Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation

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.

Clinical profile of mechanically ventilated COVID-19 patients:A retrospective observational study from Dubai

Background:We did a retrospective analysis of critical coronavirus disease 2019(COVID-19)patients admitted to our intensive care unit(ICU).The objective was to evaluate the outcome,risk factors and effect of prone position in critically ill patients requiring invasive mechanical ventilation(IMV).Patients and methods:The data were collected regarding demographics,comorbidities,laboratory parameters and treatment.Logistic regression was used for analysis of the association of risk factors to the outcome.Results:From 15 March to 30 May 2020,35(59.3%)out of 59 critical COVID-19 requiring IMV were admitted to a tertiary care hospital in Dubai.The day-28 ICU mortality was 28.8% and 48.6% in patients requiring IMV.Prone position(PP)was used in 17(48.6%)patients for median duration of 19(5-20)hours with significant PaO_(2)/FiO_(2) improvement.Acute kidney injury was common(30.5%),and half of the patients required renal replacement therapy(RRT)with higher mortality(77.8%).Lactate dehydrogenase(LDH)odd ratio(OR)-1.006[95%CI-1.00-1.01],D-dimer(OR-1.003[1.000-1.000]),low total leucocyte count(OR-1.135[1.01-1.28]),and lymphopenia(OR-0.909[0.84-0.98])were independently associated with increased risk of IMV.Conclusions:IMV requirement in patients with COVID-19 is associated with higher mortality.Inflammatory markers like LDH,D-dimer,and lymphopenia can be used to predict the prognosis.The patients with COVID-19 on IMV respond significantly with prone position,and it should be considered early with a longer duration.

呼吸机辅助急诊治疗老年急性呼吸衰竭的效果

目的:分析呼吸机辅助急诊治疗老年急性呼吸衰竭的作用。方法:选取2021年1月—2022年12月固原市人民医院收治的老年急性呼吸衰竭患者60例为研究对象,按随机数字分配表法分为对照组与观察组,各30例。对照组采用常规临床急诊治疗,观察组在对照组基础上予以呼吸机辅助治疗。比较两组临床疗效、生命体征指征、血气指标。结果:观察组临床疗效有效率高于对照组,差异有统计学意义(P=0.038);治疗后,两组心率、呼吸频率、舒张压、收缩压均降低,观察组低于对照组,差异有统计学意义(P<0.001);治疗后,两组血氧分压、动脉血二氧化碳分压、血氧饱和度水平均优于治疗前,观察组优于对照组,差异有统计学意义(P<0.001)。结论:在老年急性呼吸衰竭患者急诊治疗中予以呼吸机辅助治疗,可提高临床疗效,改善患者各项生命体征及血气指标,临床应用价值较高。

Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome

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.

ICU急性呼吸衰竭患者外周血HCAR、DcR3、AQP-5水平与机械通气撤机结局的关系及价值分析

目的 探究重症监护室(ICU)急性呼吸衰竭患者外周血超敏C反应蛋白与白蛋白比值(HCAR)、诱骗受体3(DcR3)、水通道蛋白-5(AQP-5)水平与机械通气撤机结局的关系及临床价值。方法 选取连云港市第二人民医院2018年8月—2021年8月ICU急性呼吸衰竭患者120例,均行机械通气治疗,在符合自主呼吸试验(SBT)指征且通过30 min SBT后撤机,根据撤机后48 h内是否再插管分为撤机成功组(87例)和撤机失败组(33例),撤机前采集外周血检测HCAR、DcR3、AQP-5水平,分析外周血HCAR、DcR3、AQP-5水平与撤机结局的关系及预测价值。结果 两组呼吸衰竭类型、合并器官功能障碍综合征(MODS)、肺部超声评分(LUS)、急性生理与慢性健康评价系统Ⅱ(APACHEⅡ)评分差异有统计学意义(P<0.05);撤机失败组外周血HCAR、DcR3高于撤机成功组,AQP-5低于撤机成功组(P<0.05);Pearson相关性分析显示外周血HCAR、DcR3与LUS、APACHEⅡ评分呈正相关,AQP-5与LUS、APACHEⅡ评分呈负相关(P<0.05);单因素、多因素分析均显示,外周血HCAR、DcR3、AQP-5影响撤机结局(P<0.05);外周血HCAR、DcR3、AQP-5预测撤机失败的截断值分别为4.10 mg/g、14.55μg/L、7.91μg/L,联合预测撤机失败的曲线下面积(AUC)为0.915(95%CI:0.850~0.958),大于各指标单独预测;以截断值为界分为低水平与高水平,外周血HCAR、DcR3高水平患者30 d生存率低于低水平患者,外周血AQP-5高水平患者30 d生存率高于低水平患者(P<0.05)。结论 ICU急性呼吸衰竭患者外周血HCAR、DcR3、AQP-5水平与撤机结局密切相关,联合检测可作为预测撤机失败的重要辅助手段,还能帮助临床判断死亡风险,为临床提供可靠的数据支持。

Hygrometry behavior during high-flow nasal oxygen therapy and non-invasive mechanical ventilation:A narrative review of bench to clinical studies

Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal inflammation.With the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.However,we cannot always assume stable humidification.Similarly,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of care.NIV disturbs the normal physiological system that warms and humidifies inspired gases.If NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness increases.In addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired gas.Obstructive sleep apnea syndrome is one of the most important indications for chronic use of NIV at home.Available data suggest that up to 60%of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and nose.Therefore,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with treatment.We aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.

急性呼吸衰竭患者血清超敏C反应蛋白/白蛋白比值、诱骗受体3与撤机结局的关系

目的:分析外周血超敏C反应蛋白/白蛋白比值(HCAR)、诱骗受体3(DcR3)与急性呼吸衰竭患者机械通气撤机结局的关系。方法:选取2020年11月至2021年11月接受机械通气治疗的102例急性呼吸衰竭患者为研究对象,根据撤机结局分为撤机失败组(n=21)、撤机成功组(n=81)。比较两组自主呼吸测试(SBT)前、撤机后外周血HCAR、DcR3水平,分析HCAR、DcR3水平与急性呼吸衰竭患者撤机失败的关系,外周血HCAR、DcR3水平联合对急性呼吸衰竭患者撤机失败的预测价值,分析不同水平HCAR、DcR3发生撤机失败危险度。结果:撤机失败组SBT前、撤机后外周血HCAR、DcR3水平高于撤机成功组(P<0.05);Logistic分析发现,外周血HCAR、DcR3水平与急性呼吸衰竭患者撤机失败显著相关(P<0.05);SBT前、撤机后外周血HCAR、DcR3水平联合预测优于单独预测;SBT前、撤机后外周血HCAR、DcR3水平高水平发生撤机失败的危险度是低水平的1.125、1.633、1.893、2.236倍(P<0.05)。结论:急性呼吸衰竭患者外周血HCAR、DcR3水平增加,各指标联合可以为预测急性呼吸衰竭患者机械通气撤机结局提供参考。

无创机械通气治疗急性呼吸衰竭的临床效果

目的探讨无创机械通气治疗急性呼吸衰竭临床效果。方法选取我院2023年1月至2023年12月120例急性呼吸衰竭患者,用随机数字表法分成对照组(常规急诊治疗)和研究组(无创机械通气治疗),各60例。对比两组患者的肺功能指标、生命体征和血气分析指标。结果在治疗后,两组FEV1、PEF、FEV1/FVC均高于治疗前,且研究组均高于对照组(P<0.05)。研究组患者呼吸频率和心率低于对照组(P<0.05)。在血气分析指标中,研究组患者PaCO2和PaO2指标优于对照组(P<0.05)。结论在急性呼吸衰竭患者中采用无创机械通气治疗能够有效改善患者的治疗效果,稳定生命体征,较好的控制血气分析指标。

西维来司他钠治疗脓毒症伴急性呼吸窘迫综合征的效果观察

目的:观察西维来司他钠治疗脓毒症伴急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的效果。方法:将阳江市人民医院2023年6—12月收治的脓毒症伴ARDS患者总计60例,以随机数字表法分成两组,各30例,其中一组以常规治疗为对照组,另一组以常规治疗配合西维来司他钠治疗为研究组,均治疗7 d。比较两组血清学指标(炎症指标、血小板计数、血气指标),急性生理和慢性健康状况Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、肺损伤评分,序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分,机械通气时间及病死率。结果:治疗前,两组炎症指标、血气指标、血小板计数、APACHEⅡ评分、肺损伤评分、SOFA评分相比,差异均无统计学意义(P>0.05);治疗后,两组血清炎症指标、动脉血二氧化碳分压、APACHEⅡ评分、肺损伤评分、SOFA评分均较治疗前显著下降,且研究组均低于对照组,动脉血氧饱和度及血小板计数均较治疗前提升,研究组均高于对照组,差异均有统计学意义(P<0.05)。研究组机械通气时间短于对照组,差异有统计学意义(P<0.05)。两组的14 d病死率相比,差异无统计学意义(P>0.05)。结论:脓毒症伴急性呼吸窘迫综合征患者在接受西维来司他钠治疗,可显著减轻患者的血清炎症指标水平,改善血气指标,减轻肺损伤,缩短患者的机械通气时间,效果理想。

银环蛇咬伤致急性呼吸衰竭的治疗及临床观察

目的分析银环蛇咬伤致急性呼吸衰竭的治疗及临床观察。方法对2020年1月至2022年12月在我院治疗的60例银环蛇咬伤致急性呼吸衰竭患者的临床资料进行分析,并总结治疗经验。结果60例银环蛇咬伤致急性呼吸衰竭患者均抢救成功,治疗期间未出现严重并发症。结论临床上积极抢救治疗与严密的病情观察对挽救银环蛇咬伤致急性呼吸衰竭患者的生命至关重要。

无创机械通气在早期急性重症有机磷农药中毒致呼吸衰竭患者急救中的应用效果

目的:观察无创机械通气在早期急性重症有机磷农药中毒致呼吸衰竭患者急救中的应用效果。方法:回顾性分析2018年3月至2023年2月该院收治的80例早期重症有机磷农药中毒致呼吸衰竭患者的临床资料,根据治疗方法不同将其分为对照组和观察组各40例。两组均给予有机磷农药中毒对症治疗,在此基础上,对照组给予经鼻导管/面罩吸氧,观察组给予经面罩无创机械通气,比较两组临床疗效、意识恢复时间、住院时间,治疗前、治疗1周后血气指标[氧合指数、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]水平,生命质量[生活质量综合评定问卷-74(GQOLI-74)]评分,以及治疗1周内并发症发生率。结果:观察组治疗总有效率为95.00%(38/40),高于对照组的77.50%(31/40),差异有统计学意义(P<0.05);观察组意识恢复时间、住院时间均短于对照组,差异有统计学意义(P<0.05);治疗后,观察组氧合指数、PaO_(2)水平均高于对照组,PaCO_(2)水平低于对照组,差异有统计学意义(P<0.05);观察组治疗后社会功能、心理功能、躯体功能、物质生活等GQOLI-74评分均高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为5.00%(2/40),低于对照组的22.50%(9/40),差异有统计学意义(P<0.05)。结论:无创机械通气应用于早期急性重症有机磷农药中毒患者可提高治疗总有效率和生命质量评分,缩短意识恢复时间和住院时间,改善血气指标,降低并发症发生率,效果优于经鼻导管/面罩吸氧。

AECOPD合并Ⅱ型呼吸衰竭机械通气患者肺部感染的特征及其危险因素分析

目的分析慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭患者接受机械通气治疗后发生肺部感染的特点和危险因素,为机械通气患者的临床诊疗和预防肺部感染提供依据。方法回顾性分析2021年1月至2022年11月368例AECOPD合并Ⅱ型呼吸衰竭患者的临床资料,根据机械通气治疗后是否存在肺部感染分为A组(感染组159例)、B组(未感染组209例),分析患者患有肺部感染的概率,及引发肺部感染的危险因素。结果159例患者存在肺部感染,占比43.21%,其痰液或分泌物培养共分离出178株病原菌。多因素回归分析年龄≥65岁、居住地为农村、具有长期吸烟行为且机体患有3种及以上基础疾病者、切开气管、接受机械通气治疗时间>5 d、存在侵入性操作、吸痰较为频繁是出现肺部感染的危险因素。结论在基础疾病、吸烟等多种因素影响下,AECOPD合并Ⅱ型呼吸衰竭可增加肺部感染发生风险,临床诊疗应采取针对性的应对措施,最大限度降低肺部感染的风险。

电子支气管镜肺泡灌洗联合机械通气序贯治疗慢性阻塞性肺疾病伴急性呼吸衰竭的效果

目的探讨慢性阻塞性肺疾病(简称慢阻肺)伴急性呼吸衰竭患者联合应用电子支气管镜肺泡灌洗治疗、机械通气序贯治疗的临床效果。方法选取2020年1月—2024年1月阿克苏地区第一人民医院收治的120例慢阻肺伴急性呼吸衰竭患者为研究对象,按治疗方法不同分为两组,各60例。对照组给予机械通气序贯治疗,观察组给予机械通气序贯治疗同时应用电子支气管镜肺泡灌洗治疗。比较两组临床疗效、总通气时间、总住院治疗时间、二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))、血氧分压(partial pressure of blood oxygen,PaO_(2))、呼气峰值流量(peak expiratory flow,PEF)、肺总量(total lung capacity,TLC)、C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-8(interleukin-8,IL-8)、降钙素原(procalcitonin,PCT)水平。结果观察组治疗总有效率为93.33%(56/60),高于对照组的78.33%(47/60),差异有统计学意义(χ^(2)=5.551,P=0.018)。观察组总通气时间、总住院治疗时间短于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组PaCO_(2)低于对照组,PaO_(2)、PEF、TLC高于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组患者CRP、IL-6、IL-8、PCT水平低于对照组,差异有统计学意义(P均<0.05)。结论慢阻肺伴急性呼吸衰竭患者经机械通气序贯治疗基础上,与电子支气管镜肺泡灌洗联合应用效果确切,能够进一步缩短机械通气时间,改善血气及肺功能指标水平,促进炎症因子表达下调。

小潮气量肺保护通气治疗急性有机磷农药中毒所致呼吸衰竭的临床效果分析

目的探讨小潮气量肺保护通气治疗急性有机磷农药中毒(Acute Organophosphorus Pesticide Poisoning,AOPP)所致呼吸衰竭患者的临床疗效。方法回顾性选取2021年2月—2023年9月龙岩市武平县医院收治的60例AOPP所致呼吸衰竭患者的临床资料,依据不同治疗方法分为两组,每组30例。对照组采用常规机械通气治疗,观察组采用小潮气量肺保护通气治疗。比较两组患者血气分析指标、康复效果、氧化应激水平及不良反应发生情况。结果治疗后,观察组康复时间短于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者血气分析指标、氧化应激水平比较,差异无统计学意义(P均>0.05);治疗后,观察组动脉血氧分压、超氧化物歧化酶、血氧饱和度、定谷胱甘肽水平高于对照组,动脉血二氧化碳分压、丙二醛指标低于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率为6.67%,与对照组的16.67%相比,差异无统计学意义(χ^(2)=0.647,P=0.421)。结论小潮气量肺保护通气治疗急性有机磷农药中毒所致呼吸衰竭患者可有效缓解氧化应激损伤,调节血气分析指标水平,促进患者康复。

无创机械通气对AECOPD合并呼吸衰竭患者睡眠质量、认知功能的影响

目的:分析无创机械通气对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者睡眠质量与认知功能的影响。方法:选取2022年8月至2024年2月泉州市第一医院G2呼吸与危重症医学科收治的AECOPD合并I型呼吸衰竭患者90例作为研究对象,按照随机数字表法分为对照组和观察组,每组45例。对照组采用经鼻导管高流量吸氧干预,观察组采用无创机械通气干预。比较2组患者干预前后的血气参数变化,包括动脉血氧分压(PO_(2))、二氧化碳分压(PCO_(2))与氧合指数(OI),采用匹兹堡睡眠质量指数(PSQI)比较2组患者干预前后睡眠质量的变化,采用蒙特利尔认知评估量表(MoCA)评估2组患者干预前后的认知功能。结果:干预后,观察组72 h动脉血氧分压(PO_(2))与氧合指数(OI)高于对照组,观察组PCO_(2)显著低于对照组,差异均有统计学意义(均P<0.05);干预后,观察组PSQI评分显著低于对照组,观察组MoCA评分显著高于对照组,差异均有统计学意义(均P<0.05)。结论:无创机械通气可有效纠正AECOPD合并呼吸衰竭患者缺氧状态,改善认知功能与睡眠质量,值得临床推广应用。

急性呼吸衰竭患者机械通气过程中血乳酸、血清白蛋白的变化及其对撤机结局的影响

目的:分析急性呼吸衰竭患者机械通气过程中血乳酸、血清白蛋白的变化及其对撤机结局的影响。方法:回顾性收集本院2020年6月-2022年5月期间接受机械通气治疗的106例急性呼吸衰竭患者的临床资料。并于撤机前完成血清白蛋白、血乳酸水平检测。根据撤机结局将患者分为撤机失败组和撤机成功组。设计基线资料收集表,将可能的影响因素纳入。经Logistic回归分析检验找出影响急性呼吸衰竭患者机械通气撤机结局的因素。结果:106例急性呼吸衰竭患者资料中撤机失败31例,占比29.25%。撤机失败组中长期吸烟史占比、血乳酸水平均显著高于撤机成功组,机械通气时间显著长于撤机成功组,血清白蛋白水平显著低于撤机成功组(P<0.05)。两组的年龄、性别、体重指数、动脉血氧分压、动脉二氧化碳分压进行比较,差异均无统计学意义(P>0.05)。经Logistic回归分析结果显示,长期吸烟史、机械通气时间长及血乳酸高表达是急性呼吸衰竭患者机械通气撤机结局的危险因素(OR>1,P<0.05),血清白蛋白高表达是其保护因素(OR<1,P<0.05)。结论:急性呼吸衰竭患者机械通气过程中血乳酸高表达、血清白蛋白低表达可增加撤机失败的风险,且长期吸烟史、机械通气时间与急性呼吸衰竭患者撤机结局有关。

中医康复护理对慢性阻塞性肺疾病急性加重期合并呼吸衰竭无创机械通气患者的影响

目的:探讨中医康复护理对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭无创机械通气患者的影响。方法:选取2022年8月—2024年2月在淮安市楚州中医院接受无创机械通气的AECOPD合并呼吸衰竭患者70例进行研究,随机分为观察组与对照组,各35例。对照组给予常规护理,观察组在对照组基础上给予中医康复护理。比较两组护理效果、咳痰与气促症状评分、肺功能、生活质量。结果:观察组总有效率高于对照组(P=0.046);护理后,两组咳痰、气促症状评分及圣乔治呼吸问卷评分低于护理前,观察组低于对照组(P<0.001);护理后,两组用力肺活量、第1秒用力呼气容积高于护理前,观察组高于对照组(P<0.001)。结论:中医康复护理在AECOPD合并呼吸衰竭无创机械通气患者中的应用效果显著,可缓解临床症状,改善患者肺功能,提高生活质量。

Clinical outcomes in patients with ICU-related pancreatitis

AIM:To identify risk factors predictive of intensive care unit(ICU) mortality in patients with ventilator-related pancreatitis.The clinical outcomes of patients with ventilator-related pancreatitis were compared with those of patients with pancreatitis-related respiratory failure as well as controls.METHODS:One hundred and forty-eight patients with respiratory failure requiring mechanical ventilation and concomitant acute pancreatitis were identified from a prospectively collected dataset of 9108 consecutive patients admitted with respiratory failure over a period of five years.Sixty patients met the criteria for ventilator-related pancreatitis,and 88(control patients),for pancreatitis-related respiratory failure.RESULTS:Mortality rate in ventilator-related pancreatitis was comparable to that in ICU patients without pancreatitis by case-control methodology(P=0.544).Multivariate logistic regression analysis identified low PaO2/FiO2(OR:1.032,95% CI:1.006-1.059,P=0.016) as an independent risk factor for mortality in patients with ventilator-related pancreatitis.The mortality rate in patients with ventilator-related pancreatitis was lower than that in patients with acute pancreatitis-related respiratory failure(P<0.001).CONCLUSION:We found that low PaO2/FiO2 was an independent clinical parameter predictive of ICU mortality in patients with ventilator-related pancreatitis.

Critically ill patients with cancer: A clinical perspective

Cancer patients account for 15%of all admissions to intensive care unit(ICU)and 5%will experience a critical illness resulting in ICU admission.Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods.Since early critical care and organ support is associated with improved survival,timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying.This article focused on relevant and current information on epidemiology,diagnosis,and treatment of the main clinical disorders experienced by critically ill cancer patients.

Oxygenation strategy during acute respiratory failure in immunocompromised patients

Acute respiratory failure(ARF)in immunocompromised patients remains challenging to treat.A large number of case require admission to intensive care unit(ICU)where mortality remains high.Oxygenation without intubation is important in this setting.This review summarizes recent studies assessing oxygenation devices for immunocompromised patients.Previous studies showed that non-invasive ventilation(NIV)has been associated with lower intubation and mortality rates.Indeed,in recent years,the outcomes of immunocompromised patients admitted to the ICU have improved.In the most recent randomized controlled trials,including immunocompromised patients admitted to the ICU with ARF,neither NIV nor high-flow nasal oxygen(HFNO)could reduce the mortality rate.In this setting,other strategies need to be tested to decrease the mortality rate.Early admission strategy and avoiding late failure of oxygenation strategy have been assessed in retrospective studies.However,objective criteria are still lacking to clearly discriminate time to admission or time to intubation.Also,diagnosis strategy may have an impact on intubation or mortality rates.On the other hand,lack of diagnosis has been associated with a higher mortality rate.In conclusion,improving outcomes in immunocompromised patients with ARF may include strategies other than the oxygenation strategy alone.This review discusses other unresolved questions to decrease mortality after ICU admission in such patients.