BACKGROUND Lung transplantation is a well-established treatment of end-stage lung disease.A rodent model is an inexpensive way to collect biological data from a living model after lung transplantation.However,masterin...BACKGROUND Lung transplantation is a well-established treatment of end-stage lung disease.A rodent model is an inexpensive way to collect biological data from a living model after lung transplantation.However,mastering the surgical technique takes time owing to the small organ size.AIM To conduct rat lung transplantation using a shunt cannula(SC)or modified cannula(MC)and assess their efficacy.METHODS Rat lung transplantation was performed in 11 animals in the SC group and 12 in the MC group.We devised a method of rat lung transplantation using a coronary SC for coronary artery bypass surgery as an anastomosis of pulmonary arteri-ovenous vessels and bronchioles.The same surgeon performed all surgical proce-dures in the donor and recipient rats without using a magnifying glass.The success rate of lung transplantation,operating time,and PaO2 values were com-pared after 2-h reperfusion after transplantation.RESULTS Ten and 12 lungs were successfully transplanted in the SC and MC groups,respectively.In the SC group,one animal had cardiac arrest within 1 h after reperfusion owing to bleeding during pulmonary vein anastomosis.The opera-ting time for the removal of the heart-lung block from the donor and preparation of the left lung graft was 26.8±2.3 and 25.7±1.3 min in the SC and MC groups,respectively(P=0.21).The time required for left lung transplantation in the recipients was 37.5±2.8 min and 35.9±1.4 min in the SC and MC groups,respectively(P=0.12).PaO2 values at 2 h after reperfusion were 456.2±25.5 and INTRODUCTION Lung transplantation is a well-established treatment of end-stage lung disease.Many immune and non-immune mech-anisms in lung transplantation are highly complex,and post-transplant complications such as infections and primary and chronic lung allograft dysfunction must be reduced to improve survival.Therefore,there is a need for immunological and pathophysiological analyses using animal lung transplantation models.The rat lung transplantation model was first reported in 1971[1],followed by the Mizuta Cuff model[2]in 1989.Since then,various improvements in surgical techniques,cuffs,and instruments have been reported[3-7].The advantage of using a rodent model is that it permits inexpensive collection of biological data from a living model after lung transplantation.Although trained surgeons can perform the transplantation procedure,mastering the surgical technique takes time due to the small size of the organs.The risks associated with this technique include damage to the vulnerable pulmonary artery(PA)and pulmonary vein(PV)vessel walls during anastomosis,as well as stenosis of the anastomotic site.We developed an anastomotic technique using a coronary shunt cannula(SC)for cardiac coronary artery bypass surgery as an alternative to the previously reported cuff method[2-6].This method enables anastomosis by inserting and ligating a cannula into the lumen of the PA,PV,and bronchus(Br),which is simpler and more reliable than conventional methods.This study aimed to determine problems with rat lung transplantation using the SC,develop an improved cannula,and investigate its utility.RESULTS After creating 11 lung transplantation model animals in the SC group and 12 in the MC group,all animals underwent reperfusion.One animal in the SC group had cardiac arrest 1 h after reperfusion due to hemorrhage caused by vessel wall injury during PV anastomosis.Two hours after reperfusion,we visually confirmed the maintenance of recipient hemody-namics and blood flow in the graft pulmonary cannula in 10 animals in the SC group and 12 in the MC group.The operating time for the removal of the heart-lung block from the donor and graft lung creation was 26.8±2.3 min in the SC group and 25.7±1.3 min in the MC group(P=0.21,Table 1).The duration for left lung transplantation into the recipient was 37.5±2.8 min in the SC group and 35.9±1.4 min(P=0.12,Table 1)in the MC group.Although no significant difference was found between the SC and MC groups,animals in the MC group experienced a slightly shorter operating time,smoother surgical technique,and less stressful procedure for the surgeons compared with those in the SC group.The graft lung coloration(Grade 1/2/3)after reperfusion was 0/2/8(SC group)and 0/2/10(MC group),and all grafts were reported to be successful,except in one animal in the SC group that had cardiac arrest(Table 2).The PaO2 values after 2 h of reperfusion were 456.2±25.5 mmHg in the SC group and 461.2±21.5 mmHg in the MC group(P=0.63,Table 3),showing no significant difference between the groups.展开更多
In orthopaedic patients, peripheral intravenous (IV) cannulation is a common procedure for various clinical purposes. This patient was introduced with a 17G cannula in the basilic vein of the dorsal venous arch of the...In orthopaedic patients, peripheral intravenous (IV) cannulation is a common procedure for various clinical purposes. This patient was introduced with a 17G cannula in the basilic vein of the dorsal venous arch of the left hand prior to knee replacement surgery. Post knee surgery patients use walking aids for mobilization. Cannula which has been placed at the dorsum of the hand has a potential to bend at the neck of the cannula when the wrist bend while holding the walking aid. Repeated bending can result in fatigue fracture of the cannula neck. In this patient at the time of cannula removal, it was noted the catheter part is broken and proximal migration. Ultrasound guided localization was done and removed with a venotomy under local anesthesia. It is advisable to place peripheral venous cannulas well away from the wrist joint, which will prevent catheter bending and fracture. This is a very important point to consider when placing cannulas in orthopaedic patients who undergo surgical procedures.展开更多
Redo sternotomy in pediatric patients can be complicated due to the unsuitability of many arterial cannulation sites for the pediatric population. Innominate artery cannulation provides a safe and easily reproducible ...Redo sternotomy in pediatric patients can be complicated due to the unsuitability of many arterial cannulation sites for the pediatric population. Innominate artery cannulation provides a safe and easily reproducible alternative and prevents many of the disadvantages seen in femoral and axillary artery cannulation. Its use in pediatric cardiac surgery has seen a rise [1]. Herein, we describe the technique for innominate artery cannulation in pediatric patients undergoing redo sternotomy and review our experience with the technique.展开更多
BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comp...BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.展开更多
Cavitation of centrifugal blood pump is a serious problem accompany with the blocking failure of short inlet cannula. However, hardly any work has been seen in published literature on this complex cavitation phenomeno...Cavitation of centrifugal blood pump is a serious problem accompany with the blocking failure of short inlet cannula. However, hardly any work has been seen in published literature on this complex cavitation phenomenon caused by the coupling effect of inlet cannula blocking and pumps suction. Even for cavitation studies on ordinary centrifugal pumps, similar researches on this issue are rare. In this paper, the roles of throttling, rotation speed and fluid viscosity on bubble inception and intensity in a centrifugal blood pump are studied, on the basis of experimental observations. An adjustable throttle valve installed just upstream blood pump inlet is used to simulate the throttling effect of the narrowed inlet cannula. The rotation speed is adjusted from 2 600 r/rain to 3 200 r/min. Glycerin water solutions are used to investigate the influences of kinetic viscosity. Bubbles are recorded with a high-speed video camera. Direct observation shows that different from cavitation in industrial centrifugal pumps, gas nuclei appears at the nearby of vane leading edges while throttling is light, then moves upstream to the joint position of inlet pipe and pump with the closing of the valve. It＇s found that the critical inlet pressure, obtained when bubbles are first observed, decreases linearly with viscosity and the slope is independent with rotation speeds; the critical inlet pressure and the inlet extreme pressure which is obtained when the throttle valve is nearly closed, fall linearly with rotation speed respectively and the relative pressure between them is independent with rotation speed and fluid viscosity. This paper studies experimentally on cavitation in centrifugal blood pump that caused by the failure of assembled short inlet cannula, which mav beneficial the desima of centrifugal blood Dumo with inlet cannula.展开更多
BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM...BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM To investigate the clinical efficacy of high-flow nasal cannula oxygen(HFNCO)in the resuscitation period of older orthopedic patients.METHODS In this prospective randomized controlled trial,60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups:those who used conventional face mask and those who used HFNCO.All patients were treated with 60%oxygen for 1 h after extubation.Patients in the conventional face mask group were treated with a combination of air(2 L)and oxygen(2 L)using a traditional mask,whereas those in the HFNCO group were treated with HFNCO at a constant temperature of 34℃ and flow rate of 40 L/min.We assessed the effectiveness of oxygen therapy by monitoring the patients’arterial blood gas,peripheral oxygen saturation,and postoperative complications.RESULTS The characteristics of the patients were comparable between the groups.One hour after extubation,patients in HFNCO group had a significantly higher arterial partial pressure of oxygen(paO_(2))than that of patients in conventional face mask group(P<0.001).At extubation and 1 h after extubation,patients in both groups showed a significantly higher arterial partial pressure of carbon dioxide(paCO_(2))than the baseline levels(P<0.001).There were no differences in the saturation of peripheral oxygen,paO_(2),and paCO_(2) between the groups before anesthesia and before extubation(P>0.05).There were statistically significant differences in paO_(2) between the two groups before anesthesia and 1 h after extubation and immediately after extubation and 1 h after extubation(P<0.001).However,there were no significant differences in the oxygen tolerance score before leaving the room,airway humidification,and pulmonary complications 3 d after surgery between the two groups(P>0.05).CONCLUSION HFNCO can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia.Thus,HFNCO can be used to prevent postoperative hypoxemia.展开更多
Objective:To systematically evaluate the efficacy and feasibility of high-flow nasal cannula(HFNC)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:Systematic searches on Pub...Objective:To systematically evaluate the efficacy and feasibility of high-flow nasal cannula(HFNC)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:Systematic searches on PubMed,Web of Science,the Cochrane Library,Embase,CBM(Chinese Biomedicine Database),CNKI(China National Knowledge Infrastructure),Wanfang Database and VIP were performed for randomized controlled trials(RCTs)which explored the effects of HFNC on patients with AECOPD.The retrieval time was from the establishment of each database to July 2019.RevMan5.3 software was used for statistical analysis.Results:A total of 12 articles were included,involving 812 patients.The results showed that:(1)Compared with conventional oxygen therapy,HFNC could improve patients'arterial partial oxygen pressure(PaO2)(MD=12.70,95%CI(7.00,18.40),Z=4.37,P<0.0001),reduce partial arterial blood carbon dioxide(PaCO2)(MD=-10.99,95%CI(-14.42,-7.55),Z=6.26,P<0.00001)and reduce endotracheal intubation rate(OR=0.19,95%CI(0.04,0.93),Z=2.05,P=0.04),shorten the hospitalization time(SMD=-0.74,95%CI(-1.11,-0.37),Z=3.95,P<0.0001).(2)Compared with non-invasive positive pressure ventilation,it has fewer adverse reactions(OR=0.18,95%CI(0.09,0.35),Z=5.08,P<0.00001)and shorter hospital stay(SMD=-0.57,95%CI(-0.90,-0.23),Z=3.33,P=0.0009).Conclusion:HFNC can improve the patients’hypoxia symptoms and CO2 retention,reduce the rate of tracheal intubation,and alleviate adverse reactions.However,Limited by the quality and region of the included studies,more high-quality are needed to test it.展开更多
BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstr...BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.展开更多
（IV） Intravenous therapy is one of the most commonly performed procedures in hospitalized patients yet phlebitis affects 27% to 70% of all patients receiving IV therapy. The incidence of phlebitis has proved to be a...（IV） Intravenous therapy is one of the most commonly performed procedures in hospitalized patients yet phlebitis affects 27% to 70% of all patients receiving IV therapy. The incidence of phlebitis has proved to be a menace in effective care of surgical patients, delaying their recovery and increasing duration of hospital stay and cost. The recommendations for reducing its incidence and severity have been varied and of questionable efficacy. The current study was undertaken to evaluate whether elective change of IV cannula at fixed intervals can have any impact on incidence or severity of phlebitis in surgical patients. All patients admitted to the Department of Surgery, SMIMS undergoing IV cannula insertion, fulfilling the selection criteria and willing to participate in the study, were segregated into two random groups prospectively： Group A wherein cannula was changed electively after 24 hours into a fresh vein preferably on the other upper limb and Group B wherein IV caunula was changed only on development of phlebitis or leak i.e. need-based change. The material/brand and protocol for insertion of IV cannula were standardised for all patients, including skin preparation, insertion, fixation and removal. After carmulation, assessment was made after 6 hours, 12 hours and every 24 hours thereafter at all venepuncture sites. VIP and VAS scales were used to record phlebitis and pain respectively. Upon analysis, though there was a lower VIP score in group A compared to group B （0.89 vs. 1.32）, this difference was not statistically significant （p-value = 0.277）. Furthermore, the differences in pain, as assessed by VAS, at the site of puncture and along the vein were statistically insignificant （p-value 〉 0.05）. Our results are in contradiction to few other studies which recommend a policy of routine change of carmula. Further we advocate a close and thorough monitoring of the venepuncture site and the length of vein immediately distal to the puncture site, as well as a meticulous standardized protocol for IV access.展开更多
Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive...Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)are commonly used non-invasive respiratory support methods.HFNC can provide precisely heated and humidified high-flow oxygen,reducing dead space and increasing alveolar ventilation.NIPPV can supply stable high-concentration oxygen and improve gas exchange.This article reviews the application of HFNC and NIPPV in the acute exacerbation stage of COPD,aiming to provide references for reasonable clinical selection.展开更多
目的探讨结合心率的改良呼吸频率氧合(ROX-HR)指数在患者接受经鼻高流量氧疗(HFNC)中的临床意义,同时比较ROX-HR指数与ROX指数早期预测HFNC结果的价值.方法选择天津市第一中心医院重症医学科2022年1月至2023年6月收治的进行连续HFNC的...目的探讨结合心率的改良呼吸频率氧合(ROX-HR)指数在患者接受经鼻高流量氧疗(HFNC)中的临床意义,同时比较ROX-HR指数与ROX指数早期预测HFNC结果的价值.方法选择天津市第一中心医院重症医学科2022年1月至2023年6月收治的进行连续HFNC的患者作为研究对象.153例患者被纳入研究分析.103例(67.3%)患者因急性呼吸衰竭接受HFNC,50例患者(32.7%)在拔除气管插管后开始HFNC.根据HFNC是否成功将患者分为HFNC成功组和HFNC失败组.记录HFNC启动前及HFNC启动后1、2、4、6、8、10、12、18、24和48h的HR和ROX指数,并计算ROX-HR指数.绘制受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),评价ROX-HR指数及ROX指数对急性呼吸衰竭和拔除气管插管后接受HFNC患者HFNC成功和失败的预测效能.结果因急性呼吸衰竭接受HFNC的患者中,HFNC失败和较高的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)有关,HFNC失败组APACHEⅡ和SOFA评分均明显高于HFNC成功组[APACHEⅡ评分(分):19.86(14.26,27.41)比16.24(13.60,22.69),SOFA评分(分):5(4,6)比4(3,5),均P<0.05].在拔除气管插管后开始HFNC的患者中,免疫功能低下是HFNC失败的重要因素,HFNC失败组免疫功能低下患者比例明显高于HFNC成功组[77.8%(14/18)比31.3%(1032),P<0.05].对于开始使用HFNC的急性呼吸衰竭患者,ROX-HR指数在所有时间点均能较好地评估HFNC成功与失败(AUC>0.650).对于拔管后开始HFNC的患者,HFNC失败患者的ROX-HR指数始终较低.然而,与ROX-HR指数不同,ROX指数似乎无法很好地区分HFNC成功与失败,拔管后2、4、8、18、48 h HFNC成功组与失败组差异无统计学意义.在拔管后开始HFNC的患者中,仅凭HR即可预测HFNC结局,2h、4h的AUC和95%可信区间(95%CI)分别为0.695(0.530~0.860)和0.698(0.527~0.868),P值分别为0.041和0.038.结论ROX-HR指数是早期识别高HFNC失败风险患者有前景的工具.展开更多
目的:总结经鼻高流量氧疗(High-Flow Nasal Cannula Oxygen Therapy,HFNC)患者肺康复训练的最佳证据,并应用于临床,评价其应用效果。方法:组建循证团队,以整合式健康服务领域研究成果应用的行动促进(Integrated Promoting Action on Res...目的:总结经鼻高流量氧疗(High-Flow Nasal Cannula Oxygen Therapy,HFNC)患者肺康复训练的最佳证据,并应用于临床,评价其应用效果。方法:组建循证团队,以整合式健康服务领域研究成果应用的行动促进(Integrated Promoting Action on Research Implementation in Health Services,i-PARIHS)框架为理论指导,按照证据获取、基线审查、障碍分析、证据应用、效果评价5个步骤进行证据的转换应用。采用整群抽样法,选取45例护士及120例慢性呼吸道疾病中应用HFNC的患者作为调查对象,对临床执行率<90%的审查指标的促进和障碍因素进行评估并制定行动策略。比较证据实施前后护士对临床标准的执行率及患者的6 min步行距离。结果:最终纳入13条最佳证据,制定14条审查指标。干预后14条审查指标的执行率均有所提高,且执行率均>90%。另外,证据应用阶段患者6 min步行距离优于基线审查阶段(P<0.05)。结论:基于i-PARIHS框架的肺康复循证实践,有效提高了HFNC患者肺康复训练效果,增加患者活动耐力。展开更多
文摘BACKGROUND Lung transplantation is a well-established treatment of end-stage lung disease.A rodent model is an inexpensive way to collect biological data from a living model after lung transplantation.However,mastering the surgical technique takes time owing to the small organ size.AIM To conduct rat lung transplantation using a shunt cannula(SC)or modified cannula(MC)and assess their efficacy.METHODS Rat lung transplantation was performed in 11 animals in the SC group and 12 in the MC group.We devised a method of rat lung transplantation using a coronary SC for coronary artery bypass surgery as an anastomosis of pulmonary arteri-ovenous vessels and bronchioles.The same surgeon performed all surgical proce-dures in the donor and recipient rats without using a magnifying glass.The success rate of lung transplantation,operating time,and PaO2 values were com-pared after 2-h reperfusion after transplantation.RESULTS Ten and 12 lungs were successfully transplanted in the SC and MC groups,respectively.In the SC group,one animal had cardiac arrest within 1 h after reperfusion owing to bleeding during pulmonary vein anastomosis.The opera-ting time for the removal of the heart-lung block from the donor and preparation of the left lung graft was 26.8±2.3 and 25.7±1.3 min in the SC and MC groups,respectively(P=0.21).The time required for left lung transplantation in the recipients was 37.5±2.8 min and 35.9±1.4 min in the SC and MC groups,respectively(P=0.12).PaO2 values at 2 h after reperfusion were 456.2±25.5 and INTRODUCTION Lung transplantation is a well-established treatment of end-stage lung disease.Many immune and non-immune mech-anisms in lung transplantation are highly complex,and post-transplant complications such as infections and primary and chronic lung allograft dysfunction must be reduced to improve survival.Therefore,there is a need for immunological and pathophysiological analyses using animal lung transplantation models.The rat lung transplantation model was first reported in 1971[1],followed by the Mizuta Cuff model[2]in 1989.Since then,various improvements in surgical techniques,cuffs,and instruments have been reported[3-7].The advantage of using a rodent model is that it permits inexpensive collection of biological data from a living model after lung transplantation.Although trained surgeons can perform the transplantation procedure,mastering the surgical technique takes time due to the small size of the organs.The risks associated with this technique include damage to the vulnerable pulmonary artery(PA)and pulmonary vein(PV)vessel walls during anastomosis,as well as stenosis of the anastomotic site.We developed an anastomotic technique using a coronary shunt cannula(SC)for cardiac coronary artery bypass surgery as an alternative to the previously reported cuff method[2-6].This method enables anastomosis by inserting and ligating a cannula into the lumen of the PA,PV,and bronchus(Br),which is simpler and more reliable than conventional methods.This study aimed to determine problems with rat lung transplantation using the SC,develop an improved cannula,and investigate its utility.RESULTS After creating 11 lung transplantation model animals in the SC group and 12 in the MC group,all animals underwent reperfusion.One animal in the SC group had cardiac arrest 1 h after reperfusion due to hemorrhage caused by vessel wall injury during PV anastomosis.Two hours after reperfusion,we visually confirmed the maintenance of recipient hemody-namics and blood flow in the graft pulmonary cannula in 10 animals in the SC group and 12 in the MC group.The operating time for the removal of the heart-lung block from the donor and graft lung creation was 26.8±2.3 min in the SC group and 25.7±1.3 min in the MC group(P=0.21,Table 1).The duration for left lung transplantation into the recipient was 37.5±2.8 min in the SC group and 35.9±1.4 min(P=0.12,Table 1)in the MC group.Although no significant difference was found between the SC and MC groups,animals in the MC group experienced a slightly shorter operating time,smoother surgical technique,and less stressful procedure for the surgeons compared with those in the SC group.The graft lung coloration(Grade 1/2/3)after reperfusion was 0/2/8(SC group)and 0/2/10(MC group),and all grafts were reported to be successful,except in one animal in the SC group that had cardiac arrest(Table 2).The PaO2 values after 2 h of reperfusion were 456.2±25.5 mmHg in the SC group and 461.2±21.5 mmHg in the MC group(P=0.63,Table 3),showing no significant difference between the groups.
文摘In orthopaedic patients, peripheral intravenous (IV) cannulation is a common procedure for various clinical purposes. This patient was introduced with a 17G cannula in the basilic vein of the dorsal venous arch of the left hand prior to knee replacement surgery. Post knee surgery patients use walking aids for mobilization. Cannula which has been placed at the dorsum of the hand has a potential to bend at the neck of the cannula when the wrist bend while holding the walking aid. Repeated bending can result in fatigue fracture of the cannula neck. In this patient at the time of cannula removal, it was noted the catheter part is broken and proximal migration. Ultrasound guided localization was done and removed with a venotomy under local anesthesia. It is advisable to place peripheral venous cannulas well away from the wrist joint, which will prevent catheter bending and fracture. This is a very important point to consider when placing cannulas in orthopaedic patients who undergo surgical procedures.
文摘Redo sternotomy in pediatric patients can be complicated due to the unsuitability of many arterial cannulation sites for the pediatric population. Innominate artery cannulation provides a safe and easily reproducible alternative and prevents many of the disadvantages seen in femoral and axillary artery cannulation. Its use in pediatric cardiac surgery has seen a rise [1]. Herein, we describe the technique for innominate artery cannulation in pediatric patients undergoing redo sternotomy and review our experience with the technique.
文摘BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.
基金supported by the National Natural Science Foundation of China(Grant No.51275461)the Zhejiang Provincial Natural Science Foundation of China(Grant No.Z1110189)
文摘Cavitation of centrifugal blood pump is a serious problem accompany with the blocking failure of short inlet cannula. However, hardly any work has been seen in published literature on this complex cavitation phenomenon caused by the coupling effect of inlet cannula blocking and pumps suction. Even for cavitation studies on ordinary centrifugal pumps, similar researches on this issue are rare. In this paper, the roles of throttling, rotation speed and fluid viscosity on bubble inception and intensity in a centrifugal blood pump are studied, on the basis of experimental observations. An adjustable throttle valve installed just upstream blood pump inlet is used to simulate the throttling effect of the narrowed inlet cannula. The rotation speed is adjusted from 2 600 r/rain to 3 200 r/min. Glycerin water solutions are used to investigate the influences of kinetic viscosity. Bubbles are recorded with a high-speed video camera. Direct observation shows that different from cavitation in industrial centrifugal pumps, gas nuclei appears at the nearby of vane leading edges while throttling is light, then moves upstream to the joint position of inlet pipe and pump with the closing of the valve. It＇s found that the critical inlet pressure, obtained when bubbles are first observed, decreases linearly with viscosity and the slope is independent with rotation speeds; the critical inlet pressure and the inlet extreme pressure which is obtained when the throttle valve is nearly closed, fall linearly with rotation speed respectively and the relative pressure between them is independent with rotation speed and fluid viscosity. This paper studies experimentally on cavitation in centrifugal blood pump that caused by the failure of assembled short inlet cannula, which mav beneficial the desima of centrifugal blood Dumo with inlet cannula.
文摘BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM To investigate the clinical efficacy of high-flow nasal cannula oxygen(HFNCO)in the resuscitation period of older orthopedic patients.METHODS In this prospective randomized controlled trial,60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups:those who used conventional face mask and those who used HFNCO.All patients were treated with 60%oxygen for 1 h after extubation.Patients in the conventional face mask group were treated with a combination of air(2 L)and oxygen(2 L)using a traditional mask,whereas those in the HFNCO group were treated with HFNCO at a constant temperature of 34℃ and flow rate of 40 L/min.We assessed the effectiveness of oxygen therapy by monitoring the patients’arterial blood gas,peripheral oxygen saturation,and postoperative complications.RESULTS The characteristics of the patients were comparable between the groups.One hour after extubation,patients in HFNCO group had a significantly higher arterial partial pressure of oxygen(paO_(2))than that of patients in conventional face mask group(P<0.001).At extubation and 1 h after extubation,patients in both groups showed a significantly higher arterial partial pressure of carbon dioxide(paCO_(2))than the baseline levels(P<0.001).There were no differences in the saturation of peripheral oxygen,paO_(2),and paCO_(2) between the groups before anesthesia and before extubation(P>0.05).There were statistically significant differences in paO_(2) between the two groups before anesthesia and 1 h after extubation and immediately after extubation and 1 h after extubation(P<0.001).However,there were no significant differences in the oxygen tolerance score before leaving the room,airway humidification,and pulmonary complications 3 d after surgery between the two groups(P>0.05).CONCLUSION HFNCO can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia.Thus,HFNCO can be used to prevent postoperative hypoxemia.
文摘Objective:To systematically evaluate the efficacy and feasibility of high-flow nasal cannula(HFNC)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:Systematic searches on PubMed,Web of Science,the Cochrane Library,Embase,CBM(Chinese Biomedicine Database),CNKI(China National Knowledge Infrastructure),Wanfang Database and VIP were performed for randomized controlled trials(RCTs)which explored the effects of HFNC on patients with AECOPD.The retrieval time was from the establishment of each database to July 2019.RevMan5.3 software was used for statistical analysis.Results:A total of 12 articles were included,involving 812 patients.The results showed that:(1)Compared with conventional oxygen therapy,HFNC could improve patients'arterial partial oxygen pressure(PaO2)(MD=12.70,95%CI(7.00,18.40),Z=4.37,P<0.0001),reduce partial arterial blood carbon dioxide(PaCO2)(MD=-10.99,95%CI(-14.42,-7.55),Z=6.26,P<0.00001)and reduce endotracheal intubation rate(OR=0.19,95%CI(0.04,0.93),Z=2.05,P=0.04),shorten the hospitalization time(SMD=-0.74,95%CI(-1.11,-0.37),Z=3.95,P<0.0001).(2)Compared with non-invasive positive pressure ventilation,it has fewer adverse reactions(OR=0.18,95%CI(0.09,0.35),Z=5.08,P<0.00001)and shorter hospital stay(SMD=-0.57,95%CI(-0.90,-0.23),Z=3.33,P=0.0009).Conclusion:HFNC can improve the patients’hypoxia symptoms and CO2 retention,reduce the rate of tracheal intubation,and alleviate adverse reactions.However,Limited by the quality and region of the included studies,more high-quality are needed to test it.
文摘BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.
文摘（IV） Intravenous therapy is one of the most commonly performed procedures in hospitalized patients yet phlebitis affects 27% to 70% of all patients receiving IV therapy. The incidence of phlebitis has proved to be a menace in effective care of surgical patients, delaying their recovery and increasing duration of hospital stay and cost. The recommendations for reducing its incidence and severity have been varied and of questionable efficacy. The current study was undertaken to evaluate whether elective change of IV cannula at fixed intervals can have any impact on incidence or severity of phlebitis in surgical patients. All patients admitted to the Department of Surgery, SMIMS undergoing IV cannula insertion, fulfilling the selection criteria and willing to participate in the study, were segregated into two random groups prospectively： Group A wherein cannula was changed electively after 24 hours into a fresh vein preferably on the other upper limb and Group B wherein IV caunula was changed only on development of phlebitis or leak i.e. need-based change. The material/brand and protocol for insertion of IV cannula were standardised for all patients, including skin preparation, insertion, fixation and removal. After carmulation, assessment was made after 6 hours, 12 hours and every 24 hours thereafter at all venepuncture sites. VIP and VAS scales were used to record phlebitis and pain respectively. Upon analysis, though there was a lower VIP score in group A compared to group B （0.89 vs. 1.32）, this difference was not statistically significant （p-value = 0.277）. Furthermore, the differences in pain, as assessed by VAS, at the site of puncture and along the vein were statistically insignificant （p-value 〉 0.05）. Our results are in contradiction to few other studies which recommend a policy of routine change of carmula. Further we advocate a close and thorough monitoring of the venepuncture site and the length of vein immediately distal to the puncture site, as well as a meticulous standardized protocol for IV access.
基金2022 Inner Mongolia Autonomous Region Health and Wellness Science and Technology Program Project(Project No.:202201533)。
文摘Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)are commonly used non-invasive respiratory support methods.HFNC can provide precisely heated and humidified high-flow oxygen,reducing dead space and increasing alveolar ventilation.NIPPV can supply stable high-concentration oxygen and improve gas exchange.This article reviews the application of HFNC and NIPPV in the acute exacerbation stage of COPD,aiming to provide references for reasonable clinical selection.
文摘目的探讨结合心率的改良呼吸频率氧合(ROX-HR)指数在患者接受经鼻高流量氧疗(HFNC)中的临床意义,同时比较ROX-HR指数与ROX指数早期预测HFNC结果的价值.方法选择天津市第一中心医院重症医学科2022年1月至2023年6月收治的进行连续HFNC的患者作为研究对象.153例患者被纳入研究分析.103例(67.3%)患者因急性呼吸衰竭接受HFNC,50例患者(32.7%)在拔除气管插管后开始HFNC.根据HFNC是否成功将患者分为HFNC成功组和HFNC失败组.记录HFNC启动前及HFNC启动后1、2、4、6、8、10、12、18、24和48h的HR和ROX指数,并计算ROX-HR指数.绘制受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),评价ROX-HR指数及ROX指数对急性呼吸衰竭和拔除气管插管后接受HFNC患者HFNC成功和失败的预测效能.结果因急性呼吸衰竭接受HFNC的患者中,HFNC失败和较高的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)有关,HFNC失败组APACHEⅡ和SOFA评分均明显高于HFNC成功组[APACHEⅡ评分(分):19.86(14.26,27.41)比16.24(13.60,22.69),SOFA评分(分):5(4,6)比4(3,5),均P<0.05].在拔除气管插管后开始HFNC的患者中,免疫功能低下是HFNC失败的重要因素,HFNC失败组免疫功能低下患者比例明显高于HFNC成功组[77.8%(14/18)比31.3%(1032),P<0.05].对于开始使用HFNC的急性呼吸衰竭患者,ROX-HR指数在所有时间点均能较好地评估HFNC成功与失败(AUC>0.650).对于拔管后开始HFNC的患者,HFNC失败患者的ROX-HR指数始终较低.然而,与ROX-HR指数不同,ROX指数似乎无法很好地区分HFNC成功与失败,拔管后2、4、8、18、48 h HFNC成功组与失败组差异无统计学意义.在拔管后开始HFNC的患者中,仅凭HR即可预测HFNC结局,2h、4h的AUC和95%可信区间(95%CI)分别为0.695(0.530~0.860)和0.698(0.527~0.868),P值分别为0.041和0.038.结论ROX-HR指数是早期识别高HFNC失败风险患者有前景的工具.
文摘目的:总结经鼻高流量氧疗(High-Flow Nasal Cannula Oxygen Therapy,HFNC)患者肺康复训练的最佳证据,并应用于临床,评价其应用效果。方法:组建循证团队,以整合式健康服务领域研究成果应用的行动促进(Integrated Promoting Action on Research Implementation in Health Services,i-PARIHS)框架为理论指导,按照证据获取、基线审查、障碍分析、证据应用、效果评价5个步骤进行证据的转换应用。采用整群抽样法,选取45例护士及120例慢性呼吸道疾病中应用HFNC的患者作为调查对象,对临床执行率<90%的审查指标的促进和障碍因素进行评估并制定行动策略。比较证据实施前后护士对临床标准的执行率及患者的6 min步行距离。结果:最终纳入13条最佳证据,制定14条审查指标。干预后14条审查指标的执行率均有所提高,且执行率均>90%。另外,证据应用阶段患者6 min步行距离优于基线审查阶段(P<0.05)。结论:基于i-PARIHS框架的肺康复循证实践,有效提高了HFNC患者肺康复训练效果,增加患者活动耐力。
