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Objective:Objectives To introduce the preliminary experience of flexible vacuum-assisted ureteral access sheath(FV-UAS) in the treatment of upper urinary calculi in retrograde intrarenal lithotripsy(RIRS).Methods:The clinical data of 11 patients with upper urinary calculi who were treated in Jiangxi Provincial People's Hospital from August to September 2021 were analyzed retrospectively. There were 6 males and 5 females, with the mean age of 48 years (32-72 years), the mean size of stone of 15.5 mm (11-20mm), and the mean stone volume of 1 958 mm3 (1 108-4 036 mm3), including 1 case with upper ureteral calculi, 10 cases with renal calculi, and 2 cases with calculi in multiple renal calyces. Ureteral stents were placed in 2 cases preoperatively. There were 2 cases of grade Ⅱ hydronephrosis according to Grignon classification. All patients were treated by retrograde intrarenal lithotripsy, and the FV-UAS(F12/14) was used during the operation. FV-UAS can be passively bent(>90°) with the bending of the flexible ureteroscopy(f-URS), and connect vacuum suction devices. The method of placing the FV-UAS during the operation was the same as traditional ureteral access sheath. The FV-UAS should be as close to the target stone as possible by the f-URS during the operation. F6 ureteral stent was routinely indwelled for 2-4 weeks. The operation time, postoperative complications, and stone volume clearance rate were summarized and analyzed, and stone volume clearance rate was calculated as(1-residual stone volume/preoperative stone volume)×100%. The stone volume was obtained by CT 3-D reconstruction preoperatively and first day postoperatively.Results:All patients underwent RIRS successfully at the first stage, with the usage of FV-UAS(F12/14)during the operation. The mean operation time was 57.1 minutes(34-90 minutes), and the mean stone volume clearance rate was 98.9%(94.8%-100.0%)on the first day postoperatively. Seven cases reached 100.0% stone-free rate, and 4 cases presented residual calculi. The mean hemoglobin drop was 0.8 g/L, and 1 case presented vomiting without fever on the first day postoperatively. For the 4 cases with residual calculi, no residual stone was found by B-ultrasound when the ureteral stent was removed.Conclusions:Our preliminary study found that it is feasible and safe to use FV-UAS in RIRS, which can follow the f-URS to extend into the renal pelvis and renal calyces. Vacuum-assist can increase the probability of stone-free.
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Objective To investigate the current practice of ventilation during cardiopulmonary resuscitation (CPR) in Chinese emergency physicians. Methods Self-designed questionnaires were used to survey mainly the present situation of CPR ventilation practice performed by 800 physicians who participated in the Peking Union International Summit for Emergency Medicine from April 17th to 19th, 2015. Results A total of 800 questionnaires were distributed and 638 (79.75%) valid questionnaires were taken back; the responders joining the survey came from 29 provinces and regions, including Beijing, Hebei, Shandong, Guangdong, Liaoning, etc. There were 331 males and 307 females; 91.54% (584 responders) were emergency physicians and 77.90% (497 responders) came from tertiary hospitals, 17.55% (112 responders) came from the secondary hospitals. Regarding ventilation during CPR, 86.4% (551 responders) declared the patients was routinely given endo-tracheal intubation; after intubation, 25.8% (142 responders) adopted bag-mask ventilation, and 74.2% (409 responders) applied mechanical ventilation. When a ventilator was used, 301 (73.6%) responders used the volume controlled ventilation mode, 334 (81.7%) responders set the respiratory rate (RR) lower than 15 bpm, while 89.2% (365 responders) used the tidal volume set at a range of 400-500 mL. When adopted the flow triggering sensitivity, 79.7% (326 responders) set the sensitivity at 1-6 L/min, while 16.4% (67 responders) selected the default parameter, not adjusting the flow triggering parameter; when adopted the pressure triggering sensitivity, 75.1% (307 responders) set the sensitivity between -1 to -6 cmH2O (1 cmH2O = 0.098 kPa) and 20.3% (83 responders) selected the default value, not adjusting the pressure triggering parameter. When the mechanical ventilation (MV) was adopted, 84.8% (347 responders) declared often experiencing problems with MV, such as airway high peak pressure alarms [39.6% (162/409)], lower ventilation volume per minute alarms [24.9% (102/409)], higher respiratory frequency alarms [21.3% (87/409)], but only 67.2% (275 responders) would again adjust the ventilation mode related parameters and only 59.2% (242 responders) would observe the actual respiratory frequency. Conclusions With regards to artificial ventilation during CPR, the majority of emergency physicians tend to adopt endotracheal intubation and commonly use the volume controlled mode of mechanical ventilation; among the ventilator parameter setting, the RR is not strictly in accordance with the CPR guidelines, and most of the inspiration triggering sensitivity setting was too low, very easily to induce hyperventilation; simultaneously, the emergency physicians often neglect the practical RR; although there are many problems with ventilation such as frequent alarms, only 67.2% of the emergency physicians would again adjust the ventilation parameters.
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Objective To Pulse oximetry saturation has been wildly used clinically.It has been reported that pulse oximetry plethysmographic waveform (POP) reflected the peripheral tissue perfusion.In this study,we parameterized POP,observed the value of POP parameters in normal adults,and established the normal reference value range.Methods A multi-center prospective descriptive study.Total of 1 019 adult volunteers with normovolemia from 7 cities were enrolled in this study.Sex,age,height,weight and pulse oximetry data in awake and spontaneous breathing under in quiet conditions in the room temperature were collected.POP parameters and perfusion index were analyzed using MATLAB 2012a software.The normal reference value ranges of POP parameters,including the amplitude of POP (Amp) and the area under the curve of POP (AUC),were formulated.Results Statistical differences of POP parameters were detected between men and women in the normal adult.The 95％ confidence reference value of POP parameters in normal population was as follows:Amp (104.8-2298.7) PVA and AUC (3265.8-6028.5) PVPGin total,Amp (129.4-2433.6) PVA and AUC (3319.0-5862.2) PVPG in male;Amp (89.5-2138.2) PVA and AUC (3163.9-5929.9) PVPG in female.Conclusions POP,including the amplitude of POP (Amp) and the area under the curve of POP (AUC),had normal reference value ranges in normal adults.
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ObjectiveTo investigate the feasibility of using pulse oximetry plethysmographic waveform (POP) to identify the restoration of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR).Methods An observational research was conducted. A porcine model of ventricular fibrillation (VF) arrest was reproduced. After 3 minutes of untreated VF, animals received CPR according to the latest CPR guidelines, providing chest compressions to a depth of 5 cm with a rate of 105 compressions per minute and instantaneous mechanical ventilation. After 2 minutes of CPR, animals were defibrillated with 100 J biphasic, followed by continuous chest compressions. Data of hemodynamic parameters, partial pressure of end-tidal carbon dioxide (PETCO2) and POP were collected. The change in POP was observed, and the characteristics of changes of the waves were recorded during the peri-CPR period using the time and frequency domain methods.Results VF was successfully induced in 6 pigs, except 1 death in anesthesia induction period.① After VF, invasive blood pressure waveform and POP of the animals disappeared. PETCO2 was (18.83±2.71) mmHg (1 mmHg=0.133 kPa), and diastolic arterial pressure was (23.83±5.49) mmHg in compression stage. Animals attained ROSC within 1 minute after defibrillation, with PETCO2 [(51.83±9.35) mmHg] and diastolic arterial pressure [(100.67±10.97) mmHg] elevated significantly compared with that of compression stage (t1 = 8.737,t2 = 25.860, bothP = 0.000), with appearance of arterial blood pressure waveform.② Characteristic changes in POP were found in all experimental animals. During the stages of induced VF, compression, ROSC, and compression termination, POP showed characteristic waveform changes. POP showed disappearance of waveform, regular compression wave, fluctuation hybrid and stable pulse wave in time domain method; while in the frequency domain method waveform disappearance, single peak of compression, double or fusion peak and single peak of pulse were observed.Conclusion Analysis of POP using time and frequency domain methods could not only quickly detect cardiac arrest, but also show a role as a feasible, non-invasive marker of ROSC during CPR.
