BACKGROUND Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure(PEEP)adjustments and to evaluate the wea...BACKGROUND Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure(PEEP)adjustments and to evaluate the weaning process from mechanical ventilation.The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores(LUSs).AIM To assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.METHODS An observational study was conducted over 18 months in a tertiary care hospital.Patients of both genders,aged between 18-75 years,who had been admitted to the intensive care unit,and required mechanical ventilation,were studied.A standard ventilatory strategy was used and incremental levels of PEEP[5,10,and 15 cm water(H_(2)O)]were applied.Baseline characteristics,including oxygen saturation(SpO2),LUS,mean arterial pressure(MAP),heart rate(HR),and their changes with incremental PEEP levels,were recorded and analyzed.RESULTS In this study,45.9%of patients required a PEEP of 5 cm H_(2)O to achieve the endpoint of lung aeration(LUS of 0).In addition,86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H_(2)O,respectively.The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels(P<0.001 for 5 and 10 cm H_(2)O and P=0.032 for 15 cm H_(2)O).SpO2 increased significantly with higher PEEP levels(P<0.001),confirming the effectiveness of PEEP in improving oxygenation.The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.CONCLUSION Increasing PEEP levels in mechanically ventilated patients improves lung aeration,which can be effectively assessed using bedside lung ultrasonography.展开更多
Prediction of weaning success from invasive mechanical ventilation remains a challenge in everyday clinical practice.Several prediction scores have been developed to guide success during spontaneous breathing trials t...Prediction of weaning success from invasive mechanical ventilation remains a challenge in everyday clinical practice.Several prediction scores have been developed to guide success during spontaneous breathing trials to help with weaning decisions.These scores aim to provide a structured framework to support clinical judgment.However,their effectiveness varies across patient populations,and their predictive accuracy remains inconsistent.In this review,we aim to identify the strengths and limitations of commonly used clinical prediction tools in assessing readiness for ventilator liberation.While scores such as the Rapid Shallow Breathing Index and the Integrative Weaning Index are widely adopted,their sensitivity and specificity often fall short in complex clinical settings.Factors such as underlying disease pathophysiology,patient characteristics,and clinician subjectivity impact score performance and reliability.Moreover,disparities in validation across diverse populations limit generalizability.With growing interest in artificial intelligence(AI)and machine learning,there is potential for enhanced prediction models that integrate multidimensional data and adapt to individual patient profiles.However,current AI approaches face challenges related to interpretability,bias,and ethical implementation.This paper underscores the need for more robust,individualized,and transparent prediction systems and advocates for careful integration of emerging technologies into clinical workflows to optimize weaning success and patient outcomes.展开更多
Objective:To explore the role of lung ultrasound combined with multi-organ evaluation in assessing the risk of weaning from mechanical ventilation(MV)in severe patients.Methods:A retrospective analysis was conducted o...Objective:To explore the role of lung ultrasound combined with multi-organ evaluation in assessing the risk of weaning from mechanical ventilation(MV)in severe patients.Methods:A retrospective analysis was conducted on 60 severe patients admitted to the hospital from December 2022 to December 2024,all of whom underwent MV treatment.Based on weaning status,thirty-eight patients were successfully weaned(success group),and 22 patients failed weaning(failure group).All patients underwent lung ultrasound and multi-organ evaluation.The parameter differences between the two groups were compared,risk factors for weaning risk were evaluated,and a receiver operating characteristic curve(ROC)was drawn to assess the predictive value of lung ultrasound combined with multi-organ evaluation for weaning risk.Results:The lung ultrasound score(LUS)of the success group was lower than that of the failure group,the left ventricular ejection fraction(LVEF)was higher than that of the failure group,and the diaphragmatic excursion(DE)and diaphragmatic thickening fraction(DTF)were higher than those of the failure group(P<0.05).Multifactor analysis showed that LUS was a risk factor for weaning risk,while LVEF,DE,and DTF were protective factors(P<0.05).The ROC showed that the area under the curve(AUC)of a single parameter for weaning risk was smaller than that of the combined parameters(P<0.05).Conclusion:Lung ultrasound combined with multi-organ evaluation can predict the weaning risk of severe patients undergoing MV treatment,and the diagnostic efficiency of multiple parameters combined evaluation is higher.展开更多
Indoor air quality(IAQ)is often overlooked,yet a poorly maintained environment can lead to significant health issues and reduced concentration and productivity in work or educational settings.This study presents an in...Indoor air quality(IAQ)is often overlooked,yet a poorly maintained environment can lead to significant health issues and reduced concentration and productivity in work or educational settings.This study presents an innovative control system for mechanical ventilation specifically designed for university classrooms,with the dual goal of enhancing IAQ and increasing energy efficiency.Two classrooms with distinct construction characteristics were analyzed:one with exterior walls and windows,and the other completely underground.For each classroom,a model was developed using DesignBuilder software,which was calibrated with experimental data regarding CO_(2) concentration,temperature,and relative humidity levels.The proposed ventilation system operates based on CO_(2) concentration,relative humidity,and potential for free heating and cooling.In addition,the analysis was conducted for other locations,demonstrating consistent energy savings across different climates and environments,always showing an annual reduction in energy consumption.Results demonstrate that mechanical ventilation,when integrated with heat recovery and free cooling strategies,significantly reduces energy consumption by up to 25%,while also maintaining optimal CO_(2) levels to enhance comfort and air quality.These findings emphasize the essential need for well-designed mechanical ventilation systems to ensure both psychophysical well-being and IAQ in enclosed spaces,particularly in environments intended for extended occupancy,such as classrooms.Furthermore,this approach has broad applicability,as it could be adapted to various building types,thereby contributing to sustainable energy management practices and promoting healthier indoor spaces.This study serves as a model for future designs aiming to balance energy efficiency with indoor air quality,especially relevant in the post-COVID era,where the importance of indoor air quality has become more widely recognized.展开更多
Objective:To investigate the predictive value of diaphragm thickening fraction(DTF)combined with cough peak expiratory flow(CPEF)on the success rate of weaning from mechanical ventilation.Methods:The clinical data of ...Objective:To investigate the predictive value of diaphragm thickening fraction(DTF)combined with cough peak expiratory flow(CPEF)on the success rate of weaning from mechanical ventilation.Methods:The clinical data of patients undergoing invasive mechanical ventilation via oral endotracheal intubation in the ICU of our hospital from January 2022 to December 2023 were studied.All patients underwent a 30-minute spontaneous breathing trial(SBT)using low-level pressure support ventilation(PSV)after meeting the clinical weaning screening criteria.Among them,150 patients who met the clinical weaning criteria were weaned from the ventilator.They were divided into a successful weaning group(n=100)and a failed weaning group(n=50)based on the weaning outcome.Clinical data,including age,gender,APACHE II score,duration of mechanical ventilation,DTF,and CPEF,were collected from 150 patients.The differences in clinical data between the two groups were compared,and the correlation between DTF,CPEF,and the success rate of weaning was analyzed.Results:There were no significant differences between the two groups in gender ratio(χ^(2)=0.884,P=0.347>0.05),age(t=0.350,P=0.727>0.05),and APACHE II score(t=1.295,P=0.197>0.05),but there was a significant difference in the duration of mechanical ventilation(t=3.766,P<0.001).The DTF and CPEF values in the successful weaning group were significantly higher than those in the failed weaning group(P<0.05).ROC curves were drawn to predict the weaning results using DTF,CPEF,and the combination of DTF and CPEF.The results showed that the specificity of the combination of DTF and CPEF was comparable to that of either metric alone,but the sensitivity and AUC were significantly higher than those of either metric alone.Conclusion:The combination of DTF and CPEF can be used as an effective indicator to evaluate the weaning efficacy of mechanically ventilated patients,which has important clinical significance for guiding clinical weaning treatment,improving the success rate of weaning,reducing the incidence of ventilator-associated pneumonia,and shortening the length of hospital stay.展开更多
BACKGROUND:In this study,we aimed to evaluate the impact of mechanical ventilator(MV)utilizaton during cardiopulmonary resuscitation(CPR)on out-of-hospital cardiac arrest(OHCA)patient clinical outcomes in the emergenc...BACKGROUND:In this study,we aimed to evaluate the impact of mechanical ventilator(MV)utilizaton during cardiopulmonary resuscitation(CPR)on out-of-hospital cardiac arrest(OHCA)patient clinical outcomes in the emergency department.METHODS:This single-centered,retrospective,case-control study analyzed electronic medical records.Patients aged>18 years with non-traumatic OHCA who were treated at an emergency medical center between January 2019 and December 2023 were included.These patients were accessed according to the ventilatory method used:MV ventilation(volume control,tidal volume 6-8 mL/kg,frequency 10 beat per minute,inspiratory time 1 s)and manual resuscitator bag valve(BV)ventilation.The primary outcome was the return of spontaneous circulation(ROSC).After 1:1 propensity score matching,the clinical outcomes were analyzed.RESULTS:A total of 649 patients were enrolled in this study.Before matching,the clinical outcomes and pneumothorax incidence did not differ between the MV and BV groups.After 1:1 matching between the two groups using propensity scores,522 patients(261 MV and 261 BV)were analyzed.Propensity score matching yielded an adequate balance(standardized mean difference<0.10)for all covariates.The estimated odds ratio(OR)for ROSC was 1.23(95%confidence interval[CI]:0.85-1.77;P=0.267),for survival at hospital admission was 1.02(95%CI:0.68-1.53;P=0.918),for survival at hospital discharge was 2.31(95%CI:1.10-5.20;P=0.033),and for good neurologic outcome was 2.56(95%CI:0.84-9.43;P=0.116).CONCLUSION:In patients with OHCA admitted to the emergency department,MV ventilation during CPR showed clinical outcomes similar to those of BV ventilation in most measures.However,survival at hospital discharge was significantly higher in the MV group,suggesting potential benefits of MV use in selected patients.展开更多
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed...BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed rapidly in the field of critical care in recent years.Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator.Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into a successful ventilation group(68 cases)and a failed ventilation group(26 cases)according to the outcome of ventilation.The clinical data of patients with successful and failed noninvasive ventilation were compared,and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.RESULTS There were no significant differences in gender,age,body mass index,complications,systolic pressure,heart rate,mean arterial pressure,respiratory rate,oxygen saturation,partial pressure of oxygen,oxygenation index,or time of inspiration between patients with successful and failed mechanical ventilation(P>0.05).The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide(PaCO_(2))than those with failed treatment,while potential of hydrogen(pH),diaphragm thickening fraction(DTF),diaphragm activity,and diaphragm movement time were significantly higher than those with failed treatment(P<0.05).pH[odds ratio(OR)=0.005,P<0.05],PaCO_(2)(OR=0.430,P<0.05),and DTF(OR=0.570,P<0.05)were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.展开更多
Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP lev...Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.展开更多
BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical venti...BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical ventilation.AIM To compare the neuroprotective effects of dexmedetomidine and propofol for sedation during prolonged mechanical ventilation in patients without brain injury.METHODS Patients who underwent mechanical ventilation for>72 h were randomly assigned to receive sedation with dexmedetomidine or propofol.The Richmond Agitation and Sedation Scale(RASS)was used to evaluate sedation effects,with a target range of-3 to 0.The primary outcomes were serum levels of S100-βand neuron-specific enolase(NSE)every 24 h.The secondary outcomes were remifentanil dosage,the proportion of patients requiring rescue sedation,and the time and frequency of RASS scores within the target range.RESULTS A total of 52 and 63 patients were allocated to the dexmedetomidine group and propofol group,respectively.Baseline data were comparable between groups.No significant differences were identified between groups within the median duration of study drug infusion[52.0(IQR:36.0-73.5)h vs 53.0(IQR:37.0-72.0)h,P=0.958],the median dose of remifentanil[4.5(IQR:4.0-5.0)μg/kg/h vs 4.6(IQR:4.0-5.0)μg/kg/h,P=0.395],the median percentage of time in the target RASS range without rescue sedation[85.6%(IQR:65.8%-96.6%)vs 86.7%(IQR:72.3%-95.3),P=0.592],and the median frequency within the target RASS range without rescue sedation[72.2%(60.8%-91.7%)vs 73.3%(60.0%-100.0%),P=0.880].The proportion of patients in the dexmedetomidine group who required rescue sedation was higher than in the propofol group with statistical significance(69.2%vs 50.8%,P=0.045).Serum S100-βand NSE levels in the propofol group were higher than in the dexmedetomidine group with statistical significance during the first six and five days of mechanical ventilation,respectively(all P<0.05).CONCLUSION Dexmedetomidine demonstrated stronger protective effects on the brain compared to propofol for long-term mechanical ventilation in patients without brain injury.展开更多
The high frequency ventilation(HFV)can well support the breathing of respiratory patient with 20%-40%of normal tidal volume.Now as a therapy of rescue ventilation when conversional ventilation failed,the HFV has been ...The high frequency ventilation(HFV)can well support the breathing of respiratory patient with 20%-40%of normal tidal volume.Now as a therapy of rescue ventilation when conversional ventilation failed,the HFV has been applied in the treatments of severe patients with acute respiratory failure(ARF),acute respiratory distress syndrome(ARDS),etc.However,the gas exchange mechanism(GEM)of HFV is still not fully understood by researchers.In this paper,the GEM of HFV is reviewed to track the studies in the last decades and prospect for the next likely studies.And inspired by previous studies,the GEM of HFV is suggested to be continually developed with various hypotheses which will be testified in simulation,experiment and clinic trail.One of the significant measures is to study the GEM of HFV under the cross-disciplinary integration of medicine and engineering.Fully understanding the GEM can theoretically support and expand the applications of HFV,and is helpful in investigating the potential indications and contraindications of HFV.展开更多
Invasive mechanical ventilation(IMV)has become integral to modern-day critical care.Even though critically ill patients frequently require IMV support,weaning from IMV remains an arduous task,with the reported weaning...Invasive mechanical ventilation(IMV)has become integral to modern-day critical care.Even though critically ill patients frequently require IMV support,weaning from IMV remains an arduous task,with the reported weaning failure(WF)rates being as high as 50%.Optimizing the timing for weaning may aid in reducing time spent on the ventilator,associated adverse effects,patient discomfort,and medical care costs.Since weaning is a complex process and WF is often multifactorial,several weaning scores have been developed to predict WF and aid decision-making.These scores are based on the patient's physiological and ventilatory parameters,but each has limitations.This review highlights the current role and limitations of the various clinical prediction scores available to predict WF.展开更多
The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients,...The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.展开更多
BACKGROUND For over half a century,the administration of maternal corticosteroids before anticipated preterm birth has been regarded as a cornerstone intervention for enhancing neonatal outcomes,particularly in preven...BACKGROUND For over half a century,the administration of maternal corticosteroids before anticipated preterm birth has been regarded as a cornerstone intervention for enhancing neonatal outcomes,particularly in preventing respiratory distress syndrome.Ongoing research on antenatal corticosteroids(ACS)is continuously refining the evidence regarding their efficacy and potential side effects,which may alter the application of this treatment.Recent findings indicate that in resource-limited settings,the effectiveness of ACS is contingent upon meeting specific conditions,including providing adequate medical support for preterm newborns.Future studies are expected to concentrate on developing evidence-based strategies to safely enhance ACS utilization in low-and middle-income countries.AIM To analyze the clinical effectiveness of antenatal corticosteroids in improving outcomes for preterm newborns in a tertiary care hospital setting in Kazakhstan,following current World Health Organization guidelines.METHODS This study employs a comparative retrospective cohort design to analyze single-center clinical data collected from January 2022 to February 2024.A total of 152 medical records of preterm newborns with gestational ages between 24 and 34 weeks were reviewed,focusing on the completeness of the ACS received.Quantitative variables are presented as means with standard deviations,while frequency analysis of qualitative indicators was performed using Pearson'sχ^(2) test(χ^(2))and Fisher's exact test.If statistical significance was identified,pairwise comparisons between the three observation groups were conducted using the Bonferroni correction.RESULTS The obtained data indicate that the complete implementation of antenatal steroid prophylaxis(ASP)improves neonatal outcomes,particularly by reducing the frequency of birth asphyxia(P=0.002),the need for primary resuscitation(P=0.002),the use of nasal continuous positive airway pressure(P=0.022),and the need for surfactant replacement therapy(P=0.038)compared to groups with incomplete or no ASP.Furthermore,complete ASP contributed to a decrease in morbidity among preterm newborns(e.g.,respiratory distress syndrome,intrauterine pneumonia,cerebral ischemia,bronchopulmonary dysplasia,etc.),improved Apgar scores,and reduced the need for re-intubation and the frequency of mechanical ventilation.However,it was associated with an increased incidence of uterine atony in postpartum women(P=0.0095).CONCLUSION In a tertiary hospital setting,the implementation of ACS therapy for pregnancies between 24 and 34 weeks of gestation at high risk for preterm birth significantly reduces the incidence of neonatal complications and related interventions.This,in turn,contributes to better outcomes for this cohort of children.However,the impact of ACS on maternal outcomes requires further thorough investigation.展开更多
Cardiac arrest(CA)is considered a state of clinical death in which the heart suddenly loses its ability to effectively expel blood,resulting in circulatory and respiratory arrest.CA is often catastrophic for patients,...Cardiac arrest(CA)is considered a state of clinical death in which the heart suddenly loses its ability to effectively expel blood,resulting in circulatory and respiratory arrest.CA is often catastrophic for patients,as it can cause serious long-term cardiovascular and cerebrovascular complications that affect their quality of life[1].Survey data indicate that the overall incidence rate of intraoperative CA in patients undergoing thoracic surgery in China is currently 0.138%[2].This rate is expected to increase because of the increasing proportion of older individuals(age>60 years)in the population,as well as the increasing pulmonary surgery rates.However,the incidence rate during the perianesthetic period in older patients undergoing thoracic surgery has not yet been comprehensively reported.展开更多
BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral an...BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral and non-viral etiologies are treated by traditional ARDS protocols that recommend 12-16 hours of prone position ventilation(PPV)with neuromuscular blocking agents(NMBA)and a trial of inhaled vasodilators(IVd)if oxygenation does not improve.However,debate on the efficacy of adjuncts to PPV and low tidal volume ventilation persists and evidence about the benefits of IVd/NMBA in COVID ARDS is sparse.In our multi-center retrospective review,we evaluated the impact of PPV,IVd,and NMBA on outcomes and lung mechanics in COVID ARDS patients with moderate to severe ARDS.AIM To evaluate the impact of PPV used alone or in combination with pulmonary IVd and/or NMBA in mechanically ventilated patients with moderate to severe ARDS during the COVID-19 pandemic.METHODS A retrospective study at two tertiary academic medical centers compared outcomes between COVID ARDS patients receiving PPV and patients in the supine position.PPV patients were divided based on concurrent use of ARDS adjunct therapies resulting in four subgroups:(1)PPV alone;(2)PPV and IVd;(3)PPV and NMBA;and(4)PPV,IVd,and NMBA.Primary outcomes were hospital and intensive care unit(ICU)length of stay(LOS),mortality,and venovenous extracorporeal membrane oxygenation(VV-ECMO)status.Secondary outcomes included changes in lung mechanics at 24-hour intervals for 7 days.RESULTS Total 114 patients were included in this study.Baseline respiratory parameters and Sequential Organ Failure Assessment scores were significantly worse in the PPV group.ICU LOS and LOS were significantly longer for patients who were proned,but no mortality benefit or difference in VV-ECMO status was found.Among the subgroups,no difference in primary outcomes were found.In the secondary analysis,PPV was associated with a significant improvement in arterial oxygen partial pressure(PaO_(2))/fractional inspired oxygen(FiO_(2))(P/F)ratio from day 1 to day 4(P<0.05)and higher driving pressures day 5 to day 7(P<0.05).The combination of PPV and IVd together resulted in improvements in P/F ratio from day 1 to day 7 and plateau pressure on day 4 and day 6(P<0.05).PPV with NMBA was not associated with improvements in any of the secondary outcomes.The use of all three rescue therapies together resulted in improvements in lung compliance on day 2(P<0.05)but no other improvements.CONCLUSION In mechanically ventilated patients diagnosed with moderate to severe COVID ARDS,PPV and PPV with the addition of IVd produced a significant and sustained increase in P/F ratio.The combination of PPV,IVd and NMBA improved compliance however this did not reach significance.Mortality and LOS did not improve with adjunct therapies.Further research is warranted to determine the efficacy of these therapies alone and in combination in the treatment of COVID ARDS.展开更多
BACKGROUND Ethylene glycol(EG)poisoning is often caused by the accidental ingestion of antifreeze.EG is metabolized into glycolate and oxalate and may cause metabolic acidaemia,neurotoxicity,acute kidney injury,and de...BACKGROUND Ethylene glycol(EG)poisoning is often caused by the accidental ingestion of antifreeze.EG is metabolized into glycolate and oxalate and may cause metabolic acidaemia,neurotoxicity,acute kidney injury,and death.A variety of EG poisoning case reports have been published,and we wrote this case report and literature review to summarize the clinical experience of patients who survived EG poisoning.CASE SUMMARY In this case report,a 55-year-old man developed EG poisoning after ingesting antifreeze by accident and experienced acute kidney injury,nervous system dysfunction and inhalation pneumonia.The timely use of ethanol for detoxification,initiation of haemodialysis,and protection of organ function are effective treatment methods for patients with antifreeze poisoning.The patient was discharged in the 3rd week after admission.When discharged,the patient did not report any discomfort,had stable vital signs,did not have fever or diarrhoea,and had improved liver and kidney functions.CONCLUSION A timely diagnosis,haemodialysis,and organ protection are the keys to the successful treatment of poisoned patients.展开更多
BACKGROUND Acute respiratory distress syndrome(ARDS)is a critical condition characterized by acute hypoxemia,non-cardiogenic pulmonary edema,and decreased lung compliance.The Berlin definition,updated in 2012,classifi...BACKGROUND Acute respiratory distress syndrome(ARDS)is a critical condition characterized by acute hypoxemia,non-cardiogenic pulmonary edema,and decreased lung compliance.The Berlin definition,updated in 2012,classifies ARDS severity based on the partial pressure of arterial oxygen/fractional inspired oxygen fraction ratio.Despite various treatment strategies,ARDS remains a significant public health concern with high mortality rates.AIM To evaluate the implications of driving pressure(DP)in ARDS management and its potential as a protective lung strategy.METHODS We conducted a systematic review using databases including EbscoHost,MEDLINE,CINAHL,PubMed,and Google Scholar.The search was limited to articles published between January 2015 and September 2024.Twenty-three peer-reviewed articles were selected based on inclusion criteria focusing on adult ARDS patients undergoing mechanical ventilation and DP strategies.The literature review was conducted and reported according to PRISMA 2020 guidelines.RESULTS DP,the difference between plateau pressure and positive end-expiratory pressure,is crucial in ARDS management.Studies indicate that lower DP levels are significantly associated with improved survival rates in ARDS patients.DP is a better predictor of mortality than tidal volume or positive end-expiratory pressure alone.Adjusting DP by optimizing lung compliance and minimizing overdistension and collapse can reduce ventilator-induced lung injury.CONCLUSION DP is a valuable parameter in ARDS management,offering a more precise measure of lung stress and strain than traditional metrics.Implementing DP as a threshold for safety can enhance protective ventilation strategies,po-tentially reducing mortality in ARDS patients.Further research is needed to refine DP measurement techniques and validate its clinical application in diverse patient populations.展开更多
BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated n...BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.展开更多
Background:Mechanical ventilation(MV)provides life support for patients with severe respiratory distress but can simultaneously cause ventilator-induced lung injury(VILI).However,due to a poor understanding of its mec...Background:Mechanical ventilation(MV)provides life support for patients with severe respiratory distress but can simultaneously cause ventilator-induced lung injury(VILI).However,due to a poor understanding of its mechanism,there is still a lack of effective remedies for the often-deadly VILI.Recent studies indicate that the stretch associated with MV can enhance the secretion of extracellular vesicles(EVs)and induce endoplasmic reticulum(ER)stress in airway smoothmuscle cells(ASMCs),both of which can contribute to VILI.But whetherMVassociated stretch enhances the secretion of EVs via ER stress in ASMCs as an underlying mechanism of VILI remains unknown.Methods:In this study,we exposed cultured human ASMCs to stretch(13%strain)and mouse models to MV at tidal volume(18 mL/kg).Subsequently,the amount of secreted EVs in the culture medium of ASMCs and the bronchoalveolar lavage fluid(BALF)of mousemodels was quantitatively evaluated by ultracentrifugation,transmission electron microscopy,Western blot,flow cytometry,and nanoparticle tracking analysis.The cultured ASMCs and the lung tissues of mouse models were assessed for expression of biomarkers of EVs(cluster of differentiation antigen 63,CD63),ER stress(heat shock protein family A member 5,HSPA5),and EVs regulating molecule Rab27a by immunofluorescence microscopy,immunohistochemistry(IHC)and enzyme-linked immunosorbent assay(ELISA),respectively.MicroRNAs(miRNAs)in EVs from ASMCs were measured with miRNA whole genome sequencing(miRNA-Seq).Results:We found that stretch enhanced EV secretion from cultured ASMCs.In addition,the cultured ASMCs and the mouse models were either or not pretreated with ER stress inhibitor(tauroursodeoxycholic acid,TUDCA)/EV secretion inhibitor(GW4869)prior to stretch or MV.We found that MV-associated stretch enhanced the expression of CD63,HSPA5,and Rab27a in cultured ASMCs and BALF/lung tissues of mousemodels,which could all be attenuated with TUDCA/GW4869 pretreatment.miRNA-Seq data show that differentially expressed miRNAs in EVsmainlymodulate gene transcription.Furthermore,the EVs fromcultured ASMCs under stretch tended to enhance detachment and expression of inflammatory cytokines,i.e.,transforming growth factor-β1(TGF-β1),interleukin-10(IL-10)in cultured airway epithelial cells.The expression of TGF-β1 and IL-10 in BALF of the mouse models also increased in response to MV,which was attenuated together with partial improvement of lung injury by pretreatment with TUDCA,GW4869/Rab27a siRNAs.Conclusion:Taken together,our data indicate thatMV-associated stretch can enhance the secretion of EVs from ASMCs via ER stress signaling to mediate airway inflammation and VILI,which provides new insight for further exploring EVs for the diagnosis and treatment of VILI.展开更多
At high altitudes, an Aviation Oxygen Supply System （AOSS） protects pilots from low pressure and hypoxia by continuously providing oxygen corresponding to the pilots＇ dynamic respiratory properties. An AOSS mainly ...At high altitudes, an Aviation Oxygen Supply System （AOSS） protects pilots from low pressure and hypoxia by continuously providing oxygen corresponding to the pilots＇ dynamic respiratory properties. An AOSS mainly consists of oxygen supercharging machines which are used in a high-altitude flight cabin to supply pressurized oxygen to pilots. Therefore, it is of great significance to study the airflow dynamic characteristics of an AOSS for safe, continuous, and efficient oxygen supply. In this paper, an AOSS is firstly simplified and considered as a mechanical ventilation system. Then, its corresponding mathematical model is constructed. Next, to verify the mathematical model, a prototype AOSS with a lung simulator is proposed for an experimental study. Afterwards, to build a foundation for the optimization of the AOSS, the airflow dynamic characteristics of an aircraft are analyzed, and the effects of key parameters on the respiration system are researched. Through experimental and simulation studies, it can be concluded that the mathematical model is effective. Subsequently, for stability during the respiration process, we consider setting the equivalent throttling areas of the inspiration and expiration pipelines smaller within certain limits; additionally, an excessively high oxygen supply pressure will disturb smooth airflow, and in a low-pressure environment, the pressure can be 84 cmH20 lower than the standard atmospheric pressure. This research can be referred to in the design of an oxygen supply system and the study on optimization of airflow dynamic characteristics.展开更多
文摘BACKGROUND Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure(PEEP)adjustments and to evaluate the weaning process from mechanical ventilation.The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores(LUSs).AIM To assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.METHODS An observational study was conducted over 18 months in a tertiary care hospital.Patients of both genders,aged between 18-75 years,who had been admitted to the intensive care unit,and required mechanical ventilation,were studied.A standard ventilatory strategy was used and incremental levels of PEEP[5,10,and 15 cm water(H_(2)O)]were applied.Baseline characteristics,including oxygen saturation(SpO2),LUS,mean arterial pressure(MAP),heart rate(HR),and their changes with incremental PEEP levels,were recorded and analyzed.RESULTS In this study,45.9%of patients required a PEEP of 5 cm H_(2)O to achieve the endpoint of lung aeration(LUS of 0).In addition,86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H_(2)O,respectively.The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels(P<0.001 for 5 and 10 cm H_(2)O and P=0.032 for 15 cm H_(2)O).SpO2 increased significantly with higher PEEP levels(P<0.001),confirming the effectiveness of PEEP in improving oxygenation.The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.CONCLUSION Increasing PEEP levels in mechanically ventilated patients improves lung aeration,which can be effectively assessed using bedside lung ultrasonography.
文摘Prediction of weaning success from invasive mechanical ventilation remains a challenge in everyday clinical practice.Several prediction scores have been developed to guide success during spontaneous breathing trials to help with weaning decisions.These scores aim to provide a structured framework to support clinical judgment.However,their effectiveness varies across patient populations,and their predictive accuracy remains inconsistent.In this review,we aim to identify the strengths and limitations of commonly used clinical prediction tools in assessing readiness for ventilator liberation.While scores such as the Rapid Shallow Breathing Index and the Integrative Weaning Index are widely adopted,their sensitivity and specificity often fall short in complex clinical settings.Factors such as underlying disease pathophysiology,patient characteristics,and clinician subjectivity impact score performance and reliability.Moreover,disparities in validation across diverse populations limit generalizability.With growing interest in artificial intelligence(AI)and machine learning,there is potential for enhanced prediction models that integrate multidimensional data and adapt to individual patient profiles.However,current AI approaches face challenges related to interpretability,bias,and ethical implementation.This paper underscores the need for more robust,individualized,and transparent prediction systems and advocates for careful integration of emerging technologies into clinical workflows to optimize weaning success and patient outcomes.
基金Sichuan Provincial Medical Scientific Research Project(Project No.:s19085)。
文摘Objective:To explore the role of lung ultrasound combined with multi-organ evaluation in assessing the risk of weaning from mechanical ventilation(MV)in severe patients.Methods:A retrospective analysis was conducted on 60 severe patients admitted to the hospital from December 2022 to December 2024,all of whom underwent MV treatment.Based on weaning status,thirty-eight patients were successfully weaned(success group),and 22 patients failed weaning(failure group).All patients underwent lung ultrasound and multi-organ evaluation.The parameter differences between the two groups were compared,risk factors for weaning risk were evaluated,and a receiver operating characteristic curve(ROC)was drawn to assess the predictive value of lung ultrasound combined with multi-organ evaluation for weaning risk.Results:The lung ultrasound score(LUS)of the success group was lower than that of the failure group,the left ventricular ejection fraction(LVEF)was higher than that of the failure group,and the diaphragmatic excursion(DE)and diaphragmatic thickening fraction(DTF)were higher than those of the failure group(P<0.05).Multifactor analysis showed that LUS was a risk factor for weaning risk,while LVEF,DE,and DTF were protective factors(P<0.05).The ROC showed that the area under the curve(AUC)of a single parameter for weaning risk was smaller than that of the combined parameters(P<0.05).Conclusion:Lung ultrasound combined with multi-organ evaluation can predict the weaning risk of severe patients undergoing MV treatment,and the diagnostic efficiency of multiple parameters combined evaluation is higher.
基金Funding Statement:This research was conducted as part of the Tech4You Project“Technologies for climate change adaptation and quality of life improvement”,n.ECS0000009,CUP H23C22000370006,Italian PNRR,Mission 4,Component 2,Investment 1.5 funded by the European Union-NextGenerationEU.
文摘Indoor air quality(IAQ)is often overlooked,yet a poorly maintained environment can lead to significant health issues and reduced concentration and productivity in work or educational settings.This study presents an innovative control system for mechanical ventilation specifically designed for university classrooms,with the dual goal of enhancing IAQ and increasing energy efficiency.Two classrooms with distinct construction characteristics were analyzed:one with exterior walls and windows,and the other completely underground.For each classroom,a model was developed using DesignBuilder software,which was calibrated with experimental data regarding CO_(2) concentration,temperature,and relative humidity levels.The proposed ventilation system operates based on CO_(2) concentration,relative humidity,and potential for free heating and cooling.In addition,the analysis was conducted for other locations,demonstrating consistent energy savings across different climates and environments,always showing an annual reduction in energy consumption.Results demonstrate that mechanical ventilation,when integrated with heat recovery and free cooling strategies,significantly reduces energy consumption by up to 25%,while also maintaining optimal CO_(2) levels to enhance comfort and air quality.These findings emphasize the essential need for well-designed mechanical ventilation systems to ensure both psychophysical well-being and IAQ in enclosed spaces,particularly in environments intended for extended occupancy,such as classrooms.Furthermore,this approach has broad applicability,as it could be adapted to various building types,thereby contributing to sustainable energy management practices and promoting healthier indoor spaces.This study serves as a model for future designs aiming to balance energy efficiency with indoor air quality,especially relevant in the post-COVID era,where the importance of indoor air quality has become more widely recognized.
文摘Objective:To investigate the predictive value of diaphragm thickening fraction(DTF)combined with cough peak expiratory flow(CPEF)on the success rate of weaning from mechanical ventilation.Methods:The clinical data of patients undergoing invasive mechanical ventilation via oral endotracheal intubation in the ICU of our hospital from January 2022 to December 2023 were studied.All patients underwent a 30-minute spontaneous breathing trial(SBT)using low-level pressure support ventilation(PSV)after meeting the clinical weaning screening criteria.Among them,150 patients who met the clinical weaning criteria were weaned from the ventilator.They were divided into a successful weaning group(n=100)and a failed weaning group(n=50)based on the weaning outcome.Clinical data,including age,gender,APACHE II score,duration of mechanical ventilation,DTF,and CPEF,were collected from 150 patients.The differences in clinical data between the two groups were compared,and the correlation between DTF,CPEF,and the success rate of weaning was analyzed.Results:There were no significant differences between the two groups in gender ratio(χ^(2)=0.884,P=0.347>0.05),age(t=0.350,P=0.727>0.05),and APACHE II score(t=1.295,P=0.197>0.05),but there was a significant difference in the duration of mechanical ventilation(t=3.766,P<0.001).The DTF and CPEF values in the successful weaning group were significantly higher than those in the failed weaning group(P<0.05).ROC curves were drawn to predict the weaning results using DTF,CPEF,and the combination of DTF and CPEF.The results showed that the specificity of the combination of DTF and CPEF was comparable to that of either metric alone,but the sensitivity and AUC were significantly higher than those of either metric alone.Conclusion:The combination of DTF and CPEF can be used as an effective indicator to evaluate the weaning efficacy of mechanically ventilated patients,which has important clinical significance for guiding clinical weaning treatment,improving the success rate of weaning,reducing the incidence of ventilator-associated pneumonia,and shortening the length of hospital stay.
文摘BACKGROUND:In this study,we aimed to evaluate the impact of mechanical ventilator(MV)utilizaton during cardiopulmonary resuscitation(CPR)on out-of-hospital cardiac arrest(OHCA)patient clinical outcomes in the emergency department.METHODS:This single-centered,retrospective,case-control study analyzed electronic medical records.Patients aged>18 years with non-traumatic OHCA who were treated at an emergency medical center between January 2019 and December 2023 were included.These patients were accessed according to the ventilatory method used:MV ventilation(volume control,tidal volume 6-8 mL/kg,frequency 10 beat per minute,inspiratory time 1 s)and manual resuscitator bag valve(BV)ventilation.The primary outcome was the return of spontaneous circulation(ROSC).After 1:1 propensity score matching,the clinical outcomes were analyzed.RESULTS:A total of 649 patients were enrolled in this study.Before matching,the clinical outcomes and pneumothorax incidence did not differ between the MV and BV groups.After 1:1 matching between the two groups using propensity scores,522 patients(261 MV and 261 BV)were analyzed.Propensity score matching yielded an adequate balance(standardized mean difference<0.10)for all covariates.The estimated odds ratio(OR)for ROSC was 1.23(95%confidence interval[CI]:0.85-1.77;P=0.267),for survival at hospital admission was 1.02(95%CI:0.68-1.53;P=0.918),for survival at hospital discharge was 2.31(95%CI:1.10-5.20;P=0.033),and for good neurologic outcome was 2.56(95%CI:0.84-9.43;P=0.116).CONCLUSION:In patients with OHCA admitted to the emergency department,MV ventilation during CPR showed clinical outcomes similar to those of BV ventilation in most measures.However,survival at hospital discharge was significantly higher in the MV group,suggesting potential benefits of MV use in selected patients.
文摘BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed rapidly in the field of critical care in recent years.Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator.Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into a successful ventilation group(68 cases)and a failed ventilation group(26 cases)according to the outcome of ventilation.The clinical data of patients with successful and failed noninvasive ventilation were compared,and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.RESULTS There were no significant differences in gender,age,body mass index,complications,systolic pressure,heart rate,mean arterial pressure,respiratory rate,oxygen saturation,partial pressure of oxygen,oxygenation index,or time of inspiration between patients with successful and failed mechanical ventilation(P>0.05).The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide(PaCO_(2))than those with failed treatment,while potential of hydrogen(pH),diaphragm thickening fraction(DTF),diaphragm activity,and diaphragm movement time were significantly higher than those with failed treatment(P<0.05).pH[odds ratio(OR)=0.005,P<0.05],PaCO_(2)(OR=0.430,P<0.05),and DTF(OR=0.570,P<0.05)were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.
文摘Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.
文摘BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical ventilation.AIM To compare the neuroprotective effects of dexmedetomidine and propofol for sedation during prolonged mechanical ventilation in patients without brain injury.METHODS Patients who underwent mechanical ventilation for>72 h were randomly assigned to receive sedation with dexmedetomidine or propofol.The Richmond Agitation and Sedation Scale(RASS)was used to evaluate sedation effects,with a target range of-3 to 0.The primary outcomes were serum levels of S100-βand neuron-specific enolase(NSE)every 24 h.The secondary outcomes were remifentanil dosage,the proportion of patients requiring rescue sedation,and the time and frequency of RASS scores within the target range.RESULTS A total of 52 and 63 patients were allocated to the dexmedetomidine group and propofol group,respectively.Baseline data were comparable between groups.No significant differences were identified between groups within the median duration of study drug infusion[52.0(IQR:36.0-73.5)h vs 53.0(IQR:37.0-72.0)h,P=0.958],the median dose of remifentanil[4.5(IQR:4.0-5.0)μg/kg/h vs 4.6(IQR:4.0-5.0)μg/kg/h,P=0.395],the median percentage of time in the target RASS range without rescue sedation[85.6%(IQR:65.8%-96.6%)vs 86.7%(IQR:72.3%-95.3),P=0.592],and the median frequency within the target RASS range without rescue sedation[72.2%(60.8%-91.7%)vs 73.3%(60.0%-100.0%),P=0.880].The proportion of patients in the dexmedetomidine group who required rescue sedation was higher than in the propofol group with statistical significance(69.2%vs 50.8%,P=0.045).Serum S100-βand NSE levels in the propofol group were higher than in the dexmedetomidine group with statistical significance during the first six and five days of mechanical ventilation,respectively(all P<0.05).CONCLUSION Dexmedetomidine demonstrated stronger protective effects on the brain compared to propofol for long-term mechanical ventilation in patients without brain injury.
基金the Natural Science Foundation of Hunan,China(No.2020JJ4159)the Research Foundation of Education Bureau of Hunan,China(No.19A093)+1 种基金the Interdisciplinary Program of Shanghai Jiao Tong University(No.YG2019ZDB08)the Significant Special Project form Ministry of Science and Technology of China(No.2021YFC0122500)。
文摘The high frequency ventilation(HFV)can well support the breathing of respiratory patient with 20%-40%of normal tidal volume.Now as a therapy of rescue ventilation when conversional ventilation failed,the HFV has been applied in the treatments of severe patients with acute respiratory failure(ARF),acute respiratory distress syndrome(ARDS),etc.However,the gas exchange mechanism(GEM)of HFV is still not fully understood by researchers.In this paper,the GEM of HFV is reviewed to track the studies in the last decades and prospect for the next likely studies.And inspired by previous studies,the GEM of HFV is suggested to be continually developed with various hypotheses which will be testified in simulation,experiment and clinic trail.One of the significant measures is to study the GEM of HFV under the cross-disciplinary integration of medicine and engineering.Fully understanding the GEM can theoretically support and expand the applications of HFV,and is helpful in investigating the potential indications and contraindications of HFV.
文摘Invasive mechanical ventilation(IMV)has become integral to modern-day critical care.Even though critically ill patients frequently require IMV support,weaning from IMV remains an arduous task,with the reported weaning failure(WF)rates being as high as 50%.Optimizing the timing for weaning may aid in reducing time spent on the ventilator,associated adverse effects,patient discomfort,and medical care costs.Since weaning is a complex process and WF is often multifactorial,several weaning scores have been developed to predict WF and aid decision-making.These scores are based on the patient's physiological and ventilatory parameters,but each has limitations.This review highlights the current role and limitations of the various clinical prediction scores available to predict WF.
文摘The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.
基金Supported by Non-profit Joint Stock Company“S.D.Asfendiyarov Kazakh National Medical University”,Almaty,Kazakhstan。
文摘BACKGROUND For over half a century,the administration of maternal corticosteroids before anticipated preterm birth has been regarded as a cornerstone intervention for enhancing neonatal outcomes,particularly in preventing respiratory distress syndrome.Ongoing research on antenatal corticosteroids(ACS)is continuously refining the evidence regarding their efficacy and potential side effects,which may alter the application of this treatment.Recent findings indicate that in resource-limited settings,the effectiveness of ACS is contingent upon meeting specific conditions,including providing adequate medical support for preterm newborns.Future studies are expected to concentrate on developing evidence-based strategies to safely enhance ACS utilization in low-and middle-income countries.AIM To analyze the clinical effectiveness of antenatal corticosteroids in improving outcomes for preterm newborns in a tertiary care hospital setting in Kazakhstan,following current World Health Organization guidelines.METHODS This study employs a comparative retrospective cohort design to analyze single-center clinical data collected from January 2022 to February 2024.A total of 152 medical records of preterm newborns with gestational ages between 24 and 34 weeks were reviewed,focusing on the completeness of the ACS received.Quantitative variables are presented as means with standard deviations,while frequency analysis of qualitative indicators was performed using Pearson'sχ^(2) test(χ^(2))and Fisher's exact test.If statistical significance was identified,pairwise comparisons between the three observation groups were conducted using the Bonferroni correction.RESULTS The obtained data indicate that the complete implementation of antenatal steroid prophylaxis(ASP)improves neonatal outcomes,particularly by reducing the frequency of birth asphyxia(P=0.002),the need for primary resuscitation(P=0.002),the use of nasal continuous positive airway pressure(P=0.022),and the need for surfactant replacement therapy(P=0.038)compared to groups with incomplete or no ASP.Furthermore,complete ASP contributed to a decrease in morbidity among preterm newborns(e.g.,respiratory distress syndrome,intrauterine pneumonia,cerebral ischemia,bronchopulmonary dysplasia,etc.),improved Apgar scores,and reduced the need for re-intubation and the frequency of mechanical ventilation.However,it was associated with an increased incidence of uterine atony in postpartum women(P=0.0095).CONCLUSION In a tertiary hospital setting,the implementation of ACS therapy for pregnancies between 24 and 34 weeks of gestation at high risk for preterm birth significantly reduces the incidence of neonatal complications and related interventions.This,in turn,contributes to better outcomes for this cohort of children.However,the impact of ACS on maternal outcomes requires further thorough investigation.
基金supported by the Regional Science Foundation Project of the National Natural Science Foundation of China(Project No:82160157)the Beijing High-Level Public Health Technology Talent Construction Project(Project No.:Leading Talents-03-10).
文摘Cardiac arrest(CA)is considered a state of clinical death in which the heart suddenly loses its ability to effectively expel blood,resulting in circulatory and respiratory arrest.CA is often catastrophic for patients,as it can cause serious long-term cardiovascular and cerebrovascular complications that affect their quality of life[1].Survey data indicate that the overall incidence rate of intraoperative CA in patients undergoing thoracic surgery in China is currently 0.138%[2].This rate is expected to increase because of the increasing proportion of older individuals(age>60 years)in the population,as well as the increasing pulmonary surgery rates.However,the incidence rate during the perianesthetic period in older patients undergoing thoracic surgery has not yet been comprehensively reported.
文摘BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral and non-viral etiologies are treated by traditional ARDS protocols that recommend 12-16 hours of prone position ventilation(PPV)with neuromuscular blocking agents(NMBA)and a trial of inhaled vasodilators(IVd)if oxygenation does not improve.However,debate on the efficacy of adjuncts to PPV and low tidal volume ventilation persists and evidence about the benefits of IVd/NMBA in COVID ARDS is sparse.In our multi-center retrospective review,we evaluated the impact of PPV,IVd,and NMBA on outcomes and lung mechanics in COVID ARDS patients with moderate to severe ARDS.AIM To evaluate the impact of PPV used alone or in combination with pulmonary IVd and/or NMBA in mechanically ventilated patients with moderate to severe ARDS during the COVID-19 pandemic.METHODS A retrospective study at two tertiary academic medical centers compared outcomes between COVID ARDS patients receiving PPV and patients in the supine position.PPV patients were divided based on concurrent use of ARDS adjunct therapies resulting in four subgroups:(1)PPV alone;(2)PPV and IVd;(3)PPV and NMBA;and(4)PPV,IVd,and NMBA.Primary outcomes were hospital and intensive care unit(ICU)length of stay(LOS),mortality,and venovenous extracorporeal membrane oxygenation(VV-ECMO)status.Secondary outcomes included changes in lung mechanics at 24-hour intervals for 7 days.RESULTS Total 114 patients were included in this study.Baseline respiratory parameters and Sequential Organ Failure Assessment scores were significantly worse in the PPV group.ICU LOS and LOS were significantly longer for patients who were proned,but no mortality benefit or difference in VV-ECMO status was found.Among the subgroups,no difference in primary outcomes were found.In the secondary analysis,PPV was associated with a significant improvement in arterial oxygen partial pressure(PaO_(2))/fractional inspired oxygen(FiO_(2))(P/F)ratio from day 1 to day 4(P<0.05)and higher driving pressures day 5 to day 7(P<0.05).The combination of PPV and IVd together resulted in improvements in P/F ratio from day 1 to day 7 and plateau pressure on day 4 and day 6(P<0.05).PPV with NMBA was not associated with improvements in any of the secondary outcomes.The use of all three rescue therapies together resulted in improvements in lung compliance on day 2(P<0.05)but no other improvements.CONCLUSION In mechanically ventilated patients diagnosed with moderate to severe COVID ARDS,PPV and PPV with the addition of IVd produced a significant and sustained increase in P/F ratio.The combination of PPV,IVd and NMBA improved compliance however this did not reach significance.Mortality and LOS did not improve with adjunct therapies.Further research is warranted to determine the efficacy of these therapies alone and in combination in the treatment of COVID ARDS.
文摘BACKGROUND Ethylene glycol(EG)poisoning is often caused by the accidental ingestion of antifreeze.EG is metabolized into glycolate and oxalate and may cause metabolic acidaemia,neurotoxicity,acute kidney injury,and death.A variety of EG poisoning case reports have been published,and we wrote this case report and literature review to summarize the clinical experience of patients who survived EG poisoning.CASE SUMMARY In this case report,a 55-year-old man developed EG poisoning after ingesting antifreeze by accident and experienced acute kidney injury,nervous system dysfunction and inhalation pneumonia.The timely use of ethanol for detoxification,initiation of haemodialysis,and protection of organ function are effective treatment methods for patients with antifreeze poisoning.The patient was discharged in the 3rd week after admission.When discharged,the patient did not report any discomfort,had stable vital signs,did not have fever or diarrhoea,and had improved liver and kidney functions.CONCLUSION A timely diagnosis,haemodialysis,and organ protection are the keys to the successful treatment of poisoned patients.
文摘BACKGROUND Acute respiratory distress syndrome(ARDS)is a critical condition characterized by acute hypoxemia,non-cardiogenic pulmonary edema,and decreased lung compliance.The Berlin definition,updated in 2012,classifies ARDS severity based on the partial pressure of arterial oxygen/fractional inspired oxygen fraction ratio.Despite various treatment strategies,ARDS remains a significant public health concern with high mortality rates.AIM To evaluate the implications of driving pressure(DP)in ARDS management and its potential as a protective lung strategy.METHODS We conducted a systematic review using databases including EbscoHost,MEDLINE,CINAHL,PubMed,and Google Scholar.The search was limited to articles published between January 2015 and September 2024.Twenty-three peer-reviewed articles were selected based on inclusion criteria focusing on adult ARDS patients undergoing mechanical ventilation and DP strategies.The literature review was conducted and reported according to PRISMA 2020 guidelines.RESULTS DP,the difference between plateau pressure and positive end-expiratory pressure,is crucial in ARDS management.Studies indicate that lower DP levels are significantly associated with improved survival rates in ARDS patients.DP is a better predictor of mortality than tidal volume or positive end-expiratory pressure alone.Adjusting DP by optimizing lung compliance and minimizing overdistension and collapse can reduce ventilator-induced lung injury.CONCLUSION DP is a valuable parameter in ARDS management,offering a more precise measure of lung stress and strain than traditional metrics.Implementing DP as a threshold for safety can enhance protective ventilation strategies,po-tentially reducing mortality in ARDS patients.Further research is needed to refine DP measurement techniques and validate its clinical application in diverse patient populations.
文摘BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.
基金funded by the Natural Science Foundation of China(NSFC),Grants No.12072048 to M.L.,12272063,and 11532003 to L.D.partially supported by the Science and Technology Innovation Leading Plan of High-Tech Industry in Hunan Province,China,Grant No.2020SK2018 to L.D.
文摘Background:Mechanical ventilation(MV)provides life support for patients with severe respiratory distress but can simultaneously cause ventilator-induced lung injury(VILI).However,due to a poor understanding of its mechanism,there is still a lack of effective remedies for the often-deadly VILI.Recent studies indicate that the stretch associated with MV can enhance the secretion of extracellular vesicles(EVs)and induce endoplasmic reticulum(ER)stress in airway smoothmuscle cells(ASMCs),both of which can contribute to VILI.But whetherMVassociated stretch enhances the secretion of EVs via ER stress in ASMCs as an underlying mechanism of VILI remains unknown.Methods:In this study,we exposed cultured human ASMCs to stretch(13%strain)and mouse models to MV at tidal volume(18 mL/kg).Subsequently,the amount of secreted EVs in the culture medium of ASMCs and the bronchoalveolar lavage fluid(BALF)of mousemodels was quantitatively evaluated by ultracentrifugation,transmission electron microscopy,Western blot,flow cytometry,and nanoparticle tracking analysis.The cultured ASMCs and the lung tissues of mouse models were assessed for expression of biomarkers of EVs(cluster of differentiation antigen 63,CD63),ER stress(heat shock protein family A member 5,HSPA5),and EVs regulating molecule Rab27a by immunofluorescence microscopy,immunohistochemistry(IHC)and enzyme-linked immunosorbent assay(ELISA),respectively.MicroRNAs(miRNAs)in EVs from ASMCs were measured with miRNA whole genome sequencing(miRNA-Seq).Results:We found that stretch enhanced EV secretion from cultured ASMCs.In addition,the cultured ASMCs and the mouse models were either or not pretreated with ER stress inhibitor(tauroursodeoxycholic acid,TUDCA)/EV secretion inhibitor(GW4869)prior to stretch or MV.We found that MV-associated stretch enhanced the expression of CD63,HSPA5,and Rab27a in cultured ASMCs and BALF/lung tissues of mousemodels,which could all be attenuated with TUDCA/GW4869 pretreatment.miRNA-Seq data show that differentially expressed miRNAs in EVsmainlymodulate gene transcription.Furthermore,the EVs fromcultured ASMCs under stretch tended to enhance detachment and expression of inflammatory cytokines,i.e.,transforming growth factor-β1(TGF-β1),interleukin-10(IL-10)in cultured airway epithelial cells.The expression of TGF-β1 and IL-10 in BALF of the mouse models also increased in response to MV,which was attenuated together with partial improvement of lung injury by pretreatment with TUDCA,GW4869/Rab27a siRNAs.Conclusion:Taken together,our data indicate thatMV-associated stretch can enhance the secretion of EVs from ASMCs via ER stress signaling to mediate airway inflammation and VILI,which provides new insight for further exploring EVs for the diagnosis and treatment of VILI.
文摘At high altitudes, an Aviation Oxygen Supply System （AOSS） protects pilots from low pressure and hypoxia by continuously providing oxygen corresponding to the pilots＇ dynamic respiratory properties. An AOSS mainly consists of oxygen supercharging machines which are used in a high-altitude flight cabin to supply pressurized oxygen to pilots. Therefore, it is of great significance to study the airflow dynamic characteristics of an AOSS for safe, continuous, and efficient oxygen supply. In this paper, an AOSS is firstly simplified and considered as a mechanical ventilation system. Then, its corresponding mathematical model is constructed. Next, to verify the mathematical model, a prototype AOSS with a lung simulator is proposed for an experimental study. Afterwards, to build a foundation for the optimization of the AOSS, the airflow dynamic characteristics of an aircraft are analyzed, and the effects of key parameters on the respiration system are researched. Through experimental and simulation studies, it can be concluded that the mathematical model is effective. Subsequently, for stability during the respiration process, we consider setting the equivalent throttling areas of the inspiration and expiration pipelines smaller within certain limits; additionally, an excessively high oxygen supply pressure will disturb smooth airflow, and in a low-pressure environment, the pressure can be 84 cmH20 lower than the standard atmospheric pressure. This research can be referred to in the design of an oxygen supply system and the study on optimization of airflow dynamic characteristics.
