BACKGROUND Clinical guidelines for early extubation after liver transplantation remain lacking,with significant variations in the rates of early extubation across transplantation centers.AIM To identify clinical facto...BACKGROUND Clinical guidelines for early extubation after liver transplantation remain lacking,with significant variations in the rates of early extubation across transplantation centers.AIM To identify clinical factors,including the use of epidural analgesia,associated with early extubation in living-donor liver transplantation(LDLT).METHODS The medical records of LDLT recipients were analyzed in this study,categorizing them based on extubation timing as delayed(leaving the operating room without extubation)or early(tracheal tube removed immediately after surgery).A multivariate binary logistic regression analysis was performed.Subgroup analysis was conducted,excluding patients contraindicated for epidural analgesia owing to significant coagulopathy.RESULTS Total of 159 patients,93(58.5%)underwent early extubation.Relevant clinical factors of early extubation were shorter anhepatic time[adjusted odds ratio(OR)=0.439,95%confidence interval(CI):0.232-0.831;P=0.011],absence of high-dose vasoactive drug use at the end of surgery(OR=0.235,95%CI:0.106-0.519;P<0.001),and the use of epidural analgesia(OR=15.730,95%CI:1.919-128.919;P=0.010).In a subgroup analysis of 67 patients,epidural analgesia remained a relevant clinical factor for early extubation(adjusted OR=19.381,95%CI:2.15-174.433;P=0.008).CONCLUSION Shorter anhepatic time,absence of high-dose vasoactive drug use at the end of surgery,and the use of epidural analgesia are relevant clinical factors of early extubation following LDLT.展开更多
Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60...Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60 pediatric patients undergoing elective surgery admitted to our hospital from January to August 2025 were selected and randomly divided into an observation group and a control group,with 30 cases in each group,using a random number table method.The control group received an intravenous infusion of 0.9% sodium chloride injection 30 minutes before the end of surgery,while the observation group received an intravenous pump infusion of dexmedetomidine(1μg/kg,diluted to 4μg/ml with normal saline).The severity of cough(graded from 0 to 3)and vital signs,including heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO₂),were recorded 5 minutes before extubation,at the time of extubation,and 5 minutes after extubation in both groups.Results:The severity of cough in the observation group was significantly milder than that in the control group(P<0.05),with a significantly higher proportion of grade 0 cough in the observation group(23.33%vs 3.33%).At extubation and five minutes post-extubation,the observation group exhibited significantly lower HR,SBP,and DBP than the control group(P<0.05).In contrast,SpO_(2)levels remained comparable between the groups(P>0.05).Conclusion:Dexmedetomidine can effectively suppress the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia,reduce the severity of cough,stabilize hemodynamic parameters,and has no significant impact on respiratory function,demonstrating good clinical safety.展开更多
BACKGROUND Unplanned extubation(UE)after endoscopic retrograde cholangiopancreatography plus endoscopic nasobiliary drainage(ENBD)increases patient morbidity and prolongs hospitalization duration.AIM To construct a ri...BACKGROUND Unplanned extubation(UE)after endoscopic retrograde cholangiopancreatography plus endoscopic nasobiliary drainage(ENBD)increases patient morbidity and prolongs hospitalization duration.AIM To construct a risk prediction model for UE in patients undergoing ENBD to provide evidence for clinical nursing.METHODS A multicenter retrospective study was conducted,collecting data from 981 patients undergoing ENBD from three hospitals in Chongqing from January 2018 to June 2024,randomly allocated to modeling and validation groups in a 7:3 ratio.Logistic regression analysis was used to screen independent risk factors,construct prediction models,and draw nomograms.RESULTS The overall incidence of UE was 6.12%(60/981).The majority(70.00%)of extubations occurred within 24-72 h postoperatively.Multivariate logistic regression analysis identified age≥61 years[odds ratio(OR)=2.341,95%confidence interval(CI):1.28-4.27],smoking history(OR=2.876,95%CI:1.54-5.37),prolonged fasting time(OR=1.124,95%CI:1.05-1.20),prolonged catheter duration(OR=1.286,95%CI:1.09-1.52),and consciousness changes(OR=3.152,95%CI:1.69-5.89)were independent risk factors while serum albumin was a protective factor(OR=0.912,95%CI:0.87-0.95).The model receiver operating characteristic area under curve was 0.881 with accuracy of 80.36%,sensitivity of 83.59%,and specificity of 74.88%.A nomogram total score≥199 points corresponded to a high-risk threshold.CONCLUSION The six-factor risk prediction model had good discrimination and accuracy,which can provide clinical nursing staff with scientific evidence to identify patients at high risk and help reduce the incidence of UE.展开更多
AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were ra...AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were randomly assigned to propofol (n = 41) and urapidil groups (n = 41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P > 0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO2, PaCO2, SaO(2) and intraocular pressure (TOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. RESULTS: The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P < 0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P > 0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P < 0.05), and had significant difference compared with those in urapidil group (P < 0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P < 0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P < 0.05). The changes in these indicators between the two groups had no significant difference (P > 0.05). CONCLUSION: Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.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
BACKGROUND Critical patients often had various types of tubes,unplanned extubation of any kind of tube may cause serious injury to the patient,but previous reports mainly focused on endotracheal intubation.The limitat...BACKGROUND Critical patients often had various types of tubes,unplanned extubation of any kind of tube may cause serious injury to the patient,but previous reports mainly focused on endotracheal intubation.The limitations or incorrect use of the unplanned extubation risk assessment tool may lead to improper identification of patients at a high risk of unplanned extubation and cause delay or nonimplementation of unplanned extubation prevention interventions.To effectively identify and manage the risk of unplanned extubation,a comprehensive and universal unplanned extubation risk assessment tool is needed.AIM To assess the predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale in inpatients.METHODS This was a retrospective validation study.In this study,medical records were extracted between October 2020 and September 2021 from a tertiary comprehensive hospital in southwest China.For patients with tubes during hospitalization,the following information was extracted from the hospital information system:age,sex,admission mode,education,marital status,number of tubes,discharge mode,unplanned extubation occurrence,and the Huaxi Unplanned Extubation Risk Assessment Scale(HUERAS)score.Only inpatients were included,and those with indwelling needles were excluded.The best cut-off value and the area under the curve(AUC)of the Huaxi Unplanned Extubation Risk Assessment Scale were been identified.RESULTS A total of 76033 inpatients with indwelling tubes were included in this study,and 26 unplanned extubations occurred.The patients’HUERAS scores were between 11 and 30,with an average score of 17.25±3.73.The scores of patients with or without unplanned extubation were 22.85±3.28 and 17.25±3.73,respectively(P<0.001).The results of the correlation analysis showed that the correlation coefficients between each characteristic and the total score ranged from 0.183 to 0.843.The best cut-off value was 21,and there were 14135 patients with a high risk of unplanned extubation,accounting for 18.59%.The Cronbach’sα,sensitivity,specificity,positive predictive value,and negative predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale were 0.815,84.62%,81.43%,0.16%,and 99.99%,respectively.The AUC of HUERAS was 0.851(95%CI:0.783-0.919,P<0.001).CONCLUSION The HUERAS has good reliability and predictive validity.It can effectively identify inpatients at a high risk of unplanned extubation and help clinical nurses carry out risk screening and management.展开更多
BACKGROUND: Anesthetic practices such as early tracheal extubation facilitate postoperative recovery. Early extubation after liver transplantation has been adopted by some centers in the recent two decades. No univers...BACKGROUND: Anesthetic practices such as early tracheal extubation facilitate postoperative recovery. Early extubation after liver transplantation has been adopted by some centers in the recent two decades. No universal clinical guidelines are used and questions remain. This review aimed to address the current status of early extubation after liver transplantation. DATA SOURCES: A literature search of MEDLINE and ISI Web of Knowledge databases was performed using terms such as liver transplantation, early extubation, immediate tracheal extubation fast tracking or fast track anesthesia and postoperative tracheal extubation. Additional papers were identified by a manual search of the references in the key articles. RESULTS: Review of the available literature provided an insight into the definition, evolution, advantages and risks of early extubation, and anesthetic techniques that prompt early extubation in liver transplant patients. Early extubation has proved to be feasible and safe in these patients, but the outcomes are still uncertain. CONCLUSIONS: Early extubation after liver transplantation is feasible, safe and cost-effective in the majority of patients and has been increasingly accepted as an option for conventional postoperative ventilation. Comprehensive and individualized evaluation of the patient’s condition before extubation by an experienced anesthesiologist is the cornerstone of success Understanding of its effect on the outcome remains incomplete In the future, additional trials are required to establish universal early extubation guidelines and to determine its benefits for patients and practitioners.展开更多
Background: Tracheal extubation is related to many side effects of hemodynamic, especially for patients with comorbid states. The study compared the validity of dexmedetomidine 1 μg/kg and low combination dose of dex...Background: Tracheal extubation is related to many side effects of hemodynamic, especially for patients with comorbid states. The study compared the validity of dexmedetomidine 1 μg/kg and low combination dose of dexmedetomidine 0.5 μg/kg plus Lidocaine 1 mg/kg in softening hemodynamic stress response and estimated quality of extubation in study groups. Materials and Methods: The patients in our study, one hundred and fifty of both gender, ASA class I &II patients, aged 20 - 50 years old subject to elective abdominal operations under general anesthesia were allocated into three equal groups. Anesthetic technique was standardized. Before extubation by 10 minutes, the patients in Group N, D, and DL have given 0.9% normal Saline intravenous bolus infusion, dexmedetomidine 1 μg/kg and Dexmedetomidine 0.5 μg/kg, respectively within a 10-minute period. Before complete extubation by 90 seconds, in the three groups by syringe ten cc volumes and at time of extubation, Group N and D patients received 0.9% normal Saline intravenous bolus infusion, but in Group DL received Lidocaine 1 mg/kg then extubation completed. Heart rate (HR), Diastolic BP (DBP), Systolic BP (SBP), and Mean Arterial Pressure (MAP) were noted at baseline, at the reverse, extubation, 2, 4, 6, 8, 10 min and at the regular times after that for two hours. Extubation quality was assessed by extubation quality scale. Aldrete’s recovery score and Ramsay sedation score were also recorded and also any complications were noted and recorded. Results: All the hemodynamic parameters significantly elevated extubation and numerous periods of observation in the normal saline group than dexmedetomidine and dexmedetomidine plus Lidocaine group (p-value = 0.001). Response of tachycardia was seen in 41 (82%) in patients of N group, compared to 18 (36%) and 20 (40%) in D & DL group respectively (p = 0.001). Hypertensive response statistically significant noticed in 40 (80%) patients of N group, 9 (18%) of D group and 12 (24%) of DL group (p = 0.001). Tachycardia duration and the response of hypertension were significantly prolonged in the control group. As regards extubation quality, the three groups differed in D Groups (1.93 ± 0.57) and DL (1.51 ± 0.57) had decreased scores compared to group N (2.67 ± 0.48) modulating smoother extubation (p Conclusion: Low combined dose of (Dexmedetomidine 0.5 μg/kg plus Lidocaine 1 mg/kg) IV was useful as much as Dexmedetomidine 1 μg/kg IV in softening hemodynamic stress responses during emergence.展开更多
Background:Children are at risk of extubation failure after congenital heart disease surgery.Such cases should be identified to avoid possible adverse consequences of failed extubation.This study aimed to identify ult...Background:Children are at risk of extubation failure after congenital heart disease surgery.Such cases should be identified to avoid possible adverse consequences of failed extubation.This study aimed to identify ultrasound predictors of successful extubation in children who underwent cardiac surgery.Methods:Children aged 3 months to 6 years who underwent cardiac surgery(if they were intubated for>6 h and underwent a spontaneous breathing trial)were included in this study.Results:We included 83 children who underwent surgery for congenital heart disease.Transthoracic echocardiography and lung ultrasound were performed immediately before spontaneous breathing trials.Upon spontaneous breathing trial completion,respiratory parameters,including arterial blood gas analysis and frequency-to-tidal volume ratio,were similarly recorded.For outcome assessment,all children were followed up for 48 h after extubation.We successfully extubated 57 children(68.7%).These children were significantly older and weighed more but had shorter aortic cross-clamp and cardiopulmonary bypass times.Children who could not be weaned or extubated had prolonged total mechanical ventilation and pediatric intensive care unit stay.In the multivariate regression analysis,a lung ultrasound score≥12 and ejection fraction≥40%immediately before spontaneous breathing trials were the only independent predictors of successful extubation.When combined,the lung ultrasound score and an ejection fraction≥40%showed a better diagnostic performance than every other isolated variable(lung ultrasound,N-terminal-pro-B-type natriuretic peptide,and frequency-to-tidal volume ratio).Conclusions:The combination of lung ultrasound and transthoracic echocardiography immediately before the spontaneous breathing trial effectively predicts extubation outcomes in children after cardiac surgery.展开更多
Introduction: Fast track (FT) cardiac surgery and early extubation (EE) are aimed at safe and effective rapid post-operative progression to discharge, and have been practiced for more than two decades. Their goal is t...Introduction: Fast track (FT) cardiac surgery and early extubation (EE) are aimed at safe and effective rapid post-operative progression to discharge, and have been practiced for more than two decades. Their goal is to optimize patient care perioperatively in order to decrease costs without negatively affecting morbidity and mortality. However, the factors that predict successful EE are poorly understood, and patients with significant co-morbidities are frequently excluded from protocols. We hypothesize that independent of disease severity, early extubation leads to shorter hospital stays and can be performed safely without negatively affecting outcomes. Materials and Methods: We performed a retrospective review of 919 patients who underwent coronary artery bypass grafting (CABG) at the Southern Arizona Veteran’s Affairs Health Care System medical center over 7 years. We collected pre-operative data regarding patients’ NYHA classification, presence and severity of cerebral vascular disease, peripheral vascular disease, pulmonary disease, diabetes and hypertension. Intra-operative variables were also recorded including ASA scores, ischemic times, and time to extubation. Finally, post-operative variables such as rates of reintubation and tracheotomy, and both length of ICU and total hospital stay were also compared. Results: Prolonged periods of ischemia were found to predict a delayed extubation (HR = 0.992;CI = 0.988 - 0.997, p = 0.0015) while small body surface area (HR = 1.57;CI = 1.13, 2.17, p = 0.007) and higher pre-operative functional status of the patient, such as independent versus dependent status (HR =1.68;CI = 1.30 - 2.16, p = 1.33;CI = 1.03 - 1.70, p = 0.03) were found to be associated with earlier extubation. The early extubation (EE) group (those extubated in less than the median 7.3 hours) had an average hospital stay of 5.1 ± 4.0 days, versus 7.8 ± 8.1 days in the delayed group (>4 hours), p Conclusions: In our study population, pre-operative functional class and total body surface area predicted those patients able to tolerate early extubation after cardiac surgery. Prolonged ischemia resulted in delayed extubation. Patients that were extubated in less than 4 hours had shorter ICU and hospitalization stays, while there was no significant difference between the two groups in rate of reintubation or tracheotomy.展开更多
BACKGROUND Protocols for nurse-led extubation are as safe as a physician-guided weaning in general intensive care unit(ICU).Early extubation is a cornerstone of fast-track cardiac surgery,and it has been mainly implem...BACKGROUND Protocols for nurse-led extubation are as safe as a physician-guided weaning in general intensive care unit(ICU).Early extubation is a cornerstone of fast-track cardiac surgery,and it has been mainly implemented in post-anaesthesia care units.Introducing a nurse-led extubation protocol may lead to reduced extubation time.AIM To investigate results of the implementation of a nurse-led protocol for early extubation after elective cardiac surgery,aiming at higher extubation rates by the third postoperative hour.METHODS A single centre prospective study in an 18-bed,consultant-led Cardiothoracic ICU,with a 1:1 nurse-to-patient ratio.During a 3-wk period,the protocol was implemented with:(1)Structured teaching sessions at nurse handover and at bed-space(all staff received teaching,over 90%were exposed at least twice;(2)Email;and(3)Laminated sheets at bed-space.We compared“standard practice”and“intervention”periods before and after the protocol implementation,measuring extubation rates at several time-points from the third until the 24th postoperative hour.RESULTS Of 122 cardiac surgery patients admitted to ICU,13 were excluded as early weaning was considered unsafe.Therefore,109 patients were included,54 in the standard and 55 in the intervention period.Types of surgical interventions and baseline left ventricular function were similar between groups.From the third to the 12th post-operative hour,the intervention group displayed a higher proportion of patients extubated compared to the standard group.However,results were significant only at the sixth hour(58%vs 37%,P=0.04),and not different at the third hour(13%vs 6%,P=0.33).From the 12th post-operative hour time-point onward,extubation rates became almost identical between groups(83%in standard vs 83%in intervention period).CONCLUSION The implementation of a nurse-led protocol for early extubation after cardiac surgery in ICU may gradually lead to higher rates of early extubation.展开更多
Background: Negative Pressure Pulmonary Edema (NPPE) is an uncommon, but well recognized clinical entity that continues to be reported as a complication of upper airway obstructions during induction or emergence. It r...Background: Negative Pressure Pulmonary Edema (NPPE) is an uncommon, but well recognized clinical entity that continues to be reported as a complication of upper airway obstructions during induction or emergence. It results from the negative intrathoracic pressure generated with spontaneous ventilation with concurrent upper airway obstruction. Aim: To present an unusual case of NPPE and review the pathophysiology and treatment. Case: It usually occurs in young healthy athletic adults. We are reporting NPPE in a nine-month-old ex-premature baby. We discuss his intraoperative events leading to NPPE, subsequent intraoperative course and treatment. Conclusion: NPPE needs to be promptly recognized and treated. If the edema resolves, the patient can be successfully extubated, but should be observed overnight.展开更多
Objective:This study aimed to evaluate the effectiveness of Buerger-Allen exercise(BAE)in reducing muscle cramps among recently extubated patients in the intensive care unit(ICU).Materials and Methods:A quantitative,q...Objective:This study aimed to evaluate the effectiveness of Buerger-Allen exercise(BAE)in reducing muscle cramps among recently extubated patients in the intensive care unit(ICU).Materials and Methods:A quantitative,quasi-experimental design was employed,involving 92 recently extubated ICU patients randomly assigned to either an experimental or control group.The experimental group underwent BAE,a three-step intervention targeting lower extremity circulation and muscle cramp reduction.The exercises included the elevation of lower extremities,foot and leg exercises,and a rest and recovery phase,administered twice daily for 10 days.The control group received standard nursing care without any specific exercise regimen.Muscle cramp severity was assessed using the modified Penn Spasm Frequency Scale before and after the intervention.Results:The experimental group showed a significant reduction in muscle cramp severity score postintervention,with the mean scores decreasing from 6.83±1.66 to 4.22±1.45(t=10.21,P=0.001).The control group experienced a smaller reduction,with scores decreasing from 6.98±1.57 to 6.43±1.37(t=2.810,P=0.007).Between-group analysis confirmed a significant difference postintervention,with the experimental group improving more(t=8.242,P=0.001).The Mann–Whitney U test also highlighted a significant difference between groups after the intervention(U=494.5,P=0.001),validating the effectiveness of BAE.Conclusion:BAE significantly reduces muscle cramp severity in recently extubated ICU patients,suggesting that this nonpharmacological intervention can effectively improve patient outcomes and aid in postextubation recovery.展开更多
Objective:To investigate the application effect of quality control circle activities in reducing the rate of unplanned extubation of venous access in perioperative patients.Methods:The quality control circle method wa...Objective:To investigate the application effect of quality control circle activities in reducing the rate of unplanned extubation of venous access in perioperative patients.Methods:The quality control circle method was used to analyze the causes,identify the actual causes of unplanned out-of-control,take corresponding measures,formulate corresponding countermeasures,implement standardized management,and carry out continuous improvement.Results:Following the implementation of quality control circle activities,the rate of unplanned extubation of venous access in perioperative patients decreased from 27.35%before improvement to 3.42%after improvement.Conclusion:The use of quality control circle activities in the safety management of venous access in perioperative patients is conducive to reducing the rate of unplanned extubation of venous access in perioperative patients.展开更多
Background The extubation time is critical during the intensive care unit stay in aneurysmal subarachnoid hemorrhage(aSAH)patients.The current conventional parameters for predicting extubation failure(EF)and extubatio...Background The extubation time is critical during the intensive care unit stay in aneurysmal subarachnoid hemorrhage(aSAH)patients.The current conventional parameters for predicting extubation failure(EF)and extubation time may not be suitable for this population.Here,we aimed to identify factors associated with EF in aSAH patients.Methods From a single-center observational study on aSAH patients with computed tomography angiography from 2019 to 2021,patients who received microsurgery were enrolled and divided into two groups according to whether EF occurred.Multivariable logistic regression was conducted to evaluate disease severity,medical history,and extubation time differences between patients with and without EF.Results Of 335 patients included,EF occurred with a rate of 0.14.Delayed cerebral ischemia(67.4%vs.13.5%)and acute hydrocephalus(6.5%vs.1.4%)were frequently observed in patients with EF.Also,patients who develop EF presented higher disability(65.9%vs.17.4%)and mortality(10.9%vs.0.7%)rates.Multivariable analysis demonstrated that age(OR 1.038;95%CI 1.004-1.073;P=0.028),onset to admission time(OR 0.731;95%CI 0.566-0.943;p=0.016),WFNS grade>3(OR 4.309;95%CI 1.639-11.330;p=0.003),and extubation time<24 h(OR 0.097;95%CI 0.024-0.396;p=0.001)were significantly associated with EF occurrence.Conclusions These data provide further evidence that older aSAH patients with onset to admission time<2 days and WFNS grade>3 have a high risk of developing EF,which is amplified by the ultra-early extubation.Moreover,in patients with two or more risk factors,a prolonged intubation recommendation requires consideration to avoid the EF.展开更多
目的:系统分析机械通气患者拔管失败的影响因素,为降低机械通气患者拔管失败率提供询证参考依据。方法:计算机检索中国知网、万方、VIP、CBM、Web of science、Pubmed、Cochrane Library、Embase中有关机械通气患者拔管失败影响因素的...目的:系统分析机械通气患者拔管失败的影响因素,为降低机械通气患者拔管失败率提供询证参考依据。方法:计算机检索中国知网、万方、VIP、CBM、Web of science、Pubmed、Cochrane Library、Embase中有关机械通气患者拔管失败影响因素的观察性研究,检索时限为建库至2024年2月。由2名研究者按照标准单独进行文献筛选、质量评价和资料提取。采用Stata 15.0统计软件进行Meta分析。结果:纳入48篇研究,总样本量为22391例,提取32个因素。Meta分析结果显示,机械通气时间、年龄、急性生理与慢性健康评分(APACHEⅡ评分)、糖尿病、多器官功能障碍综合征(MODS)、患有呼吸系统疾病、血清白蛋白(ALB)、浅快呼吸指数(RSBI)、二氧化碳分压(PaCO_(2))、拔管时呼吸频率、吸烟、肺部超声B线评分(LUBS)、血红蛋白(HB)、膈肌功能障碍、格拉斯哥昏迷评分法(GCS)、拔管时白细胞(WBC)、心率、B型钠尿肽(BNP)、尿素氮、慢性阻塞性肺疾病(COPD)、肾病、C反应蛋白(CRP)、心力衰竭,是机械通气患者拔管失败的影响因素(P<0.05)。结论:机械通气患者拔管失败的影响因素众多,医护人员应该制定科学详细的拔管计划,严密监测相关因素,降低患者的拔管风险。展开更多
文摘BACKGROUND Clinical guidelines for early extubation after liver transplantation remain lacking,with significant variations in the rates of early extubation across transplantation centers.AIM To identify clinical factors,including the use of epidural analgesia,associated with early extubation in living-donor liver transplantation(LDLT).METHODS The medical records of LDLT recipients were analyzed in this study,categorizing them based on extubation timing as delayed(leaving the operating room without extubation)or early(tracheal tube removed immediately after surgery).A multivariate binary logistic regression analysis was performed.Subgroup analysis was conducted,excluding patients contraindicated for epidural analgesia owing to significant coagulopathy.RESULTS Total of 159 patients,93(58.5%)underwent early extubation.Relevant clinical factors of early extubation were shorter anhepatic time[adjusted odds ratio(OR)=0.439,95%confidence interval(CI):0.232-0.831;P=0.011],absence of high-dose vasoactive drug use at the end of surgery(OR=0.235,95%CI:0.106-0.519;P<0.001),and the use of epidural analgesia(OR=15.730,95%CI:1.919-128.919;P=0.010).In a subgroup analysis of 67 patients,epidural analgesia remained a relevant clinical factor for early extubation(adjusted OR=19.381,95%CI:2.15-174.433;P=0.008).CONCLUSION Shorter anhepatic time,absence of high-dose vasoactive drug use at the end of surgery,and the use of epidural analgesia are relevant clinical factors of early extubation following LDLT.
文摘Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60 pediatric patients undergoing elective surgery admitted to our hospital from January to August 2025 were selected and randomly divided into an observation group and a control group,with 30 cases in each group,using a random number table method.The control group received an intravenous infusion of 0.9% sodium chloride injection 30 minutes before the end of surgery,while the observation group received an intravenous pump infusion of dexmedetomidine(1μg/kg,diluted to 4μg/ml with normal saline).The severity of cough(graded from 0 to 3)and vital signs,including heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO₂),were recorded 5 minutes before extubation,at the time of extubation,and 5 minutes after extubation in both groups.Results:The severity of cough in the observation group was significantly milder than that in the control group(P<0.05),with a significantly higher proportion of grade 0 cough in the observation group(23.33%vs 3.33%).At extubation and five minutes post-extubation,the observation group exhibited significantly lower HR,SBP,and DBP than the control group(P<0.05).In contrast,SpO_(2)levels remained comparable between the groups(P>0.05).Conclusion:Dexmedetomidine can effectively suppress the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia,reduce the severity of cough,stabilize hemodynamic parameters,and has no significant impact on respiratory function,demonstrating good clinical safety.
基金Supported by the Chongqing Municipal Health Commission Project,No.2024WSJK017.
文摘BACKGROUND Unplanned extubation(UE)after endoscopic retrograde cholangiopancreatography plus endoscopic nasobiliary drainage(ENBD)increases patient morbidity and prolongs hospitalization duration.AIM To construct a risk prediction model for UE in patients undergoing ENBD to provide evidence for clinical nursing.METHODS A multicenter retrospective study was conducted,collecting data from 981 patients undergoing ENBD from three hospitals in Chongqing from January 2018 to June 2024,randomly allocated to modeling and validation groups in a 7:3 ratio.Logistic regression analysis was used to screen independent risk factors,construct prediction models,and draw nomograms.RESULTS The overall incidence of UE was 6.12%(60/981).The majority(70.00%)of extubations occurred within 24-72 h postoperatively.Multivariate logistic regression analysis identified age≥61 years[odds ratio(OR)=2.341,95%confidence interval(CI):1.28-4.27],smoking history(OR=2.876,95%CI:1.54-5.37),prolonged fasting time(OR=1.124,95%CI:1.05-1.20),prolonged catheter duration(OR=1.286,95%CI:1.09-1.52),and consciousness changes(OR=3.152,95%CI:1.69-5.89)were independent risk factors while serum albumin was a protective factor(OR=0.912,95%CI:0.87-0.95).The model receiver operating characteristic area under curve was 0.881 with accuracy of 80.36%,sensitivity of 83.59%,and specificity of 74.88%.A nomogram total score≥199 points corresponded to a high-risk threshold.CONCLUSION The six-factor risk prediction model had good discrimination and accuracy,which can provide clinical nursing staff with scientific evidence to identify patients at high risk and help reduce the incidence of UE.
基金National Natural Science Foundation of China (No.39580683)
文摘AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were randomly assigned to propofol (n = 41) and urapidil groups (n = 41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P > 0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO2, PaCO2, SaO(2) and intraocular pressure (TOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. RESULTS: The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P < 0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P > 0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P < 0.05), and had significant difference compared with those in urapidil group (P < 0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P < 0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P < 0.05). The changes in these indicators between the two groups had no significant difference (P > 0.05). CONCLUSION: Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.
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 West China Nursing Discipline Development Special Fund Project,Sichuan University,No.HXHL19059。
文摘BACKGROUND Critical patients often had various types of tubes,unplanned extubation of any kind of tube may cause serious injury to the patient,but previous reports mainly focused on endotracheal intubation.The limitations or incorrect use of the unplanned extubation risk assessment tool may lead to improper identification of patients at a high risk of unplanned extubation and cause delay or nonimplementation of unplanned extubation prevention interventions.To effectively identify and manage the risk of unplanned extubation,a comprehensive and universal unplanned extubation risk assessment tool is needed.AIM To assess the predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale in inpatients.METHODS This was a retrospective validation study.In this study,medical records were extracted between October 2020 and September 2021 from a tertiary comprehensive hospital in southwest China.For patients with tubes during hospitalization,the following information was extracted from the hospital information system:age,sex,admission mode,education,marital status,number of tubes,discharge mode,unplanned extubation occurrence,and the Huaxi Unplanned Extubation Risk Assessment Scale(HUERAS)score.Only inpatients were included,and those with indwelling needles were excluded.The best cut-off value and the area under the curve(AUC)of the Huaxi Unplanned Extubation Risk Assessment Scale were been identified.RESULTS A total of 76033 inpatients with indwelling tubes were included in this study,and 26 unplanned extubations occurred.The patients’HUERAS scores were between 11 and 30,with an average score of 17.25±3.73.The scores of patients with or without unplanned extubation were 22.85±3.28 and 17.25±3.73,respectively(P<0.001).The results of the correlation analysis showed that the correlation coefficients between each characteristic and the total score ranged from 0.183 to 0.843.The best cut-off value was 21,and there were 14135 patients with a high risk of unplanned extubation,accounting for 18.59%.The Cronbach’sα,sensitivity,specificity,positive predictive value,and negative predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale were 0.815,84.62%,81.43%,0.16%,and 99.99%,respectively.The AUC of HUERAS was 0.851(95%CI:0.783-0.919,P<0.001).CONCLUSION The HUERAS has good reliability and predictive validity.It can effectively identify inpatients at a high risk of unplanned extubation and help clinical nurses carry out risk screening and management.
基金supported by a grant from the National S&T Major Project of China (2012ZX10002-017)
文摘BACKGROUND: Anesthetic practices such as early tracheal extubation facilitate postoperative recovery. Early extubation after liver transplantation has been adopted by some centers in the recent two decades. No universal clinical guidelines are used and questions remain. This review aimed to address the current status of early extubation after liver transplantation. DATA SOURCES: A literature search of MEDLINE and ISI Web of Knowledge databases was performed using terms such as liver transplantation, early extubation, immediate tracheal extubation fast tracking or fast track anesthesia and postoperative tracheal extubation. Additional papers were identified by a manual search of the references in the key articles. RESULTS: Review of the available literature provided an insight into the definition, evolution, advantages and risks of early extubation, and anesthetic techniques that prompt early extubation in liver transplant patients. Early extubation has proved to be feasible and safe in these patients, but the outcomes are still uncertain. CONCLUSIONS: Early extubation after liver transplantation is feasible, safe and cost-effective in the majority of patients and has been increasingly accepted as an option for conventional postoperative ventilation. Comprehensive and individualized evaluation of the patient’s condition before extubation by an experienced anesthesiologist is the cornerstone of success Understanding of its effect on the outcome remains incomplete In the future, additional trials are required to establish universal early extubation guidelines and to determine its benefits for patients and practitioners.
文摘Background: Tracheal extubation is related to many side effects of hemodynamic, especially for patients with comorbid states. The study compared the validity of dexmedetomidine 1 μg/kg and low combination dose of dexmedetomidine 0.5 μg/kg plus Lidocaine 1 mg/kg in softening hemodynamic stress response and estimated quality of extubation in study groups. Materials and Methods: The patients in our study, one hundred and fifty of both gender, ASA class I &II patients, aged 20 - 50 years old subject to elective abdominal operations under general anesthesia were allocated into three equal groups. Anesthetic technique was standardized. Before extubation by 10 minutes, the patients in Group N, D, and DL have given 0.9% normal Saline intravenous bolus infusion, dexmedetomidine 1 μg/kg and Dexmedetomidine 0.5 μg/kg, respectively within a 10-minute period. Before complete extubation by 90 seconds, in the three groups by syringe ten cc volumes and at time of extubation, Group N and D patients received 0.9% normal Saline intravenous bolus infusion, but in Group DL received Lidocaine 1 mg/kg then extubation completed. Heart rate (HR), Diastolic BP (DBP), Systolic BP (SBP), and Mean Arterial Pressure (MAP) were noted at baseline, at the reverse, extubation, 2, 4, 6, 8, 10 min and at the regular times after that for two hours. Extubation quality was assessed by extubation quality scale. Aldrete’s recovery score and Ramsay sedation score were also recorded and also any complications were noted and recorded. Results: All the hemodynamic parameters significantly elevated extubation and numerous periods of observation in the normal saline group than dexmedetomidine and dexmedetomidine plus Lidocaine group (p-value = 0.001). Response of tachycardia was seen in 41 (82%) in patients of N group, compared to 18 (36%) and 20 (40%) in D & DL group respectively (p = 0.001). Hypertensive response statistically significant noticed in 40 (80%) patients of N group, 9 (18%) of D group and 12 (24%) of DL group (p = 0.001). Tachycardia duration and the response of hypertension were significantly prolonged in the control group. As regards extubation quality, the three groups differed in D Groups (1.93 ± 0.57) and DL (1.51 ± 0.57) had decreased scores compared to group N (2.67 ± 0.48) modulating smoother extubation (p Conclusion: Low combined dose of (Dexmedetomidine 0.5 μg/kg plus Lidocaine 1 mg/kg) IV was useful as much as Dexmedetomidine 1 μg/kg IV in softening hemodynamic stress responses during emergence.
基金This study was supported by the Fundamental Research Funds for the Central Universities(No.3332020018)Yunnan Provincial Cardiovascular Disease Clinical Medical Center Project(No.FZX2019-06-01).
文摘Background:Children are at risk of extubation failure after congenital heart disease surgery.Such cases should be identified to avoid possible adverse consequences of failed extubation.This study aimed to identify ultrasound predictors of successful extubation in children who underwent cardiac surgery.Methods:Children aged 3 months to 6 years who underwent cardiac surgery(if they were intubated for>6 h and underwent a spontaneous breathing trial)were included in this study.Results:We included 83 children who underwent surgery for congenital heart disease.Transthoracic echocardiography and lung ultrasound were performed immediately before spontaneous breathing trials.Upon spontaneous breathing trial completion,respiratory parameters,including arterial blood gas analysis and frequency-to-tidal volume ratio,were similarly recorded.For outcome assessment,all children were followed up for 48 h after extubation.We successfully extubated 57 children(68.7%).These children were significantly older and weighed more but had shorter aortic cross-clamp and cardiopulmonary bypass times.Children who could not be weaned or extubated had prolonged total mechanical ventilation and pediatric intensive care unit stay.In the multivariate regression analysis,a lung ultrasound score≥12 and ejection fraction≥40%immediately before spontaneous breathing trials were the only independent predictors of successful extubation.When combined,the lung ultrasound score and an ejection fraction≥40%showed a better diagnostic performance than every other isolated variable(lung ultrasound,N-terminal-pro-B-type natriuretic peptide,and frequency-to-tidal volume ratio).Conclusions:The combination of lung ultrasound and transthoracic echocardiography immediately before the spontaneous breathing trial effectively predicts extubation outcomes in children after cardiac surgery.
文摘Introduction: Fast track (FT) cardiac surgery and early extubation (EE) are aimed at safe and effective rapid post-operative progression to discharge, and have been practiced for more than two decades. Their goal is to optimize patient care perioperatively in order to decrease costs without negatively affecting morbidity and mortality. However, the factors that predict successful EE are poorly understood, and patients with significant co-morbidities are frequently excluded from protocols. We hypothesize that independent of disease severity, early extubation leads to shorter hospital stays and can be performed safely without negatively affecting outcomes. Materials and Methods: We performed a retrospective review of 919 patients who underwent coronary artery bypass grafting (CABG) at the Southern Arizona Veteran’s Affairs Health Care System medical center over 7 years. We collected pre-operative data regarding patients’ NYHA classification, presence and severity of cerebral vascular disease, peripheral vascular disease, pulmonary disease, diabetes and hypertension. Intra-operative variables were also recorded including ASA scores, ischemic times, and time to extubation. Finally, post-operative variables such as rates of reintubation and tracheotomy, and both length of ICU and total hospital stay were also compared. Results: Prolonged periods of ischemia were found to predict a delayed extubation (HR = 0.992;CI = 0.988 - 0.997, p = 0.0015) while small body surface area (HR = 1.57;CI = 1.13, 2.17, p = 0.007) and higher pre-operative functional status of the patient, such as independent versus dependent status (HR =1.68;CI = 1.30 - 2.16, p = 1.33;CI = 1.03 - 1.70, p = 0.03) were found to be associated with earlier extubation. The early extubation (EE) group (those extubated in less than the median 7.3 hours) had an average hospital stay of 5.1 ± 4.0 days, versus 7.8 ± 8.1 days in the delayed group (>4 hours), p Conclusions: In our study population, pre-operative functional class and total body surface area predicted those patients able to tolerate early extubation after cardiac surgery. Prolonged ischemia resulted in delayed extubation. Patients that were extubated in less than 4 hours had shorter ICU and hospitalization stays, while there was no significant difference between the two groups in rate of reintubation or tracheotomy.
文摘BACKGROUND Protocols for nurse-led extubation are as safe as a physician-guided weaning in general intensive care unit(ICU).Early extubation is a cornerstone of fast-track cardiac surgery,and it has been mainly implemented in post-anaesthesia care units.Introducing a nurse-led extubation protocol may lead to reduced extubation time.AIM To investigate results of the implementation of a nurse-led protocol for early extubation after elective cardiac surgery,aiming at higher extubation rates by the third postoperative hour.METHODS A single centre prospective study in an 18-bed,consultant-led Cardiothoracic ICU,with a 1:1 nurse-to-patient ratio.During a 3-wk period,the protocol was implemented with:(1)Structured teaching sessions at nurse handover and at bed-space(all staff received teaching,over 90%were exposed at least twice;(2)Email;and(3)Laminated sheets at bed-space.We compared“standard practice”and“intervention”periods before and after the protocol implementation,measuring extubation rates at several time-points from the third until the 24th postoperative hour.RESULTS Of 122 cardiac surgery patients admitted to ICU,13 were excluded as early weaning was considered unsafe.Therefore,109 patients were included,54 in the standard and 55 in the intervention period.Types of surgical interventions and baseline left ventricular function were similar between groups.From the third to the 12th post-operative hour,the intervention group displayed a higher proportion of patients extubated compared to the standard group.However,results were significant only at the sixth hour(58%vs 37%,P=0.04),and not different at the third hour(13%vs 6%,P=0.33).From the 12th post-operative hour time-point onward,extubation rates became almost identical between groups(83%in standard vs 83%in intervention period).CONCLUSION The implementation of a nurse-led protocol for early extubation after cardiac surgery in ICU may gradually lead to higher rates of early extubation.
文摘Background: Negative Pressure Pulmonary Edema (NPPE) is an uncommon, but well recognized clinical entity that continues to be reported as a complication of upper airway obstructions during induction or emergence. It results from the negative intrathoracic pressure generated with spontaneous ventilation with concurrent upper airway obstruction. Aim: To present an unusual case of NPPE and review the pathophysiology and treatment. Case: It usually occurs in young healthy athletic adults. We are reporting NPPE in a nine-month-old ex-premature baby. We discuss his intraoperative events leading to NPPE, subsequent intraoperative course and treatment. Conclusion: NPPE needs to be promptly recognized and treated. If the edema resolves, the patient can be successfully extubated, but should be observed overnight.
文摘Objective:This study aimed to evaluate the effectiveness of Buerger-Allen exercise(BAE)in reducing muscle cramps among recently extubated patients in the intensive care unit(ICU).Materials and Methods:A quantitative,quasi-experimental design was employed,involving 92 recently extubated ICU patients randomly assigned to either an experimental or control group.The experimental group underwent BAE,a three-step intervention targeting lower extremity circulation and muscle cramp reduction.The exercises included the elevation of lower extremities,foot and leg exercises,and a rest and recovery phase,administered twice daily for 10 days.The control group received standard nursing care without any specific exercise regimen.Muscle cramp severity was assessed using the modified Penn Spasm Frequency Scale before and after the intervention.Results:The experimental group showed a significant reduction in muscle cramp severity score postintervention,with the mean scores decreasing from 6.83±1.66 to 4.22±1.45(t=10.21,P=0.001).The control group experienced a smaller reduction,with scores decreasing from 6.98±1.57 to 6.43±1.37(t=2.810,P=0.007).Between-group analysis confirmed a significant difference postintervention,with the experimental group improving more(t=8.242,P=0.001).The Mann–Whitney U test also highlighted a significant difference between groups after the intervention(U=494.5,P=0.001),validating the effectiveness of BAE.Conclusion:BAE significantly reduces muscle cramp severity in recently extubated ICU patients,suggesting that this nonpharmacological intervention can effectively improve patient outcomes and aid in postextubation recovery.
文摘Objective:To investigate the application effect of quality control circle activities in reducing the rate of unplanned extubation of venous access in perioperative patients.Methods:The quality control circle method was used to analyze the causes,identify the actual causes of unplanned out-of-control,take corresponding measures,formulate corresponding countermeasures,implement standardized management,and carry out continuous improvement.Results:Following the implementation of quality control circle activities,the rate of unplanned extubation of venous access in perioperative patients decreased from 27.35%before improvement to 3.42%after improvement.Conclusion:The use of quality control circle activities in the safety management of venous access in perioperative patients is conducive to reducing the rate of unplanned extubation of venous access in perioperative patients.
文摘Background The extubation time is critical during the intensive care unit stay in aneurysmal subarachnoid hemorrhage(aSAH)patients.The current conventional parameters for predicting extubation failure(EF)and extubation time may not be suitable for this population.Here,we aimed to identify factors associated with EF in aSAH patients.Methods From a single-center observational study on aSAH patients with computed tomography angiography from 2019 to 2021,patients who received microsurgery were enrolled and divided into two groups according to whether EF occurred.Multivariable logistic regression was conducted to evaluate disease severity,medical history,and extubation time differences between patients with and without EF.Results Of 335 patients included,EF occurred with a rate of 0.14.Delayed cerebral ischemia(67.4%vs.13.5%)and acute hydrocephalus(6.5%vs.1.4%)were frequently observed in patients with EF.Also,patients who develop EF presented higher disability(65.9%vs.17.4%)and mortality(10.9%vs.0.7%)rates.Multivariable analysis demonstrated that age(OR 1.038;95%CI 1.004-1.073;P=0.028),onset to admission time(OR 0.731;95%CI 0.566-0.943;p=0.016),WFNS grade>3(OR 4.309;95%CI 1.639-11.330;p=0.003),and extubation time<24 h(OR 0.097;95%CI 0.024-0.396;p=0.001)were significantly associated with EF occurrence.Conclusions These data provide further evidence that older aSAH patients with onset to admission time<2 days and WFNS grade>3 have a high risk of developing EF,which is amplified by the ultra-early extubation.Moreover,in patients with two or more risk factors,a prolonged intubation recommendation requires consideration to avoid the EF.
文摘目的:系统分析机械通气患者拔管失败的影响因素,为降低机械通气患者拔管失败率提供询证参考依据。方法:计算机检索中国知网、万方、VIP、CBM、Web of science、Pubmed、Cochrane Library、Embase中有关机械通气患者拔管失败影响因素的观察性研究,检索时限为建库至2024年2月。由2名研究者按照标准单独进行文献筛选、质量评价和资料提取。采用Stata 15.0统计软件进行Meta分析。结果:纳入48篇研究,总样本量为22391例,提取32个因素。Meta分析结果显示,机械通气时间、年龄、急性生理与慢性健康评分(APACHEⅡ评分)、糖尿病、多器官功能障碍综合征(MODS)、患有呼吸系统疾病、血清白蛋白(ALB)、浅快呼吸指数(RSBI)、二氧化碳分压(PaCO_(2))、拔管时呼吸频率、吸烟、肺部超声B线评分(LUBS)、血红蛋白(HB)、膈肌功能障碍、格拉斯哥昏迷评分法(GCS)、拔管时白细胞(WBC)、心率、B型钠尿肽(BNP)、尿素氮、慢性阻塞性肺疾病(COPD)、肾病、C反应蛋白(CRP)、心力衰竭,是机械通气患者拔管失败的影响因素(P<0.05)。结论:机械通气患者拔管失败的影响因素众多,医护人员应该制定科学详细的拔管计划,严密监测相关因素,降低患者的拔管风险。
