Sequential non-invasive following short-term invasive mechanical ventilation in the treatment of tuberculosis with respiratory failure: a randomized controlled study.

BACKGROUND: Invasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV in the treatment of respiratory failure. However, the effectiveness remains unclear. Here, we performed a randomized controlled study to assess the efficacy and safety of sequential MV in the treatment of tuberculosis with respiratory failure. METHODS: Forty-four tuberculosis patients diagnosed with respiratory failure were randomly divided into sequential MV group (n = 24) and conventional MV group (n = 20). Initially, the patients in both groups received invasive positive pressure ventilation. When the patients' conditions were relieved, the ventilation modality in sequential MV group was switched to oronasal face mask continuous positive airway pressure until weaning. RESULTS: After treatment, the patients in sequential MV group had similar respiratory rate, heart rate, oxygenation index, alveolo-arterial oxygen partial pressure difference (A-aDO2), blood pH, PaCO2 to those in conventional MV group (all P value > 0.05). There was no significant difference in ventilation time and ICU stay between the two groups (P > 0.05), but sequential MV group significantly reduced the time of invasive ventilation (mean difference (MD): - 36.2 h, 95% confidence interval (CI) - 53.6, - 18.8 h, P < 0.001). Sequential MV group also reduced the incidence of ventilator-associated pneumonia (VAP; relative risk (RR): 0.44, 95% CI 0.24, 0.83, P = 0.006) and atelectasis (RR:0.49, 95% CI 0.24,1.00, P = 0.040). CONCLUSIONS: Sequential MV was effective in treating tuberculosis with respiratory failure. It showed advantages in reducing invasive ventilation time and ventilator-associated adverse events. REGISTRATION NUMBER FOR CLINICAL TRIAL: Chinese Clinical Trial Registry ChiCTR2000032311, April 21st, 2020.

Analysis of ICU treatment on resection of giant tumors in the mediastinum of the thoracic cavity.

OBJECTIVE: The purpose of this study was to assess prognosis after resection of giant tumors (including lobectomy or pneumonectomy) in the mediastinum. MATERIALS AND METHODS: Patients with resection of a giant tumor in the mediastinum of the thoracic cavity received ICU treatment including dynamic monitoring of vital signs, arterial blood pressure and CVP detection, determination of hemorrhage, pulmonary function and blood gas assay, treatment of relevant complications, examination and treatment with fiber optic bronchoscopy, transfusion and hemostasis as well as postoperative removal of ventilators by invasive and non-invasive sequential mechanical ventilation technologies. RESULTS: Six patients were rehabilitated successfully after ICU treatment with controlled postoperative errhysis and pulmonary infection by examination and treatment with fiber optic bronchoscopy without second application of ventilators and tubes after sequential mechanical ventilation technology. One patient died from multiple organ failure under ICU treatment due to postoperative active hemorrhage after second operative hemostasis. CONCLUSIONS: During peri-operative period of resection of giant tumor (including lobectomy or pneumonectomy) in mediastinum of the thoracic cavity, the ICU plays an important role in dynamic monitoring of vital signs, treatment of postoperative stress state, postoperative hemostasis and successful removal of ventilators after sequential mechanical ventilation.

[The findings of fluorodeoxyglucose F18 imaging of coincidence single photon emission computed tomography in the lung tuberculoma].

OBJECTIVE: To assess the uptake of Fluorodeoxyglucose F18 ((18)F-FDG) coincidence single photon emission computed tomography (SPECT) imaging in lung tuberculoma. METHODS: We enrolled 27 cases with 29 tuberculomas confirmed by clinical diagnosis. (18)F-FDG triple-head coincidence imaging was performed. The intensity of uptake was graded by visual method and the relationship of the uptake and attenuation was analyzed. RESULTS: The uptake of (18)F-FDG was graded by visual method. There were 10 lesions (34.5%) in grade 0, including 7 (24.1%) lesions that showed focal lack of uptake and 3(10.3%) lesions showed normal uptake in tomograph imaging. Eleven lesions (37.9%) were graded as 1 - 2, 5 lesions (17.2%) as 3, and 3 lesions as 4. With grade 0 - 2 being regarded as benign, the false positive rate was 8/29. The intensity of (18)F-FDG uptake was divided into 3 groups (grade 0, grade 1 - 2, grade 3 - 4) and the intensity of uptake was compared with the attenuation of tuberculomas. There was a statistically significant difference among the 3 groups (χ(2) = 13.29 - 18.02, P < 0.01). CONCLUSIONS: The intensity of (18)F-FDG uptake was influenced by the attenuation of the lesion. Most lung tuberculomas for (18)F-FDG coincidence imaging were of low uptake, and lower uptake than the background was a characteristic finding for tuberculoma. The combination with CT imaging was useful for the differentiation from malignant lesions.

[CT image features of 46 cases with pneumonic-type lung cancers].

OBJECTIVE: To analyze the CT image features of pneumonic-type lung cancer and to reduce misdiagnosis. METHODS: The CT findings of 46 patients with pneumonic-type lung cancer were retrospectively reviewed, and CT image in the differential diagnosis of this special kind of disease was evaluated. RESULTS: According to the extent of lesion, these cases were divided into two groups: multi-lobe consolidation group and single lobe consolidation group. The lesions in the latter group located in the upper, middle or lower lobe, respectively. Twenty-nine cases had homogeneous consolidation lesion, 14 cases showed single or multiple cysts and cavities in the lesions, 3 cases exhibited localized low density in the lesion. Forty-one cases shown the sign of air bronchogram with presentation of narrow air bronchogram in 25 of those. Forty cases showed well or ill defined ground-glass opacitiy surrounding the consolidation lesion. Fifteen cases had multi-nodules or opacities distributed in centrilobular or centric bronchiolar location. Of the 30 patients who received contrast medium, 23 showed distinct enhancement, and 7 showed indistinct enhancement with a positive CT angiogram. CONCLUSION: CT findings including lower lobe distribution, homogeneous consolidation, narrow air bronchogram, well defined ground-glass and CT angiogram are helpful in differentiating pneumonic-type lung cancer from various kinds of infection. However, most of CT manifestations of pneumonic-type lung cancer are not specific. Therefore, it's necessary to combine CT findings with other clinical data when making diagnosis.