Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia ...Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。展开更多
Although standard oxygen face masks are first-line therapy for patients with acute hypoxemic respiratory failure,high-flow nasal cannula oxygen therapy has gained major popularity in intensive care units.The physiolog...Although standard oxygen face masks are first-line therapy for patients with acute hypoxemic respiratory failure,high-flow nasal cannula oxygen therapy has gained major popularity in intensive care units.The physiological effects of high-flow oxygen counterbalance the physiological consequences of acute hypoxemic respiratory failure by lessening the deleterious effects of intense and prolonged inspiratory efforts generated by patients.Its simplicity of application for physicians and nurses and its comfort for patients are other arguments for its use in this setting.Although clinical studies have reported a decreased risk of intubation with high-flow oxygen compared with standard oxygen,its survival benefit is uncertain.A more precise definition of acute hypoxemic respiratory failure,including a classification of severity based on oxygenation levels,is needed to better compare the efficiencies of different non-invasive oxygenation support methods(standard oxygen,high-flow oxygen,and non-invasive ventilation).Additionally,the respective role of each non-invasive oxygenation support method needs to be established through further clinical trials in acute hypoxemic respiratory failure,especially in severe forms.展开更多
2023年6月16日,欧洲危重症医学会(the European Society of Intensive Care Medicine,ESICM)在《重症监护医学杂志(Intensive Care Medicine,ICM)》发布了《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》(以下简称2023版指南...2023年6月16日,欧洲危重症医学会(the European Society of Intensive Care Medicine,ESICM)在《重症监护医学杂志(Intensive Care Medicine,ICM)》发布了《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》(以下简称2023版指南)。与2017版指南相比,2023版指南增加了“定义”和“表型”两个领域,但只是进行了阐述,并未给出推荐意见;针对“呼吸支持策略”,2023版指南增加了“经鼻高流量氧疗(high flow nasal cannula oxygen,HFNO)”“无创通气(noninvasive ventilation,NIV)”“神经肌肉阻滞剂”和“体外二氧化碳清除(extracorporeal carbon dioxide removal,ECCO_(2)R)”四个模块,对呼吸支持策略给出了相应的推荐意见;同时还针对2019年新型冠状病毒感染(COVID-19)患者给出了额外的推荐意见。但2023版指南并未明确给出ARDS新定义,2023年7月24日《美国呼吸与危重病医学杂志(American Journal of Respiratory and Critical Care Medicine,AJRCCM)》给出了ARDS的全球新定义,填补了2023版指南的定义部分。本文结合2023版指南及ARDS全球新定义对指南进行了解读,以供重症同仁参考。展开更多
文摘Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。
文摘Although standard oxygen face masks are first-line therapy for patients with acute hypoxemic respiratory failure,high-flow nasal cannula oxygen therapy has gained major popularity in intensive care units.The physiological effects of high-flow oxygen counterbalance the physiological consequences of acute hypoxemic respiratory failure by lessening the deleterious effects of intense and prolonged inspiratory efforts generated by patients.Its simplicity of application for physicians and nurses and its comfort for patients are other arguments for its use in this setting.Although clinical studies have reported a decreased risk of intubation with high-flow oxygen compared with standard oxygen,its survival benefit is uncertain.A more precise definition of acute hypoxemic respiratory failure,including a classification of severity based on oxygenation levels,is needed to better compare the efficiencies of different non-invasive oxygenation support methods(standard oxygen,high-flow oxygen,and non-invasive ventilation).Additionally,the respective role of each non-invasive oxygenation support method needs to be established through further clinical trials in acute hypoxemic respiratory failure,especially in severe forms.
文摘2023年6月16日,欧洲危重症医学会(the European Society of Intensive Care Medicine,ESICM)在《重症监护医学杂志(Intensive Care Medicine,ICM)》发布了《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》(以下简称2023版指南)。与2017版指南相比,2023版指南增加了“定义”和“表型”两个领域,但只是进行了阐述,并未给出推荐意见;针对“呼吸支持策略”,2023版指南增加了“经鼻高流量氧疗(high flow nasal cannula oxygen,HFNO)”“无创通气(noninvasive ventilation,NIV)”“神经肌肉阻滞剂”和“体外二氧化碳清除(extracorporeal carbon dioxide removal,ECCO_(2)R)”四个模块,对呼吸支持策略给出了相应的推荐意见;同时还针对2019年新型冠状病毒感染(COVID-19)患者给出了额外的推荐意见。但2023版指南并未明确给出ARDS新定义,2023年7月24日《美国呼吸与危重病医学杂志(American Journal of Respiratory and Critical Care Medicine,AJRCCM)》给出了ARDS的全球新定义,填补了2023版指南的定义部分。本文结合2023版指南及ARDS全球新定义对指南进行了解读,以供重症同仁参考。
