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Chinese Medical Journal 2005年第19期118卷 1587-1588页

作者： ZHANG Xi-long Department of Respiratory Medicine First Affiliated Hospital ofNanjing Medical University Nanjing 210029 China

I read with great interest the article by Collaborating Research Group for Noninvasivemechanical ventilation of Chinese Respiratory Society. 1 Based on the concept mentioned in this paper, I have found that it is really an encouraging new finding in the field of clinical application of mechanical ventilation and treatment of acute respiratory failure （ARF） of chronic obstructive pulmonary disease （COPD）.

关键词： NONINVASIVE ventilation mechanical ventilation

Effect of Closed Suctioning on Reducing the Contamination Released into the Environment

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Chinese Medical Journal 2017年第14期130卷 1745-1746页

作者： Hui-Jie Yu Xiang-Yun Zhu Song-Ao Xu Wei-Zhong Cao Yun-Song Yu Department of Emergency Intensive Care Unit The First Hospital of Jiaxing Jiaxing Zhejiang 314000 China Department of Infectious Diseases Sir Run Run Shaw Hospital College of Medicine Zhejiang University Hangzhou Zhejiang 310016 China

With the development of critical care medicine,mechanical ventilation is extensively used in the Intensive Care Units （ICUs）.Patients receiving invasive mechanical ventilation require sputum suctioning either regularly or as required to clear secretions from the airway and maintain airway patency.Accordingly,the requirement to disconnect the breathing loop tube for sputum suctioning is determined by the use of open or closed modes ofsuctioning.At present,the open suctioning system is most commonly used for clearing airway secretions.Since resistance to bacterial strains is rapidly increasing,the possibility of open suctioning in contaminating the ICU environment is often questioned,which was investigated in this study.

关键词： Air Culture Closed Tracheal Suctioning Endotracheal Suctioning mechanical ventilation

Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

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Open Journal of Pediatrics 2023年第5期13卷 697-706页

作者： Arnildo Linck Junior Flávia Lopes Gabani Edmarlon Girotto Ana Maria Rigo Silva Selma Maffei Andrade Department of Pediatrics and Pediatric Surgery Universidade Estadual de Londrina Londrina Brazil

Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54;CI 95%: 0.39 - 0.74) we

关键词： Pediatric Intensive Care Units Outcomes Assessment In-Hospital Mortality Hospital Stay mechanical ventilation Catheter-Related Infections

Nursing Strategy for Multidisciplinary Team Comprehensively Treating Three Children with Fulminant Myocarditis

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Medicinal Plant 2022年第5期13卷 97-99页

作者： Dongqin HE Department of pediatric Taihe Hospital(Hubei University of Medicine)Shiyan 442000China

[Objectives]To explore nursing strategy for comprehensive treatment of children with fulminant myocarditis by multidisciplinary team(MDT),and clarify the nursing emphasis and difficulties in the treatment of fulminant myocarditis in children.[Methods]Retrospective analysis was made on three cases of fulminant myocarditis in children treated in Taihe Hospital of Shiyan City from January 2021 to January 2022.The different clinical characteristics and treatment plans were analyzed and compared,and the nursing emphasis and difficulties in comprehensive treatment of fulminant myocarditis in children were discussed.[Results]The minimum age of three children with fulminant myocarditis was 11 days old,and the remaining two children were 9-12 years old.All three children were successfully treated,in which two cases were treated with extracorporeal membrane oxygenation(ECMO)combining with mechanical ventilation(MV),including one case of neonatal explosive myocarditis.One case was treated with temporary cardiac pacing implantation.The psychological counseling and nursing of children with fulminant myocarditis and their guardians were also critical to the successful treatment and good prognosis of the disease.[Conclusions]The condition of fulminant myocarditis in children is dangerous,and it should closely observe the changes of the illness condition.The key to successful treatment is to start a comprehensive treatment plan based on life support as early as possible.The key point of nursing is to closely assist in observing the condition at the early stage,assist in maintaining and operation during advanced life support period,and avoid complications.At the same time,strengthening the psychological care of pediatric patients and guardians and health education after leaving hospital are the key and difficult points of nursing.

关键词： Fulminant myocarditis Extracorporeal membrane oxygenation mechanical ventilation Nursing strategy

Oxygenation strategies after extubation of critically ill and postoperative patients

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Journal of Intensive Medicine 2021年第2期1卷 65-70页

作者： Arnaud W.Thille Mathilde Wairy Sylvain Le Pape Jean-Pierre Frat Médecine Intensive Réanimation Centre Hospitalier Universitaire de PoitiersPoitiers 86021France ALIVE Research group INSERM CIC 1402University of PoitiersPoitiers 86021France

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.

关键词： Noninvasive ventilation High-flow nasal oxygen therapy Ventilator weaning Airway extubation mechanical ventilation Intensive care unit

Predictive value of initial procalcitonin level in perioperative period of critically ill cancer patients

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Precision Medicine Research 2022年第1期4卷 14-18页

作者： Yu-Lin Wu Cui-Han Wang Yan-Kun Zhang Xiao-Wu Zhang Rui Xia Shan-Shan Lin Bei-Tian Jia Ya-Meng Cui Dong-Hao Wang Tianjin Medical University Cancer Institute and Hospital Tianjin 300060China Tianjin Hospital of Integration of Taditional Chinese and Western Medicine&Nankai Hospital Tianjin 300102China Tianjin Fourth Central Hospital Tianjin 300142China Tianjn University of Traditional Chinese Medicine Tianjin301617China

The predictive value of the initial procalcitonin(PCT)level was explored in the perioperative peniod of citically ill cancer patients.Background:It is quite important to predict infections in patients in the intensive care unit (ICU).Cancer surgery is characterized by large trauma,long duration,and wide operation scope;and there are many inflammatory factors in the tumor.Common manifestations of systermic inflammatory response syndrome(SIRS)。such as fever,elevated white blood cells,and elevated infammatory indicators,frequently occur in patients during the penioperative period as a result of the above factors.These factors are diverse and complex;additionally,advanced cancer and the trauma of major surgery are important factors that influence PCT blood levels.Because all of the aforementioned factors make it dificult to distinguish the postoperative inflammatory response fom the true infection in clinical practice,conventional methods cannot prediet disease sevenity or disease course.Methods:A total of 53 patients with endotracheal intubation admitted to the ICU of Tianjin Medical University Cancer Institute and Hospital from January 2020 to May 2020,were retrospectively selected.According to the patient source,35 cases were assigned to ORIG(Operating Room to ICU Group),and 18 cases were assigned to General Ward to ICU group(GWO).At the ICU admission,the patient's age,sex,surgical site of tumor,reason for ICU and other data were recorded to form a database;PCT,B-type natiuretic peptide(BNP),high sensitivity toponin I(hsTni),serumn creatinine(Cr),serum cystatin C(Cys-c)and other laboratory indicators were detected;scores of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)and sequential organ failure assessment(SOFA)were marked 24 h after ICU admission;Proportion of Antibiotics,Time Antibiotic Application,and Time Indicators(Ventilator support Time,Endotracheal Intubation Time,ICU Stay Time)were recorded during the period from ICU admission to ICU discharge.Results:APAHCE Ⅱ score and SOFA score increased

关键词： critically ill cancer patients perioperative period mechanical ventilation procalcitonin disease severity

Clinical outcomes of moderate to severe COVID-19 patients receiving invasive vs. non-invasive ventilation

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Asian Pacific Journal of Tropical Medicine 2021年第4期14卷 176-182页

作者： Zubia Jamil Samreen Khalid Shahid Mumtaz Abbasi Yasir Waheed Jamal Ahmed Department of Medicine Foundation University Medical CollegeFoundation UniversityDHA Phase 1 Islamabad 44000Pakistan Fauji Foundation Hospital Rawalpindi 46000Pakistan Department of Multidisciplinary Lab Foundation University Medical CollegeFoundation UniversityDHA Phase 1 Islamabad 44000Pakistan Department of Pulmonology Fauji Foundation HospitalRawalpindi 46000Pakistan

Objective:To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit(HDU)in relation to invasive vs.non-invasive mode of ventilation.Methods:In this study,the patients required either non-invasive[oxygen≤10 L/min or>10 L/min through mask or nasal prongs,rebreather masks and bilevel positive airway pressure(BiPAP)]or invasive ventilation.For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen,Kaplan Meier and log rank analyses were used.In the end,independent predictors of survival were determined by Cox regression analysis.Results:Invasive ventilation was required by 15.1%patients while 84.9%patients needed non-invasive ventilation.Patients with evidence of thromboembolism,high inflammatory markers and hypoxemia mainly required invasive ventilation.The 30-day in hospital mortality was 72.7%for the invasive group and 12.9%for the non-invasive group(1.8%oxygen10 L/min,3.6%rebreather mask and 4.5%BiPAP).The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group(Pventilation were independent predictors of outcome.Conclusions:Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury.Thus,protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.

关键词： COVID-19 SARS-CoV-2 Non-invasive ventilation Respiratory insufficiency Hypoxia mechanical ventilation

Pneumoscrotum in a Patient with Pneumocystis jirovecii Pneumonia: A Case Report

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Open Journal of Respiratory Diseases 2022年第4期12卷 83-87页

作者： Chongiin Kim Rodrigo García-Tomé Ahmet Baydur Division of General Medicine Department of Internal Medicine University of Southern California Los Angeles USA Los Angeles County + University of Southern California Medical Center Los Angeles USA Division of Pulmonary Critical Care and Sleep Medicine University of Southern California Los Angeles USA

Pneumoscrotum is a rare condition described as the accumulation of air within the scrotum. We report the case of a patient with acquired immune deficiency syndrome (AIDS) with Pneumocystis jirovecii pneumonia who deve... 详细信息

关键词： mechanical ventilation Pneumomediastinum Pneumoscrotum Pneumothorax Volutrauma

Expression Changes of Early Response Genes in Lung Due to High Volume ventilation

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2005年第3期25卷 339-342页

作者：王月兰姚尚龙熊平 Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Department of Immunology Tongji Medical College Huazhong University of Science and Technology

The expression changes of early response genes due to ventilation with high volume in adult rats in vivo were observed. Forty SD male rats were randomly divided into control and 30, 60, 90 and 120 min ventilation groups, respectively (n=8 in each group). The animals were ventilated with tidal volume of 42 ml/kg and a PEEP level of 0 cmH_2O at a rate of 40 breaths per minute in room air with a ventilator was given to the small animals. The expression of Egr-1, C-jun and IL-1β mRNA and proteins was detected by RT-PCR and immunohistochemical technique, respectively. The pathological changes in lung tissues were examined by HE staining. The results indicated that the expression of Egr-1, C-jun and IL-1β mRNA was detectable at 30th min after overventilation, but there was no significant difference in comparison with that in control group until overventilation for 60 min. However, at 90 and 120 min there was a significent increase as compared with 30 min or control group (Pventilation group, the expression intensity of Egr-1, C-jun and IL-1β proteins in lung cells was the strongest and the nuclear translocation was increased markedly in comparison with any other groups (Pventilation activated and upregulated the expression of early response genes and the expression of these genes may be taken as the early signal to predict the onset and degree of lung injury. These results may demonstrated partially that the expression of early response genes induced by the mechanical stretch is associated with biochamic lung injury.

关键词： mechanical ventilation lung injury early response gene transcription factor

The effect of prone position for ventilatorassociated pneumonia in adult patients:a systematic review and meta-analysis

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Emergency and Critical Care Medicine 2021年第1期1卷 37-44页

作者： Xingxing Zhu Zongqing Lu Wenyan Xiao Jin Zhang Di Jia Min Yang The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine The Second Affiliated Hospital of Anhui Medical UniversityHefeiChina The Second Department of Intensive Care Unit The Second Affiliated Hospital of Anhui Medical UniversityHefeiChina

Background:The effect and safety of prone position(PP)in ventilator-associated pneumonia(VAP)patients was uncertain.We systematically reviewed the literature published to investigate whether PP benefits for patients with VAP compared with conventional supine position(SP).Methods:PubMed,EMbase,Cochrane Library,CNKI and WanFang Database were electronically searched to collect randomized controlled trials(RCTs)about the PP ventilation and SP ventilation in intensive care unit(ICU)patients from inception to May 2020.Meta-analysis was performed by Revan 5.3 software.Results:A total of 7 RCTs involving 1604 patients were included.Compared to regular SP ventilation,the PP ventilation group had no statistical significance in the four aspects.The results of subgroup analysis showed that the incidence of VAP and all-cause mortality were not affected by the patient’s initial oxygenation index.However,the incidence of VAP tended to decrease when the duration of PP ventilation was less than 16 hours per day.Meanwhile,the all-cause mortality was significantly decreased while the daily time was more than 16 hours.Conclusions:Current evidence showed that the PP ventilation could not decrease the incidence of VAP,all-cause mortality,length of mechanical ventilation,and ICU stay.However,the daily duration of PP ventilation may have an impact on the incidence of VAP and all-cause mortality in critical patients.

关键词： mechanical ventilation Meta-analysis Prone position Systematic review Ventilator-associated pneumonia