目的 探讨高流量氧疗在ICU机械通气患者脱机过程中的应用效果。方法 105例ICU中因呼吸衰竭行机械通气治疗后脱机但未拔管的患者，采用随机数值表法分为研究组和对照组。研究组采用气管插管处接高流量氧疗系统行氧疗湿化治疗，对照组采...目的 探讨高流量氧疗在ICU机械通气患者脱机过程中的应用效果。方法 105例ICU中因呼吸衰竭行机械通气治疗后脱机但未拔管的患者，采用随机数值表法分为研究组和对照组。研究组采用气管插管处接高流量氧疗系统行氧疗湿化治疗，对照组采用气管插管处接人工鼻联合文丘里空氧混合阀行传统氧疗。监测比较脱机后6、12、24 h两组患者的呼吸频率、动脉血pH、PaO2、氧合指数（PaO2/FiO2）、PaCO2、气道湿化效果、纤支镜吸痰次数。比较脱机期间两组患者再上机率、拔管后无创呼吸机使用率、拔管后72 h内再插管率及ICU住院天数。结果 氧疗后6、12、24 h研究组患者的呼吸频率、PaO2、氧合指数均优于对照组（P〈0.01）；两组动脉血pH、PaCO2比较差异无统计学意义（P〉0.05）；研究组气道湿化效果优于对照组（P〈0.01），纤支镜吸痰次数较对照组少（2.1±1.3 vs. 3.0±1.3,P〈0.01）。研究组脱机期间再上机率低于对照组（11.8% vs. 29.6%，P〈0.05），两组拔管后无创呼吸机使用率（17.6% vs. 31.5%，P〉0.05），拔管后72 h内再插管率（7.8% vs. 18.5%，P〉0.05）以及ICU住院天数（14.3±3.0 vs. 14.3±3.3，P〉0.05）比较差异无统计学意义。结论 高流量氧疗系统可以降低ICU机械通气患者脱机后的呼吸频率，改善氧合，提高气道湿化效果,减少纤支镜吸痰次数，并降低脱机后再上机率，但拔管后无创呼吸机使用率、72 h内再插管率和ICU住院天数差异无统计学意义。展开更多
BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noni...BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy.METHODS: Fifty patients including 24 patients with withdrawal of mechanical ventilation(conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy(sequential group) were analyzed retrospectively after appearance of pulmonary infection control(PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia(VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups.RESULTS: Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased.CONCLUSION: Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.展开更多
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 su展开更多
文摘目的 探讨高流量氧疗在ICU机械通气患者脱机过程中的应用效果。方法 105例ICU中因呼吸衰竭行机械通气治疗后脱机但未拔管的患者，采用随机数值表法分为研究组和对照组。研究组采用气管插管处接高流量氧疗系统行氧疗湿化治疗，对照组采用气管插管处接人工鼻联合文丘里空氧混合阀行传统氧疗。监测比较脱机后6、12、24 h两组患者的呼吸频率、动脉血pH、PaO2、氧合指数（PaO2/FiO2）、PaCO2、气道湿化效果、纤支镜吸痰次数。比较脱机期间两组患者再上机率、拔管后无创呼吸机使用率、拔管后72 h内再插管率及ICU住院天数。结果 氧疗后6、12、24 h研究组患者的呼吸频率、PaO2、氧合指数均优于对照组（P〈0.01）；两组动脉血pH、PaCO2比较差异无统计学意义（P〉0.05）；研究组气道湿化效果优于对照组（P〈0.01），纤支镜吸痰次数较对照组少（2.1±1.3 vs. 3.0±1.3,P〈0.01）。研究组脱机期间再上机率低于对照组（11.8% vs. 29.6%，P〈0.05），两组拔管后无创呼吸机使用率（17.6% vs. 31.5%，P〉0.05），拔管后72 h内再插管率（7.8% vs. 18.5%，P〉0.05）以及ICU住院天数（14.3±3.0 vs. 14.3±3.3，P〉0.05）比较差异无统计学意义。结论 高流量氧疗系统可以降低ICU机械通气患者脱机后的呼吸频率，改善氧合，提高气道湿化效果,减少纤支镜吸痰次数，并降低脱机后再上机率，但拔管后无创呼吸机使用率、72 h内再插管率和ICU住院天数差异无统计学意义。
基金supported by the fund for clinical research project(2015xkj086)
文摘BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy.METHODS: Fifty patients including 24 patients with withdrawal of mechanical ventilation(conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy(sequential group) were analyzed retrospectively after appearance of pulmonary infection control(PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia(VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups.RESULTS: Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased.CONCLUSION: Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.
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 su
