Objective To compare the humidification effect of the MR410 humidification system and MR850 humidification system in the process of mechanical ventilation. Methods Sixty-nine patients underwent mechanical ventilation were recruited and randomly assigned to a MR850 group and a MR410 group. The temperature and relative humidity at sites where tracheal intubation or incision, the absolute humidity, the sticky degree of sputum in initial three days after admission were measured. Meanwhile the number of ventilator alarms related to sputum clogging and pipeline water, incidence of ventilator associated pneumonia, duration of mechanical ventilation, and mortality were recorded. Results In the MR850 group,the temperature of inhaled gas was ( 36. 97 ±1. 57) ℃, relative humidity was ( 98. 35 ±1. 32) % , absolute humidity was ( 43. 66 ±1. 15) mg H2O/L, which were more closer to the optimal inhaled gas for human body.The MR850 humidification system was superior to the MR410 humidification system with thinner airway secretions, less pipeline water, fewer ventilator alarms, and shorter duration of mechanical ventilation. There was no significant difference in mortality between two groups. Conclusions Compared with MR410 humidification system, MR850 humidification system is more able to provide better artificial airway humidification and better clinical effect.
Objective To investigate the effect of a real-time compliance dashboard to help reduce ventilator-associated pneumonia ( VAP) with ventilator bundle. Methods 240 patients who were admitted into the intensive care unit ( ICU) of Shougang Hospital of Peking University and had received mechanical ventilation ( MV) for over 48 hours, between January 2010 and November 2011, were studied prospectively. The patients were divided into two groups by random number table, ie. a dashboard group ( n = 120) with implementation of a real-time compliance dashboard to help reduce VAP with ventilator bundle, and a control group ( n=120) with implementation of usually routine order to help reduce VAP with ventilator bundle. The success rate of ventilator bundle implementation, incidence of VAP, duration of MV, duration within ICU, mortality within 28 days, cost within ICU were compared between two groups. Results Compared with the control group, the success rate of ventilator bundle implementation obviously increased ( 81.6% vs. 52.5%) , incidence of VAP ( 14. 5/1000 days of MV vs. 36.2 /1000 days of MV) , duration of MV [ 5( 4,7) days vs. 8( 6,11) days] , duration within ICU [ 8( 6,12) days vs. 13( 8,16) days] , mortality of 28 days ( 12.6% vs. 28.6% ) , and cost within ICU ( 36,437 vs. 58,942) in the dashboard group obviously reduced ( Plt;0.05) . Conclusions Implementation of a real time compliance dashboard to help reduce VAP with ventilator bundle can obviously improve medical personnel compliance and reduce incidence of VAP, duration of MV, duration within ICU, mortality and cost in ICU than those of routine medical order to help reduce VAP with ventilator bundle.
Objective To evaluate the influence of early mobilization on delirium and respiratory dynamics in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The study prospectively recruited 107 AECOPD patients who admitted between January 2014 and June 2015 and underwent mechanical ventilation.On basis of same routine treatment,the patients were randomly divided into a treatment group (54 cases)receiving regime of early mobilization,and a control group (53 cases)receiving routine sedation and analgesia treatment.The incidence of delirium,duration of delirium,time of mechanical ventilation,and ICU mortality were compared between two groups.The respiratory mechanical parameters including endogenous positive end expiratory pressure (PEEPi),airway resistance(Raw),static compliance(Cs),and dynamic compliance(Cd)before treatment,3 days and 5 days after treatment were also compared between two groups. Results Compared with the control group,the incidence of delirium decreased (59.3% vs. 77.4%),the duration of delirium [(1.8±1.1)d vs. (2.6±1.3)d] and mechanical ventilation[(6.2±3.4)d vs. (7.9±4.2)d] reduced in the treatment group with significant difference(P<0.05).There was no significant difference in respiratory mechanical parameters before treatment between two groups(P>0.05).While at 3 days and 5 days after treatment,PEEPi decreased [(6.23±2.83)cm H2O vs. (7.42±2.62)cm H2O,(4.46±2.20)cm H2O vs. (5.92±2.51)cm H2O],Raw decreased [(20.35±7.15)cmH2O·L-1·s-1 vs. (23.23±6.64)cm H2O·L-1·s-1,(16.00±5.41)cm H2O·L-1·s-1 vs. (19.02±6.37)cm H2O·L-1·s-1],Cd increased [(25.20±9.37)mL/cm H2O vs (21.75±7.38)mL/cm H2O,(27.46±5.45)mL/cm H2O vs. (24.40±6.68)mL/cm H2O] in the treatment group compared with the control group(P<0.05),and the difference in Cs was not significant(P>0.05).No complications such as slippage,physical injury,or malignant arrhythmia occurred in two groups.The mortality slightly decreased in the treatment group compared with the control group (5.6% vs 11.3%),but the difference was not statistically significant(P>0.05). Conclusions The incidence of delirium is high in mechanically ventilated patients with AECOPD.Early mobilization can reduce the incidence and duration of delirium,decrease the airway resistance,increase the dynamic lung compliance,relieve dynamic pulmonary hyperinflation and reduce PEEPi,so as to improve the respiratory function and shorten the time of mechanical ventilation.Therefore,early mobilization is an effective and safe regime for AECOPD patients underwent mechanical ventilation.
Objective To estimate the feasibility and efficacy of respiratory function score ( RFS)guided ventilator weaning in mechanical ventilated patients with respiratory failure. Methods By a prospective control study,136 patients with acute respiratory failure who had received endotracheal intubation and mechanical ventilation from January 2010 to May 2012 were randomly divided into three group, ie. a RFS-guided 3-4 group ( n=60) , a RFS-guided 5-6 group ( n = 51) , and a traditional group ( n =25) . TheRFS-guided groups underwent ventilator weaning by guidance of RFS 3-4 and 5-6 respectively. The traditional group underwent ventilator weaning by ordinary way. The ventilation and oxygenation index, RFS,direct weaning success rate, total weaning success rate, total mechanical ventilation time, re-intubation rate,and ventilator-associated pneumonia ( VAP) incidence rate were observed.Results The direct weaning success rate in the RFS-guided 3-4 group, the RFS-guided 5-6 group, and the traditional group was 98. 3%( 59/60) , 82. 4% ( 42 /51) , and 100% ( 25 /25) , respectively. The total duration of mechanical ventilation was ( 5. 2 ±2. 5) days, ( 5. 0 ±3. 0) days, and( 7. 5 ±3. 5) days, respectively. the re-intubation rate was 0( 0 /60) , 1. 9% ( 1 /51) , and 0 ( 0/25) , respectively. VAP incidence rate was 11. 7% ( 7/60) , 13. 7%( 7 /51) and 24% ( 6 /25) , respectively. Compared with the traditional group, the direct weaning success rate and total weaning success rate in the RFS-guided 3-4 group were not significant different( P gt;0. 05) , while the total mechanical ventilation time and VAP incidence rate were significantly lower ( P lt; 0. 05) . Compared with the traditional group, the direct weaning success rate and total mechanical ventilation time in the RFSguided 5-6 group were significantly lower ( P lt;0. 05) , but the total weaning success rate was not significantly different ( P gt;0. 05) . Compared with the RFS-guided 5-6 group, the directweaning success rate in the RFSguided 3-4 group was significantly increased. Conclusions Mechanical ventilator weaning of patients with respiratory failure under RFS guidance is safe and feasible. RFS 3-4 guided ventilator weaning can significantly improve the therapeutic effect.
ObjectiveTo evaluate the effects of home mechanical ventilation (HMV) for stable chronic obstructive pulmonary disease (COPD) patients with respiratory failure in Tongzhou district of Beijing city. MethodsTwenty stable COPD patients with respiratory failure were included in the study.During the one-year follow-up period,4 patients died and 1 withdrew and 15 patients finished the follow-up.The patients was followed up by telephone each month and guided in drug administration,HMV,and rehabilitation therapy.At the beginning of the study and one year later,the patients were interviewed and accessed on the general data,nutritional status,COPD assessment test (CAT),Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,and arterial blood gas analysis. ResultsAt the end of one-year follow-up,nutrition index,CAT,Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,pH,and PaO2 did not change significantly (P>0.05),while PaCO2 decreased significantly compared with those at the beginning of the study (P<0.05).Compared with the past year,the times of hospitalization due to acute exacerbation of COPD was significantly reduced during the follow-up year (P<0.05). ConclusionHMV can ameliorate carbon dioxide retention and reduce times of hospitalization due to acute exacerbation of COPD for COPD patients with respiratory failure.
Acute respiratory distress syndrome is one of the forms of respiratory failure that seriously threaten human life. It has the characteristics of very high morbidity, mortality and hospitalization costs. How to treat acute respiratory distress syndrome to improve the quality of life of patients is particularly important. Mechanical ventilation is an important treatment for acute respiratory distress syndrome. This article will review the progress in mechanical ventilation therapy for acute respiratory distress syndrome, including non-invasive mechanical ventilation and invasive mechanical ventilation (tidal volume, lung recruitment, positive end-expiratory pressure, prone position ventilation, and high-frequency oscillatory ventilation), aiming to provide basis and reference for future exploration of the treatment direction of acute respiratory distress syndrome.