Effect analysis of information-guided enteral nutrition-associated diarrhea treatment process in patients with chronic obstructive pulmonary disease undergoing continuous non-invasive assisted ventilation: a mixed cohort study of pre- and post-control / 中华危重病急救医学

Objective:To clarify the application effect of information-guided enteral nutrition-associated diarrhea (ENAD) management process in patients with chronic obstructive pulmonary disease (COPD) undergoing non-invasive assisted ventilation.Methods:A mixed cohort study of pre- and post-control was conducted. Thirty-nine patients with COPD who were admitted to the emergency intensive care unit (ICU) of Huzhou First People's Hospital from July 1, 2021 to July 31, 2022 were enrolled. Taking the completion of the software development of ENAD management software for critically ill patients on January 28, 2022 as the time node, 20 patients admitted from July 1, 2021 to January 28, 2022 were set as the control group, and 19 patients admitted from January 29 to July 31, 2022 were set as the observation group. The two groups of patients received the same enteral nutrition support treatment, and the control group implemented the conventional ENAD treatment process with enteral nutrition intolerance disposal process as the core. On the basis of the control group, the observation group implemented the information-guided ENAD treatment process, and the system software actively captured the information of ENAD patients and reminded the medical team to improve the patient's diarrhea-related examination and provide alternative treatment plans. The duration of antidiarrhea, feeding interruption rate, and energy and protein intake, blood biochemical indexes, incidence of abnormal blood electrolyte metabolism, daily continuous non-invasive assisted ventilation and endotracheal intubation after 7 days of targeted diarrhea intervention were compared between the two groups.Results:Except for the basal pulse rate, there were no significant differences in gender distribution, age, and vital signs, basic nutritional status, arterial blood gas analysis and blood biochemistry at admission between the two groups, indicating comparability between the two groups. When ENAD occurred, the patients in the observation group obtained earlier cessation of diarrhea than those in the control group [days: 3.00 (2.00, 3.25) vs. 4.00 (3.00, 5.00), P < 0.01], and the feeding interruption rate was significantly lower than that in the control group [10.53% (2/19) vs. 65.00% (13/20), P < 0.01]. After 7 days of diarrhea intervention, the energy intake of the observation group was significantly higher than that of the control group [kJ·kg -1·d -1: 66.28 (43.34, 70.36) vs. 47.88 (34.60, 52.32), P < 0.01], the levels of hemoglobin (Hb), albumin (Alb) and serum prealbumin (PAB) were significantly higher than those in the control group [Hb (g/L): 119.79±10.04 vs. 110.20±7.75, Alb (g/L): 36.00 (33.75, 37.25) vs. 31.00 (30.00, 33.00), PAB (mg/L): 155.79±25.78 vs. 140.95±14.97, all P < 0.05], the daily continuous non-invasive assisted ventilation duration was significantly shorter than that of the control group [hours: 14 (12, 16) vs. 16 (14, 18), P < 0.01], and the arterial partial pressure of carbon dioxide (PaCO 2) was significantly lower than that of the control group [mmHg (1 mmHg ≈ 0.133 kPa): 66.00 (62.00, 70.00) vs. 68.00 (67.50, 70.05), P < 0.05]. However, there were no significant differences in protein intake, incidence of abnormal electrolyte metabolism, and incidence of endotracheal intubation due to acute respiratory failure between the two groups. Conclusion:The information-guided ENAD treatment process can enable the COPD patients undergoing continuous non-invasive assisted ventilation who experience ENAD to receive earlier cessation of diarrhea, and improve the protein energy metabolism and respiratory function of the patients.

Mortalidad de pacientes en ventilación mecánica prolongada: Estudio de cohorte retrospectiva con análisis de propensión / Mortality in Patients Requiring Prolonged Mechanical Ventilation: A Retrospective Cohort Study with Propensity Score Analysis

RESUMEN Se ha observado un aumento en el número de pacientes que requieren ser derivados a centros de desvinculación de ventilación mecánica y rehabilitación. Material y métodos: Se realizó un estudio observacional con análisis por puntaje de propensión en el que se analizaron los predictores de mortalidad en una cohorte de trece años internados en un centro de desvinculación de ventilación mecánica y rehabilitación. Resultados: La mortalidad analizada mediante ponderación por el inverso de la proba bilidad de tratamiento se asoció a edad [OR = 1,037 (IC95 % 1,023-1,052), p < 0,001], desvinculación de la ventilación mecánica (VM) [OR = 0,398 (IC95 % 0,282-0,560), p < 0,001], decanulación [OR = 0,059 (IC95 % 0,038-0,091), p < 0,001], antecedentes cardiovasculares [OR = 1,684 (IC95 % 1,146-2,474), p < 0,001], neumonía en no en fermedad pulmonar obstructiva crónica [OR = 2,649 (IC95 % 1,631-4,302), p < 0,001] y la presencia de enfermedad pulmonar obstructiva crónica [OR = 0,477 (IC95 %0,298- 0,762), p = 0,002] El análisis de regresión logística múltiple de la muestra emparejada mantuvo la aso ciación entre la desvinculación de la ventilación mecánica [OR = 0,313 (IC95 % 0,137- 0,715), p = 0,006] y la decanulación [OR = 0,057 (IC95 % 0,021-0,155), p ≤ 0,001] como variables asociadas a una menor mortalidad y a la edad [OR = 1,056 (IC95 % 1,026-1,087), p ≤ 0,001] como predictora asociada a mayor mortalidad. Conclusión: La mortalidad en pacientes con ventilación mecánica en un centro de des vinculación de ventilación mecánica y rehabilitación se asoció de manera independiente a una mayor edad, imposibilidad para la desvinculación de la ventilación mecánica y la no decanulación. Es importante contar con dichos predictores para poder planificar objetivos de tratamiento reales.

ABSTRACT Introduction: An increase has been observed in the number of patients requiring spe cialized care in mechanical ventilation weaning and rehabilitation centers (MVWRCs). Methods: An observational study with propensity score analysis was conducted on a 13- year cohort of patients in a MVWRC in Argentina. Predictors of mortality were analyzed. Results: Mortality assessed using the inverse probability of treatment weighting was as sociated with age [OR=1.037 (95% CI: 1.023-1.052), p<0.001], weaning from mechanical ventilation (MV) [OR=0.398 (95% CI: 0.282-0.560), p<0.001], decannulation [OR=0.059 (95% CI: 0.038-0.091), p<0.001], history of cardiovascular disease [OR=1.684 (95% CI: 1.146-2.474), p<0.001], pneumonia in non-chronic obstructive pulmonary disease (non-COPD) [OR=2.649 (95% CI: 1.631-4.302), p<0.001], and COPD [OR=0.477 (95% CI: 0.298-0.762), p=0.002]. Multiple logistic regression analysis in the propensity score-matched sample indicated that weaning from MV [OR=0.313 (95% CI: 0.137-0.715), p=0.006] and decannulation [OR=0.057 (95% CI: 0.021-0.155), p=<0.001] remained associated with lower morta lity, whereas age [OR=1.056 (95% CI: 1.026-1.087), p=<0.001] remained a predictor associated with higher mortality. Conclusion: Mortality in patients requiring MV in a MVWRC was independently associa ted with older age, failed weaning from MV, and non-decannulation. It is very important to identify such predictors in order to plan attainable treatment goals.

Comparison of the effects between low-level assisted ventilation and T-piece method on respiratory mechanics during weaning of mechanically ventilated patients / 中华危重病急救医学

Objective:To compare the difference of low-level assisted ventilation and T-piece method on respiratory mechanics of patients with invasive mechanical ventilation during spontaneous breathing trial (SBT) within 3 days before extubation.Methods:A retrospective observational study was conducted. Twenty-five patients with difficulty in weaning or delayed weaning from invasive mechanical ventilation who were admitted to department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2018 to June 2020, and were in stable condition and entered the weaning stage after more than 72 hours of invasive mechanical ventilation were studied. A total of 119 cases of respiratory mechanical indexes were collected, which were divided into the low-level assisted ventilation group and the T-piece group according to the ventilator method and parameters used during the data collection. The different ventilation modes related respiratory mechanics indexes such as the esophageal pressure (Pes), the gastric pressure (Pga), the transdiaphragmatic pressure (Pdi), the maximum Pdi (Pdimax), Pdi/Pdimax ratio, the esophageal pressure-time product (PTPes), the gastric pressure-time product (PTPga), the transdiaphragmatic pressure-time product (PTPdi), the diaphragmatic electromyography (EMGdi), the maximum diaphragmatic electromyography (EMGdimax), PTPdi/PTPes ratio, Pes/Pdi ratio, the inspiratory time (Ti), the expiratory time (Te) and the total time respiratory cycle (Ttot) at the end of monitoring were recorded and compared between the two groups.Results:Compared with the T-piece group, Pes, PTPes, PTPdi/PTPes ratio, Pes/Pdi ratio and Te were higher in low-level assisted ventilation group [Pes (cmH 2O, 1 cmH 2O = 0.098 kPa): 2.84 (-1.80, 5.83) vs. -0.94 (-8.50, 2.06), PTPes (cmH 2O·s·min -1): 1.87 (-2.50, 5.93) vs. -0.95 (-9.71, 2.56), PTPdi/PTPes ratio: 0.07 (-1.74, 1.65) vs. -1.82 (-4.15, -1.25), Pes/Pdi ratio: 0.17 (-0.43, 0.64) vs. -0.47 (-0.65, -0.11), Te (s): 1.65 (1.36, 2.18) vs. 1.33 (1.05, 1.75), all P < 0.05], there were no significant differences in Pga, Pdi, Pdimax, Pdi/Pdimax ratio, PTPga, PTPdi, EMGdi, EMGdimax, Ti and Ttot between the T-piece group and the low-level assisted pressure ventilation group [Pga (cmH 2O): 6.96 (3.54,7.60) vs. 7.74 (4.37, 11.30), Pdi (cmH 2O): 9.24 (4.58, 17.31) vs. 6.18 (2.98, 11.96), Pdimax (cmH 2O): 47.20 (20.60, 52.30) vs. 29.95 (21.50, 47.20), Pdi/Pdimax ratio: 0.25 (0.01, 0.34) vs. 0.25 (0.12, 0.41), PTPga (cmH 2O·s·min -1): 7.20 (2.54, 9.97) vs. 7.97 (5.74, 13.07), PTPdi (cmH 2O·s·min -1): 12.15 (2.95, 19.86) vs. 6.87 (2.50, 12.63), EMGdi (μV): 0.05 (0.03, 0.07) vs. 0.04 (0.02, 0.06), EMGdimax (μV): 0.07 (0.05, 0.09) vs. 0.07 (0.04, 0.09), Ti (s): 1.20 (0.95, 1.33) vs. 1.07 (0.95, 1.33), Ttot (s): 2.59 (2.22, 3.09) vs. 2.77 (2.35, 3.24), all P > 0.05]. Conclusions:When mechanically ventilated patients undergo SBT, the use of T-piece method increases the work of breathing compared with low-level assisted ventilation method. Therefore, long-term use of T-piece should be avoided during SBT.

Application progress of extracorporeal membrane oxygenation in the perioperative period of lung transplantation / 器官移植

Lung transplantation is the ultimate treatment for many kinds of end-stage lung diseases. However, the perioperative management of lung transplantation is complicated with high fatality of patients. Extracorporeal membrane oxygenation (ECMO) is an effective method of extracorporeal respiration and circulation support. ECMO plays an important role in the perioperative support treatment of lung transplantation, which breaks the limitation of contraindications and promotes the development of lung transplantation. In this article, the indications, catheter placement strategies and application of ECMO in the perioperative period of lung transplantation were reviewed.

Goal-targeted therapy of inhalation injury with intratracheal delivery of drugs / 中华烧伤杂志

Early airway management and respiratory support are essential for severe inhalation injury. Intratracheal delivery of drugs is better than other methods of administration, because of its higher local drug concentration, faster and more precise effect, and less systemic adverse reactions. It attracts more and more attention at present. In recent years, a growing number of drugs can be used in intratracheal delivery, in addition to common bronchodilators, mucolytics, and glucocorticoids, there are anti-inflammatory agents, antioxidants, and anticoagulants, etc. It is of great significance to improve the prognosis of patients with inhalation injuries with intratracheal delivery of drugs in goal-targeted therapy.

Caracterización clínica y epidemiológica de pacientes en ventilación manual asistida / Clinical and epidemiological characterization of patients in assisted manual ventilation

Antecedentes: No hay estudios publicados de pacientes ventilados manualmente, solo algunos reportes de caso. Metodología: Se realizó un estudio descriptivo retrospectivo de diecinueve casos de pacientes con intubación endotraqueal y ventilados manualmente con el objetivo de determinar sus características clínicas, de febrero a mayo 2015 en el Hospital Roosevelt. Resultados: Trece de 19 (63%) eran mujeres, con rango de edad entre 19 y 78 años (promedio 49 años). Se ventilaron 12/19 (63%) en la emergencia, 6/19 (32%) en encamamiento. El motivo de consulta más frecuente fue insuficiencia respiratoria con 7 casos. Las enfermedades de base más frecuentes fueron hipertensión arterial y diabetes mellitus con 8 y 5 casos respectivamente. El 19% de los pacientes que fueron extubados volvieron a ser intubado. Diez de 19 (53%) falleció, 6/19 (32%) egresaron vivos, 2/19 (10%) continuaron hospitalizados y 1/19 (5%) tubo egreso contraindicado. Una escala de Glasgow menor a 8 puntos fue un factor de riesgo para morir (P 0.0063, OR27). Conclusiones: La mortalidad asociada a ventilación manual fue de 58%. Un Glasgow menos a 8 puntos representa 26 veces mayor riesgo a morir...(AU)

Background: There are no published studies of patients ventilated manually, only a few case reports. Methodology: A retrospective study of nineteen cases of patients with endotracheal intubation was performed manually ventilated in order to determine their clinical characteristics, from February to May 2015 in the Roosevelt Hospital. Results: Thirteen of 19 (63%) were females, with ages ranging from 19 to 78 years (mean 49 years), 12/19 (63%) were ventilated in emergency, 6/19 (32%) in bedridden. The most frequent reason for consultation was respiratory failure in 7 cases. Diseases were more frequent basis hypertension and diabetes mellitus with 8 and 5 cases respectively. 19% of patients were extubated again be intubated. Ten of 19 (53%) died, 6/19 (32%) discharged alive, 2/19 (10%) remained hospitalized and 1/19 (5%) contraindicated discharge tube. A smaller scale Glasgow 8 points was a risk factor for death (P 0.0063, OR 27). Conclusions: The mortality associated with manual ventilation was 58%. A Glasgow least 8 points represents 26 times more likely to die...(AU)

Observing the clinical efficacy of noninvasive ventilator assisted ventilation combined with morphine in treating acute left heart failure / 中华急诊医学杂志

Objective To investigate the efficacy and security of noninvasive ventilator assisted ventilation combined with morphine in treating acute left heart failure.Methods Sixty patients suffering acute left heart failure were divided into two groups:conventional therapy group (thirty cases using morphine and other medicine) and combined group (thirty cases using noninvasive ventilator assisted ventilation combined with morphine).Observe and record clinical results for blood pressure,heart rate,respiratory rate,blood gas analysis,left ventricular ejection fraction (LVEF) as well as occurrence rate of remission time and adverse reaction before treatment,one hour after treatment and remission respectively.Results Clinical results for blood pressure,heart rate,respiratory rate,blood gas analysis,left ventricular ejection fraction (LVEF) have improved after treatment,all clinical indexs have improved obviously except for partial pressure of carbon dioxide in combined group.The difference was significant (P ＜ 0.05) ; Remission time in combined group (6.20 ± 4.12 hours) was shorter than morphine group (8.67 ± 5.28) hours,which has statistically difference (P ＜ 0.05).But occurrence rate of adverse reaction and complication raised slightly in combined group (43.3％ vs.40％).Conclusions Noninvasive ventilator assisted ventilation combined with morphine can relieve clinical symptoms promptly in acute left heart failure,improve prognosis,it is a effectively and safety therapeutic measures.

Use of non-invasive ventilation in a pregnant woman with acute respiratory distress syndrome due to pneumonia.

Utility of non-invasive ventilation (NIV) in patients with acute respiratory distress syndrome (ARDS) is not proven. We report a case of a 28-year-old primigravida female with ARDS due to community-acquired severe pneumonia in whom non-invasive ventilation was instituted in an attempt to improve oxygenation and avoid intubation. This lead to an improvement in arterial oxygenation and reduction in respiratory rate of the patient and gradual disappearance of fetal distress.

A Study on the Changes in Ventilator Care Rate and Outcome of Very Low Birth Weight Infants During Last Four Years

PURPOSE: Recently there has been a decrease in ventilator care rate and duration of very low birth weight infants(VLBWI) in Fatima Hospital. The aims of this study were to survey the frequency and duration of ventilation in VLBWI and to develop a non-invasive neonatal intensive care unit (NICU) policy. METHODS: We performed a retrospective study of 284 newborn of infants less than 1,500 gm admitted to NICU and discharged from January 1998 to December 2001. Patients were intubated or applied continuous positive airway pressure(CPAP) via nasal prong immediately after presenting signs of respiratory distress. We analyzed epidemiologic data to study the changes in ventilator care rate, duration and outcome of ventilator care groups. RESULTS: Of 284 newborn infants, 146 required invasive management, such as endotracheal intubation and assisted ventilation. The characteristics, the severity of clinical symptoms and laboratory findings in ventilator care groups at birth showed no significant differences. The annual proportion of infants requiring assisted ventilation decreased according to increasing gestational age. The median duration of ventilation decreased markedly from 6.0 days in 1998 to 2.7 days in 2001. Final complications and outcomes in ventilator care groups showed no significant differences. CONCLUSION: Our study shows a significant reduction in the invasiveness of the treatment of VLBW infants, which was not associated with an increased mortality or morbidity. A non-invasive strategy for the VLBW infant with minimal to moderate respiratory distress after birth in NICU is better than immediate invasive management. Non-invasive nasal CPAP is a simpler and safer method than invasive assisted ventilation.