Pulmonary rehabilitation protocols in urgent lung transplantation patients / 世界急诊医学杂志（英文）

@#BACKGROUND: Prolonged invasive respiratory support and extracorporeal membrane oxygenation (ECMO) in patients requiring urgent lung transplantation (ULTx) present significant challenges to clinical practice due to severe underlying diseases and complex conditions. The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center. METHODS: A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation (IMV) and ECMO between January 2018 and January 2023. Data were retrieved from electronic medical records at our lung transplant center. RESULTS: Fourteen patients (mean age 57.43±10.97 years; 12 males, 2 females) underwent ULTx with bridging ECMO and IMV. The mean body mass index was 23.94±3.33 kg/m², and the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 21.50±3.96. The Nutritional Risk Screening 2002 (NRS 2002) scores were ≥3. ULTx was performed after an 8.5-day waiting period (interquartile interval [IQR] 5.0-26.5 d). Following the surgeries, the average lengths of ECMO and IMV were 1.0 (IQR 1.0-2.0) d and 5.0 (IQR 3.0-7.3) d, respectively. The total length of hospital stay was 60.1±30.8 d, with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d. Two patients died within 30 d after ULTx, with a 30-day survival rate of 85.71%. CONCLUSION: Patients receiving ULTx showed an acceptable short-term survival rate, validating the practicality and safety of the treatment protocols implemented in our center.

Development and application of an smart emergency respirator with open airway / 中华危重病急救医学

To solve the problems of insufficient airway opening, insufficient or excessive ventilation, ventilation interruption, and the rescuer's physical strength during the process of cardiopulmonary resuscitation (CPR) outside the hospital and in the hospital, and to ensure the accuracy of ventilation frequency rate and tidal volume. Zhongnan Hospital and School of Nursing, Wuhan University, jointly designed and developed a smart emergency respirator with open airway function, that has been granted National Utility Model Patent of China (ZL 2021 2 1557989.8). The device is structured of pillow, pneumatic booster pump and mask. It can be used simply by plugging the pillow under the patient's head and shoulder, turning on the power supply and wearing the mask. The smart emergency respirator can quickly and effectively open the patient's airway and give accurate ventilation with adjustable ventilation parameters. The default settings are 10 times/min in respiratory rate and 500 mL in tidal volume. The whole operation does not require the operator have professional operation ability, which can be independently applied used in any cases without oxygen source or power supply, therefore, the application scenario has no limit. The device has the advantages of small size, simple operation and low production cost, which can reduce human source, save physical strength and significantly improve the quality of CPR. The device is suitable for respiratory support in multiple scenes outside and inside the hospital, and can significantly improve the success rate of treatment.

Clinical research of less invasive surfactant administration combined with nasal intermittent positive pressure ventilation in preterm infants with respiratory distress syndrome / 中华急诊医学杂志

Objective:To evaluate the efficacy and safety of less invasive surfactant administration (LISA) combined with nasal intermittent positive pressure ventilation (NIPPV) in the treatment of infants with respiratory distress syndrome (RDS).Methods:A prospective study was conducted on preterm infants of gestational age ≤34 weeks with RDS who were admitted to the Neonatal Intensive Care Unit of Xuzhou Central Hospital from October 2019 to November 2021. The infants were randomly assigned into the LISA+NIPPV group and the intubation-surfactant-extubation (INSURE) +nasal continuous positive airway pressure (NCPAP) group. In the LISA+NIPPV group, with the support of NIPPV, a Lisa tube was inserted through the vocal cords under direct vision with direct laryngoscope, and then pulmonary surfactant (PS) was infused into the lung. In the INSURE+NCPAP group, the patients were endotracheally intubated and infused with PS into the lung through endotracheal tube, then extubated and continued to receive NCPAP therapy (INSURE). The blood gas analysis at 1 h and 6 h after PS infusion, the adverse reactions during injection, clinical efficacy, bronchopulmonary dysplasia (BPD) and other related complications were compared between the two groups.Results:A total of 112 preterm infants with RDS were enrolled, including 58 in the LISA+NIPPV group and 54 in the INSURE+NCPAP group. The blood oxygen partial pressure (PaO 2) and PaO 2/FiO 2 (P/F) in the LISA+NIPPV group were significantly higher than those in the INSURE+NCPAP group at 1 h and 6 h after PS infusion, while carbon dioxide partial pressure (PaCO 2) were significantly lower than that in the INSURE+NCPAP group, and the differences were statistically significant (all P<0.05). The rate of tracheal intubation within 72 h (15.5% vs. 33.3%), the duration of non-invasive ventilation [ (7.5 ± 4.3) d vs.(9.9 ± 5.5) d ], total oxygen inhaling [ (10.5 ± 3.5) d vs.(13.3 ± 4.1) d ], failure rate of machine withdrawal (8.6% vs. 31.0% ), the times of apnea [7.0 (3.0-21.0) times vs. 15.0 (4.0-28.0) times ] and re-administration of PS (17.2% vs. 33.3%) in the LISA+NIPPV group were significantly lower than those in the INSURE+NCPAP group, and the differences were statistically significant ( P<0.05). The incidence of regurgitation in the LISA+NIPPV group was lower than that in the INSURE+NCPAP group (13.8% vs. 35.2%), and the difference was statistically significant ( P<0.05). There was no significant difference in the time needed for intubation between the two groups ( P>0.05). The occurrence of BPD in the LISA+NIPPV group was significantly lower than that in the INSURE+NCPAP group (10.3% vs. 25.9%), and there was no significant difference in other related complication between the two groups (all P>0.05). Conclusions:LISA combined with NIPPV in the treatment of preterm infants with RDS can effectively improve oxygenation, reduce carbon dioxide retention, reduce the mechanical ventilation rate, shorten the duration of noninvasive mechanical ventilation, and reduce the incidence of BPD.

Analysis of predictors of response to high-flow oxygen nasal cannula therapy in a pediatric intensive care unit / Análisis de factores predictores de respuesta a la oxigenoterapia de alto flujo en una unidad de cuidados intensivos pediátricos

Abstract Background: Bronchiolitis is one of the most frequent reasons for admission to pediatric intensive care units. Medical treatment is primarily supportive. The usefulness of high-flow oxygen (HFO) nasal cannula in these patients has been described. This study evaluated the clinical and analytical variables of patients admitted to our Pediatric Intensive Care Unit (PICU) for initiation or continuation of HFO for respiratory distress and to identify any variable that may be a predictor of success or failure of this technique. Methods: We conducted a retrospective observational study that included infants aged < 24 months admitted to our PICU due to bronchiolitis between January 2015 and March 2019 for HFO. Results: We analyzed the characteristics between responders (n = 112) and non-responders (n = 37). No statistically significant differences were observed between groups regarding sex, age, weight, comorbidities, nasopharyngeal aspirate result, hours of evolution, and respiratory and heart rate. However, a pCO2 ≥ 75 mmHg (p = 0.043) and a SCORE of bronchiolitis severity (p = 0.032) were predictors of HFNC failure. Conclusions: The pCO2 level and SCORE of bronchiolitis severity are predictors of this respiratory support modality.

Resumen Introducción: La bronquiolitis es uno de los motivos más frecuentes de ingreso en las Unidades de Cuidados Intensivos Pediátricos (UCIP); el tratamiento médico es básicamente de soporte. Se ha descrito la utilidad de la oxigenoterapia de alto flujo (OAF) en estos pacientes. El objetivo de este estudio fue evaluar algunas variables clínicas y analíticas de los pacientes que ingresan en nuestra UCIP para inicio o continuación de OAF ante cuadros de dificultad respiratoria e identificar cualquier variable que pueda ser factor predictor del éxito o fracaso de esta técnica. Métodos: Se realizó un estudio retrospectivo observacional, incluyendo lactantes menores de 24 meses ingresados en la UCIP entre enero de 2015 y marzo de 2019 para OAF ante cuadros de bronquiolitis. Resultados: Se analizaron las características entre el grupo de respondedores (n = 112) y no respondedores (n = 37). No se observaron diferencias estadísticamente significativas en cuanto al sexo, edad, peso, comorbilidades, resultado del aspirado naso-faríngeo, horas de evolución, frecuencia respiratoria, frecuencia cardiaca entre ambos grupos. Sin embargo, una pCO2 ≥75 mmHg (p = 0.043) y un SCORE de gravedad de la bronquiolitis mayor (p = 0.032) fueron factores predictores de fracaso de la OAF. Conclusiones: El nivel de pCO2 y el SCORE de gravedad de la bronquiolitis son factores predictores de esta modalidad de soporte respiratorio.

Utility of Bain’s Circuit to Deliver Respiratory Support in a Resource‑Limited Setting during the COVID‑19 Pandemic

Introduction:Patients with COVID pneumonia, who did not respond to high‑flow oxygen by nonrebreathing mask (NRBM), needed additional support to deliver oxygen with pressure. We present our innovation to use Bain’s circuit to deliver continuous positive airway pressure (CPAP) along with 100% oxygen in patients with COVID‑19 when there was a shortage of respiratory support equipment. Materials and Methods: It is a retrospective observational study conducted at two high‑volume, government‑designated, tertiary level COVID centers of Northern India, during May and June 2021. After taking informed consent from all patients included in the study, a nonventilated noninvasive ventilation (NIV) mask was used as the interface between Bain’s circuit and the patient for making a tight seal. Vital parameters were recorded on admission, before putting the patient on Bain’s circuit, at 30 min, and 6 h after the initiation of Bain’s circuit. Results: Forty‑five patients were enrolled in this study. There was a significant reduction in the work of breathing after the application of Bain’s circuit. Vital parameters show improvement of the condition. Sensorium also showed a significant improvement after the application of Bain’s circuit. Overall, 40% of patients who received Bain’s circuit were weaned off to oxygen by NRBM, 31.1% of patients were bridged to NIV, and 28.9% of patients got intubated. Conclusion: The aim of presenting our experience is to generate interest regarding innovations in the face of crisis which may not be perfect but are practical for the situation. We do not recommend the use of Bain’s circuit to provide NIV support under normal circumstances. Further studies are needed to support the use of Bain’s circuit with modifications as a CPAP/NIV delivering device in selected patients.

Less invasive surfactant administration combined with bi-level positive airway pressure in preterm infants with respiratory distress syndrome : a clinical research / 中国新生儿科杂志

Objective:To study the efficacy and safety of less invasive surfactant administration (LISA) combined with bi-level positive airway pressure (BiPAP) ventilation in premature infants with respiratory distress syndrome (RDS).Methods:Premature infants with RDS at gestational age of 26~32 weeks in the NICU of our hospital from January 2020 to October 2021 were enrolled in this randomized controlled trial. They were randomly assigned to the LISA+BiPAP group or the intubation-surfactant-extubation (INSURE) + nasal continuous positive airway pressure (NCPAP) group, and given the corresponding treatment according to the group. The blood gas analysis at 1 h and 6 h after intratracheal instillation of pulmonary surfactant (PS), medication, noninvasive respiratory support time, total oxygen use time, weaning failure rate and endotracheal intubation rate within 72 h after PS administration were compared between the two groups, as well as the incidence of bronchopulmonary dysplasia (BPD).Results:A total of 86 preterm infants with RDS were enrolled in the study, including 44 in the LISA+BiPAP group and 42 in the INSURE+NCPAP group. Arterial partial pressure of oxygen in the LISA+BiPAP group at 1 h and 6 h after intratracheal instillation of PS were higher than those in the INSURE+NCPAP group, while PaCO 2 and oxygenation index (OI) were lower than those in the INSURE+NCPAP group, and the differences were statistically significant (all P<0.05). The duration of noninvasive respiratory support time [(12.2±8.7) d vs. (16.0 ±7.6) d], total oxygen use time [(16.6 ±8.3) d vs. (20.3±7.4) d], length of hospitalization[(22.6±10.3) d vs. (27.1±12.6) d], weaning failure rate [(11.4% (5/44) vs. 31.0% (13/42)], endotracheal intubation rate within 72 h after PS administration [11.4% (5/44) vs. 28.6% (12/42)], and re-administration of PS [18.2% (8/44) vs. 38.1% (16/42)] in the LISA+BiPAP group were lower than those in the INSURE+NCPAP group, and the differences were statistically significant ( P<0.05). The time needed for intubation and the incidence of regurgitation in the LISA+BiPAP group were lower than those in the INSURE+NCPAP group, and the differences were statistically significant ( P<0.05). The incidence of BPD in the LISA+BiPAP group was lower than those in the INSURE+NCPAP group [11.4% (5/44) vs. 31.0% (13/42)] ( P<0.05), the difference was also statistically significant ( P<0.05). There was no significant difference in the incidence of other complications between the two groups ( P>0.05). Conclusions:LISA combined with BiPAP can effectively improve oxygenation, reduce the mechanical ventilation rate, shorten the duration of non-invasive respiratory support, and reduce the incidence of BPD in the treatment of premature infants with RDS at the gestational age of 26~32 weeks.

Research progress on treatment measures for pediatric acute lung injury / 中国小儿急救医学

Pediatric acute lung injury(ALI)is a common disease in pediatric intensive care unit with a high fatality rate.Because the etiology of ALI is complex, the exact pathogenesis of ALI is not clear.At present, it is known that the important factors leading to the incidence of ALI in children are oxidative stress and dysregulation of inflammatory response.Progressive hypoxemia and respiratory distress are the main clinical manifestations of ALI.Respiratory support and drug control are the common treatment measures.In recent years, stem cell and molecular targeted therapy as new treatment pathways of ALI, have achieved certain achievements in the research, and are expected to become new treatment methods of ALI in chidren.

Effects of quality improvement project of respiratory support in delivery room on the short-term clinical outcomes of very/extremely low birth weight infants / 中国新生儿科杂志

Objective:To study the effects of quality improvement project of respiratory support in delivery room on the short-term clinical outcomes of very/extremely low birth weight infant (VLBWI/ELBWI).Methods:The clinical data of VLBWI/ELBWI before and after the implementation of the quality improvement project of respiratory support in delivery room in our hospital were retrospectively analyzed. The incidences of endotracheal intubation in delivery room, total endotracheal intubation within 72 h after birth, mechanical ventilation duration, total oxygen therapy duration, bronchopulmonary dysplasia (BPD) and other complications were compared between pre-improvement group (from January to October 2019) and post-improvement group (from January to December 2020).Results:A total of 85 cases were included in pre-improvement group and 85 in post-improvement group. The gestational age of the two groups were (29.2±1.4) weeks and (29.1±1.5)weeks and the birth weight were (1 180±195) g and (1 186±207) g, without significant differences ( P>0.05). After the implementation of the quality improvement project, the incidence of endotracheal intubation in the delivery room decreased from 32.9% to 2.4%, and the total incidence of endotracheal intubation within 72 h after birth decreased from 58.8% to 27.1%. The usage of pulmonary surfactant significantly decreased from 54.1% to 38.8% ( P<0.05) and the incidence of hemodynamically significant patent ductus arteriosus (hsPDA) also significantly decreased from 17.6% to 5.9% ( P<0.05).No significant differences existed among other complications ( P>0.05). Conclusions:The quality improvement project of respiratory support in the delivery room can significantly reduce the incidence of endotracheal intubation in VLBWI/ELBWI without increasing short-term adverse outcome.

Effectiveness of non-invasive ventilation in treating infants aged 1 to 12 months with severe bronchiolitis: A systematic review and meta-analysis

@#<p style="text-align: justify;"><strong>Objective.</strong> This study was done to determine the effectiveness of non-invasive ventilation (NIV) in treating infants aged 1 to 12 months with severe bronchiolitis based on a systematic review of literature and meta-analysis of quantitative results.</p><p style="text-align: justify;"><strong>Methods.</strong> We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for identification, screening, and identification of eligible studies. Five databases (PubMed, Herdin, Cochrane Library, Google Scholar, and Science Direct) were searched for relevant studies involving the use of NIV among children with severe bronchiolitis. Included studies were assessed for quality and risk of bias.</p><p style="text-align: justify;"><strong>Results.</strong> There were 9 included eligible studies. The length of hospital stay and duration of respiratory support were significantly lower with the use of NIV compared with IMV (invasive mechanical ventilation) based on pooled standard mean difference (SMD) estimates; however, there was high statistical heterogeneity in the included studies. This can be attributed to differences in the mode of intervention used among studies, patient-specific factors, and viral virulence. Significant improvements in heart rate, oxygen saturation, and tCO2 were seen in the included studies. One study showed statistically significant differences in changes in respiratory rate and improvement in respiratory status based on two bronchiolitis severity scores among infants placed on NIV.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Fair to good-quality evidence from included studies reveals that there is a significant reduction in length of hospital stay, duration of respiratory support, and improvements in respiratory parameters among infants who received NIV for severe bronchiolitis. Larger, well-designed clinical trials on the use of NIV among resource-limited settings wherein it may offer valuable clinical utility, are recommended for future study</p>

Recomendaciones para la implementación de soporte respiratorio pediátrico en COVID-19. Kinesiología Intensiva y Terapia Respiratoria Pediátrica de Chile / Recommendations for the implementation of pediatric respiratory support in COVID-19. Intensive Kinesiology and Respiratory Therapy Chilean

Resumen: De acuerdo a la información disponible, los pacientes pediátricos con COVID-19 tendrían una me nor frecuencia, se presentarían en su mayoría con un cuadro clínico de leve a moderado, y con una baja tasa de morbimortalidad asociada5. Sin embargo, es incierto el comportamiento real que tendrá el SARS-CoV-2 en Chile, así como tampoco sabemos el impacto que tendrá su interacción con otros virus respiratorios en el desenlace clínico. Asumiendo que los pacientes pediátricos que requieran hospitalización por sospecha o confirmación de COVID-19 necesitarán de diferentes niveles de so porte respiratorio, hemos elaborado recomendaciones transversales fundamentadas en el óptimo manejo del apoyo respiratorio pediátrico, basados en los principios de calidad y eficiencia en la en trega del soporte, en parámetros de bioseguridad y en el uso apropiado de recursos6. Estos elementos que se encuentran relacionados al armado y filtrado de los aerosoles producidos por algunos equipos de soporte ventilatorio, son recomendados en esta guía con el fin de unificar criterios técnicos que permitan entregar un apoyo óptimo al paciente pediátrico, manteniendo la mayor bioseguridad po sible para el paciente y el equipo de salud.

Abstract: According to the available information, pediatric cases of COVID-19 would present less frequently, most of them with mild to moderate clinical picture, and low associated morbidity and mortality5. However, we do not know the actual behavior that SARS-CoV-2 will have in Chile, nor the impact that its interaction with other respiratory viruses will have on the clinical outcome. On the assump tion that pediatric patients requiring hospitalization due to suspicion or confirmation of COVID-19 will need different levels of respiratory support, we have developed wide-range recommendations based on the optimal management of pediatric respiratory support according to the principles of quality and efficiency in the delivery of support, biosafety parameters, and appropriate use of resou rces6. These elements, which are related to assembling and filtering the aerosols produced by some respiratory support equipment, are recommended in this guide in order to unify technical criteria that allow optimal support for the pediatric patient while maintaining the highest possible biosafety for the patient and the health team.

Update on the diagnosis and management of COVID-19 in pediatric patients

Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a pandemic in March 2020, affecting millions of people worldwide. However, COVID-19 in pediatric patients represents 1-5% of all cases, and the risk for developing severe disease and critical illness is much lower in children with COVID-19 than in adults. Multisystem inflammatory syndrome in children (MIS-C), a possible complication of COVID-19, has been described as a hyperinflammatory condition with multiorgan involvement similar to that in Kawasaki disease or toxic shock syndrome in children with evidence of SARS-CoV-2 infection. This review presents an update on the diagnostic methods for COVID-19, including reverse-transcriptase polymerase chain reaction (RT-PCR) tests, serology tests, and imaging, and summarizes the current recommendations for the management of the disease. Particular emphasis is placed on respiratory support, which includes noninvasive ventilation and invasive mechanical ventilation strategies according to lung compliance and pattern of lung injury. Pharmacological treatment, including pathogen-targeted drugs and host-directed therapies, has been addressed. The diagnostic criteria and management of MIS-C are also summarized.

Application of ECMO in the treatment of severe adenovirus pneumonia / 中国小儿急救医学

Adenovirus is one of the common pathogens causing respiratory tract infection in children, which can cause severe pneumonia.Severe adenovirus pneumonia has an acute onset, rapid progress, and many complications, but there is no specific treatment and the mortality rate is high.Mechanical ventilation is an important means of respiratory support for the treatment of severe adenoviral pneumonia, and ventilator-associated lung injury is an inevitable drawback of mechanical ventilation.ECMO can replace and support cardiopulmonary function for a long time, reduce the occurrence of such damage, and improve oxygenation.When patients with severe adenovirus pneumonia develop respiratory failure or ARDS, and conventional treatment fails to improve hypoxemia, or accompanied by air leakage and other complications, ECMO treatment should be considered.However, there are few relevant studies in China, and further experience needs to be accumulated in the selection of respiratory support modes, intervention opportunities and management points of ECMO respiratory support for severe adenovirus pneumonia.

A review on progress of diagnosis and respiratory support therapy of acute respiratory distress syndrome / 中国中西医结合急救杂志

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by progressive hypoxemia and respiratory distress, which occurs in the course of critical illness, and diffuse interstitial and alveolar edema caused by injury of alveolar capillary endothelial cells and alveolar epithelial cells, the overall morbidity and mortality of ARDS are still high. In recent years, with a better understanding of ARDS, more and more researches on this subject have been made, establishing a new concept for the diagnosis and treatment of ARDS. Early respiratory function support and correction of hypoxia are the main measures for treatment of ARDS, and mechanical ventilation is still a primary method for respiratory support of ARDS patients. In this review, we present a summary of the modern advance in diagnosis and respiratory support for treatment of ARDS.

Clinical application of noninvasive high_frequency ventilation in neonatal respiratory support / 中华实用儿科临床杂志

Noninvasive high_frequency ventilation( NIHFV)is a new form of noninvasive ventilation which distends positive pressure continuously with oscillations superimposed on spontaneous tidal breathing,through a nonin_vasive interface. NIHFV,which provides the advantages of nasal continuous positive airway pressure and high frequency ventilation,can rapidly improve oxygenation,effectively remove carbon dioxide,and does not require synchronous techno_logy. It is considered as a new and effective noninvasive ventilation mode. In this paper,the application of NIHFV to neo_nates were reviewed,including mechanics of gas exchange,research advances and approach to the use of NIHFV.

Clinical application of noninvasive high-frequency ventilation in neonatal respiratory support / 中华实用儿科临床杂志

Noninvasive high-frequency ventilation (NIHFV) is a new form of noninvasive ventilation which distends positive pressure continuously with oscillations superimposed on spontaneous tidal breathing, through a noninvasive interface.NIHFV, which provides the advantages of nasal continuous positive airway pressure and high frequency ventilation, can rapidly improve oxygenation, effectively remove carbon dioxide, and does not require synchronous techno-logy.It is considered as a new and effective noninvasive ventilation mode.In this paper, the application of NIHFV to neonates were reviewed, including mechanics of gas exchange, research advances and approach to the use of NIHFV.

Application of ECMO in the treatment of severe adenovirus pneumonia / 中国小儿急救医学

Adenovirus is one of the common pathogens causing respiratory tract infection in chil﹣dren,which can cause severe pneumonia. Severe adenovirus pneumonia has an acute onset,rapid progress,and many complications,but there is no specific treatment and the mortality rate is high. Mechanical ventilation is an important means of respiratory support for the treatment of severe adenoviral pneumonia,and ventilator﹣associated lung injury is an inevitable drawback of mechanical ventilation. ECMO can replace and support cardiopulmonary function for a long time,reduce the occurrence of such damage,and improve oxygenation. When patients with severe adenovirus pneumonia develop respiratory failure or ARDS,and conventional treat﹣ment fails to improve hypoxemia,or accompanied by air leakage and other complications,ECMO treatment should be considered. However,there are few relevant studies in China,and further experience needs to be ac﹣cumulated in the selection of respiratory support modes,intervention opportunities and management points of ECMO respiratory support for severe adenovirus pneumonia.

Respiratory support of extracorporeal membrane oxygenation in children / 中国小儿急救医学

Patients with respiratory crisis occupied a large numbers in extracorporeal membrane oxy-genation(ECMO) group. ECMO is able to give a plenty amount of gas exchange for body essential metabolic needs by ECMO oxygenator whoever the lungs are of function or not. The key indications for respiratory ECMO are that the patient had no response to all medical treatment except ECMO,and the origin cause of the disease is potentially recoverable. Besides the contraindications and accessibility, ECMO has no special settings among the different ages or cause of diseases. The VV-ECMO is preferred for respiratory support. VA-ECMO should be considered if cardiovascular failure exists. ECMO may offer a powerful respiratory support to patient with critically ill conditions until recovery. The outcomes are influenced by some factors including the reversibility and the cause of diseases.

Early application of noninvasive respiratory support benefits very low birth weight infant / 实用医学杂志

Objective Investigate the effects of early application of noninvasive respiratory support on very low birth weight infant(VLBWI). Method A total of 65 VLBWI(born during September 2015 to September 2016 with 28-32 weeks gestational age;1000 g ≤ birth weight < 1500 g;exclusion of combination with congenital deformity)were randomly divided into the early application of noninvasive respiratory support as observation group (n = 33) and the application of endotracheal intubation with gen respiratory support as control group (n = 32). Comparison of two groups was carried out by SPSS in terms of incidence of endotracheal intubation,BPD,pulmonary infection,pneumothorax,and necrotizing enterocolitis,together with rescue ratio,total oxygenation time and hospitalization. Results No significant difference was found on incidence of pneumothorax,necrotizing enterocolitis and rescue ratio between two groups. The incidence of endotracheal intubation,BPD,pulmonary infection and total oxygenation time was markly decreased in observation group. Conclusion Early application of noninvasive respiratory support benefits VLBWI via reducing incidence of endotracheal intubation,BPD,pulmonary infection, total oxygenation time.

Early respiratory support for very preterm infant to prevent bronchopulmonary dysplasia / 中国小儿急救医学

Although respiratory distress syndrome( RDS) ,one of the most common cause of respira-tory failure in the very or extremely preterm infant,has not been yet the major disorder of death with advances of respiratory support;In fact,RDS often complicated with BPD which developed with the maturation of de-pendence,the outcome of BPD and its development step into the focus of modern NICU. Powerful evidence-based consensus and suggestions have been stated in early respiratory support for very and extremely preterm infant:Early nasal CPAP( nCPAP) should be the best alternative to intubation for very or extremely preterm infant with high-risk of RDS and RDS; Early administration of Pulmonary surfactant ( PS ) with suitable methods( InSurE,Intubation Surfactant Extubation or LISA,Less invasive surfactant administration);Individ-ual threshould for nCPAP or other noninvasive ventilation failure should be established,but early PS adminis-tration and gentle ventilation will decrease the incidence of ventilator-induced injury on failuring noninvasive ventilation;Noninvasive ventilation with the use of caffeine will short the duration of ventilation and improve the success of weaning off. All the strategies in respiratory support to prevent BPD for very preterm infant still need more practice sustain improvement since multiple causes account for the development of BPD.