Background The recruitment maneuver （RM） has been shown to improve oxygenation in some patients with acute respiratory distress syndrome. But there is a lack of standardization and lack of clinical studies to prove ...Background The recruitment maneuver （RM） has been shown to improve oxygenation in some patients with acute respiratory distress syndrome. But there is a lack of standardization and lack of clinical studies to prove the improvement on clinical outcome. We conducted this study to evaluate the clinical efficacy and safety of the RM in patients with acute respiratory distress syndrome （ARDS） using Iow tidal volume ventilation.Methods We randomly assigned 110 patients with ARDS from 14 Chinese intensive care units （ICUs） at the tertiary teaching hospitals. Patients with PaO2 ≤200 mmHg at FiO2 1.0 and PEEP ≥10 cmH2O were included in the study.Patients were randomized into two groups： control group and RM group. The tidal volume was set to 6-8 mi per kilogram of predicted body weight （PBW） in both groups. RM was performed by continuous positive airway pressure （CPAP） of 40 cmH2O maintained for 40 seconds. RMs was conducted every eight hours for the first five days, or stopped within five days if the patient reached the weaning standard.Results One hundred and ten patients had completed the requirements for the primary study goals, 55 from the RM group and 55 control patients. Baseline characteristics remained similar in the two groups. In the RM group the PaO2/FiO2 was significantly increased compared to baseline at 120 minutes after RM on day one and day two （P=0.007and P=0.001）. There were no significant differences between the RM and control group in hospital mortality （41.8% vs.56.4%, P=0.13）, 28-day mortality （29.1% vs. 43.6%, P=0.11） and ventilator-free days at day 28 （10.8±10.1 vs. 7.4±10.0,P=0.08）. ICU mortality （32.7% vs. 52.7%, P=0.03）, the rate of survival with unassisted breathing for at least 48 consecutive hours at day 28 （58.2% vs. 36.2%, P=0.02）, and nonpulmonary organ failure-free days at day 28 （17.4±11.1vs. 13.0±12.0, P=0.03） favored the RM group. There was no significant difference in mean blood pressure and heart rate before RM and at 30, 60,展开更多
Continuous improvements in perinatal care have resultedin increased survival of premature infants.Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease(CLD...Continuous improvements in perinatal care have resultedin increased survival of premature infants.Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease(CLD) or bronchopulmonary dysplasia.Strategies to minimize the risk of lung injury have been developed and include improved antenatal management(education,regionalization,steroids,and antibiotics),exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support.The most frequently used mode of assisted ventilation is pressure support ventilation that may lead to patientventilator asynchrony that is associated with poor outcome.Ventilator-induced diaphragmatic dysfunction or disuse atrophy of diaphragm fibers may also occur.This has led to the development of new ventilation modes including neurally adjusted ventilatory assist(NAVA).This ventilation mode is controlled by electrodes embedded within a nasogastric catheter which detect the electrical diaphragmatic activity(Edi) and transmit it to trigger the ventilator in synchrony with the patient's own respiratory efforts.This permits the patient to control peak inspiratory pressure,mean airway pressure and tidal volume.Back up pressure control(PC) is provided when there is no Edi signal and no pneumatic trigger.Compared with standard conventional ventilation,NAVA improves blood gas regulation with lower peak inspiratory pressure and oxygen requirements in preterm infants.NAVA is safe mode of ventilation.The majority of studies have shown no significant adverse events in neonates ventilated with NAVA nor a difference in the rate of intraventricular hemorrhage,pneumothorax,or necrotizing enterocolitis when compared to conventional ventilation.Future large size randomized controlled trials should be established to compare NAVA with volume targeted and pressure controlled ventilation in newborns with mature respiratory drive.Most previous studies and trials were not sufficiently large and did not inclu展开更多
Importance: The appropriate anesthetic method can reduce the complications of children with tracheal foreign body and reduce the mortality rate of children. What kind of anesthetic method to choose has always been the...Importance: The appropriate anesthetic method can reduce the complications of children with tracheal foreign body and reduce the mortality rate of children. What kind of anesthetic method to choose has always been the focus of debate. Purpose: To evaluate the efficacy and safety of anesthesia with propofol-remifentanil combined with rocuronium for foreign body aspiration (FBA) removal with the positive-pressure ventilation technique. Methods: Medical records of patients who underwent bronchoscopy for evaluation of FBA in our unit from January 2015 to January 2018 were retrospectively reviewed. Demographic data (age and sex), nature of foreign body and location, complications, length of hospital stay and outcome were analyzed. Results: A total of 2886 children were included in this study. The median age was 24 months (8 months to 10 years). FBA was detected and removed in 95.6％ of patients. The average operation time was 17 ± 5 min and average length of hospital stay was 2 days. Observed peri-interventional complications included desaturation (n = 66), laryngospasm (n = 19), laryngeal or subglottic edema (n = 15), irritating cough (n = 3), body movement (n = 76) and pneumonia (n = 206). No deaths occurred during hospitalization or follow-up in this series. Interpretation: Anesthesia with propofol-remifentanil combined with rocuronium under positive-pressure ventilation is an effective and safe technique during FBA removal in children.展开更多
OBJECTIVE: To investigate the relationship between sleep apnea hypopnea syndrome (SAHS) and some cardiovascular abnormalities in elderly snorers, as well as the effectiveness of nasal continuous positive airway pressu...OBJECTIVE: To investigate the relationship between sleep apnea hypopnea syndrome (SAHS) and some cardiovascular abnormalities in elderly snorers, as well as the effectiveness of nasal continuous positive airway pressure on those with SAHS. METHODS: With the use of polysomnography, 73 elderly snorers (older than 60 years) were examined and placed into either the SAHS group or the control group. Using ambulatory electrocardiogram (ECG) and blood pressure measurement, daily nocturnal rhythm of blood pressure, hypertension, heart rate variability, some arrhythmia and angina pectoris of coronary heart disease (CHD) were monitored and compared between the two groups before and after 5 - 7 days of treatment with nasal continuous positive airway pressure on the SAHS group. RESULTS: This study indicated a higher incidence (47.9%) of sleep apnea syndrome in elderly snorers and demonstrated that there was a significantly higher incidence of hypertension, disappearance in daily nocturnal rhythm of blood pressure, poor effectiveness of nitrate on angina pectoris of coronary heart disease, decreased heart rate variability during sleep, increased arrhythmia and lower pulse oxygen saturation (SpO(2)) levels in the SAHS group than in the control group. After nasal continuous positive airway pressure treatment during sleep, snoring control, significantly higher SpO(2) levels and lower index of apnea/hypopnea were achieved in the SAHS group; heart rate variability (HRV) and blood pressure day nocturnal rhythm were returned to normal levels. CONCLUSION: This research suggests that there is a close relationship between the development of sleep apnea syndrome and some cardiovascular diseases. Continuous positive nasal airway pressure is effective not only on SAHS but also on coexisting cardiovascular disorders.展开更多
Introduction: During the application of non-invasive positive pressure ventilation (NPPV) therapy in home mechanical ventilation (HMV), leaks in the NPPV mask may occur owing to the position of the mask due to conditi...Introduction: During the application of non-invasive positive pressure ventilation (NPPV) therapy in home mechanical ventilation (HMV), leaks in the NPPV mask may occur owing to the position of the mask due to conditions such as skin disorders. Methods: To investigate whether such a leak affects FiO2 supplied to the alveoli, we simulated a patient with chronic obstructive pulmonary disorder during NPPV in HMV. In addition, FiO2 was measured in the portion assumed to be the mouth and lungs while setting the flow of the oxygen concentrator and leak amount based on a previous study. Results: FiO2 supplied to the lungs increased statistically significantly upon increasing the amount of leak (P Conclusions: We observed that FiO2 supplied to alveoli can be reduced by a leak in the NPPV mask. Because our results differ from those previously reported, we believe that further studies should reassess the selection of respirators and oxygen concentrators.展开更多
Systemic air embolism through a bronchovenous fistu-la(BVF) has been described in patients undergoing positive-pressure ventilation. However, no report has mentioned the potential risks of systemic air embolism throug...Systemic air embolism through a bronchovenous fistu-la(BVF) has been described in patients undergoing positive-pressure ventilation. However, no report has mentioned the potential risks of systemic air embolism through a BVF in patients undergoing extracorporeal membrane oxygenation(ECMO). Positive-pressure ventilation and ECMO support in patients with lung injury can increase the risk of systemic air embolism through a BVF. Increased alveolar pressure, decreased pulmonary venous pressure, and anticoagulation are thought to be the factors that contribute to this complication. Here, we present a case of systemic air embolism in a patient with ECMO and mechanical ventilator support.展开更多
OBJECTIVE: To investigate the impact of proportional assist ventilation (PAV) on tolerance and breathlessness in ventilated chronic obstructive pulmonary disease (COPD), and to describe the patient-ventilator interact...OBJECTIVE: To investigate the impact of proportional assist ventilation (PAV) on tolerance and breathlessness in ventilated chronic obstructive pulmonary disease (COPD), and to describe the patient-ventilator interaction, hemodynamic state, breathing pattern and work of breath during PAV and pressure support ventilation (PSV). METHODS: Ten intubated COPD patients on weaning from mechanical ventilation were studied. Elastance and resistance were measured by both the inspiratory-hold technique during a brief period of volume control ventilation and runaway technique during PAV. Each assistance level of PAV (80%, 60% and 40%) and PSV was selected randomly. Patients' response, hemodynamics, blood gas and lung mechanics were monitored. RESULTS: Tidal volume and respiratory rate didn't change in a consistent manner as the level of assist was decreased (P > 0.05). With the level of assist increasing, peak inspiratory pressure was increasing significantly (P展开更多
Background and purpose: Patients with severely impaired pulmonary function have an increased operative risk for major lung resection. The clinical benefits of pre- and perioperative, non-invasive pressure support vent...Background and purpose: Patients with severely impaired pulmonary function have an increased operative risk for major lung resection. The clinical benefits of pre- and perioperative, non-invasive pressure support ventilation (NIPSV) have up to now not been extensively evaluated. Patients with severely reduced pulmonary function were investigated in this prospective and randomised single centre clinical trial. Methods: Standard pulmonary evaluation was performed in all patients before major lung resection. To predict postoperative pulmonary function, a lung perfusion-ventilation scan was carried out. All patients enrolled in the study were instructed preoperatively on how to use a NIPSV respirator. Af-ter lung resection patients were randomised either for continuation of NIPSV or for standard treatment. Results: Of the 52 patients assessed, 21 patients met the inclusion criteria for the study protocol. Predicted mean postoperative FEV1 was 1.10 L (range 0.92 - 1.27 L). Lobectomy was performed in 14 patients, pneumonectomy in 6 patients and a segmentectomy in 1 patient. No inhospital deaths occurred. Pulmonary complications (reintubation, pneumonia) were more frequent in the NIPSV group than in the control group (3 patients versus 1 patient), without statistical significance (p = 0.31). Conclusions: We observed no mortality and a low morbidity in this high risk group. Postoperative continuation of NIPSV had no beneficial effect on the clinical outcome. Preoperative conditioning with NIPSV, however, seems to be a suitable tool for patients with severely impaired pulmonary function. This study may serve therefore as basis for further investigations for the potential clinical benefits of prophylactic NIPSV in major lung surgery.展开更多
目的比较早期应用无创高频振荡通气(nasal high frequency oscillatory ventilation,nHFOV)与经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)作为早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)初...目的比较早期应用无创高频振荡通气(nasal high frequency oscillatory ventilation,nHFOV)与经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)作为早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)初始治疗的临床效果。方法选取在新生儿重症监护病房(neonatal intensive care unit,NICU)住院治疗的86例RDS早产患儿,随机分为nHFOV组(n=44)及nCPAP组(n=42)。分析比较两组患儿初始治疗失败率、呼吸支持治疗相关数据、病死率及各种不良反应发生的情况。结果nHFOV组初始治疗失败率、BPD发生率、总通气时间、治疗后二氧化碳分压(partial pressure of carbon dioxide,PaCO2)均明显低于nCPAP组,差异有统计学意义(P<0.05);而两组治疗后氧分压(partial pressure of oxygen,PaO2)、病死率、无创通气时间以及新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、早产儿视网膜病(retinopathy of prematurity,ROP)、颅内出血(intraventricular hemorrhage,IVH)、消化道穿孔、气胸/气漏及鼻损伤等不良反应发生率差异无统计学意义(P>0.05)。结论作为RDS早产儿的初始治疗方式,nHFOV临床治疗效果优于nCPAP,而各种不良反应发生率较nCPAP低或相当,可作为一种新的无创通气方式在临床使用。展开更多
文摘Background The recruitment maneuver （RM） has been shown to improve oxygenation in some patients with acute respiratory distress syndrome. But there is a lack of standardization and lack of clinical studies to prove the improvement on clinical outcome. We conducted this study to evaluate the clinical efficacy and safety of the RM in patients with acute respiratory distress syndrome （ARDS） using Iow tidal volume ventilation.Methods We randomly assigned 110 patients with ARDS from 14 Chinese intensive care units （ICUs） at the tertiary teaching hospitals. Patients with PaO2 ≤200 mmHg at FiO2 1.0 and PEEP ≥10 cmH2O were included in the study.Patients were randomized into two groups： control group and RM group. The tidal volume was set to 6-8 mi per kilogram of predicted body weight （PBW） in both groups. RM was performed by continuous positive airway pressure （CPAP） of 40 cmH2O maintained for 40 seconds. RMs was conducted every eight hours for the first five days, or stopped within five days if the patient reached the weaning standard.Results One hundred and ten patients had completed the requirements for the primary study goals, 55 from the RM group and 55 control patients. Baseline characteristics remained similar in the two groups. In the RM group the PaO2/FiO2 was significantly increased compared to baseline at 120 minutes after RM on day one and day two （P=0.007and P=0.001）. There were no significant differences between the RM and control group in hospital mortality （41.8% vs.56.4%, P=0.13）, 28-day mortality （29.1% vs. 43.6%, P=0.11） and ventilator-free days at day 28 （10.8±10.1 vs. 7.4±10.0,P=0.08）. ICU mortality （32.7% vs. 52.7%, P=0.03）, the rate of survival with unassisted breathing for at least 48 consecutive hours at day 28 （58.2% vs. 36.2%, P=0.02）, and nonpulmonary organ failure-free days at day 28 （17.4±11.1vs. 13.0±12.0, P=0.03） favored the RM group. There was no significant difference in mean blood pressure and heart rate before RM and at 30, 60,
文摘Continuous improvements in perinatal care have resultedin increased survival of premature infants.Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease(CLD) or bronchopulmonary dysplasia.Strategies to minimize the risk of lung injury have been developed and include improved antenatal management(education,regionalization,steroids,and antibiotics),exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support.The most frequently used mode of assisted ventilation is pressure support ventilation that may lead to patientventilator asynchrony that is associated with poor outcome.Ventilator-induced diaphragmatic dysfunction or disuse atrophy of diaphragm fibers may also occur.This has led to the development of new ventilation modes including neurally adjusted ventilatory assist(NAVA).This ventilation mode is controlled by electrodes embedded within a nasogastric catheter which detect the electrical diaphragmatic activity(Edi) and transmit it to trigger the ventilator in synchrony with the patient's own respiratory efforts.This permits the patient to control peak inspiratory pressure,mean airway pressure and tidal volume.Back up pressure control(PC) is provided when there is no Edi signal and no pneumatic trigger.Compared with standard conventional ventilation,NAVA improves blood gas regulation with lower peak inspiratory pressure and oxygen requirements in preterm infants.NAVA is safe mode of ventilation.The majority of studies have shown no significant adverse events in neonates ventilated with NAVA nor a difference in the rate of intraventricular hemorrhage,pneumothorax,or necrotizing enterocolitis when compared to conventional ventilation.Future large size randomized controlled trials should be established to compare NAVA with volume targeted and pressure controlled ventilation in newborns with mature respiratory drive.Most previous studies and trials were not sufficiently large and did not inclu
文摘Importance: The appropriate anesthetic method can reduce the complications of children with tracheal foreign body and reduce the mortality rate of children. What kind of anesthetic method to choose has always been the focus of debate. Purpose: To evaluate the efficacy and safety of anesthesia with propofol-remifentanil combined with rocuronium for foreign body aspiration (FBA) removal with the positive-pressure ventilation technique. Methods: Medical records of patients who underwent bronchoscopy for evaluation of FBA in our unit from January 2015 to January 2018 were retrospectively reviewed. Demographic data (age and sex), nature of foreign body and location, complications, length of hospital stay and outcome were analyzed. Results: A total of 2886 children were included in this study. The median age was 24 months (8 months to 10 years). FBA was detected and removed in 95.6％ of patients. The average operation time was 17 ± 5 min and average length of hospital stay was 2 days. Observed peri-interventional complications included desaturation (n = 66), laryngospasm (n = 19), laryngeal or subglottic edema (n = 15), irritating cough (n = 3), body movement (n = 76) and pneumonia (n = 206). No deaths occurred during hospitalization or follow-up in this series. Interpretation: Anesthesia with propofol-remifentanil combined with rocuronium under positive-pressure ventilation is an effective and safe technique during FBA removal in children.
文摘OBJECTIVE: To investigate the relationship between sleep apnea hypopnea syndrome (SAHS) and some cardiovascular abnormalities in elderly snorers, as well as the effectiveness of nasal continuous positive airway pressure on those with SAHS. METHODS: With the use of polysomnography, 73 elderly snorers (older than 60 years) were examined and placed into either the SAHS group or the control group. Using ambulatory electrocardiogram (ECG) and blood pressure measurement, daily nocturnal rhythm of blood pressure, hypertension, heart rate variability, some arrhythmia and angina pectoris of coronary heart disease (CHD) were monitored and compared between the two groups before and after 5 - 7 days of treatment with nasal continuous positive airway pressure on the SAHS group. RESULTS: This study indicated a higher incidence (47.9%) of sleep apnea syndrome in elderly snorers and demonstrated that there was a significantly higher incidence of hypertension, disappearance in daily nocturnal rhythm of blood pressure, poor effectiveness of nitrate on angina pectoris of coronary heart disease, decreased heart rate variability during sleep, increased arrhythmia and lower pulse oxygen saturation (SpO(2)) levels in the SAHS group than in the control group. After nasal continuous positive airway pressure treatment during sleep, snoring control, significantly higher SpO(2) levels and lower index of apnea/hypopnea were achieved in the SAHS group; heart rate variability (HRV) and blood pressure day nocturnal rhythm were returned to normal levels. CONCLUSION: This research suggests that there is a close relationship between the development of sleep apnea syndrome and some cardiovascular diseases. Continuous positive nasal airway pressure is effective not only on SAHS but also on coexisting cardiovascular disorders.
文摘Introduction: During the application of non-invasive positive pressure ventilation (NPPV) therapy in home mechanical ventilation (HMV), leaks in the NPPV mask may occur owing to the position of the mask due to conditions such as skin disorders. Methods: To investigate whether such a leak affects FiO2 supplied to the alveoli, we simulated a patient with chronic obstructive pulmonary disorder during NPPV in HMV. In addition, FiO2 was measured in the portion assumed to be the mouth and lungs while setting the flow of the oxygen concentrator and leak amount based on a previous study. Results: FiO2 supplied to the lungs increased statistically significantly upon increasing the amount of leak (P Conclusions: We observed that FiO2 supplied to alveoli can be reduced by a leak in the NPPV mask. Because our results differ from those previously reported, we believe that further studies should reassess the selection of respirators and oxygen concentrators.
基金Supported by 2014 Research Grant from Kangwon National University
文摘Systemic air embolism through a bronchovenous fistu-la(BVF) has been described in patients undergoing positive-pressure ventilation. However, no report has mentioned the potential risks of systemic air embolism through a BVF in patients undergoing extracorporeal membrane oxygenation(ECMO). Positive-pressure ventilation and ECMO support in patients with lung injury can increase the risk of systemic air embolism through a BVF. Increased alveolar pressure, decreased pulmonary venous pressure, and anticoagulation are thought to be the factors that contribute to this complication. Here, we present a case of systemic air embolism in a patient with ECMO and mechanical ventilator support.
文摘OBJECTIVE: To investigate the impact of proportional assist ventilation (PAV) on tolerance and breathlessness in ventilated chronic obstructive pulmonary disease (COPD), and to describe the patient-ventilator interaction, hemodynamic state, breathing pattern and work of breath during PAV and pressure support ventilation (PSV). METHODS: Ten intubated COPD patients on weaning from mechanical ventilation were studied. Elastance and resistance were measured by both the inspiratory-hold technique during a brief period of volume control ventilation and runaway technique during PAV. Each assistance level of PAV (80%, 60% and 40%) and PSV was selected randomly. Patients' response, hemodynamics, blood gas and lung mechanics were monitored. RESULTS: Tidal volume and respiratory rate didn't change in a consistent manner as the level of assist was decreased (P > 0.05). With the level of assist increasing, peak inspiratory pressure was increasing significantly (P
文摘Background and purpose: Patients with severely impaired pulmonary function have an increased operative risk for major lung resection. The clinical benefits of pre- and perioperative, non-invasive pressure support ventilation (NIPSV) have up to now not been extensively evaluated. Patients with severely reduced pulmonary function were investigated in this prospective and randomised single centre clinical trial. Methods: Standard pulmonary evaluation was performed in all patients before major lung resection. To predict postoperative pulmonary function, a lung perfusion-ventilation scan was carried out. All patients enrolled in the study were instructed preoperatively on how to use a NIPSV respirator. Af-ter lung resection patients were randomised either for continuation of NIPSV or for standard treatment. Results: Of the 52 patients assessed, 21 patients met the inclusion criteria for the study protocol. Predicted mean postoperative FEV1 was 1.10 L (range 0.92 - 1.27 L). Lobectomy was performed in 14 patients, pneumonectomy in 6 patients and a segmentectomy in 1 patient. No inhospital deaths occurred. Pulmonary complications (reintubation, pneumonia) were more frequent in the NIPSV group than in the control group (3 patients versus 1 patient), without statistical significance (p = 0.31). Conclusions: We observed no mortality and a low morbidity in this high risk group. Postoperative continuation of NIPSV had no beneficial effect on the clinical outcome. Preoperative conditioning with NIPSV, however, seems to be a suitable tool for patients with severely impaired pulmonary function. This study may serve therefore as basis for further investigations for the potential clinical benefits of prophylactic NIPSV in major lung surgery.
文摘目的比较早期应用无创高频振荡通气(nasal high frequency oscillatory ventilation,nHFOV)与经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)作为早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)初始治疗的临床效果。方法选取在新生儿重症监护病房(neonatal intensive care unit,NICU)住院治疗的86例RDS早产患儿,随机分为nHFOV组(n=44)及nCPAP组(n=42)。分析比较两组患儿初始治疗失败率、呼吸支持治疗相关数据、病死率及各种不良反应发生的情况。结果nHFOV组初始治疗失败率、BPD发生率、总通气时间、治疗后二氧化碳分压(partial pressure of carbon dioxide,PaCO2)均明显低于nCPAP组,差异有统计学意义(P<0.05);而两组治疗后氧分压(partial pressure of oxygen,PaO2)、病死率、无创通气时间以及新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、早产儿视网膜病(retinopathy of prematurity,ROP)、颅内出血(intraventricular hemorrhage,IVH)、消化道穿孔、气胸/气漏及鼻损伤等不良反应发生率差异无统计学意义(P>0.05)。结论作为RDS早产儿的初始治疗方式,nHFOV临床治疗效果优于nCPAP,而各种不良反应发生率较nCPAP低或相当,可作为一种新的无创通气方式在临床使用。
