BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmon...BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.展开更多
BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noni...BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy.METHODS: Fifty patients including 24 patients with withdrawal of mechanical ventilation(conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy(sequential group) were analyzed retrospectively after appearance of pulmonary infection control(PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia(VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups.RESULTS: Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased.CONCLUSION: Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.展开更多
BACKGROUND Patients with critical coronavirus disease 2019(COVID-19),characterized by respiratory failure requiring mechanical ventilation(MV),are at high risk of mortality.An effective and practical MV weaning protoc...BACKGROUND Patients with critical coronavirus disease 2019(COVID-19),characterized by respiratory failure requiring mechanical ventilation(MV),are at high risk of mortality.An effective and practical MV weaning protocol is needed for these fragile cases.CASE SUMMARY Here,we present two critical COVID-19 patients who presented with fever,cough and fatigue.COVID-19 diagnosis was confirmed based on blood cell counts,chest computed tomography(CT)imaging,and nuclei acid test results.To address the patients’respiratory failure,they first received noninvasive ventilation(NIV).When their condition did not improve after 2 h of NIV,each patient was advanced to MV[tidal volume(Vt),6 mL/kg ideal body weight(IBW);8-10 cmH2 O of positive end-expiratory pressure;respiratory rate,20 breaths/min;and 40%-80%FiO2]with prone positioning for 12 h/day for the first 5 d of MV.Extensive infection control measures were conducted to minimize morbidity,and pharmacotherapy consisting of an antiviral,immune-enhancer,and thrombosis prophylactic was administered in both cases.Upon resolution of lung changes evidenced by CT,the patients were sequentially weaned using a weaning screening test,spontaneous breathing test,and airbag leak test.After withdrawal of MV,the patients were transitioned through NIV and high-flow nasal cannula oxygen support.Both patients recovered well.CONCLUSION A MV protocol attentive to intubation/extubation timing,prone positioning early in MV,infection control,and sequential withdrawal of respiratory support,may be an effective regimen for patients with critical COVID-19.展开更多
文摘BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.
基金supported by the fund for clinical research project(2015xkj086)
文摘BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy.METHODS: Fifty patients including 24 patients with withdrawal of mechanical ventilation(conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy(sequential group) were analyzed retrospectively after appearance of pulmonary infection control(PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia(VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups.RESULTS: Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased.CONCLUSION: Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.
文摘BACKGROUND Patients with critical coronavirus disease 2019(COVID-19),characterized by respiratory failure requiring mechanical ventilation(MV),are at high risk of mortality.An effective and practical MV weaning protocol is needed for these fragile cases.CASE SUMMARY Here,we present two critical COVID-19 patients who presented with fever,cough and fatigue.COVID-19 diagnosis was confirmed based on blood cell counts,chest computed tomography(CT)imaging,and nuclei acid test results.To address the patients’respiratory failure,they first received noninvasive ventilation(NIV).When their condition did not improve after 2 h of NIV,each patient was advanced to MV[tidal volume(Vt),6 mL/kg ideal body weight(IBW);8-10 cmH2 O of positive end-expiratory pressure;respiratory rate,20 breaths/min;and 40%-80%FiO2]with prone positioning for 12 h/day for the first 5 d of MV.Extensive infection control measures were conducted to minimize morbidity,and pharmacotherapy consisting of an antiviral,immune-enhancer,and thrombosis prophylactic was administered in both cases.Upon resolution of lung changes evidenced by CT,the patients were sequentially weaned using a weaning screening test,spontaneous breathing test,and airbag leak test.After withdrawal of MV,the patients were transitioned through NIV and high-flow nasal cannula oxygen support.Both patients recovered well.CONCLUSION A MV protocol attentive to intubation/extubation timing,prone positioning early in MV,infection control,and sequential withdrawal of respiratory support,may be an effective regimen for patients with critical COVID-19.
