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
目的探究分阶段式呼吸肌训练对提高呼吸衰竭患者无创通气撤机成功率的影响。方法选取2020年1月—2022年12月在南京医科大学附属淮安第一医院呼吸与危重症医学科(pulmonary and critical care medicine,PCCM)治疗的102例呼吸衰竭患者为...目的探究分阶段式呼吸肌训练对提高呼吸衰竭患者无创通气撤机成功率的影响。方法选取2020年1月—2022年12月在南京医科大学附属淮安第一医院呼吸与危重症医学科(pulmonary and critical care medicine,PCCM)治疗的102例呼吸衰竭患者为研究对象。采用随机数字表法将患者分为对照组和观察组,每组51例。对照组实施常规护理干预,观察组在对照组基础上实施分阶段式呼吸肌训练。分别于干预前和干预2周后比较2组患者撤机成功率、机械通气时间及呼吸肌力水平及氧合指数情况。结果干预2周后,观察组撤机成功率高于对照组,且机械通气时间短于对照组,差异均有统计学意义(P<0.05);干预后,2组最大口腔吸气压(MIP)、最大口腔呼气压(MEP)及氧合指数均高于干预前,且观察组高于同期对照组,差异有统计学意义(P<0.05)。结论分阶段式呼吸肌训练在临床护理中效果较好,可促进呼吸衰竭患者呼吸肌力恢复,改善膈肌功能,缩短机械通气时间,提高撤机成功率。展开更多
目的分析发现-组织领导-明确情况-分析了解-改进方案(find organize clarify understand select,FOCUS)-计划-执行-检查-行动(plan do check act,PDCA)模式对重症监护室(intensive care unit,ICU)重症患者呼吸机相关性肺炎(ventilator a...目的分析发现-组织领导-明确情况-分析了解-改进方案(find organize clarify understand select,FOCUS)-计划-执行-检查-行动(plan do check act,PDCA)模式对重症监护室(intensive care unit,ICU)重症患者呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的影响。方法选取2022年10月—2023年9月菏泽市牡丹人民医院ICU接受机械通气治疗的重症患者120例,根据干预时间将其分为2组,即2022年10月—2023年3月60例患者作为对照组,2023年4—9月60例患者作为研究组。对照组接受常规干预措施预防VAP,研究组在此基础上,采用FOCUS-PDCA模式预防VAP。比较2组患者机械通气时间、住院时间、住院费用、一次性脱机成功率与VAP发生率。结果与对照组相比,研究组机械通气时间、住院时间更短(P<0.05),住院费用更低(P<0.05)。研究组一次性脱机成功率为96.67%,高于对照组的85.00%(χ^(2)=4.904,P<0.05);VAP发生率为1.67%,低于对照组的13.33%(χ^(2)=4.324,P<0.05)。结论FOCUS-PDCA模式能够有效降低ICU重症患者VAP的发生率,缩短机械通气时间与住院时间,节省住院费用,提高一次性脱机成功率,具有临床应用价值。展开更多
目的:探讨浅快呼吸指数(RSBI)、中心静脉血氧饱和度(SCVO_2)及其变化率(ΔSCVO_2)对机械通气患者拔管成功率的预测价值。方法:采用前瞻性研究方法,选取重症监护室的机械通气患者70例次,按拔管结果分成拔管成功(ES)组和拔管失败(EF)组,比...目的:探讨浅快呼吸指数(RSBI)、中心静脉血氧饱和度(SCVO_2)及其变化率(ΔSCVO_2)对机械通气患者拔管成功率的预测价值。方法:采用前瞻性研究方法,选取重症监护室的机械通气患者70例次,按拔管结果分成拔管成功(ES)组和拔管失败(EF)组,比较2组SCVO_2、ΔSCVO_2及RSBI。结果:2组患者性别、年龄差异无统计学意义(P>0.05)。2组自主呼吸试验(SBT)30min SCVO_2、ΔSCVO_2及RSBI差异有统计学意义(P<0.05)。SBT 30 min SCVO_2与拔管成功率正相关(r=0.283,P=0.025),ΔSCVO_2和RSBI与拔管成功率负相关(r=-0.425,-0.282,P=0.001,0.025)。SBT 30min SCVO_2、ΔSCVO_2和RSBI的ROC下面积分别为0.697、0.810、0.651。结论:SBT 30 min SCVO_2、ΔSCVO_2和RSBI对机械通气患者拔管成功率具有一定的预测价值,ΔSCVO_2、SBT 30 min SCVO_2优于RSBI。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.
文摘目的探究分阶段式呼吸肌训练对提高呼吸衰竭患者无创通气撤机成功率的影响。方法选取2020年1月—2022年12月在南京医科大学附属淮安第一医院呼吸与危重症医学科(pulmonary and critical care medicine,PCCM)治疗的102例呼吸衰竭患者为研究对象。采用随机数字表法将患者分为对照组和观察组,每组51例。对照组实施常规护理干预,观察组在对照组基础上实施分阶段式呼吸肌训练。分别于干预前和干预2周后比较2组患者撤机成功率、机械通气时间及呼吸肌力水平及氧合指数情况。结果干预2周后,观察组撤机成功率高于对照组,且机械通气时间短于对照组,差异均有统计学意义(P<0.05);干预后,2组最大口腔吸气压(MIP)、最大口腔呼气压(MEP)及氧合指数均高于干预前,且观察组高于同期对照组,差异有统计学意义(P<0.05)。结论分阶段式呼吸肌训练在临床护理中效果较好,可促进呼吸衰竭患者呼吸肌力恢复,改善膈肌功能,缩短机械通气时间,提高撤机成功率。
文摘目的分析发现-组织领导-明确情况-分析了解-改进方案(find organize clarify understand select,FOCUS)-计划-执行-检查-行动(plan do check act,PDCA)模式对重症监护室(intensive care unit,ICU)重症患者呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的影响。方法选取2022年10月—2023年9月菏泽市牡丹人民医院ICU接受机械通气治疗的重症患者120例,根据干预时间将其分为2组,即2022年10月—2023年3月60例患者作为对照组,2023年4—9月60例患者作为研究组。对照组接受常规干预措施预防VAP,研究组在此基础上,采用FOCUS-PDCA模式预防VAP。比较2组患者机械通气时间、住院时间、住院费用、一次性脱机成功率与VAP发生率。结果与对照组相比,研究组机械通气时间、住院时间更短(P<0.05),住院费用更低(P<0.05)。研究组一次性脱机成功率为96.67%,高于对照组的85.00%(χ^(2)=4.904,P<0.05);VAP发生率为1.67%,低于对照组的13.33%(χ^(2)=4.324,P<0.05)。结论FOCUS-PDCA模式能够有效降低ICU重症患者VAP的发生率,缩短机械通气时间与住院时间,节省住院费用,提高一次性脱机成功率,具有临床应用价值。
文摘目的:探讨浅快呼吸指数(RSBI)、中心静脉血氧饱和度(SCVO_2)及其变化率(ΔSCVO_2)对机械通气患者拔管成功率的预测价值。方法:采用前瞻性研究方法,选取重症监护室的机械通气患者70例次,按拔管结果分成拔管成功(ES)组和拔管失败(EF)组,比较2组SCVO_2、ΔSCVO_2及RSBI。结果:2组患者性别、年龄差异无统计学意义(P>0.05)。2组自主呼吸试验(SBT)30min SCVO_2、ΔSCVO_2及RSBI差异有统计学意义(P<0.05)。SBT 30 min SCVO_2与拔管成功率正相关(r=0.283,P=0.025),ΔSCVO_2和RSBI与拔管成功率负相关(r=-0.425,-0.282,P=0.001,0.025)。SBT 30min SCVO_2、ΔSCVO_2和RSBI的ROC下面积分别为0.697、0.810、0.651。结论:SBT 30 min SCVO_2、ΔSCVO_2和RSBI对机械通气患者拔管成功率具有一定的预测价值,ΔSCVO_2、SBT 30 min SCVO_2优于RSBI。
