Objective To determine the usefulness of serial measurements of the rapid shallow breathing index ( f/VT , RSBI) as a predictor for successfully weaning of patients undergoing prolonged mechanical ventilation ( gt; 72 hours) . Methods 76 mechanically ventilated patients were prospectively analyzed. 120-min spontaneous breathing trial was conducted after the patients having fullfiled the traditional weaning criteria, and RSBI were continuously monitored by the ventilator at five time points ( 5, 15, 30,60, and 120 min) . A repeated measure of general linear model in SPSS 15.0 was conducted to analyze the data. Results 62 patients completed 120-minute spontaneous breath trial and in which 20 patients failed weaning. There was no significant difference of RSBI at five time points during weaning ( P gt;0. 05) . But thevariation trends of RSBI during weaning time were significant different between the successful weaning patients and the failed weaning patients ( P lt; 0. 05) . Conclusions In patients undergoing prolonged mechanical ventilation, the variation trend of RSBI is more valuable than single RSBI in the prediction ofsuccessful weaning.
Objective To study the clinical feasibility of invasive mechanical ventilation with bilevel positive airway pressure（BiPAP） non-invasive ventilator in the stable patients needing prolonged mechanical ventilation.Methods Eleven patients with respiratory failure admitted in intensive care unit（ICU）of our department，who needed prolonged mechanical ventilation，between Jun 2004 and Nov 2007 were enrolled in the study and followed until death or Jan 2008.The arterial blood gas analysis data，length of stay(LOS)，LOS after changing to BiPAP non-invasive ventilator（Synchrony，Harmony，RESPIRONICS，VPAP III ST-A，RESMED），survival time after discharge(or fulfilled the discharge standards) were reviewed retrospectively.Results The settings of inspiratory pressure，expiratory pressure and respiratory rate of non-invasive ventilation were 21.3 (16-26) cm H2O，4 cm H2O，and 16 min-1，respectively.The LOS (or up to the discharge standard) was (91.5±50.2) days.The LOS (or up to the discharge standard) after changing to BiPAP ventilator was (23.5±12.2) days.The mean survival time after discharge (or up to the discharge standard) was (353.1±296.5) days.Four patients were still alive up to the end of the study.The arterial pH，PaCO2，PaO2，and SaO2 were not significant different before and after changing to BiPAP ventilator.Conclusion The mechanical ventilation with BiPAP non-invasive ventilator via tracheotomy tube is an alternative choice for stable patients needing prolonged mechanical ventilation.
Objective To investigate the outcome and prognostic factors of hospital mortality in patients with acute cerebrovascular disease requiring mechanical ventilation.Methods Data from 94 patients with acute cerebrovascular disease in central intensive care unit(ICU) were collected and retrospectively analyzed.Prognostic factors of hospital mortality were analyzed by univariate statistics and multivariate logistic regression.Results Hospital mortality was 53.2%(50/94).There was significance diference in parameters such as APACHE II score，blood glucose，lengh of hospital stay，lengh of ICU stay，time of mechanical ventilation，incision of trachea，lung infections，lesion loci and its naturer between the survival and non-survival groups（all Plt;0.05）.Multivariate logistic regression revealed that blood glucose，lung infections，diseased region under tentorium of cerebellum，time of mechanical ventilation were independent prognostic risk factors of hospital mortality(all Plt;0.05).Whereas the lengh of ICU stay was protective factor(Plt;0.05).Conclusion The hospital mortality is considerably high in patients with acute cerebrovascular disease requiring mechanical ventilation. The prognostic factors such as blood glucose and lung infections should be evaluate cautiously and prevented aggressively.
Objective We investigated the effect of supplementation with alanyl-glutamine dipeptide on insulin resistance and outcome in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods A prospective, randomized, open and controlled trial was conducted. Patients with COPD and respiratory failure were recruited between Jan 2005 to Feb 2006 and randomly assigned to a trial group (n=14) with glutamine dipeptide supplmented parenteral nutrition and a control group (n=16) with isocaloric, isonitrogenic parenteral nutrition. On the third day and fifth day of nutrition treatment, blood glucose was clamped at level of 4.4 to 6.1 mmol/L by intravenously bumped insulin. Blood gas, blood glucose level, insulin dosage were recorded everyday. The outcomes were mortality, length of stay (LOS) in hospital and in ICU, mechanical ventilation times and the costs of ICU and hospital.Results Thirty patients successfully completed the trial. There was no difference in blood gas between two groups, but PaO2 increased gradually. Compared with control group, blood glucose level had trend to decrease in trial group. The average insul in consumption decreased significantly in trial group on the fifth day. There was no statistical difference between two groups in mortality, length of stay in hospital and the costs of hospital. But compared with control group, length of stay in ICU and mechanical ventilation days had trend to decrease in trial group. Conclusion Alanyl-glutamine dipeptide do not improve pulmonary function of patients with COPD and respiratory failure. However, alanyl-glutamine dipeptide attenuated insul in resistance and stabilized blood glucose. This trial does not confirm alanyl-glutamine di peptide can improve outcome in critically ill patients with COPD and respiratory failure between two groups in mortality at the end of 30 days, length of stay in hospital and the costs of hospital. But the length of stay in ICU and the duration of mechanical ventilation does decrease, but not significantly, in the trial group.
Objective To investigate whether the respiratory support weaning based on adaptive support ventilation ( ASV) could reduce the duration of mechanical ventilation in patients after fast-track coronary artery bypass grafting ( CABG) . Methods After CABG during the same fast-track general anesthesia, 46 patients were randomly assigned to an ASV group or a synchronized intermittent mandatory ventilation ( SIMV) group as control. The duration of mechanical ventilation, hemodynamic parameters, and airway pressures were recorded. Meanwhile, the variables and the number of the arterial blood gas were recorded. Results The duration of mechanical ventilation was shorter in the ASV group than that in the control group [ 196( 152-286) ] min vs. 253( 196-498) min, P lt;0. 05] . The duration of ICUstay was shorterin the ASV group than that in the control group [ ( 14. 5 ±0. 7) h vs. ( 16. 8 ±0. 4 ) h, P lt;0. 01] . Fewer arterial blood analyses were performed in the ASV group than those in the control group [ 5 ( 4-7) vs.7( 6-9) , P lt; 0. 05] . Conclusions A ventilation weaning protocol based on ASV is practicable. It may accelerate tracheal extubation, shorten the length of ICU stay, and simplify ventilation management in patients after fast-track CABG.
Sepsis 已经成为危重症医学中较为常见的一种综合征，它定义为因病原体感染而引起的全身性炎症反应综合征。严重Sepsis患者预后不佳，治疗上也较为困难，特别是合并Septic Shock和多器官功能不全综合征（MODS）的患者，死亡率仍然较高，因此近年来在临床及研究上均已引起明显的重视。为了能促进Sepsis的研究及治疗，国际上多个医学专科分会联合发起“拯救Sepsis运动（Surviving Sepsis Campaign, SSC）”，并于2004年首次发表了相应的指南，即Surviving Sepsis Campaign Guideline for Management of Severe Sepsis and Septic Shock。今年初SSC再次发表了新版的指南，主要是结合近年的研究成果而在原版的基础上进行适当的补充和更新，以指导临床上严重Sepsis的抢救及治疗。
Objective To investigate the feasibility of collecting exhaled breath condensate ( EBC)fromartificially ventilated patients with modified EcoScreen condenser. Methods ①In vitro test with lung simulator: the modified EcoScreen condenser was connected to lung simulator and mechanically ventilated for 60 min through three different types of connected tube as follows: dry ventilator pipe disconnected to humidifier, connected to the unheated humidifier, and connected to heated humidifier.Meanwhile, the changes of the peak pressure of inspiration ( PI) and tidal volume ( VT ) were observed. The volume of condensate was measured at last. ②In vivo test from artificially ventilated patients: 10 patients were artificially ventilated and their EBCs were collected with the modified EcoScreen condenser through dry pipe disconnected to humidifier for 20 min. The changes of PI, VT , respiratory frequency( f) , heart rate( HR) , mean arterial blood pressure ( MAP) , and blood oxygen saturation ( SpO2 ) were observed. Results ①In vitro test with lung simulator: At the end of the ventilating through the dry pipe disconnected to humidifier for 60 min,2. 2 mL condensate wascollected. Neither the change of PI or VT nor the obstruction of the collecting tube by iced condensate were observed. The ventilating through dry pipe connected to unheated humidifier had to stop at 50 min as the obstruction of the collecting tube caused by ice. 5 mL condensate was collected. It was observed that VTdecreased and PI increased. After ventilation through dry pipe connected to heated humidifier for 60 min,10. 5 mL condensate was collected while PI slightly increased and VT decreased. ② In vivo test from artificially ventilated patients: After ventilation through dry pipe disconnected to humidifier for 20 min, 2 mL EBC was collected without significance changes in PI, VT, f, HR, MAP, and SpO2 . Conclusions The modified EcoScreen condenser can be favourably applied to artificially ventilated patients for collecting EBC.It is recommended to performfor 20 min through the pipe disconnected to humidifier to obtain sufficient EBC without condensate dilution and airway obstruction. It is warranted more attention to the clinical and mechanical monitoring in this procedure.
Objective To observe the serumlevel of neuron-specific enolase( NSE) in patients with pulmonary encephalopathy and its changes after treatment with mechanical ventilation. Methods Twentyone patients with pulmonary encephalopathy were enrolled. Glasgow coma scale( GCS) , serumNSE level, and arterial blood gas were evaluated at three time-points: before mechanical ventilation, after 12 hours mechanical ventilation, and the moment of consciousness. Results 18 patients recovered consciousness, and 3 patients remained in persistent coma and died. GCS and arterial blood gas improved obviously after 12 hours mechanical ventilation. Meanwhile, the serumNSE concentration decreased significantly after 12 hours mechanical ventilation [ ( 24. 54 ±6. 65) μg/L] and at the moment of consciousness [ ( 14. 19 ±2. 91) μg/L] compared with before mechanical ventilation( P lt; 0. 05, P lt; 0. 01) . Conclusion Dynamic measurment of serumNSE may be a useful biomarker for assessing the severity of cerebral injury and predicting prognosis.
Objective To investigate the influence of different mechanical ventilation modes on inflammatory reaction among COPD patients with severe respiratory failure. Methods A total of 102 COPD patients with severe respiratory failure, admitted in Zhongshan Hospital between January 20007 and June 2012, were enrolled in this study. The subjects were divided into an ASV group receiving adaptive support ventilation, and a SIMV + PSV group received synchronized intermittent mandatory ventilation and pressure support ventilation, with 51 cases in each group. Breathing pattern, respiratory mechanics, hemodynamic parameters and seruminflammatory factors were examined among all patients. Results Tidal volume ( VT ) was significantly higher, and the control respiratory rate and ventilation time were significantly lower in the ASV group than those in the SIMV + PSV group ( P lt; 0.05) . Comparing with the SIMV + PSV group, obviously lower peak airway pressure ( Ppeak) ,mean airway pressure ( Pmean) and airway plateau pressure ( Pplat) were observed in the ASV group ( P lt; 0.05) . The patients in the ASV group had obviously lower levels of C-reactive protein, procalcitonin and α1 acid glycoprotein. Conclusion ASV ventilation mode may reduce the inflammatory reaction, facilitate spontaneously breathing and decrease mechanical ventilation time.
ObjectiveTo detect the concentration of 8-isoprostane (8-iso-PG) in exhaled breath condensate (EBC) of patients with or at risk for ARDS in ventilation, and investigate its clinical significance.MethodsFifty-five patients with or at risk for ARDS in ventilation admitted between February 2014 and June 2016 were recruited as an experimental group, and simultaneous 30 normal cases were recruited as a control group. Their EBC was collected with EcoScreen condenser. The EBC 8-iso-PG level of the patients between different grades of ARDS (mild, moderate, and sever) or at risk for ARDS was compared, and the correlation of EBC 8-iso-PG with the clinical indicators was analyzed.ResultsThe 8-iso-PG levels in EBC and serum of the patients with or at risk for ARDS in ventilation were higher than those in the control group [EBC: (44.83±11.58) ng/L vs. (19.47±4.06) ng/L; serum: (481.53±444.94) ng/L vs. (19.91±17.60) ng/L] (all P<0.05). The EBC 8-iso-PG of the patients with moderate ARDS (n=15) and severe ARDS (n=7) [(47.18±11.68) ng/L and (50.29±11.06) ng/L] was higher than those with mild ARDS (n=7) or at risk for ARDS (n=26) [(33.04±7.62) ng/L) and (37.17±11.08) ng/L] (all P<0.05). However EBC 8-iso-PG was not different between the patients with mild ARDS and those at risk for ARDS (P>0.05 ). The increased EBC 8-iso-PG could predict ARDS with an area under the receiver operating curve of 0.73. The EBC 8-iso-PG of the patients with or at risk for ARDS was correlated with lung injury score (r=0.418, P<0.01), PaO2/FiO2 (r=–0.378, P<0.05), chest radiograph scores (r=0.410, P<0.05), AaDO2 (r=0.368, P<0.05), and APACHEⅡ score (r=0.718, P<0.05).ConclusionEBC 8-iso-PG can reflect the oxidative stress in lung of ARDS patients in ventilation, and can contribute to the diagnosis and evaluation for moderate and severe ARDS.