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
AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) ...AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.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
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
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
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
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 Hypoxemia due to respiratory depression and airway obstruction during upper gastrointestinal endoscopy with sedation is a common concern.The Wei nasal jet tube(WNJT)is a new nasopharyngeal airway with the a...BACKGROUND Hypoxemia due to respiratory depression and airway obstruction during upper gastrointestinal endoscopy with sedation is a common concern.The Wei nasal jet tube(WNJT)is a new nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall channel.The available evidence indicates that with a low oxygen flow,compared with nasal cannula,the WNJT does not decrease the occurrence of hypoxemia during upper gastrointestinal endoscopy with propofol sedation.To date,there has been no study assessing the performance of WNJT for supplemental oxygen during upper gastrointestinal endoscopy with sedation when a moderate oxygen flow is used.AIM To determine whether the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided in patients with a normal body mass index.METHODS This study was performed in 291 patients undergoing elective gastroscopy with propofol mono-sedation.Patients were randomized into one of two groups to receive either the WNJT(WNJT group,n=147)or the nasal cannula(nasal cannula group,n=144)for supplemental oxygen at a 5-L/min flow during gastroscopy.The lowest SpO2 during gastroscopy was recorded.The primary endpoint was the incidence of hypoxemia or severe hypoxemia during gastroscopy.RESULTS The total incidence of hypoxemia and severe hypoxemia during gastroscopy was significantly decreased in the WNJT group compared with the nasal cannula group(P=0.000).The lowest median SpO2 during gastroscopy was significantly higher(98%;interquartile range,97-99)in the WNJT group than in the nasal cannula group(96%;interquartile range,93-98).Epistaxis by device insertion in the WNJT group occurred in 7 patients but stopped naturally without any treatment.The two groups were comparable in terms of the satisfaction of physicians,anesthetists and patients.CONCLUSION With a moderate oxygen flow,the WNJT is more effective for the prevention of hypoxemia during gastroscopy with propofol mono-sedation compared with nasal prongs,but causing slight epistaxis in a few patients.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
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.
基金Supported by The Department of Anesthesiology and Perioperative Medicine,Tufts Medical Center,Boston,United States
文摘AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.
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.
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.
基金Supported by“Renfu”Research Fund by Chinese Society of Digestive Endoscopy,No.CSDE012017120006.
文摘BACKGROUND Hypoxemia due to respiratory depression and airway obstruction during upper gastrointestinal endoscopy with sedation is a common concern.The Wei nasal jet tube(WNJT)is a new nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall channel.The available evidence indicates that with a low oxygen flow,compared with nasal cannula,the WNJT does not decrease the occurrence of hypoxemia during upper gastrointestinal endoscopy with propofol sedation.To date,there has been no study assessing the performance of WNJT for supplemental oxygen during upper gastrointestinal endoscopy with sedation when a moderate oxygen flow is used.AIM To determine whether the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided in patients with a normal body mass index.METHODS This study was performed in 291 patients undergoing elective gastroscopy with propofol mono-sedation.Patients were randomized into one of two groups to receive either the WNJT(WNJT group,n=147)or the nasal cannula(nasal cannula group,n=144)for supplemental oxygen at a 5-L/min flow during gastroscopy.The lowest SpO2 during gastroscopy was recorded.The primary endpoint was the incidence of hypoxemia or severe hypoxemia during gastroscopy.RESULTS The total incidence of hypoxemia and severe hypoxemia during gastroscopy was significantly decreased in the WNJT group compared with the nasal cannula group(P=0.000).The lowest median SpO2 during gastroscopy was significantly higher(98%;interquartile range,97-99)in the WNJT group than in the nasal cannula group(96%;interquartile range,93-98).Epistaxis by device insertion in the WNJT group occurred in 7 patients but stopped naturally without any treatment.The two groups were comparable in terms of the satisfaction of physicians,anesthetists and patients.CONCLUSION With a moderate oxygen flow,the WNJT is more effective for the prevention of hypoxemia during gastroscopy with propofol mono-sedation compared with nasal prongs,but causing slight epistaxis in a few patients.
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.
