Effect of preoperative duration of mechanical ventilation on prognosis in patients with ventricular septal defect: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To summarize the relationship between preoperative duration of mechanical ventilation and prognosis in patients with ventricular septal defect. Methods    The clinical data of patients with ventricular septal defect requiring ventilator support preoperatively and undergoing surgical treatment in our hospital from May 2009 to May 2020 were retrospectively reviewed. Based on the duration of preoperative ventilation, the patients were divided into three groups: a group A (0-47 hours), a group B (48-96 hours), and a group C (>96 hours). Each group's postoperative recovery, complications, and medical costs were analyzed. Results     Finally 272 patients were enrolled, including 154 males and 118 females, with a median surgical age of 2 (1, 4) months. There were 43 patients in the group A, 75 patients in the group B, and 154 patients in the group C. Early death occured in 3 (1.3%) patients, all in the group C. No statistical difference in mortality was found among the three groups (P=0.734). The mean postoperative duration of mechanical ventilation in the three groups was 158.6±133.5 hours, 101.2±56.1 hours, and 133.1±97.9 hours, respectively. The group B had significantly shorter duration than the other two groups (P<0.05). The mean postoperative hospital stay in the three groups was 17.5±9.9 days, 13.5±5.8 days, and 16.5±10.8 days, respectively. Postoperative hospital stay in the group B was significantly shorter than that in the other two groups (P<0.05). The mean total in-hospital cost in the three groups were 89 000±34 000 yuan, 87 000±21 000 yuan, and 109 000±41 000 yuan, respectively. The costs in the group C were significantly higher than those in the other two groups (P≤0.001). Conclusion    Prompt surgical repair is necessary for patients with ventricular septal defects requiring ventilator support preoperatively. However, attention should be paid to surgical timing. Preoperative duration of mechanical ventilation is associated with better surgical outcomes within 48-96 hours than 0-47 hours or >96 hours.

Respiratory support in patients with acute respiratory distress syndrome:an expert opinion interpretation / 中国小儿急救医学

Acute respiratory distress syndrome (ARDS) is a common disease in intensive care unit. ARDS has attracted wide attention of clinicians for its high in-hospital mortality and high incidence of long-term mortality. This expert opinion reviews the available clinical evidence and adjuvant treatment of ventilator support. Based on clinical evidence and experience,we provide suggestions for the management of patients with ARDS. We interpret this expert opinion and some experience in children was added,hoping to provide suggestions for the treatment of children with ARDS.

Continuous Infusion of Ketamine in Mechanically Ventilated Patient in Septic Shock with Status Asthmaticus / 대한구급학회지

Ketamine is well known for its analgesic, bronchodilating and sympathetic stimulating effect. Hence, it has been widely used for induction of patients with hypotension or asthma and also for analgesic and sedating purposes in the ICU. We presented a 62 year old female patient with ventilator support in septic shock with refractory asthma whom we managed successfully with continuous intravenous infusion of ketamine postoperatively in the ICU. The patient had a history of asthma but had been asymptomatic recently and was scheduled for an emergent explo-laparotomy under the diagnosis of acute panperitonitis. Before the induction of anesthesia, the patient was in septic shock but no wheezing could be auscultated. After the induction of general anesthesia and endotracheal intubation, wheezing was apparent in both lung fields with a high peak inspiratory pressure. Inotropics, vasopressors and bronchodilators were promptly instituted without any improvement of asthma and the patient had to be transferred to the ICU with intubated after the operation. Clinical symptoms of asthma continued throughout the first day despite using bronchodilators under mechanical ventilation but, after starting the IV infusion of ketamine, there were decrease in the peak inspiratory pressure and wheezing with a subsequent improvement in the arterial blood gas analysis findings. We could also achieve considerable analgesic and sedating effect without any decrease in the blood pressure. The patient's general physical status improved and weaning with extubation was successfully done on the 21st day and was transferred to the general ward on the 28th day.

A pilot study of using spurt,repeated cryoinjury and off-ventilator to establish rat model of acute myocardial infarction / 第三军医大学学报

Objective To explore a new method of establishing rat model of acute myocardial infarction by off ventilator support,spurt and repeated cryoinjury.Methods Sixty Wistar rats with male and female in half were randomized into three experimental groups according to cryoinjury time with 20 rats in each group:15-second group(cryoinjury for 5 s each time,three times in total),25-second group(5 s each time,five times in total)and 40-second group(5 s each time,eight times in total).The heart was exposed through a 1.0-to 1.5-cm left lateral thoracotomy.Cryoinjury of the LV free wall(LVFW)was performed by applying for 5 s a round copper probe of 6-mm in diameter immersed in liquid nitrogen for 5 min to reach-190 ℃,then the thoracic cavity was closed immediately.When the rats' breath restored,the cryoinjury of the LVFW in situ was repeatedly to ensure a transmural injury according to the protocol.The survival rate during operation and in 28 days after operation was observed.Also infarct size was observed by heart pathological section stained with Masson's trichrome on day 28 after operation.Results Infarct size in all three groups was larger than 20% signified by transmural injury,and completely myocardiolysis and distinct infarct boundary were observed.The survival rate was 16/20 in 15-second group,5/20 in 40-second group(P0.05 vs 15-second group and 40-second group).The infarct size in 40-second group was larger than the other two groups(standard deviation:10.564 4% vs 5.192 6%,6.496 0% in 15,25-second group,respectively)and its survival rate was lowest.The procedure of 25-second group was more complicated and had a tendency of higher death rate than that in 15-second group.Conclusion Using spurt,repeated ultra low temperature cryoinjury for 15 s may be an ideal method to establish the rat model of acute myocardial infarction.