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Objective:To compare the clinical efficacy of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) in the treatment of infants with severe respiratory syncytial virus (RSV) pneumonia.Methods:A prospective randomized controlled trial was conducted. The infants with severe RSV pneumonia who received invasive mechanical ventilation admitted to intensive care unit (ICU) of Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2018 to December 2019 were enrolled. According to the order of admission, each infant was assigned to HFOV group or CMV group by random number table. The basic data, pediatric critical score, blood gas analysis, ventilator parameters, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO 2)/arterial partial pressure of oxygen (PaO 2)×100], duration of mechanical ventilation, length of ICU stay, complications, prognosis, use of muscle relaxants and vasoactive drugs and other clinical indicators of the two groups were recorded. Results:A total of 28 infants were enrolled in the analysis, including 15 infants receiving CMV and 13 infants receiving HFOV. There were no significant differences in age, body weight, pediatric critical score and OI before enrollment, type Ⅱ respiratory failure, multiple organ dysfunction, basic diseases and laboratory examination indexes before enrollment between the two groups. Six hours after enrollment, compared with CMV group, heart rate (HR), respiratory rate (RR), case of transcutaneous oxygen saturation (SpO 2) decrease, case of HR decrease, case of cardiopulmonary resuscitation (CPR) and OI in HFOV group were significantly decreased [HR (bpm): 130 (125, 138) vs. 144 (140, 160), RR (times/min): 35 (34, 38) vs. 40 (35, 45), SpO 2 decrease (case: 1 vs. 10), HR decrease (case: 0 vs. 6), CPR (case: 0 vs. 4), OI: 6.5 (4.4, 8.9) vs. 9.3 (8.0, 12.8)], while case of use of muscle relaxants (case: 3 vs. 0) and volume of 7-day positive fluid balance [mL/kg: 167.1 (113.8, 212.6) vs. 90.8 (57.8, 112.7)] were significantly higher, the differences were statistically significant (all P < 0.05). There was no use of blood purification treatment, no severe complications such as pneumothorax and intracranial hemorrhage, and no death within 28 days in the two groups. Conclusion:Compared with CMV, HFOV in the treatment of infants with severe RSV pneumonia can improve the oxygenation level and clinical physiological indexes earlier, reduce the incidence of adverse events such as HR, SpO 2 decrease and CPR, increase the use of muscle relaxants and the positive fluid balance, and do not increase the incidence of severe complications such as pneumothorax and intracranial hemorrhage, so its clinical application is safe.
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Objective To quantitatively analyze the energy loss ( EL) of the left ventricle in dilated cardiomyopathy (DCM) by vector flow mapping (VFM). Methods Sixty-four DCM patients confirmed by clinical were enrolled and divided into three groups according to the level of left ventricular ejection fraction (LVEF):mild decreased LVEF group(group A,40% ≤ LVEF＜ 50% ),moderate decreased LVEF group ( group B,30% ≤LVEF＜40% ) and severe decreased LVEF group ( group C,LVEF＜30% ). Forty healthy volunteers were selected as control group ( group D,53% ≤ LVEF≤73% ) for physical examination. The images of apical four-chamber and three-chamber in color Doppler echocardiography were acquired and EL was analyzed in different phases in a cardiac cycle. Results There was no significant difference of the EL in isovolumic systole and isovolumic diastole between DCM groups and the control group ( P ＞ 0.05). In rapid and slow ejection period,the EL in group B and C were much lower than those in the control group ( P＜0.05). In rapid filling phase,the EL in DCM groups were much lower than that in the control group ( P＜0.05).While in slow filling period and atrial systole the EL in group C was lower than that in the control group ( P ＜0.05). Conclusions VFM provides a new perspective for the cardiac function study of DCM patients.
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Objective To quantitatively investigate the dynamic changes of aortic-mitral angle (AMA) using real-time three-dimensional transesophageal echocardiography (RT3D-TEE) in the whole cardiac cycle. Methods RT3D-TEE was performed in 19 patients in West China Hospital of Sichuan University in January to March 2016. Custom software of Acuson-4.0 eSie Valves was used to detect and track the mitral and aortic annuli in 3D space throughout the cardiac cycle, allowing automated measurement of changes in AMA. The dynamic changes of AMA during a whole cardiac cycle were observed using paired t test. And the inter-observer and intra-observer variability were evaluated by Bland-Altman analysis. Results AMA was smaller in systole than in diastole (111.35°±10.68°vs. 118.14°±10.89°, t=-2.56, P < 0.05).The inter-observer and intra-observer repeatability were good,and the 95% confidence interval was (-6.6°, 5.6°) and (-7.1°, 8.7°) (r=0.80, P=0.0055 and r=0.69, P=0.0283). Conclusions Quantitative measurement of the AMA by RT3D-TEE is feasible, with good inter-observer and intra-observer agreement. These parameters may contribute to the implementation of the aortic or mitral valves replacement.