BACKGROUND Coronavirus disease 2019(COVID-19)severity is classified as asymptomatic,mild,moderate,severe,and critical.Mild cases account for a large percentage of cases in the epidemic and typically exhibit a favorabl...BACKGROUND Coronavirus disease 2019(COVID-19)severity is classified as asymptomatic,mild,moderate,severe,and critical.Mild cases account for a large percentage of cases in the epidemic and typically exhibit a favorable prognosis.However,a 49%-67%mortality is noted in critical cases.No COVID-19-specific drug has been reported to date,and symptomatic and optimal supportive care,including oxygenation,anti-coinfection treatments,and ventilation,represent the mainstay of treatment for this disease,especially in critical patients.CASE SUMMARY In the above-mentioned context,we share our experience with the treatment of one critical COVID-19 case and review the relevant literature.CONCLUSION Timely tracheal intubation,reasonable mechanical ventilation support,appropriate anti-infection treatment,and early anticoagulation and immunity support are key factors in the successful treatment of this case.展开更多
Background:Conventional pressure support ventilation(PSP)is triggered and cycled off by pneumatic signals such as flow.Patient-ventilator asynchrony is common during pressure support ventilation,thereby contributing t...Background:Conventional pressure support ventilation(PSP)is triggered and cycled off by pneumatic signals such as flow.Patient-ventilator asynchrony is common during pressure support ventilation,thereby contributing to an increased inspiratory effort.Using diaphragm electrical activity,neurally controlled pressure support(PSN)could hypothetically eliminate the asynchrony and reduce inspiratory effort.The purpose of this study was to compare the differences between PSN and PSP in terms of patient-ventilator synchrony,inspiratory effort,and breathing pattern.Methods:Eight post-operative patients without respiratory system comorbidity,eight patients with acute respiratory distress syndrome(ARDS)and obvious restrictive acute respiratory failure(ARF),and eight patients with chronic obstructive pulmonary disease(COPD)and mixed restrictive and obstructive ARF were enrolled.Patient-ventilator interactions were analyzed with macro asynchronies(ineffective,double,and auto triggering),micro asynchronies(inspiratory trigger delay,premature,and late cycling),and the total asynchrony index(AI).Inspiratory efforts for triggering and total inspiration were analyzed.Results:Total AI of PSN was consistently lower than that of PSP in COPD(3%vs.93%,P=0.012 for 100%support level;8%vs.104%,P=0.012 for 150%support level),ARDS(8%vs.29%,P=0.012 for 100%support level;16%vs.41%,P=0.017 for 150%support level),and post-operative patients(21%vs.35%,P=0.012 for 100%support level;15%vs.50%,P=0.017 for 150%support level).Improved support levels from 100%to 150%statistically increased total AI during PSP but not during PSN in patients with COPD or ARDS.Patients’inspiratory efforts for triggering and total inspiration were significantly lower during PSN than during PSP in patients with COPD or ARDS under both support levels(P<0.05).There was no difference in breathing patterns between PSN and PSP.Conclusions:PSN improves patient-ventilator synchrony and generates a respiratory pattern similar to PSP independently of any level of support in patients with different respiratory system mechanical properties.PSN,which reduces the trigger and total patient’s inspiratory effort in patients with COPD or ARDS,might be an alternative mode for PSP.Trial Registration:ClinicalTrials.gov,NCT01979627;https://clinicaltrials.gov/ct2/show/record/NCT01979627.展开更多
基金Supported by the Health and Family Planning Commission of Shenzhen Municipality,No.SZLY2018024and Sanming Project of Medicine in Shenzhen,No.SZSM201512031.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)severity is classified as asymptomatic,mild,moderate,severe,and critical.Mild cases account for a large percentage of cases in the epidemic and typically exhibit a favorable prognosis.However,a 49%-67%mortality is noted in critical cases.No COVID-19-specific drug has been reported to date,and symptomatic and optimal supportive care,including oxygenation,anti-coinfection treatments,and ventilation,represent the mainstay of treatment for this disease,especially in critical patients.CASE SUMMARY In the above-mentioned context,we share our experience with the treatment of one critical COVID-19 case and review the relevant literature.CONCLUSION Timely tracheal intubation,reasonable mechanical ventilation support,appropriate anti-infection treatment,and early anticoagulation and immunity support are key factors in the successful treatment of this case.
基金National Science and Technology Major Project(No.2020ZX09201015)Clinical Science and Technology Specific Projects of Jiangsu Province(Nos.BE2018743,BE2019749)+3 种基金National Natural Science Foundation of China(Nos.81870066,81670074,81930058)Natural Science Foundation of Jiangsu Province(No.BK20171271)Jiangsu Provincial Medical Youth Talent(No.QNRC 2016807)Third Level Talents of the"333 High Level Talents Training Project"in the fifth phase in Jiangsu(No.LGY2016051)。
文摘Background:Conventional pressure support ventilation(PSP)is triggered and cycled off by pneumatic signals such as flow.Patient-ventilator asynchrony is common during pressure support ventilation,thereby contributing to an increased inspiratory effort.Using diaphragm electrical activity,neurally controlled pressure support(PSN)could hypothetically eliminate the asynchrony and reduce inspiratory effort.The purpose of this study was to compare the differences between PSN and PSP in terms of patient-ventilator synchrony,inspiratory effort,and breathing pattern.Methods:Eight post-operative patients without respiratory system comorbidity,eight patients with acute respiratory distress syndrome(ARDS)and obvious restrictive acute respiratory failure(ARF),and eight patients with chronic obstructive pulmonary disease(COPD)and mixed restrictive and obstructive ARF were enrolled.Patient-ventilator interactions were analyzed with macro asynchronies(ineffective,double,and auto triggering),micro asynchronies(inspiratory trigger delay,premature,and late cycling),and the total asynchrony index(AI).Inspiratory efforts for triggering and total inspiration were analyzed.Results:Total AI of PSN was consistently lower than that of PSP in COPD(3%vs.93%,P=0.012 for 100%support level;8%vs.104%,P=0.012 for 150%support level),ARDS(8%vs.29%,P=0.012 for 100%support level;16%vs.41%,P=0.017 for 150%support level),and post-operative patients(21%vs.35%,P=0.012 for 100%support level;15%vs.50%,P=0.017 for 150%support level).Improved support levels from 100%to 150%statistically increased total AI during PSP but not during PSN in patients with COPD or ARDS.Patients’inspiratory efforts for triggering and total inspiration were significantly lower during PSN than during PSP in patients with COPD or ARDS under both support levels(P<0.05).There was no difference in breathing patterns between PSN and PSP.Conclusions:PSN improves patient-ventilator synchrony and generates a respiratory pattern similar to PSP independently of any level of support in patients with different respiratory system mechanical properties.PSN,which reduces the trigger and total patient’s inspiratory effort in patients with COPD or ARDS,might be an alternative mode for PSP.Trial Registration:ClinicalTrials.gov,NCT01979627;https://clinicaltrials.gov/ct2/show/record/NCT01979627.
