ObjectiveTo observe repairing process of trachea epithelium cells in chlorine-induced airway epithelial injury.MethodsTwelve mice were exposed to chlorine gas and prepared the mice model of airway damage. Three mice were executed respectively on 2nd, 4th, 7th, 10th day after exposure to chlorine gas, and tracheal tissues were collected. In addition 3 normal mice served as control. Airway repair and cell proliferation were detected by EdU labeling method. The basal cell markers keratin 5 (K5), keratin 14 (K14) were adopted as the tracheal epithelial markers for locating the position of the proliferation of repairing cells. Morphological analysis was adopted to measure the proliferation rate as well as the recovery of the false stratified epithelium.ResultsIn the control group, cell proliferation rate was very low, all basal cells expressed K5, and most basal cells did not express K14. Most of epithelial cells shed from the trachea epithelium after exposure to chlorine gas. 2-4 days after chlorine exposure, K5 and K14 expression basal cells increased, K14 expression cells increased greatly. In the peak period of cell proliferation, only a small number of ciliated cells appeared in the repairing trachea area. Epithelial cells repaired fast and widely at the bottom of the trachea.ConclusionThe trachea residual basal cells play roles of progenitor cells and repair the airway epithelium after chlorine damage in mice.
Objective To systematically review the effectiveness and model building process of heparin treatment for animal model with smoke inhalation injury. Methods Databases including PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect animal experiments about the treatment of heparin for animal model with smoke inhalation injury from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. Results A total of nine studies involving 11 animal experiments were included. The results showed that building animal model with smoke inhalation injury were through burning of cotton towels or pine sawdust by sheep or rats below 40℃. The results of meta-analysis showed that there was no significant difference in mortality rate between two groups (heparin group vs. control group: RR=0.38, 95%CI 0.14 to 1.05, P=0.06; heparin plus DMSO group vs. DMSO group: RR=0.10, 95%CI 0.01 to 1.51, P=0.10). In addition, the pulmonary artery pressure (MD=–3.31, 95%CI –4.51 to –2.11, P<0.000 01), wet to dry weight ratio (MD=–0.90, 95%CI –1.19 to –0.61, P<0.000 01), and lung water content (MD=–1.18, 95%CI –1.67 to –0.70, P<0.000 01) of the experimental group were lower than those in the control group. PaO2/FiO2 after 12 hours (MD=131.00, 95%CI 59.54 to 202.46, P=0.000 3), PaO2/FiO2 after 24 hours (MD=114.00, 95%CI 60.56 to 167.44, P<0.000 1), PaO2/FiO2 after 48 hours (MD=46.00, 95%CI 20.62 to 71.38, P=0.000 4) were higher than those in the control group. However, there was no significant difference in coagulation function between both groups. Conclusion The current evidence shows that the establishment of animal model of smoke inhalation injury is still lack of standard method. Heparin can decrease pulmonary artery pressure and lung water content in animal models with smoke inhalation injury. Due to the limited quality and quantity of included studies, the above conclusions are still needed to be verified by more high quality studies.
ObjectiveTo retrospectively compare the clinical effects of high frequency oscillatory ventilation (HFOV) and conventional ventilation (CV) on patients with acute respiratory distress syndrome (ARDS) induced by smoke inhalation injury. MethodsForty-three patients with smoke inhalation induced ARDS were admitted in the Center Hospital of Hu Ludao between October 2004 and June 2015.Among the patients, 19 cases were treated with CV (CV group) and 24 cases were treated with HFOV (HFOV group).The clinical data were collected and compared between two groups including blood gas at certain time points (6 h, 24 h, 48 h, 96 h, and 7 d) as well as complications and prognosis. ResultsThere was no significant difference in arterial blood gas between two groups before treatment (P > 0.05).After ventilation treatment, there were significant differences in arterial blood gas parameters between two groups except arterial carbon dioxide partial pressure at 48 and 96 h.And the patients in the HFOV group improved more obviously.The hospitalization time and ventilation time in the HFOV group were significantly shorter than those in the CV group (P < 0.05).No significant difference was found between two groups in the incidences of mortality, complications or 30-day survival rate (P > 0.05). ConclusionsBoth high frequency oscillatory ventilation and conventional ventilation can improve the clinical status in patients with smoke inhalation induced ARDS.These two ventilation modes do not present any difference with respect to prognosis by present evidence.
Objective To compare the application effects of two kinds of oxygen and nebulizer inhalation devices applied to patients undergoing partial hepatectomy, with a view to providing reference for clinical selection oxygen and nebulizer inhalation modality. Methods A prospective case-control study was used to select 228 patients who required oxygen inhalation and nebulization after hepatectomy under general anesthesia in the Department of Liver Surgery of West China Hospital of Sichuan University from January to December 2022 as study subjects, and were randomly divided into two groups: grouping group (n=77) and integrating group (n=151). The traditional oxygen inhalation device and atomization device (grouping oxygen inhalation atomization device) commonly used in clinic were used in the grouping group, and the humidifying bottle and humidifying water were replaced every 24 hours. The integrating group adopts a new device (integrated oxygen atomization inhalation device) which integrates oxygen inhalation and atomization functions. The integrating group was divided into integrating group 1 (n=77) and integrating group 2 (n=74) according to the different time of changing the humidifying bottle and humidifying water. The time for replacing the humidifying bottle and humidifying water in the integrating 1 was the same as that in the grouping group. The time for replacing the humidifying bottle and humidifying water in the integrating group 2 was 48 h after used, and replace again it after 72 hours of used. Samples from different parts of the grouping group and the integrating group 1 were collected at 24 h, 48 h, 72 h, 96 h and 120 h after oxygen inhalation, respectively, for colony culture. In the integrating group 2, samples were taken for colony culture when the device was changed twice (48 h and 120 h). At the same time, the nurses’ fogging operation time and the fogging noise of the two groups were measured. The self-made patients’ satisfaction questionnaire and nurses’ questionnaire were used to investigate the satisfaction of two groups of patients and 30 medical staff respectively. Results There were no statistically significant difference in the number of bacterial colonies between the grouping group and the integrating group 1 at different time periods and between the two groups at the same time (P＞0.05). In terms of atomization performance, atomization noise in the integrating group was lower than that of the grouping group (P＜0.05), and the atomization preparation and disposal time in the integrating group were shorter than that of the grouping group (P＜0.05). The patients and nurses were more satisfied with the integrating group (P＜0.05). Conclusions There is no difference in pollution risk between the integrated oxygen atomization bottle and the grouped oxygen atomization bottle. The atomization performance and humidification performance of the integrated oxygen atomization bottle are better than that of the grouped oxygen atomization bottle. The noise generated during operation is small, the comfort of patients is high, and the operation time of nurses can be shortened and the work efficiency can be improved, which has high clinical application value.
摘要:目的:定量测定50 %小儿在喉罩表面涂抹丁卡因胶浆的情况下平稳拔除喉罩时呼气末七氟烷浓度。方法:25例择期行四肢及体表手术的患儿,高流量吸入七氟烷诱导并以七氟烷和氧化亚氮维持麻醉,不使用肌肉松弛剂及静脉麻醉药物,手术结束后停止吸入氧化亚氮,并维持设定的七氟烷浓度10min后拔除喉罩。根据Dixon序贯法确定喉罩拔除时的七氟烷浓度,每0.1 Vol%七氟烷为1个增减单位。患儿未出现咳嗽、牙关紧闭、体动、屏气及喉痉挛则认为拔除喉罩平稳。结果:50 %小儿平稳拔除喉罩时呼气末七氟烷浓度(EC50)为1.22 Vol%(95 %的置信区间分别为0.99 Vol%～1.49 Vol%)。结论:在喉罩表面涂抹丁卡因胶浆的情况下,3～8岁患儿喉罩满意拔除时呼气末七氟烷EC50值为1.22 Vol%。Abstract: Objective: To determine the concentration of sevoflurane where 50%( EC50 ) of the attempts to remove the laryngeal mask airway (LMA ) with the Teracainum Gel would be successful in children. Methods: Twentyfive nonpremedicated children, aged 38 years old, ASA physical status I, scheduled for extremities or peripherical surgery were enrolled in this study. General anesthesia was induced with sevoflurane and maintained with sevoflurane and nitrous oxide in oxygen. After the surgery, the target concentration was maintained for at least 10 min, and then the LMA was removed. Each target concentration was predetermined by the Dixon’s upanddown method (with 0.1 Vol% as a step size), starting at 1.20 Vol% concentration of sevoflurane. A removal accomplished without coughing, teeth clenching, gross purposeful movement, breath holding or laryngospasm, during or within 1 min after removal was considered to be successful. Results:The concentration of sevoflurane to achieve successful LMA removal in 50% of children was 1.22 Vol% (95%CL, 0.99 Vol%1.49 Vol%). Conclusion: The EC50 value of sevoflurane for LMA smooth extubation in children aged 38 years old with teracainum gel was 1.22 Vol%.
Objective To compare three approaches of lipopolysaccharides ( LPS) administration for inducing acute lung injury ( ALI) in mice. Methods LPS ( 5 mg/kg) was intratracheally aerosol administered ( ITA group) , intratracheally instilled ( ITI group) , or intraperitoneally injected ( IPI group) to induce ALI in BLAB/ c mice. Evans Blue instead of LPS was intratracheally administered to observe the liquid distribution in the lungs. Two hours after LPS administration, the mice were sacrificed and the lungs were removed to determine wet-to-dry lung weight ratio ( W/D) , and the histological changes were evaluated by HE staining. Phosphorylation level of IκB-αand NF-κB p65 in lung tissue were investigated by Western blot. Transcription intensity of TNF-α and IL-1β mRNA in lung tissue were detected by real-time quantitative PCR. Results Evans Blue distributed more uniformly in the ITA group than the ITI group. The lung W/D ratio and histological changes score in three LPS administration groups were all significantly higher than the normal control group ( P lt;0. 01) , with the ITA group being the highest. The phosphorylation levels of IκB-αand NF-κB p65 were significantly higher in the ITA group than the ITI group ( P lt;0. 05) , and were significantly higher in the ITI group than the IPI group ( P lt; 0. 05) . Transcription intensity of TNF-αand IL-1βmRNA was significantly higher in the ITA group than the ITI group ( P lt;0. 05) , and were significantly higher in the ITI group than the IPI group ( P lt;0. 05) . Conclusion Being non-invasive and convenient,intratracheal LPS aerosol inhalation is an optimal method to induce ALI in mice because it induces more extensive and uniformly distributed injuries in lung.
High-flow nasal cannula (HFNC) oxygen therapy, which is important in noninvasive respiratory support, is increasingly being used in critically ill neonates with respiratory failure because it is comfortable, easy to set up, and has a low incidence of nasal trauma. The advantages, indications, and risks of HFNC have been the focus of research in recent years, resulting in the development of the application. Based on current evidence, we developed guidelines for HFNC in neonates using the grading of recommendations assessment, development and evaluation (GRADE). The guideline was formulated after extensive consultations with neonatologists, respiratory therapists, nurse specialists, and evidence-based medicine experts. We have proposed 24 recommendations for 9 key questions. This guideline aims to be a source of evidence and references of HFNC oxygen therapy in clinical practice, and so that more neonates and their families will benefit from HFNC.
Objective To observe the systemic inhalation anesthetic effects of preterm children with different gestational ages under ocular fundus examination, and to assess its safety. Methods Fifty-one preterm children with retinopathy of prematurity (ROP) were included in the study. These kids were divided into 2 groups, group Ⅰ included 24 kids with a corrected gestational age of 33 to ＜44 weeks, and group Ⅱ included 27 kids with a corrected gestational age of 44 to 64 weeks. The preterm months were same (t=-1.3.P＞0.05), but the body weights were different (t=-10.5.P＜0.05) between these two groups. Anesthesia was induced by inhalation of 6% sevoflurane, and the period from the beginning of inhalation to disappearance of body movement was the induction time. 6% sevoflurane was inhaled continuously for another period of the induction time, and then the concentration of sevoflurane was adjusted to a maintenance concentration. The initial maintenance concentration was 3%, and was adjusted by 0.5% each time. Sequential method was used to determine the subsequent maintenance concentration. If the preceding patient had not moved during the maintenance period, the sevoflurane concentration was decreased by 0.5% for the next patient. If the preceding patient had moved during the maintenance period, the sevoflurane concentration was increased by 0.5% for the next patient. Respiratory depression and cough during the induction and maintenance period, duration of anesthesia and recovery time were recorded. Choking and vomiting during drinking or milk-feeding in one hour after the ocular fundus examination were also recorded. Results The effective inhale concentration in 50% patient of sevoflurane was 2.5% in group Ⅰ, 2.9% in group Ⅱ. The average maintenance concentration was (2.5plusmn;0.5)% in group Ⅰ, (3.0plusmn;0.5)% in group Ⅱ. The difference was statistically significant (t=-3.3.P＜0.05). The average duration of anesthesia and the average awake time were the same (t=0.04 and -1.0 respectively.P＞0.05) between these two groups. The average induction time was significantly shorter in group Ⅰ than in group Ⅱ, the difference was statistically significant (t=-4.9.P＜0.05). All patients were successfully completed the ocular examination. No respiratory depression or cough occurred during and after the examination. No choking and vomiting during drinking or milkfeeding in one hour after the ocular fundus examination. Conclusion Anesthesia with inhaled sevoflurane by a face mask is safe for preterm outpatients undergoing fundus examination.
ObjectiveTo systematically review the clinical effects of non-humidified versus humidified low-to-moderate flow oxygen inhalation therapy via nasal cannula. MethodsRandomized controlled trials (RCTs), clinical controlled trials (CCTs) and cross-over studies about the clinical effects of non-humidified versus humidified low-to-moderate flow nasal cannula oxygen inhalation therapy in hospitalized adult patients were searched in The Cochrane Library (Issue 3, 2016), The Joanna Briggs Institute Evidence Based Practice (EBP) Database, EMbase, PubMed, Web of Science, CBM, CNKI, VIP and WanFang Data from inception to March 2016. Three reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of nine RCTs and three CCTs involving 3 756 patients were finally included. The results of meta-analysis indicated that: non-humidified was superior to humidified oxygen therapy in reducing bacterial contamination of oxygen apparatus (P < 0.05) and the time of daily replacement of sterile water oxygen humidifier bottles (P < 0.05), while the two groups were alike in relieving nasal dryness (RR=1.08, 95%CI 0.91 to 1.29, P=0.37), nasal bleeding (RR=1.17, 95%CI 0.66 to 2.08, P=0.59) and discomfort (RR=0.80, 95%CI 0.56 to 1.14, P=0.22). ConclusionCurrent evidence indicates that there is no significant difference between non-humidified and humidified low-to-moderate flow nasal cannula oxygen inhalation therapy in relieving patients' nasal dryness, nasal bleeding and discomfort. But non-humidified oxygen therapy can reduce bacterial contamination of oxygen apparatus, simplify the operation procedures and lessen nurses' operation time.
Objective To compare the clinical efficacy of intravenous polymyxin B alone and intravenous drip combined with nebulized inhaled polymyxin B in treatment of patients with carbapenem-resistant organism (CRO) pneumonia. Methods The clinical data of 85 patients with CRO pneumonia admitted to the Intensive Care Unit of Nanjing Drum Tower Hospital from September 2020 to June 2023 were collected using a retrospective study. According to the different ways of administration of polymyxin B, the patients receiving polymyxin B intravenous drip therapy alone were included in group A, and the patients receiving polymyxin B intravenous drip therapy combined with nebulized inhalation therapy were included in group B. The therapeutic effective rate, bacterial clearance rate, 30-day all-cause mortality and the level of infection indexes before and after the use of medication were compared between the two groups. The occurrence of acute kidney injury during the use of drugs in the two groups was observed and recorded. Results The pathogenicity culture results showed that there was no statistically significant difference between the two groups (P=0.144). Serum procalcitonin and C-reactive protein were significantly lower in the two groups after drug administration compared with those before drug administration (both P<0.05). The therapeutic efficiency and bacterial clearance rate in group B were higher than those in group A (both P<0.05). There was no statistically significant difference in 30-day all-cause mortality between the two groups (P=0.664). And there was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.650). Conclusion When polymyxin B is used to treat patients with CRO pneumonia, the intravenous drip combined with nebulized inhalation regimen is superior to intravenous drip therapy alone and does not increase the risk of developing nephrotoxicity.