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 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.
ObjectiveTo establish a simple and stable model of benign tracheal stenosis in SD rats by nylon brush scraping induced mechanical injury, and to observe the pathological changes of tracheal tissue at different time points after modeling.MethodsTwenty SD rats were divided into sham operation group (10 rats) and stenosis model group (10 rats) by random number method. Symptoms and survival conditions were observed, tracheal tissues were obtained, granulation tissue proliferation was observed, and stenosis indexes were measured and compared. Another fifteen rats were sacrificed at different time points (days 0, 2, 4, 6, and 8) after modeling. Tracheal tissues were obtained, HE staining and Masson staining were performed to observe pathological changes with time.ResultsThe survival rate of the sham operation group was 100% on the 8th day after operation, and the survival rate was 0% on the 8th day after operation in the stenosis model group. The difference in survival condition between the two groups was statistically significant (P=0.000 1) by Log-rank test. The stenosis index in the sham operation group was (6.12±1.78)%, and in the stenosis model group was (60.28±12.56)%. The difference in the stenosis between the two groups was statistically significant (P<0.000 01). HE staining results showed that the tracheal lumen was unobstructed and no granulation tissue hyperplasia or stenosis was found in the sham operation group. The epithelial mucosa was intact and smooth, and the cilia structure was clearly visible. It was a pseudo-stratified ciliated columnar epithelium, which was consistent with the characteristics of normal airway mucosa. While in stenosis model group, the lumen was significantly narrowed, and the stenosis was mainly caused by granulation tissue hyperplasia. No epithelial structure was observed, or epithelial structure was extremely abnormal. Masson staining showed that the fibroblasts in the injured site increased first and then decreased, and the collagenous fiber (blue) in the injured site gradually increased with time.ConclusionsA model of benign tracheal stenosis in rats can be successfully established by nylon brush scraping induced mechanical injury. The modeling method is simple, controllable and reproducible. The model can be widely used in the investigation of pathogenic mechanism for benign airway stenosis and efficacy exploration of new treatment.
ObjectiveTo compare two different ways to establish mouse model with acute lung injury (ALI) via intratracheal instillation or intraperitoneal injection of lipopolysaccharide (LPS). MethodsBALB/c mice received intraperitoneal/intratracheal administration of LPS or sham operation. Wet/dry lung weight ratio, protein concentration in bronchoalveolar lavage fluid (BALF), and lung tissue histology were examined at 0, 1, 2, 6, 12, 18, 24, 48 h after LPS administration. Tumor necrosis factor-α (TNF-α) in BALF and serum was assayed with ELISA method. ResultsLPS treatment significantly increased wet/dry lung weight ratio, BALF protein concentration and TNF-α concentration in serum and BALF. Lung tissue was damaged after LPS challenge. The mice received LPS intraperitoneal injection got a more significant lung edema than those received LPS intratracheal instillation. Inversely, LPS intratracheal instillation induced more severed microstructure destruction. ConclusionsALI animal model by LPS intratracheal instillation or intraperitoneal injection induces inflammation and tissue damage in lung. However, the degree of tissue damage or self-healing induced by two methods is different. Therefore the decision of which way to establish ALI model will depend on the study purpose.
Objective To evaluate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 ( sTREM-1 ) in endotracheal aspirate and plasma of patients with ventilator-associated pneumonia ( VAP) . Methods The consentration of sTREM-1 in plasma and endotracheal aspirate, and serum high-sensitivity C-reactive protein ( hs-CRP) were measured by enzyme-linked immunosorbent assay ( ELISA) in 68 patients with VAP ( VAP group) , 50 patients underwent ventilation without VAP ( non-VAP group) , and 50 healthy individuals ( control group) . The sensitivity and specificity of each parameter were calculated. Results In the patients with VAP, sTREM-1 in plasma and endotracheal aspirate before treatment were significantly higher than that in the non-VAP group [ ( 143.62 ±46.82) pg/mL vs. ( 68.56 ±16.24) pg/mL, ( 352.86 ±92.57) pg/mL vs. ( 126.21 ±42.28) pg/mL, Plt;0.05] ; sTREM-1 in plasma and endotracheal aspirate on the 3rd and the 7th day during treatment were significantly decreased ( Plt;0. 05) . By ROC analysis, the cut-off value of sTREM-1 in endotracheal aspirate were 193.64 pg/mL, with sensitivity and specificity of 93.84% and 89.51% respectively. The areas under ROC curve of sTREM-1 in endotracheal aspirate were 0.912. Clinical diagnostic value of sTREM-1 in endotracheal aspirate was better than plasma sTREM-1 and serum hs-CRP ( areas under ROC curve were 0. 768 and 0. 704 respectively) . Conclusions sTREM-1 may be helpful for evaluating the therapeutic effect in patients with VAP. The diagnostic value of sTREM-1 in endotracheal aspirate may be superior to plasma sTREM-1 and serum hs-CRP.
ObjectiveTo investigate the biocompatibility and immunogenicity of the tracheal matrix decellularized by sodium perchlorate (NaClO4).MethodsBone marrow mesenchymal stem cells (BMSCs) were divided from 2-month-old New Zealand white rabbits. The trachea of 6-month-old New Zealand white rabbits were trimmed to a length of 1.5 cm and randomly divided into control group (group A1, n=5, just stripped the loose connective tissue outside the trachea) and experimental group (group B1, n=5, decellularized by improved NaClO4 immersion method). The cytotoxicity of the scaffold leaching solution was detected by MTT assay, and the major histocompatibility complex (MHC) expression was detected by immunohistochemical method. The 4th generation of BMSCs were seeded onto the scaffold of 2 groups, and the cell activity around the material was observed by inverted microscope after Giemsa staining at 48 hours, while the cells states on the scaffold were observed at 7 and 14 days after culturing by scanning electron microscope. Another 10 6-month-old New Zealand white rabbits were randomly divided into control group (group A2, n=5) and experimental group (group B2, n=5), which implanted the native trachea and decellularized tracheal matrix into the subcutaneous sac of the back neck, respectively. The serum immunoglobulin IgM and IgG contents were analysed at 5, 10, 15, 20, 25, and 30 days after operation, and HE staining observation was performed at 30 days after operation.ResultsMTT assay showed that the proliferation activity of BMSCs cultured in the leach liquor of group B1 was well, showing no significant difference when compared with group A1 and negative control group with pure culture medium (P>0.05). The immunohistochemical staining showed that the decellularized process could significantly reducing the antigenicity of matrix materials. Giemsa staining showed that BMSCs grew well around the two tracheal matrixs (groups A1 and B1) in vitro. Scanning electron microscope observation showed that the cells were attached to the outer wall of the tracheal material in group A1, which present a flat, round, oval shaped, tightly arranged cells and cluster distribution; and in group B1, the cells formed a single lamellar sheet cover the outer wall of the tracheal material, whose morphology was similar to that in group A1, and the growth trend was better. In vivo experimental results showed that the rejection of group B2 was lower than that of group A2. The contens of IgM and IgG in group A2 were significantly higher than those in group B2 at each time point after operation (P<0.05). HE staining showed no signs of rejection, macrophagocyte, or lymphocyte infiltration occurred, and the collagen fibers maintained their integrity in group B2.ConclusionThe decellularized matrix treated by NaClO4 has a fine biocompatibility, while its immunogenicity decreased, and it is suitable for the scaffold material for constructing of tissue engineered trachea.
Congenital tracheal stenosis (CTS) is a rare but potentially life-threatening disease which results in congnital airway lesion. CTS is often associated with cardiovascular anomalies and presented with a wide spectrum of symptoms. CTS has challenged pediatric surgeons for decades. Various classic approaches and new techniques, including computational fluid dynamics, tissue-engineering trachea, and 3D printing have been proposed for diagnosis and treatment of CTS. This review provides a snapshot of the main progress of diagnosis and treatment of CTS.
Objective To explore a new surgical treatment of patients with severe congenital heart disease associated with tracheal or bronchial stenosis. Methods We retrospectively analyzed clinical data of 32 patients with severe pulmonary blood increased congenital heart disease complicated with tracheal or bronchial stenosis in our hospital between June 2010 and June 2014. There were 18 males and 13 females with an average age of 14.6±4.0 months and a weight of 8.8±3.0 kg. Results Average hospital stay was 12 days. Duration of intraoperative cardiopulmonary bypass was 65.0±21.0 min. Duration of aortic interruption was 42.0±16.0 min. Duration of postoperative ventilator was 25.0±18.0 h. ICU retention time was 4.0±1.8 d. All patients were survived. On the 9th day after surgery, the X-ray chest film revealed that the cardio-thoracic ratio was reduced compared with pre-operation but no statistical significance (P>0.05). Left ventricular end-diastolic dimension (LVEDD) was decreased (P<0.05). Pulmonary artery pressure was lower (P<0.01). The velocity of bloodstream in pulmonary artery was approximately normal. The computed tomography angiography (CTA) on the 9th day after surgery revealed that diameter of pulmonary artery in all patients reduced compared with that of pre-operation (P<0.01). Tracheal diameter of 28 patients returned to normal level and 3 patients had residual mild tracheal stenosis. All preoperative atelectasis recovered to normal level. All patients recovered completely. When the patients were followed up for 6 months to 4 years, the patients grew healthily and no abnormity occurred. Conclusion For the patients with tracheal or bronchial stenosis related to severe congenital heart disease,it is necessary to adopt surgical procedure to relieve the pressure of trachea or bronchus.The bronchial decompression surgery is a perfect and effective method for the patients with tracheal or bronchial stenosis related to severe congenital heart disease.
Objective To investigate the effects of dust mite allergen Derp1 on the expressions of IL-6 and IL-8 in primary rat bronchial epithelial cells. Methods The primary rat bronchial epithelial cells were divided into a control group and three experimental groups. In the experimental groups, the cells were cultured with 3 different concentrations of Derp1 ( 1, 5, 10 μg/mL) for 3 different time ( 4, 8, 24 h) .Inverted microscope was employed to observe the morphological changes of bronchial epithelial cells and intercellular space, and supernatants were assayed for IL-6 and IL-8 with ELISA. Results Complete flattening of single cells layer was observed in the control group. In the experimental groups, the cells treated with Derp1 allergen showed no obvious changes in the cell morphology and intercellular space. However,There was a significant change in the level of cytokines production compared with the control group. The levels of IL-6 and IL-8 began to rise at 4 h, and reach to high level at 8 h, especially in the 5 and 10 μg/mL groups ( P lt;0. 01) . In the 24h group, the concentrations further increased but not reach statistical difference compared with 8h group ( P gt; 0. 05) . Conclusions The Derp1 allergen can stimulate the release of inflammatory cytokines such as IL-6 and IL-8 fromthe rat trachea- bronchia epithelial cells. It is suggested that dust mite allergen -induced cytokines may play important roles in the pathogenesis of allergic asthma.