,43 patients were subsequently intubated due to failure of NIV.Of the 63 patients(47.01%)who died,22(66.66%)were from the IV group and 40(92.02%)were from the NIV-followed-by-intubation group,and 1(1.72%)were from the NIV-only group.Multivariate analysis showed that the presence of a respiratory comorbidity(OR=16.56,95%CI=1.56-175.48,P=0.02)was an independent predictor of survival.Conclusions:Respiratory co-morbidity is a significant adverse predictor of survival outcome.The decision on the type of respiratory support should be made on a patient-to-patient basis.
基金The authors wish to acknowledge the funding support for the HASARS Database on data collection and management from the Hong Kong Government’s Health,Welfare and Food Bureau and Research Fund for the Control of lnfectious Diseases.
文摘Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease.Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database.Intubation rate,mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions(NIV Hospita1)were compared against 13 hospitals using solely invasive ventilation(IMV Hospitals).Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups.Results Both hospital groups had comparable demographics and clinical profiles,but NIV Hospital(42 patients)had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement.Compared to IMV Hospitals(451 patients).NIV Hospital had lower adjusted odds ratios for intubation(0.36,95%C10.164-0.791,P=0.011)and death(0.235.95%C10.077-0.716,P=0.O 11),and improved earlier after pulsed steroid rescue.There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation,non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.
文摘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.
文摘Objective:To describe the strategies and outcomes of mechanical ventilation in a poorly equipped facility.Methods:This retrospective descriptive study included patients with COVID-19 who were admitted to the intensive care unit(ICU)and mechanically ventilated between September 1,2020,and May 31,2021.Data were collected from medical records and databases.Results:54 Patients aged(62.9±13.3)years were included.Among these cases,79.6%had at least one comorbidity.On admission,all patients had hypoxia.The median peripheral oxygen saturation in room air was 76%(61%,83%).Non-invasive ventilation(NIV)was performed in 75.9%of the patients,and invasive mechanical ventilation(IMV)in 68.5%.IMV was performed on patients due to severe coma(8.1%),failure of standard oxygen therapy(27.0%),and failure of NIV(64.9%).An arterial blood gas test was performed in 14.8%of the patients.NIV failed in 90.2%of cases and succeeded in 9.8%.IMV was successful in 5.4%of cases,vs.94.6%of mortality.The overall mortality rate of patients on ventilation in the ICU was 88.9%.The causes of death included severe respiratory distress syndrome(85.2%),multiple organ failure(14.8%),and pulmonary embolism(13.0%).Conclusions:The ventilation management of COVID-19 patients in the ICU with NIV and IMV in a scarce resource setting is associated with a high mortality rate.Shortcomings are identified in ventilation strategies,protocols,and monitoring.Required improvements were also proposed.
