Background:Elevated anxiety levels are common in patients on mechanical ventilation(MV)and may challenge recovery.Research suggests music-based interventions may reduce anxiety during MV.However,studies inves-tigating...Background:Elevated anxiety levels are common in patients on mechanical ventilation(MV)and may challenge recovery.Research suggests music-based interventions may reduce anxiety during MV.However,studies inves-tigating specific music therapy techniques,addressing psychological and physiological well-being in patients on MV,are scarce.Methods:This three-arm randomized clinical pilot study was conducted with MV patients admitted to the intensive care unit(ICU)of Hospital San Joséin Bogotá,Colombia between March 7,2022,and July 11,2022.Patients were divided into three groups:intervention group 1(IG1),music-assisted relaxation;intervention group 2(IG2),patient-preferred therapeutic music listening;and control group(CG),standard care.The main outcome measure was the 6-item State-Anxiety Inventory.Secondary outcomes were:pain(measured with a visual analog scale),resilience(measured with the Brief Resilience Scale),agitation/sedation(measured with the Richmond Agitation-Sedation Scale),vital signs(including heart rate,blood pressure,oxygen saturation,and respiratory rate),days of MV,extubation success,and days in the ICU.Additionally,three patients underwent electroencephalography during the interventions.Results:Data from 23 patients were analyzed in this study.The age range of the patients was 24.0-84.0 years,with a median age of 66.0 years(interquartile range:57.0-74.0).Of the 23 patients,19 were female(82.6%).No statistically significant differences between the groups were observed for anxiety(P=0.330),pain(P=0.624),resilience(P=0.916),agitation/sedation(P=0.273),length of ICU stay(P=0.785),or vital signs.A statistically significant difference between the groups was found for days of MV(P=0.019).Electroencephalography mea-surements showed a trend toward delta and theta band power decrease for two patients and a power increase on both beta frequencies(slow and fast)in the frontal areas of the brain for one patient.Conclusions:In this pilot study,music therapy did not significantly affect the anxiety levels in patien展开更多
BACKGROUND Many studies have revealed a link between non-alcoholic fatty liver disease(NA-FLD)and coronavirus disease 2019(COVID-19),making understanding the relationship between these two conditions an absolute requi...BACKGROUND Many studies have revealed a link between non-alcoholic fatty liver disease(NA-FLD)and coronavirus disease 2019(COVID-19),making understanding the relationship between these two conditions an absolute requirement.AIM To provide a qualitative synthesis on the currently present data evaluating COVID-19 and NAFLD.METHODS This systematic review was conducted in accordance with the guidelines pro-vided by preferred reporting items for systematic reviews and meta-analyses and the questionnaire utilized the population,intervention,comparison,and outcome framework.The search strategy was run on three separate databases,PubMed/MEDLINE,Scopus,and Cochrane Central,which were systematically searched from inception until March 2024 to select all relevant studies.In addition,ClinicalTrials.gov,Medrxiv.org,and Google Scholar were searched to identify grey literature.RESULTS After retrieval of 11 studies,a total of 39282 patients data were pooled.Mortality was found in 11.5%and 9.4%of people in NAFLD and non-NAFLD groups.In all,23.2%of NAFLD patients and 22%of non-NAFLD admissions diagnosed with COVID-19 were admitted to the intensive care unit,with days of stay varying.Ventilatory support ranged from 5%to 40.5%in the NAFLD cohort and from 3.1%to 20%in the non-NAFLD cohort.The incidence of acute liver injury showed significance.Clinical improvement on days 7 and 14 between the two classifications was significant.Hospitalization stay ranged from 9.6 days to 18.8 days and 7.3 days to 16.4 days in the aforementioned cohorts respectively,with 73.3%and 76.3%of patients being discharged.Readmission rates varied.CONCLUSION Clinical outcomes except mortality consistently showed a worsening trend in patients with NAFLD and concomitant COVID-19.Further research in conducting prospective longitudinal studies is essential for a more powerful conclusion.展开更多
BACKGROUND Mechanical ventilation is a common resuscitation method in the intensive care unit(ICU).Unfortunately,this treatment process prolongs the ICU stay of patients with an increased incidence of delirium,which u...BACKGROUND Mechanical ventilation is a common resuscitation method in the intensive care unit(ICU).Unfortunately,this treatment process prolongs the ICU stay of patients with an increased incidence of delirium,which ultimately affects the prognosis.AIM To evaluate the effect of progressive early rehabilitation training on treatment and prognosis of patients with mechanical ventilation in ICU.METHODS The convenience sampling method selected 190 patients with mechanical ventilation admitted to the Fourth Hospital of Hebei Medical University from March 2020 to March 2021.According to the random number table method,they were divided into the control and intervention groups.The control group received routine nursing and rehabilitation measures,whereas the intervention group received progressive early rehabilitation training.In addition,the incidence and duration of delirium were compared for the two groups along with mechanical ventilation time,ICU hospitalization time,functional independence measure(FIM)score,Barthel index,and the incidence of complications(deep venous thrombosis,pressure sores,and acquired muscle weakness).RESULTS In the intervention group,the incidence of delirium was significantly lower than in the control group(28%vs 52%,P<0.001).In the intervention group,the duration of delirium,mechanical ventilation time,and ICU stay were shorter than in the control group(P<0.001).The FIM and Barthel index scores were significantly higher in the intervention group than the control group(P<0.001).The total incidence of complications in the intervention group was 3.15%,which was lower than 17.89%in the control group(P<0.001).CONCLUSION Progressive early rehabilitation training reduced the incidence of delirium and complications in ICU patients with mechanical ventilation,which improved prognosis and quality of life.展开更多
BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in i...BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in intensive care unit(ICU)patients.METHODS:We retrospectively screened the medical records of adult patients(age≥18 years)who required mechanical ventilation(MV)≥24 hours from January 1,2018,to December 31,2018.All arterial blood gas(ABG)tested during MV was retrieved,and MV settings were recorded.The median arterial partial pressure of oxygen(PaO2)>120 mmHg(1 mmHg=0.133 kPa)was defined as mild to moderate hyperoxemia,and PaO2>300 mmHg as extreme hyperoxemia.Intensivists’response to hyperoxemia was assessed based on the reduction of fraction of inspired oxygen(FiO2)within one hour after hyperoxemia was recorded.Multivariable logistic regression analysis was performed to determine the independent factors associated with the intensivists’response to hyperoxemia.RESULTS:A total of 592 patients were fi nally analyzed.The median Acute Physiology and Chronic Health Evaluation II(APACHE II)score was 21(15-26).The PaO2,arterial oxygen saturation(SaO2),FiO2,and positive end expiratory pressure(PEEP)were 96.4(74.0-126.0)mmHg,97.8%(95.2%-99.1%),0.4(0.4-0.5),and 5(3-6)cmH2O,respectively.Totally 174(29.39%)patients had PaO2>120 mmHg,and 19(3.21%)patients had extreme hyperoxemia at PaO2>300 mmHg.In cases of mild to moderate hyperoxemia with FiO2≤0.4,only 13(2.20%)patients had a decrease in FiO2 within one hour.The multivariable logistic regression analysis showed that a positive response was independently associated with FiO2(odds ratio[OR]1.09,95%confi dence interval[CI]1.06-1.12,P<0.001),PaO2(OR 1.01,95%CI 1.00-1.01,P=0.002),and working shifts(OR 5.09,95%CI 1.87-13.80,P=0.001).CONCLUSIONS:Hyperoxemia occurs frequently and is neglected in most cases,particularly when mild to moderate hyperoxemia,hyperoxemia with lower FiO2,hyperoxemia during night and middle-night shifts,or FiO2 less likely to be decreased展开更多
BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients.Cardiac surgery is an important way to treat cardiovascular disease,bu...BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients.Cardiac surgery is an important way to treat cardiovascular disease,but it can prolong mechanical ventilation time,intensive care unit(ICU)stay,and postoperative hospitalization for patients.Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time,length of ICU stay,and duration of postoperative hospitalization after cardiac surgery.METHODS A literature search of PubMed,Web of Science,Cochrane Library,EMBASE,China National Knowledge Infrastructure,WanFang,and the China Science and Technology journal VIP database was performed on April 13,2022.The data was independently extracted by two authors.The inclusion criteria were:(1)Randomized controlled trial;(2)Accessible as a full paper;(3)Patients who received cardiac surgery;(4)Preoperative inspiratory muscle training was implemented in these patients;(5)The study reported at least one of the following:Mechanical ventilation time,length of ICU stay,and/or duration of postoperative hospitalization;and(6)In English language.RESULTS We analyzed six randomized controlled trials with a total of 925 participants.The pooled mean difference of mechanical ventilation time was-0.45 h[95%confidence interval(CI):-1.59-0.69],which was not statistically significant between the intervention group and the control group.The pooled mean difference of length of ICU stay was 0.44 h(95%CI:-0.58-1.45).The pooled mean difference of postoperative hospitalization was-1.77 d in the intervention group vs the control group[95%CI:-2.41-(-1.12)].CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery.More high-quality studies are needed to confirm our conclusion.展开更多
In intensive care units(ICUs),the decision to extubate is a critical one because mortality is particularly high in case of reintubation.Around 15%of patients ready to be weaned offa ventilator experience extubation fa...In intensive care units(ICUs),the decision to extubate is a critical one because mortality is particularly high in case of reintubation.Around 15%of patients ready to be weaned offa ventilator experience extubation failure leading to reintubation.The use of high-flow nasal oxygen and non-invasive ventilation are two alternatives of standard oxygen supplementation that may help to prevent reintubation.High-flow nasal oxygen and non-invasive ventilation,may be used to prevent reintubation in patients with low(e.g.,patients without comorbidities and with short durations of mechanical ventilation)and high risk(e.g.,patients>65 years and those with underlying cardiac disease,chronic respiratory disorders,and/or hypercapnia at the time of extubation)of reintubation,respectively.However,non-invasive ventilation used as a rescue therapy to treat established post-extubation respiratory failure could increase mortality by delaying reintubation,and should therefore be used very carefully in this setting.The oxygenation strategy to be applied in postoperative patients is different from the patients who are extubated in the ICUs.Standard oxygen after a surgical procedure is adequate,even following major abdominal or cardio-thoracic surgery,but should probably be switched to high-flow nasal oxygen in patients with hypoxemic.Unlike in patients experiencing post-extubation respiratory failure in ICUs wherein non-invasive ventilation may have deleterious effects,it may actually improve the outcomes in postoperative patients with respiratory failure.This review discusses the different clinical situations with the aim of choosing the most effective oxygenation strategy to prevent post-extubation respiratory failure and to avoid reintubation.展开更多
Acute exacerbations of interstitial lung disease(AE-ILD)represent an acute,frequent and often highly morbid event in the disease course of ILD patients.Admission in the intensive care unit(ICU)is very common and the n...Acute exacerbations of interstitial lung disease(AE-ILD)represent an acute,frequent and often highly morbid event in the disease course of ILD patients.Admission in the intensive care unit(ICU)is very common and the need for mechanical ventilation arises early.While non-invasive ventilation has shown promise in staving off intubation in selected patients,it is unclear whether mechanical ventilation can alter the exacerbation course unless it is a bridge to lung transplantation.Risk stratification using clinical and radiographic findings,and early palliative care involvement,are important in ICU care.In this review,we discuss many of the pathophysiological aspects of AE-ILD and raise the hypothesis that ventilation strategies used in acute respiratory distress syndrome might be implemented in AE-ILD.We present possible decision-making and management algorithms that can be used by the intensivist when caring for these patients.展开更多
Uniform ventilation is important for the safety of long tunnel in underground buildings,it is difficult to install the large size air duct to ensure the centerline of each cross-section of the traditional variable cro...Uniform ventilation is important for the safety of long tunnel in underground buildings,it is difficult to install the large size air duct to ensure the centerline of each cross-section of the traditional variable cross-section ventila-tion system(VCVS)superimposed on the same horizontal axis,which is significant to the ventilation uniformity,energy consumption and installation convenience of the VCVS.On the contrary,each cross-section of the Equal Cross-section Ventilation System(ECVS)has the same horizontal axis,therefore,it is more convenient to manu-facture and install the large size air duct in the underground long tunnel and achieve uniform ventilation.This study proposes an ECVS,using computational fluid dynamics(CFD)numerical simulation analyzed the influences of main duct velocity,aspect ratio,and outlet numbers on uniformity and energy consumption per unit air vol-ume(ECPV).It revealed that when each ventilation equalizer’s valve Angle𝛽is given,uniformity of air supply decreases slightly with an increase in the inlet velocity.When the air supply main duct aspect ratio increases,the outlet velocity standard deviation range is from 0.22 to 0.34.When outlet numbers N=7~12 and𝛽are constant,air supply uniformity and resistance coefficient𝜉also decrease with the decrease of outlet numbers.The outlet number has a significant influence on the uniformity of system air supply,main duct velocity,and aspect ratio are relatively small.ECPV is positively correlated with the main duct velocity and outlet number,and is negatively correlated with aspect ratio.展开更多
The novel coronavirus,which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality.It has increased hospital occupancy,heralded economic turmoil,an...The novel coronavirus,which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality.It has increased hospital occupancy,heralded economic turmoil,and the rapid transmission and community spread have added to the burden of the virus.Most of the patients are admitted to the intensive care unit(ICU)for acute hypoxic respiratory failure often secondary to acute respiratory distress syndrome(ARDS).Based on the limited data available,there have been different opinions about the respiratory mechanics of the ARDS caused by coronavirus disease 2019(COVID-19).Our article provides an insight into COVID-19 pathophysiology and how it differs from typical ARDS.Based on these differences,our article explains the different approach to ventilation in COVID-19 ARDS compared to typical ARDS.We critically analyze the role of positive end-expiratory pressure(PEEP)and proning in the ICU patients.Through the limited data and clinical experience are available,we believe that early proning in COVID-19 patients improves oxygenation and optimal PEEP should be titrated based on individual lung compliance.展开更多
基金financially supported by the Vice-Rectorate for Research by the Fundación Universitaria de Cien-cias de la Salud,Bogotá,Colombia,Institutional Research Com-mittee,17 de diciembre de 2021-Acta No.08 de 2021.
文摘Background:Elevated anxiety levels are common in patients on mechanical ventilation(MV)and may challenge recovery.Research suggests music-based interventions may reduce anxiety during MV.However,studies inves-tigating specific music therapy techniques,addressing psychological and physiological well-being in patients on MV,are scarce.Methods:This three-arm randomized clinical pilot study was conducted with MV patients admitted to the intensive care unit(ICU)of Hospital San Joséin Bogotá,Colombia between March 7,2022,and July 11,2022.Patients were divided into three groups:intervention group 1(IG1),music-assisted relaxation;intervention group 2(IG2),patient-preferred therapeutic music listening;and control group(CG),standard care.The main outcome measure was the 6-item State-Anxiety Inventory.Secondary outcomes were:pain(measured with a visual analog scale),resilience(measured with the Brief Resilience Scale),agitation/sedation(measured with the Richmond Agitation-Sedation Scale),vital signs(including heart rate,blood pressure,oxygen saturation,and respiratory rate),days of MV,extubation success,and days in the ICU.Additionally,three patients underwent electroencephalography during the interventions.Results:Data from 23 patients were analyzed in this study.The age range of the patients was 24.0-84.0 years,with a median age of 66.0 years(interquartile range:57.0-74.0).Of the 23 patients,19 were female(82.6%).No statistically significant differences between the groups were observed for anxiety(P=0.330),pain(P=0.624),resilience(P=0.916),agitation/sedation(P=0.273),length of ICU stay(P=0.785),or vital signs.A statistically significant difference between the groups was found for days of MV(P=0.019).Electroencephalography mea-surements showed a trend toward delta and theta band power decrease for two patients and a power increase on both beta frequencies(slow and fast)in the frontal areas of the brain for one patient.Conclusions:In this pilot study,music therapy did not significantly affect the anxiety levels in patien
文摘BACKGROUND Many studies have revealed a link between non-alcoholic fatty liver disease(NA-FLD)and coronavirus disease 2019(COVID-19),making understanding the relationship between these two conditions an absolute requirement.AIM To provide a qualitative synthesis on the currently present data evaluating COVID-19 and NAFLD.METHODS This systematic review was conducted in accordance with the guidelines pro-vided by preferred reporting items for systematic reviews and meta-analyses and the questionnaire utilized the population,intervention,comparison,and outcome framework.The search strategy was run on three separate databases,PubMed/MEDLINE,Scopus,and Cochrane Central,which were systematically searched from inception until March 2024 to select all relevant studies.In addition,ClinicalTrials.gov,Medrxiv.org,and Google Scholar were searched to identify grey literature.RESULTS After retrieval of 11 studies,a total of 39282 patients data were pooled.Mortality was found in 11.5%and 9.4%of people in NAFLD and non-NAFLD groups.In all,23.2%of NAFLD patients and 22%of non-NAFLD admissions diagnosed with COVID-19 were admitted to the intensive care unit,with days of stay varying.Ventilatory support ranged from 5%to 40.5%in the NAFLD cohort and from 3.1%to 20%in the non-NAFLD cohort.The incidence of acute liver injury showed significance.Clinical improvement on days 7 and 14 between the two classifications was significant.Hospitalization stay ranged from 9.6 days to 18.8 days and 7.3 days to 16.4 days in the aforementioned cohorts respectively,with 73.3%and 76.3%of patients being discharged.Readmission rates varied.CONCLUSION Clinical outcomes except mortality consistently showed a worsening trend in patients with NAFLD and concomitant COVID-19.Further research in conducting prospective longitudinal studies is essential for a more powerful conclusion.
文摘BACKGROUND Mechanical ventilation is a common resuscitation method in the intensive care unit(ICU).Unfortunately,this treatment process prolongs the ICU stay of patients with an increased incidence of delirium,which ultimately affects the prognosis.AIM To evaluate the effect of progressive early rehabilitation training on treatment and prognosis of patients with mechanical ventilation in ICU.METHODS The convenience sampling method selected 190 patients with mechanical ventilation admitted to the Fourth Hospital of Hebei Medical University from March 2020 to March 2021.According to the random number table method,they were divided into the control and intervention groups.The control group received routine nursing and rehabilitation measures,whereas the intervention group received progressive early rehabilitation training.In addition,the incidence and duration of delirium were compared for the two groups along with mechanical ventilation time,ICU hospitalization time,functional independence measure(FIM)score,Barthel index,and the incidence of complications(deep venous thrombosis,pressure sores,and acquired muscle weakness).RESULTS In the intervention group,the incidence of delirium was significantly lower than in the control group(28%vs 52%,P<0.001).In the intervention group,the duration of delirium,mechanical ventilation time,and ICU stay were shorter than in the control group(P<0.001).The FIM and Barthel index scores were significantly higher in the intervention group than the control group(P<0.001).The total incidence of complications in the intervention group was 3.15%,which was lower than 17.89%in the control group(P<0.001).CONCLUSION Progressive early rehabilitation training reduced the incidence of delirium and complications in ICU patients with mechanical ventilation,which improved prognosis and quality of life.
文摘BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in intensive care unit(ICU)patients.METHODS:We retrospectively screened the medical records of adult patients(age≥18 years)who required mechanical ventilation(MV)≥24 hours from January 1,2018,to December 31,2018.All arterial blood gas(ABG)tested during MV was retrieved,and MV settings were recorded.The median arterial partial pressure of oxygen(PaO2)>120 mmHg(1 mmHg=0.133 kPa)was defined as mild to moderate hyperoxemia,and PaO2>300 mmHg as extreme hyperoxemia.Intensivists’response to hyperoxemia was assessed based on the reduction of fraction of inspired oxygen(FiO2)within one hour after hyperoxemia was recorded.Multivariable logistic regression analysis was performed to determine the independent factors associated with the intensivists’response to hyperoxemia.RESULTS:A total of 592 patients were fi nally analyzed.The median Acute Physiology and Chronic Health Evaluation II(APACHE II)score was 21(15-26).The PaO2,arterial oxygen saturation(SaO2),FiO2,and positive end expiratory pressure(PEEP)were 96.4(74.0-126.0)mmHg,97.8%(95.2%-99.1%),0.4(0.4-0.5),and 5(3-6)cmH2O,respectively.Totally 174(29.39%)patients had PaO2>120 mmHg,and 19(3.21%)patients had extreme hyperoxemia at PaO2>300 mmHg.In cases of mild to moderate hyperoxemia with FiO2≤0.4,only 13(2.20%)patients had a decrease in FiO2 within one hour.The multivariable logistic regression analysis showed that a positive response was independently associated with FiO2(odds ratio[OR]1.09,95%confi dence interval[CI]1.06-1.12,P<0.001),PaO2(OR 1.01,95%CI 1.00-1.01,P=0.002),and working shifts(OR 5.09,95%CI 1.87-13.80,P=0.001).CONCLUSIONS:Hyperoxemia occurs frequently and is neglected in most cases,particularly when mild to moderate hyperoxemia,hyperoxemia with lower FiO2,hyperoxemia during night and middle-night shifts,or FiO2 less likely to be decreased
文摘BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients.Cardiac surgery is an important way to treat cardiovascular disease,but it can prolong mechanical ventilation time,intensive care unit(ICU)stay,and postoperative hospitalization for patients.Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time,length of ICU stay,and duration of postoperative hospitalization after cardiac surgery.METHODS A literature search of PubMed,Web of Science,Cochrane Library,EMBASE,China National Knowledge Infrastructure,WanFang,and the China Science and Technology journal VIP database was performed on April 13,2022.The data was independently extracted by two authors.The inclusion criteria were:(1)Randomized controlled trial;(2)Accessible as a full paper;(3)Patients who received cardiac surgery;(4)Preoperative inspiratory muscle training was implemented in these patients;(5)The study reported at least one of the following:Mechanical ventilation time,length of ICU stay,and/or duration of postoperative hospitalization;and(6)In English language.RESULTS We analyzed six randomized controlled trials with a total of 925 participants.The pooled mean difference of mechanical ventilation time was-0.45 h[95%confidence interval(CI):-1.59-0.69],which was not statistically significant between the intervention group and the control group.The pooled mean difference of length of ICU stay was 0.44 h(95%CI:-0.58-1.45).The pooled mean difference of postoperative hospitalization was-1.77 d in the intervention group vs the control group[95%CI:-2.41-(-1.12)].CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery.More high-quality studies are needed to confirm our conclusion.
文摘In intensive care units(ICUs),the decision to extubate is a critical one because mortality is particularly high in case of reintubation.Around 15%of patients ready to be weaned offa ventilator experience extubation failure leading to reintubation.The use of high-flow nasal oxygen and non-invasive ventilation are two alternatives of standard oxygen supplementation that may help to prevent reintubation.High-flow nasal oxygen and non-invasive ventilation,may be used to prevent reintubation in patients with low(e.g.,patients without comorbidities and with short durations of mechanical ventilation)and high risk(e.g.,patients>65 years and those with underlying cardiac disease,chronic respiratory disorders,and/or hypercapnia at the time of extubation)of reintubation,respectively.However,non-invasive ventilation used as a rescue therapy to treat established post-extubation respiratory failure could increase mortality by delaying reintubation,and should therefore be used very carefully in this setting.The oxygenation strategy to be applied in postoperative patients is different from the patients who are extubated in the ICUs.Standard oxygen after a surgical procedure is adequate,even following major abdominal or cardio-thoracic surgery,but should probably be switched to high-flow nasal oxygen in patients with hypoxemic.Unlike in patients experiencing post-extubation respiratory failure in ICUs wherein non-invasive ventilation may have deleterious effects,it may actually improve the outcomes in postoperative patients with respiratory failure.This review discusses the different clinical situations with the aim of choosing the most effective oxygenation strategy to prevent post-extubation respiratory failure and to avoid reintubation.
文摘Acute exacerbations of interstitial lung disease(AE-ILD)represent an acute,frequent and often highly morbid event in the disease course of ILD patients.Admission in the intensive care unit(ICU)is very common and the need for mechanical ventilation arises early.While non-invasive ventilation has shown promise in staving off intubation in selected patients,it is unclear whether mechanical ventilation can alter the exacerbation course unless it is a bridge to lung transplantation.Risk stratification using clinical and radiographic findings,and early palliative care involvement,are important in ICU care.In this review,we discuss many of the pathophysiological aspects of AE-ILD and raise the hypothesis that ventilation strategies used in acute respiratory distress syndrome might be implemented in AE-ILD.We present possible decision-making and management algorithms that can be used by the intensivist when caring for these patients.
基金This work was supported by Scientific Research Fund of Hunan Provincial Education Department[19A001]Natural Science Foundation of Hunan Province[2019JJ40303]+1 种基金State Key Laboratory of Air-conditioning Equipment and System Energy Conservation[ACSKL2018KT18]Double-First class International Collaboration Fund of Changsha University of Science and Technology[2018IC16].
文摘Uniform ventilation is important for the safety of long tunnel in underground buildings,it is difficult to install the large size air duct to ensure the centerline of each cross-section of the traditional variable cross-section ventila-tion system(VCVS)superimposed on the same horizontal axis,which is significant to the ventilation uniformity,energy consumption and installation convenience of the VCVS.On the contrary,each cross-section of the Equal Cross-section Ventilation System(ECVS)has the same horizontal axis,therefore,it is more convenient to manu-facture and install the large size air duct in the underground long tunnel and achieve uniform ventilation.This study proposes an ECVS,using computational fluid dynamics(CFD)numerical simulation analyzed the influences of main duct velocity,aspect ratio,and outlet numbers on uniformity and energy consumption per unit air vol-ume(ECPV).It revealed that when each ventilation equalizer’s valve Angle𝛽is given,uniformity of air supply decreases slightly with an increase in the inlet velocity.When the air supply main duct aspect ratio increases,the outlet velocity standard deviation range is from 0.22 to 0.34.When outlet numbers N=7~12 and𝛽are constant,air supply uniformity and resistance coefficient𝜉also decrease with the decrease of outlet numbers.The outlet number has a significant influence on the uniformity of system air supply,main duct velocity,and aspect ratio are relatively small.ECPV is positively correlated with the main duct velocity and outlet number,and is negatively correlated with aspect ratio.
文摘The novel coronavirus,which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality.It has increased hospital occupancy,heralded economic turmoil,and the rapid transmission and community spread have added to the burden of the virus.Most of the patients are admitted to the intensive care unit(ICU)for acute hypoxic respiratory failure often secondary to acute respiratory distress syndrome(ARDS).Based on the limited data available,there have been different opinions about the respiratory mechanics of the ARDS caused by coronavirus disease 2019(COVID-19).Our article provides an insight into COVID-19 pathophysiology and how it differs from typical ARDS.Based on these differences,our article explains the different approach to ventilation in COVID-19 ARDS compared to typical ARDS.We critically analyze the role of positive end-expiratory pressure(PEEP)and proning in the ICU patients.Through the limited data and clinical experience are available,we believe that early proning in COVID-19 patients improves oxygenation and optimal PEEP should be titrated based on individual lung compliance.
