Applications of different flow rates of humidified high flow nasal cannula oxygen therapy on ICU patients with difficult weaning / 中国实用护理杂志

Objective:To explore the effects of different initial flow rates of humidified high flow nasal cannula oxygen therapy on weaning outcomes and comfort level among ICU patients with difficult weaning.Methods:A total of 99 ICU patients with difficult weaning received at Guangzhou Red Cross Hospital ICU from June 2019 to June 2021 were enrolled in the present study, they were assigned to 40 L/min group, 50 L/min group and 60 L/min group according to the random number table method, with 33 cases in each group. The weaning outcomes among three groups were compared, the degree of dryness of oral/nasal cavity, throat pain as well as vital signs and blood gas indexes were also compared before extubation and 30 min after the first humidified high flow nasal cannula (HHFNC) oxygen therapy.Results:There was no significant difference in length of stay in ICU and hospital, re-intubation within 7 days, the mortality within 28 days in ICU and the hospital among three groups ( P>0.05). The weaning success rate were 78.8% (24/33) and 77.4% (23/31) in 50 L/min group and 60 L/min, higher than in the 40 L/min group 53.1% (17/32), the difference was statistically significant ( χ2=4.78, 4.09, both P<0.05). After oxygen therapy, the scores of dryness of oral/nasal cavity and throat pain in the 40 L/min group, 50 L/min group and 60 L/min group were (3.16 ± 0.77), (2.94 ± 0.80) and (3.27 ± 0.92), (3.09 ± 0.77), and (4.10 ± 1.01), (3.97 ± 1.40), the differences were statistically significant ( F=5.21, 9.26, both P<0.05), and the differences between 50 L/min group and 40 L/min group and 60 L/min group were statistically significant ( t values were 2.62-3.99, all P<0.05). However, there was no significant difference in vital signs and blood gas indexes among the three groups before extubation and after oxygen therapy ( P>0.05). Conclusions:Humidified high flow nasal cannula oxygen therapy for the ICU patients with difficult weaning, oxygen flow with 50L/min can not only effectively promote weaning success rate but also improve patients′ respiratory comfort level.

The ventilator weaning strategies for prolonged mechanic ventilation in children / 中国小儿急救医学

The main reason for prolonged mechanic ventilation in children staying in PICU for a long time is that it cannot weaning.The reasons for prolonged mechanic ventilation are complex and diverse, and how to deal with it is a difficult problem faced by clinicians.This review summarized the etiology and weaning strategies of prolonged mechanic ventilation in children, so as to provide evidence for clinicians to deal with this problem.

The concept and research progress of long-term mechanical ventilation in children / 中国小儿急救医学

In recent years, the number of children with prolonged mechanical ventilation has increased rapidly, and they have been in intensive care units for a long time, resulting in a heavy disease burden and high mortality.Families and society are also paying more and more attention to this special group.The United States and Canada have issued a management consensus on mechanical ventilation for children at home, but the allocation of medical resources in China and other countries is very different, and the domestic family-centered management plan is still difficult at this stage.This review summarized the current status of long-term mechanical ventilation in children in China and other countries, and hoped to learn from foreign experience to help domestic children with long-term mechanical ventilation better.

An analysis on one emergent case of delayed amniotic fluid embolism complicated with acute pituitary crisis leading to difficult weaning / 中国中西医结合急救杂志

Amniotic fluid embolism (AFE) is a clinical syndrome caused by amniotic fluid suddenly going into the maternal blood circulation in the process of delivery, the incidence is extremely low, however, its mortality is relatively high; since its clinical manifestations lack specificities, misdiagnosis or overlook of its presence often occurs. In this article, 1 case of delayed amniotic fluid embolism complicated with pituitary crisis leading to difficulty in weaning mechanical ventilation was reported in order to improve the understanding of AFE.

Investigation of adjuvant treatment for difficult weaning from mechanical ventilation / 中华危重病急救医学

Objective To investigate the value of drug intervention for difficult weaning from mechanical ventilation. Methods A prospective single-blind randomized controlled trial was conducted. 120 patients with difficult weaning from mechanical ventilation encountered in Department of Critical Care Medicine of Peking University Third Hospital from January 2008 to December 2013 were included,and the patients were divided into treatment group and control group according to random number table,with 60 cases in each group. Patients received furosemide therapy in the treatment group 3 days before weaning up to 48 hours after weaning in order to control negative liquid balance. Enema was given the day before weaning to reduce abdominal pressure. On the weaning day,all of the patients received nitroglycerin and beta blocker or cedilanid to prevent or control elevation of blood pressure and heart rate in the process of weaning. All patients in treatment group received anisodamine in small dosage 2 hours before extubation.The patients in control group received conventional treatment without drug intervention. Baseline indexes of two groups were compared,including the heart rate,respiration rate(RR),mean arterial pressure(MAP),pulse blood oxygen saturation(SpO2),blood gas,hemoglobin(HG),albumin(ALB)and creatinine(Cr). The main reasons of difficulty in weaning,sedative and analgesic drug selection,presence of abdominal discomfort before weaning,interval between sputum suction before extubation,liquid balance at the beginning of the investigation and at time of weaning,24 hours and 48 hours after weaning,failures of spontaneous breathing test(SBT),length of mechanical ventilation,length of ICU stay,and total length of mechanical ventilation and total length of ICU stay during hospitalization. Results There was no statistically significant difference in the heart rate,RR,MAP,SpO2,blood gas,HG,ALB,Cr at the beginning of the investigation between the two groups. The main reasons for difficult weaning in both groups of patients were respiratory dysfunction,cardiac insufficiency,and central nervous system dysfunction. The use of propofol combined dexmedetomidine in the treatment group was more frequent than the control group〔16.7%(10/60)vs. 1.7%(1/60),χ2=8.107,P=0.004〕,and there was no statistically significant difference in the use of other combinations of sedative drugs between the two groups. Abdominal discomfort before weaning was milder in treatment group as compared with control group〔10.0%(6/60)vs. 25.0%(15/60),χ2=4.675,P=0.031〕. The interval between sputum suction before extubation in the treatment group was significantly longer than that of the control group〔hours:1(1,2)vs. 1(1,1),Z=-2.209,P= 0.027〕. SBT failure was less frequent in treatment group compared with control group〔times:0(0,1)vs. 1(1,2),Z=-6.561,P=0.000〕. Liquid balance was better in the treatment group than the control group at time of weaning,24 hours and 48 hours after weaning〔at time of weaning:-567.71 (-755.95,-226.41)vs. 1 256.76(472.48,1 796.63),Z=-9.038,P=0.000;24 hours after weaning:-5.03 (-530.28,245.09)vs. 342.28(125.36,613.25),Z=-4.711,P=0.000;48 hours after weaning:115.50(-450.26, 485.00)vs. 330.00(16.25,575.25),Z=-1.932,P=0.053〕. Compared with control group,length of mechanical ventilation〔days:1.0(1.0,2.0)vs. 2.0(2.0,3.0),Z=-6.545,P=0.000〕,ICU stay time〔days:3.0(3.0,4.0) vs. 4.0(4.0,5.0),Z=-6.545,P=0.000〕,and total length of mechanical ventilation〔days:8.0(6.0,12.0)vs. 11.0(8.0,15.0),Z=-4.091,P=0.000〕and total length of ICU stay during hospitalization〔days:12.5(9.2,19.0) vs. 17.0(12.0,29.5),Z=-2.722,P=0.000〕were all significantly shorter in the treatment group. Conclusions Adjuvant drugs therapy is helpful in patients weaning from the mechanical ventilation,and can shorten length of mechanical ventilation and ICU stay time. Propofol,combined dexmedetomidine,is helpful for weaning.

Effects of exercise therapy for patients with difficult weaning using mechanical ventilation / 中国实用护理杂志

Objective To evaluate the effects of exercise therapy for patients with difficult weaning using mechanical ventilation.Methods A total of 63 patients with difficult weaning using mechanical ventilation were randomly divided into the experimental group(33 cases) and the control group(30 cases).The patients in the control group received routine respiratory care,however,the patients in the experimental group received gradual and individualized exercise therapy according to patients' condition and physical strength.The items such as the tidal volume,respiratory rate,PaO2/FiO2 were compared between two groups.Results Compared with the control group,the tidal volume,respiratory rate,PaO2/FiO2 and the score of APACHE Ⅱ were better in the experimental group on the 21th and 28th day after mechanical ventilation,the heart rate was better in the experimental group on the 28th day after mechanical ventilation.In addition,the duration of mechanical ventilation and ICU hospitalization was shorter in the experimental group.But the rate of complications showed no significant difference.Conclusions Exercise therapy has a positive effect on patients with difficult weaning using mechanical ventilation.