Risk factors for air leakage during invasive mechanical ventilation in pediatric intensive care units.

PURPOSE: This study aimed to investigate air leakage during invasive mechanical ventilation (IMV) in a pediatric intensive care unit (PICU) and explore potential risk factors. METHODS: We conducted a retrospective cohort study of children who underwent IMV in a single-center PICU in a tertiary referral hospital. Air leakage risk factors and factors associated with an improved outcome were assessed. RESULTS: A total of 548 children who underwent IMV were enrolled in this study. Air leakage occurred in 7.5% (41/548) of the cases in the PICU. Air leakage increased the duration of IMV and hospitalization time. Multivariate logistic regression analysis showed a higher risk of air leakage during IMV for PICU patients with acute respiratory dyspnea syndrome (ARDS) (OR = 4.38), a higher pediatric critical illness score (PCIS) (OR = 1.08), or a higher peak inspiratory pressure (PIP) (OR = 1.08), whereas the risk was lower for patients with central respiratory failure (OR = 0.14). The logistic model had excellent predictive power for air leakage, with an area under the curve of 0.883 and tenfold cross-validation. Patients aged between 1 and 6 years who were diagnosed with measles or pneumonia and had a low positive end-expiratory pressure (PEEP) or high PaO2/FiO2 ratio were associated with improved outcomes. Patients diagnosed with central respiratory failure or congenital heart diseases were associated with less desirable outcomes. CONCLUSIONS: Patients with ARDS, a higher PCIS at admission or a higher PIP were at higher risk of air leakage.

Functional MRI Changes in Patients after Thyroidectomy under General Anesthesia.

Cognitive changes affecting elderly patients following surgery under anesthesia have drawn significant attention and have been investigated in considerable depth. Resting-state functional magnetic resonance imaging (rs-fMRI) can be used to assess changes in brain functional connectivity (FC) associated with postoperative changes in cognition, a common complication in seniors undergoing surgery. In this study, we recruited 20 patients over 55 of age and scheduled an elective thyroidectomy under general anesthesia to assess perioperative changes in brain FC density (FCD) in patients undergoing thyroidectomy under general anesthesia using rs-fMRI. All 20 patients underwent a series of clinical, quantitative, neurological, and neuropsychological tests and fMRI examinations on the day before surgery (Day 0) and 7 days after surgery (Day 7). The following tests were conducted on all patients: the Minimental State Examination (MMSE), the digit symbol substitution test (DSST), the trail making test (part A), the verbal fluency test, and Warrington's recognition memory test (WRMT). FMRI data were acquired using a 3T MR system; the FCD values were calculated using the REST software package. We used paired t-tests to compare the FCD between Day 7 and Day 0. A value of p < 0.05 was considered to reflect statistical significance. The postoperative FCD was significantly reduced in the supplementary motor area (SMA). Analyses of the percentage changes of errors in the WRMT revealed a significant and negative correlation with the mean percentage change of FCD in the SMA (Spearman's r = -0.54, 95% CI: (-0.80, -0.12), p = 0.014). Postoperative changes in FCD in the SMA may be associated with the perioperative neurocognitive changes in patients undergoing partial thyroidectomy under general anesthesia.

Post-treatment with propofol inhibits inflammatory response in LPS-induced alveolar type II epithelial cells.

Over-inflammation and severe lung injury are major causes of morbidity and mortality in patients with coronavirus disease 2019 (COVID-19). With the COVID-19 pandemic, an increasing number of patients with preexisting lung injury and inflammation are undergoing surgery or artificial ventilation under sedation in intensive care units, where 2,6-diisopropylphenol (propofol) is a commonly used drug for sedation. The aim of the present study was to investigate whether post-inflammation treatment with propofol protects epithelial type II cells against inflammation in an in vitro model of inflammation. The A549 cell line, characterised as epithelial type II cells, were exposed to lipopolysaccharide (LPS) for 2 h and subsequently treated with different concentrations of propofol (0, 10, 25 or 50 µM) for 3 h. Western blot and reverse transcription-quantitative PCR analyses were used to detect the protein and mRNA expression levels, respectively, of CD14 and Toll-like receptor 4 (TLR4). Immunofluorescence staining was used to detect the in situ CD14 and TLR4 expression in epithelial type II cells. Tumor necrosis factor (TNF)-α production was also examined using ELISA. LPS significantly increased the expression of CD14 and TLR4, as well as the secretion of TNF-α. Post-treatment with 25 and 50 µM propofol of the LPS-treated cells significantly decreased CD14 and TLR4 expression, as well as TNF-α secretion, compared with the cells treated with LPS only, indicating that post-treatment with propofol alleviated inflammation and this effect was dose-dependent. The present study suggested that treatment with propofol after LPS administration has a protective effect on epithelial type II cells.

Propofol regulates the expression of TLR4 through miR­21 in human umbilical vein endothelial cells.

Propofol (2,6-diisopropylphenol) is one of the most commonly used intravenous anesthetics. Anesthetics can regulate the inflammatory process; however, the mechanism remains to be fully elucidated. The present study aimed to investigate whether and how propofol affects the inflammatory reaction in human umbilical vein endothelial cells (HUVECs). The expression levels of Toll­like receptor 4 (TLR4) and cluster of differentiation 14 (CD14) were determined in HUVECs treated with propofol and lipopolysaccharide (LPS) using western blot and reverse transcription­quantitative polymerase chain reaction analyses. In addition, whether propofol regulated the expression of TLR4 though microRNA (miR)­21 was examined. The results showed that LPS promoted the expression levels of TLR4, CD14 and tumor necrosis factor α (TNFα), and suppressed the expression of miR­21 in HUVECs. Propofol suppressed the expression levels of TLR4, CD14 and TNFα, and upregulated the expression of miR­21 in a concentration­dependent manner. miR­21 downregulated the expression of TLR4 at the mRNA and protein levels, whereas the miR­21 mimic reversed the effect of LPS on the expression of TLR4. In addition, the miR­21 inhibitor inhibited the downregulatory effect of propofol on the expression of TLR4. TargetScan analysis showed that TLR4 was included in the list of targets of miR­21. Fluorescent reporter assays showed that the miR­21 mimic and propofol treatment reduced the fluorescence intensity in cells transfected with a reporter vector containing the wild­type TLR4 3'­untranslated region. Taken together, the results of the present study demonstrated that propofol regulated the expression of TLR4 in HUVECs through miR­21.