[A discussion about the tactics of mechanical ventilation for acute respiratory distress occurring in the first case of influenza A (H5N1) in Guizhou Province].

OBJECTIVE: To discuss the tactics of mechanical ventilation in a human severe case of influenza A (H5N1) complicated with acute respiratory distress syndrome (ARDS). METHODS: The data of the patient infected by the influenza A (H5N1) admitted to People's Hospital of Guizhou Province on January 15, 2009, were analyzed and summarized. RESULTS: The patient, a 29-year-old man, had been healthy in the past, but had exposed to the environment of bird flu before illness. The initial symptom was unremitting high fever, and then the clinical situation deteriorated progressively with occurrence of dyspnea. Pulmonary infiltrates were evident in the left lower lobe on January 19, and rapidly progressed to involve bilateral lungs presenting ARDS-like changes. Mechanical ventilation became the most important treatment among others. The ventilation mode was synchronized intermittent mandatory ventilation (SIMV)+ pressure support (PS) + positive end expiratory pressure (PEEP), following lung protective ventilatory strategies, with low tidal volume. The patient's condition improved day by day without developing multiple organ dysfunction. The patient fully recovered and was discharged on February 6. CONCLUSION: Early detection, early diagnosis, and finely effective intervention are to improve oxygenation by mechanical ventilation with low tidal volume and adequate PEEP are critical to reducing the mortality.

[Comparison of value of GRACE, APACHEII and REMS for early prognosis of death in patients with acute myocardial infarction].

OBJECTIVE: To evaluate and compare the predictive value of short-term risk of death of global registry of acute coronary events (GRACE) risk scores, acute physiology and chronic health evaluation II (APACHEII) scores and rapid emergency medicine score (REMS) in patients with acute myocardial infarction (AMI). METHODS: A retrospective review of clinical data of 390 patients with AMI admitted from October 2012 to March 2013 in emergency department and cardiology care unit (CCU) in Guizhou People's Hospital were performed. The lowest scores within 24 hours of GRACE risk score, APACHEII risk score, and REMS risk score, respectively, for each patient were recorded. Mortality rate within 30 days after onset was calculated. Prediction of the mortality rate of AMI within 30 days as made in three scoring systems was compared. RESULTS: A total of 54 patients died from cardiovascular disease within 30 days. GRACE risk scores, APACHEII scores, and REMS risk scores were higher in non-survivors as compared with that of survivors (GRACE: 206.09±24.67 vs. 150.17±25.72, t=-4.349, P=0.000; APACHEII: 15.81±7.60 vs. 7.50±2.83, t=-4.182, P=0.000; REMS: 7.11±2.70 vs. 5.38±2.59, t=-2.345, P=0.020). Area under the receiver operator characteristic curve (ROC curve) for GRACE risk scores, APACHEII risk scores and REMS in patients with AMI died from cardiac vascular disease in 30 days were 0.862 [95% confidence interval (95%CI) 0.76-0.95, P=0.000], 0.825 (95%CI 0.71-0.93, P=0.002) and 0.615 (95%CI 0.46-0.77, P=0.192), sensitivity of three kinds of scoring system was 92.32%, 76.91%, 69.26%, respectively, with specificity of 66.23%, 77.84%, 54.02% respectively. CONCLUSIONS: GRACE and APACHEII scores for patients with AMI risk of short-term death showed more accurate in predicting early than GRACE scores, and REMS for AMI risk of short-term death did not have predictive value.