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
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
The high-flowing sand-concrete （HFSC） containing natural sands as aggregate was carried out. The high fluidity and stability of HFSC can be achieved by tailoring the mix design parameters, such as fine to coarse san...The high-flowing sand-concrete （HFSC） containing natural sands as aggregate was carried out. The high fluidity and stability of HFSC can be achieved by tailoring the mix design parameters, such as fine to coarse sand ratio, dosage of additions, water to binder ratio and dosage of admixtures. Mini-cone slump test, v-fl.mnel time test and viscosity model parameters were used to characterize the behaviour of HFSC in fresh state. The mechanical compressive strength in 28 d was also determined. A factorial design approach was used to establish models highlighting the effect of each mix-parameter on measured properties of HFSC. The derived models are valid for mixtures made with 0 to 0.3 of dune sand to total sand ratio, 82 to 418 kg/m3 of marble powder, 0.42 to 0.46 of water/binder ratio and 1.3% to 1.9% of superplasticizer high water-reducer. The results show that the derived models constitute very efficient means for understanding the influence of key mix-parameters on HFSC properties and are useful in selecting the optimum mix proportions, by simulating their impact on fluidity, stability and compressive strength.展开更多
The effects of quality and content of fly ash on the early-age cracking behavior of high-flowing concrete （HFC） were investigated. The early-age cracking behavior of the HFC was analyzed by combining the tests of ev...The effects of quality and content of fly ash on the early-age cracking behavior of high-flowing concrete （HFC） were investigated. The early-age cracking behavior of the HFC was analyzed by combining the tests of evaporation capacity and electrical resistivity of the HFC. In these tests, a modified flat-type specimen was adopted. The results show that the HFC will have a lower evaporation capacity when it is mixed with fine fly ash, while it will have a higher evaporation capacity when grade II! fly ash is used as mineral admixture. And the electrical resistivity rate of HFC reduces with the increase of the content of fly ash. A nonlinear relationship exists between the cracking time of HFC and the minimum electrical resistivity. The early-age cracking behavior of HFC with fly ash can be enhanced by appropriately increasing the fine particle content and MgO, K2O, and SO3 contents of fly ash. The optimal content of fly ash, which makes a satisfied early-age cracking behavior of HFC, is obtained. And when the content of fly ash exceeds a critical value, the early-age cracking behavior of HFC will rapidly decrease.展开更多
High-flow hydraulic one-way valves in water pipes are typically used to mitigate conditions,which would otherwise cause vibration and cavitation erosion after long-term operation.To prevent cavitation and enhance the ...High-flow hydraulic one-way valves in water pipes are typically used to mitigate conditions,which would otherwise cause vibration and cavitation erosion after long-term operation.To prevent cavitation and enhance the performance of hydraulic one-way valves,in the present work a dedicated experimental study has been conducted.The structural parameters relating to the pilot valve core,the main valve core,and the through-flow section of the considered flow channel have been changed to analyse reverse impact,and cavitation,characteristics.The results show that the control pressure has a weak effect on the cavitation characteristics,while changes in the structural parameters can significantly affect them.In particular,the cavitation index,representing the extent of cavitation,has been found to display a linear correlation with the inlet pressure,but,not with the inlet flow rate.Most importantly,a stepped throttling structure can reduce the pressure oscillation,improve the response speed,enhance the impact characteristics,and decrease the likelihood and severity of cavitation.The larger the flow passage area,the shorter the unloading time.Cavitation mainly occurs when the pilot valve core is fully opened.The stepped main valve core throttling structure has been found to be an optimal option.展开更多
Operating principle of water three-way valve with high flow for individual hydraulic prop in coal was presented in this paper, its strict and precise mathematical model was established, its flow field was simulated nu...Operating principle of water three-way valve with high flow for individual hydraulic prop in coal was presented in this paper, its strict and precise mathematical model was established, its flow field was simulated numerically by software Fluent, and its dynamic characteristics were analyzed during the work process such as raising leg, loading and overflow, the influence of the related parameters on high-flow water three-way valve was determined. The results as follows： during the raising leg stage and early raising leg stage, when the damping ratio increases, the overshoot of system decreases and the setting time reduces, and the dynamic response performance has a significant improvement. During the loading stage and the overflow stage, the pressure in plunger chamber of single hydraulic prop, the output flow and the displacement of the high-flow water three-way valve decrease with the decreasing of the external load. The spring stiffness of the safety valve directs the flow and the spool＇s displacement of the safety valve, and it can be used to control the high-flow three-way valve＇s sensitivity.展开更多
Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to inve...Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.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 Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.C...BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.CASE SUMMARY In this case report,we describe a case of the successful combination of the prone position(PP)and high-flow nasal oxygen(HFNO)therapy in a spontaneously breathing,severe COVID-19 patient who presented with fever,fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing.The therapy significantly improved the patient's clinical symptoms,oxygenation status,and radiological characteristics of lung injury during hospitalization,and the patient showed good tolerance and avoided intubation.Additionally,we did not find that medical staff wearing optimal airborne personal protective equipment(PPE)were infected by the new coronavirus in our institution.CONCLUSION We conclude that the combination of PP and HFNO could benefit spontaneously breathing,severe COVID-19 patients.The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.展开更多
This study is aimed to evaluate the effectiveness and safety of the treatment of highflow priapism with superselective transcatheter embolization.From Sep.1999 to Jan.2013,six patients with high-flow priapism underwen...This study is aimed to evaluate the effectiveness and safety of the treatment of highflow priapism with superselective transcatheter embolization.From Sep.1999 to Jan.2013,six patients with high-flow priapism underwent superselective transcatheter embolization of the cavernous artery.Recurrence of priapism,and change in erectile function detected by nocturnal penile tumescence and rigidity(NPTR)test and the International Index of Erectile Function 5-item questionnaire(IIEF-5)were evaluated during a mean follow-up of 12 months.A single superselective transcatheter embolization was sufficient for complete resolution of priapism in the six patients.None of the patients had a relapse of priapism after embolization,and all the patients who had premorbid normal erectile function showed maintained potency with normal results of NPTR and a mean postoperative IIEF-5 score of 23.5(range 23 to 24)during the follow-up period.In conclusion,superselective transcatheter embolization is an effective and safe treatment method for high-flow priapism,and it can ensure a high level of preservation of premorbid erectile function.展开更多
Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia ...Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。展开更多
Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracor...Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.展开更多
Chronic obstructive pulmonary disease(COPD)is one of the leading causes of death worldwide.During severe exacerbations,COPD patients may develop acute respiratory failure(ARF),often necessitating hospital admission du...Chronic obstructive pulmonary disease(COPD)is one of the leading causes of death worldwide.During severe exacerbations,COPD patients may develop acute respiratory failure(ARF),often necessitating hospital admission due to impaired gas exchange.In COPD patients,the diaphragm is subjected to an increased workload resulting from airflow limitations and geometric changes in the thorax due to pulmonary hyperinflation.Noninvasive ventilation(NIV)plays a crucial role in managing type II ARF by improving alveolar ventilation,reducing the work of breathing,minimizing the need for endotracheal intubation(ETI),and decreasing both hospital stays and mortality rates.Studies have shown that approximately 64%of patients with acute exacerbation of COPD(AECOPD)may fail NIV,primarily due to worsening respiratory function,interface intolerance,cardiovascular instability,or neurological deterioration.For patients intolerant to NIV,a trial with a high-flow nasal cannula(HFNC)is recommended.Recently,HFNC has gained popularity as a novel respiratory support system and is increasingly used in routine clinical practice for AECOPD patients.It delivers warmed,humidified,and oxygen-enriched air through a nasal cannula at flow rates of up to 60 L/min.This narrative review aims to describe the physiological effects of HFNC in the COPD population and provide an updated overview of HFNC’s role in AECOPD patients requiring hospitalization.展开更多
In patients with hypoxemic acute respiratory failure(ARF),the first-line treatment is oxygen therapy,which may include the administration of high-flow nasal oxygen(HFNO),noninvasive ventilation(NIV),or continuous posi...In patients with hypoxemic acute respiratory failure(ARF),the first-line treatment is oxygen therapy,which may include the administration of high-flow nasal oxygen(HFNO),noninvasive ventilation(NIV),or continuous positive airway pressure(CPAP).In addition to improving oxygenation,HFNO and NIV reduce the work of breathing as compared to standard oxygen,while CPAP does not.However,tolerance to NIV and CPAP is clinically challenging,resulting in treatment interruption in 10%-20%of cases.Compared to standard oxygen,HFNO has been shown to reduce the risk of intubation,while the benefits of NIV or CPAP,even when delivered via a helmet,require further evaluation.Although evidence for the efficacy of HFNO in reducing mortality remains inconclusive,HFNO has emerged as the reference treatment and is recommended for patients with hypoxemic ARF given its benefit in reducing the risk of intubation.展开更多
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.
文摘The high-flowing sand-concrete （HFSC） containing natural sands as aggregate was carried out. The high fluidity and stability of HFSC can be achieved by tailoring the mix design parameters, such as fine to coarse sand ratio, dosage of additions, water to binder ratio and dosage of admixtures. Mini-cone slump test, v-fl.mnel time test and viscosity model parameters were used to characterize the behaviour of HFSC in fresh state. The mechanical compressive strength in 28 d was also determined. A factorial design approach was used to establish models highlighting the effect of each mix-parameter on measured properties of HFSC. The derived models are valid for mixtures made with 0 to 0.3 of dune sand to total sand ratio, 82 to 418 kg/m3 of marble powder, 0.42 to 0.46 of water/binder ratio and 1.3% to 1.9% of superplasticizer high water-reducer. The results show that the derived models constitute very efficient means for understanding the influence of key mix-parameters on HFSC properties and are useful in selecting the optimum mix proportions, by simulating their impact on fluidity, stability and compressive strength.
基金Project(50478003)supported by the National Natural Science Foundation of ChinaProject(2002F007)supported by the Natural Science Foundation of Fujian Province,China
文摘The effects of quality and content of fly ash on the early-age cracking behavior of high-flowing concrete （HFC） were investigated. The early-age cracking behavior of the HFC was analyzed by combining the tests of evaporation capacity and electrical resistivity of the HFC. In these tests, a modified flat-type specimen was adopted. The results show that the HFC will have a lower evaporation capacity when it is mixed with fine fly ash, while it will have a higher evaporation capacity when grade II! fly ash is used as mineral admixture. And the electrical resistivity rate of HFC reduces with the increase of the content of fly ash. A nonlinear relationship exists between the cracking time of HFC and the minimum electrical resistivity. The early-age cracking behavior of HFC with fly ash can be enhanced by appropriately increasing the fine particle content and MgO, K2O, and SO3 contents of fly ash. The optimal content of fly ash, which makes a satisfied early-age cracking behavior of HFC, is obtained. And when the content of fly ash exceeds a critical value, the early-age cracking behavior of HFC will rapidly decrease.
基金supported by the University Natural Science Research Programme of Jiangsu Province(grant numbers 18KJB460028)the Natural Science Foundation of Jiangsu Province(grant numbers BK20180177)+1 种基金the Major Programme from the Natural Science Foundation for Colleges and Universities of Jiangsu Province(grant numbers 18KJA460008)the Project of Xuzhou Applied and Basic Research(grant numbers KH17012).
文摘High-flow hydraulic one-way valves in water pipes are typically used to mitigate conditions,which would otherwise cause vibration and cavitation erosion after long-term operation.To prevent cavitation and enhance the performance of hydraulic one-way valves,in the present work a dedicated experimental study has been conducted.The structural parameters relating to the pilot valve core,the main valve core,and the through-flow section of the considered flow channel have been changed to analyse reverse impact,and cavitation,characteristics.The results show that the control pressure has a weak effect on the cavitation characteristics,while changes in the structural parameters can significantly affect them.In particular,the cavitation index,representing the extent of cavitation,has been found to display a linear correlation with the inlet pressure,but,not with the inlet flow rate.Most importantly,a stepped throttling structure can reduce the pressure oscillation,improve the response speed,enhance the impact characteristics,and decrease the likelihood and severity of cavitation.The larger the flow passage area,the shorter the unloading time.Cavitation mainly occurs when the pilot valve core is fully opened.The stepped main valve core throttling structure has been found to be an optimal option.
基金Supported by the National Natural Science Foundation of China （51075001） the Nature Science Research Project of Anhui Province （KJ2009A020）
文摘Operating principle of water three-way valve with high flow for individual hydraulic prop in coal was presented in this paper, its strict and precise mathematical model was established, its flow field was simulated numerically by software Fluent, and its dynamic characteristics were analyzed during the work process such as raising leg, loading and overflow, the influence of the related parameters on high-flow water three-way valve was determined. The results as follows： during the raising leg stage and early raising leg stage, when the damping ratio increases, the overshoot of system decreases and the setting time reduces, and the dynamic response performance has a significant improvement. During the loading stage and the overflow stage, the pressure in plunger chamber of single hydraulic prop, the output flow and the displacement of the high-flow water three-way valve decrease with the decreasing of the external load. The spring stiffness of the safety valve directs the flow and the spool＇s displacement of the safety valve, and it can be used to control the high-flow three-way valve＇s sensitivity.
文摘Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.
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 Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.CASE SUMMARY In this case report,we describe a case of the successful combination of the prone position(PP)and high-flow nasal oxygen(HFNO)therapy in a spontaneously breathing,severe COVID-19 patient who presented with fever,fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing.The therapy significantly improved the patient's clinical symptoms,oxygenation status,and radiological characteristics of lung injury during hospitalization,and the patient showed good tolerance and avoided intubation.Additionally,we did not find that medical staff wearing optimal airborne personal protective equipment(PPE)were infected by the new coronavirus in our institution.CONCLUSION We conclude that the combination of PP and HFNO could benefit spontaneously breathing,severe COVID-19 patients.The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.
基金partly supported by the National Natural Science Foundation of China(No.81370705 and No.81471450)
文摘This study is aimed to evaluate the effectiveness and safety of the treatment of highflow priapism with superselective transcatheter embolization.From Sep.1999 to Jan.2013,six patients with high-flow priapism underwent superselective transcatheter embolization of the cavernous artery.Recurrence of priapism,and change in erectile function detected by nocturnal penile tumescence and rigidity(NPTR)test and the International Index of Erectile Function 5-item questionnaire(IIEF-5)were evaluated during a mean follow-up of 12 months.A single superselective transcatheter embolization was sufficient for complete resolution of priapism in the six patients.None of the patients had a relapse of priapism after embolization,and all the patients who had premorbid normal erectile function showed maintained potency with normal results of NPTR and a mean postoperative IIEF-5 score of 23.5(range 23 to 24)during the follow-up period.In conclusion,superselective transcatheter embolization is an effective and safe treatment method for high-flow priapism,and it can ensure a high level of preservation of premorbid erectile function.
文摘Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。
文摘Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.
文摘Chronic obstructive pulmonary disease(COPD)is one of the leading causes of death worldwide.During severe exacerbations,COPD patients may develop acute respiratory failure(ARF),often necessitating hospital admission due to impaired gas exchange.In COPD patients,the diaphragm is subjected to an increased workload resulting from airflow limitations and geometric changes in the thorax due to pulmonary hyperinflation.Noninvasive ventilation(NIV)plays a crucial role in managing type II ARF by improving alveolar ventilation,reducing the work of breathing,minimizing the need for endotracheal intubation(ETI),and decreasing both hospital stays and mortality rates.Studies have shown that approximately 64%of patients with acute exacerbation of COPD(AECOPD)may fail NIV,primarily due to worsening respiratory function,interface intolerance,cardiovascular instability,or neurological deterioration.For patients intolerant to NIV,a trial with a high-flow nasal cannula(HFNC)is recommended.Recently,HFNC has gained popularity as a novel respiratory support system and is increasingly used in routine clinical practice for AECOPD patients.It delivers warmed,humidified,and oxygen-enriched air through a nasal cannula at flow rates of up to 60 L/min.This narrative review aims to describe the physiological effects of HFNC in the COPD population and provide an updated overview of HFNC’s role in AECOPD patients requiring hospitalization.
文摘In patients with hypoxemic acute respiratory failure(ARF),the first-line treatment is oxygen therapy,which may include the administration of high-flow nasal oxygen(HFNO),noninvasive ventilation(NIV),or continuous positive airway pressure(CPAP).In addition to improving oxygenation,HFNO and NIV reduce the work of breathing as compared to standard oxygen,while CPAP does not.However,tolerance to NIV and CPAP is clinically challenging,resulting in treatment interruption in 10%-20%of cases.Compared to standard oxygen,HFNO has been shown to reduce the risk of intubation,while the benefits of NIV or CPAP,even when delivered via a helmet,require further evaluation.Although evidence for the efficacy of HFNO in reducing mortality remains inconclusive,HFNO has emerged as the reference treatment and is recommended for patients with hypoxemic ARF given its benefit in reducing the risk of intubation.
