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Objective To evaluation the effect of high flow humidification oxygen (HFHO) therapy for two elderly cases with respiratory rhythm abnormalities and multiple organ dysfunction weaning from mechanical ventilation.Methods Clinical features and weaning processes of two elderly cases with respiratory rhythm abnormalities and multiple organ dysfunction were analyzed and the related literature was reviewed.Results Two elderly patients had multiple organ dysfunction,respiratory rhythm abnormalities and other difficult weaning factors.After a variety of unsuccessfully weaning patterns,HFHO was successfully used in helping patients wean from mechanical ventilation,with gradually increasing the time of HFHO and restoring respiratory muscle function.Conclusions For elderly patients with artificial airways,respiratory muscle dysfunction(long-term mechanical ventilation)and/or respiratory rhythm abnormalities,HFHO is a promising weaning method.
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Objective To summarize the value of early mechanical ventilation plus continuous vacuum suction in treatment of serious pulmonary contusion.Methods Forty-eight cases of severe pulmonary contusion were assigned to mechanical ventilation plus continuous vacuum suction (observation group,n =20) and mechanical ventilation plus discontinuous vacuum suction (control group,n =28)according to the random number table.Modes of mechanical ventilation were synchronized intermittent mandatory ventilation (SIMV),pressure support ventilation (PSV),and positive and expiratory pressure (PEEP).Changes in blood gas analysis,mechanical ventilation time,and associated complications were compared between groups.Results At ventilation time of 6 and 24 hours,PaO2 in observation group was (100.36 ± 5.90) mmHg and (105.34 ± 7.40) mmHg respectively,with significant differences from (75.36 ± 8.95) mmHg and (76.36 ± 8.35) mmHg in control group (P ＜ 0.01).At ventilation time of 24 hours,PaO2/FiO2 was (283.50 ± 15.20) mmHg in observation group and (201.50 ± 10.20) mmHg in control group (P ＜0.01).Mechanical ventilation time and PEEP at ventilation time of 48 hours in observation group was (3.2 ± 1.1) days and (4.5 ± 2.3) cmH2 O,with significant differences from (6.5 ± 2.8) days and (8.5 ± 2.5) cmH2O in control group (P ＜ 0.01).Associated complications of the two groups revealed no significant difference (P ＞ 0.05).Conclusion Early mechanical ventilation with sustained vacuum suction is effective to keep airway clear,improve oxygenation index,decrease PEEP level,and control the duration of mechanical ventilation,but may not lower the risks of ventilator-associated pneumonia and pulmonary atelectasis.
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Objective To assess the clinical efffects off Ipratropium bromide combined with atomization inhalation of budesonide via a ventilator with a Y-shaped connector on acute exacerbation off chronic obstructive pulmonary disease (AECOPD).Methods A total off 62 AECOPD patients treated at our hospital from June 2013 to September 2014 were randomly divided into the experimental group (n=31,treated with ipratropium bromide combined with atomization inhalation of budesonide) and the control group (n =31,treated with the same amount of saline).Results The airway pressure of mechanical ventilation,the time of mechanical ventilation and the time of staying in the intensive care unit all showed significant differences between the experimental and control groups [(25.4±5.2) cmH2O vs.(38.1±3.4) cmH2O,(6.5±1.3) d vs.(6.8±1.4) d,(8.9±2.1) d vs.(9.5±1.5) d,t=10.934,0.960,1.108,respectively,P＜0.05 for all].The rate of tracheotomy was lower in the experimental group than in the control group (17/31 or 54.8％ vs.20/31 or 64.5％,x2 =0.603,P＜0.05).Conclusions Ipratropium bromide combined with budesonide inhalation under mechanical ventilation via a Y-shaped connector has ffavorable clinical effects on AECOPD.
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Objective To analyze the reasons for accidental extubation in infants during mechanical ventilation and to explore effective intervention countermeasures.Methods A total of 148 infants with accidental extubation from May 2013 to February 2014 who given routine nursing care were selected as control group.Another 152 infants with accidental extubation in pediatric intensive care unit (PICU) who given optimization nursing care from March to December 2014 were selected as observation group.Retrospective analysis of accidental extubation,artificial airway way and intervention care were conducted.Results The total intratracheal tube time was 283 d in control group and 253 d in observation group.Nineteen cases (6.7％) suffered accidental exudation in control group and that of 8 cases(3.2％) in observation group,and there was significant difference between two groups,x2=5.25,P＜0.05.The primary reason of unplanned extubation was that infants with unconsciousness,the second cause was the improper catheter fixed.The third cause was the patient's comfort level and so on the improper nursing operation leading to accidental extubation too short or too shallow.Conclusion Infants given mechanical ventilation should pay more attention to the intervention of accidental extubation,appropriate calm,physical constraints and correct fixed pipeline.
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Objective To establish an animal model of crush syndrome in rabbits and investigate the preventive effect of negative pressure drainage.Methods Twenty-four New Zealand rabbits were randomly divided into four groups:control group,traditional treatment group,negative-pressure treatment group and mixed treatment group,with six rabbits per group.Blood urea nitrogen (BUN),creatinine (Cr),K,creatine kinase (CK) and myoglobin (Myo) were detected before crush and at 6,12,24,48,72 hours after decompression.Edema and analgesia of extremities were determined and changes of kidney and muscular tissue were observed by light microscope.Results As time went on,K,Myo,BUN and CR had unobvious rise in each treatment group,without the presence of renal failure.The control group showed marvelous increases of K,Myo,BUN and Cr at 6 hours after decompression,from (4.61 ±0.98)mmol/L,(4.22±0.93) ng/ml,(7.76±1.40) mmol/L,(101.32±9.35)μmol/Lto (7.88±1.95)mmol/L,(11.34 ±3.86) ng/ml,(15.91 ± 1.76) mmol/L,(258.32 ±91.40) μmol/L separately,with renal failure and significant differences in comparison with other treatment group (P ＜0.05).The level of tissue edema and degree of analgesia in negative-pressure treatment group and mixed treatment group were lower than those in the traditional treatment group.Renal damage in all the treatment groups was milder than that in the control group by light microscopic observation,while there was no significant difference of muscle injury among groups.Conclusion Negative pressure drainage may prevent crush syndrome.