ObjectiveTo investigate whether inferior vena cava (IVC) ultrasound can improve the success rate of weaning in patients with respiratory failure by comparing the difference of success rate between ultrasound-guided weaning mode and spontaneous breathing test (SBT) weaning mode.MethodsFrom November 2017 to May 2018, 31 respiratory failure patients underwent mechanical ventilation in intensive care unit were randomly divided into an ultrasonic guidance group (16 cases) and a control group (15 cases). All of them were offline after meeting the offline indications. The routine group was assessed by SBT for offline procedures. The diameter and variation rate of inferior vena cava were measured at SBT. IVC diameter >2.0 cm and variation rate < 50% were given intravenous diuretics. After the IVC diameter reached the standard again, the catheter was taken off the machine after passing SBT. The patients of both groups were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing. The following data were recorded at weaning, ie. Acute Physiological and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, arterial blood gas analysis, plasma albumin, serum electrolyte sodium, potassium, 7-day and 14-day weaning success rate.ResultsThere were no significant differences in APACHEⅡ score, plasma albumin level, arterial oxygen partial pressure, carbon dioxide partial pressure, pH, blood sodium level or blood potassium level between the two groups at the beginning of weaning (all P>0.05), and the 2-day weaning success rate was higher in the ultrasound group than that in the control group (95% vs. 73%, P=0.039); the 7-day weaning success rate was higher in the ultrasound group than that in the control group (87% vs. 66%, P=0.043). No significant difference was found in the 14-day weaning success rate (68% in the ultrasound group vs. 53% in the control group, P=0.446).ConclusionUltrasound can improve the success rate of weaning in patients with respiratory failure.
Objective To compare the feasibility and safety of video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation. Methods A total of 80 patients undergoing VATS (48 wedge resections, 8 sympathectomies, 24 pleural biopsies) between January 2015 and June 2017 were included. Those patients were randomized into two groups. The 40 patients were enrolled as a treatment group (19 males and 21 females at age of 23.3±10.2 years) and received surgery under non-intubated intravenous anesthesia with spontaneous ventilation. And the other 40 patients were enrolled as a control group (21 males and 19 females at age of 22.2±9.9 years) and received surgery under routine intravenous anesthesia with intubated ventilation. Results Comparing with the control group, the patients of the treatment group had lower white blood cell count (5.8×109±2.4×109 vs. 7.3×109±3.6×109, P<0.001), lower gastrointestinal adverse reaction rate (7.5%vs. 27.5%, P=0.002), lower sore throat rate (5.0% vs. 30.0%, P<0.001), lower cough grade (0.9±0.3vs 2.1±0.5, P<0.050), shorter drainage time (1.8±1.6 dvs. 3.7±1.8 d, P<0.050) and shorter hospital stay (2.3±1.8 dvs. 5.8±2.3 d, P<0.050). Conclusion Video-assisted thoracoscopic surgery under non-intubated, intravenous anesthesia with spontaneous ventilation is safe and feasible, which also has certain advantages in reducing the postoperative complications and promoting patients' quick recovery from surgery.
Objective To explore the safety and feasibility of spontaneous breathing anesthesia combined with tubeless uniportal thoracoscopy in pulmonary bullae surgery. Methods Totally 112 patients with pulmonary bullae in the Affiliated Hospital of Inner Mongolia Medical University from March 2015 to May 2017 were enrolled. According to the random number chosen by computer, the patients were randomly divided into two groups: a tubeless group (spontaneous breathing anesthesia combined with tubeless uniportalthoracoscopy) and a control group (uniportal thoracoscopy by general anesthesia with tracheal intubation) . There were 49 males and 7 females with an average age of 25.5±6.5 years in the tubeless group, and 50 males and 6 females with an average age of 23.5±4.5 years in the control group. The difference of the lowest intraoperative arterial oxygen saturation (SaO2), SaO2 at postoperative one hour, operation time, postoperative awakening time, hospital stay, hospitalization cost and postoperative pain score were analyzed. Results There was no significant difference between the two groups in the operation time, the lowest SaO2, SaO2 at one hour after the operation and the partial pressure of carbon dioxide (PaCO2). The awakening time and duration of postoperative hospital stay in the tubeless group was shorter than those in the control group (P=0.000). The cost of hospitalization in the tubeless group was less than that in the control group (P=0.000). The discomfort caused by urinary tract and visual analogue score (VAS) in the tubeless group were better than those in the control group. Conclusion It is safe and feasible to use spontaneous breathing anesthesia combined with tubeless uniportal thoracoscopy in pulmonary bullae resection.
One-compartment lumped-parameter models of respiratory mechanics, representing the airflow resistance of the tracheobronchial tree with a linear or nonlinear resistor, are not able to describe the mechanical property of airways in different generations. Therefore, based on the anatomic structure of tracheobronchial tree and the mechanical property of airways in each generation, this study classified the human airways into three segments: the upper airway segment, the collapsible airway segment, and the small airway segment. Finally, a nonlinear, multi-compartment lumped-parameter model of respiratory mechanics with three airway segments was established. With the respiratory muscle effort as driving pressure, the model was used to simulate the tidal breathing of healthy adults. The results were consistent with the physiological data and the previously published results, suggesting that this model could be used for pathophysiological research of respiratory system.
目的探讨单腔气管内插管保留自主呼吸的静脉全身麻醉下小儿胸腔镜手术的可行性及安全性。 方法选取郑州大学第一附属医院胸外科2012年2～12月采用单腔气管内插管保留自主呼吸行静脉全身麻醉下胸腔镜手术治疗的14例患儿作为试验组，男9例、女5例，年龄4～9岁；选取2010年5月至2011年10月采用常规双腔气管内插管全身麻醉下胸腔镜手术治疗的20例小儿患者作为对照组，男13例、女7例，年龄3～10岁。比较两组手术时间、术中失血量、术毕至拔管时间、住院费用、住院时间及术后并发症发生率等指标。 结果两组患儿手术均顺利，无术中术后死亡。试验组和对照组患儿平均手术时间[（85.7±16.9）min vs.（83.5±16.5）]及术中失血量[（90.0±55.0）ml vs.（85.0±50.0）ml]差异无统计学意义（P>0.05）。试验组的术毕至拔管时间[（0.5±0.1）min vs.（8.3±1.4）min]、住院费用[（24.3±4.7）千元vs.（27.8±5.3）千元]、住院时间[（6.6±0.9）d vs.（12.7±3.2）d]、术后并发症发生率（7.1%vs.25.0%）都显著短或少于对照组（P < 0.05）。 结论单腔气管内插管保留自主呼吸静脉全身麻醉下小儿胸腔镜手术治疗小儿胸部疾病具有一定的安全性及可行性。
ObjectiveTo compare the difference of respiratory mechanics parameters between three different spontaneous breathing trials on COPD patients in weaning process. Methods17 patients with COPD underwent mechanical ventilation for at least 48 hours who were stable and ready for weaning were enrolled. All patients underwent three spontaneous breathing trials, ie, automatic tube compensation (ATC,compensation level 100%),low level pressure support ventilation (PSV,7 cm H2O) and T-piece. Each spontaneous breathing trials continued for 10 minutes. Before each autonomous respiration experiment ended,the respiratory mechanics parameters including high airway pressure (PIP),breathing rate (RR),blood oxygen saturation (SaO2),airway occlusion pressure at 0.1 second (P0.1),maximal inspiratory mouth pressure(Pimax) and rapid shallow breathing index (RSBI) were measured. Their differences between three spontaneous breathing trials were compared. Results12 patients successfully completed three different methods of spontaneous breathing test. Compared with the T-piece,P0.1,Pimax,RSBI and RR in the COPD patients using low level PSV and ATC were significantly decreased while VT and SaO2 were increased. The difference of each parameter in the low level PSV group and the ATC group had statistical significance compared with T-piece group (P<0.05). Compared with the low PSV group,P0.1,Pimax,RSBI and RR in ATC group were elevated while PIP,VT and SaO2 were reduced. The differences of P0.1,Pimax,RSBI,PIP and RR between two groups were statistically significant (P<0.05). ConclusionFor COPD patients in weaning process with spontaneous breathing trial,both low levels of PSV and ATC are better than T-piece,and the patients are more comfortable with ATC100% than PSV.
Objective To determine whether B-type natriuretic peptide （BNP） levels combined with Spontaneous breathing trial (SBT) could improve the weaning outcome. Methods Eighty-three patients who were ready to undergo a 90-minute weaning trial （low-pressure support level） were enrolled .Weaning was considered to be successful if the patient passed the trial and sustained spontaneous breathing for more than 48 h after extubation. Plasma BNP was measured just before and at the end of the trial. All patients were divided into a weaning success group and a weaning failure group according to the outcomes of weaning. Categorical variables，expressed as percentages，were analyzed with a chi-square test or a Fisher’s exact test. Continuous variables were expressed as median （25th-75th percentile） and were compared using the Wilcoxon paired test （for related samples） or the Kolgomorov-Smirnov test （for independent samples）. A two-tailed p value of less than 0.05 was taken to indicate statistical significance. Receiver operating characteristic （ROC） curve analysis was performed to assess plasma BNP’s ability to discriminate the subjects who weaned succesfully or failed. Results Overall，13 patients （16.7%） failed the weaning process （6 patients passed the trial but failed extubation）. At the end of SBT，the BNP levels of the weaning failure group were significantly higher than the weaning success group. The BNP levels of the weaning failure group were significantly higher than the weaning success group （Plt;0.001）. The area under cure （AUC） of the ROC curve of BNP to predict the failure of weaning was 0.94±0.03 （Plt;0.001）.At a cut-off level of 123 pg/mL,BNP had a predictive efficiency in weaning outcome as Yourdon’s index of 0.837，sensitivity of 92.3%，and specificity of 91.4%. Conclusion Monitoring the change of BNP during a SBT may improve weaning outcome.
Objective To assess the risk factors associated with extubation failure in patients who had successfully passed a spontaneous breathing trial.Methods Patients receiving invasive mechanical ventilation for over 48 h were enrolled in the study，they were admitted into Emergency ICU of Zhongshan Hospital during May 2006 and Oct.2007.A spontaneous breathing trial was conducted by a pressure support of 7 cm H2O for 30 min.Clinical data were prospectively recorded for the patient receiving full ventilatory support before and after the spontaneous breathing trial.Regarding the extubation outcome，patients were divived into extubation success group and extubation failure group.Results A total of 58 patients with a mean（±SD） age of 69.4±12.7 years passed spontaneous breathing trial and were extubated.Extubation failure occurred in 11 patients（19%）.The univariate analysis indicated the following associations with extubation failure：elderly patients（78.1±7.9 years vs 67.4±15.1years，Plt;0.05），higher rapid shallow breathing index（RSBI） value（83±12 breaths·min-1·L-1 vs 68±19 breaths·min-1·L-1，Plt;0.05）and excessive respiratory tract secretions（54.5％ vs 21.3％，Plt;0.05）.Conclusion Among routinely measured clinical variables，elderly patients，higher RSBI value and amount of respiratory tract secretions were the valuable index for predicting extubation failure despite a successful spontaneous breathing trial.