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
Clinical DataCase selection: 100 cases who met thediagnostic criteria of senile dementiaformulated by American Association ofPsychiatry in Handbook of Diagnosis andStatistics (DSM-Ⅲ-R, 3rd revised edition)
BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comp...BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.展开更多
BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small are...BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small area of the skin.Published cases of HF burns have mostly reported small HF burn areas.Few cases of HF inhalation injury have been reported to date.CASE SUMMARY A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60%of the total body surface area(TBSA),including deep second degree burns on 47%and third degree burns on 13%of the TBSA,after he fell into a pickling pool containing 15%HF.Comprehensive treatments were carried out after the patient was admitted.Ventricular fibrillation occurred 9 times within the first 2 h,and the lowest serum Ca2+concentration was 0.192 mmol/L.A dose of calcium gluconate(37 g)was intravenously supplied during the first 24 h,and the total amount of calcium gluconate supplementation was 343 g.Extracorporeal membrane oxygenation(ECMO)was applied for 8 d to handle the acute respiratory distress syndrome(ARDS)induced by the HF inhalation injury.The patient was discharged after 99 d of comprehensive treatment,including skin grafting.CONCLUSION Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS.Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.展开更多
Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to inve...Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.展开更多
BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.C...BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.CASE SUMMARY In this case report,we describe a case of the successful combination of the prone position(PP)and high-flow nasal oxygen(HFNO)therapy in a spontaneously breathing,severe COVID-19 patient who presented with fever,fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing.The therapy significantly improved the patient's clinical symptoms,oxygenation status,and radiological characteristics of lung injury during hospitalization,and the patient showed good tolerance and avoided intubation.Additionally,we did not find that medical staff wearing optimal airborne personal protective equipment(PPE)were infected by the new coronavirus in our institution.CONCLUSION We conclude that the combination of PP and HFNO could benefit spontaneously breathing,severe COVID-19 patients.The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.展开更多
Coronavirus disease 2019(COVID-19)related acute respiratory distress syndrome(ARDS)is a severe complication of infection with severe acute respiratory syndrome coronavirus 2,and the primary cause of death in the curre...Coronavirus disease 2019(COVID-19)related acute respiratory distress syndrome(ARDS)is a severe complication of infection with severe acute respiratory syndrome coronavirus 2,and the primary cause of death in the current pandemic.Critically ill patients often undergo extracorporeal membrane oxygenation(ECMO)therapy as the last resort over an extended period.ECMO therapy requires sedation of the patient,which is usually achieved by intravenous administration of sedatives.The shortage of intravenous sedative drugs due to the ongoing pandemic,and attempts to improve treatment outcome for COVID-19 patients,drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy.Administration of volatile anesthetics requires an appropriate delivery.Commercially available ones are the anesthetic gas reflection systems AnaConDa®and MIRUSTM,and each should be combined with a gas scavenging system.In this review,we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS.We focus particularly on the technical details of administration of volatile anesthetics.Furthermore,we describe the advantages of inhaled sedation and volatile anesthetics,and we discuss the limitations as well as the requirements for safe application in the clinical setting.展开更多
目的探讨术后延长吸氧时间对老年全膝关节置换术(TKA)病人术后疼痛、炎症因子及免疫功能的影响。方法选取2022年1月至2023年1月西安交通大学第二附属医院收治的拟行TKA治疗的病人142例,男65例,女77例;年龄(73.35±7.30)岁。采用随...目的探讨术后延长吸氧时间对老年全膝关节置换术(TKA)病人术后疼痛、炎症因子及免疫功能的影响。方法选取2022年1月至2023年1月西安交通大学第二附属医院收治的拟行TKA治疗的病人142例,男65例,女77例;年龄(73.35±7.30)岁。采用随机数字表法将病人分为观察组和对照组,每组71例。对照组病人术后给予8 h的常规鼻导管低流量(3 L/min)吸氧,观察组在对照组的基础上延长吸氧时间至术后48 h。观察两组术前和术后8、24、48 h简易精神状态检查量表(MMSE)评分和疼痛视觉模拟量表(VAS)评分,术前和术后8、48 h血清炎症因子和免疫功能指标水平;术前和术后24、48 h脉搏血氧饱和度(SpO_(2))、心率和呼吸频率情况。结果观察组术后24、48 h MMSE评分显著高于对照组(P<0.05),VAS评分显著低于对照组(P<0.05)。两组术后24、48 h VAS评分较术前均显著降低(P<0.05)。对照组术后各时点MMSE评分较术前均显著降低(P<0.05),观察组术后8、24 h MMSE评分显著降低(P<0.05)。观察组术后24、48 h SpO_(2)显著高于对照组(P<0.05),心率、呼吸频率显著低于对照组(P<0.05)。观察组术后48 h白介素-10(IL-10)、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平显著高于对照组(P<0.05),白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平显著低于对照组(P<0.05)。与术前比较,两组术后8、48 h血清IL-6、TNF-α水平均显著升高(P<0.05),CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均显著降低(P<0.05)。结论术后延长吸氧时间可降低老年TKA病人疼痛,提高病人术后免疫功能,改善炎症因子水平。展开更多
目的探讨烧伤合并吸入性损伤患者行机械通气第24小时的氧合指数(OI)对患者预后的影响。方法142例烧伤合并吸入性损伤行机械通气患者,根据第24小时的OI值分为A组[OI≤200 mm Hg(1 mm Hg=0.133 kPa),36例]、B组(200 mm Hg<OI≤300 mm H...目的探讨烧伤合并吸入性损伤患者行机械通气第24小时的氧合指数(OI)对患者预后的影响。方法142例烧伤合并吸入性损伤行机械通气患者,根据第24小时的OI值分为A组[OI≤200 mm Hg(1 mm Hg=0.133 kPa),36例]、B组(200 mm Hg<OI≤300 mm Hg,46例)、C组(OI>300 mm Hg,60例)。比较三组一般资料及预后情况;依据预后情况将患者分为预后不良组(86例)与预后良好组(56例)。采用单因素和多因素Logistic回归分析烧伤合并吸入性损伤机械通气患者预后不良的危险因素。结果三组年龄、烧伤总面积(TBSA)、机械通气前氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))及预后情况比较,差异具有统计学意义(P<0.05)。C组年龄(40.07±21.20)岁小于A组的(54.64±17.83)岁和B组的(51.72±17.99)岁(P<0.05);B组TBSA(60.43±29.04)%和C组TBSA(62.89±24.85)%小于A组的(74.14±21.90)%,预后不良率54.3%、48.3%低于A组的88.9%(P<0.05)。机械通气前,A组和B组PaO_(2)水平显著低于C组,PaCO_(2)高于C组(P<0.05);B和C组SaO_(2)高于A组(P<0.05)。三组机械通气开始时间、三度烧伤面积及入院延迟复苏情况比较差异无统计学意义(P>0.05)。预后不良组与预后良好组患者的年龄、TBSA、机械通气后第24小时OI比较差异具有统计学意义(P<0.05);预后不良组与预后良好组患者的机械通气开始时间、机械通气时间及机械通气前PaO_(2)、PaCO_(2)、SaO_(2)比较差异无统计学意义(P>0.05)。将筛选出P<0.05的因素纳入多元Logistic回归分析,排除混杂因素后,结果显示:机械通气后第24小时OI≤200 mm Hg、TBSA大、老年是烧伤合并吸入性损伤行机械通气患者预后不良的独立危险因素(OR=5.551、1.046、10.187,P<0.05)。结论机械通气第24小时OI≤200 mm Hg的烧伤合并吸入性损伤患者预后不良,TBSA越大,机械通气前PaO_(2)及SaO_(2)越低,通气后第24小时的OI可能越低。展开更多
Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOT)through the nasal cannulae has demonstrated clinical benefits.Limited data exist on whether such effects are also present in HFOT thro...Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOT)through the nasal cannulae has demonstrated clinical benefits.Limited data exist on whether such effects are also present in HFOT through tracheostomy.Hence,we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation.Methods A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical ventilation.The patients underwent a 30-min spontaneous breathing trial(SBT)and received oxygen either via T-piece or by HFOT through tracheostomy,followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner.At the start and end of each session,blood gasses,breathing frequency(f),and tidal volume(VT)via a Wright's spirometer were measured,along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction,which expressed the inspiratory muscle effort.Results Eleven patients were enrolled in whom 19 sessions were uneventfully completed;eight patients were studied twice on two different days with alternate sessions;and three patients were studied once.Patients were randomly assigned to start the SBT with a T-piece(n=10 sessions)or with HFOT(n=9 sessions).With HFOT,VT and minute ventilation(VE)significantly increased during SBT(from[465±119]mL to[549±134]mL,P<0.001 and from[12.4±4.3]L/min to[13.1±4.2]L/min,P<0.05,respectively),but they did not change significantly during SBT with T-piece(from[495±132]mL to[461±123]mL and from[12.8±4.4]mL to[12.0±4.4]mL,respectively);f/VT decreased during HFOT(from[64±31]breaths/(min∙L)to[49±24]breaths/(min∙L),P<0.001),but it did not change significantly during SBT with T-piece(from[59±28]breaths/(min∙L)to[64±33]breaths/(min∙L));partial pressure of arterial oxygen increased during HFOT(from[99±39]mmHg to[132±48]mmHg,P<0.001),but it decreased during SBT with T-piece(from[124±50]mmHg to[83±22]mmHg,P<0.01).In addition,with HFOT,diaphragmatic excursion increased(from[12.9±3.3]mm to[15.7±4.4]mm,P<0.001),but it did not change significantly during SBT with T-piece(from[13.4±3.3]mm to[13.6±3.3]mm).The diaphragmatic thickening fraction did not change during SBT either with T-piece or with HFOT.Conclusion In patients with prolonged mechanical ventilation,HFOT through tracheostomy compared with T-piece improves ventilation,pattern of breathing,and oxygenation without increasing the inspiratory muscle effort.Trial Registration Clinicaltrials.gov ldentifer:NCT04758910.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Clinical DataCase selection: 100 cases who met thediagnostic criteria of senile dementiaformulated by American Association ofPsychiatry in Handbook of Diagnosis andStatistics (DSM-Ⅲ-R, 3rd revised edition)
文摘BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.
基金Supported by the National Nature Science Foundation of China,No.81701899 and No.81671911Youth Incubation Plan of the Military Medical Science and Technology,No.16QNP091+3 种基金Naval Medical University Youth Start-up Fund,No.2016QN10the Logistics Scientific Research Program,No.AWS14C001-4Jiangsu Provincial Health Commission Project,No.H2017071Suzhou Clinical Medical Center Construction Program,No.SZZXJ201506
文摘BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small area of the skin.Published cases of HF burns have mostly reported small HF burn areas.Few cases of HF inhalation injury have been reported to date.CASE SUMMARY A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60%of the total body surface area(TBSA),including deep second degree burns on 47%and third degree burns on 13%of the TBSA,after he fell into a pickling pool containing 15%HF.Comprehensive treatments were carried out after the patient was admitted.Ventricular fibrillation occurred 9 times within the first 2 h,and the lowest serum Ca2+concentration was 0.192 mmol/L.A dose of calcium gluconate(37 g)was intravenously supplied during the first 24 h,and the total amount of calcium gluconate supplementation was 343 g.Extracorporeal membrane oxygenation(ECMO)was applied for 8 d to handle the acute respiratory distress syndrome(ARDS)induced by the HF inhalation injury.The patient was discharged after 99 d of comprehensive treatment,including skin grafting.CONCLUSION Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS.Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.
文摘Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.
文摘BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.CASE SUMMARY In this case report,we describe a case of the successful combination of the prone position(PP)and high-flow nasal oxygen(HFNO)therapy in a spontaneously breathing,severe COVID-19 patient who presented with fever,fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing.The therapy significantly improved the patient's clinical symptoms,oxygenation status,and radiological characteristics of lung injury during hospitalization,and the patient showed good tolerance and avoided intubation.Additionally,we did not find that medical staff wearing optimal airborne personal protective equipment(PPE)were infected by the new coronavirus in our institution.CONCLUSION We conclude that the combination of PP and HFNO could benefit spontaneously breathing,severe COVID-19 patients.The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.
文摘Coronavirus disease 2019(COVID-19)related acute respiratory distress syndrome(ARDS)is a severe complication of infection with severe acute respiratory syndrome coronavirus 2,and the primary cause of death in the current pandemic.Critically ill patients often undergo extracorporeal membrane oxygenation(ECMO)therapy as the last resort over an extended period.ECMO therapy requires sedation of the patient,which is usually achieved by intravenous administration of sedatives.The shortage of intravenous sedative drugs due to the ongoing pandemic,and attempts to improve treatment outcome for COVID-19 patients,drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy.Administration of volatile anesthetics requires an appropriate delivery.Commercially available ones are the anesthetic gas reflection systems AnaConDa®and MIRUSTM,and each should be combined with a gas scavenging system.In this review,we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS.We focus particularly on the technical details of administration of volatile anesthetics.Furthermore,we describe the advantages of inhaled sedation and volatile anesthetics,and we discuss the limitations as well as the requirements for safe application in the clinical setting.
文摘目的探讨术后延长吸氧时间对老年全膝关节置换术(TKA)病人术后疼痛、炎症因子及免疫功能的影响。方法选取2022年1月至2023年1月西安交通大学第二附属医院收治的拟行TKA治疗的病人142例,男65例,女77例;年龄(73.35±7.30)岁。采用随机数字表法将病人分为观察组和对照组,每组71例。对照组病人术后给予8 h的常规鼻导管低流量(3 L/min)吸氧,观察组在对照组的基础上延长吸氧时间至术后48 h。观察两组术前和术后8、24、48 h简易精神状态检查量表(MMSE)评分和疼痛视觉模拟量表(VAS)评分,术前和术后8、48 h血清炎症因子和免疫功能指标水平;术前和术后24、48 h脉搏血氧饱和度(SpO_(2))、心率和呼吸频率情况。结果观察组术后24、48 h MMSE评分显著高于对照组(P<0.05),VAS评分显著低于对照组(P<0.05)。两组术后24、48 h VAS评分较术前均显著降低(P<0.05)。对照组术后各时点MMSE评分较术前均显著降低(P<0.05),观察组术后8、24 h MMSE评分显著降低(P<0.05)。观察组术后24、48 h SpO_(2)显著高于对照组(P<0.05),心率、呼吸频率显著低于对照组(P<0.05)。观察组术后48 h白介素-10(IL-10)、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平显著高于对照组(P<0.05),白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平显著低于对照组(P<0.05)。与术前比较,两组术后8、48 h血清IL-6、TNF-α水平均显著升高(P<0.05),CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均显著降低(P<0.05)。结论术后延长吸氧时间可降低老年TKA病人疼痛,提高病人术后免疫功能,改善炎症因子水平。
文摘目的探讨烧伤合并吸入性损伤患者行机械通气第24小时的氧合指数(OI)对患者预后的影响。方法142例烧伤合并吸入性损伤行机械通气患者,根据第24小时的OI值分为A组[OI≤200 mm Hg(1 mm Hg=0.133 kPa),36例]、B组(200 mm Hg<OI≤300 mm Hg,46例)、C组(OI>300 mm Hg,60例)。比较三组一般资料及预后情况;依据预后情况将患者分为预后不良组(86例)与预后良好组(56例)。采用单因素和多因素Logistic回归分析烧伤合并吸入性损伤机械通气患者预后不良的危险因素。结果三组年龄、烧伤总面积(TBSA)、机械通气前氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))及预后情况比较,差异具有统计学意义(P<0.05)。C组年龄(40.07±21.20)岁小于A组的(54.64±17.83)岁和B组的(51.72±17.99)岁(P<0.05);B组TBSA(60.43±29.04)%和C组TBSA(62.89±24.85)%小于A组的(74.14±21.90)%,预后不良率54.3%、48.3%低于A组的88.9%(P<0.05)。机械通气前,A组和B组PaO_(2)水平显著低于C组,PaCO_(2)高于C组(P<0.05);B和C组SaO_(2)高于A组(P<0.05)。三组机械通气开始时间、三度烧伤面积及入院延迟复苏情况比较差异无统计学意义(P>0.05)。预后不良组与预后良好组患者的年龄、TBSA、机械通气后第24小时OI比较差异具有统计学意义(P<0.05);预后不良组与预后良好组患者的机械通气开始时间、机械通气时间及机械通气前PaO_(2)、PaCO_(2)、SaO_(2)比较差异无统计学意义(P>0.05)。将筛选出P<0.05的因素纳入多元Logistic回归分析,排除混杂因素后,结果显示:机械通气后第24小时OI≤200 mm Hg、TBSA大、老年是烧伤合并吸入性损伤行机械通气患者预后不良的独立危险因素(OR=5.551、1.046、10.187,P<0.05)。结论机械通气第24小时OI≤200 mm Hg的烧伤合并吸入性损伤患者预后不良,TBSA越大,机械通气前PaO_(2)及SaO_(2)越低,通气后第24小时的OI可能越低。
基金The study protocol was approved by the Evangelismos Hospital Ethics Committee(reference number:771/2019)This study was registered in ClinicalTrials.gov(NCT04758910).
文摘Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOT)through the nasal cannulae has demonstrated clinical benefits.Limited data exist on whether such effects are also present in HFOT through tracheostomy.Hence,we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation.Methods A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical ventilation.The patients underwent a 30-min spontaneous breathing trial(SBT)and received oxygen either via T-piece or by HFOT through tracheostomy,followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner.At the start and end of each session,blood gasses,breathing frequency(f),and tidal volume(VT)via a Wright's spirometer were measured,along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction,which expressed the inspiratory muscle effort.Results Eleven patients were enrolled in whom 19 sessions were uneventfully completed;eight patients were studied twice on two different days with alternate sessions;and three patients were studied once.Patients were randomly assigned to start the SBT with a T-piece(n=10 sessions)or with HFOT(n=9 sessions).With HFOT,VT and minute ventilation(VE)significantly increased during SBT(from[465±119]mL to[549±134]mL,P<0.001 and from[12.4±4.3]L/min to[13.1±4.2]L/min,P<0.05,respectively),but they did not change significantly during SBT with T-piece(from[495±132]mL to[461±123]mL and from[12.8±4.4]mL to[12.0±4.4]mL,respectively);f/VT decreased during HFOT(from[64±31]breaths/(min∙L)to[49±24]breaths/(min∙L),P<0.001),but it did not change significantly during SBT with T-piece(from[59±28]breaths/(min∙L)to[64±33]breaths/(min∙L));partial pressure of arterial oxygen increased during HFOT(from[99±39]mmHg to[132±48]mmHg,P<0.001),but it decreased during SBT with T-piece(from[124±50]mmHg to[83±22]mmHg,P<0.01).In addition,with HFOT,diaphragmatic excursion increased(from[12.9±3.3]mm to[15.7±4.4]mm,P<0.001),but it did not change significantly during SBT with T-piece(from[13.4±3.3]mm to[13.6±3.3]mm).The diaphragmatic thickening fraction did not change during SBT either with T-piece or with HFOT.Conclusion In patients with prolonged mechanical ventilation,HFOT through tracheostomy compared with T-piece improves ventilation,pattern of breathing,and oxygenation without increasing the inspiratory muscle effort.Trial Registration Clinicaltrials.gov ldentifer:NCT04758910.
