ABSTRACT
Objective To evaluate the feasibility and safety of tracheal extubation in operating room for patients with end-stage chronic obstructive pulmonary disease (COPD) after single-lung transplantation. Methods Clinical data of 57 recipients who underwent single-lung transplantation due to end-stage COPD were retrospectively analyzed. According to the evaluation indexes of tracheal extubation in operating room established by our hospital, 17 recipients eligible for tracheal extubation in operating room were assigned into the operating room extubation group (OR extubation group) and 40 recipients receiving tracheal extubation in intensive care unit (ICU) were allocated in the ICU extubation group. The evaluation results of intraoperative tracheal extubation and postoperative recovery were compared between two groups. Results Compared with the ICU extubation group, recipients in the OR extubation group had higher oxygenation index, lower arterial partial pressure of carbon dioxide (PaCO2), lower blood lactic acid level, less fluctuation range of blood pressure and fewer cases receiving extracorporeal membrane oxygenation (ECMO) during operation (all P < 0.05). Two recipients in the OR extubation group received repeated tracheal intubation at 6 and 8 h after returning to ICU, and tracheal extubation at postoperative 6 and 9 d. In the OR extubation group, time of postoperative mechanical ventilation, length of postoperative ICU and hospital stay of the recipients were shorter than those in the ICU extubation group (all P < 0.05). The incidence of grade 3 primary graft dysfunction (PGD), atrial tachyarrhythmia, continuous renal replacement therapy and 1-year survival rate did not significantly differ between two groups (all P > 0.05). Conclusions The tracheal extubation regimen in the operating room for COPD patients after single-lung transplantation established by our hospital is safe and feasible, which shortens the time of postoperative mechanical ventilation, the length of postoperative ICU and hospital stay, whereas does not increase the incidence of postoperative complications.
ABSTRACT
Objective To explore true thoughts and experience about student-based nursing teaching rounds among vocational college nursing students in Pediatric during the initial stage of clinical practice.Methods Interview was conducted on 27 nursing students of seven focus groups with semi-structured interview.The data was transcribed based on the tape and were analyzed by Giorgi analysis.Results Nursing students held positive attitude to this mode.Three themes were extracted:stimulating nursing students' learning potential,enhancing the comprehensive ability of nursing students; some students had difficulties in case selection,disease analysis and physical examination; suggesting that detailed rounds guideline should be issued to students first,and teaching rounds should be held every two weeks.Conclusions We should strengthen training of the ability of nursing assessment in pediatrics for nursing students,play the role of facilitator and advocate self-directed learning methods.