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Objective:To identify the risk factors for the first weaning failure following mandibular distraction osteogenesis in pediatric patients with Pierre Robin sequence (PRS).Methods:Clinical data of pediatric patients with PRS who underwent mandibular distraction osteogenesis from January 2018 to February 2023 were collected, including sex, age, premature birth, birth weight, surgical weight, cleft palate, syndrome type PRS, laryngeal/tracheobronchial malacia, simple congenital heart disease, complex congenital heart disease, preoperative mechanical ventilation, preoperative pulmonary infection, blood albumin concentration, difficulty in tracheal intubation under a visual laryngoscope, surgical duration, postoperative ventilator-associated pneumonia, duration of mechanical ventilation at first weaning, and traction length at first weaning. Children in whom the first postoperative machine withdrawal failed were included in observation group and matched to control cases(control group) in a 1∶4 ratio. The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify the risk factors for postoperative weaning failure. Results:There were significant differences in birth weight, cleft palate, duration of mechanical ventilation and traction length at first weaning, rate of combined cleft palate, preoperative pulmonary infection rate, rate of preoperative mechanical ventilation, and rate of postoperative ventilator-associated pneumonia between the two groups ( P<0.05). Binary logistic stepwise regression analysis showed that the preoperative mechanical ventilation ( OR=18.154, 95% CI 3.971-82.990, P<0.001) and postoperative ventilator-associated pneumonia ( OR=36.942, 95% CI 1.307-1043.985, P=0.034) were independent risk factors for first weaning failure after mandibular distraction osteogenesis, while birth weight gain ( OR=0.225, 95% CI 0.076-0.668, P=0.007) was a protective factor for first weaning failure ( P<0.05). Conclusions:Preoperative mechanical ventilation and postoperative ventilator-associated pneumonia are independent risk factors and birth weight gain is a protective factor for first weaning failure following mandibular distraction osteogenesis in pediatric patients with PRS.
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Resumo Fundamentos Para ventilação prática e protetora durante a ressuscitação cardiopulmonar (RCP), desenvolveu-se um ventilador mecânico (VLP2000E) de 150 gramas que limita o pico de pressão inspiratória (PPI) durante ventilação e compressões torácicas simultâneas. Objetivos Avaliar a viabilidade da ventilação com VLP2000E durante RCP e comparar os parâmetros monitorados versus ventilação com bolsa-válvula. Métodos Estudo experimental randomizado com 10 porcos intubados por grupo. Após sete minutos de fibrilação ventricular, iniciaram-se ciclos de RCP de 2 minutos. Todos os animais foram ventilados com VLP2000E após o retorno da circulação espontânea (RCE). Resultados Os grupos bolsa-válvula e VLP2000E apresentaram taxa de RCE (60% vs. 50%, respectivamente) e saturação arterial de oxigênio similares na maioria dos ciclos de RCP, volume corrente basal diferente [0,764 (0,068) vs. 0,591 (0,123) L, p = 0,0309, respectivamente] e, em 14 ciclos, diferentes PPI [52 (9) vs. 39 (5) cm H2O, respectivamente], volume corrente [0,635 (0,172) vs. 0,306 (0,129) L], ETCO2 [14 (8) vs. 27 (9) mm Hg], e pico de fluxo inspiratório [0,878 (0,234) vs. 0,533 (0,105) L/s], todos p < 0,0001. A complacência pulmonar dinâmica (≥ 0,025 L/cm H2O) diminuiu após o RCE no grupo bolsa-válvula, mas se manteve no grupo VLP2000E [ 0,019 (0,006) vs. 0,024 (0,008) L/cm H2O, p = 0,0003]. Conclusões Ventilação com VLP2000E durante RCP é viável e equivalente a ventilação com bolsa-válvula quanto à taxa de RCE e saturação arterial de oxigênio. Esse ventilador produz melhores parâmetros respiratórios, com pressão das vias aéreas e volume corrente menores. Ventilação com VLP2000E também previne a redução significante da complacência pulmonar dinâmica observada após ventilação com bolsa-válvula. Seria interessante realizar mais estudos pré-clínicos para confirmar esses resultados.
Abstract Background For practical and protective ventilation during cardiopulmonary resuscitation (CPR), a 150-grams mechanical ventilator (VLP2000E) that limits peak inspiratory pressure (PIP) during simultaneous ventilation with chest compressions was developed. Objectives To evaluate the feasibility of VLP2000E ventilation during CPR and to compare monitored parameters versus bag-valve ventilation. Methods A randomized experimental study with 10 intubated pigs per group. After seven minutes of ventricular fibrillation, 2-minute CPR cycles were delivered. All animals were placed on VLP2000E after achieving return of spontaneous circulation (ROSC). Results Bag-valve and VLP2000E groups had similar ROSC rate (60% vs. 50%, respectively) and arterial oxygen saturation in most CPR cycles, different baseline tidal volume [0.764 (0.068) vs. 0.591 (0.123) L, p = 0.0309, respectively] and, in 14 cycles, different PIP [52 (9) vs. 39 (5) cm H2O, respectively], tidal volume [0.635 (0.172) vs. 0.306 (0.129) L], ETCO2[14 (8) vs. 27 (9) mm Hg], and peak inspiratory flow [0.878 (0.234) vs. 0.533 (0.105) L/s], all p < 0.0001. Dynamic lung compliance (≥ 0.025 L/cm H2O) decreased after ROSC in bag-valve group but was maintained in VLP2000E group [0.019 (0.006) vs. 0.024 (0.008) L/cm H2O, p = 0.0003]. Conclusions VLP2000E ventilation during CPR is feasible and equivalent to bag-valve ventilation in ROSC rate and arterial oxygen saturation. It produces better respiratory parameters, with lower airway pressure and tidal volume. VLP2000E ventilation also prevents the significant decrease of dynamic lung compliance observed after bag-valve ventilation. Further preclinical studies confirming these findings would be interesting.
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At the beginning of the COVID-19 pandemic in Chile, in March 2020, a projection indicated that a significant group of patients with pneumonia would require admission to an Intensive Care Unit and connection to a mechanical ventilator. Therefore, a paucity of these devices and other supplies was predicted. The initiative "Un respiro para Chile" brought together many people and institutions, public and private. In the course of three months, it allowed the design and building of several ventilatory assistance devices, which could be used in critically ill patients.
Subject(s)
Humans , Pandemics , COVID-19 , Respiration, Artificial , Ventilators, Mechanical , Chile/epidemiology , Intensive Care UnitsABSTRACT
RESUMO Objetivo: medir os efeitos da parametrização dos alarmes sonoros de frequência respiratória dos ventiladores mecânicos para redução do número de alarmes disparados durante o banho no leito. Método: ensaio clínico pragmático, para comparar o número de alarmes do ventilador mecânico nos grupos: intervenção - os alarmes de Frequência Respiratória foram parametrizados no início do banho; controle - não realizada parametrização. Estudo registrado em 27/08/2019 no Registro Brasileiro de Ensaios Clínicos, RBR-6y6tyc, Rio de Janeiro, Brasil. Resultados: os modelos de regressão evidenciaram que a parametrização, realizada e mantida durante e após o banho no grupo intervenção, teve o efeito de aumentar 12,5 e 6,4 vezes, respectivamente, o número médio de disparos de alarmes de frequência respiratória alta; e não teve efeito nos alarmes de frequência respiratória baixa. Conclusão: a contribuição deste estudo é auxiliar os profissionais de saúde na formulação de protocolos de parametrização individualizada dos alarmes dos Ventiladores Mecânicos.
ABSTRACT Objective: to measure the effects of parameterizing the audible respiratory rate alarms of mechanical ventilators to reduce the number of alarms triggered during bed bath. Method: pragmatic clinical trial, to compare the number of alarms of the mechanical ventilator, in the groups: intervention - the Respiratory Rate alarms were parameterized at the beginning of the bath; control - no parameterization performed. Study registered on 27/08/2019 in the Brazilian Registry of Clinical Trials, RBR-6y6tyc, Rio de Janeiro, Brazil. Results: Regression models showed that parameterization, performed and maintained during and after bath in the intervention group, had the effect of increasing the average number of high respiratory rate alarm triggers by 12.5 and 6.4 times, respectively; and had no effect on low respiratory rate alarms. Conclusion: The contribution of this study is to assist health professionals in formulating protocols for individualized parameterization of alarms for Mechanical Ventilators.
RESUMEN Objetivo: medir los efectos de la parametrización de las alarmas sonoras de frecuencia respiratoria de los ventiladores mecánicos para reducir el número de alarmas disparadas durante el baño en cama. Método: ensayo clínico pragmático, para comparar el número de alarmas del ventilador mecánico en los grupos: intervención - se parametrizaron las alarmas de Frecuencia Respiratoria al inicio del baño; control - no se realizó parametrización. Estudio registrado el 27/08/2019 en el Registro Brasileño de Ensayos Clínicos, RBR-6y6tyc, Río de Janeiro, Brasil. Resultados: Los modelos de regresión mostraron que la parametrización, realizada y mantenida durante y después del baño en el grupo de intervención, tuvo el efecto de aumentar 12,5 y 6,4 veces, respectivamente, el número medio de disparos de alarmas de frecuencia respiratoria alta; y no tuvo ningún efecto sobre las alarmas de frecuencia respiratoria baja. Conclusión: la contribución de este estudio es ayudar a los profesionales de la salud en la formulación de protocolos para la parametrización individual de las alarmas de los Ventiladores Mecánicos.
Subject(s)
Ventilators, Mechanical , Clinical Alarms , Alert Fatigue, Health PersonnelABSTRACT
Objective:To observe the efficacy and safety of mechanical ventilation combined with different doses of sildenafil in the treatment of persistent pulmonary hypertension of newborn (PPHN).Methods:A total of 160 children with PPHN admitted to Dezhou Maternal and Child Health Hospital from January 2018 to December 2019 were selected and divided into group A, B, C and D by random stratification, with 40 cases in each group. All the children in the group were actively corrected for acidosis, provided with intravenous nutrition support, warmth, anti-infection and other measures, and adopted ventilator to assist mechanical ventilation. Group A, B, and C were given different doses of sildenafil 0.5, 1.0, and 2.0 mg/(kg·time) respectively, while group D was not given sildenafil treatment, but only mechanical ventilation. Blood gas analysis indexes including partial arterial oxygenpressure (PaO 2), partial arterial carbon dioxide pressure (PaCO 2), saturationoxygen (SaO 2), and pulmonary artery pressure (SPAP), systemic blood pressure (SBP) of children were tested before the treatment and 72 h after the treatment. The treatment time, hospitalization time, hospitalization expenses and the incidence of adverse reactions of mechanical ventilation in 4 groups were recorded and compared. Results:The effective rate in the group A, B and C was higher than that in the group D: 80.0%(32/40), 85.0%(34/40), 87.5%(35/40) vs. 57.5%(23/40), the difference was statistically significant ( P<0.05). Before treatment, the levels of blood gas analysis indexes in 4 groups had no significant differences ( P>0.05). After treatment, the level of PaO 2 in the group A, B and C was significantly higher than that in the group D ( P<0.05), the level of PaCO 2 in the group B and C was significantly lower than that in group D ( P<0.05), and the level of SaO 2 in the group B and C was significantly higher than that in the group D ( P<0.05). After treatment, the level of SPAP in group B and C was significantly lower than that in the group D: (28.56 ± 3.93), (27.14 ± 3.32) mmHg(1 mmHg = 0.133 kPa) vs. (33.57 ± 4.68) mmHg, P<0.05, and the level of SBP in 4 groups had no significant difference ( P>0.05). The hospitalization time and mechanical ventilation time in group A, B and C were significantly shorter than those in group D ( P<0.05). No drug-related adverse reactions, pulmonary hemorrhage, hypotension, arrhythmia, pneumothorax and other complications occurred during the treatment in the 4 groups. Conclusions:Mechanical ventilation combined with sildenafil can significantly reduce pulmonary artery pressure and improve pulmonary oxygenation in children with PPHN. In the range of 0.5 - 1.0 mg/kg, the efficacy is more obvious when increasing the dose of sildenafil.
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RESUMO Objetivo: medir os efeitos da parametrização dos alarmes sonoros de frequência respiratória dos ventiladores mecânicos para redução do número de alarmes disparados durante o banho no leito. Método: ensaio clínico pragmático, para comparar o número de alarmes do ventilador mecânico nos grupos: intervenção - os alarmes de Frequência Respiratória foram parametrizados no início do banho; controle - não realizada parametrização. Estudo registrado em 27/08/2019 no Registro Brasileiro de Ensaios Clínicos, RBR-6y6tyc, Rio de Janeiro, Brasil. Resultados: os modelos de regressão evidenciaram que a parametrização, realizada e mantida durante e após o banho no grupo intervenção, teve o efeito de aumentar 12,5 e 6,4 vezes, respectivamente, o número médio de disparos de alarmes de frequência respiratória alta; e não teve efeito nos alarmes de frequência respiratória baixa. Conclusão: a contribuição deste estudo é auxiliar os profissionais de saúde na formulação de protocolos de parametrização individualizada dos alarmes dos Ventiladores Mecânicos.
ABSTRACT Objective: to measure the effects of parameterizing the audible respiratory rate alarms of mechanical ventilators to reduce the number of alarms triggered during bed bath. Method: pragmatic clinical trial, to compare the number of alarms of the mechanical ventilator, in the groups: intervention - the Respiratory Rate alarms were parameterized at the beginning of the bath; control - no parameterization performed. Study registered on 27/08/2019 in the Brazilian Registry of Clinical Trials, RBR-6y6tyc, Rio de Janeiro, Brazil. Results: Regression models showed that parameterization, performed and maintained during and after bath in the intervention group, had the effect of increasing the average number of high respiratory rate alarm triggers by 12.5 and 6.4 times, respectively; and had no effect on low respiratory rate alarms. Conclusion: The contribution of this study is to assist health professionals in formulating protocols for individualized parameterization of alarms for Mechanical Ventilators.
RESUMEN Objetivo: medir los efectos de la parametrización de las alarmas sonoras de frecuencia respiratoria de los ventiladores mecánicos para reducir el número de alarmas disparadas durante el baño en cama. Método: ensayo clínico pragmático, para comparar el número de alarmas del ventilador mecánico en los grupos: intervención - se parametrizaron las alarmas de Frecuencia Respiratoria al inicio del baño; control - no se realizó parametrización. Estudio registrado el 27/08/2019 en el Registro Brasileño de Ensayos Clínicos, RBR-6y6tyc, Río de Janeiro, Brasil. Resultados: Los modelos de regresión mostraron que la parametrización, realizada y mantenida durante y después del baño en el grupo de intervención, tuvo el efecto de aumentar 12,5 y 6,4 veces, respectivamente, el número medio de disparos de alarmas de frecuencia respiratoria alta; y no tuvo ningún efecto sobre las alarmas de frecuencia respiratoria baja. Conclusión: la contribución de este estudio es ayudar a los profesionales de la salud en la formulación de protocolos para la parametrización individual de las alarmas de los Ventiladores Mecánicos.
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INTRODUCCIÓN. El posicionamiento prono es una de las estrategias ventilatorias más estudiadas y difundidas de la medicina intensiva, forma parte del manejo de ventilación protectiva con impacto en disminución de la mortalidad en pacientes con síndrome de dificultad respiratoria aguda. OBJETIVO. Revisar la evidencia disponible acerca de ventilación en posición prona en pacientes con síndrome de dificultad respiratoria aguda, enfocada en el análisis fisiopatológico y clínico. MATERIALES Y MÉTODOS. Se realizó una revisión bibliográfica en la base de datos de buscadores académicos como PubMed, Google Scholar y Elsevier, en los idiomas español e inglés, en el período comprendido entre los años 1970-2020; se seleccionaron 16 publicaciones en texto completo: 3 metaanálisis, 10 estudios randomizado, 3 revisiones sistemáticas. CONCLUSIÓN. En base a la evidencia y percepción recopilada de la experiencia de los autores, la ventilación en posición prona es una estrategia de manejo de primera línea, fiable, que no requiere para su empleo equipamiento costoso ni complejo y ha demostrado mejoría en desenlaces relevantes en el tratamiento del paciente crítico respiratorio como disminución en la mortalidad y optimización de los parámetros ventilatorios y de oxigenación.
INTRODUCTION. Prone positioning is one of the most studied and widespread ventilatory strategies in intensive medicine, it is part of protective ventilation management with an impact on mortality reduction in patients with acute respiratory distress syndrome. OBJECTIVE. To review the available evidence about ventilation in the prone position in patients with acute respiratory distress syndrome, focused on the pathophysiological and clinical analysis. MATERIALS AND METHODS. A bibliographic review was carried out in the databases of academic search engines such as PubMed, Google Scholar and Elsevier, in the Spanish and English languages, in the period between the years 1970-2020, 16 full text publications were selected: 3 meta-analyses, 10 randomized studies, 3 systematic reviews. CONCLUSION. Based on the evidence and perception gathered from the authors' experience, prone ventilation is a reliable first-line management strategy that does not require costly or complex equipment for its use and has demonstrated improvements in relevant outcomes in the treatment of the critically ill respiratory patient, such as decreased mortality and optimization of ventilatory and oxygenation parameters.
Subject(s)
Humans , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/therapy , Ventilators, Mechanical , Prone Position , Respiratory Distress Syndrome, Newborn/physiopathology , Respiratory Distress Syndrome, Newborn/mortality , Critical Care , Severe Acute Respiratory Syndrome/therapyABSTRACT
Objetivo: analisar relação entre a cobertura pela Estratégia de Saúde da Família e a disponibilidade de respiradores com a taxa de contágio e mortalidade da COVID-19 no Estado de Santa Catarina, Brasil. Materiais e métodos: trata-se de um estudo ecológico, que utiliza modelos computacionais de análise geoespacial sobre o avanço do COVID-19 nos 295 municípios de Santa Catarina. Resultados: o Estado apresentou casos em todos os municípios, e uma taxa de infecção por Covid-19 de 1,63%. No modelo de regressão realizado, a cobertura pela Estratégia de Saúde da Família apresentou correlação com a mortalidade e a taxa de infecção pela Covid-19. A quantidade de respiradores apresentou correlação com a mortalidade. Conclusão: em Santa Catarina a Estratégia de Saúde da Família e a compra de novos respiradores, apresentam-se como aliados no enfrentamento à COVID 19..Au
Objective: to relate the coverage by the FHS and the availability of respirators with the transmission and mortality rate of COVID-19 in the state of Santa Catarina, Brazil. Materials and methods: this is an ecological study, which uses computational models of geospatial analysis on the progress of COVID-19 to the 295 cities in Santa Catarina. The correlation between the FHS coverage and the number of respirators grouped in the mesoregions was calculated with the COVID-19 transmission and mortality rates. Results: the state had low infection rates of 0.07% and mortality of 1.72%, when compared to Brazil. There was an increase in cases in smaller municipalities, indicating the interiorization of the pandemic. There was no correlation between FHS coverage with infection and mortality. However, respirators are associated with lower mortality. Conclusion: regional disparity was found in the presence of respirators in the state's micro-regions, suggesting an imbalance in the quality of care for critically ill patients during the pandemic..Au
Subject(s)
Humans , Ventilators, Mechanical , Coronavirus InfectionsABSTRACT
Objective:To investigate the role of chest wall elastic resistance in determining the effects of positive end-expiratory pressure (PEEP) on central venous pressure (CVP) in patients with mechanical ventilation (MV).Methods:In this prospective study, according to the median of ratio of chest wall elastic resistance to respiratory system elastic resistance (Ers), patients were divided into high chest wall elastic resistance group (Ecw/Ers≥0.24) and low chest wall elastic resistance group [elastance of chest wall (Ecw)/Ers<0.24]. PEEP was set at 5, 10, 15 cmH 2O (1 cmH 2O=0.098 kPa) respectively. Clinical data including CVP, heart rate (HR), blood pressure (BP) and respiratory mechanics were recorded. Results:Seventy patients receiving MV were included from November 2017 to December 2018. Clinical characteristics including age, BP, HR, baseline PEEP, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F) and comorbidities were comparable in two groups. However, patients with high Ecw/Ers ratio presented higher body mass index (BMI) than those with low Ecw/Ers ratio[ (25.4±3.2) kg/m 2 vs. (23.4±3.2) kg/m 2, P=0.011]. As PEEP increased from 5 cmH 2O to 10 cmH 2O, CVP in high Ecw/Ers group increased significantly compared with that in low Ecw/Ers group [1.75(1.00, 2.13) mmHg (1 mmHg=0.133kPa) vs. 1.50(0.50, 2.00)mmHg, P=0.038], which was the same as PEEP increased from 10 cmH 2O to 15 cmH 2O [2.00(1.50, 3.00)mmHg vs. 1.50(1.00, 2.00)mmHg, P=0.041] or PEEP increased from 5 cmH 2O to 15 cmH 2O [ 3.75(3.00,4.63)mmHg vs. 3.00(1.63, 4.00)mmHg, P=0.012]. When PEEP increased from 5 cmH 2O to 10 cmH 2O, 10 cmH 2O to 15 cmH 2O and 10 cmH 2O to 15 cmH 2O, there were significant correlations between Ecw/Ers and CVP elevation ( r=0.29, P=0.016; r=0.31, P=0.011; r=0.31, P=0.01 respectively). Conclusions:In patients receiving mechanical ventilation, elevation of PEEP leads to a synchronous change of CVP, which is corelated with patients′ chest wall elastic resistances.
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Objective:To evaluate the clinical efficacy of Qingfei-Xiaoyan Decoction combined with anti infective mechanical ventilation in the treatment of senile severe pneumonia. Methods:A total of 102 patients with severe pneumonia in our hospital from June 2018 to May 2021 who met the inclusion criteria were randomly divided into two groups by random number table method, with 51 in each group. The control group was treated with anti-infection mechanical ventilation, and the study group was treated with Qingfei-Xiaoyan Decoction on the basis of the control group. Both groups were treated for 2 weeks. TCM syndrome scores were performed before and after treatment. The severity of infection was evaluated by clinical pulmonary infection score (CPIS), FVC, FEV1 and peak expiratory flow (PEF) were detected by pulmonary function meter, and the levels of TNF-α, high mobility group box 1 (HMGB1) and CRP were detected by enzyme-linked immunosorbent assay, adverse events were recorded and clinical efficacy was evaluated. Results:The total effective rate was 94.1% (48/51) in the study group and 80.4% (41/51) in the control group, and there was significant difference between the two groups ( χ2=4.320, P=0.038). After treatment, the TCM syndrome score and CPIS score of the study group were significantly lower than those of the control group ( t values were 14.203 and 11.403, respectively, all Ps<0.01), FVC, FEV1 and PEF in the study group were significantly higher than those in the control group ( t values were 4.663, 3.451 and 13.220, respectively, all Ps<0.01), and the levels of serum CRP, TNF-α and HMGB1 in the study group were significantly lower than those in the control group ( t values were 14.672, 10.277 and 24.453, respectively, all Ps<0.01). During the treatment, no serious adverse reactions occurred in both groups. Conclusions:Qingfei-Xiaoyan Decoction combined with anti-infective mechanical ventilation has a significant effect in the treatment of senile severe pneumonia. It can alleviate clinical symptoms, improve lung function, reduce inflammatory reaction with safety.
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ABSTRACT Objective: Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation (MV). However, data on VAP in patients on prolonged MV (PMV) are scarce. We aimed to describe the characteristics of VAP patients on PMV and to identify factors associated with mortality. Methods: This was a retrospective cohort study including VAP patients on PMV. We recorded baseline characteristics, as well as 30-day and 90-day mortality rates. Variables associated with mortality were determined by Kaplan-Meier survival analysis and Cox regression model. Results: We identified 80 episodes of VAP in 62 subjects on PMV. The medians for age, Charlson Comorbidity Index, SOFA score, and days on MV were, respectively, 69.5 years, 5, 4, and 56 days. Episodes of VAP occurred between days 21 and 50 of MV in 28 patients (45.2%) and, by day 90 of MV, in 48 patients (77.4%). The 30-day and 90-day mortality rates were 30.0% and 63.7%, respectively. There were associations of 30-day mortality with the SOFA score (hazard ratio [HR] = 1.30; 95% CI: 1.12-1.52; p < 0.001) and use of vasoactive agents (HR = 4.0; 95% CI: 1.2-12.9; p = 0.02), whereas 90-day mortality was associated with age (HR = 1.03; 95% CI: 1.00-1.05; p = 0.003), SOFA score (HR = 1.20; 95% CI: 1.07-1.34; p = 0.001), use of vasoactive agents (HR = 4.07; 95% CI: 1.93-8.55; p < 0.001), and COPD (HR = 3.35; 95% CI: 1.71-6.60; p < 0.001). Conclusions: Mortality rates in VAP patients on PMV are considerably high. The onset of VAP can occur various days after MV initiation. The SOFA score is useful for predicting fatal outcomes. The factors associated with mortality could help guide therapeutic decisions and determine prognosis.
RESUMO Objetivo: A pneumonia associada à ventilação mecânica (PAVM) é uma séria complicação da ventilação mecânica (VM). Entretanto, dados sobre PAVM em pacientes em VM prolongada (VMP) são escassos. Nosso objetivo foi descrever as características de pacientes com PAVM em VMP e identificar fatores associados à mortalidade. Métodos: Estudo de coorte retrospectivo incluindo pacientes com PAVM em VMP. Foram registradas características basais, bem como as taxas de mortalidade em 30 e 90 dias. As variáveis associadas à mortalidade foram determinadas por meio da análise de sobrevida de Kaplan-Meier e do modelo de regressão de Cox. Resultados: Foram identificados 80 episódios de PAVM em 62 indivíduos em VMP. As medianas de idade, índice de comorbidade de Charlson, pontuação no SOFA, e dias em VM foram, respectivamente, de 69,5 anos, 5, 4 e 56 dias. Os episódios de PAVM ocorreram entre o 21º e o 50º dia de VM em 28 pacientes (45,2%) e até o 90º dia de VM em 48 pacientes (77,4%). As taxas de mortalidade em 30 e 90 dias foram de 30,0% e 63,7%, respectivamente. A mortalidade em 30 dias associou-se a pontuação no SOFA (razão de risco [RR] = 1,30; IC95%: 1,12-1,52; p < 0,001) e uso de drogas vasoativas (RR = 4,0; IC95%: 1,2-12,9; p = 0,02), enquanto a mortalidade em 90 dias associou-se a idade (RR = 1,03; IC95%: 1,00-1,05; p = 0,003), pontuação no SOFA (RR = 1,20; IC95%: 1,07-1,34; p = 0,001), uso de drogas vasoativas (RR = 4,07; IC95%: 1,93-8,55; p < 0,001) e DPOC (RR = 3,35; IC95%: 1,71-6,60; p < 0,001). Conclusões: As taxas de mortalidade em pacientes com PAVM em VMP são consideravelmente altas. O início da PAVM pode ocorrer vários dias após a instituição da VM. O escore SOFA é útil para predição de desfechos fatais. Os fatores associados à mortalidade podem ajudar a orientar as decisões terapêuticas e a determinar o prognóstico.
Subject(s)
Humans , Aged , Pneumonia, Ventilator-Associated/etiology , Respiration, Artificial/adverse effects , Retrospective Studies , Risk Factors , Organ Dysfunction Scores , Intensive Care UnitsABSTRACT
ABSTRACT Purpose: To investigate the effects of propofol on inflammatory response and activation of p38 mitogen-activated protein kinase (MAPK) signaling pathway in rats with ventilator-associated lung injury (VALI). Methods: Thirty-six Sprague Dawley (SD) rats were divided into control, VALI and VALI+propofol groups. The VALI group received the mechanical ventilation for 2 h. The VALI+propofol group received the mechanical ventilation for 2 h, which was accompanied by intravenous injection of propofol with dose of 8 mg·kg-1·h-1. At the end, the mean arterial pressure (MAP) and blood gas indexes were measured, and the lung wet/dry mass ratio (W/D) and biochemical indexes of lung tissue and bronchoalveolar lavage fluid (BALF) were determined. Results: Compared with VALI group, in VALI+propofol group the blood pH, partial pressure of oxygen, partial pressure of carbon dioxide and MAP were increased, the lung W/D, lung tissue myeloperoxidase activity and total protein concentration, white blood cell count, and tumor necrosis factor α, interleukin 1β and interleukin 6 levels in BALF were decreased, and the p-p38 MAPK protein expression level and phosphorylated p38 MAPK (p-p38 MAPK)/p38 MAPK ratio were decreased. Conclusions: Propofol treatment may alleviate the VALI in rats by reducing the inflammatory response and inhibiting the activation of p38 MAPK signaling pathway.
Subject(s)
Animals , Rats , Propofol/pharmacology , Ventilator-Induced Lung Injury/drug therapy , Signal Transduction , Rats, Sprague-Dawley , p38 Mitogen-Activated Protein Kinases/metabolism , Lung/metabolismABSTRACT
1. INTRODUCCIÓNLa pandemia ocasionada por el Corona-virus tipo 2 del Síndrome Respiratorio Agudo Grave (SARSCoV-2) en la actua-lidad, anticipa una demanda de ventila-dores mecánicos, la Organización Mun-dial de la Salud (OMS), reporta que el 5% de los contagiados cae de forma rápida en insuficiencia respiratoria y requiere de cuidados intensivos1-3. La Food and Drug Administration (FDA), quien aprobó de manera temporal el uso de la Máquina de Anestesia (MA) como Ventilador Mecánico (VM) y la American Society of Anesthesiologists (ASA) junto con la Anesthesia Patient Safety Founda-tion (APSF), publicaron una declaración donde se reconoció que las máquinas de anestesia no están diseñadas para entregar apoyo ventilatorio a largo plazo, sin em-bargo, se han transformado en la primera línea natural de apoyo durante la pan-demia cuando no hay suficientes ventila-dores en áreas críticas hospitalarias1,2,4.Países como Chile por medio de la So-ciedad de Anestesiología de Chile (SACHA), ha puesto en práctica estas recomendaciones previo a un informe técnico. De igual manera en la Unidad Técnica de Anestesiología y a través de este protocolo se procura estandarizar el manejo de la MA con varias recomenda-ciones, para que puedan ser utilizadas en forma segura y efectiva, dado que el uso de las máquinas de anestesia como VM "es una maniobra de salvataje"2. De esta manera se pretende entregar li-neamientos para dar asistencia ventila-toria a pacientes que requieren ventilación mecánica por un cuadro positivo para In-fección por Coronavirus-19 (COVID-19) utilizando una MA, ante la imposibilidad de disponer de un Ventilador de Cuidados Intensivos (VCI).
1. INTRODUCTIONThe pandemic caused by the Severe Acute Respiratory Syndrome (SARSCoV-2) Coronavirus type 2, currently anticipates a demand for mechanical ventilators, the World Health Organization (WHO), re-ports that 5% of infected people rapidly fall into respiratory failure and require in-tensive care1-3 .The Food and Drug Administration (FDA), which temporarily approved the use of the Anesthesia Machine (AM) as a Mechanical Ventilator (MV). The Ame-rican Society of Anesthesiologists (ASA) together with the Anesthesia Patient Safety Foundation (APSF), issued a state-ment acknowledging that anesthesia ma-chines are not designed to deliver long-term ventilation support, however, they have become the first natural line of su-pport during the pandemic, when there are not enough ventilators in critical hos-pital areas1,2,4.Countries such as Chile, through the Society of Anesthesiology of Chile (SACHA), have implemented these re-commendations prior to a technical report. Similarly, in the Technical Unit of Anesthesiology and through this protocol, it is trying to standardize the management of AM with several recommendations, so they can be used in the safest and most effective way, since the use of anesthesia machines as a MV "is a dangerous ma-neuver"2.In this way, guidelines are provided to in order to give mechanical ventilation as-sistance the patients who required me-chanical ventilation due to one posi-tive picture of Coroanvirus-19 Infection (COVID-19) using an AM, given the im-possibility of having an Intensive Care Ventilator (IVC).
Subject(s)
Humans , Male , Female , Respiration, Artificial , Ventilators, Mechanical , Coronavirus Infections , Severe Acute Respiratory Syndrome , Equipment and Supplies , Anesthesia , Respiratory Insufficiency , Coronavirus , Critical Care , Interactive Ventilatory Support , Intubation, Intratracheal , AnesthesiologyABSTRACT
RESUMO A pandemia por COVID-19 tem deixado os gestores, os profissionais de saúde e a população preocupados com a potencial escassez de ventiladores pulmonares para suporte de pacientes graves. No Brasil, há diversas iniciativas com o intuito de produzir ventiladores alternativos para ajudar a suprir essa demanda. Para auxiliar as equipes que atuam nessas iniciativas, são expostos alguns conceitos básicos sobre fisiologia e mecânica respiratória, os termos comumente utilizados no contexto da ventilação mecânica, as fases do ciclo ventilatório, as diferenças entre disparo e ciclagem, os modos ventilatórios básicos e outros aspectos relevantes, como mecanismos de lesão pulmonar induzida pela ventilação mecânica, pacientes com drive respiratório, necessidade de umidificação de vias aéreas, risco de contaminação cruzada e disseminação de aerossóis. Após a fase de desenvolvimento de protótipo, são necessários testes pré-clínicos de bancada e em modelos animais, a fim de determinar a segurança e o desempenho dos equipamentos, seguindo requisitos técnicos mínimos exigidos. Então, é imprescindível passar pelo processo regulatório exigido pela Agência Nacional de Vigilância Sanitária (ANVISA). A empresa responsável pela fabricação do equipamento deve estar regularizada junto à ANVISA, que também deve ser notificada da condução dos testes clínicos em humanos, seguindo protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa. O registro do ventilador junto à ANVISA deve ser acompanhado de um dossiê, composto por documentos e informações detalhadas neste artigo, que não tem o propósito de esgotar o assunto, mas de nortear os procedimentos necessários.
ABSTRACT The COVID-19 pandemic has brought concerns to managers, healthcare professionals, and the general population related to the potential mechanical ventilators' shortage for severely ill patients. In Brazil, there are several initiatives aimed at producing alternative ventilators to cover this gap. To assist the teams that work in these initiatives, we provide a discussion of some basic concepts on physiology and respiratory mechanics, commonly used mechanical ventilation terms, the differences between triggering and cycling, the basic ventilation modes and other relevant aspects, such as mechanisms of ventilator-induced lung injury, respiratory drive, airway heating and humidification, cross-contamination risks, and aerosol dissemination. After the prototype development phase, preclinical bench-tests and animal model trials are needed to determine the safety and performance of the ventilator, following the minimum technical requirements. Next, it is mandatory going through the regulatory procedures as required by the Brazilian Health Regulatory Agency (Agência Nacional de Vigilância Sanitária - ANVISA). The manufacturing company should be appropriately registered by ANVISA, which also must be notified about the conduction of clinical trials, following the research protocol approval by the Research Ethics Committee. The registration requisition of the ventilator with ANVISA should include a dossier containing the information described in this paper, which is not intended to cover all related matters but to provide guidance on the required procedures.
Subject(s)
Humans , Animals , Pneumonia, Viral/therapy , Respiration, Artificial/instrumentation , Ventilators, Mechanical , Coronavirus Infections/therapy , Pneumonia, Viral/epidemiology , Brazil/epidemiology , Respiratory Mechanics , Coronavirus Infections/epidemiology , Equipment Design , Ventilator-Induced Lung Injury/prevention & control , Pandemics , COVID-19Subject(s)
Humans , Male , Female , Adult , Aged , Pulmonary Veins , Atrial Fibrillation/surgery , Tachycardia, Supraventricular/surgery , Catheter Ablation , Fluoroscopy , Treatment Outcome , Middle AgedABSTRACT
Objetivo. Los recursos hospitalarios resultan insuficientes ante la demanda de pacientes graves con COVID-19. La adecuada gestión de recursos es esencial para brindar la mejor atención posible. Se revisaron criterios que ayuden a tomar decisiones adecuadas y oportunas, siguiendo principios éticos. La priorización del soporte ventilatorio invasivo debe hacerse de manera transparente y objetiva, evaluando integralmente al paciente y basado en criterios objetivos como escalas de pronóstico, ciclo de vida o compromiso clínico. El tratamiento sintomático (incluyendo cuidados paliativos) es indispensable en esta pandemia y la comunicación con el aciente o la familia permiten humanizar la atención del personal de salud.
Objetive. Hospital resources are insufficient given the demand for seriously ill patients with COVID-19. Proper resource management is essential to provide the best possible care. Criteria to help make appropriate and timely decisions were reviewed, following ethical principles. The prioritization of invasive ventilatory support must be done in a transparent and objective manner, comprehensively evaluating the patient and based on objective criteria such as prognostic scales, life cycle or clinical commitment. Symptomatic treatment (including palliative care) is essential in this pandemic and communication with the patient or family makes it possible to humanize the care of health personnel.
ABSTRACT
RESUMO Objetivo: Comparar a eficiência das técnicas de vibrocompressão e hiperinsuflação com ventilador mecânico de forma isolada e a associação das duas técnicas (hiperinsuflação com ventilador mecânico + vibrocompressão), na quantidade de secreção aspirada e na alteração de parâmetros hemodinâmicos e pulmonares. Métodos: Ensaio clínico randomizado com pacientes críticos em ventilação mecânica, realizado na unidade de terapia intensiva de um hospital universitário. Os pacientes foram randomizados para receber uma das técnicas de higiene brônquica por 10 minutos (vibrocompressão, ou hiperinsuflação com ventilador mecânico, ou hiperinsuflação com ventilador mecânico + vibrocompressão). Após, foram novamente randomizados para receber inicialmente a técnica (previamente randomizada) ou apenas a aspiração isolada. Foram analisados o peso de secreção aspirada (em gramas), dados de mecânica ventilatória e cardiopulmonares, antes e após a aplicação das técnicas. A frequência de reintubação traqueal, o tempo de ventilação mecânica e a mortalidade, também foram avaliados. Resultados: Foram incluídos 93 pacientes (29 vibrocompressão, 32 hiperinsuflação com ventilador mecânico e 32 hiperinsuflação com ventilador mecânico + vibrocompressão) em ventilação mecânica por mais de 24 horas. O grupo hiperinsuflação com ventilador mecânico + vibrocompressão foi o único que apresentou aumento significativo da secreção aspirada, quando comparado a aspiração isolada 0,7g (0,1 - 2,5g) versus 0,2g (0,0 - 0,6g), com valor de p = 0,006. Conclusão: Quando comparada à aspiração isolada, a associação das técnicas hiperinsuflação com ventilador mecânico + vibrocompressão foi mais eficiente na quantidade de secreção aspirada.
ABSTRACT Objective: To compare the effects of vibrocompression and hyperinflation with mechanical ventilator techniques alone and in combination (hyperinflation with mechanical ventilator + vibrocompression) on the amount of aspirated secretion and the change in hemodynamic and pulmonary parameters. Methods: A randomized clinical trial with critically ill patients on mechanical ventilation conducted in the intensive care unit of a university hospital. The patients were randomly allocated to receive one of the bronchial hygiene techniques for 10 minutes (vibrocompression or hyperinflation with mechanical ventilator or hyperinflation with mechanical ventilator + vibrocompression). Afterwards, the patients were again randomly allocated to receive either the previous randomly allocated technique or only tracheal aspiration. The weight of aspirated secretions (in grams), ventilatory mechanics and cardiopulmonary data before and after the application of the techniques were analyzed. The tracheal reintubation frequency and time and mortality on mechanical ventilation were also evaluated. Results: A total of 93 patients (29 vibrocompression, 32 hyperinflation with mechanical ventilator and 32 hyperinflation with mechanical ventilator + vibrocompression) on mechanical ventilation for more than 24 hours were included. The hyperinflation with mechanical ventilator + vibrocompression group was the only one that presented a significant increase in aspirated secretions compared to tracheal aspiration alone [0.7g (0.1 - 2.5g) versus 0.2g (0.0 - 0.6g), p value = 0.006]. Conclusion: Compared to tracheal aspiration alone, the combination of hyperinflation with mechanical ventilator + vibrocompression techniques was most efficient for increasing the amount of aspirated secretions.
Subject(s)
Humans , Male , Female , Aged , Respiration, Artificial , Suction/methods , Ventilators, Mechanical , Intensive Care Units , Time Factors , Critical Illness , Hemodynamics , Hospitals, University , Middle AgedABSTRACT
Objective@#To evaluate the protective effects of ulinastatin combined with lung-protective ventilation on lungs in patients undergoing laparoscopic colorectal carcinoma surgery.@*Methods@#A total of 120 patients undergoing laparoscopic radical resection of colorectal cancer in Yuncheng Central Hospital were selected in this study.According to thedigital table, they were randomly divided into conventional mechanical ventilation group(G0 group), lung protection mechanical ventilation group(G1 group), conventional mechanical ventilation combined with ulinastatin group(G2 group)and lung protection mechanical ventilation combined with ulinastatin group(G3 group), with 30 cases in each group.Ulinastatin 2 500IU was intravenously infused 10min before induction of anesthesia in G2 group and G3 group.Ventilator parameters were set as tidal volume(VT)10mL/kg, respiratory frequency 12 times/min, inspiration-expiration ratio(I∶E)1∶2 in G0 group and G2 group.VT 6mL/kg in G1 group and G3 group , positive end-expiratory pressure ventilation(PEEP)5-10cmH2O, respiratory frequency 12-18 times/min, once every 30min.Before anesthesia induction(T0), before pneumoperitoneum(T1), 2h after pneumoperitoneum(T2), before extubation(T3), 24h after operation(T4), arterial blood was collected to detect partial pressure of oxygen(PaO2), oxygenation index(OI). And mean airway pressure(Pmean), peak airway pressure(Ppeak)at T1-3 were recorded.Venous blood was collected at T0, T3 and T4 to detect serum concentrations of interleukin-6(IL-6), interleukin-8(IL-8)and tumor necrosis factor-alpha(TNF-α).@*Results@#At T3, the PaO2 of G1 group, G2 group and G3 group were (457±60)mmHg, (460±49)mmHg and (510±45)mmHg, respectively.At T4, the PaO2 of the three groups were (90±6)mmHg, (92±7)mmHg and (96±7)mmHg, respectively.The PaO2 in G1 group and G2 group were lower thanthose in G3 group at T3-4(t=3.872, 3.850, 4.186, 2.513, all P<0.05). At T2, the OI of the three groups were (460±44), (462±37) and (481±31), respectively.At T3, the OI of the three groups were (460±51), (475±62) and (504±38), respectively.The OI in G1 group and G2 group were lower than those in group G3 at T2-3(t=2.142, 3.753, 2.209, 2.170, all P<0.05). At T2, the Pmean of G1 group, G2 group and G3 group were (10.5±1.5)cmH2O, (11.2±1.9)cmH2O and (9.5±0.9)cmH2O, respectively, the Ppeak of the three groups were (22.3±3.0)cmH2O, (24.0±3.3)cmH2O and (22.3±2.9)cmH2O, respectively.At T3, the Pmean of the three groups were (10.9±1.1)cmH2O, (11.1±1.8)cmH2O and (9.8±0.9)cmH2O, respectively, the Ppeak of the three groups were (22.8±2.7)cmH2O, (24.1±2.1)cmH2O and (21.6±2.0)cmH2O, respectively.The Pmean in G1 group and G2 group at T2-3 were lower than those in G3 group(t=3.061, 4.580, 5.759, 4.305, 3.746, all P<0.05), the Ppeak in G2 group at T2-3 were lower than those in G3 group(t=2.952, 4.630, all P<0.05). At T4, the serum concentrations of IL-6 of G1 group, G2 group and G3 group were (151±28)ng/L, (152±20)ng/L and (136±18)ng/L, respectively, the IL-8 levels of the three groups were (468±28)ng/L, (359±65)ng/L and (327±51)ng/L, respectively, the TNF-α levels of the three groups were (1.09±0.20)ng/L, (1.08±0.20)ng/L and (0.94±0.20)ng/L, respectively.The concentrations of IL-6, IL-8 and TNF-α at T4 in G1 group and G2 group were higher than those in G3 group(t=2.428, 4.094, 2.536, 4.251, 2.807, 3.128, 4.119, 2.592, 3.446, 2.555, all P<0.05).@*Conclusion@#The combination of ulinastatin and lung-protective ventilation provides protective effects on lungs and exerts better efficacy than either alone.
ABSTRACT
To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome ( ARDS) undergoing mechanical ventilation.Methods From March 2016 to September 2018,90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group (D group,30 cases),propofol group(P group,30 cases), midazolam group(M group,30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group (C group).In M,P and D groups,the sedative drugs were infused by micro -pump on the basis of analgesic treatment ( fentanyl citrate ).The heart rate ( HR),mean arterial pressure ( MAP), Murray score,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score,plasma norepinephrine ( NS), plasma cortisol(Cor),and blood T lymphocyte subsets (CD+4 ,CD+8 ,CD+4 ／CD+8 ) were observed in all patients at T0 (the beginning of sedation),T1 (6h after sedation),T2 (24h after sedation),T3(48h after sedation).The levels of NS and Cor in plasma and blood T lymphocyte subsets (CD+4 ,CD+8 ,CD+4 ／CD+8 ) in C group were measured at 8:00 a.m.the next day.Results The plasma NS and Cor at T0 in M,P and D group were higher than those in C group (all P＜0.05),while the levels of CD +4 were lower than those in C group ( all P＜0.05).Compared with T0,the plasma NS and Cor decreased at T3 in M,P and D group (all P＜0.05).The plasma Cor at T3 in P group was lower than that in M group[(475.77 ±49.69)μg／L vs.(502.33 ±60.92) μg／L] (t＝-26.57,P＜0.05).The plasma NS and Cor at T3 in D group were lower than those in M group [(20.64 ±4.70) ng／L vs.(25.29 ±4.03) ng／L, (442.83 ±66.59) μg／L vs.(502.33 ±60.92) μg／L] ( t＝-4.51,-59.50,all P＜0.05),and were lower than those of P group [( 20.64 ±4.70) ng／L vs.( 23.60 ±4.49) ng／L, (442.83 ±66.59) μg／L vs.( 475.77 ± 49.69)μg／L](t＝-2.96,-32.93,all P＜0.05).Compared with T0,the level of CD +4 decreased at T1,T2 and T3 (except T3 in D group) in M,P and D group (all P＜0.05),and the level of CD +8 decreased at T1,T2 and T3 in M and P group (all P＜0.05),but those in D group at T1,T2 and T3 were not significantly decreased (all P＞0.05). The levels of CD +8 at T2 and T3 in P and D groups were higher than that of M group ( all P＜0.05).The level of CD+4 ／CD+8 at T3 in D group were higher than that in M and P group [(1.46 ±0.30) vs.(1.26 ±0.33),(1.46 ± 0.30) vs.(1.32 ±0.34)]( t＝0.21,0.15,all P＜0.05).Conclusion Sedation with dexmedetomidine or propofol can alleviate stress response and improve immune function in ARDS patients undergoing mechanical ventilation ,and dexmedetomidine is better than propofol.
ABSTRACT
Objective To investigate the effect of early mobilization on gastrointestinal function and delirium in patients with mechanical ventilation of chronic obstructive pulmonary disease (COPD).Methods A total of 87 mechanically ventilated patients with COPD who met the inclusion criteria were selected as subjects from April 2017 to March 2018 in intensive care unit(ICU) of Huxi Hospital Affiliated to Jining Medical College.The patients were divided into treatment group (44 cases) and control group (43 cases) by the random number table method.On the basis of the same conventional treatment,the treatment group received early mobilization.The incidence of acute gastrointestinal injury (AGI),duration of AGI,incidence of delirium,duration of delirium,days of mechanical ventilation and 28-day mortality were compared between the two groups.Results The incidence rate of AGI in the treatment group was lower than that in the control group[40.9％ (18/44) vs.62.7％ (27/43)],and the duration in the treatment group was shortened[(3.95 ± 1.62)d vs.(5.23 ± 2.03)d],and the incidence rate of delirium in the treatment group was lower[54.5％ (24/44) vs.76.7％ (33/43)],the duration of delirium in the treatment group was shortened [(2.36 t 0.9) d vs.(3.25 ± 1.27) d],the mechanical ventilation time in the treatment group was decreased [(6.39 ± 1.76) d vs.(7.56 ± 1.49) d],the differences were statistically significant (x2 =4.17,t =-2.280,x2 =4.744,t =-2.919,-3.358,all P ＜ 0.05).There was no statistically significant difference in the rate of 28-day mortality between the two groups [2.3 ％ (1/43) vs.9.3 ％ (4/43),x2 =-1.984,P ＞ 0.05].Conclusion Early mobilization can reduce the incidence and duration of AGI and delirium in COPD patients with mechanical ventilation,reduce the severity of AGI,and shorten the time of mechanical ventilation.