ABSTRACT
Objective To study the effect of high-flow nasal cannula oxygen therapy (HFNC) in reduction in re-intubation rate, length of ICU stay and improvement of respiratory function in patients with high cervical spinal cord injury.Methods Single center retrospective study was carried out in our intensive care unit from September 2016 to March 2018. Post-operative patients ready for planned extubation with high cervical spinal cord injury were included. The length of ICU stay, re-intubation rate in case of respiratory failure, respiratory rate, pulse rate, MAP, SaO2, PaO2/FiO2, and PaCO2 of patients at 6, 24 and 72 h after extubation were compared between the HFNC and conventional oxygen therapy (COT) groups. Results During the study period, 38 patients were enrolled in the study. Of them, 16 patients were assigned in the HFNC group and 22patients in the COT group. Re-intubation rate was significantly different between the two groups (18.8％ vs 27.3％, P<0.05), but the length of ICU stay had no significant difference [(15.5±3.4) days vs (16.6±5.2) days]. The respiratory rate, pulse rate, SaO2 and PaO2/FiO2 at 6 h after extubation in the HFNC group were improved markedly than those in the COT group (P<0.05); and the PaCO2 and PaO2/FiO2 at 24 and 72 h after extubation in the HFNC group had much more improvement than those in the COT group (P<0.05). Conclusions Among individuals with post-operative high cervical spinal cord injury, high-flow oxygen therapy could reduce re-intubation rate, and PaCO2 level, and improve the respiratory function, but cannot reduce the length of ICU stay. High-flow oxygen therapy may offer advantages for patients with high cervical spinal cord injury.
ABSTRACT
Objective To investigate the relationship between serum cholinesterase(ChE) and acute-phase proteins in patients with multiple trauma, then to evaluate their significance to judge prognosis. Method It's a prospective observation study. Patients with multiple trauma admitted to emergency intensive care unit,Second Af-filiated Hospital, Zhejiang Universieg, school of medicihe within 24 h after trauma from Oct. 2005 to Oct. 2007 were enrolled. And those with chronic liver disease, touching orgnaophosphorus, active tuberculosis, tumor, in-fection of major organ before trauma, liver injury or age < 18 year were excluded. Among 81 patients, 57 were male and24 female. The average age was (46±18) years, and the average injury severity score was (34.0±11.9).Seventy six healthy were selected as controls, 53 male and 23 female, with an average age of (44±16)years. The exclusion standards were the same as those in patients. Both groups had same gender proportion and age. Senum ChE and acute-phase proteins(APP) including albumin(ALB), prealbumin(PAB), transferrin(TRF),C-reactive protein(CRP) in patients were detected at 1, 3, 7 d after trauma. The acute physiology and chronic health evaluation Ⅲ (APACHEⅢ) was recorded simuhancously. Serum ChE, ALB, PAB, TRF, CRP in the controls were also detected. All of these indexes in the controls were compared with thoses in patients by t test or rank surn test. The dynamic changes of serum ChE and APPs in patients were analyzed by one way repeated mea-sures ANOVA. The relationships between serum ChE and those APPs and the relationships between APACHE Ⅲ and these indexes were analyzed by Pearson correlation analysis. We also compared these indexes between patients with different outcomes by t test or rank sum test. The values of serum ChE and those APPs to judge prognosis were evaluated by logistic regression analysis. Results Patients had lower serum ChE, ALB, PAB, TRF and higher CRP than the healthy at 1, 3, 7 d post trauma. Serum ChE activity in patients was reducod over 25% (42.3%～50.2%) than that in the healthy, and showed a tendency to decrease after trauma, which resembled PAB and TRF. Serum ChE was positively correlated with ALB, PAB and TRF at 1, 3, 7 d, and negatively correlated with CRP at 3, 7 d. At 1, 3, 7 d post trauma, APACHEⅢ in patients was negatively correlated with serum ChE and TRF, but negatively correlated with ALB only at 1 d, and negatively correlated with PAB only at 1,7 d, and posi-tively correlated with CRP only at 7 d. Non-survivors had lower serum ChE activity and TRF than survivors at 1,3,7 d after trauma, but had lower ALB only at 7 d after trauma and had lower PAB only at 1,7 d after trauma than survivors, and had higher CRP than survivors only at 7 d after trauma. Logistic regression analysis showed serum ChE and PAB were the only two independent risk factors to judge prognosis. Conclusions Serum ChE may be in-cluded as negative acute-phase protein, and is better than other APPs in reflecting injury severity and prognosis in patients with multiple trauma.