ABSTRACT
Objective:To explore the value of point-of-care cardiopulmonary ultrasound (POCUS) in the evaluation of modifying mechanical ventilation and weaning timing of neonates with respiratory distress syndrome (RDS).Methods:A total of 82 infants with RDS received invasive mechanical ventilation in the neonatal intensive care unit of the First Affiliated Hospital of Nanjing Medical University from January 2019 to October 2020 were enrolled.Endotracheal tube was extubated after getting in line with the clinical weaning standard. According to the results of ventilator withdrawal, infants were divided into successful group and failure group. POCUS were performed within half hour of intubation and extubation. Lung ultrasound score (LUS), left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), left ventricular eccentricity index (LVEI) and pulmonary artery systolic pressure (PASP) were recorded also with the arterial blood gas, ventilator parameters, duration of mechanical ventilation and oxygen therapy. The above indexes were compared between two groups to evaluate the predictive value of POCUS for mechanical ventilation evacuation.Results:The gestational age [(28.6±4.2)W vs (32.5±3.7)W], body weight [(1 289±790)g vs (1 969±771)g], initial ventilation PaO 2 [(41.2±8.5)mmHg vs (50.1±12.2)mmHg], LVEF of ventilator withdrawal[(62.7±3.9)% vs (66.9±3.1)%] of the failed weaning group were lower than those of successful group (all P<0.05). LUS at ventilator withdrawal[(13.7±1.0) points vs (11.1±1.6) points], PASP [(40.5±7.2)mmHg vs (32.9±6.2)mmHg] and the duration of mechanical ventilation [(5.4±4.7)d vs (3.6±2.3)d], duration of oxygen therapy [(48.5±25.0)d vs (24.5±18.5)d] were higher than those of successful group (all P<0.05). The initial LUS of mechanical ventilation was positively correlated with the duration of mechanical ventilation ( r=0.188, P<0.01), and TAPSE was negatively correlated with the duration of mechanical ventilation ( r=-0.344, P<0.01). LUS was positively correlated with X-ray grading and mean airway pressure at the initial and withdrawal time ( rs=0.790, P<0.01 and rs=0.686, P<0.01; r=0.383, P<0.01 and r=0.548, P<0.01). To assess LUS prediction of weaning failure, the area under ROC curve (AUC) was 0.922, and the combined ΔLUS (change of pre- and post-LUS ) ≤7 points and ΔPASP (change of pre- and post-PASP) ≤9.5 mmHg predicted AUC was 0.912. Prediction of AUC by using LUS combining PASP and LVEF was 0.937, Youden index was 0.736, the cut-off value was 0.185, with sensitivity 89.5% and the specificity 84.1%. LUS≥13 points, PASP≥43 mmHg and LVEF≤60% were related to weaning failure by using the Logistic regression analysis (all P<0.05). Conclusions:Bedside POCUS can effectively evaluate the application of mechanical ventilation process and predict the weaning of infants with RDS. POCUS is practical, real-time, accurate, and worthy of clinical application.
ABSTRACT
Objective:To study the clinical application of ultrasound-guided puncture and catheter tip positioning in peripherally inserted central catheter (PICC) among very/extremely low birth weight infants (VLBWI/ELBWI).Method:From January 2019 to August 2020, VLBWI/ELBWI admitted to NICU of our hospital and received PICC were prospectively enrolled in the study. Based on the last digit of medical record number was odd or even, the infants were assigned into ultrasound group and X-ray group. In the ultrasound group, puncture and catheter tip positioning were performed at bedside guided by ultrasound, while in the X-ray group, these procedures were performed empirically. The differences of catheterization procedure duration, first-time success rate, the visibility of catheter tip, primary dislocation rate, secondary dislocation rate and complication rate were compared between the two groups using SPSS 25.0.Result:A total of 118 premature infants were enrolled, including 57 cases in ultrasound group (50 cases VLBWI and 7 cases ELBWI) and 61 cases in X-ray group (54 cases VLBWI and 7 cases ELBWI). The catheterization procedure duration [(23.2±7.1) min vs. (34.1±7.5) min], first-time success rate (93.0% vs. 65.6%), the visibility of catheter tip (96.5% vs. 83.6%), primary dislocation rate (7.0% vs. 24.6%) and complication rate (7.0% vs. 21.3%) in ultrasound group were all better than X-ray group ( P<0.05). For ELBWI, the above five indexes in the ultrasound group were better than the X-ray subgroup ( P<0.05). For VLBWI, only the catheterization procedure duration and first-time success rate were better in the ultrasound group than the X-ray group ( P<0.05). Conclusion:Ultrasound-guided PICC catheterization in VLBWI/ELBWI is convenient and accurate, which can improve success rate, reduce radiation exposure and repeated catheterization injury. Timely tracking and adjustment of the catheter under ultrasound can reduce complications after catheterization. This technique is worth popularizing among VLBWI/ELBWI.
ABSTRACT
Objective To evaluate the effect of magnetic resonance thoracic ductography (MRTD)in the diagnosis of right thoracic duct.Methods MRTD data were analyzed retrospective,and the detection rate of right thoracic duct was summarized and compared with that of lymphoscintigraphy,direct lymphangiography and operation.Results 12 cases of right thoracic duct were detected in 1547 cases of MRTD.The detection rate was 0.78%,in which 1 case was complied with total internal organs inversion,and 1 case with right aortic arch.Lymphoscintigraphy were performed in all 12 cases and right thoracic duct were detected in 4 cases.Direct lymphangiography were performed in 4 cases and right thoracic duct were observed in all of them.7 cases of them received right lum-bar duct adhesiolysis.Conclusion MRTD is a noninvasive method for diagnosis of right thoracic duct,which providing useful guid-ance for surgical operation.Its detection rate and diagnostic accuracy are higher than those of lymphoscintigraphy.