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Journal of Clinical and Nursing Research 2024年第2期8卷 104-110页

作者： Cheng Shi Shunyi Hospital Beijing Traditional Chinese Medicine HospitalBeijing 101300China

Objective:To explore the clinical effect of a non-invasive ventilator combined with conventional therapy in the treatment of patients with chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:68 patients with COPD combined with respiratory failure treated in our hospital from September 2021 to October 2023 were selected as the research subjects.Using the random number table method,they were divided into a control group and an experimental group of 34 cases each.The control group received conventional symptomatic treatment,and the experimental group received non-invasive ventilator treatment based on the control group.The clinical effects,blood gas indicators(partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),arterial oxygen saturation(SaO_(2))),lung function(forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),6 min walking distance),complications,and inflammatory factor levels(c-reactive protein(CRP),interleukin-6(IL-6),neutrophil-to-lymphocyte ratio(NLR))of the two groups of patients were observed.Results:(1)The clinical efficacy of the patients in the experimental group(33/97.06%)was more significant as compared with the control group(25/73.53%)(Prespiratory failure.

关键词： Non-invasive ventilator Conventional therapy Chronic obstructive pulmonary disease respiratory failure Clinical effect

Noninvasive respiratory Strategies in Patients with Acute Hypoxemic respiratory failure and COVID-19 in Gabon: A Prospective Observational Study

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Open Journal of Emergency Medicine 2024年第1期12卷 18-27页

作者： Ghislain Edjo Nkilly Raphael Okoue Ondo Fernande Manga Stéphane Oliveira Jean Marcel Mandji-Lawson Romain Tchoua Department of Emergency Anesthesia Resuscitation Omar Bongo Ondimba Army Training Hospital Libreville Gabon Department of Anesthesia and Resuscitation Libreville University Hospital Center Libreville Gabon Department of Anesthesia and Resuscitation Akanda Army Training Hospital Libreville Gabon

Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique that could reduce the need for tracheal intubation and mortality in patients with respiratory failure due to COVID-19 admitted to intensive care units (ICUs) of Military’s Hospital (HIAOBO) in Gabon. Design, Setting, and Participants-Methodology: Prospective observational study over 10 months (January 2021-October 2021). We included patients admitted to intensive care for SARS Cov2 pneumonia who had benefited from available ventilatory support: high concentration face mask, High Flow Nasal cannula (HFNC), NIV (Non Invasive Ventilation), Continuous Positive Airway Pressure (CPAP). The choice was guided by the clinical condition, and the choice of the prescribing physicians. Recourse to mechanical ventilation was decided when faced with a Glasgow score of less than 13, an SpO2/FiO2 ratio ≤ 300, a FR ≥ 35/min, the impossibility of drainage of secretions. Main Outcomes and Measures: The primary outcome was the proportion of patients requiring intubation. The secondary outcomes were mortality in ICU. Results: The sample included 97 patients, the average age was55.6 years, hypertension was the main comorbidity (51.1%). Mean respiratory rate (RR) was 30.8 cycles/min, admission SpO2 was 83%, respiratory alkalosis was present in 63% of patients, mean CT involvement was 51%.respiratory support was NIV (56.7%), CPAP (21.65%), high concentration face mask (18.55%). Sixteen percent (16%) of patients were intubated, 93% of them following failure of NIV. Mortality was 30%, mechanical ventilation was an independent risk factor for mortality. Conclusions: Non Invasive Ventilation, CPAP, and high-concentration face mask were frequently used in patients with COVID-related acute respiratory failure. The CPAP has reduced the need for intubation. Mechanical ventilation is a risk factor for death.

关键词： respiratory failure COVID 19-Intensive Care Units Military Hospital Gabon

Analysis of the Effectiveness of Targeted Nursing in Children with Severe Viral Encephalitis Complicated with respiratory failure

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Journal of Clinical and Nursing Research 2024年第1期8卷 65-70页

作者： Dechen Zhao Henan Children’s Hospital Zhengzhou 450000Henan ProvinceChina

Objective:To explore and analyze the effectiveness of targeted nursing in children with severe viral encephalitis complicated with respiratory failure.Methods:From April 2021 to April 2023,74 children with severe viral encephalitis complicated with respiratory failure admitted to the Department of Pediatrics of our hospital were selected as the research objects and divided into the target group(n=37)and the reference group(n=37).Targeted nursing was given to the target group,while general nursing was given to the reference group.Physical rehabilitation,motor scores,and lung function were compared between the groups.Results:The recovery time of limb abnormalities,convulsions,abnormal consciousness,and cranial nerve disorders in the target group was significantly better than that in the reference group(Prespiratory failure in children,speed up the recovery of motor function,and improve lung function.This nursing model has a significant application effect in children with severe viral encephalitis complicated with respiratory failure.

关键词： Targeted nursing Severe viral encephalitis in children respiratory failure

Clinical Study on respiratory Medicine Treatment of Chronic Obstructive Pulmonary Disease Combined with respiratory failure

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Journal of Clinical and Nursing Research 2024年第5期8卷 293-298页

作者： Jianhua Yu Sanshandao Street Community Health Service Center Laizhou CityYantai 261418Shandong ProvinceChina

Objective:To explore the respiratory medicine treatment methods for treating chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:70 cases of COPD patients with combined respiratory failure admitted to our hospital from January 2021 to January 2023 were selected as the study subjects,and randomly divided into the control group and the experimental group,each with 35 cases.The control group received only conventional treatment,and the experimental group received non-invasive positive pressure ventilation,and the treatment effects and changes in the levels of IL-18,hs-CRP,and CES2 inflammatory factors were observed and evaluated in the two groups.Results:There was no significant difference between the general data of the two groups(P>0.05);after treatment,the total effective rate of clinical efficacy of the observation group(91.43%)was significantly higher than that of the control group(71.43%),and the difference showed a significant correlation(Prespiratory failure,showing a good clinical application prospect.

关键词： Chronic obstructive pulmonary disease respiratory failure Non-invasive positive pressure ventilation Therapeutic effect Inflammatory factor

Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics

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World Journal of Clinical Cases 2022年第21期10卷 7314-7323页

作者： Bing-Yin Niu Guan Wang Bin Li Gen-Shen Zhen Yi-Bing Weng Department of Critical Care Medicine Beijing Luhe HospitalBeijing 101100China

BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance,alveolar capillary injury,pulmonary edema,refractory hypoxemia,and reduced lung compliance.Prolonged hypoxia can cause acid-base balance disorder,peripheral circulatory failure,blood-pressure reduction,arrhythmia,and other adverse consequences.AIM To investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory failure.METHODS We selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive Care Unit and divided them into sequential and regular groups according to a randomized trial,with each group comprising 54 patients.The sequential group received invasive and non-invasive sequential mechanical ventilation,whereas the regular group received invasive mechanical ventilation.Blood-gas parameters,hemodynamic parameters,respiratory mechanical parameters,inflammatory factors,and treatment outcomes were compared between the two groups before and after mechanical-ventilation treatment.RESULTS The arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24,48,and 72 h of treatment were higher than those of the conventional group(P<0.05).The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group(P<0.05).The pH value of the sequential group at 24 and 72 h of treatment,the central venous pressure value of the treatment at 24 h,and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group(P<0.05).The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group(P<0.05),the measured values of interleukin-6 and tumor necrosis factor-αin the s

关键词： Sequential treatment Mechanical ventilation Severe pneumonia respiratory failure Compliance

Clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

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世界临床病例杂志 2023年第26期11卷 6040-6050页

作者： Jun-Jun Wang Zhong Zhou Li-Ying Zhang Department of respiratory and Critical Care Medicine The First People's Hospital of Yangquan CityYangquan 045000Shanxi ProvinceChina Department of respiratory and Critical Care Medicine Guiyang Public Health Treatment CenterGuiyang 550001Guizhou ProvinceChina Department of respiratory and Critical Care Medicine The Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200023China

BACKGROUND At present,understanding of the most effective ventilation methods for treating chronic obstructive pulmonary disease(COPD)patients experiencing acute worsening symptoms and respiratory failure remains relatively limited.This report analyzed the efficiency and side effects of various ventilation techniques used for individuals experiencing an acute COPD exacerbation.AIM To determine whether pressure-controlled ventilation(PCV)can lower peak airway pressures(PAPs)and reduce the incidence of barotrauma compared to volume-controlled ventilation(VCV),without compromising clinical outcomes and oxygenation parameters.METHODS We have evaluated 600 patients who were hospitalized due to a severe COPD exacerbation,with 400 receiving mechanical ventilation for the respiratory failure.The participants were divided into two different groups,who were administered either VCV or PCV,along with appropriate management.We thereafter observed patients'attributes,clinical factors,and laboratory,radiographic,and arterial blood gas evaluations at the start and during their stay in the intensive care unit(ICU).We have also employed appropriate statistical methods for the data analysis.RESULTS Both the VCV and PCV groups experienced significant enhancements in the respiratory rate,tidal volume,and arterial blood gas values during their time in the ICU.However,no significant distinctions were detected between the groups in terms of oxygenation indices(partial pressures of oxygen/raction of inspired oxygen ratio)and partial pressures of carbon dioxide improvements.There was no considerable disparity observed between the VCV and PCV groups in the hospital mortality(32%vs 28%,P=0.53),the number of days of ICU stay[median interquartile range(IQR):9(6-14)d vs 8(5-13)d,P=0.41],or the duration of the mechanical ventilation[median(IQR):6(4-10)d vs 5(3-9)d,P=0.47].The PCV group displayed lower PAPs compared to the VCV group(P<0.05)from the beginning of mechanical ventilation until extubation or ICU departure.The occurrence of barotrauma

关键词： Chronic obstructive pulmonary disease Mechanical ventilation Volume-controlled ventilation Pressurecontrolled ventilation Barotrauma respiratory failure

It is time to update the ARDS definition: It starts with COVID-19-induced respiratory failure

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Journal of Intensive Medicine 2022年第1期2卷 29-31页

作者： Chun Pan Ling Liu Jianfeng Xie Haibo Qiu Yi Yang Department of Critical Care Medicine Jiangsu Provincial Key Laboratory of Critical Care MedicineZhongda HospitalSchool of MedicineSoutheast UniversityNanjingJiang Su 210009China

Coronavirus disease 2019(COVID-19)may rapidly worsen respiratory failure,thereby leading to death.COVID-19-induced respiratory failure exhibits some atypical characteristics,silent hypoxemia,and high lung compliance.Some histopathological changes associated with COVID-19-induced respiratory failure differ from those of classic acute respiratory distress syndrome(ARDS).However,compared with classical ARDS,COVID-19-induced respi-ratory failure has a similar timing of onset,clinical syndromes,radiological profile,and mortality rate in the intensive care unit(ICU).respiratory failure induced by COVID-19 is a type of ARDS and is currently underdiag-nosed.This condition stretches the definition of classic ARDS;therefore,an updated definition is warranted.

关键词： COVID-19 Acute respiratory distress syndrome respiratory failure Silent hypoxemia Histopathological changes

respiratory failure after scoliosis correction surgery in patients with Prader-Willi syndrome: Two case reports

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World Journal of Clinical Cases 2021年第32期9卷 9960-9969页

作者： Ju-Yul Yoon Sung-Hee Park Yu Hui Won Department of Physical Medicine and Rehabilitation Jeonbuk National University Medical SchoolJeonju 54907JeonbukSouth Korea Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital Jeonju 54907JeonbukSouth Korea

BACKGROUND Sleep-disordered breathing,including hypoventilation and obstructive sleep apnea,is often observed in Prader-Willi syndrome(PWS).Particularly in adolescence,scoliosis causes a progressive restrictive pulmonary pattern,leading to hypoventilation,so timely corrective surgery is required.However,the effect is controversial.In addition,since mental retardation of PWS,patient effort-based respiratory tests may be less reliable.So far,no studies have accurately reported on the comparison of respiratory function before and after corrective surgery,and appropriate respiratory function measurement method in PWS.CASE SUMMARY We present two cases of adolescent PWS with typical characteristics,including obesity,mental retardation,and scoliosis.Two boys,aged 12 and 13,diagnosed with PWS,both underwent scoliosis correction surgery.Before and immediately after surgery,arterial blood tests showed no abnormalities and no respiratory symptoms occurred.However,after 6-7 mo,both patients complained of daytime sleepiness,difficulty sleeping at night,dyspnea on exertion,and showed cyanosis.Hypercapnia and hypoxia were confirmed by polysomnography and transcutaneous CO2 monitoring during sleep and were diagnosed with obstructive sleep apnea and alveolar hypoventilation.It was corrected by nighttime noninvasive ventilation application and normal findings of arterial blood gas were maintained after 6-8 mo follow-up.CONCLUSION Even after scoliosis surgery,“periodic”monitoring of respiratory failure with an“objective”test method is needed for timely respiratory support.

关键词： Prader-Willi syndrome respiratory failure Noninvasive ventilation Obstructive sleep apnea Scoliosis Case report

Diuretic combinations in critically ill patients with respiratory failure:A systematic review and meta-analysis

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World Journal of Critical Care Medicine 2022年第3期11卷 178-191页

作者： Jean Maxime Côté Nadir Goulamhoussen Blaithin A McMahon Patrick T Murray Division of Nephrology Department of MedicineCentre Hospitalier de l'Universitéde MontréalMontréal H2X0C1QuébecCanada Division of Nephrology Department of MedicineMedical University of South CarolinaCharlestonSC 29425United States Department of Medicine School of MedicineUniversity College DublinDublin D078NNIreland

BACKGROUND In patients with respiratory failure,loop diuretics remain the cornerstone of the treatment to maintain fluid balance,but resistance is common.AIM To determine the efficacy and safety of common diuretic combinations in critically ill patients with respiratory failure.METHODS We searched MEDLINE,Embase,Cochrane Library and PROSPERO for studies reporting the effects of a combination of a loop diuretic with another class of diuretic.A meta-analysis using mean differences(MD)with 95%confidence interval(CI)was performed for the 24-h fluid balance(primary outcome)and the 24-h urine output,while descriptive statistics were used for safety events.RESULTS Nine studies totalling 440 patients from a total of 6510 citations were included.When compared to loop diuretics alone,the addition of a second diuretic is associated with an improved negative fluid balance at 24 h[MD:-1.06 L(95%CI:-1.46;-0.65)],driven by the combination of a thiazide plus furosemide[MD:-1.25 L(95%CI:-1.68;-0.82)],while no difference was observed with the combination of a loop-diuretic plus acetazolamide[MD:-0.40 L(95%CI:-0.96;0.16)]or spironolactone[MD:-0.65 L(95%CI:-1.66;0.36)].Heterogeneity was high and the report of clinical and safety endpoints varied across studies.CONCLUSION Based on limited evidence,the addition of a second diuretic to a loop diuretic may promote diuresis and negative fluid balance in patients with respiratory failure,but only when using a thiazide.Further larger trials to evaluate the safety and efficacy of such interventions in patients with respiratory failure are required.

关键词： respiratory failure Diuretics Fluid management Furosemide Thiazide Systematic review

Mortality and morbidity of acute hypoxemic respiratory failure and acute respiratory distress syndrome in infants and young children

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Chinese Medical Journal 2012年第13期125卷 2265-2271页

作者： ZHU Yan-feng XU Feng LU Xiu-lan WANG Ying CHEN Jian-li CHAO Jian-xin ZHOU Xiao-wen ZHANG Jian-hui HUANG Yan-zhi YU Wen-liang XIE Min-hui YAN Chao-ying LU Zhu-jin SUN Bo Departments of Pediatrics and Pediatric Critical Care Children's Hospital of Fudan University Shanghai 201102 Chin~ Department of Pediatric Critical Care Children's Hospital of Chongqing Medical University Chongqing 400014 China Department of Pediatric Critical Care Hunan Children's Hospital Changsha Hunan 410007 China Department of Pediatric Critical Care Shanghai Children's Medical Center of Shanghai Jiao Tong University Shanghai 200127 China Department of Pediatric Critical Care Guiyang Children's Hospital Guizhou Guiyang 550003 China Department of Pediatric Critical Care Quanzhou Children's Hospital Quanzhou Fujian 362000 China Department of Pediatric Critical Care Jinan Children's Hospital Jinan Shandong 250022 China Department of Pediatric Critical Care Guangzhou Women and Children's Medical Center Guangzhou Guangdong 510000 China Department of Pediatric Critical Care Changchun Children's Hospital Changchun Jilin 130061 China Department of Pediatric Critical Care Nanjing Children's Hospital Nanjing Jiangsu 210008 China Department of Pediatric Critical Care Children's Hospital of Soochow University Suzhou Jiangsu 215000 China Departments of Pediatric Critical Care First Hospital of Jilin University Changchun Jilin 130021. China

Background Acute hypoxemic respiratory failure （AHRF） often develops acute respiratory distress syndrome （ARDS）, and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively. This study aimed at prospectively investigating incidence, causes, mortality and its risk factors, and any relationship to initial tidal volume （VT） levels of mechanical ventilation, in children 〈5 years of age with AHRF and ARDS. Methods In 12 consecutive months in 23 pediatric intensive care units （PICU）, AHRF and ARDS were identified in those requiring 〉12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge. ARDS was diagnosed according to the American-European Consensus definitions. The mortality and ventilation free days （VFD） were measured as the primary outcome, and major complications, initial disease severity, and burden were measured as the secondary outcome. Results In 13 491 PICU admissions, there were 439 AHRF, of which 345 （78.6%） developed ARDS, resulting in incidences of 3.3% and 2.6%, and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia （62.9%） and sepsis （33.7%） as major underlying diseases respectively. No association was found in VT levels during the first 7 days with mortality, nor for V-r at levels 〈6, 6-8, 8-10, and 〉10 ml/kg in the first 3 days with mortality or length of VFD. By binary Logistic regression analyses, higher pediatric risk of mortality score III, higher initial oxygenation index, and age 〈1 year were associated with higher mortality or shorter VFD in AHRF. Conclusions The incidence and mortalities of AHRF and ARDS in children 〈5 years were similar to or lower than the previously reported rates （in age up to 15 years）, associated with initial disease severity and other confounders, but causal relationship for the initial VT levels as the independent factor to the major outcome was not found.

关键词： acute respiratory distress syndrome hypoxemia respiratory failure morbidity mortality respiratory therapy