ABSTRACT
Objective:To explore the effect of bundle management strategy in early mobility of patients with mechanical ventilation.Methods:Seventy-two mechanically ventilated patients admitted to the respiratory intensive care unit (RICU) of Fenyang Hospital of Shanxi Province from December 2019 to June 2020 were enrolled. The patients were divided into routine nursing control group (routine control group) and early mobility bundle management group (bundle group), with 36 cases in each group. The routine control group received regular nursing, including monitoring vital signs, raising the head of the bed, turning over and buttoning the back every 2 hours, daily awakening, airway humidification, prevention of digestive tract ulcer, analgesia and sedation management, prevention of deep vein embolism, pipeline management, regular monitoring of blood gas analysis and electrolytes according to the changes of the condition, prevention of aspiration, prevention of bacterial colonization, correct hand hygiene, and so on. The bundle group implemented the cluster early mobility strategy based on routine nursing. Firstly, set up a professional team to execute the standards. The team determined the plan and implemented the 4-level mobility plan, companied with psychological intervention, decided the termination standard and quality control. The incidence of intensive care unit acquired weakness (ICU-AW), ventilator-associated pneumonia (VAP), delirium, the duration of mechanical ventilation and the length of intensive care unit (ICU) stay were evaluated.Results:Compared with the routine control group, the incidences of ICU-AW, VAP, and delirium in the bundle group were significantly lower (the incidence of ICU-AW: 36.11% vs. 69.44%, χ 2 = 8.025, P = 0.005; the incidence of VAP: 8.33% vs. 30.56%, χ 2 = 5.675, P = 0.017; the incidence of delirium: 5.56% vs. 36.11%, χ 2 = 10.180, P = 0.001), the duration of mechanical ventilation was significantly shorter (days: 7.13±1.34 vs. 10.46±1.48, t = -10.145, P < 0.001), and the length of ICU stay was also significantly decreased (days: 9.03±2.43 vs. 13.06±3.63, t = -5.535, P < 0.001). Conclusions:The implementation of bundle management strategy of early mobility can promote the rehabilitation of mechanical ventilated patients, improve the prognosis and the quality of life. The effect is noticeable and it is worth popularizing.
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Objective:To observe the effect of tracheotomy high-flow oxygen therapy (THFO) on the clinical efficacy of non-mechanically ventilated patients undergoing a tracheotomy.Methods:Sixty adult patients with tracheotomy and non-mechanical ventilation who were diagnosed and treated from January 2019 to December 2020 in Fenyang Hospital of Shanxi Province were enrolled. According to the random number table, the patients were divided into Venturi oxygen therapy group and THFO group, 30 cases in each group. The THFO group was given oxygen therapy with THFO; the Venturi group (without mask) was given Venturi connected the MR850 base and the ventilator tube. Observe the changes of two groups at 7 AM within 5 days, including body temperature which was 1 ℃ higher than the baseline, white blood cell count (WBC) which was 2×10 9/L higher than baseline, oxygenation index (PaO 2/FiO 2) < 300 mmHg (1 mmHg = 0.133 kPa), the occurrence of lower respiratory tract infections (based on radiography), and changes in sputum indexing and sputum formation. Results:Compared with the Venturi oxygen therapy group, the body temperature increased > 1 ℃, WBC increased by 2×10 9/L, PaO 2/FiO 2 < 300 mmHg, and the proportion of lower respiratory tract infection in THFO group decreased significantly [body temperature increased > 1 ℃: 10.0% (3/30) vs. 13.3% (4/30), WBC increased by 2×10 9/L: 10.0% (3/30) vs. 30.0% (9/30), PaO 2/FiO 2 < 300 mmHg: 3.3% (1/30) vs. 10.0% (3/30), the proportion of lower respiratory tract infection: 6.7% (2/30) vs. 13.3% (4/30), all P < 0.05]. The proportion of patients with sputum scab formation and sputum viscosity of Ⅰ degree were significantly increased [sputum scab formation: 16.7% (5/30) vs. 6.7% (2/30), sputum viscosity of Ⅰ degree: 30.0% (9/30) vs. 20.0% (6/30), both P < 0.05]. Conclusion:THFO during non-mechanical ventilation of adult patients with tracheotomy can maintain a higher oxygen partial pressure and ideally control the temperature and humidity of the inhaled gas, promote the discharge of sputum with degreeⅠ andⅡ viscosity, thereby reducing the tracheotomy complications such as lower respiratory tract infections.
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Objective To investigate the effect of oxygen therapy with Venturi combined with MR850 heating humidifier on patients without mechanical ventilation after tracheotomy. Methods Eighty patients (≥ 18 years old) who had undergone tracheotomy and without mechanical ventilation admitted to Fenyang Hospital of Shanxi Province from June 2016 to December 2017 were enrolled, and they were divided into control group and observation group according to random number table method, with 40 patients in each group. The observation group was given Venturi (removed the mask) combined with MR850 device active warm and humid oxygen therapy; the control group was given one-off ordinary flow device and warm and humid exchanger (artificial nose, HME) passive humid oxygen therapy. Body temperature increased by 1 ℃ above basal body temperature, white blood cell count (WBC) increased 2×109/L than the base value, oxygenation index (PaO2/FiO2) < 300 mmHg (1 mmHg = 0.133 kPa), airway mucosal hemorrhage, pulmonary infection and sputum viscosity were observed in the two groups for 5 days after oxygen therapy. Results Among the 80 patients, there were 46 males and 34 females, with an average age of (67.7±12.2) years. Compared with the control group, the incidence of increased body temperature (5.0% vs. 20.0%), the incidence of increased WBC (7.5% vs. 35.0%), the incidence of low PaO2/FiO2(2.5% vs. 7.5%), the incidence of airway mucosal bleeding (5.0 % vs. 15.0%) and the incidence of pulmonary infection (2.5% vs. 10.0%) were significantly decreased in the observation group (all P < 0.01), and the proportion of sputum viscosity Ⅰ degree of patients was significantly increased (57.5% vs. 12.5%, P < 0.01). Conclusion Venturi combined with MR850 device can effectively control airway temperature and humidity, promote sputum dilution and conducive to drainage, reduce pulmonary infection in adults patients without mechanical ventilation after tracheotomy, thereby reducing postoperative complications of tracheotomy.
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Objective To observe the differences in functional capacities generated by different simple breathing balloons extruded by different hand types and methods.Methods The lung functional measurement instrument was used to measure the generated functional capacities of two types of simple breathing balloon extruded by different hand methods: using big-, mid- and small-size hands with 5 fingers generally separately open and maximally extended states or with both small-size hands to extrude balloon; the effective generated gas quantity of the above methods were compared.Results ① Comparison between different balloons: the functional capacity generated by black rubber balloon extruded by any hand type was 68 - 132 mL lower than that generated by light blue silicon balloon. ② The comparison between different hand types: the functional capacities generated by any hand at maximally extended state in extruding balloon was 13 - 70 mL higher than that by hand commonly separate state; extrusion by a small size hand was nearly unable to reach 400 mL, while the functional capacity was 520 - 650 mL when the balloon was extruded by a big size hand, and 435 - 635 mL by a mid-size hand; it was necessary to use both small hands when the black rubber balloon was extruded, when the light blue silicon air bag was extruded, the functional capacity could reach 430 - 440 mL with a small size hand. ③ Difference in extruding methods: the functional capacity generated by either big size hand or mid-size hand with 5 fingers maximally extending state to extrude balloon was significantly higher than that with 5 fingers commonly separate state, the functional capacity generated by both small size hands with fingers maximally separating and extending state to extrude balloon was obviously higher than that generated by 5 fingers generally separating and extending state, the functional capacities generated by light blue silicon balloon were obviously higher than those by black rubber balloon, no matter the 5 fingers of big- or mid-size hand being at generally separating or extending state (mL: 623.00±21.11 vs. 522.00±41.85 by big size hand with common 5 fingers separate state, 649.00±26.01 vs. 575.00±58.55 by big sizehand with maximum 5 fingers extending state; 566.00±37.77 vs. 436.00±21.19 by mid-size hand with common 5 fingers separate state, 637.00±30.02 vs. 505.00±37.49 by mid-size hand with maximum 5 fingers extending state); the light blue silicon balloon extruded by small hand with 5 fingers at generally separate state and at maximally extending state could generate functional capacities (mL)432.00±13.02 and 444.00±37.18 respectively, significantly higher than those using the 2 types of hand state extruding a black rubber balloon (the tidal volume < 400 mL), the functional capacities generated by both small hands extruding a light blue silicon balloon was obviously higher than that by using a black rubber balloon (mL: 557.00±54.98 vs. 489.00±40.12, allP < 0.05).Conclusions Different functional capacities will be generated by different hand sizes, different hand extruding methods and types of simple breathing balloon, clinical application should be based on patients' body weights to decide their tidal volumes, and combined with the rescuers' hand sizes and types of simple breathing balloon to choose a proper extruding method for a certain patient, thus sufficient oxygen can be surely provided in time for him/her and rescue successful rate can be elevated.