Comparative efficacy of common alternative spontaneous breathing trials in critically ill patients: a network meta-analysis

Successful weaning from ventilator play a critical role in improving the prognosis of patients who are treated in the intensive care unit(ICU).Several spontaneous breath trials(SBTs)have been developed to evaluate the ability of an individual patient to remain spontaneous breathing after disconnecting mechanical ventilation.However,it remains unclear which SBT techniques should be preferentially taken into consideration for critically ill patients receiving ventilator.We performed this network meta-analysis to investigate the comparative efficacy of all common SBTs and then found that automatic tube compensation(ATC)was better than others in increasing initial SBTsuccess rate and successful weaning rate.Therefore,ATC should be optimally considered to assess the ability of liberating ventilator in critical ill.

Analysis and Comparison of the Effect of Preserving Spontaneous Breathing Without Intubation and Endotracheal Intubation with One Lung Ventilation in Single-hole Thoracoscopic Bulla Suture

Objective:To explore the situation of patients and the compare the effect between two methods,which are preserving spontaneous breathing without intubation and endotracheal intubation with one lung ventilation in the single-hole thoracoscopic bulla suture.Method:42 patients who received single-hole thoracoscopic pulmonary bullae suture in our hospital from January 2020 to December 2021 were selected as the study subjects,including 19 patients who underwent endotracheal intubation and one lung ventilation as the control group and 23 patients who underwent single-hole thoracoscopic pulmonary bullae suture without intubation as the study group.The relevant indexes,postoperative general conditions,complications and pneumothorax recurrence of the two groups were analyzed and observed.Results:In the control group,the scores of anesthesia time(points),resuscitation time(points),surgical visual field score(points),surgical time(points),and surgical bleeding volume(points)were 20.8±4.6,19.9±7.9,1.7±0.5,44.9±7.9,and 11.4±2.4 respectively.In the study group,the scores of anesthesia time(points),resuscitation time(points),surgical visual field score(points),surgical time(points),and scores of surgical bleeding(points)were 17.9±4.3,15.4±3.4,1.9±0.4,48.4±7.1,10.9±2.2,respectively.There was no statistical difference in surgical visual field score,surgical time and surgical bleeding whereas there was a statistical difference between anesthesia time and resuscitation time.In the control group after operation,VAS score at 6 hours after operation,SaO_(2)(%)after operation,PaCO_(2)(mmHg)after operation,drainage volume(ML)after operation,feeding time(H)after operation,retention time of thoracic tube after operation(H),WBC(109)on the first day after operation,hospitalization time(d),and total hospitalization cost(RMB 1000)were 2.1±0.7,98.2±1.4,42.4±4.9,139.1±23.1,6.9±1.6,37.1±5.4,7.9±2.1,6.6±1.3,and 2.6±0.3 respectively.As for the study group,the VAS score at 6 hours after operation,SaO_(2)(%)after operation,PaCO_(2)(mmHg)after operation,drainage volume(ML)after operation,feeding time(H)after operation,retention time of thoracic tube after operation(H),WBC(109)on the first day after operation,hospitalization time(d),and total hospitalization cost(RMB 1000)were 1.9±0.4,97.9±1.2,42.8±5.1,151.8±21.9,4.3±1.4,15.3±2.6,5.2±2.3,4.2±1.2,and 1.8±0.4 respectively.Among them,there were no significant differences in visual analog scale(VAS)score at 6 hours after operation,SaO_(2) after operation and PaCO_(2) after operation between the two groups,but there were significant differences in other factors.The complication rate of the control group was 36.84%,which was significantly higher than that of the study group(4.35%),with statistical difference.The recurrence rate of the control group was 21.05%,which was not significantly different from that of the study group(4.35%).Conclusion:The single-hole thoracoscopic bullae suture without intubation can reduce the anesthesia time and resuscitation time of patients,reduce the hospitalization cost of patients,reduce the treatment burden,shorten the first feeding time,and reduce the complication rate of patients.Therefore,it is worthy of clinical promotion.

A Novel Particle Filtering Method for Estimation of Pulse Pressure Variation during Spontaneous Breathing

The first automatic algorithm was designed to estimate the pulse pressure variation (PPVPPV) from arterial blood pressure (ABP) signals under spontaneous breathing conditions. While currently there are a few publicly available algorithms to automatically estimate PPVPPV accurately and reliably in mechani-cally ventilated subjects, at the moment there is no automatic algorithm for estimating PPVPPV on sponta-neously breathing subjects. The algorithm utilizes our recently developed sequential Monte Carlo method (SMCM), which is called a maximum a-posteriori adaptive marginalized particle filter (MAM-PF). The performance assessment results of the proposed algorithm on real ABP signals from spontaneously breath-ing subjects were reported.

保留自主呼吸全麻环杓关节拨动复位术联合嗓音训练治疗环杓关节脱位的临床分析

目的探讨保留自主呼吸静脉全麻下环杓关节拨动复位术在治疗环杓关节脱位患者中的应用价值。方法收集河南省人民医院就诊或院内会诊的环杓关节脱位患者18例,其中男8例,女10例,年龄28~72(42.67±8.67)岁。全麻下保留自主呼吸,调整杓状软骨方向与角度行关节复位。术后1周复查喉镜评估,若症状改善不满意者以同样的方法再次复位。结合嗓音功能训练,分别于术后1周、1个月进行嗓音功能评估。结果一次性复位成功患者14例,术后声嘶症状明显改善,术后1周后再次行复位4例,其中成功2例,术后1周时F0、Jitter、Shimmer、NHR、VHI较术前均降低,MPT明显延长,差异有统计学意义(P<0.05),术后1个月时配合嗓音训练后嗓音功能较术前改善更明显,差异有统计学意义(P<0.01)。结论保留患者的自主呼吸全麻手术,患者舒适无痛苦记忆,视野直观,操作精确,尤其是适用于咽反射较为敏感或者对手术产生恐惧排斥情绪者,值得在有条件的医院广泛开展应用。

Efficacy of continuous tracheal gas insufflation in spontaneously breathing canine with acute lung injury

Objective To investigate the effects of continuous tracheal gas insufflation (CTGI) combined with biphasic intermittent positive airway pressure (BIPAP) ventilation on dogs with spontaneous breathing. Methods Eight canine models with oleic acid induced lung injury and spontaneous breathing were ventilated in a random order by Evita 2 (Drager Inc., Germany) in modes of BIPAP (BIPAP group) and BIPAP with CTGI flow rate of 3, 6 and 9?L/min (T3, T6 and T9 groups), respectively. The setting parameters of BIPAP were fiction of inspired oxygen 60%, inspiratory to expiratory ratio 1∶1, respiratory rate 20 and positive end expiratory pressure 5?cm?H2O. Arterial and mixed venous blood gas, lung mechanics, systemic and pulmonary hemodynamics status were monitored at the same level of PaCO2 obtained by adjusting peak inspiratory pressure of BIPAP. Results Peak inspiratory pressure in the T6 group (14±4?cm?H2O) and in the T9 group (11±3?cm?H2O) were significantly lower than that of BIPAP (20±5?cm?H2O, P<0.01), but there was no significant difference among the T3, T6 and T9 groups or between the T3 and BIPAP groups. PaO2, mean artery blood pressure, mean pulmonary artery pressure, pulmonary artery wedge pressure, cardiac ouput, oxygen delivery and oxygen consumption all remained unchanged in four different conditions.Conclusions Using BIPAP combined with CTGI does not cause asynchrony between ventilator and spontaneous breathing, but significantly decreases airway pressure with no influence on hemodynamics and oxygenation. Therefore, BIPAP with CTGI may be a useful support technique, especially in cases where the airway pressure should be limited.

Acute respiratory distress syndrome:focusing on secondary injury

Acute respiratory distress syndrome(ARDS)is one of the most common severe diseases seen in the clinical setting.With the continuous exploration of ARDS in recent decades,the understanding of ARDS has improved.ARDS is not a simple lung disease but a clinical syndrome with various etiologies and pathophysiological changes.However,in the intensive care unit,ARDS often occurs a few days after primary lung injury or after a few days of treatment for other severe extrapulmonary diseases.Under such conditions,ARDS often progresses rapidly to severe ARDS and is difficult to treat.The occurrence and development of ARDS in these circumstances are thus not related to primary lung injury;the real cause of ARDS may be the“second hit”caused by inappropriate treatment.In view of the limited effective treatments for ARDS,the strategic focus has shifted to identifying potential or high-risk ARDS patients during the early stages of the disease and implementing treatment strategies aimed at reducing ARDS and related organ failure.Future research should focus on the prevention of ARDS.