Objective To identify the clinical features and risk factors for mortality associated with severe influenza B pneumonia of adults admitted to respiratory intensive care unit (ICU). Methods Patients with confirmed influenza B infection and respiratory failure between February 2020 and February 2022 who were admitted to the ICU were sequentially included. Demographic features, clinical data, microbiological data, complications, and outcomes were collected. Univariate logistic regression analysis was performed to identify risk factors associated with hospital mortality. A comparison with severe influenza A pneumonia was made to explore the characteristics of influenza B virus-associated pneumonia. Results A total of 23 patients with influenza B pneumonia were included. The survival group included 18 patients and the death group included 5 patients, with an ICU mortality of 21.7%. The median age in the death group was 64 (64, 72.5) years, which was significantly older than the survival group, with a median age 59 (30.25, 64.25) years (P=0.030). Univariate logistic regression analysis indicated that SOFA score [odds ratio (OR) 1.307, 95% confidential interval (CI) 1.013 - 1.686, P=0.039], decreased hemoglobin (OR 0.845, 95%CI 0.715 - 0.997, P=0.046), and high blood urea nitrogen (BUN) (OR 1.432, 95%CI 1.044 - 1.963, P=0.026) were independent risk factors for hospital mortality. Compared with influenza A pneumonia, patients with severe influenza B pneumonia had more complications (60.0% vs. 87.0%, P=0.023). Conclusions The mortality of severe influenza B virus-associated pneumonia with was high. Increased SOFA score, anemia, and high BUN were risk factors for ICU mortality of severe influenza B infection in adults.
Objective To analyze the risk factors of treatment failure by noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and explore the best time that NPPV be replaced by invasive ventilation when NPPV failure occurs. Methods The data of patients with ARF due to AECOPD who were treated with NPPV from January 2013 to December 2015 were retrospectively collected. The patients were divided into two groups: the NPPV success group and the NPPV failure group (individuals who required endotracheal intubation or tracheotomy at any time). The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score was analyzed; the Glasgow Coma Scale score, respiratory rate (RR), pH value, partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2) ratio, and partial pressure of carbon dioxide were also analyzed at admission, after 2 hours of NPPV, and after 24 hours of NPPV. Results A total of 185 patients with ARF due to AECOPD were included. NPPV failed in 35.1% of the patients (65/185). Multivariate analysis identified the following factors to be independently associated with NPPV failure: APACHEⅡscore≥30 [odds ratio (OR)=20.603, 95% confidence interval (CI) (5.309, 80.525), P<0.001], RR at admission≥35 per minute [OR=3.723, 95%CI (1.197, 11.037), P=0.020], pH value after 2 hours of NPPV<7.25 [OR=2.517, 95%CI (0.905, 7.028), P=0.070], PaO2 after 2 hours of NPPV<60 mm Hg (1 mm Hg=0.133 kPa) [OR=3.915, 95%CI (1.374, 11.508), P=0.010], and PaO2/FiO2 after 2 hours of NPPV<200 mm Hg [OR=4.024, 95%CI (1.542, 11.004), P=0.010]. Conclusion When patients with ARF due to AECOPD have a higher severity score, have a rapid RR at admission, or fail to improve in terms of pH and oxygenation after 2 hours of NPPV, the risk of NPPV failure is higher.
Objective To evaluate the rescue intubation induced by ketamine and midazolam in patients with acute respiratory failure.Methods 81 patients with acute respiratory failure admitted between June 2010 and June 2012 were recruited in the study. They were randomly divided to a MF group to receive 0. 05 mg/kg of midazolam + 1 to 2 μg/kg of fentanyl ( n =41) , and aMK group to received 0. 05 mg/kg of midazolam + 0. 5 to 1 mg/kg of ketamine ( n =40) for rescue intubation. The APACHEⅡ score on initial24 hours after admission in ICU, length of ICU stay, and 28-day mortality were recorded. The differences in arterial blood pressure, heart rate, respiration rate, and blood oxygen saturation before intubation and 10 minutes after intubation were compared. Incidences of hypotension and other adverse events and difficult intubation were also recorded.Results The midazolamdose in the MK group was significantly less than that in the MF group ( P lt; 0. 01) . The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group ( P lt;0. 05) . The incidence of hypotension was 41. 5% in the MF group, significantly higher than that in the MK group ( 20. 0% , P lt;0. 05) . The incidence of hypotension had no correlation with midazolamdosage ( P gt;0. 05) . There was no significant difference in adverse events except for the arrhythmia between two groups. The length of ICU stay and 28-day mortality were similar in both groups ( P gt; 0. 05) . The incidence of difficult tracheal intubation was nearly 50% in both groups.Conclusions In patients with respiratory failure, rescue intubation induced by ketamine can reduce the dose of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.
Objective To explore the effect of respiratory training based on mechanical vibration-assisted sputum expulsion on arterial blood gases in patients with chronic obstructive pulmonary type 2 respiratory failure and clinical efficacy observation. Methods 105 patients with chronic obstructive pulmonary disease combined with type 2 respiratory failure who were hospitalized in our hospital from November 2019 to February 2023 were selected as study subjects. They were randomly numbered and divided into experimental and control groups according to the order of admission, and 3 patients withdrew from the study cohort due to their own reasons, and 51 cases each of the experimental and control groups were finally included. Patients in the control group were given conventional treatment and lung function exercise, while the experimental group was given respiratory training with mechanical vibration-assisted sputum expulsion. Lung function and blood gas analysis indexes were measured before and 2 weeks after treatment to evaluate the clinical efficacy and incidence of adverse events in the two groups. Results After the treatment, pulmonary function indexes such as PEF, FVC, FEV1 and FEV1/FVC, and blood gas analysis indexes such as PaO2, PaCO2 of the experimental group and daily sputum excretion improved significantly compared with those of the pre-treatment and control groups (P<0.05). The total clinical efficacy rate of the patients in the experimental group was significantly higher than that of the control group (P<0.05), and the incidence of adverse events was lower than that of the control group, but the difference was not statistically significant (P>0.05). Conclusion Respiratory training based on mechanical vibration-assisted sputum expectoration can help improve the lung function and blood gas level of patients with chronic obstructive pulmonary disease combined with type 2 respiratory failure, and it has a certain clinical value in promoting the rehabilitation and prognosis of patients.
Acute poisoning is characterized by a sudden and rapid onset, most poisons lack specific antidotes. Even with the full use of blood purification, mechanical ventilation, and various drugs, it is often difficult to change the fatal outcome of critically ill patients. In recent years, extracorporeal membrane oxygenation (ECMO) has gradually gained attention and exploratory application in the treatment of acute poisoning due to its significant cardiopulmonary function support, veno-venous ECMO is used for severe lung injury after poisoning, acute respiratory distress syndrome and respiratory failure due to ineffective mechanical ventilation, and it can also be used to assist the removal of residual poisons in the lungs. Veno-arterial ECMO is commonly employed in patients with circulatory failure following poisoning, fatal cardiac arrhythmias, and arrest of cardiac and respiratory. The application of veno-arterio-venous ECMO has also been reported. The mode of ECMO necessitates timely adjustments according to the evolving illness, while ongoing exploration of additional clinical indications is underway. This review analyzes and evaluates the application scope and effectiveness of ECMO in acute poisoning in recent years, with a view to better exploring and rationalizing the use of this technology.
Objective To investigate the physiological effects of different oxygen injection site on ventilatory status and oxygenation during noninvasive positive pressure ventilation ( NPPV) with portable noninvasive ventilators. Methods A prospective crossover randomized study was performed. Oxygen injection site was randomized into the outlet of the ventilator, the connection site between mask and circuit, and the mask under the condition of leak port immobilized in the mask. Oxygen flow was retained in the baseline level at the initial 5 to 10 minutes, and adjusted to obtain arterial oxygen saturation measured by pulse oximetry ( SpO2 ) ranging from 90% to 95% after SpO2 remains stable. SpO2 at the initial 5 to 10 minutes, oxygen flow, ventilatory status, oxygenation, hemodynamics and dyspnea indexes at0. 5 hour, 1 hour, and 2 hours of NPPV were compared between different oxygen injection sites. Results 10 patients were recruited into the study. Under the condition of the same oxygen flow, SpO2 with oxygen injection site in the outlet of the ventilator was significantly higher than that with oxygen injection site in the connection site between mask and circuit [ ( 98.9 ±0.9) % vs. ( 96.9 ±1.1) % , P =0. 003] , whereas SpO2 with oxygen injection site in the connection site between mask and circuit was significantly higher than that with oxygen injection site in the mask [ ( 96.9 ±1.1) % vs. ( 94.1 ±1.6) %, P = 0.000] . Oxygen flow with oxygen injection site in the mask was statistically higher than that with oxygen injection site at other sites ( P lt; 0.05) . Arterial oxygen tension/ oxygen flow with oxygen injection site in the outlet of the ventilator was significantly higher than that with oxygen injection site in the connection site between mask and circuit ( 67.9 ±31.1 vs. 37.0 ±15.0, P =0.007) , and than that with oxygen injection site in the mask ( 67.9 ± 31.1 vs. 25.0 ±9.1, P = 0.000) . pH, arterial carbon dioxide tension, hemodynamics and dyspnea indexes were not significantly different between different oxygen injection sites ( P gt; 0.05) .Conclusions When portable noninvasive ventilator was applied during NPPV, oxygen injection site significantly affects improvement of oxygenation, and shows a trend for affecting ventilatory status and work of breathing. When the leak port was immobilized in the mask, the nearer oxygen injection site approaches the outlet of the ventilator, the more easily oxygenation is improved and the lower oxygen flow is demanded.
高频通气(HFV)是一种高通气频率和低潮气量的通气方式，其通气频率至少为机体正常呼吸频率的4倍，而潮气量近于或小于解剖死腔。其主要类型包括：高频正压通气、高频喷射通气和高频振荡通气等。其中，高频振荡通气(HFOV)是目前公认的最先进高频通气技术，在临床中应用最广泛。
Objective To investigate the effectiveness of noninvasive positive pressure ventilation( NPPV) in acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) complicated with severe type Ⅱ respiratory failure.Methods 37 patients who were admitted fromJanuary 2008 to June 2009 due to AECOPD complicated with severe type Ⅱ respiratory failure and had received NPPV therapy were enrolled as a NPPV group. Another similar 42 cases who had not received NPPV therapy served as control. All subjects received standard medication therapy according to the guideline. Arterial blood gases before and after treatment, the duration of hospitalization and intubation rate were observed. Results The arterial pH, PaO2 ,and PaCO2 improved significantly after treatment as compared with baseline in both groups ( P lt; 0. 05) .Compared with the control group, the average duration of hospitalization was significantly shorter ( 10 ±5 vs.19 ±4 days, P lt;0. 05) and the intubation rate was significantly lower ( 2. 7% vs. 16. 7% , P lt;0. 05) in the NPPV group. Conclusion The use of NPPV in AECOPD patients complicated with severe type Ⅱ respiratory failure is effective in improving arterial blood gases, reducing the duration of hospitalization and intubation rate.
Abstract： Objective To analyze risk factors associated with postoperative respiratory failure in patients with valvular surgery. Methods Between January 2001 and November 2010, clinical data of 618 patients with 339 males and 279 fameles at age of 10-74（44.01±13.95）years,undergoing valvular operations were investigated retrospectively. We divided the patients into two groups according to the presence （74 patients）or absence（544 patients）of postoperative respiratory failure. Its risk factors were evaluated by univariate and multivariate logistic regression analysis. Results The hospital mortality rate of valvular surgery was 6.1%（38/618）.The morbidity rate of respiratory failure was 12.0%（74/618） with hospital mortality rate at 17.6%（13/74） which was significantly higher than those patients without postoperative respiratory failure at 4.6%（25/544, χ2=18.994, P=0.000）. Univariate analysis showed age＞ 65 years（P=0.005）, New York Heart Association（NYHA）classⅣ（P=0.014）, election fraction＜ 50.0%（P=0.003）, cardiopulmonary bypass time＞ 3 h（P=0.001）, aortic cross clamping time＞ 2 h（P=0.008）, concomitant operation（ valvular operation with coronary artery bypass grafting, Bentall or radiofrequency ablation maze operation（P=0.000）, reoperation（P=0.012）, postoperative complications （P=0.000）, and blood transfusion＞ 2 000 ml（P=0.000） were important risk factors for postoperative respiratory failure. Multivariate logistic regression showed that concomitant operation（P=0.003）, reoperation（P=0.010）, postoperative complications（P=0.000）, and blood transfusion＞2 000 ml（P=0.012）were significant independent predictive risk factors. Conclusion This study suggest that patients with predictive risk factors of postoperative respiratory failure need more carefully treated. The morbidity of these patients would be reduced through improving perioperative management, shortening cardiopulmonary bypass time and reducing postoperative complications.
摘要:目的：探讨纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中的临床应用价值。方法：237例慢阻肺合并重度呼吸衰竭患者,随机分为纤支镜经口引导气管插管组(纤支镜组)125例和喉镜经口引导气管插管组(喉镜组)112例,分别在纤支镜和喉镜引导下按常规进行气管插管术。结果：纤支镜组和喉镜组一次获得插管成功率分别为984%和920%(P＜005),平均插管时间分别为（613±391） min 和（926±415） min(P＜005)。纤支镜组有5例患者出现咽喉部少量出血,并发症发生率为40%;喉镜组共有12例发生并发症,并发症发生率为107%(P＜005),其中齿、舌、咽或喉部损伤6例,反射性呕吐致误吸2例,单侧肺通气1例,插入食管2例,心跳呼吸骤停1例。结论：纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中是一种简便快速、成功率高和并发症少的有效方法,值得临床推广应用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.