BACKGROUND Critically ill patients often present on admission or develop acute respiratory failure requiring intubation and application of positive pressure ventilation during their hospital stay.AIM To investigate an...BACKGROUND Critically ill patients often present on admission or develop acute respiratory failure requiring intubation and application of positive pressure ventilation during their hospital stay.AIM To investigate and identify the epidemiological data,parameters associated with respiratory settings or the mechanics,and values related to arterial blood gases(ABGs)that are associated with outcomes in critically ill patients.METHODS A retrospective analysis of 131 patients[mean age,67.3 years;mean acute physiology and chronic health evaluation(APACHE)score,21.4]with acute respiratory failure requiring invasive mechanical ventilation was performed.The parameters that were statistically analyzed included demographic data,the presence of comorbidities,the presence of coronavirus disease 19(COVID-19),the respiratory rate(RR),peak airway pressure(Ppeak),minute ventilation(MV),positive endexpiratory pressure,and the values related to ABGs.In order to facilitate the statistical analysis,patients were evaluated and compared in groups:Survivors(n=41)vs non-survivors(n=90)and patients without acute kidney injury(AKI)(n=60)vs patients with AKI(n=71).Four endpoints were studied:Mortality,length of stay,duration of mechanical ventilation,and AKI.Group comparisons were performed using the following statistical tests:Theχ^(2) test with Yates’correction,Fisher’s exact test,the Mann-Whitney U test,and Spearman’s rank correlation analysis.Binary logistic regression analysis conducted after the univariate statistical tests facilitated the investigation of the independent predictors of mortality and AKI.A two-sided P value of less than 0.05 was considered the threshold of statistical significance.RESULTS Non-survivors presented statistically significant differences in terms of being older in age,the presence of comorbidities,elevated APACHE score,medical(vs surgical)reasons for admission,presence of COVID-19,lower pH at ABGs,lower values of the oxygenation ratio(arterial oxygen partial pressure to the fraction of inspired oxygen)and arterial oxygen partial pressure,and elevated values of Ppeak,positive end-expiratory pressure,RR,arterial carbon dioxide partial pressure,and MV.The factors identified as independent predictors of mortality were the presence of comorbidities,APACHE score,COVID-19 status,arterial carbon dioxide partial pressure,Ppeak,RR,and MV.COVID-19 presence and elevated values of RR and Ppeak were positively correlated with the other three endpoints(length of stay,the duration of mechanical ventilation in survivors,and the occurrence of AKI in the entire study population)that were studied.The other parameters exhibited a variable(either positive/negative,or no)correlation to the four endpoints under investigation.CONCLUSION Among all investigated outcome measures,COVID-19,Ppeak,and RR were strongly associated with all the endpoints studied,suggesting that proper interventions involving the modifiable respiratory parameters Ppeak and RR could improve the overall outcome in these patients.A novel finding of this study was the relationship between RR and AKI,which is worthy of further investigation.Future studies may explore the clinical interpretation of these findings to improve outcomes in critically ill patients with acute respiratory failure.展开更多
BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid er...BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid era,but direct head-to-head cost comparisons between the two modalities are not available in literature.AIM To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.METHODS A prospective observational single-center case control study including adult patients with ARF(PaO2/FiO2 ratio<300)admitted from January 1,2024 to December 31,2024 in medical intensive care unit(ICU)of a tertiary care hospital requiring either NIV or invasive ventilation.NIV and IMV groups were compared based on average length of ICU and hospital stay,mortality,net cost of ICU treatment,need for intubation and tracheostomy.RESULTS A total of 319 patients were included in the study(197 in NIV,122 in IMV group).Statistically significant difference in length of ICU stay(NIV group:5±3.25 days,IMV group:9±2.6 days;P<0.05)and mortality rate was seen(11%NIV vs 34%IMV;P<0.01).On multivariate analyses,mortality showed a stronger association with IMV[odds ratio(OR)=7.73;95%CI:3.12-19.18]as compared to ICU stay(OR=2.73;95%CI:2.15-3.48).A total of 33 patients(17%)in NIV group required intubation of which 3 were tracheostomized,while 14 patients(11%)in IMV group needed tracheostomy.The net average cost of ICU stay was₹83902 in NIV group while in IMV group,the net ICU cost was₹476216.The average cost of ICU stay was five times higher with IMV.CONCLUSION NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.展开更多
This paper summarizes the systematic rehabilitation nursing experience for a patient with acute respiratory failure combined with heart failure and obesity(BMI=39.1).Key nursing interventions included implementing a s...This paper summarizes the systematic rehabilitation nursing experience for a patient with acute respiratory failure combined with heart failure and obesity(BMI=39.1).Key nursing interventions included implementing a sequential respiratory support strategy(high-flow oxygen therapy→non-invasive ventilation→transition to home ventilator),conducting phased exercise rehabilitation training,delivering precise nutritional management(total daily calorie intake controlled at 1500-1800 kcal),enhancing interdisciplinary risk prevention and control,and employing SMART goal setting for behavioral intervention.Following systematic intervention,after 4 days of hospitalization,the patient’s SpO2 increased from 80%to 92%while off mechanical ventilator support,and the self-care ability score rose to 85 points.One week after discharge,the patient’s body weight had decreased by 2 kg,pulmonary function indices showed improvement,and the patient successfully returned to work.展开更多
Background Although noninvasive positive pressure ventilation （NPPV） has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respirat...Background Although noninvasive positive pressure ventilation （NPPV） has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respiratory failure after cardiac surgery.Therefore,we conducted a prospective randomized control study in a university surgical intensive care unit to evaluate the efficacy and safety of NPPV in the treatment of acute respiratory failure after cardiac surgery,and explore the predicting factors of NPPV failure.Methods From September 2011 to November 2012 patients with acute respiratory failure after cardiac surgery who had indication for the use of NPPV were randomly divided into a NPPV treatment group （NPPV group） and the conventional treatment group （control group）.The between-group differences in the patients＇ baseline characteristics,re-intubation rate,tracheotomy rate,ventilator associated pneumonia （VAP） incidence,in-hospital mortality,mechanical ventilation time after enrollment （MV time）,intensive care unit （ICU） and postoperative hospital stays were compared.The factors that predict NPPV failure were analyzed.Results During the study period,a total of 139 patients who had acute respiratory failure after cardiac surgery were recorded,and 95 of them met the inclusion criteria,which included 59 males and 36 females with a mean age of （61.5±11.2） years.Forty-three patients underwent coronary artery bypass grafting （CABG）,23 underwent valve surgery,13 underwent CABG＋valve surgery,13 underwent major vascular surgery,and three underwent other surgeries.The NPPV group had 48 patients and the control group had 47 patients.In the NPPV group,the re-intubation rate was 18.8％,tracheotomy rate was 12.5％,VAP incidence was 0,and the in-hospital mortality was 18.8％,significantly lower than in the control group 80.9％,29.8％,17.0％ and 38.3％ respectively,P ＜0.05 or P ＜0.01.The MV time and ICU stay （expressed as the median （P25,P75）） were 18.0 （9.2,35.0） hours and 4.0 （2.0,5.0） days,which were significantly shorter than in the control group,96.0 （26.0,240.0） hours and 6.0 （4.0,9.0） days respectively,P ＜0.05 or P ＜0.01.The postoperative hospital stays of the two groups were similar.The univariate analysis showed that the NPPV success subgroup had more patients with acute lung injury （ALl） （17 vs.0,P=0.038）,fewer patients with pneumonia （2 vs.7,P ＜0.001） and lower acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） scores （16.1±2.8 vs.21.8±3.2,P ＜0.001）.Multivariate analysis showed that pneumonia （P=-0.027） and a high APACHE Ⅱ score ＞20 （P=-0.002） were the independent risk factors of NPPV failure.Conclusions We conclude that NPPV can be applied in selected patients with acute respiratory failure after cardiac surgery to reduce the need of re-intubation and improve clinical outcome as compared with conventional treatment.Pneumonia and a high APACHE Ⅱ score ＞20 might be the independent risk factors of NPPV failure in this group of patients.展开更多
Extracorporeal membrane oxygenation （ECMO） is a type of extracorporeal life support （ECLS）, and technological advances have expanded the use of this technique from the confines of the operating room by producing a...Extracorporeal membrane oxygenation （ECMO） is a type of extracorporeal life support （ECLS）, and technological advances have expanded the use of this technique from the confines of the operating room by producing a compact system that could revolutionize the treatment of different types of respiratory failure.展开更多
AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV)use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric in...AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV)use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU)or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortalityⅢ(PRIsM-Ⅲ)scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV)were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%)failed treatment and required MV.The majority of the patients(74%)had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P=0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲscores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P<0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.展开更多
Acute respiratory distress syndrome(ARDS)is a severe clinical condition characterized by acute respiratory failure due to widespread pulmonary inflammation and edema.The incidence of ARDS among intensive care unit(ICU...Acute respiratory distress syndrome(ARDS)is a severe clinical condition characterized by acute respiratory failure due to widespread pulmonary inflammation and edema.The incidence of ARDS among intensive care unit(ICU)patients is approximately 10%,with mortality rates ranging from 35%to 45%and exceeding 50%in severe cases.[1]Identifying and controlling risk factors for ARDS is critical for early prevention.Smoking remains a significant global public health issue,affecting one-third of adults and 40%of children through exposure to secondhand smoke.[2]In an animal study,cigarette smoke impaired lung endothelial barrier function through oxidative stress and exacerbated lipopolysaccharide-induced increases in vascular permeability in vivo.This finding is consistent with the pathological changes observed in ARDS.[3]Although many observational studies have suggested a potential link between smoking and ARDS,the causal relationship remains unclear.This study uses Mendelian randomization(MR)to explore whether smoking behavior causally influences ARDS and investigates the mechanisms by which smoking may contribute to ARDS development through transcriptomic analysis of the Gene Expression Omnibus(GEO)database.展开更多
Acute respiratory failure(ARF)in immunocompromised patients remains challenging to treat.A large number of case require admission to intensive care unit(ICU)where mortality remains high.Oxygenation without intubation ...Acute respiratory failure(ARF)in immunocompromised patients remains challenging to treat.A large number of case require admission to intensive care unit(ICU)where mortality remains high.Oxygenation without intubation is important in this setting.This review summarizes recent studies assessing oxygenation devices for immunocompromised patients.Previous studies showed that non-invasive ventilation(NIV)has been associated with lower intubation and mortality rates.Indeed,in recent years,the outcomes of immunocompromised patients admitted to the ICU have improved.In the most recent randomized controlled trials,including immunocompromised patients admitted to the ICU with ARF,neither NIV nor high-flow nasal oxygen(HFNO)could reduce the mortality rate.In this setting,other strategies need to be tested to decrease the mortality rate.Early admission strategy and avoiding late failure of oxygenation strategy have been assessed in retrospective studies.However,objective criteria are still lacking to clearly discriminate time to admission or time to intubation.Also,diagnosis strategy may have an impact on intubation or mortality rates.On the other hand,lack of diagnosis has been associated with a higher mortality rate.In conclusion,improving outcomes in immunocompromised patients with ARF may include strategies other than the oxygenation strategy alone.This review discusses other unresolved questions to decrease mortality after ICU admission in such patients.展开更多
Background Since the beginning of the coronavirus disease 2019(COVID-19)pandemic,prone positioning has been widely applied for non-intubated,spontaneously breathing patients.However,the efficacy and safety of prone po...Background Since the beginning of the coronavirus disease 2019(COVID-19)pandemic,prone positioning has been widely applied for non-intubated,spontaneously breathing patients.However,the efficacy and safety of prone positioning in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure remain unclear.We aimed to systematically analyze the outcomes associated with awake prone positioning(APP).Methods We conducted a systematic literature search of PubMed/MEDLINE,Cochrane Library,Embase,and Web of Science from January 1,2020,to June 3,2022.This study included adult patients with acute respiratory failure caused by COVID-19.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines were followed,and the study quality was assessed using the Cochrane risk-of-bias tool.The primary outcome was the reported cumulative intubation risk across randomized controlled trials(RCTs),and the effect estimates were calculated as risk ratios(RRs;95%confidence interval[CI]).Results A total of 495 studies were identified,of which 10 fulfilled the selection criteria,and 2294 patients were included.In comparison to supine positioning,APP significantly reduced the need for intubation in the overall population(RR=0.84,95%CI:0.74–0.95).The two groups showed no significant differences in the incidence of adverse events(RR=1.16,95%CI:0.48–2.76).The meta-analysis revealed no difference in mortality between the groups(RR=0.93,95%CI:0.77–1.11).Conclusions APP was safe and reduced the need for intubation in patients with respiratory failure associated with COVID-19.However,it did not significantly reduce mortality in comparison to usual care without prone positioning.展开更多
Hypophosphataemia is defined as low level of phosphate in the blood (normal range 0.8 - 1.4 mmol/l), which can be drug-induced such as uniphyline. We present a case of elderly female patient with known chronic obstruc...Hypophosphataemia is defined as low level of phosphate in the blood (normal range 0.8 - 1.4 mmol/l), which can be drug-induced such as uniphyline. We present a case of elderly female patient with known chronic obstructive pulmonary disease, admitted with acute respiratory failure and low serum phosphate level, her clinical signs and serum phosphate level did not improve with conventional therapy and intravenous phosphate replacement, until her recently commenced uniphyline was discontinued. This highlights the importance of awareness amongst the clinicians about this rare but potential side effect of uniphyline. We suggest monitoring phosphate levels in patients admitted with acute respiratory failure especially those on extended bronchodilator therapy.展开更多
BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmon...BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.展开更多
BACKGROUND The extensive availability of ultrasound(US)technology has increased its use for point-of-care applications in many health care settings.During anaesthesia and surgery,acute respiratory failure or pulmonary...BACKGROUND The extensive availability of ultrasound(US)technology has increased its use for point-of-care applications in many health care settings.During anaesthesia and surgery,acute respiratory failure or pulmonary oedema are common lifethreatening events that,if not recognized and treated appropriately,result in a high mortality rate.CASE SUMMARY We report a patient under anaesthesia whose lung US examination showed multiple vertical artefacts(B-lines)in the lung tissue,indicating pulmonary oedema.The respiratory state improved with the resolution of the pulmonary oedema after our treatment.CONCLUSION We believe that US of the lungs may be a useful tool for dynamic respiratory monitoring at the bedside during anaesthesia.展开更多
Pneumonia is a common complication in organ transplantation patients. Multiple respiratory pathogens such as bacteria, viruses and fungi are potentially coexisted. A 60-year-old male with left eye post corneal transpl...Pneumonia is a common complication in organ transplantation patients. Multiple respiratory pathogens such as bacteria, viruses and fungi are potentially coexisted. A 60-year-old male with left eye post corneal transplantation developed acute severe pneumonia caused by <em>Pneumocystis jiroveci</em> (PJP) coinfection with <em>Nocardia spp</em>. and <em>Cytomegalovirus</em> (CMV). He was hospitalized due to acute respiratory failure. Chest radiographs and chest Computed Tomography (CT) revealed extensive ground-glass opacities. PJP was diagnosed from Bronchoalveolar Lavage Fluid (BALF). The pneumonia was persistent despite of receiving intravenous cotrimoxazole. Tracheal aspirate showed faint gram-positive filamentous beaded branching organisms. Consequently <em>Nocardia spp</em>. was proven. Intravenous cotrimoxazole was continued and intravenous imipenem was added. After a course of dual antibiotics, pneumonia was gradually improved. A week after, he developed the worsened acute respiratory failure. The bronchoscopy was performed. The new pathogens were not detected from BALF microbiology. The BALF cytology was unremarkable. PJP was detected by Polymerase Chain Reaction (PCR) from BALF. CMV antigenemia was detected from BALF and blood. Intravenous ganciclovir was given. This report describes PJP coinfected with <em>Nocardia spp</em>. and CMV in post corneal transplantation patient suffering from severe pneumonia. Multiple respiratory pathogens are common among transplantation patients representing host immunosuppression and inadequate antimicorbial prophylaxis.展开更多
Background:Awake prone positioning(APP)can reportedly reduce the need for intubation and help improve prognosis of patients with acute hypoxemic respiratory failure(AHRF)infected with COVID-19.However,its physiologica...Background:Awake prone positioning(APP)can reportedly reduce the need for intubation and help improve prognosis of patients with acute hypoxemic respiratory failure(AHRF)infected with COVID-19.However,its physiological mechanism remains unclear.In this study,we evaluated the effect of APP on lung ventilation in patients with moderate-to-severe AHRF to better understand the effects on ventilation distribution and to prevent intubation in non-intubated patients.Methods:The prospective study was performed in the Department of Critical Care Medicine at Shanghai General Hospital,China,from January 2021 to November 2022.The study included patients with AHRF(partial pressure of oxygen[PaO_(2)]/inspired oxygen concentration[FiO_(2)]<200 mmHg or oxygen saturation[SpO_(2)]/FiO_(2)<235]treated with high-flow nasal oxygen.Electrical impedance tomography(EIT)measurements including center of ventilation(COV),global inhomogeneity(GI)index,and regional ventilation delay(RVD)index were performed in the supine position(To),30 min after the start of APP(Ti),and 30 min returning to supine position after the APP(T2).Clinical parameters like SpO_(2),respiratory rate(RR),FiO_(2),heart rate(HR),and ROX(the ratio of SpO_(2) as measured by pulse oximetry/FiO_(2) to RR)were also recorded simultaneously at To,Ti,and T2.To evaluate the effect of the time points on the variables,Mauchly's test was performed for sphericity and repeated measures analysis of variance was applied with Bonferroni's post hoc multiple comparisons.Results:Ten patients were enrolled.The Pa02/FiO_(2) ratio was(111.4±33.4)mmHg at the time of recruitment.ROX showed a significant increase after initiation of APP(median(interquartile range[IQR)):To:7.5(6.0-10.1)vs.Ti:7.6(6.4-9.3)vs.T2:8.3(7.2-11.0),P=0.043).RR(P=0.409),HR(P=0.417),and SpO_(2)/FiO_(2)(P=0.262)did not change significantly during prone positioning(PP).The CoV moved from the ventral area to the dorsal area(To:48.8%±6.2%vs.T:54.8%±6.8%vs.T2:50.3%±6.1%,P=0.030)after APP.The GI decreased significantly after APP(To:median=42.7%,[IQR:38.3%-47.5%]vs.Ti:median=38.2%,[IQR:34.6%-50.7%]vs.T2:median=37.4%,[IQR:34.2%-41.4%],P=0.049).RVD(P=0.794)did not change after APP.Conclusions:APP can improve ventilation distribution and homogeneity of lung ventilation as assessed by EIT in non-intubated patients with AHRF.Trail Registration Chinese Clinical Trial Registry Identifier:ChiCTR2000035895.展开更多
Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical vent...Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease.Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database.Intubation rate,mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions(NIV Hospita1)were compared against 13 hospitals using solely invasive ventilation(IMV Hospitals).Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups.Results Both hospital groups had comparable demographics and clinical profiles,but NIV Hospital(42 patients)had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement.Compared to IMV Hospitals(451 patients).NIV Hospital had lower adjusted odds ratios for intubation(0.36,95%C10.164-0.791,P=0.011)and death(0.235.95%C10.077-0.716,P=0.O 11),and improved earlier after pulsed steroid rescue.There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation,non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.展开更多
Although standard oxygen face masks are first-line therapy for patients with acute hypoxemic respiratory failure,high-flow nasal cannula oxygen therapy has gained major popularity in intensive care units.The physiolog...Although standard oxygen face masks are first-line therapy for patients with acute hypoxemic respiratory failure,high-flow nasal cannula oxygen therapy has gained major popularity in intensive care units.The physiological effects of high-flow oxygen counterbalance the physiological consequences of acute hypoxemic respiratory failure by lessening the deleterious effects of intense and prolonged inspiratory efforts generated by patients.Its simplicity of application for physicians and nurses and its comfort for patients are other arguments for its use in this setting.Although clinical studies have reported a decreased risk of intubation with high-flow oxygen compared with standard oxygen,its survival benefit is uncertain.A more precise definition of acute hypoxemic respiratory failure,including a classification of severity based on oxygenation levels,is needed to better compare the efficiencies of different non-invasive oxygenation support methods(standard oxygen,high-flow oxygen,and non-invasive ventilation).Additionally,the respective role of each non-invasive oxygenation support method needs to be established through further clinical trials in acute hypoxemic respiratory failure,especially in severe forms.展开更多
In recent years,the incidence of acute respiratory distress syndrome(ARDS)has been gradually increasing.Despite advances in supportive care,ARDS remains a significant cause of morbidity and mortality in critically ill...In recent years,the incidence of acute respiratory distress syndrome(ARDS)has been gradually increasing.Despite advances in supportive care,ARDS remains a significant cause of morbidity and mortality in critically ill patients.ARDS is characterized by acute hypoxaemic respiratory failure with diffuse pulmonary inflammation and bilateral edema due to excessive alveolocapillary permeability in patients with non-cardiogenic pulmonary diseases.Over the past seven decades,our understanding of the pathology and clinical characteristics of ARDS has evolved significantly,yet it remains an area of active research and discovery.ARDs is highly heterogeneous,including diverse pathological causes,clinical presentations,and treatment responses,presenting a significant challenge for clinicians and researchers.In this review,we comprehensively discuss the latest advancements in ARDS research,focusing on its heterogeneity,pathophysiological mechanisms,and emerging therapeutic approaches,such as cellular therapy,immunotherapy,and targeted therapy.Moreover,we also examine the pathological characteristics of cOvID-19-related ARDS and discuss the corresponding therapeutic approaches.In the face of challenges posed by ARDS heterogeneity,recent advancements offer hope for improved patient outcomes.Further research is essential to translate these findings into effective clinical interventions and personalized treatment approaches for ARDS,ultimately leading to better outcomes for patients suffering from ARDS.展开更多
Cancer patients account for 15%of all admissions to intensive care unit(ICU)and 5%will experience a critical illness resulting in ICU admission.Mortality rates have decreased during the last decades because of new ant...Cancer patients account for 15%of all admissions to intensive care unit(ICU)and 5%will experience a critical illness resulting in ICU admission.Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods.Since early critical care and organ support is associated with improved survival,timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying.This article focused on relevant and current information on epidemiology,diagnosis,and treatment of the main clinical disorders experienced by critically ill cancer patients.展开更多
The article provides information on our achievements in the application of modern diagnostic methods and modern methods of treating patients with viral pneumonia,confirmed by covid-19.For this,statistical data of 2,00...The article provides information on our achievements in the application of modern diagnostic methods and modern methods of treating patients with viral pneumonia,confirmed by covid-19.For this,statistical data of 2,000 patients were used.Of the 2,000 patients treated,920 were men,1,070 were women and 10 were children.Viral pneumonia-glaucoma syndrome in 1650 out of 2,000 patients with 10-20%damage;In 350,the diagnosis of viral pneumonia-frostbite syndrome with 50-85%damage,CRDS,respiratory failure was confirmed.Thus,50 out of 350 patients treated at the intensive care unit(ICU)out of 2,000 were intubated and connected to artificial ventilation.The research was carried out in 3 stages:I stage-admission to the intensive care unit;II stage-from the day of intubation to spontaneous breathing(7-14 days);and III stage-covers the period of extubation and recovery.The results of clinical,functional,hemodynamic and echocardiographic studies of the patients participating in the examination were analyzed.Also,the patients underwent bacteriological research studied the sensitivity to antibiotics.In addition,the composition of blood gases and the oxygenation index-Carrico were studied.展开更多
Objective: To investigate the efficacy, safety and nursing improvement of noninvasive positive pressure ventilation (NPPV) in high-risk patients with acute respiratory failure after cardiac surgery. Methods: From Sept...Objective: To investigate the efficacy, safety and nursing improvement of noninvasive positive pressure ventilation (NPPV) in high-risk patients with acute respiratory failure after cardiac surgery. Methods: From September 2018 to October 2019, high-risk patients who may develop acute respiratory failure after cardiac surgery were selected and randomly divided into non-invasive ventilation group and conventional treatment group (control group). The reintubation rate, tracheotomy rate, fatality rate, 24 h intake and output, respiratory rate, arterial blood gas PaO2 and PaCO2 were compared between the two groups of patients;at the same time, the patient comfort and mask leakage after improved nursing technology were compared. Results: The preoperative and intraoperative conditions of the two groups of patients were basically similar, but the reintubation rate, tracheotomy rate, fatality rate, and respiratory rate of the patients in the preventive application of NPPV group were significantly lower than those of the control group, and the 24 h input and output and arterial blood gas PaO2 were also excellent in the control group. Conclusion: NPPV used prophylactically in high-risk patients after cardiac surgery can significantly reduce the re-intubation rate, improve patient outcomes, and is markedly more effective than the conventional treatment group.展开更多
文摘BACKGROUND Critically ill patients often present on admission or develop acute respiratory failure requiring intubation and application of positive pressure ventilation during their hospital stay.AIM To investigate and identify the epidemiological data,parameters associated with respiratory settings or the mechanics,and values related to arterial blood gases(ABGs)that are associated with outcomes in critically ill patients.METHODS A retrospective analysis of 131 patients[mean age,67.3 years;mean acute physiology and chronic health evaluation(APACHE)score,21.4]with acute respiratory failure requiring invasive mechanical ventilation was performed.The parameters that were statistically analyzed included demographic data,the presence of comorbidities,the presence of coronavirus disease 19(COVID-19),the respiratory rate(RR),peak airway pressure(Ppeak),minute ventilation(MV),positive endexpiratory pressure,and the values related to ABGs.In order to facilitate the statistical analysis,patients were evaluated and compared in groups:Survivors(n=41)vs non-survivors(n=90)and patients without acute kidney injury(AKI)(n=60)vs patients with AKI(n=71).Four endpoints were studied:Mortality,length of stay,duration of mechanical ventilation,and AKI.Group comparisons were performed using the following statistical tests:Theχ^(2) test with Yates’correction,Fisher’s exact test,the Mann-Whitney U test,and Spearman’s rank correlation analysis.Binary logistic regression analysis conducted after the univariate statistical tests facilitated the investigation of the independent predictors of mortality and AKI.A two-sided P value of less than 0.05 was considered the threshold of statistical significance.RESULTS Non-survivors presented statistically significant differences in terms of being older in age,the presence of comorbidities,elevated APACHE score,medical(vs surgical)reasons for admission,presence of COVID-19,lower pH at ABGs,lower values of the oxygenation ratio(arterial oxygen partial pressure to the fraction of inspired oxygen)and arterial oxygen partial pressure,and elevated values of Ppeak,positive end-expiratory pressure,RR,arterial carbon dioxide partial pressure,and MV.The factors identified as independent predictors of mortality were the presence of comorbidities,APACHE score,COVID-19 status,arterial carbon dioxide partial pressure,Ppeak,RR,and MV.COVID-19 presence and elevated values of RR and Ppeak were positively correlated with the other three endpoints(length of stay,the duration of mechanical ventilation in survivors,and the occurrence of AKI in the entire study population)that were studied.The other parameters exhibited a variable(either positive/negative,or no)correlation to the four endpoints under investigation.CONCLUSION Among all investigated outcome measures,COVID-19,Ppeak,and RR were strongly associated with all the endpoints studied,suggesting that proper interventions involving the modifiable respiratory parameters Ppeak and RR could improve the overall outcome in these patients.A novel finding of this study was the relationship between RR and AKI,which is worthy of further investigation.Future studies may explore the clinical interpretation of these findings to improve outcomes in critically ill patients with acute respiratory failure.
文摘BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid era,but direct head-to-head cost comparisons between the two modalities are not available in literature.AIM To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.METHODS A prospective observational single-center case control study including adult patients with ARF(PaO2/FiO2 ratio<300)admitted from January 1,2024 to December 31,2024 in medical intensive care unit(ICU)of a tertiary care hospital requiring either NIV or invasive ventilation.NIV and IMV groups were compared based on average length of ICU and hospital stay,mortality,net cost of ICU treatment,need for intubation and tracheostomy.RESULTS A total of 319 patients were included in the study(197 in NIV,122 in IMV group).Statistically significant difference in length of ICU stay(NIV group:5±3.25 days,IMV group:9±2.6 days;P<0.05)and mortality rate was seen(11%NIV vs 34%IMV;P<0.01).On multivariate analyses,mortality showed a stronger association with IMV[odds ratio(OR)=7.73;95%CI:3.12-19.18]as compared to ICU stay(OR=2.73;95%CI:2.15-3.48).A total of 33 patients(17%)in NIV group required intubation of which 3 were tracheostomized,while 14 patients(11%)in IMV group needed tracheostomy.The net average cost of ICU stay was₹83902 in NIV group while in IMV group,the net ICU cost was₹476216.The average cost of ICU stay was five times higher with IMV.CONCLUSION NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.
文摘This paper summarizes the systematic rehabilitation nursing experience for a patient with acute respiratory failure combined with heart failure and obesity(BMI=39.1).Key nursing interventions included implementing a sequential respiratory support strategy(high-flow oxygen therapy→non-invasive ventilation→transition to home ventilator),conducting phased exercise rehabilitation training,delivering precise nutritional management(total daily calorie intake controlled at 1500-1800 kcal),enhancing interdisciplinary risk prevention and control,and employing SMART goal setting for behavioral intervention.Following systematic intervention,after 4 days of hospitalization,the patient’s SpO2 increased from 80%to 92%while off mechanical ventilator support,and the self-care ability score rose to 85 points.One week after discharge,the patient’s body weight had decreased by 2 kg,pulmonary function indices showed improvement,and the patient successfully returned to work.
文摘Background Although noninvasive positive pressure ventilation （NPPV） has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respiratory failure after cardiac surgery.Therefore,we conducted a prospective randomized control study in a university surgical intensive care unit to evaluate the efficacy and safety of NPPV in the treatment of acute respiratory failure after cardiac surgery,and explore the predicting factors of NPPV failure.Methods From September 2011 to November 2012 patients with acute respiratory failure after cardiac surgery who had indication for the use of NPPV were randomly divided into a NPPV treatment group （NPPV group） and the conventional treatment group （control group）.The between-group differences in the patients＇ baseline characteristics,re-intubation rate,tracheotomy rate,ventilator associated pneumonia （VAP） incidence,in-hospital mortality,mechanical ventilation time after enrollment （MV time）,intensive care unit （ICU） and postoperative hospital stays were compared.The factors that predict NPPV failure were analyzed.Results During the study period,a total of 139 patients who had acute respiratory failure after cardiac surgery were recorded,and 95 of them met the inclusion criteria,which included 59 males and 36 females with a mean age of （61.5±11.2） years.Forty-three patients underwent coronary artery bypass grafting （CABG）,23 underwent valve surgery,13 underwent CABG＋valve surgery,13 underwent major vascular surgery,and three underwent other surgeries.The NPPV group had 48 patients and the control group had 47 patients.In the NPPV group,the re-intubation rate was 18.8％,tracheotomy rate was 12.5％,VAP incidence was 0,and the in-hospital mortality was 18.8％,significantly lower than in the control group 80.9％,29.8％,17.0％ and 38.3％ respectively,P ＜0.05 or P ＜0.01.The MV time and ICU stay （expressed as the median （P25,P75）） were 18.0 （9.2,35.0） hours and 4.0 （2.0,5.0） days,which were significantly shorter than in the control group,96.0 （26.0,240.0） hours and 6.0 （4.0,9.0） days respectively,P ＜0.05 or P ＜0.01.The postoperative hospital stays of the two groups were similar.The univariate analysis showed that the NPPV success subgroup had more patients with acute lung injury （ALl） （17 vs.0,P=0.038）,fewer patients with pneumonia （2 vs.7,P ＜0.001） and lower acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） scores （16.1±2.8 vs.21.8±3.2,P ＜0.001）.Multivariate analysis showed that pneumonia （P=-0.027） and a high APACHE Ⅱ score ＞20 （P=-0.002） were the independent risk factors of NPPV failure.Conclusions We conclude that NPPV can be applied in selected patients with acute respiratory failure after cardiac surgery to reduce the need of re-intubation and improve clinical outcome as compared with conventional treatment.Pneumonia and a high APACHE Ⅱ score ＞20 might be the independent risk factors of NPPV failure in this group of patients.
文摘Extracorporeal membrane oxygenation （ECMO） is a type of extracorporeal life support （ECLS）, and technological advances have expanded the use of this technique from the confines of the operating room by producing a compact system that could revolutionize the treatment of different types of respiratory failure.
基金supported by NIH National Center for Advancing Translational Science,No.UL1TR001881
文摘AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV)use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU)or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortalityⅢ(PRIsM-Ⅲ)scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV)were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%)failed treatment and required MV.The majority of the patients(74%)had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P=0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲscores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P<0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.
基金funded by the Hunan Provincial Natural Science Foundation of China(2024JJ2038,2024JJ9161)the Central Government Guides Local Science and Technology Development Fund Projects(2024ZYC031)+4 种基金the Hunan Health High-Level Talent Project(R2023073)the National Key Clinical Specialty Scientific Research Project(Z2023114)the Young Doctor Foundation of Hunan Provincial People’s Hospital(BSJJ202209)the Key Cultivation Project of Hunan Provincial People’s Hospital(RS2022A06)the Clinical Research Center for Emergency and Critical Care in Hunan Province(2021SK4011).
文摘Acute respiratory distress syndrome(ARDS)is a severe clinical condition characterized by acute respiratory failure due to widespread pulmonary inflammation and edema.The incidence of ARDS among intensive care unit(ICU)patients is approximately 10%,with mortality rates ranging from 35%to 45%and exceeding 50%in severe cases.[1]Identifying and controlling risk factors for ARDS is critical for early prevention.Smoking remains a significant global public health issue,affecting one-third of adults and 40%of children through exposure to secondhand smoke.[2]In an animal study,cigarette smoke impaired lung endothelial barrier function through oxidative stress and exacerbated lipopolysaccharide-induced increases in vascular permeability in vivo.This finding is consistent with the pathological changes observed in ARDS.[3]Although many observational studies have suggested a potential link between smoking and ARDS,the causal relationship remains unclear.This study uses Mendelian randomization(MR)to explore whether smoking behavior causally influences ARDS and investigates the mechanisms by which smoking may contribute to ARDS development through transcriptomic analysis of the Gene Expression Omnibus(GEO)database.
文摘Acute respiratory failure(ARF)in immunocompromised patients remains challenging to treat.A large number of case require admission to intensive care unit(ICU)where mortality remains high.Oxygenation without intubation is important in this setting.This review summarizes recent studies assessing oxygenation devices for immunocompromised patients.Previous studies showed that non-invasive ventilation(NIV)has been associated with lower intubation and mortality rates.Indeed,in recent years,the outcomes of immunocompromised patients admitted to the ICU have improved.In the most recent randomized controlled trials,including immunocompromised patients admitted to the ICU with ARF,neither NIV nor high-flow nasal oxygen(HFNO)could reduce the mortality rate.In this setting,other strategies need to be tested to decrease the mortality rate.Early admission strategy and avoiding late failure of oxygenation strategy have been assessed in retrospective studies.However,objective criteria are still lacking to clearly discriminate time to admission or time to intubation.Also,diagnosis strategy may have an impact on intubation or mortality rates.On the other hand,lack of diagnosis has been associated with a higher mortality rate.In conclusion,improving outcomes in immunocompromised patients with ARF may include strategies other than the oxygenation strategy alone.This review discusses other unresolved questions to decrease mortality after ICU admission in such patients.
基金supported by the Clinical Research Plan of SHDC (grant number:SHDC2020CR2013A)the Clinical Research Plan of SHDC (grant number:SHDC2020CR5010-003).
文摘Background Since the beginning of the coronavirus disease 2019(COVID-19)pandemic,prone positioning has been widely applied for non-intubated,spontaneously breathing patients.However,the efficacy and safety of prone positioning in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure remain unclear.We aimed to systematically analyze the outcomes associated with awake prone positioning(APP).Methods We conducted a systematic literature search of PubMed/MEDLINE,Cochrane Library,Embase,and Web of Science from January 1,2020,to June 3,2022.This study included adult patients with acute respiratory failure caused by COVID-19.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines were followed,and the study quality was assessed using the Cochrane risk-of-bias tool.The primary outcome was the reported cumulative intubation risk across randomized controlled trials(RCTs),and the effect estimates were calculated as risk ratios(RRs;95%confidence interval[CI]).Results A total of 495 studies were identified,of which 10 fulfilled the selection criteria,and 2294 patients were included.In comparison to supine positioning,APP significantly reduced the need for intubation in the overall population(RR=0.84,95%CI:0.74–0.95).The two groups showed no significant differences in the incidence of adverse events(RR=1.16,95%CI:0.48–2.76).The meta-analysis revealed no difference in mortality between the groups(RR=0.93,95%CI:0.77–1.11).Conclusions APP was safe and reduced the need for intubation in patients with respiratory failure associated with COVID-19.However,it did not significantly reduce mortality in comparison to usual care without prone positioning.
文摘Hypophosphataemia is defined as low level of phosphate in the blood (normal range 0.8 - 1.4 mmol/l), which can be drug-induced such as uniphyline. We present a case of elderly female patient with known chronic obstructive pulmonary disease, admitted with acute respiratory failure and low serum phosphate level, her clinical signs and serum phosphate level did not improve with conventional therapy and intravenous phosphate replacement, until her recently commenced uniphyline was discontinued. This highlights the importance of awareness amongst the clinicians about this rare but potential side effect of uniphyline. We suggest monitoring phosphate levels in patients admitted with acute respiratory failure especially those on extended bronchodilator therapy.
文摘BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.
文摘BACKGROUND The extensive availability of ultrasound(US)technology has increased its use for point-of-care applications in many health care settings.During anaesthesia and surgery,acute respiratory failure or pulmonary oedema are common lifethreatening events that,if not recognized and treated appropriately,result in a high mortality rate.CASE SUMMARY We report a patient under anaesthesia whose lung US examination showed multiple vertical artefacts(B-lines)in the lung tissue,indicating pulmonary oedema.The respiratory state improved with the resolution of the pulmonary oedema after our treatment.CONCLUSION We believe that US of the lungs may be a useful tool for dynamic respiratory monitoring at the bedside during anaesthesia.
文摘Pneumonia is a common complication in organ transplantation patients. Multiple respiratory pathogens such as bacteria, viruses and fungi are potentially coexisted. A 60-year-old male with left eye post corneal transplantation developed acute severe pneumonia caused by <em>Pneumocystis jiroveci</em> (PJP) coinfection with <em>Nocardia spp</em>. and <em>Cytomegalovirus</em> (CMV). He was hospitalized due to acute respiratory failure. Chest radiographs and chest Computed Tomography (CT) revealed extensive ground-glass opacities. PJP was diagnosed from Bronchoalveolar Lavage Fluid (BALF). The pneumonia was persistent despite of receiving intravenous cotrimoxazole. Tracheal aspirate showed faint gram-positive filamentous beaded branching organisms. Consequently <em>Nocardia spp</em>. was proven. Intravenous cotrimoxazole was continued and intravenous imipenem was added. After a course of dual antibiotics, pneumonia was gradually improved. A week after, he developed the worsened acute respiratory failure. The bronchoscopy was performed. The new pathogens were not detected from BALF microbiology. The BALF cytology was unremarkable. PJP was detected by Polymerase Chain Reaction (PCR) from BALF. CMV antigenemia was detected from BALF and blood. Intravenous ganciclovir was given. This report describes PJP coinfected with <em>Nocardia spp</em>. and CMV in post corneal transplantation patient suffering from severe pneumonia. Multiple respiratory pathogens are common among transplantation patients representing host immunosuppression and inadequate antimicorbial prophylaxis.
基金supported by National Clinical Key Specialty(grant number:Z155080000004))Clinical management optimization project of SHDC(grant number:SHDC22022206).
文摘Background:Awake prone positioning(APP)can reportedly reduce the need for intubation and help improve prognosis of patients with acute hypoxemic respiratory failure(AHRF)infected with COVID-19.However,its physiological mechanism remains unclear.In this study,we evaluated the effect of APP on lung ventilation in patients with moderate-to-severe AHRF to better understand the effects on ventilation distribution and to prevent intubation in non-intubated patients.Methods:The prospective study was performed in the Department of Critical Care Medicine at Shanghai General Hospital,China,from January 2021 to November 2022.The study included patients with AHRF(partial pressure of oxygen[PaO_(2)]/inspired oxygen concentration[FiO_(2)]<200 mmHg or oxygen saturation[SpO_(2)]/FiO_(2)<235]treated with high-flow nasal oxygen.Electrical impedance tomography(EIT)measurements including center of ventilation(COV),global inhomogeneity(GI)index,and regional ventilation delay(RVD)index were performed in the supine position(To),30 min after the start of APP(Ti),and 30 min returning to supine position after the APP(T2).Clinical parameters like SpO_(2),respiratory rate(RR),FiO_(2),heart rate(HR),and ROX(the ratio of SpO_(2) as measured by pulse oximetry/FiO_(2) to RR)were also recorded simultaneously at To,Ti,and T2.To evaluate the effect of the time points on the variables,Mauchly's test was performed for sphericity and repeated measures analysis of variance was applied with Bonferroni's post hoc multiple comparisons.Results:Ten patients were enrolled.The Pa02/FiO_(2) ratio was(111.4±33.4)mmHg at the time of recruitment.ROX showed a significant increase after initiation of APP(median(interquartile range[IQR)):To:7.5(6.0-10.1)vs.Ti:7.6(6.4-9.3)vs.T2:8.3(7.2-11.0),P=0.043).RR(P=0.409),HR(P=0.417),and SpO_(2)/FiO_(2)(P=0.262)did not change significantly during prone positioning(PP).The CoV moved from the ventral area to the dorsal area(To:48.8%±6.2%vs.T:54.8%±6.8%vs.T2:50.3%±6.1%,P=0.030)after APP.The GI decreased significantly after APP(To:median=42.7%,[IQR:38.3%-47.5%]vs.Ti:median=38.2%,[IQR:34.6%-50.7%]vs.T2:median=37.4%,[IQR:34.2%-41.4%],P=0.049).RVD(P=0.794)did not change after APP.Conclusions:APP can improve ventilation distribution and homogeneity of lung ventilation as assessed by EIT in non-intubated patients with AHRF.Trail Registration Chinese Clinical Trial Registry Identifier:ChiCTR2000035895.
基金The authors wish to acknowledge the funding support for the HASARS Database on data collection and management from the Hong Kong Government’s Health,Welfare and Food Bureau and Research Fund for the Control of lnfectious Diseases.
文摘Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease.Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database.Intubation rate,mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions(NIV Hospita1)were compared against 13 hospitals using solely invasive ventilation(IMV Hospitals).Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups.Results Both hospital groups had comparable demographics and clinical profiles,but NIV Hospital(42 patients)had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement.Compared to IMV Hospitals(451 patients).NIV Hospital had lower adjusted odds ratios for intubation(0.36,95%C10.164-0.791,P=0.011)and death(0.235.95%C10.077-0.716,P=0.O 11),and improved earlier after pulsed steroid rescue.There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation,non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.
文摘Although standard oxygen face masks are first-line therapy for patients with acute hypoxemic respiratory failure,high-flow nasal cannula oxygen therapy has gained major popularity in intensive care units.The physiological effects of high-flow oxygen counterbalance the physiological consequences of acute hypoxemic respiratory failure by lessening the deleterious effects of intense and prolonged inspiratory efforts generated by patients.Its simplicity of application for physicians and nurses and its comfort for patients are other arguments for its use in this setting.Although clinical studies have reported a decreased risk of intubation with high-flow oxygen compared with standard oxygen,its survival benefit is uncertain.A more precise definition of acute hypoxemic respiratory failure,including a classification of severity based on oxygenation levels,is needed to better compare the efficiencies of different non-invasive oxygenation support methods(standard oxygen,high-flow oxygen,and non-invasive ventilation).Additionally,the respective role of each non-invasive oxygenation support method needs to be established through further clinical trials in acute hypoxemic respiratory failure,especially in severe forms.
基金supported by the Technological Innovation 2030-Major Project for the Prevention and Control of Cancer,Cardiovascular and Cerebrovascular Diseases,Respiratory Diseases,and Metabolic Diseases(2024ZD0520200/2024ZD0520204)Development Center for Medical Science&Technology,National Health Commission of the People's Republic of China+5 种基金the National Natural Science Foundation of China(82241060,82272241,82270392,82402574)1.3.5 Project for Disciplinesof Excellence(ZYYC23008ZYGD23035)Center of Excellence-lnternational Cooperation Initiative Grant(139170032)China Postdoctoral Science Foundation(2023M732462)by Projects of Sichuan Provincial Department of Science and Technology(2023ZYD0094).
文摘In recent years,the incidence of acute respiratory distress syndrome(ARDS)has been gradually increasing.Despite advances in supportive care,ARDS remains a significant cause of morbidity and mortality in critically ill patients.ARDS is characterized by acute hypoxaemic respiratory failure with diffuse pulmonary inflammation and bilateral edema due to excessive alveolocapillary permeability in patients with non-cardiogenic pulmonary diseases.Over the past seven decades,our understanding of the pathology and clinical characteristics of ARDS has evolved significantly,yet it remains an area of active research and discovery.ARDs is highly heterogeneous,including diverse pathological causes,clinical presentations,and treatment responses,presenting a significant challenge for clinicians and researchers.In this review,we comprehensively discuss the latest advancements in ARDS research,focusing on its heterogeneity,pathophysiological mechanisms,and emerging therapeutic approaches,such as cellular therapy,immunotherapy,and targeted therapy.Moreover,we also examine the pathological characteristics of cOvID-19-related ARDS and discuss the corresponding therapeutic approaches.In the face of challenges posed by ARDS heterogeneity,recent advancements offer hope for improved patient outcomes.Further research is essential to translate these findings into effective clinical interventions and personalized treatment approaches for ARDS,ultimately leading to better outcomes for patients suffering from ARDS.
文摘Cancer patients account for 15%of all admissions to intensive care unit(ICU)and 5%will experience a critical illness resulting in ICU admission.Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods.Since early critical care and organ support is associated with improved survival,timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying.This article focused on relevant and current information on epidemiology,diagnosis,and treatment of the main clinical disorders experienced by critically ill cancer patients.
文摘The article provides information on our achievements in the application of modern diagnostic methods and modern methods of treating patients with viral pneumonia,confirmed by covid-19.For this,statistical data of 2,000 patients were used.Of the 2,000 patients treated,920 were men,1,070 were women and 10 were children.Viral pneumonia-glaucoma syndrome in 1650 out of 2,000 patients with 10-20%damage;In 350,the diagnosis of viral pneumonia-frostbite syndrome with 50-85%damage,CRDS,respiratory failure was confirmed.Thus,50 out of 350 patients treated at the intensive care unit(ICU)out of 2,000 were intubated and connected to artificial ventilation.The research was carried out in 3 stages:I stage-admission to the intensive care unit;II stage-from the day of intubation to spontaneous breathing(7-14 days);and III stage-covers the period of extubation and recovery.The results of clinical,functional,hemodynamic and echocardiographic studies of the patients participating in the examination were analyzed.Also,the patients underwent bacteriological research studied the sensitivity to antibiotics.In addition,the composition of blood gases and the oxygenation index-Carrico were studied.
文摘Objective: To investigate the efficacy, safety and nursing improvement of noninvasive positive pressure ventilation (NPPV) in high-risk patients with acute respiratory failure after cardiac surgery. Methods: From September 2018 to October 2019, high-risk patients who may develop acute respiratory failure after cardiac surgery were selected and randomly divided into non-invasive ventilation group and conventional treatment group (control group). The reintubation rate, tracheotomy rate, fatality rate, 24 h intake and output, respiratory rate, arterial blood gas PaO2 and PaCO2 were compared between the two groups of patients;at the same time, the patient comfort and mask leakage after improved nursing technology were compared. Results: The preoperative and intraoperative conditions of the two groups of patients were basically similar, but the reintubation rate, tracheotomy rate, fatality rate, and respiratory rate of the patients in the preventive application of NPPV group were significantly lower than those of the control group, and the 24 h input and output and arterial blood gas PaO2 were also excellent in the control group. Conclusion: NPPV used prophylactically in high-risk patients after cardiac surgery can significantly reduce the re-intubation rate, improve patient outcomes, and is markedly more effective than the conventional treatment group.
