Effect of postoperative oxygen therapy regimen modification on oxygenation in patients with acute type A aortic dissection.

Objective: In this study, we investigated the effect of various oxygen therapy regimens on oxygenation in patients with acute type A aortic dissection (AAD). Methods: A quasi-randomized controlled trial was conducted, in which patients with AAD hospitalized for surgery from June to September 2021 were assigned to the control group (patients received conventional oxygen therapy after postoperative mechanical ventilation, weaning, and extubation) and those who were admitted from October to December 2021 were assigned to the observation group [patients underwent optimally adjusted therapy based on the treatment of the control group, which mainly included prioritized elevation of positive end-expiratory pressure (PEEP) and restricted use of the fraction of inspired oxygen (FiO2)].The postoperative oxygenation index, blood gas analysis, and duration of mechanical ventilation were compared between the two groups. Results: There were significant differences in oxygenation observed at 2 h postoperatively between the groups. 12, 24, and 72 h postoperatively, the oxygenation index varied significantly between the two groups. There were statistically significant differences in the time effects of the oxygenation index and PaO2 between the two groups, as well as significant differences in the length of stay in the intensive care unit. Conclusion: For the postoperative care of patients with AAD, it is suggested that the minimum FiO2 required for oxygenation of patients be maintained. In addition, it is possible to enhance PEEP as a priority when PaO2 is low.

Evidence-based systematic review of removal of peripheral arterial catheter in critically ill adult patients.

OBJECTIVE: To evaluate and summarize literature pertaining to evidence of peripheral arterial catheterization in adults, and to provide a reference for clinical practice. METHODS: We undertook a systematic review of literature on the removal of peripheral arterial manometric catheters in adult patients from various sources such as UpToDate, BMJ, National Institute for Health and Care Excellence (NICE), Medlive, Cochrane Library, Joanna Briggs Institute (JBI) Evidence-based Health Care Center Database, CINAHL, PubMed, Wanfang Data, VIP, and other databases. The retrieval time was set as from the establishment of the database till August 30, 2021. We screened the studies that fulfilled the inclusion criteria, evaluated their quality, and retrieved and summarized such articles. RESULTS: The review included 8 articles: 1 clinical decision, 3 guidelines, 2 evidence summaries, 1 systematic review, and 1 expert consensus. In all, 17 pieces of strong evidence were collected and extracted based on the following 5 dimensions: assessment of removal timing, preparation before removal, removal procedure, compression time, and key points after removal. CONCLUSIONS: The removal of a peripheral arterial manometry catheter requires careful consideration by medical professionals. In order to increase the removal standardization rate and decrease the incidence of clinical complications, standardized procedures and training need to be developed.

The effects of using a micro-infusion pump without accompanying fluid at a low flow rate on patients undergoing cardiac surgery.

BACKGROUND: Since a micro-infusion pump continuously pumps drugs at a low speed, it has the risk of complications including venous blood return, indwelling needle blockage, and the lack of regular delivery of drugs. This study aimed to investigate venous blood return and indwelling needle blockage after cardiac surgery when a micro-infusion pump was used at a very low flow rate of only 2 ml/h without any accompanying fluid. METHODS: A total of 215 patients, who were hospitalized at the Second Hospital of Shandong University between May and December 2020, received a continuous intravenous administration of drugs via a micro-infusion pump at 2 ml/h without or with accompanying fluid. These patients were randomly divided into an observation group (108 patients) and a control group (107 patients). In the observation group, drugs were administered at 2 ml/h without any additional fluid. In contrast, the control group received drugs also at 2 ml/h but with a normal saline through an intravenous drip. The venous backflow, blockage of the indwelling needle and catheter, and other adverse reactions were evaluated In addition, the volume of an accompanying fluid as well as the mean of nursing work time and additional costs were calculated. RESULTS: The main finding of this analysis showed no statistically significant differences in the number of complications such as venous backflow, blockage of the indwelling needle or catheter, or any adverse reactions between the observational and control groups (P > 0.05). Compared to the control group, the observation group had significantly reduced the amount of fluid intake (P< 0.001). In addition, the 2 ml/h infusion tempo without any additional fluid shortened nursing hours (P < 0.001), and thus reduced costs for the observation group vs. the control group. CONCLUSIONS: It is feasible and safe to administer drugs via a micro-infusion pump at the slow 2 ml/h tempo without any accompanying fluid to patients after surgery requiring minimal volume of fluids.