Objective To analyze the risk factors of treatment failure by noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and explore the best time that NPPV be replaced by invasive ventilation when NPPV failure occurs. Methods The data of patients with ARF due to AECOPD who were treated with NPPV from January 2013 to December 2015 were retrospectively collected. The patients were divided into two groups: the NPPV success group and the NPPV failure group (individuals who required endotracheal intubation or tracheotomy at any time). The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score was analyzed; the Glasgow Coma Scale score, respiratory rate (RR), pH value, partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2) ratio, and partial pressure of carbon dioxide were also analyzed at admission, after 2 hours of NPPV, and after 24 hours of NPPV. Results A total of 185 patients with ARF due to AECOPD were included. NPPV failed in 35.1% of the patients (65/185). Multivariate analysis identified the following factors to be independently associated with NPPV failure: APACHEⅡscore≥30 [odds ratio (OR)=20.603, 95% confidence interval (CI) (5.309, 80.525), P<0.001], RR at admission≥35 per minute [OR=3.723, 95%CI (1.197, 11.037), P=0.020], pH value after 2 hours of NPPV<7.25 [OR=2.517, 95%CI (0.905, 7.028), P=0.070], PaO2 after 2 hours of NPPV<60 mm Hg (1 mm Hg=0.133 kPa) [OR=3.915, 95%CI (1.374, 11.508), P=0.010], and PaO2/FiO2 after 2 hours of NPPV<200 mm Hg [OR=4.024, 95%CI (1.542, 11.004), P=0.010]. Conclusion When patients with ARF due to AECOPD have a higher severity score, have a rapid RR at admission, or fail to improve in terms of pH and oxygenation after 2 hours of NPPV, the risk of NPPV failure is higher.
ObjectiveTo systematically review the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 16 RCTs involving 1 593 patients were included. The results of meta-analysis showed that: there was no significant difference in the success rate of the first insertion (RR=0.99, 95%CI 0.96 to 1.02, P=0.55). The airway pressure of patients whose position were head higher than foot was significantly lower in the laryngeal mask group than in the tracheal intubation group (MD=–1.20, 95%CI –1.81 to –0.59, P=0.000 1), but there was no significant difference between two groups in reverse position patients (MD=0.48, 95%CI –0.90 to 1.87, P=0.49). The incidence of sore throat (RR=0.58, 95%CI 0.46 to 0.74, P<0.000 01), the incidence of blood stain (RR=0.48, 95%CI 0.30 to 0.77, P=0.002), the incidence of laryngeal spasm/bronchial spasm (OR=0.30, 95%CI 0.11 to 0.80, P=0.02) and the incidence of cough/hiccup (RR=0.10, 95%CI 0.07 to 0.15, P<0.000 01) in the laryngeal mask group were significantly lower than those in the tracheal intubation group.ConclusionThe current evidence shows that compared with tracheal intubation, laryngeal mask can effectively reduce airway pressure of patients whose position are head higher than foot. The risks of various complications are significant higher in tracheal intubation in laparoscopic surgery. Laryngeal mask can maintain patients' normal respiratory functions while reduce damage and do not increase the occurrence of reflux aspiration. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo analyze the feasibility and advantages of non-intubated anesthesia in thoracoscopic lobectomy.MethodsThe clinical data of 59 patients with thoracoscopic lobectomy and non-intubated anesthesia in the Department of Thoracic Surgery, Tongji Hospital from January 2015 to December 2017 were retrospectively reviewed, including 24 males and 35 females, aged 56.86±7.13 years (an observation group); 59 patients with thoracoscopic lobectomy undergoing general anesthesia with tracheal intubation in the same period were randomly selected, as a control group, including 27 males and 32 females, aged 55.37±6.86 years. Complications such as airway injury, refractory cough, pharyngalgia, nausea and vomiting were compared between the two groups. Postoperative inflammatory factor levels, postoperative hospital stay, and intraoperative and postoperative hospitalization costs were also compared.ResultsThere was no difference between the two groups in general conditions such as age, gender, body mass index. There was also no difference in operation time, intraoperative bleeding volume or lymph node dissection. But the observation group had lower levels of procalcitonin and C reactive protein at postoperative 1 d (0.12±0.51 ng/ml vs. 0.14±0.70 ng/ml, P=0.03; 11.30±3.60 mg/L vs. 13.33±4.41 mg/L, P=0.01), lower rate of postoperative complications of refractory cough, pharyngalgia, nausea and vomiting (3.38% vs. 15.25%, P=0.03; 5.08% vs. 20.33%, P=0.01; 3.38% vs. 15.25%, P=0.03), less retain time of thoracic duct, postoperative hospital stay, and lower intraoperative and postoperative hospitalization costs (5.89±1.37 d vs. 7.00±1.73 d, P=0.00; 10.01±1.85 d vs. 11.37±2.45 d, P=0.00; 53 810.94±5 745.44 yuan vs. 58 223.16±6 445.08 yuan, P=0.00).ConclusionThoracoscopic lobectomy with non-intubated anesthesia can avoid traditional airway injury caused by endotracheal intubation, reduce postoperative symptoms such as refractory cough, pharyngalgia, nausea and vomiting caused by general anesthesia, reduce or even avoid lung injury caused by one-side lung ventilation, promote recovery after surgery, reduce antibiotic use, and shorten hospital stay, which is more consistent with the requirements of the concept of overall minimal invasiveness and enhanced recovery.
Objective To investigate the current situation of salivation in patients with orotracheal cannula, and to systematically analyze its influencing factors. Methods Patients who underwent tracheal intubation treatment in 47 tertiary comprehensive medical institutions were selected between October 10th and 20th, 2023. A cross-sectional survey method was used to conduct an online survey of the patient’s salivation status. The patients were divided into the salivation group and no-salivation group. Results A total of 565 questionnaires were collected and 561 were valid, with an effective recovery rate of 99%. Among 561 patients, 284 were males (50.62%) and 277 were females (49.38%), with an age of (59.80±10.96) years; 159 cases of salivation occurred, with a total static saliva flow rate of (7.21±3.15) mL and the incidence of salivation was 28.34% (159/561). There were statistically significant differences in age, education level, body mass index, primary disease, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days, intubation depth, intubation process, sedation and/or analgesia days, and enteral nutrition treatment between the two groups (P<0.05). There was no statistically significant difference in other indicators between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that body mass index, neurological diseases, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days and intubation process were independent risk factors for salivation in patients with oral catheterization. Conclusion The incidence of salivation in patients with orotracheal cannula is 28.34%, which is directly related to body mass index, neurological diseases, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days and intubation process.
ObjectiveTo compare the clinical efficacy between right visual double lumen tube (VDLT) intubation and right common double lumen tube (DLT) intubation in lung isolation technique. MethodsA total of 57 patients undergoing thoracoscopic surgery with right DLT lung isolation technique in the First People's Hospital of Chenzhou City and West China Hospital from June 2020 to June 2021 were randomly divided into two groups: a DLT group (n=29, 16 males and 13 females, with a mean age of 54.3±13.2 years) and a VDLT group (n=28, 18 males and 10 females, with a mean age of 55.1±13.7 years) at 1 : 1 with random number table generated by the computer. The clinical data of the two groups were compared. ResultsCompared with the DLT group, the catheter positioning time in the VDLT group was statistically shorter (74.9±47.5 s vs. 151.6±88.9 s, P<0.001), the right upper lung occlusion rate (21.4% vs. 51.7%) and the intraoperative re-adjustment catheterization rate (14.3% vs. 48.3%) were lower (P<0.05). The quality of lung collapses immediately after thoracotomy (67.9% vs. 24.1%) and 20 minutes after thoracotomy (100.0% vs. 75.9%) were improved (P<0.05). There was no significant difference in the rate of fiberoptic bronchoscope assistance for positioning, or the incidence of pharynx pain and hoarseness between the two groups (P>0.05). ConclusionCompared with common DLT, VDLT is more efficient, accurate and intuitive in the location of right bronchial intubation.
目的 研究氯胺酮能否降低咪达唑仑诱导急诊危重患者气管插管对血压的影响。 方法 将2010年6月－2011年12月收治的56例急诊危重呼吸衰竭成年患者，随机分成咪达唑仑+芬太尼（MF）组和咪达唑仑+氯胺酮（MK）组，气管插管前咪达唑仑0.05 mg/kg静脉注入，然后MF组芬太尼2 μg/kg静脉注入，MK组氯胺酮0.5 mg/kg静脉注入，待患者达镇静状态后实施气管插管。记录用药前和插管后10 min的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）的变化，观察低血压的发生情况。 结果 实施药物诱导气管插管后血压下降以MF组更明显（P＜0.01）。低血压发生率MF组为51.7%，MK组为18.5%，两组比较差异有统计学意义（χ2=6.715，P=0.01）。 结论 急诊危重患者气管插管应用氯胺酮可减少咪达唑仑所致低血压的发生率。
ObjectiveTo explore the risk factors for tracheal stenosis caused by tracheotomy or intubation.MethodsFrom July 2010 to July 2020, a total of 44 patients were suffered with tracheal stenosis caused by tracheotomy or intubation at the First Affiliated Hospital of Hunan Normal University as case group (n=44), and 34 patients were suffered tracheotomy or intubation without tracheal stenosis as control group (n=34). The clinical application of intratracheal tube cuff diameter was investigated by univariate comparison, ROC analysis and multivariate logistic regression analysis.ResultsUnivariate analysis showed intratracheal tube cuff diameter (C)/transverse diameter at the level of the clavicle >150%, intubation time>7d, tracheal intubations/tracheostomy ≥2, recurrent respiratory tract infections and replacement of tracheal tube≥ 2 were the influence factors of posttracheostomy tracheal stenosis (PTTS) and postintubation tracheal stenosis (PITS) (P<0.005). Multivariate Logistic regression analysis showed C/T>150% (OR=6.681, 95%CI: 1.164 - 38.363), intubation time>7d (OR=4.723, 95%CI: 1.413 - 15.779), tracheal intubations/tracheostomy ≥2 (OR=4.526, 95%CI: 1.133 - 18.083) and recurrent respiratory tract infections (OR=3.681, 95%CI: 1.177 - 11.513) were positively correlated with PTTS and PITS. The area under the ROC curve (AUC) of C/T>150% was 0.665 with the sensitivity of 0.364 and the specificity of 0.033 (95%CI: 0.555 - 0.775). AUC of intubation time>7 d was 0.717 with the sensitivity of 0.568 and the specificity of 0.133 (95%CI: 0.613 - 0.821). AUC of tracheal intubations/tracheostomy ≥2 was 0.683 with the sensitivity of 0.432 and the specificity of 0.067 (95%CI: 0.574 - 0.791). AUC of recurrent respiratory tract infections was 0.707 with the sensitivity of 0.614 and the specificity of 0.200 (95%CI: 0.603 - 0.811). However, there was no statistically significant difference C/T>150% and those clinical data in Z test (Z=0.839, P=0.402; Z=0.302, P=0.763; Z=0.751, P=0.453).ConclusionIntubation time>7 d, tracheal intubations/tracheostomy ≥2, recurrent respiratory tract infections, replacement of tracheal tube≥ 2 and C/T>150% are risk factors for PTTS and PITS.
Objective To systematically assess the effectiveness and safety of ProSeal laryngeal mask (PLMA) compared to endotracheal tube (TT) for airway management in the patients undergoing laparoscopic biliary tract surgery.Methods Using the Cochrane systematic review methods, we searched the Cochrane Controlled Trial Registers (CCTR) of The Cochrane Library, MEDLINE, VIP, and CNKI databases through May 2008. We also handsearched relevant journals and conference proceedings. Two reviewers independently selected studies and assessed the quality of the trials. Disagreements were resolved by discussion, in consultation with a third reviewer. RevMan 4.2 software provided by the Cochrane Collaboration was used for meta-analysis which was performed for combining the results of homogeneitystudies. Results Seven studies involving 493 patients undergoing laparoscopic biliary tract surgery were included. Meta analysis results showed that: ① Side effects: none of the patients experienced regurgitation or hypoventilation. ② PLMA was superior to TT in terms of less postoperative sore throat (OR=0.27, 95%CI 0.13 to 0.53, P=0.0002) and response during extubation (OR=0.01, 95%CI 0.00 to 0.03, Plt;0.00001). ③ PLMA was similar to TT in terms of effective ventilation during peritoneal insufflation (Ppeak: WMD=0.01, 95%CI -0.66 to 0.68, P=0.98; PetCO2: WMD=0.01, 95%CI -0.58 to 0.59, P=0.99) and ease of insertion (OR=0.58, 95%CI 0.23 to 1.47, P=0.25). ④ Hemodymatics changed during the procedure: PLMA was more stable than TT. Conclusion It is safe to use PLMA for ventilation in laparoscopic biliary tract surgery. However, up to now, we still cannot draw a definite conclusion due to the low quality of the included studies, and more high quality trials of PLMA airway management for laporoscopic surgery are needed.