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.
ObjectiveTo evaluate the reliability,validity and feasibility of a patient-reported outcomes (PRO) scale in the subjects with respiratory failure. Methods364 patients with chronic respiratory failure and 97 healthy subjects were face-to-face interviewed by well-trained investigators,and the data of respiratory failure -PRO instrument were collected. The psychometric performance such as reliability,validity,responsiveness and clinical feasibility in the respiratory failure -PRO instrument was evaluated. ResultsThe Cronbach's alpha coefficient of the respiratory failure -PRO instrument and each dimension were greater than 0.7. Factor analysis showed that the instrument had good construct validity. The scores of each of the facets and total scores between the patients and the healthy subjects were different. The recovery rate and the efficient rate of the questionnaire were more than 95%,and the time required to complete a questionnaire was within 15 minutes,indicating that the scale had a high clinical feasibility. ConclusionThe respiratory failure -PRO instrument has good reliability,validity,responsiveness and clinical feasibility.
ObjectiveTo explore the risk factors for postoperative respiratory failure (RF) in patients with esophageal cancer, construct a predictive model based on the least absolute shrinkage and selection operator (LASSO)-logistic regression, and visualize the constructed model. MethodsA retrospective analysis was conducted on patients with esophageal cancer who underwent surgical treatment in the Department of Thoracic Surgery, Sun Yat-sen University Cancer Center Gansu Hospital from 2020 to 2023. Patients were divided into a RF group and a non-RF (NRF) group according to whether RF occurred after surgery. Clinical data of the two groups were collected, and LASSO-logistic regression was used to optimize feature selection and construct the predictive model. The model was internally validated by repeated sampling 1000 times based on the Bootstrap method. ResultsA total of 217 patients were included, among which 24 were in the RF group, including 22 males and 2 females, with an average age of (63.33±9.10) years; 193 were in the NRF group, including 161 males and 32 females, with an average age of (62.14±8.44) years. LASSO-logistic regression analysis showed that the percentage of forced expiratory volume in one second/forced vital capacity (FEV1/FVC) to predicted value (FEV1/FVC%pred) [OR=0.944, 95%CI (0.897, 0.993), P=0.026], postoperative anastomotic fistula [OR=4.106, 95%CI (1.457, 11.575), P=0.008], and postoperative lung infection [OR=3.776, 95%CI (1.373, 10.388), P=0.010] were risk factors for postoperative RF in patients with esophageal cancer. Based on the above risk factors, a predictive model was constructed, with an area under the receiver operating characteristic curve of 0.819 [95%CI (0.737, 0.901)]. The Hosmer-Lemeshow test for the calibration curve showed that the model had good goodness of fit (P=0.527). The decision curve showed that the model had good clinical net benefit when the threshold probability was between 5% and 50%. Conclusion FEV1/FVC%pred, postoperative anastomotic fistula, and postoperative lung infection are risk factors for postoperative RF in patients with esophageal cancer. The predictive model constructed based on LASSO-logistic regression analysis is expected to help medical staff screen high-risk patients for early individualized intervention.
Objective To explore the predictive value of serum procalcitonin (PCT), D-dimer (D-D) and decoy receptor 3 (DcR3) for prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure undergoing non-invasive ventilation (NIV). Methods A total of 95 patients with AECOPD and respiratory failure undergoing basic treatment and NIV in the hospital were retrospectively enrolled between September (n=65) 2017 and February 2021. According to prognosis after treatment, they were divided into a good prognosis group and a poor prognosis group (n=30). The general data of all patients were collected. The influencing factors of prognosis were analyzed by multivariate logistic regression model. The levels of DcR3, PCT and D-D were detected by enzyme-linked immunosorbent assay, colloidal gold colorimetry and immunoturbidimetry. The patients condition was assessed by scores of acute physiology chronic health evaluation scoring system Ⅱ (APACHEⅡ). The partial pressure of arterial oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were recorded. And the above indexes between the two groups were compared. The relationship between DcR3, PCT, D-D and APACHEⅡ score, PaO2, PaCO2 was analyzed by Pearson correlation analysis. The prognostic value of DcR3, PCT and D-D was analyzed by receiver operating characteristic (ROC) curve. Results There was no significant difference in gender, GOLD grading or underlying diseases between the poor prognosis group and the good prognosis group (P>0.05), but there were significant differences in age, DcR3, PCT, D-D, APACHEⅡ score, PaO2 and PaCO2 after treatment (P<0.05). DcR3, PCT, D-D, APACHEⅡ score and PaCO2 in the poor prognosis group were higher than those in the good prognosis group, while PaO2 was lower than that in the good prognosis group (P<0.05). Logistic regression analysis showed that DcR3 ≥5.50 ng/mL (OR=21.889), PCT ≥ 5.00 μg/L (OR=3.782), D-D ≥3.00 μg/L (OR=4.162) and APACHEⅡ score ≥20 points (OR=2.540) were all influencing factors of prognosis (P<0.05). The results of Pearson correlation analysis showed that DcR3, PCT and D-D were positively correlated with APACHEⅡ score and PaCO2, while negatively correlated with PaO2 (P<0.05). The results of ROC curve analysis showed that area under ROC curve of DcR3, PCT and D-D for predicting the prognosis were 0.745 (95%CI 0.631 - 0.859), 0.691 (95%CI 0.579 - 0.803) and 0.796 (95%CI 0.696 - 0.895), respectively (P<0.05). Conclusion The serum DcR3, PCT and D-D levels are related to disease progression in patients with AECOPD and respiratory failure after NIV, which have good predictive efficiency for prognosis and can be applied as important biological indexes to evaluate prognosis and guide treatment.
During the new coronavirus disease 2019 (COVID-19) pandemic, there has been controversy over whether emergency surgical management should be performed or not in the patients with COVID-19. Stanford type A aortic dissection is a very urgent life-threatening disease, and guidelines recommend surgical treatment for patients with type A aortic dissection in the first instance. However, intraoperative extracorporeal circulation can be fatal to patients recovering from COVID-19. During the pandemic, extracorporeal membrane oxygenation (ECMO) has played an important role in supporting COVID-19 patients with acute respiratory failure. This article reports a successful V-V ECMO treatment for a Stanford type A aortic dissection patient, who suffered respiratory failure caused by COVID-19 after emergency surgery.
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.
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.
ObjectiveTo systematically evaluate the effect of high-flow nasal cannula in immunocompromised patients with acute respiratory failure.MethodsRandomized controlled trials (RCT) or cohort studies on the efficacy of high-flow oxygen therapy in immunocompromised patients with acute respiratory failure were reviewed by computer in PubMed, EMBASE, Cochrane Library, and China Knowledge Network, Wanfang and VIP databases. The group used HFNC and the control group used a mask or a nasal catheter to give oxygen-based conventional oxygen therapy (COT) or noninvasive ventilation (NIV). Two investigators conducted quality assessments and data extractions based on the Cochrane Collaboration Risk Assessment Manual and the Newcastle-Ottawa Scale. Meta analysis was performed using RevMan 5.3 software. The main outcome measures included tracheal intubation rate, and intensive care unit (ICU) mortality. The secondary outcomes included ICU hospitalization time.ResultsThe study included 13 articles (4 RCTs, 9 cohort studies), a total of 1133 subjects, with 583 in the HFNC group and 550 in the control group (280 in the COT and 270 in the NIV). Meta-analysis showed that HFNC was significantly different from COT in reducing tracheal intubation rate in immunocompromised patients with respiratory failure (OR=0.49, 95%CI 0.33 - 0.72, P=0.0003), but no statistical significance compared with NIV (OR=0.73, 95%CI 0.52 - 1.02, P=0.07); two-combination analysis showed that HFNC had a significant advantage in reducing tracheal intubation rate compared with COT/NIV (combined OR=0.61, 95%CI 0.47 - 0.79, P=0.0002). In terms of ICU mortality, there was a statistically significant difference between HFNC and COT (OR=0.59, 95%CI 0.35 - 1.01, P=0.05) or NIV (OR=0.63, 95%CI 0.44 - 0.91, P=0.01). The results of the two subcombinations and analysis did not change (combined OR=0.62, 95%CI 0.46 - 0.83, P=0.002). In terms of ICU hospital stay, there was no statistically significant difference between HFNC and COT (MD=−4.52, 95%CI −9.43 - 0.39, P=0.07), but the difference was statistically significant compared with NIV (MD=−1.46, 95%CI −2.41 - −0.51, P =0.003); the two sub-combinations and analysis results showed significant difference (combined MD=−3.41, 95%CI −6.16 - −0.66, P=0.01). According to different research types, after subgroup analysis, the analysis results were not different from the combined results. Sensitivity analysis revealed that HFNC could significantly reduce the patient's ICU hospital stay compared with the control group oxygen therapy. The results of the funnel chart analysis show that there were publication offsets in the studies on tracheal intubation rate and ICU mortality included in the literature; studies on ICU hospital stays had a smaller publication offset.ConclusionsCompared with COT, HFNC can reduce the tracheal intubation rate of patients, but there is no significant difference compared with NIV; HFNC can reduce the ICU mortality of patients compared with COT/NIV. However, due to the high heterogeneity between the studies, whether HFNC can reduce ICU hospital stay remains to be further explored.
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 systematically review the efficacy of noninvasive positive pressure ventilation (NPPV) by helmet in adults with acute respiratory failure. Methods Randomized controlled trials (RCTs) or cohort studies about noninvasive positive pressure ventilation (NPPV) by helmet in adults with acute respiratory failure were retrieved in PubMed, The Cochrane Library (Issue 11, 2016), Web of Science, EMbase, CBM, CNKI and WanFang Data databases from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Stata 12.0 software was then used to perform meta-analysis. Results A total of eight studies were included. The results of meta-analysis showed that, NPPV by helmet could significantly reduce the carbon dioxide partial pressure (cohort study: SMD=–0.46, 95%CI –0.75 to –0.18, P=0.001), tracheal intubation rate (RCT: OR=0.36, 95%CI 0.17 to 0.77, P=0.008) and hospital mortality (RCT: OR=0.48, 95%CI 0.24 to 0.98, P=0.044), improve the positive end expiratory pressure (RCT: SMD=1.27, 95%CI 0.87 to 1.67, P<0.05) and respiratory status (RCT: SMD=–0.45, 95%CI –0.81 to –0.08,P=0.017). There was no significant difference in the duration of NPPV(cohort study: OR=–0.20, 95%CI –0.50 to 0.09, P=0.177; RCT: OR=–0.24, 95%CI –0.86 to 0.38, P=0.445). Conclusion NPPV by helmet can reduce the carbon dioxide partial pressure, tracheal intubation rate, hospital mortality and improve the positive end expiratory pressure, respiratory status. But the effects in the duration of NPPV and oxygenation index are uncertain. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.