ObjectiveTo evaluate the effectiveness and safety of nebulized amikacin for the treatment of ventilator-associated pneumonia (VAP) caused by gram-negative bacilli. MethodsFrom January 2010 to December 2013,a total of 120 patients with VAP due to gram-negative bacilli were randomised to a nebulized group (60 patients) and a control group (60 patients) in Shanghai Fifth People's Hospital. On the basis of similar routine treatment and systemic antibiotics based on the physicians' decision according to guidelines,the patients received 400 mg nebulized amikacin diluted in 5 mL normal saline in the nebulized group or 5 mL normal saline in the control group twice daily for 7 days. The rate of clinical cure and bacterial eradication,mortality,weaning rate and adverse events were recorded. ResultsAt the end of nebulized treatment,the rate of clinical cure in the nebulized group was significantly higher than that in the control group (75.0% vs. 53.3%,P=0.013). So was the rate of bacterial eradication (75.0% vs. 44.4%,P=0.008). But the crude mortality and weaning rate were similar between two groups (P>0.05). The adverse events in two groups were similar too (P>0.05). When followed-up to the 28th day,the weaning rate in the nebulized group was significantly higher than that in the control group (71.7% vs. 51.7%,P=0.024),but the crude mortality was not different (P>0.05). ConclusionNebulized amikacin as an adjunctive therapy for the treatment of VAP,which do not demonstrate obviously adverse events,can help improve rate of clinical cure and bacterial eradication and long-term weaning rate,but can not reduce patients' crude mortality.
Objective To evaluate the efficacy and safety of inhaled amphotericin B ( AmB) in prophylaxis of invasive pulmonary aspergillosis ( IPA) in both animal studies and clinical researches. Methods MEDLINE, ISI, EMBASE and Wanfang Periodical Databases were searched until march 2011 for case-control study on the efficacy and safety of inhaled AmB in prophylaxis of IPA. The articles were evaluated according to inclusion criteria. Poor-quality studies were excluded, and RevMan 4. 22 sofeware was applied for investigating the heterogeneity among individual studies and calculating the pooled odds ratio ( OR) and 95% confidence interval ( CI) . Results Five animal studies with a total of 626 animals were included. The overall survival rate of the immunosuppressed animals with pulmonary aspergillosis treated with nebulized AmB was increased ( 38.3% vs. 9.7% , OR=13.93, 95% CI 7.46 ～26.01, Plt;0. 000 01) . Six clinical trials including 1354 patients were considered. Our meta-analysis showed that inhaled AmB could significantly reduce the incidence rate of IPA ( 2.6% vs. 9.2% , OR=0.27, 95% CI 0.16 ～0.46, P lt;0. 000 01) , but had no definite benefit on mortality. Four studies evaluated the potential side effects of nebulized AmB and showed that there were no significant adverse events. Conclusions Empirical inhaled AmB is associated with a lower rate of IPA but no significant
ObjectiveTo explore the effect of respiratory support in Community Respiratory Support Center on patients with chronic obstructive pulmonary disease (COPD) in stable phase. MethodsSixty-four GOLD gradeⅢpatients with stable COPD over age of 55 years were randomly divided into two groups.A respiratory support group received respiratory support in Community Respiratory Support Center, including health education, long-term oxygen therapy (LTOT), long-term ambroxol for atomization, long-term budesonide and formoterol for inhalation.A control group were prescribed budesonide and formoterol for inhalation when recruited, informed LTOT and long-term ambroxol for atomization at home, and follow-up visits to clinic every month. ResultsAfter 24 months of treatment in the respiratory support group, SpO2, PaO2, FEV1%pred, 6MWD, BMI, and ALB increased, mMRC, CAT, Hb, PaCO2 decreased (P < 0.05).While in the control group, FEV1%pred decreased, mMRC and CAT increased (P < 0.05), other indexes did not change significantly (P > 0.05).The times of acute exacerbation and hospitalization of the respiratory support group was less than that in the control group(P < 0.05). ConclusionsEstablishing Community Respiratory Support Center will benefit patients with stable COPD correct hypoxemia, slow the deterioration of lung function, improve the nutritional status of patients, and can also increase patients compliance to treatment.
Objective To evaluate the effects of midazolam intravenous drip combined with lidocaine via nebulization on patients during mechanical ventilation in intensive care unit ( ICU) . Methods 60 thoracic patients required postoperative mechanical ventilation in ICUwere randomized into 2 groups. The patients in therapeutic group received lidocaine 1 mg/kg via nebulization and midazolam intravenous drip 0. 1 mg·kg- 1·h- 1 . The patients in control group received 0. 9% NaCl 1 mg/kg via nebulization andmidazolam0. 1 mg·kg- 1 ·h- 1 . According to the scale of Ramsay, the additional midazolam and fentanyl were injected to maintain sedation and inhibit cough in both groups. During ventilation, calm score, the number and the severity of cough, the mean arterial pressure ( MAP) , heart rate ( HR) , and the consumption of midazolam and fentanyl were record. Results The number and severity of cough, the scale of MAP and HR in the therapeutic group were all significant lower than those in the control group ( P lt; 0. 05) . Theconsumption of midazolam and fentanyl in the therapeutic group were also significantly lower than that in the control group ( P lt; 0. 05) .Conclusion Midazolam intravenous drip combined with lidocaine via nebulization can reduce the side effects and requirement of sedative and opioids drug in ICU patients undergoing mechanical ventilation.
ObjectiveTo investigate the disinfection effect of dry-fogging hydrogen peroxide (DFHP) on ambulance inner surfaces.MethodsThis study was carried out using simulated field test and field test from October to December 2018. In the simulated field test, the carriers with Geobacillus stearothemopilus (ATCC12980) spores were placed in 6 places in the ambulance, and disinfected for 60 minutes with DFHP of 0.38–0.72 g/m3. The carriers were cultured for up to 7 days to observe whether the bacteria were eliminated. Before and after the DFHP disinfection, the microbial sampling of the surface in the ambulance was carried out, and the colonies were counted after the cultivation.ResultsThe eliminating rate of the bacteria carriers on the uncovered surface was 100% (20/20), and that of the covered surface was 10% (1/10). The pass rate of microbial sampling was 100% (26/26).ConclusionsThe DFHP had a significant decontamination effect on the ambulance inner uncovered surfaces. The DFHP equipment is automated and their disinfecting quality is consistent, therefore it is suitable for the disinfection of ambulance inner surfaces. But the limitation of disinfection effect on covered surfaces should be avoided.
ObjectiveTo evaluate the clinical manifestation, radiological, pathological features and treatment of organizing pneumonia (OP) induced by aerosolized recombinant super compound interferon (rSIFN-co). MethodsClinical features and related laboratory examinations of a patient with OP developing after initiation of rSIFN-co for treatment of lung adenocarcinoma were analyzed, and the relevant literature was reviewed. ResultsA 48-year-old man developed cough, fevers, shortness of breath and weight loss, shortly half a month after initiation of therapy with rSIFN-co for lung adenocarcinoma. Chest high resolution computerized tomography (HRCT) showed multiple lung infection diseases. However, the anti-infection treatment was invalid. Lung tissue biopsy by bronchofibroscope was consistent with OP. After discontinuation of rSIFN-co and receiving pulse corticosteroid therapy followed by oral methylprednisolone, the pneumonic symptoms and chest manifestations markedly improved. After eight-month follow-up, the patient's condition was stable. The relative literature screening from Pubmed and Wanfangdata was implemented, but there was no report about OP caused by aerosolized rSIFN-co for lung adenocarcinoma. ConclusionThis report suggests that treatment with aerosolized rSIFN-co for lung adenocarcinoma may induce OP, a rare complication, and clinicians should have vigilance on it.
Objective To compare three approaches of lipopolysaccharides ( LPS) administration for inducing acute lung injury ( ALI) in mice. Methods LPS ( 5 mg/kg) was intratracheally aerosol administered ( ITA group) , intratracheally instilled ( ITI group) , or intraperitoneally injected ( IPI group) to induce ALI in BLAB/ c mice. Evans Blue instead of LPS was intratracheally administered to observe the liquid distribution in the lungs. Two hours after LPS administration, the mice were sacrificed and the lungs were removed to determine wet-to-dry lung weight ratio ( W/D) , and the histological changes were evaluated by HE staining. Phosphorylation level of IκB-αand NF-κB p65 in lung tissue were investigated by Western blot. Transcription intensity of TNF-α and IL-1β mRNA in lung tissue were detected by real-time quantitative PCR. Results Evans Blue distributed more uniformly in the ITA group than the ITI group. The lung W/D ratio and histological changes score in three LPS administration groups were all significantly higher than the normal control group ( P lt;0. 01) , with the ITA group being the highest. The phosphorylation levels of IκB-αand NF-κB p65 were significantly higher in the ITA group than the ITI group ( P lt;0. 05) , and were significantly higher in the ITI group than the IPI group ( P lt; 0. 05) . Transcription intensity of TNF-αand IL-1βmRNA was significantly higher in the ITA group than the ITI group ( P lt;0. 05) , and were significantly higher in the ITI group than the IPI group ( P lt;0. 05) . Conclusion Being non-invasive and convenient,intratracheal LPS aerosol inhalation is an optimal method to induce ALI in mice because it induces more extensive and uniformly distributed injuries in lung.
Objective To compare the application effects of two kinds of oxygen and nebulizer inhalation devices applied to patients undergoing partial hepatectomy, with a view to providing reference for clinical selection oxygen and nebulizer inhalation modality. Methods A prospective case-control study was used to select 228 patients who required oxygen inhalation and nebulization after hepatectomy under general anesthesia in the Department of Liver Surgery of West China Hospital of Sichuan University from January to December 2022 as study subjects, and were randomly divided into two groups: grouping group (n=77) and integrating group (n=151). The traditional oxygen inhalation device and atomization device (grouping oxygen inhalation atomization device) commonly used in clinic were used in the grouping group, and the humidifying bottle and humidifying water were replaced every 24 hours. The integrating group adopts a new device (integrated oxygen atomization inhalation device) which integrates oxygen inhalation and atomization functions. The integrating group was divided into integrating group 1 (n=77) and integrating group 2 (n=74) according to the different time of changing the humidifying bottle and humidifying water. The time for replacing the humidifying bottle and humidifying water in the integrating 1 was the same as that in the grouping group. The time for replacing the humidifying bottle and humidifying water in the integrating group 2 was 48 h after used, and replace again it after 72 hours of used. Samples from different parts of the grouping group and the integrating group 1 were collected at 24 h, 48 h, 72 h, 96 h and 120 h after oxygen inhalation, respectively, for colony culture. In the integrating group 2, samples were taken for colony culture when the device was changed twice (48 h and 120 h). At the same time, the nurses’ fogging operation time and the fogging noise of the two groups were measured. The self-made patients’ satisfaction questionnaire and nurses’ questionnaire were used to investigate the satisfaction of two groups of patients and 30 medical staff respectively. Results There were no statistically significant difference in the number of bacterial colonies between the grouping group and the integrating group 1 at different time periods and between the two groups at the same time (P＞0.05). In terms of atomization performance, atomization noise in the integrating group was lower than that of the grouping group (P＜0.05), and the atomization preparation and disposal time in the integrating group were shorter than that of the grouping group (P＜0.05). The patients and nurses were more satisfied with the integrating group (P＜0.05). Conclusions There is no difference in pollution risk between the integrated oxygen atomization bottle and the grouped oxygen atomization bottle. The atomization performance and humidification performance of the integrated oxygen atomization bottle are better than that of the grouped oxygen atomization bottle. The noise generated during operation is small, the comfort of patients is high, and the operation time of nurses can be shortened and the work efficiency can be improved, which has high clinical application value.