ObjectiveProlonged mechanical ventilation (PMV) is a prognostic marker for short-term adverse outcomes in patients after lung transplantation.The risk of prolonged mechanical ventilation after lung transplantation is still not clear. The study to identify the risk factors of prolonged mechanical ventilation (PMV) after lung transplantation.Methods This retrospective observational study recruited patients who underwent lung transplantation in Wuxi People’s Hospital from January 2020 to December 2022. Relevant information was collected from patients and donors, including recipient data (gender, age, BMI, blood type, comorbidities), donor data (age, BMI, time of endotracheal intubation, oxygenation index, history of smoking, and any comorbidity with multidrug-resistant bacterial infections), and surgical data (surgical mode, incision type, operation time, cold ischemia time of the donor lung, intraoperative bleeding, and ECMO support), and postoperative data (multi-resistant bacterial lung infection, multi-resistant bacterial bloodstream infection, and mean arterial pressure on postoperative admission to the monitoring unit). Patients with a duration of mechanical ventilation ≤72 hours were allocated to the non-prolonged mechanical ventilation group, and patients with a duration of mechanical ventilation>72 hours were allocated to the prolonged mechanical ventilation group. LASSO regression analysis was applied to screen risk factors., and a clinical prediction model for the risk of prolonged mechanical ventilation after lung.ResultsPatients who met the inclusion criteria were divided into the training set and the validation set. There were 307 cases in the training set group and 138 cases in the validation set group. The basic characteristics of the training set and the validation set were compared. There were statistically significant differences in the recipient’s BMI, donor’s gender, CRKP of the donor lung swab, whether the recipient had pulmonary infection before the operation, the type of transplantation, the cold ischemia time of the donor lung, whether ECMO was used during the operation, the duration of ECMO assistance, CRKP of sputum, and the CRE index of the recipient's anal test (P<0.05). 2. The results of the multivariate logistic regression model showed that female recipients, preoperative mechanical ventilation in recipients, preoperative pulmonary infection in recipients, intraoperative application of ECMO, and the detection of multi-drug resistant Acinetobacter baumannii, multi-drug resistant Klebsiella pneumoniae and maltoclomonas aeruginosa in postoperative sputum were independent risk factors for prolonged mechanical ventilation after lung transplantation. The AUC of the clinical prediction model in the training set and the validation set was 0.838 and 0.828 respectively, suggesting that the prediction model has good discrimination. In the decision curves of the training set and the validation set, the threshold probabilities of the curves in the range of 0.05-0.98 and 0.02-0.85 were higher than the two extreme lines, indicating that the model has certain clinical validity.ConclusionsFemale patients, Preoperative pulmonary infection, preoperative mechanical ventilation,blood type B, blood type O, application of ECMO assistance, multi-resistant Acinetobacter baumannii infection, multi-resistant Klebsiella pneumoniae infection, and multi-resistant Stenotrophomonas maltophilia infection are independent risk factors for PMV (prolonged mechanical ventilation) after lung transplantation.
Objective To investigate the risk factors of prolonged postoperative mechanical ventilation for adult patients with atrioventricular septal defect (AVSD). Methods We retrospectively analyzed the clinical data of 76 patients with AVSD aged more than 18 years in our hospital from January 1, 2011 to December 31, 2017. The patients ventilated longer than 24 hours were described as a prolonged ventilation group (n=27) and the others as a normal group (n=49). There were 9 males and 18 females aged 32.22±9.64 years in the prolonged ventilation group, and 16 males and 33 females aged 35.98±11.34 years in the normal group. Perioperative variables between the two groups were compared and selected, and then analyzed by logistic regression analysis. Results The result of univariate analysis showed that there was a statistical difference in weight, preoperative pulmonary artery systolic pressure, duration of cardiopulmonary bypass, the level of postoperative platelet, hemoglobin, blood glucose, lactic acid and serum creatinine, postoperative maximum heart rate and postoperative infection rate between the prolonged ventilated group and the normal group. Multivarable logistic regression showed that preoperative pulmonary artery hypertension (OR=1.056, 95%CI 1.005 to 1.110, P=0.030), prolonged duration of cardiopulmonary bypass (OR=1.036, 95%CI 1.007 to 1.066, P=0.016) and the low postoperative hemoglobin level (OR=0.874, 95%CI 0.786 to 0.973, P=0.014) were the risk factors of prolonged postoperative mechanical ventilation. Conclusion Preoperative pulmonary artery hypertension, long duration of cardiopulmonary bypass and postoperative anaemia are the risk factors associated with prolonged postoperative mechanical ventilation.
Objective
To explore the feasibility of ultrasound diagnosis of diaphragmatic paralysis in patients with ventilation after congenital heart disease surgery.
Methods
There were 542 patients with congenital heart disease after surgery, difficult to be weaned off the ventilator or suspected diaphragmatic paralysis of the patients, respectively, in the ventilator continous positive pressure breathing (CPAP) mode and completely independent breathing state, whose ultrasound examination of diaphragm function was conducted to determine the presence of diaphragmatic paralysis in our hospital between January 1, 2013 and April 30, 2016. There were 327 males and 215 females at age of 14±32 months. The results of ultrasound diagnosis between ventilator CPAP mode and completely spontaneous breathing mode were compared.
Results
Five hundred and forty-two patients underwent ultrasound diaphragmatic examination. The results of bedside ultrasound were completely diagnosed: in completely spontaneous breathing, 82 patients who were diagnosed as diaphragmatic paralysis, including 39 on the right, 25 on the left, 18 on both sides; in CPAP mode, 82 patients who were diagnosed as diaphragmatic paralysis, 38 on the right, left 25, bilateral 19. Using ultrasound in CPAP mode to diagnose diaphragmatic paralysis after congenital heart disease surgery, compared with the completely spontaneous breathing state, the sensitivity was 100.0% and the specificity was 99.9%.
Conclusion
It is accurate and feasible to diagnose the presence of diaphragmatic paralysis in patients with ventilation after congenital heart disease surgery.
Objective
To investigate the clinical significance of lateral position ventilation in the treatment of invasive ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).
Methods
From October 2014 to December 2016, 60 eligible patients with AECOPD who meeting the inclusion criteria were randomly assigned to an intervention group (n=30) or a control group (n=30). Expectorant, antiasthmatic, anti-infective, invasive ventilation, bronchoscopy, analgesic sedation, invasive-noninvasive sequential ventilation, nutritional support, intensive care and other treatment were conducted in two groups, but lateral position ventilation was subsequently performed in the intervention group and the control group used half lateral position. Outcome measurements included pH, PaO2/FiO2, arterial partial pressure of carbon dioxide (PaCO2), heart rate (HR), respiratory rate (R) and air way resistance (Raw) before and one day after invasive ventilation, and duration of control of pulmonary infection (PIC), invasive mechanic ventilation (IMV), mechanic ventilation (MV) and intensive care unit (ICU) stay.
Results
Compared with before ventilation, the levels of PaO2/FiO2, PaCO2, HR, R and Raw were significantly changed in two groups after ventilation (P<0.05). One day later after ventilation, pH [interventionvs. control: (7.43±0.07) vs. (7.37±0.11)], PaO2/FiO2[(253.52±65.33) mm Hg (1 mm Hg=0.133 kPa) vs. (215.46±58.72) mm Hg] and PaCO2 [(52.45±7.15) mm Hg vs. (59.39±8.44) mm Hg] were statistically significant (P<0.05), but no significant difference was found in HR, R or Raw between two groups (P>0.05). Compared with the control group, PIC [(3.7±1.4) daysvs. (5.3±2.2) days], IMV [(4.0±1.5) days vs. (6.1±3.0) days], MV [(4.7±2.0) days vs. (7.3±3.7) days] and ICU stay [(6.2±2.1) days vs. (8.5±4.2) days] were significantly decreased (P<0.05) in the intervention group.
Conclusions
In AECOPD patients, invasive ventilation using lateral position ventilation can significantly improve arterial blood gas index, decrease Raw, shorten the time of PIC, IMV, MV and ICU stay.
In the clinical practice, the mechanical ventilation is a very important assisting method to improve the patients' breath. Whether or not the parameters set for the ventilator are correct would affect the pulmonary gas exchange. In this study, we try to build an advisory system based on the gas exchange model for mechanical ventilation using fuzzy logic. The gas exchange mathematic model can simulate the individual patient's pulmonary gas exchange, and can help doctors to learn the patient's exact situation. With the fuzzy logic algorithm, the system can generate ventilator settings respond to individual patient, and provide advice to the doctors. It was evaluated in 10 intensive care patient cases, with mathematic models fitted to the retrospective data and then used to simulate patient response to changes in therapy. Compared to the ventilator set only as part of routine clinical care, the present system could reduce the inspired oxygen fraction, reduce the respiratory work, and improve gas exchange with the model simulated outcome.
Objective To evaluate the relationship between sublingual microcirculation differences and weaning success rate and prognosis in elderly patients with severe pneumonia. Methods A retrospective observation cohort study was conducted. Forty-two elderly patients with severe pneumonia who underwent mechanical ventilation in the intensive care unit of Sir Run Run Hospital, Nanjing Medical University from February 2022 to August 2022 were recruited in the study. They were divided into a high-flow nasal cannula oxygen group (HFNC group, n=33) and a non-invasive positive pressure ventilation group (NIPPV group, n=9) according to the mode of post-weaning ventilation. The differences of N-terminal brain natriuretic peptide precursor (NT-proBNP), cardiac index (CI) and sublingual microcirculation indexes between the two groups were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of each parameter on weaning success rate and case fatality rate. Results Compared with the NIPPV group, CI, propotion of perfused vessels (PPV) and perfused vessel density (PVD) were higher, and NT-proBNP and total vessel density (TVD) were lower in the HFNC group (all P<0.05). The prediction value of PPV combined with PVD was the largest, with area under the ROC curve (AUC) of 0.875, sensitivity of 75.8%, specificity of 88.9%. CI, NT-proBNP, CI combined with NT-proBNP, PPV, PVD all had predictive value. Compared with the death group, the survival group had higher CI, central venous-to-arterial carbon dioxide difference [P(v-a)CO2] and PPV. For the prediction value of weaning success, CI combined with NT-proBNP had the largest predictive value, with AUC of 0.919, sensitivity of 81.8%, specificity of 100.0%, followed by CI. NT-proBNP, PPV, PVD, PPV combined with PVD all had predictive value. Compared with the death group, the survival group had higher CI, P(v-a)CO2 and PPV (all P<0.05). For predictive value assessment of 28-day survival rate, CI plus PPV had the largest AUC of 0.875, with sensitivity of 69.4%, and specificity of 100.0%. CI, P(v-a)CO2 and PPV all have predictive value. Conclusions Both CI and PPV can be used as predictors of weaning success rate and survival rate. PPV combined with PVD is an ideal predictor of survival rate.
Objective To investigate the thirst status of patients in intensive care unit (ICU) who underwent oral tracheal intubation and ventilator assisted ventilation, and explore its influence factors. Methods A total of 172 patients with oral tracheal intubation admitted in ICU from June 2020 to September 2021 were investigated, and a numerical rating scale was employed for rating their thirst feelings. The patients were divided into a thirst group and a non-thirst group based on thirst status. The thirst status and influence factors of thirst distress were analyzed. Results The incidence of thirst in the ICU patients with oral tracheal intubation and ventilator assisted ventilation was 88.4%, and the thirst score in the thirst group was 7.70±1.17. Single factor analysis showed statistically significant difference between the two groups in sex, medical payment, smoking, drinking, duration of mechanical ventilation, humidification effect, sputum viscosity, gastrointestinal decompression, fasting, continuous renal replacement therapy, diuretics, 24-hour urine volume and liquid balance, heart function grading, sedatives, agitation, sweating, acute physiology and chronic health evaluation Ⅱ, endotracheal intubation depth, body mass index, PCO2, PO2, HCO3–, tidal volume, and sodium ion (all P<0.05). Multivariable regression analysis demonstrated that diuretics, sputum viscosity, sodium ion, alcohol consumption, smoking, intubation depth, and cardiac function were independent influence factors for the occurrence of thirst in the ICU patients who received tracheal intubation (P<0.01). Conclusions The incidence of thirst was high in ICU patients with airway intubation and ventilator assisted ventilation. Diuretics, sputum viscosity, sodium ion, alcohol consumption, smoking, 24-hour urine volume, and cardiac function grading were independent influence factors for the occurrence of thirst in ICU patients with tracheal intubation. It is necessary to implement targeted intervention to prevent and alleviate the thirst degree of patients, reduce the occurrence of related complications, and improve patient comfort.
It is difficult to select the appropriate ventilation mode in clinical mechanical ventilation. This paper presents a nonlinear multi-compartment lung model to solve the difficulty. The purpose is to optimize respiratory airflow patterns and get the minimum of the work of inspiratory phrase and lung volume acceleration, minimum of the elastic potential energy and rapidity of airflow rate changes of expiratory phrase. Sigmoidal function is used to smooth the respiratory function of nonlinear equations. The equations are established to solve nonlinear boundary conditions BVP, and finally the problem was solved with gradient descent method. Experimental results showed that lung volume and the rate of airflow after optimization had good sensitivity and convergence speed. The results provide a theoretical basis for the development of multivariable controller monitoring critically ill mechanically ventilated patients.
ObjectiveTo evaluate the effects of home mechanical ventilation (HMV) for stable chronic obstructive pulmonary disease (COPD) patients with respiratory failure in Tongzhou district of Beijing city.
MethodsTwenty stable COPD patients with respiratory failure were included in the study.During the one-year follow-up period,4 patients died and 1 withdrew and 15 patients finished the follow-up.The patients was followed up by telephone each month and guided in drug administration,HMV,and rehabilitation therapy.At the beginning of the study and one year later,the patients were interviewed and accessed on the general data,nutritional status,COPD assessment test (CAT),Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,and arterial blood gas analysis.
ResultsAt the end of one-year follow-up,nutrition index,CAT,Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,pH,and PaO2 did not change significantly (P>0.05),while PaCO2 decreased significantly compared with those at the beginning of the study (P<0.05).Compared with the past year,the times of hospitalization due to acute exacerbation of COPD was significantly reduced during the follow-up year (P<0.05).
ConclusionHMV can ameliorate carbon dioxide retention and reduce times of hospitalization due to acute exacerbation of COPD for COPD patients with respiratory failure.
ObjectiveTo investigate the effects of arterial blood gas index control during invasive mechanical ventilation on prognosis in COPD patients with type Ⅱ respiratory failure.
MethodsSeventy-six COPD patients with hypercapnic respiratory failure who underwent invasive mechanical ventilation were recruited in the study. The patients were divided into group A with conventional arterial blood gas index control [pH of 7.40±0.05,PaO2 of (70±5)mm Hg,PaCO2 of (55±5)mm Hg],and group B with low index control [pH of 7.35±0.05,PaO2 of (60±5)mm Hg,PaCO2 of (60±5)mm Hg]. Two groups were compared on the required parameters of invasive mechanical ventilation,the duration of invasive mechanical ventilation,the incidence rate of sequential therapy in noninvasive mechanical ventilation,ventilator associated pneumonia and secondary intubation,etc.
ResultsThe required parameters of invasive mechanical ventilation in group B including tidal volume (VT) and pressure support (PS),the duration of invasive mechanical ventilation,the incidence rate of sequential therapy in noninvasive mechanical ventilation,ventilator associated pneumonia and secondary intubation were all significantly lower than those in group A (P<0.05).
ConclusionThe strategy to permit a lower PaO2 and carbon dioxide retention to a certain extent at lower FiO2,VT and PS levels in invasive mechanical ventilation can reduce the duration of invasive mechanical ventilation and the occurrence of ventilator associated complications,and improve the prognosis in COPD patients with type Ⅱ respiratory failure.
