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Longer duration of initial invasive mechanical ventilation is still a crucial risk factor for moderate‑to‑severe bronchopulmonary dysplasia in very preterm infants:a multicentrer prospective study

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World Journal of Pediatrics 2023年第6期19卷 577-585页

作者： Cong Dou Yong-Hui Yu Qing-Cui Zhuo Jian-Hong Qi Lei Huang Yan-Jie Ding De-Juan Yang Li Li Dan Li Xiao-Kang Wang Yan Wang Xin Qiao Xiang Zhang Bing-Jin Zhang Hai-Yan Jiang Zhong-Liang Li Simmy Reddy Department of Neonatology Maternal and Child Health Care Hospital of Shandong ProvinceShandong UniversityJinan 250014China Department of Neonatology Shandong Provincial Hospital affiliated to Shandong First Medical UniversityHuaiYin DistrictNo.324Jingwu RoadJinan 250021China Department of Neonatology Shandong Provincial HospitalShandong UniversityHuaiYin DistrictNo.324Jingwu RoadJinan 250021China Department of Neonatology Qilu Hospital of Shandong UniversityJinan 250012China Department of Neonatology Shandong Provincial Maternal and Child Health Care HospitalJinan 250014China Department of Neonatology Yantai Yuhuangding HospitalYantai 264000China Department of Neonatology The First Affiliated Hospital of Shandong First Medical UniversityJinan 250014China Department of Neonatology Linyi People’s HospitalLinyi 276000China Department of Neonatology Liaocheng People’s HospitalLiaocheng 252000China Department of Neonatology The Affiliated Taian City Central Hospital of Qingdao UniversityTaian 271000China Department of Neonatology Jinan Maternity and Child Healthcare HospitalJinan 250001China Department of Neonatology Hebei Petro China Central HospitalLangfang 065000China Department of Neonatology Shengli Olifield Central HospitalDongying 257000China Department of Neonatology The Third Hospital of Baogang GroupBaotou 014000China Department of Neonatology W.F.Maternal and Child Health HospitalWeifang 261011China Cheeloo College of Medicine Shandong UniversityJinan 250000China

Objectives We aimed to evaluate the risk factors for moderate-to-severe bronchopulmonary dysplasia(BPD)and focus on discussing its relationship with the duration of initial invasive mechanical ventilation(IMV)in very preterm neonates less than 32 weeks of gestational age(GA).Methods We performed a prospective cohort study involving infants born at 23–31 weeks of GA who were admitted to 47 different neonatal intensive care unit(NICU)hospitals in China from January 2018 to December 2021.Patient data were obtained from the Sina-northern Neonatal Network(SNN)Database.Results We identified 6538 very preterm infants,of whom 49.5%(3236/6538)received initial IMV support,and 12.6%(823/6538)were diagnosed with moderate-to-severe BPD symptoms.The median duration of initial IMV in the moderateto-severe BPD group was 26(17–41)days,while in the no or mild BPD group,it was 6(3–10)days.The incidence rate of moderate-to-severe BPD and the median duration of initial IMV were quite different across different GAs.Multivariable logistic regression analysis showed that the onset of moderate-to-severe BPD was significantly associated with the duration of initial IMV[adjusted odds ratio(AOR):1.97;95%confidence interval(CI):1.10–2.67],late-onset neonatal sepsis(LONS),and patent ductus arteriosus(PDA).Conclusion In this multicenter cohort study,the duration of initial IMV was still relatively long in very premature infants,and the longer duration of initial IMV accounts for the increased risk of moderate-to-severe BPD.

关键词： Bronchopulmonary dysplasia invasive mechanical ventilation Multicenter cohort-Preterm infants Prospective

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Assessment of respiratory support decision and the outcome of invasive mechanical ventilation in severe COVID-19 with ARDS

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Journal of Intensive Medicine 2022年第2期2卷 92-102页

作者： Shuhan Cai Fangfang Zhu Hongtao Hu Hui Xiang Dawei Wang Jing Wang Lu Li Xiao Yang Aihua Qin Xin Rao Yun Luo Jianguo Li Kianoush B.Kashani Bo Hu Zhiyong Peng Department of Critical Care Medicine Zhongnan Hospital of Wuhan UniversityWuhanHubei 430071China Clinical Research Center of Hubei Critical Care Medicine WuhanHubei 430071China Division of Nephrology and Hypertension Division of Pulmonary and Critical Care MedicineDepartment of MedicineMayo ClinicRochesterMN 55905USA Division of Pulmonary and Critical Care Medicine Department of MedicineMayo ClinicRochesterMN 55905USA

Background:The coronavirus disease 2019(COVID-19)is an ongoing pandemic.invasive mechanical ventilation(IMV)is essential for the management of COVID-19 with acute respiratory distress syndrome(ARDS).We aimed to assess the impact of compliance with a respiratory decision support system on the outcomes of patients with COVID-19-associated ARDS who required IMV.Methods:In this retrospective,single-center,case series study,patients with COVID-19-associated ARDS who required IMV at Zhongnan Hospital of Wuhan University,China,from January 8th,2020,to March 24th,2020,with the final follow-up date of April 20th,2020,were included.Demographic,clinical,laboratory,imaging,and management information were collected and analyzed.Compliance with the respiratory support decision system was documented,and its relationship with 28-day mortality was evaluated.Results:The study included 46 COVID-19-associated ARDS patients who required IMV.The median age of the 46 patients was 68.5 years,and 31 were men.The partial pressure of arterial oxygen(PaO_(2))/fraction of inspired oxygen(FiO_(2))ratio at intensive care unit(ICU)admission was 104 mmHg.The median total length of IMV was 12.0(interquartile range[IQR]:6.0–27.3)days,and the median respiratory support decision score was 11.0(IQR:7.8–16.0).To 28 days after ICU admission,18(39.1%)patients died.Survivors had a significantly higher respiratory support decision score than non-survivors(15.0[10.3–17.0]vs.8.5(6.0–10.3),P=0.001).Using receiver operating characteristic(ROC)curve to assess the discrimination of respiratory support decision score to 28-day mortality,the area under the curve(AUC)was 0.796(95%confidence interval[CI]:0.657–0.934,P=0.001)and the cut-offwas 11.5(sensitivity=0.679,specificity=0.889).Patients with a higher score(>11.5)were more likely to survive at 28 days after ICU admission(log-rank test,Pventilation.Wi

关键词： COVID-19 Acute respiratory distress syndrome(ARDS) Respiratory support decision invasive mechanical ventilation Severe acute respiratory coronavirus 2 (SARS-CoV-2)

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Effect of noninvasive positive pressure ventilation on weaning success in patients receiving invasive mechanical ventilation： a meta-analysis

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Chinese Medical Journal 2013年第7期126卷 1337-1343页

作者： ZHU Fen LIU Zi-long LONG Xuan WU Xiao-dan ZHOU Jing BAI Chun-xue LI Shan-qun Department of Pulmonary Medicine Center of Snoring and Sleep Apnea Medicine Zhongshan Hospital Fudan University Shanghai 200032 China

Background Noninvasive positive pressure ventilation （NIPPV） has been proposed to shorten the duration of mechanical ventilation in intubated patients, especially those who fail initial weaning from invasive mechanical ventilation （IMV）. However, there are also some discrepancies in terms of weaning success or failure, incidence of re-intubation, complications observed during study and patient outcomes. The primary objective of this update was to specifically investigate the role of NIPPV on facilitating weaning and avoiding re-intubation in patients intubated for different etiologies of acute respiratory failure, by comparing with conventional invasive weaning approach. Methods We searched randomized controlled trials （RCTs） comparing noninvasive weaning of early extubation and immediate application of NIPPV with invasive weaning in intubated patients from PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Knowledge and Springerlink databases. Records from conference proceedings and reference lists of relevant studies were also identified. Results A total of 11 RCTs with 623 patients were available for the present analysis. Compared with IMV, NIPPV significantly increased weaning success rates （odds ratio （OR）： 2.50, 95% confidence interval （C/）： 1.46-4.30, P=0.0009）, decreased mortality （OR： 0.39, 95% CI： 0.20-0.75, P=0.005）, and reduced the incidence of ventilator associated pneumonia （VAP）（OR： 0.17, 95% CI： 0.08-0.37, P 〈0.00001） and complications （OR： 0.22, 95% CI： 0.07-0.72, P=0.01）. However, effect of NIPPV on re-intubation did not reach statistical difference （OR： 0.61, 95% CI： 0.33-1.11, P=0.11）. Conclusions Early extubation and immediate application of NIPPV is superior to conventional invasive weaning approach in increasing weaning success rates, decreasing the risk of mortality and reducing the incidence of VAP and complications, in patients who need weaning from IMV. However, it should be applied with caution, as there is insufficient beneficial evidence to definitely recommend i

关键词： noninvasive positive pressure ventilation invasive mechanical ventilation weaning meta-analysis

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Analysis of risk factors for hospital mortality in patients with chronic obstructive pulmonary diseases requiring invasive mechanical ventilation

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Chinese Medical Journal 2007年第4期120卷 287-293页

作者： LIU Hui ZHANG Tian-tuo YE Jin Department of Internal Medicine Division of Pulmonary andCritical Care Department of Otolaryngology Head and Neck Surgery

Background Accurate prediction for prognosis is important for hospitalized patients with chronic obstructive pulmonary disease （COPD） requiring invasive mechanic ventilation （IMV） and for their family members to make end-of-life decisions. The response to therapy in such a patient population has rarely been investigated. The aim of the study was to evaluate the risk factors in these patients and investigate their response to IMV and the relationship between their responses and prognosis. Methods A cohort of 138 patients with COPD requiring IMV≥12 hours for acute respiratory failure of diverse etiological factors during a 4-year period were retrospectively studied using prospectively gathered data. All variables potentially related to hospital mortality were evaluated by univariate and multiple stepwise logistic regression analysis. Results The mean age of all patients investigated was （65.7±11.6） years and the hospital mortality was 39.9% （31.1% with COPD exacerbation）. Correction of acidosis （pHi〉7.30） was seen in 58 patients （69.9%） in survivors but only 12 patients （21.8%） in nonsurvivors （P〈0.05） after ventilation. Using multivariate logistic analysis, the variables independently associated with hospital mortality were a higher acute physiology score before intubation, lower pH value measured 24 hours after the onset of ventilation and development of multiorgan dysfunction syndrome （MODS）. Conclusions In COPD patients requiring IMV, the postintubation pH value can not only reflect patients＇ response to treatment, but also serve as an independent determinant of hospital mortality apart from other risk factors such as a higher preintubation APACHE II score and development of MODS. A close correlation between the response to IMV and prognosis was proved in these patients.

关键词： chronic obstructive pulmonary disease invasive mechanical ventilation mortality respiratory failure

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Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome

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Chinese Medical Journal 2005年第17期118卷 1413-1421页

作者： Loretta YC Yam Alfred YF Chan Thomas MT Cheung Eva LH Tsui Jane CK Chan Vivian CW Wong Division of Respiratory and Critical Care Medicine Department ofMedicine Pamela Youde Nethersole Eastern Hospital Hong KongChina Division of Respiratory and Critical Care Medicine Department ofMedicine Pamela Youde Nethersole Eastern Hospital Hong KongChina Division of Respiratory and Critical Care Medicine Department ofMedicine Pamela Youde Nethersole Eastern Hospital Hong KongChina Hong Kong Hospital Authority Head Office Hong Kong ChinaHong Kong Hospital Authority Head Office Hong Kong ChinaHong Kong Hospital Authority Head Office Hong Kong China

Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support. We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation tr... 详细信息

关键词： acute respiratory failure infection control invasive mechanical ventilation non-invasive ventilation severe acute respiratory syndrome

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Prognosis and weaning of elderly multiple organ dysfunction syndrome patients with invasive mechanical ventilation

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Chinese Medical Journal 2014年第1期127卷 11-17页

作者： Xiao Kun Su Longxiang Han Bingchao Guo Chao Feng Lin Jiang Zhaoxu Wang Huijuan Lin Yong Jia Yanhong She Danyang Xie Lixin Department of Respiratory Medicine Chinese People's Liberation Army General Hospital Beijing 100853 China Nanlou Respiratory Diseases Department Chinese People's Liberation Army General Hospital Beijing 100853 China Medical Coliege Nankai University Tianjin 300071 China Department of Respiratory Medicine Bethune International Peace Hospital Shijiazhuang Hebei 050082 China Department-of Cardiology Cardiovascular Institute and Fu WaiHospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Department of Respiratory Medicine Shandong Jining No. 1 People'sHospital Jining Shandong 272001 China

Background Elderly multiple organ dysfunction syndrome （MODS） patients receiving invasive mechanical ventilation have poor prognosis in intensive care units （ICUs）.We studied the usefulness of four commonly used severity scores and extrapulmonary factors that affected weaning to predict outcome of such patients.Methods Clinical data of 197 patients on admission to ICUs （from January 2009 to June 2012） were used retrospectively.The Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ,APACHE Ⅲ,Sample Acute Physiological Score （SAPS） Ⅱ and MODS scores were calculated.All the patients were grouped into survivors and nonsurvivors according to the prognosis.Patients,who weaned from ventilator （n=154）,were subdivided into a successful weaning group and a failed weaning group.The receiver operating characteristic （ROC） curves and Logistic regression was used for prognostic and weaning assessment.Results Based on the outcomes,the areas under the ROC of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,and MODS were 0.837,0.833,0.824,and 0.837,respectively.The Logistic regression analysis revealed that the odds ratio （OR） of underlying lung diseases,serum albumin and creatinine,and the number of organ failures was 2.374,0.920,1.003,and 1.547.APACHE Ⅱ scores on admission performed excellent （ROC：0.921） on the weaning assessments.Conclusions APACHE Ⅱ and MODS systems were marginally better for evaluating the prognosis of elderly MODS patients who received invasive mechanical ventilation.Underlying lung diseases,serum albumin,serum creatinine and the number of organ failures were independent prognostic factors.Using the APACHE Ⅱ scores on admission before weaning may increase the likelihood of successful weaning.（ClinicalTrial.gov identifier NCT01802983）.

关键词： elderly multiple organ dysfunction syndrome invasive mechanical ventilation weaning prognosis

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Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stagesⅢb-Ⅴchronic kidney disease?

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World Journal of Virology 2023年第5期12卷 286-295页

作者： Harinivaas Shanmugavel Geetha Sushmita Prabhu Abinesh Sekar Maya Gogtay Yuvaraj Singh Ajay K Mishra George M Abraham Suzanne Martin Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Hospice and Palliative Medicine University of Texas Health-San AntonioSan AntonioTX 78201United States Division of Cardiology Saint Vincent HospitalWorcesterMA 01608United States Department of Nephrology Saint Vincent HospitalWorcesterMA 01608United States

BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and COVID-19.METHODS We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-ⅤCKD.The primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no MV.Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables.Cutoffs for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/L.RESULTS 290 were screened,and 118 met the inclusion criteria.CRP,D-dimer,and ferritin were significantly different among the three groups.On univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P<0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD patients.The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-ⅤCKD.This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

关键词： Coronavirus disease 2019 Chronic kidney disease Inflammatory markers C-reactive protein invasive mechanical ventilation Non-invasive mechanical ventilation

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Oxygenation strategy during acute respiratory failure in immunocompromised patients

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Journal of Intensive Medicine 2021年第2期1卷 81-89页

作者： Virginie Lemiale Elise Yvin Achille Kouatchet Djamel Mokart Alexandre Demoule Guillaume Dumas Grrr-OH Research Group Service de Médecine Intensive et Réanimation APHP Hopital Saint Louis1 Avenue Claude VellefauxParis 75010France Service de Réanimation Médicale et Médecine Hyperbare Angers 49100France Institut Paoli-Calmettes Réanimation Medico-ChirurgicaleMarseille 13009France AP-HP Groupe Hospitalier Universitaire APHP-Sorbonne Universitésite Pitié-SalpêtrièreService de Médecine Intensive et Réanimation(Département R3S)and Sorbonne UniversitéINSERMUMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueParis 75013France

Acute respiratory failure(ARF)in immunocompromised patients remains challenging to treat.A large number of case require admission to intensive care unit(ICU)where mortality remains high.Oxygenation without intubation is important in this setting.This review summarizes recent studies assessing oxygenation devices for immunocompromised patients.Previous studies showed that non-invasive ventilation(NIV)has been associated with lower intubation and mortality rates.Indeed,in recent years,the outcomes of immunocompromised patients admitted to the ICU have improved.In the most recent randomized controlled trials,including immunocompromised patients admitted to the ICU with ARF,neither NIV nor high-flow nasal oxygen(HFNO)could reduce the mortality rate.In this setting,other strategies need to be tested to decrease the mortality rate.Early admission strategy and avoiding late failure of oxygenation strategy have been assessed in retrospective studies.However,objective criteria are still lacking to clearly discriminate time to admission or time to intubation.Also,diagnosis strategy may have an impact on intubation or mortality rates.On the other hand,lack of diagnosis has been associated with a higher mortality rate.In conclusion,improving outcomes in immunocompromised patients with ARF may include strategies other than the oxygenation strategy alone.This review discusses other unresolved questions to decrease mortality after ICU admission in such patients.

关键词： Outcome Acute respiratory failure invasive mechanical ventilation

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Clinical profile of mechanically ventilated COVID-19 patients:A retrospective observational study from Dubai

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Discussion of Clinical Cases 2021年第1期8卷 15-23页

作者： Prashant Nasa Aanchal Singh Habib Talal Syed Saroj Patidar Vishal Sapakale Kandy Koul Rajesh Kumar Critical Care Medicine NMC Speciality Hospital DubaiUnited Arab Emirates

Background:We did a retrospective analysis of critical coronavirus disease 2019(COVID-19)patients admitted to our intensive care unit(ICU).The objective was to evaluate the outcome,risk factors and effect of prone position in critically ill patients requiring invasive mechanical ventilation(IMV).Patients and methods:The data were collected regarding demographics,comorbidities,laboratory parameters and treatment.Logistic regression was used for analysis of the association of risk factors to the outcome.Results:From 15 March to 30 May 2020,35(59.3%)out of 59 critical COVID-19 requiring IMV were admitted to a tertiary care hospital in Dubai.The day-28 ICU mortality was 28.8% and 48.6% in patients requiring IMV.Prone position(PP)was used in 17(48.6%)patients for median duration of 19(5-20)hours with significant PaO_(2)/FiO_(2) improvement.Acute kidney injury was common(30.5%),and half of the patients required renal replacement therapy(RRT)with higher mortality(77.8%).Lactate dehydrogenase(LDH)odd ratio(OR)-1.006[95%CI-1.00-1.01],D-dimer(OR-1.003[1.000-1.000]),low total leucocyte count(OR-1.135[1.01-1.28]),and lymphopenia(OR-0.909[0.84-0.98])were independently associated with increased risk of IMV.Conclusions:IMV requirement in patients with COVID-19 is associated with higher mortality.Inflammatory markers like LDH,D-dimer,and lymphopenia can be used to predict the prognosis.The patients with COVID-19 on IMV respond significantly with prone position,and it should be considered early with a longer duration.

关键词： Coronavirus disease 2019 COVID-19 related respiratory failure Acute respiratory distress syndrome invasive mechanical ventilation

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Respiratory evaluation of patients requiring ventilator support due to acute respiratory failure

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Open Journal of Nursing 2012年第3期2卷 336-340页

作者： Carmen Silvia Valente Barbas Giovana Caroline Lopes Debora Feijo Vieira Lara Poletto Couto Leticia Kawano Dourado Eliana Caser University of Sao Paulo Sao PauloBrazil

This review, based on relevant published evidence and the authors` clinical experience, presents how to evaluate a patient with acute respiratory failure requiring ventilatory support. This patient must be carefully evaluated by nurses, physiotherapists, respiratory care practitioners and physicians regarding the elucidation of the cause of the acute episode of respiratory failure by means of physical examination with the measurement of respiratory parameters and assessment of arterial blood gases analysis to make a correct respiratory diagnosis. After the initial evaluation, the patient must quickly receive adequate oxygen and ventilatory support that has to be carefully monitored until its discontinuation. When available, a noninvasive ventilation trial must be done in patients presenting desaturation during oxygen mask and or PaCO2 retention, especially in cases of cardiogenic pulmonary edema and severe exacerbation of chronic obstructive pulmonary disease. In cases of noninvasive ventilation trial-failure, endotracheal intubation and invasive protective mechanical ventilation must be promptly initiated. In severe ARDS patients, low tidal ventilation, higher PEEP levels, prone positioning and recruitment maneuvers with adequate PEEP titration should be used. Recently, new modes of ventilation should allow a better patient-ventilator interaction or synchrony permitting a sufficient unloading of respiratory muscles and increase patient comfort. Patients with chronic obstructive pulmonary disease may be considered for a trial for early extubation to noninvasive positive pressure ventilation in centers with extensive experience in noninvasive positive pressure ventilation.

关键词： Respiratory Failure Noninvasive ventilation Endotracheal Intubation invasive mechanical ventilation Patient-Ventilator Synchrony

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