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Predictive performance of the variation rate of the driving pressure on the outcome of invasive mechanical ventilation in patients with acute respiratory distress syndrome

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Chinese Journal of Traumatology 2024年第2期27卷 107-113页

作者： Hui-Dan Jing Jun-Ying Tian Wei Li Bing-Ling He Hong-Chao Li Fu-Xia Jian Cui Shang Feng Shen Department of Intensive Care Unit The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550004China Department of Intensive Care Unit Army Medical Center of PLAChongqing400042China College of Foreign Languges Chongqing Medical UniversityChongqing400016China

Purpose:To assess the value of the driving pressure variation rate(ΔP%)in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.Methods:In this case-control study,a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled.Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days.Outcome measures including driving pressure,PaO2:FiO2,and positive end-expiratory pressure,etc.were assessed every 24 h from day 0 to day 14 until successful weaning was achieved.The measurement data of non-normal distribution were presented as median(Q1,Q3),and the differences between groups were compared by Wilcoxon rank sum test.And categorical data use the Chi-square test or Fisher's exact test to compare.The predictive value ofΔP%in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.Results:Of the total 35 patients included in the study,17 were successful vs.18 failed in weaning from a ventilator after 14 days of mechanical ventilation.The cut-off values of the medianΔP%measured by Operator 1 vs.Operator 2 in the first 4 days were≥4.17%and 4.55%,respectively(pmechanical ventilation duration between the successful weaning group and the failure weaning group(8(6,13)vs.12(7.5,17.3),p=0.043).The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group(0.2‰vs.2.3‰,p=0.001).There was a significant difference noted between these 2 groups in the 28-day mortality(11.8%vs.66.7%,

关键词： Driving pressure Driving pressure variation rate Acute respiratory distress syndrome mechanical ventilation

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Prediction of mechanical ventilation outcome by early abdominal-visceral-blood-flow-and-function score in critically ill patients after cardiopulmonary bypass in the ICU: A prospective observational study

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Journal of Intensive Medicine 2024年第1期4卷 101-107页

作者： Chaofu Yue Longxiang Su Jun Wang Na Cui Yuankai Zhou Wei Cheng Bo Tang Xi Rui Huaiwu He Yun Long Department of Intensive Care Unit Peking Union Medical College HospitalBeijingChina Department of Intensive Care Unit Qujing First People’s HospitalQujingYunnanChina Department of Intensive Care Unit Shiyan People’s Hospital of Bao’an DistrictShenzhenGuangdongChina

Background:Abdominal organs are important organs that sense and respond to ischemia and hypoxia,but there are few evaluation methods.We use ultrasonography to evaluate abdominal organ function and blood flow in patients with mechanical ventilation(MV)after cardiopulmonary bypass and to obtain a semiquantitative score for abdominal organ function and blood flow.Methods:Patients with cardiopulmonary bypass in the Critical Care Department of Peking Union Medical College Hospital in China from March to July 2021 were enrolled in this prospective observational study.The correlation of the abdominal-visceral-blood-flow-and-function score(AVBFS)with the duration of MV,number of days spent in the intensive care unit(ICU),acute physiology and chronic health evaluation II(APACHE-II),sequential organ failure assessment(SOFA),lactate,epinephrine,and norepinephrine use was analyzed,and the results were used to assess the predictive value of the receiver operating characteristic curve(ROC)regression analysis score for the duration of MV.Results:Of the 92 patients who underwent cardiopulmonary bypass,41 were finally included.The AVBFS were significantly correlated with the duration of MV,number of days spent in the ICU,APACHE-II score,SOFA score,and norepinephrine use time.The AVBFS in a group of patients using ventilators≥36 h were significantly higher than those obtained for a group of patients using ventilators<36 h(P<0.05).The evaluation results for the AVBFS at 0-12 h after ICU admission were as follows:area under the ROC curve(AUC)=0.876(95%confidence interval[CI]:0.767 to 0.984),cut-off value=2.5,specificity=0.842,and sensitivity=0.773.Conclusions:Abdominal visceral organ function and blood perfusion can be used to evaluate gastrointestinal function.It is related to early and late extubation after cardiac surgery.

关键词： Ultrasonic evaluation Abdominal-visceral-blood-flow-and-function score(AVBFS) Gastrointestinal dysfunction mechanical ventilation Cardiopulmonary bypass

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Impact of Sedation Protocols on Elderly Patients Undergoing mechanical ventilation and Off-Line Weaning

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Journal of Clinical and Nursing Research 2024年第4期8卷 322-333页

作者： Yihui Li Yamin Yuan Jinquan Zhou Li Ma The Second Hospital&Clinical Medical School Lanzhou UniversityDepartment of Critical Care MedicineLanzhou 730030Gansu ProvinceChina

The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.

关键词： Elderly patients mechanical ventilation Off-line strategy Sedation treatment

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Driving pressure in mechanical ventilation:A review

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World Journal of Critical Care Medicine 2024年第1期13卷 15-27页

作者： Syeda Farheen Zaidi Asim Shaikh Daniyal Aziz Khan Salim Surani Iqbal Ratnani Department of Medicine Queen Mary UniversityLondon E14NSUnited Kingdom Department of Medicine Aga Khan UniversitySindhKarachi 74500Pakistan Department of Medicine Jinnah Postgraduate Medical CenterSindhKarachi 75510Pakistan Department of Medicine and Pharmacology Texas A and M UniversityCollege StationTX 77843United States Department of Anesthesiology and Critical Care Houston Methodist HospitalHoustonTX 77030United States

Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.

关键词： Driving pressure Acute respiratory distress syndrome Mortality Positive end-expiratory pressure Ventilator induced lung injury mechanical ventilation

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Multi-objective optimization of mechanical ventilation with the aid of purifiers in two scenarios:Regular operation and mitigating the spread of respiratory infectious diseases

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Building Simulation 2023年第5期16卷 795-811页

作者： Yiqun Li Yujie Fan Chengqiang Zhi Wei Ye Xu Zhang School of mechanical Engineering Tongji UniversityShanghai 201804China Department of Building Science Tsinghua UniversityBeijing 100084China Key Laboratory of Engineering Structure Performance Evolution and Control Ministry of EducationTongji UniversityShanghai 200092China

COVID-19 and its impact on society have raised concerns about scaling up mechanical ventilation(MV)systems and the energy consequences.This paper attempted to combine MV and portable air cleaners(PACs)to achieve acceptable indoor air quality(IAQ)and energy reduction in two scenarios:regular operation and mitigating the spread of respiratory infectious diseases(RIDs).We proposed a multi-objective optimization method that combined the NSGA-II and TOPSIS techniques to determine the total equivalent ventilation rate of the MV-PAC system in both scenarios.The concentrations of PM_(2.5) and CO_(2) were primary indicators for IAQ.The modified Wells-Riley equation was adopted to predict RID transmissions.An open office with an MV-PAC system was used to demonstrate the method’s applicability.Meanwhile,a field study was conducted to validate the method and evaluate occupants’perceptions of the MV-PAC system.Results showed that optimal solutions of the combined system can be obtained based on various IAQ requirements,seasons,outdoor conditions,etc.For regular operation,PACs were generally prioritized to maintain IAQ while reducing energy consumption even when outdoor PM_(2.5) concentration was high.MV can remain constant or be reduced at low occupancies.In RID scenarios,it is possible to mitigate transmissions when the quanta were<48 h^(−1).No significant difference was found in the subjective perception of the MV and PACs.Moreover,the effects of infiltration on the optimal solution can be substantial.Nonetheless,our results suggested that an MV-PAC system can replace the MV system for offices for daily use and RID mitigation.

关键词： mechanical ventilation portable air cleaners infiltration multi-objective open office

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Safety and efficacy of ciprofol vs.propofol for sedation in intensive care unit patients with mechanical ventilation:a multi-center,open label,randomized,phase 2 trial

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Chinese Medical Journal 2022年第9期135卷 1043-1051页

作者： Yongjun Liu Xiangyou Yu Duming Zhu Jun Zeng Qinhan Lin Bin Zang Chuanxi Chen Ning Liu Xiao Liu Wei Gao Xiangdong Guan Department of Critical Care Medicine The First Affiliated HospitalSun Yat-sen UniversityGuangzhou 510080China Department of Critical Care Medicine The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830011China Department of Critical Care Medicine Zhongshan HospitalFudan UniversityShanghai 200032China Department of Critical Care Medicine Guangzhou First People's HospitalGuangzhou 510180China Department of Critical Care Medicine Qingyuan People's HospitalThe Sixth Affiliated Hospital of Guangzhou Medical UniversityQingyuan 511518China Department of Critical Care Medicine Shengjing Hospital of China Medical UniversityShenyang 110022China Department of Research and Development Haisco Pharmaceutical Group Co.LtdShanghai 201203China.

Background:Ciprofol(HSK3486;Haisco Pharmaceutical Group Co.,Ltd.,Chengdu,China),developed as a novel 2,6-disubstituted phenol derivative showed similar tolerability and efficacy characteristics as propofol when applicated as continuous intravenous infusion for 12 h maintenance sedation in a previous phase 1 trial.The phase 2 trial was designed to investigate the safety,efficacy,and pharmacokinetic characteristics of ciprofol for sedation of patients undergoing mechanical ventilation.Methods:In this multicenter,open label,randomized,propofol positive-controlled,phase 2 trial,39 Chinese intensive care unit patients receiving mechanical ventilation were enrolled and randomly assigned to a ciprofol or propofol group in a 2:1 ratio.The ciprofol infusion was started with a loading infusion of 0.1-0.2 mg/kg for 0.5-5.0 min,followed by an initial maintenance infusion rate of 0.30 mg·kg^(-1)·h^(-1),which could be adjusted to an infusion rate of 0.06 to 0.80 mg·kg^(-1)·h^(-1),whereas for propofol the loading infusion dose was 0.5-1.0 mg/kg for 0.5-5.0 min,followed by an initial maintenance infusion rate of 1.50 mg·kg^(-1)·h^(-1),which could be adjusted to 0.30-4.00 mg·kg^(-1)·h^(-1)to achieve-2 to+1 Richmond Agitation-Sedation Scale sedation within 6-24 h of drug administration.Results:Of the 39 enrolled patients,36 completed the trial.The median(min,max)of the average time to sedation compliance values for ciprofol and propofol were 60.0(52.6,60.0)min and 60.0(55.2,60.0)min,with median difference of 0.00(95%confidence interval:0.00,0.00).In total,29(74.4%)patients comprising 18(69.2%)in the ciprofol and 11(84.6%)in the propofol group experienced 86 treatment emergent adverse events(TEAEs),the majority being of severity grade 1 or 2.Drug-and sedation-related TEAEs were hypotension(7.7%vs.23.1%,P=0.310)and sinus bradycardia(3.8%vs.7.7%,P=1.000)in the ciprofol and propofol groups,respectively.The plasma concentration-time curves for ciprofol and propofol were similar.Conclusions:ciprofol is comparable to propofol with good t

关键词： HSK3486 Ciprofol Propofol Sedation mechanical ventilation

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Effects of Tanreqing Injection on ICU Mortality among ICU Patients Receiving mechanical ventilation: Time-Dependent Cox Regression Analysis of A Large Registry

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Chinese Journal of Integrative Medicine 2023年第9期29卷 782-790页

作者： WANG Wen HE Qiao WANG Ming-qi XU Jia-yue JI Peng ZHANG Rui ZOU Kang SUN Xin Chinese Evidence-Based Medicine Center West China HospitalSichuan UniversityChengdu610041China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan Chengdu610041China Sichuan Center of Technology Innovation for Real World Data Chengdu610041China Intensive Care Unit West China HospitalSichuan UniversityChengdu610041China Information Center West China HospitalSichuan UniversityChengdu610041China

Objective To assess whether the use of Tanreqing(TRQ)Injection could show improvements in time to extubation,intensive care unit(ICU)mortality,ventilator-associated events(VAEs)and infection-related ventilator associated complication(IVAC)among patients receiving mechanical ventilation(MV).Methods A time-dependent cox-regression analysis was conducted using data from a well-established registry of healthcare-associated infections at ICUs in China.Patients receiving continuous MV for 3 days or more were included.A time-varying exposure definition was used for TRQ Injection,which were recorded on daily basis.The outcomes included time to extubation,ICU mortality,VAEs and IVAC.Time-dependent Cox models were used to compare the clinical outcomes between TRQ Injection and non-use,after controlling for the influence of comorbidities/conditions and other medications with both fixed and time-varying covariates.For the analyses of time to extubation and ICU mortality,Fine-Gray competing risk models were also used to measure competing risks and outcomes of interest.Results Overall,7,685 patients were included for the analyses of MV duration,and 7,273 patients for the analysis of ICU mortality.Compared to non-use,patients with TRQ Injection had a lower risk of ICU mortality(Hazards ratios(HR)0.761,95%CI,0.581–0.997),and was associated with a higher hazard for time to extubation(HR 1.105,95%CI,1.005–1.216),suggesting a beneficial effect on shortened time to extubation.No significant differences were observed between TRQ Injection and non-use regarding VAEs(HR 1.057,95%CI,0.912–1.225)and IVAC(HR 1.177,95%CI,0.929–1.491).The effect estimates were robust when using alternative statistic models,applying alternative inclusion and exclusion criteria,and handling missing data by alternative approaches.Conclusion Our findings suggested that the use of TRQ Injection might lower mortality and improve time to extubation among patients receiving MV,even after controlling for the factor that the use of TRQ changed over time.

关键词： Tanreqing critical care mechanical ventilation mortality ventilator-associated events

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Risk factors of mortality and severe disability in the patients with cerebrovascular diseases treated with perioperative mechanical ventilation

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World Journal of Clinical Cases 2022年第16期10卷 5230-5240页

作者： Jin-Zhu Zhang Hao Chen Xin Wang Kan Xu Department of Neurosurgery The First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina

BACKGROUND The prognosis of cerebrovascular diseases treated with mechanical ventilation during perioperative has not been clearly reported.AIM To analyze mortality and functional disability and to determine predictors of unfavorable outcome in the patients with cerebrovascular diseases treated with mechanical ventilation.METHODS A retrospective follow-up study of 111 cerebrovascular disease patients who underwent mechanical ventilation during the perioperative period in the First Hospital of Jilin University from June 2016 to June 2019 was performed.Main measurements were mortality and functional outcome in-hospital and after 3-month follow-up.According to the modified rankin scale(mRS),the functional outcome was divided into three groups:Good recovery(mRS≤3),severe disability(mRS=4 or 5)and death(mRS=6).Univariate analysis was used to compare the differences between three functional outcomes.Multivariate logistic regression analysis was used to for risk factors of mortality and severe disability.RESULTS The average age of 111 patients was 56.46±12.53 years,59(53.15%)were males.The mortality of in-hospital and 3-month follow-up were 36.9% and 45.0%,respectively.Of 71 discharged patients,46.47% were seriously disabled and 12.67% died after three months follow-up.Univariate analysis showed that preoperative glasgow coma scale,operation start time and ventilation reasons had statistically significant differences in different functional outcomes.Multiple logistic regression analysis showed that the cause of ventilation was related to the death and poor prognosis of patients with cerebrovascular diseases.Compared with brainstem compression,the risk of death or severe disability of pulmonary disease,status epilepticus,impaired respiratory center function,and shock were 0.096(95%CI:0.028-0.328),0.026(95%CI:0.004-0.163),0.095(95%CI:0.013-0.709),0.095(95%CI:0.020-0.444),respectively.CONCLUSION The survival rate and prognostic outcomes of patients with cerebrovascular diseases treated with mechanical ventilation during th

关键词： Cerebrovascular diseases mechanical ventilation Perioperative Mortality Functional outcome

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Evaluation of progressive early rehabilitation training mode in intensive care unit patients with mechanical ventilation

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World Journal of Clinical Cases 2022年第23期10卷 8152-8160页

作者： Xiao-Jing Qie Zhi-Hong Liu Li-Min Guo Department of Cardiology The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011Hebei ProvinceChina Department of Intensive Care Unit The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011Hebei ProvinceChina

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%,Pmechanical ventilation time,and ICU stay were shorter than in the control group(Pmechanical ventilation,which improved prognosis and quality of life.

关键词： mechanical ventilation Intensive care unit Early rehabilitation training Delirium Barthel index

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mechanical ventilation strategy for pulmonary rehabilitation based on patient-ventilator interaction

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Science China(Technological Sciences) 2021年第4期64卷 869-878页

作者： HAO LiMing LI Xiao SHI Yan CAI MaoLin REN Shuai XIE Fei LI YaNa WANG Na WANG YiXuan LUO ZuJin XU Meng School of Automation Science and Electrical Engineering Beihang UniversityBeijing 100191China Department of Rehabilitation The Fouth Medical Center of PLA General HospitalBeijing 100048China Department of Pulmonary and Critical Care Medicine Chinese PLA General HospitalBeijing 100039China Department of Respiratory and Critical Care Medicine Beijing Engineering Research Center of Respiratory and Critical Care MedicineBeijing Institute of Respiratory MedicineBeijing Chao-Yang HospitalCapital Medical UniversityBeijing 100043China Department of Orthopedics Chinese PLA General HospitalBeijing 100039China State Key Laboratory of Fluid Power and Mechatronic Systems Zhejiang UniversityHangzhou 310027China

mechanical ventilation is an effective medical means in the treatment of patients with critically ill,COVID-19 and other pulmonary diseases.During the mechanical ventilation and the weaning process,the conduct of pulmonary rehabilitation is essential for the patients to improve the spontaneous breathing ability and to avoid the weakness of respiratory muscles and other pulmonary functional trauma.However,inappropriate mechanical ventilation strategies for pulmonary rehabilitation often result in weaning difficulties and other ventilator complications.In this article,the mechanical ventilation strategies for pulmonary rehabilitation are studied based on the analysis of patient-ventilator interaction.A pneumatic model of the mechanical ventilation system is established to determine the mathematical relationship among the pressure,the volumetric flow,and the tidal volume.Each ventilation cycle is divided into four phases according to the different respiratory characteristics of patients,namely,the triggering phase,the inhalation phase,the switching phase,and the exhalation phase.The control parameters of the ventilator are adjusted by analyzing the interaction between the patient and the ventilator at different phases.A novel fuzzy control method of the ventilator support pressure is proposed in the pressure support ventilation mode.According to the fuzzy rules in this research,the plateau pressure can be obtained by the trigger sensitivity and the patient’s inspiratory effort.An experiment prototype of the ventilator is established to verify the accuracy of the pneumatic model and the validity of the mechanical ventilation strategies proposed in this article.In addition,through the discussion of the patient-ventilator asynchrony,the strategies for mechanical ventilation can be adjusted accordingly.The results of this research are meaningful for the clinical operation of mechanical ventilation.Besides,these results provide a theoretical basis for the future research on the intelligent control of ventilator and the a

关键词： mechanical ventilation pulmonary rehabilitation phases division fuzzy control patient-ventilator interaction

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