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Corona virus disease 2019 (COVID-19) progresses very rapidly and a part of patients' condition quickly deteriorate to a severe type or critical severe type, even died of multiple organ failure. Therapeutic principle of these patients is centered on improving oxygenation and lung protection and multiple organ function support. Respiration support includes high-flow nasal cannula oxygen therapy (HFNC), non-invasive positive pressure ventilation (NIPPV), tracheal cannula with mechanical ventilation and extracorporeal membrane oxygenation (ECMO) and assistance methods including lung recruitment and prone position ventilation. Considering COVID-19 progresses rapidly and is very difficult in respiratory therapy, we should pay close attention to above mentioned methods. In particular, identifying risk factors of treatment failure of HFNC and NIPPV in early phase, applying lung recruitment prudently and active application of turning around and beat back and prone position ventilation to help postural drainage and early tracheal cannula with mechanical ventilation and ECMO would be beneficial to the patients.
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Objective To explore the effect of sitting and lateral sputum aspiration on the retention time of tracheal cannula in patients with neurosurgical tracheotomy. Methods Totally 120 cases of neurosurgery tracheotomy in hospitalized patients complicated with pulmonary infection by random number table method, 58 cases were divided into experimental group and control group 62 examples, two groups of patients with sputum top all joint taps to the back of the chest, the experimental group after taps take seat effectively causes cough; In the control group, the lateral position was used to effectively cough or induce cough, and the daily sputum volume of the two groups of patients was observed. To observe the time when the body temperature was restored to normal after the phlegm of the two groups of patients, the time of the lung auscultation, and the time of the tracheal tube retention. Results Implementing position row of phlegm daily sputum volume within a week the experimental group were (44.84±6.85) ml, (44.60±6.80) ml, (43.79±5.98) ml, (44.38±5.42) ml, (42.22±5.45) ml, (38.12±4.77) ml, (36.88±4.57) ml and control group were(36.13±7.34) ml, (35.15±7.34) ml, (36.13±7.34) ml, (37.13±7.34) ml, (37.13±7.34) ml, (32.97±7.17) ml, (31.35±4.36) ml, the difference had statistical significance (t=4.30-7.31, P<0.01);In the two groups, the time of normal body temperature recovery, the time of hearing and the time of the lung and the time spent in the tracheal tube were compared, and the experimental group were respectively (9.93±2.02) d, (32.33±1.50) d, (37.33±1.50) d, while control group were(15.77±1.05) d, (37.63 ± 2.33) d, (42.63 ± 2.33) d, the difference had statistical significance (t=20.04, 14.71, P<0.01). Conclusions It is better to reduce the retention time of tracheal tube in patients with neurosurgical patients than the lateral position.
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Objective To explore the efficacy of self-made adjustable tracheal cannula in obese patients with tracheotomy. Methods A corresponding model of tracheal cannula was taken and cut with a length of 16 cm. It is noted that the inflation catheter of the airbag should not be broken. A further trim was done along the longitudinal side of the inflation catheter. The inflation catheter was retained. A rubber cork from a nutrient solution bottle was chosen, and a hole was trimmed with the same length of the diameter of the tracheal cannula, through which the tracheal cannula was put. A disposal oxygen mask was trimmed into two wings like a butterfly, the middle of which was made into a hole with the same length of the diameter of the tracheal cannula. Two rectangular holes were made on the two wings in order to fit the rubber cork. The fixed wings of and rubber cork were put together through sutures. The other end of the tracheal cannula was cut and put on a connector and sterilized with ethylene oxide in the supply room. The intraoperative method was the same as the conventional tracheotomy. After the cannula was inserted, the length of the cannula was adjusted by moving the rubber cork up and down according to the obesity of the patient′s neck. Results Compared with regular tracheal cannula, the self-made adjustable tracheal cannula could be easily inserted into the trachea of patients no matter how obese their necks were. It could be connected to ventilator, keep patient′s airway clear and effectively drain phlegm. No slippage was observed in our practice. It was simple, accessible and lower in cost. Conclusions The application of self-made adjustable tracheal cannula in obese patients with tracheotomy can meet the clinical therapeutic needs, and it also proves to be affordable for patients.
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Objective:To develop a catheter of movable tracheal cannula for single lung ventilation so as to compensate the existed disadvantages of using double-lumen bronchial catheter and bronchial occlusive device in single lung ventilation in present.Methods: A long tracheal catheter was installed into a short endotracheal catheter so as to form a complete catheter of tracheal cannula. The internally installed catheter could be rotated and moved in the cannula. After then, the front-end direction of internally installed catheter was chose through rotated the catheter according to the requirement of operation, and the single lung ventilation could be achieved when the internally installed catheter was pushed forward and was inserted in left or right bronchus. After the operation, the internally installed catheter exited out from bronchus to trachea and was used to implement double lung ventilation, or it was pulled out from outer cannula and the double lung ventilation was implemented by using outer cannual.Results: The ventilation effect of single-lung was doubtless when the catheter of movable tracheal cannula was inserted in left or right bronchus by using internally installed catheter. The technique of intubation tube was simpler than that of double-lumen bronchial catheter and bronchial occlusive device. The internally installed catheter could rotate in the outer cannula so as to protect tracheal wall and avoid oxygen deficit of patient during the processes of replacing tracheal catheter and the difficulty of replacing tracheal catheter post-operation of double-lumen bronchial catheter. Besides, it also could avoid the injury risk of anastomotic stoma of esophageal surgery caused by mis-insertion of tracheal catheter in esophagus.Conclusion: This kind of removable tracheal cannula has reasonable design, simple operation of intubation and better clinical practicability, and its feasibility is better that the product is transformed.
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Objective:To develop a catheter of movable tracheal cannula for single lung ventilation so as to compensate the existed disadvantages of using double-lumen bronchial catheter and bronchial occlusive device in single lung ventilation in present.Methods: A long tracheal catheter was installed into a short endotracheal catheter so as to form a complete catheter of tracheal cannula. The internally installed catheter could be rotated and moved in the cannula. After then, the front-end direction of internally installed catheter was chose through rotated the catheter according to the requirement of operation, and the single lung ventilation could be achieved when the internally installed catheter was pushed forward and was inserted in left or right bronchus. After the operation, the internally installed catheter exited out from bronchus to trachea and was used to implement double lung ventilation, or it was pulled out from outer cannula and the double lung ventilation was implemented by using outer cannual.Results: The ventilation effect of single-lung was doubtless when the catheter of movable tracheal cannula was inserted in left or right bronchus by using internally installed catheter. The technique of intubation tube was simpler than that of double-lumen bronchial catheter and bronchial occlusive device. The internally installed catheter could rotate in the outer cannula so as to protect tracheal wall and avoid oxygen deficit of patient during the processes of replacing tracheal catheter and the difficulty of replacing tracheal catheter post-operation of double-lumen bronchial catheter. Besides, it also could avoid the injury risk of anastomotic stoma of esophageal surgery caused by mis-insertion of tracheal catheter in esophagus.Conclusion: This kind of removable tracheal cannula has reasonable design, simple operation of intubation and better clinical practicability, and its feasibility is better that the product is transformed.
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OBJECTIVE To introduce a new type of tracheal cannula which has the top hole and can seal the outlet for patient with severe brain injury after tracheotomy. METHODS Patients with severe brain injury after tracheotomy were divided into test group using the new type of tracheal cannula(25 cases) and control group using the cuffed Portex tube(25 cases).The incidence,the onset time and the time for control of pulmonary infection were compared between the two groups. RESULTS In the test group,the incidence of pulmonary infection was 52%(13 cases),the onset time was(3?1.3) days and the time for control was(5?1.7) days;in the control group,the above indices were 84%(21 cases),(3?1.5) days and(12?2.2) days separately. CONCLUSIONS The new type of tracheal cannula which has the top hole and can seal the outlrt is better than the cuffed Portex tube in the prevention and treatment of pulmonary infection after tracheotomy.
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To analyze drug resistance of pseudomonas aeruginosa in patients with mechanical ventilation, drug resistance of pseudomonas aeruginosa in patients with tracheal incision was increased, compared with tracheal cannula. The drug resistance to amikacin, ciprofloxacin, meziocillin, ticarcillin was significantly increased( P