Safety of modified T-piece resuscitator versus nasal cannula oxygen in electronic bronchoscopy for infants: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To optimize the oxygen therapy regimens for infants with pulmonary diseases during bronchoscopy.@*METHODS@#A prospective randomized, controlled, and single-center clinical trial was conducted on 42 infants who underwent electronic bronchoscopy from July 2019 to July 2021. These infants were divided into a nasal cannula (NC) group and a modified T-piece resuscitator (TPR) group using a random number table. The lowest intraoperative blood oxygen saturation was recorded as the primary outcome, and intraoperative heart rate and respiratory results were recorded as the secondary outcomes.@*RESULTS@#Compared with the NC group, the modified TPR group had a significantly higher level of minimum oxygen saturation during surgery and a significantly lower incidence rate of hypoxemia (P<0.05). In the modified TPR group, there were 6 infants with mild hypoxemia, 2 with moderate hypoxemia, and 1 with severe hypoxemia, while in the NC group, there were 3 infants with mild hypoxemia, 5 with moderate hypoxemia, and 9 with severe hypoxemia (P<0.05). The modified TPR group had a significantly lower incidence rate of intraoperative respiratory rhythm abnormalities than the NC group (P<0.05), but there was no significant difference in the incidence rate of arrhythmias between the two groups (P>0.05).@*CONCLUSIONS@#Modified TPR can significantly reduce the risk of hypoxemia in infants with pulmonary diseases during electronic bronchoscopy, and TPR significantly decreases the severity of hypoxemia and the incidence of respiratory rhythm abnormalities compared with traditional NC.

Comparison of the effects between low-level assisted ventilation and T-piece method on respiratory mechanics during weaning of mechanically ventilated patients / 中华危重病急救医学

Objective:To compare the difference of low-level assisted ventilation and T-piece method on respiratory mechanics of patients with invasive mechanical ventilation during spontaneous breathing trial (SBT) within 3 days before extubation.Methods:A retrospective observational study was conducted. Twenty-five patients with difficulty in weaning or delayed weaning from invasive mechanical ventilation who were admitted to department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2018 to June 2020, and were in stable condition and entered the weaning stage after more than 72 hours of invasive mechanical ventilation were studied. A total of 119 cases of respiratory mechanical indexes were collected, which were divided into the low-level assisted ventilation group and the T-piece group according to the ventilator method and parameters used during the data collection. The different ventilation modes related respiratory mechanics indexes such as the esophageal pressure (Pes), the gastric pressure (Pga), the transdiaphragmatic pressure (Pdi), the maximum Pdi (Pdimax), Pdi/Pdimax ratio, the esophageal pressure-time product (PTPes), the gastric pressure-time product (PTPga), the transdiaphragmatic pressure-time product (PTPdi), the diaphragmatic electromyography (EMGdi), the maximum diaphragmatic electromyography (EMGdimax), PTPdi/PTPes ratio, Pes/Pdi ratio, the inspiratory time (Ti), the expiratory time (Te) and the total time respiratory cycle (Ttot) at the end of monitoring were recorded and compared between the two groups.Results:Compared with the T-piece group, Pes, PTPes, PTPdi/PTPes ratio, Pes/Pdi ratio and Te were higher in low-level assisted ventilation group [Pes (cmH 2O, 1 cmH 2O = 0.098 kPa): 2.84 (-1.80, 5.83) vs. -0.94 (-8.50, 2.06), PTPes (cmH 2O·s·min -1): 1.87 (-2.50, 5.93) vs. -0.95 (-9.71, 2.56), PTPdi/PTPes ratio: 0.07 (-1.74, 1.65) vs. -1.82 (-4.15, -1.25), Pes/Pdi ratio: 0.17 (-0.43, 0.64) vs. -0.47 (-0.65, -0.11), Te (s): 1.65 (1.36, 2.18) vs. 1.33 (1.05, 1.75), all P < 0.05], there were no significant differences in Pga, Pdi, Pdimax, Pdi/Pdimax ratio, PTPga, PTPdi, EMGdi, EMGdimax, Ti and Ttot between the T-piece group and the low-level assisted pressure ventilation group [Pga (cmH 2O): 6.96 (3.54,7.60) vs. 7.74 (4.37, 11.30), Pdi (cmH 2O): 9.24 (4.58, 17.31) vs. 6.18 (2.98, 11.96), Pdimax (cmH 2O): 47.20 (20.60, 52.30) vs. 29.95 (21.50, 47.20), Pdi/Pdimax ratio: 0.25 (0.01, 0.34) vs. 0.25 (0.12, 0.41), PTPga (cmH 2O·s·min -1): 7.20 (2.54, 9.97) vs. 7.97 (5.74, 13.07), PTPdi (cmH 2O·s·min -1): 12.15 (2.95, 19.86) vs. 6.87 (2.50, 12.63), EMGdi (μV): 0.05 (0.03, 0.07) vs. 0.04 (0.02, 0.06), EMGdimax (μV): 0.07 (0.05, 0.09) vs. 0.07 (0.04, 0.09), Ti (s): 1.20 (0.95, 1.33) vs. 1.07 (0.95, 1.33), Ttot (s): 2.59 (2.22, 3.09) vs. 2.77 (2.35, 3.24), all P > 0.05]. Conclusions:When mechanically ventilated patients undergo SBT, the use of T-piece method increases the work of breathing compared with low-level assisted ventilation method. Therefore, long-term use of T-piece should be avoided during SBT.

Does T-piece resuscitator in the delivery room improve the resuscitation efficacy on very preterm infants / 中国新生儿科杂志

Objective To study the efficacy of T-piece resuscitator on the very preterm infants in the delivery room.Method Very preterm infants (gestational age 28 ～ 31 weeks) who needed positive pressure ventilation during delivery room resuscitation were included in the study between January 2010 and December 2015.Enrolled infants were randomly assigned to self-inflating bag group and T-piece group.Tracheal intubation ratio,duration of mechanical ventilation,continuous positive airway pressure (CPAP),supplementary oxygen through a nasal cannula and total oxygen requirement were compared between groups.The percentages of pneumothorax,sepsis,necrotizing enterocolitis (NEC),bronchopulmonary dysplasia (BPD),retinopathy of prematurity (ROP),intracranial hemorrhage and patent ductus arteriosus (PDA) between groups were also compared.Data were analyzed using independent sample t test and chi-square test.Result A total of 51 preterm infants were enrolled in this study,with 25 infants in the self-inflating bag group and 26 in the T-piece group.There was no statistically significant difference in the gender,gestational age,birth weight,Apgar scores,delivery mode and antenatal glucocorticoids between the two groups (P ＞ 0.05).The ratio of intubation in T-piece group was significantly lower than that in self-inflating bag group (15.4％ vs.44.0％,P ＜ 0.05).Further more,duration of mechanical ventilation and total oxygen requirement in the T-piece group were significantly shorter than those in the self-inflating bag group [(4.2±2.8) dvs.(10.1 ±4.3) d,(36.2±14.7) dvs.(47.2±19.2) d,P＜0.05].However,the duration of nasal CPAP and supplementary oxygen through a nasal cannula,the rate of pneumothorax,sepsis,NEC,BPD,ROP,intracranial hemorrhage and PDA did not differ significantly between groups (P ＞ 0.05).Conclusion Compared with the self-inflating bag group,the use of the T-piece in delivery room decrease the rate of tracheal intubation and the duration of mechanical ventilation and total oxygen requirement.

Reduction of intubation rate during newborn resuscitationafter transition from self-inflating bag to T-piece resuscitator: A quality improvement project

Introduction: T-piece resuscitator (TPR) has many advantages compared to self-inflating bag (SIB). Early Continuous Positive Airway Pressure (CPAP) during newborn resuscitation (NR) with TPR at delivery can reduce intubation rate. Methods: We speculated that the intubation rate at delivery room was high because SIB had always been used during NR and this can be improved with TPR. Intubation rate of newborn 50%. An audit was carried out in June 2010 to verify this problem using a check sheet. Results: 25 neonates without major congenital anomalies who required NR with SIB at delivery were included. Intubation rate of babies <24 hours of life when SIB was used was 68%. Post-intervention audit (August to November 2010) on 25 newborns showed that the intubation rate within 24 hours dropped to 8% when TPR was used. Proportion of intubated babies reduced from 48.3% (2008-2009) to 35.1% (2011-2012), odds ratio 0.58 (95% CI 0.49-0.68). Proportion of neonates on CPAP increased from 63.5% (2008-2009) to 81.0% (2011-2012), odds ratio 2.44 (95% CI 2.03-2.93). Mean ventilation days fell to below 4 days after 2010. Since then, all delivery standbys were accompanied by TPR and it was used for all NR regardless of settings. There was decline in intubation rate secondary to early provision of CPAP with TPR during NR. Mean ventilation days, mortality and length of NICU stay were reduced. Conclusion: This practice should be adopted by all hospitals in the country to achieve Millennium Development Goal 4 (2/3 decline of under 5 mortality rate) by 2015.

The Effect of Oxygen Supply Devices on Arterial Oxygen Tension in Postoperative Patients / 대한마취과학회지

Arterial hypoxemia in the postoperative period is of particular importance hecause it may delay recovery, exacerbate organ dysfunction, and contribute to motality. Oxygen supply during recovery period is to prevent the complications attributed to hypoxemia, including confusion, cardiac arrythmia, reactive pulmonary hypertension, lactic acidosis and tissue death. A low flow oxygen supply device, O2-Cap, is used to supply oxygen in postoperative patients. However, it was hypothesized that increase of inspired oxygen fraction (F1O2) in an O2-Cap is less than that in a T-Piece with an expiratory limb served as a reservoir. The purpose of this study was to compare the effects of O2-Cap and T-Piece on the increase of arterial tension (PaO2) during early postoperative period. In a prospective study, we measured vital signs, PaO2, and arterial carbon dioxide tension (PaCO2) in 24 adult patients (ASA class I or II) breathing room air in the operation room. After aMominal surgery, they were transferred to the recovery room with the endotracheal tube (intemal diameter, 7.5 mm) whose cuff is deflated. We devided the patients into two groups in the same number. Group C received O2 of 5 1/m via an O2-Cap and group T via a T-piece. Postoperative values were obtained at 5 min, 30 min, and 60 min in the recovery room and were compared between two groups. Preoperative values were served as controls in each group. Vital signs were similar in the two groups. PaCO2 in both groups maintained normal ranges. PaO2 in group C increased significantly to 132.5+/-28.1 mmHg, 134.7+/-26.8 mmHg, and 136.7+/-23.6 mmHg at 5 min, 30 min, and 60 min after operation, respectively, compared with preoperative value, 99.7+/-10.0 mmHg (p<0.05). Group T also showed a significant increases in PaO2 from 102.4+/-18.2 mmHg, preoperatively to 223.1+/-56.1 mmHg, 267.0+/-90.0 mmHg, and 249.8+/-76.5 mmHg at 5 min, 30 min, and 60 min after operation, respectively (p<0.05). PaO2 in group T increased more than that in group C during the same period after the operation. It is concluded that T-Piece with a reservoir increases PaO2 more than O2-Cap andmaintains normal range of PaCO2 without hemodynamic instability. Therefore it is expected that T-Piece with reservoir of 70 ml is safe and effective in spontaneously breathing intubated patients for oxygen supply during postoperative period.

The Study of Oxygen Therapy with Modified T - piece in Pediatric Patients after Open Heart Surgery / 대한마취과학회지

Oxygen therapy is the important method of critical care especially to pediatric patients of post-open heart surgery. The purpose of this study is to investigate the effect of oxygen therspy with modified T-piece in pediatric patients. We supply oxygen via modified T-piece after ventilatory weaning as following rates in turn : group 1; 0.05L/min/kg, group 2; 0.1L /min/kg, group 3; 0.3L/nun/kg, group 4; 0.5L/min/kg. Arterial blood gas analysis was done and heart rate, systolic and diastolic blood pressure, body temperature and oxygen sat uration were recorded. We defined absolute oxygen flow as oxygen flow/weight x weight. The relationshiop between oxygen flow/weight or absolute oxygen flow and PaO2 SaO2, was statistically significant. We got the regression equation as following : PaO2,=119.7xoxygen flow/weight+132.7 (R2=0.13), SaO2=3.2xoxygen flow/weight+97.9 (R2=0.11), PaO2=6.7Xabsolute oxygen flow+141.6 (R2=0.11), SaO2=0.16Xabsolute oxygen flow+96.2 (R2= 0.1). There were significant factors, by which PaO2, was influenced, such as oxygen flow/ weight(Pearson correlation coefficient, r=0.34), absolute oxygen flow(r=0.37), SaO2(r= 0.57), heart rate(r=-0.35), body temperature(r=0.21). As the result of mutiple regression analysis of these factors, we got the regression equation as following : PaO2=-1254.8+67.1Xoxygen flow/weight+14.5XSa0-1.6XPaCO2-0.5XheartXrate+ 2.7Xbody tempersture (R2= 0.44), PaO2=-1240+5.4Xabsolute oxygen flow+14.0XSaO2-1.4 PaCO2-0.6Xheart rate+4.0 body temperature-2.1Xweight (R2=0.46) It were group 1; 0.66, group 2; 0.69, group 3; 0.71, group 4; 0.75 that were calculated FIO2 using AaDO2 in case of FIO2=1.0 and increased significantly. However, because R2 that we got in the regression equation is too small, even though there is statistical significance, we think that clinical application of the result of our study is difficult.

The Study of Oxygen Therapy with Modified T - piece in Pediatric Patients after Open Heart Surgery / 대한마취과학회지

Oxygen therapy is the important method of critical care especially to pediatric patients of post-open heart surgery. The purpose of this study is to investigate the effect of oxygen therspy with modified T-piece in pediatric patients. We supply oxygen via modified T-piece after ventilatory weaning as following rates in turn : group 1; 0.05L/min/kg, group 2; 0.1L /min/kg, group 3; 0.3L/nun/kg, group 4; 0.5L/min/kg. Arterial blood gas analysis was done and heart rate, systolic and diastolic blood pressure, body temperature and oxygen sat uration were recorded. We defined absolute oxygen flow as oxygen flow/weight x weight. The relationshiop between oxygen flow/weight or absolute oxygen flow and PaO2 SaO2, was statistically significant. We got the regression equation as following : PaO2,=119.7xoxygen flow/weight+132.7 (R2=0.13), SaO2=3.2xoxygen flow/weight+97.9 (R2=0.11), PaO2=6.7Xabsolute oxygen flow+141.6 (R2=0.11), SaO2=0.16Xabsolute oxygen flow+96.2 (R2= 0.1). There were significant factors, by which PaO2, was influenced, such as oxygen flow/ weight(Pearson correlation coefficient, r=0.34), absolute oxygen flow(r=0.37), SaO2(r= 0.57), heart rate(r=-0.35), body temperature(r=0.21). As the result of mutiple regression analysis of these factors, we got the regression equation as following : PaO2=-1254.8+67.1Xoxygen flow/weight+14.5XSa0-1.6XPaCO2-0.5XheartXrate+ 2.7Xbody tempersture (R2= 0.44), PaO2=-1240+5.4Xabsolute oxygen flow+14.0XSaO2-1.4 PaCO2-0.6Xheart rate+4.0 body temperature-2.1Xweight (R2=0.46) It were group 1; 0.66, group 2; 0.69, group 3; 0.71, group 4; 0.75 that were calculated FIO2 using AaDO2 in case of FIO2=1.0 and increased significantly. However, because R2 that we got in the regression equation is too small, even though there is statistical significance, we think that clinical application of the result of our study is difficult.