ABSTRACT
Objective:To evaluate the efficacy and related factors of high-flow nasal cannula (HFNC) for the treatment of adult typeⅠ respiratory failure.Methods:The medical records of the subjects with acute hypoxemic respiratory failure supported by HFNC therapy in the medical intensive care unit between October 2017 and February 2019 were reviewed retrospectively. The patients′ baseline characteristics and the serial changes in the respiratory parameters after HFNC therapy at 1 and 24 hours were measured. Therapy success was defined as the avoidance of intubation. The subjects were divided into two groups.Results:Of the 75 eligible patients, 62.7%(47/75) belonged to success group. Overall, HFNC therapy significantly improved the physiologic parameters, such as partial pressure of arterial oxygen (PaO 2), saturation of arterial oxygen (SaO 2), respiratory rate (RR), and heart rate (HR), throughout the first 24 hours. After the adjustment for the other clinical variables, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA), cardiogenic pulmonary edema, and PaO 2 improvement at 1 and 24 hours were associated with therapy success. The overall intensive mortality was 25.3%. However, out of 37.3% of the patients who required belonged to failure group, the mortality was 67.9%. The mortality in the failure group was associated with the use of a vasopressor and a limited PaO 2 improvement at 1 hour. Conclusions:HFNC can significantly improve the physiological parameters of adult patients with acute type I respiratory failure and avoid endotracheal intubation in some patients. The failure to improve oxygenation within 24 hours was a useful predictor of intubation. Among the failure group, the vasopressor use and failed oxygenation improvement were associated with mortality.
ABSTRACT
Objective To evaluate the efficacy and safety of Willis covered stent in the treatment of traumatic carotid cavernous fistulae (tCCF).Methods The imaging and clinical data of 7 patients with tCCF treated with Willis covered stent in Shanghai Punan Hospital from November 2015 to June 2018 were analyzed retrospectively.Results Seven Willis covered stent were used in 7 patients.Immediately after stent release,angiography showed that the fistulae completely disappeared in 6 cases.One patient had a small amount of endoleak,and there was still a small amount of endoleaks after balloon dilatation.It was not further treated.There were no operative complications.During 3-12 months follow-up,no new neurological deficits were found in all patients.Angiographic follow-up of 2 patients showed that the fistulae completely disappeared without recurrence.The internal carotid arteries were patent,no in-stent stenosis and stent displacement.Conclusions Wills covered stent can be used as a treatment for tCCF.Its efficacy is satisfactory and the safety is good.