Clinical experience of high-flow nasal cannula oxygen therapy in severe corona virus disease 2019 (COVID-19) patients / 浙江大学学报·医学版

Acute respiratory failure due to acute hypoxemia is the major manifestation in severe coronavirus disease 2019 (COVID-19) induced by severe acute respiratory syndrome coronavirus 2 infection. Rational and effective respiratory support is crucial in the management of COVID-19 patients. High-flow nasal cannula (HFNC) has been utilized widely due to its superiority over other non-invasive respiratory support techniques. To avoid HFNC failure and intubation delay, the key issues are proper patients, timely application and improving compliance. It should be noted that elder patients are vulnerable for failed HFNC. We applied HFNC for oxygen therapy in severe and critical COVID-19 patients and summarized the following experiences. Firstly, to select the proper size of nasal catheter, to locate it at suitable place, and to confirm the nose and the upper respiratory airway unobstructed. Secondly, an initial flow of 60 L/min and 37℃ should be given immediately for patients with obvious respiratory distress or weak cough ability; otherwise, low-level support should be given first and the level gradually increased. Thirdly, to avoid hypoxia or hypoxemia, the treatment goal of HFNC should be maintained the oxygen saturation (SpO) above 95% for patients without chronic pulmonary disease. Finally, patients should wear a surgical mask during HFNC treatment to reduce the risk of virus transmission through droplets or aerosols.

Clinical experience of high-flow nasal cannula oxygen therapy in severe COVID-19 patients / 浙江大学学报·医学版

Acute respiratory failure due to acute hypoxemia is the major manifestation in severe coronavirus disease 2019 (COVID-19). Rational and effective respiratory support is crucial in the management of COVID-19 patients. High-flow nasal cannula (HFNC) has been utilized widely due to its superiority over other non-invasive respiratory support techniques. To avoid HFNC failure and intubation delay, the key issues are proper patients, timely application and improving compliance. It should be noted that elder patients are vulnerable for failed HFNC. We applied HFNC for oxygen therapy in severe and critical ill COVID-19 patients and summarized the following experiences. Firstly, to select the proper size of nasal catheter, to locate it at suitable place, and to confirm the nose and the upper respiratory airway unobstructed. Secondly, an initial ow of 60 L/min and 37℃ should be given immediately for patients with obvious respiratory distress or weak cough ability; otherwise, low-level support should be given first and the level gradually increased. Thirdly, to avoid hypoxia or hypoxemia, the treatment goal of HFNC should be maintained the oxygen saturation (SpO) above 95% for patients without chronic pulmonary disease. Finally, patients should wear a surgical mask during HFNC treatment to reduce the risk of virus transmission through droplets or aerosols.

Study on the accuracy of oxygen concentration of modified oxygen treatment with Venturi and humidity system / 中华危重病急救医学

OBJECTIVE@#To verify the accuracy of oxygen concentration (FiO2) of modified oxygen treatment with Venturi and humidity system.@*METHODS@#Patients just after ventilator weaning and before the removal of tracheal intubation/tracheotomy tube, who admitted to the intensive care unit (ICU) of Henan Provincial People's Hospital from May 1st to December 15th in 2017, were enrolled. All patients were given a modified oxygen treatment with Venturi and humidity system, and the oxygen flow rate (Flow) of the Venturi device and the oretical value of FiO2 were adjusted according to the patient's condition. Patients were divided into five groups based on doctor's orders: Flow 3 L/min FiO2 0.24, Flow 3 L/min FiO2 0.26, Flow 6 L/min FiO2 0.28, Flow 6 L/min FiO2 0.30, Flow 9 L/min FiO2 0.35. The value of FiO2 at the inhalation end of patients of each group was measured by TSI airflow analyzer, and the consistency between the measured value of FiO2 at the inhalation end and the FiO2 marked value of Venturi was compared and analyzed.@*RESULTS@#When the FiO2 theoretical value of Venturi were adjusted to 0.24, 0.26, 0.28, 0.30, and 0.35, the measured values of FiO2 at the inhalation end of patients were 0.38±0.05, 0.38±0.05, 0.40±0.04, 0.41±0.04, and 0.77±0.11, respectively, which were all significantly higher than the theoretical value of FiO2 (all P < 0.01). The difference between the measured value of FiO2 at the inhalation side and the FiO2 value of the Venturi annotated and the difference rate were both "V"-shaped, both of which decreased with the increase in theoretical value of FiO2 to a Flow of 9 L/min and a theoretical value of FiO2 0.35, the accuracy was the worst, with the FiO2 difference of 0.42±0.11, and the FiO2 difference rate of (121.6±36.5)%.@*CONCLUSIONS@#There is a difference between the measured value and the theoretical value of FiO2 at the inhalation end of the modified Venturi oxygen therapy humidification system, which needs to be paid attention to during clinical oxygen therapy.

Study on the accuracy of oxygen concentration of modified oxygen treatment with Venturi and humidity system / 中华危重病急救医学

Objective@#To verify the accuracy of oxygen concentration (FiO2) of modified oxygen treatment with Venturi and humidity system.@*Methods@#Patients just after ventilator weaning and before the removal of tracheal intubation/tracheotomy tube, who admitted to the intensive care unit (ICU) of Henan Provincial People's Hospital from May 1st to December 15th in 2017, were enrolled. All patients were given a modified oxygen treatment with Venturi and humidity system, and the oxygen flow rate (Flow) of the Venturi device and the oretical value of FiO2 were adjusted according to the patient's condition. Patients were divided into five groups based on doctor's orders: Flow 3 L/min FiO2 0.24, Flow 3 L/min FiO2 0.26, Flow 6 L/min FiO2 0.28, Flow 6 L/min FiO2 0.30, Flow 9 L/min FiO2 0.35. The value of FiO2 at the inhalation end of patients of each group was measured by TSI airflow analyzer, and the consistency between the measured value of FiO2 at the inhalation end and the FiO2 marked value of Venturi was compared and analyzed.@*Results@#When the FiO2 theoretical value of Venturi were adjusted to 0.24, 0.26, 0.28, 0.30, and 0.35, the measured values of FiO2 at the inhalation end of patients were 0.38±0.05, 0.38±0.05, 0.40±0.04, 0.41±0.04, and 0.77±0.11, respectively, which were all significantly higher than the theoretical value of FiO2 (all P < 0.01). The difference between the measured value of FiO2 at the inhalation side and the FiO2 value of the Venturi annotated and the difference rate were both "V"-shaped, both of which decreased with the increase in theoretical value of FiO2 to a Flow of 9 L/min and a theoretical value of FiO2 0.35, the accuracy was the worst, with the FiO2 difference of 0.42±0.11, and the FiO2 difference rate of (121.6±36.5)%.@*Conclusion@#There is a difference between the measured value and the theoretical value of FiO2 at the inhalation end of the modified Venturi oxygen therapy humidification system, which needs to be paid attention to during clinical oxygen therapy.

Examination of the Psychological Models of Asthmatic Patients.and Its Role in Asthma / 上海第二医科大学学报

ObjectiveThis article investigates the distribution of psychological models and its association with asthma by means of examining the psychological models of asthmatic patients.MethodsUsing 80.8 test table provided by the Institute of Applied Psychology of Suzhou University to exam the psychological models of two hundred cases in their non- acute episodes. Results From two hundred asthmatic patients we can notice the association between psychological models and the degree of asthma. In severe asthmatic patients, most was dispersed - puzzle model, occupying 65.3% (17/26),the second was intermediate model 30.7% (8/26). The majority in medium asthmatic patients was intermediate model, taking 53% (53/100), the second was dispersed-puzzle model, 34% (34/100).The easy-disturbance model was the most in mild ones, 51.4% (38/74), the intermediate model was the second, 25.6%(19/74). ConclusionThere are different psychological models in asthmatic patients. In treatments, except the medical therapy, we should direct and take active care of the patients in psychological health aspect.

Role of reactive oxygen species in regulation of respiratory rhythm in medial area of nucleus retrofacialis / 第二军医大学学报

Objective:To explore the role of reactive oxygen species(ROS,i.e,H_2O_2 and O_2-) in regulation of respiratory rhythm in the medial area of nucleus retrofacialis(mNRF).Methods: Medullary slices of neonatal SD rats,including hypoglossal nerve(Ⅻn) and mNRF,were made according to Suzue's method.Simultaneous recording of the Ⅻn respiratory rhythmic activity(RRA) with suction electrode and the respiratory neuronal discharge were performed with whole cell patch in the mNRF on the brainstem slice in vitro.The effect of t-butyl hydroperoxide(tBHP) and ?-lipoic acid(?-LA) on the respiratory pacemaker neurons and respiratory rhythm in the mNRF were observed.Results: tBHP significantly decreased respiratory cycle(RC) and increased respiratory amplitude;?-LA significantly increased RC and decreased its amplitude.Meanwhile,?-LA significantly prolonged the action potential of the respiratory cadmium-insensitive pacemaker neurons and reduced its amplitude,but it had no significant effect on the cadmium-sensitive respiratory pacemaker neurons.Voltage steps and ramps showed that ?-LA inhibited both the transient and persistent sodium current of cadmium-insensitive pacemaker neurons.Conclusion: ROS has an excitatory effect on the respiratory rhythm and the cadmium-insensitive respiratory pacemaker neurons through modulating sodium current.