ObjectiveTo investigate the clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients.MethodsA total of 130 critically ill patients who undergoing mechanical ventilation for more than 48 hours in our hospital were recruited from June 2014 to June 2017. Serum 25(OH)D3 was detected on admission and before spontaneous breathing test (SBT) meanwhile general clinical data and laboratory examination indexes were recorded. The cases were divided into a successful weaning group and a failure weaning group according to the outcome of weaning from mechanical ventilation. Logistic regression equation was used to analyze the relationship between vitamin D level and failure weaning, and a receiver operating characteristic (ROC) curve was used to analyze the predictive value for failure weaning.ResultsThere were 46 patients with failure weaning among 130 patients (35.38%). Compared with the successful weaning group, the failure weaning group had significantly higher Acute Physiology and Chronic Health EvaluationⅡ score, longer duration in intensive care unit, higher respiratory rate, higher rapid shallow breathing index, higher C-reactive protein, higher N-terminal prohormone of brain natriuretic peptide, higher serum creatinine, and significantly lower albumin (all P<0.05). 25(OH)D3 level classifications on admission and before SBT in the failure weaning group were worse than those in the successful weaning group (P<0.05). 25(OH)D3 levels of the failure weaning group were lower than those of the successful weaning group [on admission: (18.16±4.33) ng/ml vs. (21.60±5.25) ng/ml, P<0.05; before SBT: (13.50±3.52) ng/mlvs. (18.61±4.30) ng/ml, P<0.05]. Multivariate logistic regression analysis showed that 25(OH)D3 levels on admission and before SBT were independent risk factors for failure weaning (OR values were 2.257 and 2.613, respectively, both P<0.05). ROC curve analysis showed that areas under ROC curve were 0.772 and 0.836, respectively, with sensitivities of 80.3% and 85.2%, specificities of 69.0% and 71.0%, respectively.Conclusions25(OH)D3 deficiency or insufficiency is common in critically ill patients. The lower the level of vitamin D, the higher the risk of failure weaning. So it may be an independent predictor of failure weaning.
ObjectiveTo detect the concentration of 8-isoprostane (8-iso-PG) in exhaled breath condensate (EBC) of patients with or at risk for ARDS in ventilation, and investigate its clinical significance.MethodsFifty-five patients with or at risk for ARDS in ventilation admitted between February 2014 and June 2016 were recruited as an experimental group, and simultaneous 30 normal cases were recruited as a control group. Their EBC was collected with EcoScreen condenser. The EBC 8-iso-PG level of the patients between different grades of ARDS (mild, moderate, and sever) or at risk for ARDS was compared, and the correlation of EBC 8-iso-PG with the clinical indicators was analyzed.ResultsThe 8-iso-PG levels in EBC and serum of the patients with or at risk for ARDS in ventilation were higher than those in the control group [EBC: (44.83±11.58) ng/L vs. (19.47±4.06) ng/L; serum: (481.53±444.94) ng/L vs. (19.91±17.60) ng/L] (all P<0.05). The EBC 8-iso-PG of the patients with moderate ARDS (n=15) and severe ARDS (n=7) [(47.18±11.68) ng/L and (50.29±11.06) ng/L] was higher than those with mild ARDS (n=7) or at risk for ARDS (n=26) [(33.04±7.62) ng/L) and (37.17±11.08) ng/L] (all P<0.05). However EBC 8-iso-PG was not different between the patients with mild ARDS and those at risk for ARDS (P>0.05 ). The increased EBC 8-iso-PG could predict ARDS with an area under the receiver operating curve of 0.73. The EBC 8-iso-PG of the patients with or at risk for ARDS was correlated with lung injury score (r=0.418, P<0.01), PaO2/FiO2 (r=–0.378, P<0.05), chest radiograph scores (r=0.410, P<0.05), AaDO2 (r=0.368, P<0.05), and APACHEⅡ score (r=0.718, P<0.05).ConclusionEBC 8-iso-PG can reflect the oxidative stress in lung of ARDS patients in ventilation, and can contribute to the diagnosis and evaluation for moderate and severe ARDS.
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 analyze the risk factors for duration of mechanical ventilation in critically ill patients. Methods Ninety-six patients who received mechanical ventilation from January 2011 to December 2011 in intensive care unit were recruited in the study. The clinical data were collected retrospectively including the general condition, underlying diseases, vital signs before ventilation, laboratory examination, and APACHEⅡ score of the patients, etc. According to ventilation time, the patients were divided into a long-term group ( n = 41) and a short-term group ( n = 55) . Risk factors were screened by univariate analysis, then analyzed by logistic regression method.Results Univariate analysis revealed that the differences of temperature, respiratory index, PaCO2 , white blood cell count ( WBC) , plasma albumin ( ALB) , blood urea nitrogen ( BUN) , pulmonary artery wedge pressure ( PAWP) , APACHEⅡ, sex, lung infection in X-ray, abdominal distention, and complications between two groups were significant.With logistic multiple regression analysis, the lower level of ALB, higher level of PAWP, lung infection in X-ray, APACHE Ⅱ score, abdominal distention, and complications were independent predictors of long-term mechanical ventilation ( P lt;0. 05) . Conclusion Early improving the nutritional status and cardiac function, control infection effectively, keep stool patency, and avoid complications may shorten the duration of mechanical ventilation in critically ill patients.
Objective To analyze the common causes of ventilator alarms during mechanical ventilation and their management. Methods A total of 104 ventilator alarms that were not instantly solved by first-line residents but referred to pulmonary therapist and attending physicians during September 2007 and August 2008 in the MICU of our hospital were analyzed retrospectively. Results Of all the 104 ventilator alarms, 27 ( 26%) were due to problems of ventilation circuits; 18 were due to patient effortagainst ventilator secondary to anxiety, horror or pain; 15 were due to inappropriate ventilator parameters;13 were due to airway problems; 5 were due to ventilator malfunction; 4 were due to worsening clinical status; 22 were due to other causes. Conclusion During mechanical ventilation, accurate assessment andprompt management of ventilator alarms are of great importance to patient safety and ventilation efficacy.
ObjectiveTo compare the predictive values of dynamic energy expenditure (EE) monitoring and the traditional method (rapid shallow breath index) for weaning in patient who is suitable for weaning from mechanical ventilation and accepts sequentially reduced support of ventilator.MethodsThis study included a total of 93 patients who were admitted to the Department of Intensive Care Medicine in 2018 to 2019, and were eligible for weaning from mechanical ventilation. The energy expenditure monitoring device of GE ventilator (CARESCAPE R860) was used to record the patient's change rate of EE [δEE(%), T1 (PSV 20/5), T2 (PSV 15/5), T3 (PSV 10-5/5), T4 (PSV 5/5)] while the ventilation support was declined. The differences in δEE were compared between the two groups of patients who were successful weaned (a successful group S) or failed (a failed group) at different phases. The receiver operator characteristic (ROC) curve was used to analyze the predictive value of δEE to the success rate of weaning.ResultA total of 36 patients failed weaning procedure. There was no significant difference in the basic status and disease type between the successful group and the failed group. There was no difference in δEE1 between T1-T2 phases [(5.67±2.31)% vs. (6.40±1.90)%, P>0.05], but significant difference in δEE between T2-T3 and T3-T4 phases [δEE2: (11.35±5.39)% vs. (14.21±6.33)%, P<0.05; δEE3: (8.39±3.90)% vs. (17.32±9.07)%, P<0.05]. The area under the ROC curve predicted by δEE2 and δEE3 for the patient's weaning results was higher than rapid shallow breath index (0.83 and 0.75 vs. 0.64, P<0.05).ConclusionDynamic energy expenditure monitoring can effectively evaluate and predict the success rate of weaning from mechanical ventilation, and can be applied to the clinical treatment process.
ObjectiveTo evaluate the predictive value of diaphragmatic rapid shallow breathing index (D-RSBI) for weaning outcome prediction.MethodsThis was a prospective observation study. Respiratory rate (RR) and tidal volume (Vt) were recorded at the end of spontaneous breathing trial, and both M-Mode and B-Mode ultrasonography were used to assess the right diaphragmatic displacement (DD). In parallel, outcome of the weaning attempt, length of mechanical ventilation, length of stay in intensive care unit (ICU) and mortality of ICU were recorded. According to the weaning outcome, the patients were grouped into the successful group and the failed group. The receiver operator characteristic (ROC) curve was used to assess the value of rapid shallow breathing index (RSBI, RR/Vt) and D-RSBI (RR/DD) in predicting weaning failure for ICU patients with mechanical ventilation.ResultsA total of 110 patients recruited in this study. Of them, 73 (66.4%) patients were successfully liberated from mechanical ventilation, and 37 patients failed (33.6%) weaning procedure. The RSBI and D-RSBI of the patients in the failed group were higher than those in the success weaning group (P<0.01). The area under the ROC curves of RSBI and D-RSBI for predicting weaning failure was 0.78 (95% confidence interval 0.69 - 0.87), 0.91 (95% confidence interval 0.85 - 0.97), respectively, a cutoff of RSBI>69 breaths/(L·min) yielded sensitivity of 55% and specificity of 89%, and a cutoff of D-RSBI>1.5 breaths/(min·mm) yielded sensitivity of 87% and specificity of 80%.ConclusionD-RSBI is more accurate than traditional RSBI in predicting the weaning outcome.
ObjectiveTo improve the understanding of prolonged weaning. MethodsA clinical case of prolonged weaning who had been successfully weaned from mechanical ventilation was retrospectively analyzed. The related literature was also reviewed. ResultsThe patient received invasive mechanical ventilation for 5 months,diagnosed as ventilator-associated pneumonia,type Ⅱrespiratory failure,Green-Barry syndrome,hypoproteinemia,anemia,and electrolyte disorder. Through the control of infection,nutritional support,psychological counseling,the patient was weaned from ventilator gradually and succeeded eventually. ConclusionsProlonged weaning is relatively difficult and wastes a long time. Professional treatment team and specialized treatment room are necessory. There are few reports about prolonged weaning.
ObjectiveTo compare the indirect calorimetry (IC) measured resting energy expenditure (MREE) with adjusted Harris-Benedict formula calculating resting energy expenditure (CREE) in the mechanically ventilated surgical critically ill patients and to evaluate the relationship between the resting energy expenditure (REE) with the severity of illness. MethodsTwenty-one patients undergonging mechanical ventilation for critical illness in the intensive care unit of general surgery between August 2008 and February 2010 were included in this study. Data during the study period of nutrition support were collected for computation of the severity of critical illness by acute physiology and chronic health evaluation Ⅱ scores (APACHE Ⅱ scores) and organ dysfunction scores (Marshall scores). MREE was measured by using IC of the MedGraphics CCM/D System within the first 7 d after nutrition therapy. CREE was calculated by using the HarrisBenedict formula adjusted with correction factors for illness at the same time. According to APACHE Ⅱ scores on admission, the enrolled patients were divided into two groups: APACHEⅡ score ≥20 scores group (n=8) and APACHE Ⅱ score lt;20 scores group (n=13), and the differences between MREE and CREE of patients in two groups were determined. ResultsThe reduction of variation tendency in CREE other than MREE in the enrolled patients within the first week of nutritional support was statistical significance (Plt;0.001). The CREE of patients 〔(1 984.49±461.83) kcal/d〕 was significantly higher than the MREE 〔(1 563.88±496.93) kcal/d〕 during the first week of nutritional support (Plt;0.001). The MREE on the 0, 1, 2, and 4 d after nutrition therapy were statistically significant lower than CREE at the same time interval in these patients (Plt;0.01), and the differences at the other time points were not significant (Pgt;0.05). There was a trend towards a reduction in APACHE Ⅱ and Marshall scores within the first week of nutrition therapy that reached statistical significance (Plt;0.001). During the first week of nutrition therapy, APACHEⅡ and Marshall scores of patients in ≥20 scores group were significantly higher than those in lt;20 scores group, respectively (Plt;0.05 or Plt;0.01), and the reductions of APACHE Ⅱ scores and Marshall scores were significant in patients of two groups (Plt;0.001). A significant positive correlation was found between CREE with APACHE Ⅱ scores (r=0.656, Plt;0.001) and Marshall scores (r=0.608，Plt;0.001) in patients within the first week after nutrition support. Although no statistically significant correlation was observed between MREE and APACHEⅡ scores (r=-0.045， P=0.563), a significant positive correlation was observed between MREE and Marshall scores (r=0.263, P=0.001) within the first week after nutrition therapy. There was no correlation between MREE and CREE (r=0.064, P=0.408) in patients at the same time interval. The reduction of MREE of patients in ≥20 scores group other than in lt;20 scores group was statistically significant within the first week after nutrition therapy (P=0.034). In addition, the MREE of patients in ≥20 scores group were not significantly different from those in lt;20 scores group (Pgt;0.05), and the mean CREE was not different in two groups patients within the first week of nutritional therapy 〔(1 999.55±372.73) kcal/d vs. (1 918.39±375.27) kcal/d, P=0.887〕. CREE was significantly higher than MREE of patients in ≥20 scores group within the first week except the 3 d and 5 d after nutrition therapy (Plt;0.05), while in lt;20 scores group CREE was significantly higher than MREE in patients only within the first 3 d after nutrition therapy (Plt;0.05 or Plt;0.01). MREE and CREE of patients in ≥20 scores group were not different from those in lt;20 scores group, respectively (Pgt;0.05).
Objective To analyze the clinical features and treatment of severe H1N1 influenza.Methods The clinical data of 34 patients with severe H1N1 influenza admitted to intensive care unit from October to December 2009 were reviewed. Results The patients aged 3 months to 60 years with an average of ( 13. 9 ±4. 5) years, of which 24 patients were younger than 7 years old. Fever( 30 cases) , cough( 32 cases) , progressive shortness of breath( 19 cases) were the main symptoms. White blood cell count was normal in 21 cases, increased in 6 cases, and decreased in 7 cases. Lymphocyte count was normal in 16 cases, increased in 12 cases, and decreased in6 cases. Chest X-ray films showed bilateral or unilateral patchy pulmonary fuzzy shadows in28 cases. Chest CT showed diffuse interstitial lesion in1 case, pleural effusion in 2 cases, and bronchiectasis in 1 case. The hepatic and myocardial enzymogramparameters were all abnormal.30 cases were treated by oseltamivir and ribavirin, 4 cases by methyllprednisolone, and 6 cases by gamma globulin. 8 cases underwent routine intubation and mechanical ventilation, and 5 cases received non-invasive mechanical ventilation. All 34 patients were cured. Conclusions Lung, heart, and liver are the major target organs in severe H1N1 influenza. Mechanical ventilatory support is an important treatment for severe H1N1influenza.