[Application of high-flow humidified oxygen therapy in patients with tracheotomy and non-mechanical ventilation].

OBJECTIVE: To observe the effect of tracheotomy high-flow oxygen therapy (THFO) on the clinical efficacy of non-mechanically ventilated patients undergoing a tracheotomy. METHODS: Sixty adult patients with tracheotomy and non-mechanical ventilation who were diagnosed and treated from January 2019 to December 2020 in Fenyang Hospital of Shanxi Province were enrolled. According to the random number table, the patients were divided into Venturi oxygen therapy group and THFO group, 30 cases in each group. The THFO group was given oxygen therapy with THFO; the Venturi group (without mask) was given Venturi connected the MR850 base and the ventilator tube. Observe the changes of two groups at 7 AM within 5 days, including body temperature which was 1 centigrade higher than the baseline, white blood cell count (WBC) which was 2×109/L higher than baseline, oxygenation index (PaO2/FiO2) < 300 mmHg (1 mmHg = 0.133 kPa), the occurrence of lower respiratory tract infections (based on radiography), and changes in sputum indexing and sputum formation. RESULTS: Compared with the Venturi oxygen therapy group, the body temperature increased > 1 centigrade, WBC increased by 2×109/L, PaO2/FiO2 < 300 mmHg, and the proportion of lower respiratory tract infection in THFO group decreased significantly [body temperature increased > 1 centigrade: 10.0% (3/30) vs. 13.3% (4/30), WBC increased by 2×109/L: 10.0% (3/30) vs. 30.0% (9/30), PaO2/FiO2 < 300 mmHg: 3.3% (1/30) vs. 10.0% (3/30), the proportion of lower respiratory tract infection: 6.7% (2/30) vs. 13.3% (4/30), all P < 0.05]. The proportion of patients with sputum scab formation and sputum viscosity of I degree were significantly increased [sputum scab formation: 16.7% (5/30) vs. 6.7% (2/30), sputum viscosity of I degree: 30.0% (9/30) vs. 20.0% (6/30), both P < 0.05]. CONCLUSIONS: THFO during non-mechanical ventilation of adult patients with tracheotomy can maintain a higher oxygen partial pressure and ideally control the temperature and humidity of the inhaled gas, promote the discharge of sputum with degree I and II viscosity, thereby reducing the tracheotomy complications such as lower respiratory tract infections.

[Application of bundle management strategy in early mobility of mechanically ventilated patients].

OBJECTIVE: To explore the effect of bundle management strategy in early mobility of patients with mechanical ventilation. METHODS: Seventy-two mechanically ventilated patients admitted to the respiratory intensive care unit (RICU) of Fenyang Hospital of Shanxi Province from December 2019 to June 2020 were enrolled. The patients were divided into routine nursing control group (routine control group) and early mobility bundle management group (bundle group), with 36 cases in each group. The routine control group received regular nursing, including monitoring vital signs, raising the head of the bed, turning over and buttoning the back every 2 hours, daily awakening, airway humidification, prevention of digestive tract ulcer, analgesia and sedation management, prevention of deep vein embolism, pipeline management, regular monitoring of blood gas analysis and electrolytes according to the changes of the condition, prevention of aspiration, prevention of bacterial colonization, correct hand hygiene, and so on. The bundle group implemented the cluster early mobility strategy based on routine nursing. Firstly, set up a professional team to execute the standards. The team determined the plan and implemented the 4-level mobility plan, companied with psychological intervention, decided the termination standard and quality control. The incidence of intensive care unit acquired weakness (ICU-AW), ventilator-associated pneumonia (VAP), delirium, the duration of mechanical ventilation and the length of intensive care unit (ICU) stay were evaluated. RESULTS: Compared with the routine control group, the incidences of ICU-AW, VAP, and delirium in the bundle group were significantly lower (the incidence of ICU-AW: 36.11% vs. 69.44%, χ2 = 8.025, P = 0.005; the incidence of VAP: 8.33% vs. 30.56%, χ2 = 5.675, P = 0.017; the incidence of delirium: 5.56% vs. 36.11%, χ2 = 10.180, P = 0.001), the duration of mechanical ventilation was significantly shorter (days: 7.13±1.34 vs. 10.46±1.48, t = -10.145, P < 0.001), and the length of ICU stay was also significantly decreased (days: 9.03±2.43 vs. 13.06±3.63, t = -5.535, P < 0.001). CONCLUSIONS: The implementation of bundle management strategy of early mobility can promote the rehabilitation of mechanical ventilated patients, improve the prognosis and the quality of life. The effect is noticeable and it is worth popularizing.

[Application of Venturi combined with MR850 in ventilator offline patients with tracheotomy].

OBJECTIVE: To investigate the effect of oxygen therapy with Venturi combined with MR850 heating humidifier on patients without mechanical ventilation after tracheotomy. METHODS: Eighty patients (≥ 18 years old) who had undergone tracheotomy and without mechanical ventilation admitted to Fenyang Hospital of Shanxi Province from June 2016 to December 2017 were enrolled, and they were divided into control group and observation group according to random number table method, with 40 patients in each group. The observation group was given Venturi (removed the mask) combined with MR850 device active warm and humid oxygen therapy; the control group was given one-off ordinary flow device and warm and humid exchanger (artificial nose, HME) passive humid oxygen therapy. Body temperature increased by 1 centigrade above basal body temperature, white blood cell count (WBC) increased 2×109/L than the base value, oxygenation index (PaO2/FiO2) < 300 mmHg (1 mmHg = 0.133 kPa), airway mucosal hemorrhage, pulmonary infection and sputum viscosity were observed in the two groups for 5 days after oxygen therapy. RESULTS: Among the 80 patients, there were 46 males and 34 females, with an average age of (67.7±12.2) years. Compared with the control group, the incidence of increased body temperature (5.0% vs. 20.0%), the incidence of increased WBC (7.5% vs. 35.0%), the incidence of low PaO2/FiO2 (2.5% vs. 7.5%), the incidence of airway mucosal bleeding (5.0 % vs. 15.0%) and the incidence of pulmonary infection (2.5% vs. 10.0%) were significantly decreased in the observation group (all P < 0.01), and the proportion of sputum viscosity I degree of patients was significantly increased (57.5% vs. 12.5%, P < 0.01). CONCLUSIONS: Venturi combined with MR850 device can effectively control airway temperature and humidity, promote sputum dilution and conducive to drainage, reduce pulmonary infection in adults patients without mechanical ventilation after tracheotomy, thereby reducing postoperative complications of tracheotomy.