ObjectiveTo investigate the association of preoperative serum uric acid (UA) levels with postoperative prolonged mechanical ventilation (PMV) in patients undergoing mechanical heart valve replacement.MethodsClinical data of 311 patients undergoing mechanical heart valve replacement in The First Affiliated Hospital of Anhui Medical University from January 2017 to December 2017 were retrospectively analyzed. There were 164 males at age of 55.6±11.4 years and 147 females at age of 54.2±9.8 years. The patients were divided into a PMV group (>48 h) and a control group according to whether the duration of PMV was longer than 48 hours. Spearman's rank correlation coefficient and logistic regression analysis were conducted to evaluate the relationship between preoperative UA and postoperative PMV. The predictive value of UA for PMV was undertaken using the receiver operating characteristic (ROC) curve..ResultsAmong 311 patients, 38 (12.2%) developed postoperative PMV. Preoperative serum UA level mean values were 6.11±1.94 mg/dl, while the mean UA concentration in the PMV group was significantly higher than that in the control group (7.48±2.24 mg/dl vs. 5.92±1.82 mg/dl, P<0.001). Rank correlation analysis showed that UA was positively correlated with postoperative PMV (rs=0.205, P<0.001). Multivariate logistic regression analysis demonstrated that preoperative elevated UA was associated independently with postoperative PMV with odds ratio (OR)=1.44 and confidence interval (CI) 1.15–1.81 (P=0.002). The area under the ROC curve of UA predicting PMV was 0.72, 95% CI0.635–0.806, 6.40 mg/dl was the optimal cut-off value, and the sensitivity and specificity was 76.3% and 63.0% at this time, respectively.ConclusionPreoperative elevated serum UA is an independent risk factor for postoperative PMV in patients undergoing mechanical heart valve replacement and has a good predictive value.
Objective To explore the application value of shear wave elastography (SWE) combined with diaphragmatic thickening fraction (DTF) and rapid shallow breathing index (RSBI) in predicting the results of weaning of patients with mechanical ventilation. Methods Fifty-two patients with severe illness who were hospitalized in this hospital from January 2022 to September 2022 were treated with mechanical ventilation. After meeting the conditions for weaning, they underwent spontaneous breathing test, and the diaphragm function of patients was evaluated by measuring DTF using ultrasound technology and shear modulus (SM) using SWE technology. According to the weaning results, they were divided into weaning success group and weaning failure group, The differences of mechanical ventilation time, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, respiratory rate, RSBI, oxygenation index, DTF, SM and other parameters between the two groups were compared. Multivariate logistic regression was used to analyze the factors affecting the withdrawal results. The receiver operator characteristic (ROC) curve was used to evaluate the predictive value of potential influencing factors on the withdrawal results. Results There were 39 cases of successful withdrawal and 13 cases of failure. There were significant differences in mechanical ventilation time, respiratory rate, RSBI, DTF and SM between the successful weaning group and the failure group (P<0.05). Through multivariate logistic regression analysis, RSBI [area under the ROC curve (AUC)=0.771, 95% confidence interval (CI) 0.589 - 0.953], DTF (AUC=0.806, 95%CI 0.661 - 0.951), SM (AUC=0.838, 95%CI 0.695 - 0.981) were independent factors that affected the results of withdrawal. The single parameter AUC was smaller than the combined index with RSBI≤70.48 times·min–1L–1, DTF≥30.0%, SM≥10.0 kPa as the cutoff value (AUC=0.937, 95%CI 0.714 - 1.0, diagnostic sensitivity, specificity and accuracy were 94.9%, 84.6% and 92.3% respectively). Conclusions SWE technology provides a new quantitative index for evaluating diaphragm function by evaluating diaphragm stiffness. Diaphragm stiffness combined with DTF and RSBI can better predict the successful withdrawal in patients with mechanical ventilation.
ObjectiveTo evaluate the effects of home mechanical ventilation (HMV) for stable chronic obstructive pulmonary disease (COPD) patients with respiratory failure in Tongzhou district of Beijing city. MethodsTwenty stable COPD patients with respiratory failure were included in the study.During the one-year follow-up period,4 patients died and 1 withdrew and 15 patients finished the follow-up.The patients was followed up by telephone each month and guided in drug administration,HMV,and rehabilitation therapy.At the beginning of the study and one year later,the patients were interviewed and accessed on the general data,nutritional status,COPD assessment test (CAT),Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,and arterial blood gas analysis. ResultsAt the end of one-year follow-up,nutrition index,CAT,Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,pH,and PaO2 did not change significantly (P>0.05),while PaCO2 decreased significantly compared with those at the beginning of the study (P<0.05).Compared with the past year,the times of hospitalization due to acute exacerbation of COPD was significantly reduced during the follow-up year (P<0.05). ConclusionHMV can ameliorate carbon dioxide retention and reduce times of hospitalization due to acute exacerbation of COPD for COPD patients with respiratory failure.
Objective To investigate the thirst status of patients in intensive care unit (ICU) who underwent oral tracheal intubation and ventilator assisted ventilation, and explore its influence factors. Methods A total of 172 patients with oral tracheal intubation admitted in ICU from June 2020 to September 2021 were investigated, and a numerical rating scale was employed for rating their thirst feelings. The patients were divided into a thirst group and a non-thirst group based on thirst status. The thirst status and influence factors of thirst distress were analyzed. Results The incidence of thirst in the ICU patients with oral tracheal intubation and ventilator assisted ventilation was 88.4%, and the thirst score in the thirst group was 7.70±1.17. Single factor analysis showed statistically significant difference between the two groups in sex, medical payment, smoking, drinking, duration of mechanical ventilation, humidification effect, sputum viscosity, gastrointestinal decompression, fasting, continuous renal replacement therapy, diuretics, 24-hour urine volume and liquid balance, heart function grading, sedatives, agitation, sweating, acute physiology and chronic health evaluation Ⅱ, endotracheal intubation depth, body mass index, PCO2, PO2, HCO3–, tidal volume, and sodium ion (all P<0.05). Multivariable regression analysis demonstrated that diuretics, sputum viscosity, sodium ion, alcohol consumption, smoking, intubation depth, and cardiac function were independent influence factors for the occurrence of thirst in the ICU patients who received tracheal intubation (P<0.01). Conclusions The incidence of thirst was high in ICU patients with airway intubation and ventilator assisted ventilation. Diuretics, sputum viscosity, sodium ion, alcohol consumption, smoking, 24-hour urine volume, and cardiac function grading were independent influence factors for the occurrence of thirst in ICU patients with tracheal intubation. It is necessary to implement targeted intervention to prevent and alleviate the thirst degree of patients, reduce the occurrence of related complications, and improve patient comfort.
Objective To explore the oxygen therapy effects of high-flow T-tube oxygen therapy on neurointensive care patients who have undergone tracheostomy and are undergoing mechanical ventilation while meeting the criteria for weaning from mechanical ventilation, especially in terms of controlling airway temperature and humidity, promoting mucus dilution, and reducing postoperative complications. MethodsCollected data from 50 neurointensive care patients who underwent tracheostomy and were on mechanical ventilation, meeting the criteria for weaning from mechanical ventilation, treated at West China Hospital of Sichuan University from September 2019 to September 2021. The three groups of patients had different weaning methods: a high-flow T-tube for weaning, a heat and moisture exchanger (artificial nose) for weaning, and a high-flow tracheal joint for weaning. The vital signs, dyspnea and blood gas analysis before and three days after weaning were collected. The primary outcomes were mechanical sputum excretion, postural drainage, phlegm-resolving drugs use, airway-related events (artificial airway blockage, artificial nose blockage, lung infection), stay in ICU (days), and death in ICU. Results Among the 50 patients, 28 were males and 22 were females. There were no significant differences in age, weight, height, gender, finger pulse oxygen saturation, heart rate, APACHEII score, sequential organ failure assessment, or Glasgow coma scale among the three groups (P>0.05). There was no statistical difference in the number of 72-hour mechanical sputum excretion or the use of phlegm-resolving drugs in the three groups (P=0.113, P=1.00). Conclusion The use of high-flow T-tube oxygen therapy in neurointensive care patients who have undergone tracheostomy, are on mechanical ventilation, and meet the criteria for weaning from mechanical ventilation can effectively control airway temperature and humidity, promote mucus dilution for better drainage, thereby reducing post-tracheostomy complications.
In the clinical practice, the mechanical ventilation is a very important assisting method to improve the patients' breath. Whether or not the parameters set for the ventilator are correct would affect the pulmonary gas exchange. In this study, we try to build an advisory system based on the gas exchange model for mechanical ventilation using fuzzy logic. The gas exchange mathematic model can simulate the individual patient's pulmonary gas exchange, and can help doctors to learn the patient's exact situation. With the fuzzy logic algorithm, the system can generate ventilator settings respond to individual patient, and provide advice to the doctors. It was evaluated in 10 intensive care patient cases, with mathematic models fitted to the retrospective data and then used to simulate patient response to changes in therapy. Compared to the ventilator set only as part of routine clinical care, the present system could reduce the inspired oxygen fraction, reduce the respiratory work, and improve gas exchange with the model simulated outcome.
Objective To evaluate the relationship between sublingual microcirculation differences and weaning success rate and prognosis in elderly patients with severe pneumonia. Methods A retrospective observation cohort study was conducted. Forty-two elderly patients with severe pneumonia who underwent mechanical ventilation in the intensive care unit of Sir Run Run Hospital, Nanjing Medical University from February 2022 to August 2022 were recruited in the study. They were divided into a high-flow nasal cannula oxygen group (HFNC group, n=33) and a non-invasive positive pressure ventilation group (NIPPV group, n=9) according to the mode of post-weaning ventilation. The differences of N-terminal brain natriuretic peptide precursor (NT-proBNP), cardiac index (CI) and sublingual microcirculation indexes between the two groups were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of each parameter on weaning success rate and case fatality rate. Results Compared with the NIPPV group, CI, propotion of perfused vessels (PPV) and perfused vessel density (PVD) were higher, and NT-proBNP and total vessel density (TVD) were lower in the HFNC group (all P<0.05). The prediction value of PPV combined with PVD was the largest, with area under the ROC curve (AUC) of 0.875, sensitivity of 75.8%, specificity of 88.9%. CI, NT-proBNP, CI combined with NT-proBNP, PPV, PVD all had predictive value. Compared with the death group, the survival group had higher CI, central venous-to-arterial carbon dioxide difference [P(v-a)CO2] and PPV. For the prediction value of weaning success, CI combined with NT-proBNP had the largest predictive value, with AUC of 0.919, sensitivity of 81.8%, specificity of 100.0%, followed by CI. NT-proBNP, PPV, PVD, PPV combined with PVD all had predictive value. Compared with the death group, the survival group had higher CI, P(v-a)CO2 and PPV (all P<0.05). For predictive value assessment of 28-day survival rate, CI plus PPV had the largest AUC of 0.875, with sensitivity of 69.4%, and specificity of 100.0%. CI, P(v-a)CO2 and PPV all have predictive value. Conclusions Both CI and PPV can be used as predictors of weaning success rate and survival rate. PPV combined with PVD is an ideal predictor of survival rate.
Objective To compare the sequential efficacy of high-flow nasal cannula oxygen therapy (HFNC) with non-invasive mechanical ventilation (NIV). Methods Randomized controlled trials comparing the efficacy of NIV sequential invasive mechanical ventilation with HFNC were included in the Chinese Journal Full-text Database, VIP Journal database, Wanfang Database, Chinese Biomedical Literature Database, PubMed, Cochrane Library and Embase. Meta-analysis was performed using RevMan5.4 software. Results A total of 2404 subjects were included in 19 studies. Meta-analysis results showed that compared with NIV, HFNC had a statistically significant difference in reducing patients' re-intubation rate in invasive mechanical ventilation sequence [relative risk (RR)=0.65, 95% confidence interval (CI) 0.50 - 0.86, Z=3.10, P=0.002]. HFNC showed statistically significant difference compared with NIV in reducing lung infection rate (RR=0.40, 95%CI 0.21 - 0.79, Z=2.67, P=0.008). HFNC was significantly different from NIV in terms of length of stay in Intensive Care Unit (ICU) (MD=–5.77, 95%CI –7.64 - –3.90, Z=6.05, P<0.00001). HFNC was significantly different from NIV in improving 24 h oxygenation index (MD=13.16, 95%CI 8.77 - 17.55, Z=5.87, P<0.00001). There was no significant difference in ICU mortality between HFNC and NIV (RR=0.70, 95%CI 0.45 - 1.08, Z=1.61, P=0.11). Conclusion Compared with NIV, sequential application of HFNC in invasive mechanical ventilation can improve the reintubation rate and pulmonary infection rate to a certain extent, reduce the length of ICU stay and improve the 24 h oxygenation index, while there is no difference in ICU mortality, which is worthy of clinical application.
摘要:目的: 评价机械通气对胸腔内脉搏氧饱和度的影响。 方法 :以食道、气管和降主动脉作为胸腔内脉搏氧饱和度的监测位点,将改制后的氧饱和度探头分别固定于上述部位,并连接于同一监护仪上。纯氧通气,待上述氧饱和度容积波波形和读数稳定,停止机械通气30s。以录像的方式记录机械通气停止前后30 s内食道、气管和降主动脉SpO2容积波和读数的变化。同时记录舌SpO2。 结果 :机械通气时,食道、气管和降主动脉三个监测位点均可获得异常高大的SpO2容积波;停止通气时,异常高大的氧饱和度波形消失。食道、气管和降主动脉脉搏容积波变异率分别为112%,74%,302%。降主动脉脉搏容积波的变异率明显高于食道和气管( 〖WTBX〗P ＜005)。机械通气停止前后30s内食道、气管和降主动脉的SpO2读数变化无显著差异(〖WTBX〗P ＞005)。 结论 :机械通气对胸腔内食道、气管和降主动脉氧饱和度读数无影响,主要影响是脉搏容积波。且各位点间脉搏氧容积波受呼吸的影响不同。Abstract: Objective: To investigate the impact of mechanical ventilation on pulse oximetry in thoracic cavity. Methods : After dogs anesthesia induction and thoracotomy, pulse oximeters were simultaneously placed at esophagus, trachea, and descending aorta, and connected with the same monitor for SpO2 monitoring. During ventilation with 100% oxygen, the mechanical ventilator was temporarily switched off for 30 seconds after high quality PPG waveforms and SpO2 readings were obtained. SpO2 signals and readings from esophagus (SeO2), trachea (StraO2), descending aorta (SDAO2) shown on the monitoring screen were recorded by the SONY video before and after stopventilation. And StonO2 were also recorded. Results : Abnormally largeamplitude PPG waves were found in normal waves at monitoring sites of esophagus, trachea, and descending aorta in all animals during ventilation; however, they disappeared without ventilator. The variation rate in ventilationinduced PPG amplitude were 112%, 74%, 302% at esophagus, trachea and descending aorta respectively. The PPG amplitude variation rate from SDAO2 was higher than that from SeO2 and StraO2 (〖WTBX〗P ＜005). However, the SpO2 readings obtained from pulse oximetries in all sites were no significantly statistical difference within 30s before and after temporarily stopventilation (〖WTBX〗P ＞005). Conclusion : Abnormally amplitude PPG waveforms from oximetry probe placed at esophagus, trachea, and descending aorta were induced by ventilation. The Variation rate in ventilationinduced PPG amplitude was various at different monitoring sites. The SpO2 readings from esophagus, trachea, and descending aorta were not significantly contaminated by ventilation.
Pressure-support ventilation (PSV) is a form of important ventilation mode. Patient-ventilator synchrony of pressure support ventilation can be divided into inspiration-triggered and expiration-triggered ones. Whether the ventilator can track the patient's inspiration and expiration very well or not is an important evaluating item of the performance of the ventilator. The ventilator should response to the patient's inspiration effort on time and deliver the air flow to the patient under various conditions, such as different patient's lung types and inspiration effort, etc. Similarly, the ventilator should be able to response to the patient's expiration action, and to decrease the patient lung's internal pressure rapidly. Using the Active Servo Lung (ASL5000) respiratory simulation system, we evaluated the spontaneous breathing of PSV mode on E5, Servo i and Evital XL. The following parameters, the delay time before flow to the patient starts once the trigger variable signaling the start of inspiration, the lowest inspiratory airway pressure generated prior to the initiation of PSV, etc. were measured.