高频振荡呼吸机治疗新生儿呼吸衰竭的临床疗效

目的：分析探讨高频振荡呼吸机治疗新生儿呼吸衰竭的临床效果。方法2010年1月—2015年1月期间,该院共接收呼吸衰竭的新生儿52例,选择此52例患儿作为此次试验的临床研究对象,并以随机数字表法为分组依据将其平均分配为对照组以及试验组,对照组26例患儿接受常频机械通气呼吸机治疗,试验组患儿则接受高频振荡通气呼吸机治疗,治疗后比较两组患儿的PH、PCO、PO、FiO四项指标水平以及两组患者在治疗时间、住院时间、上机花费上是否存在差异。结果两组患儿经过合理的治疗以及悉心护理后,全部存活出院,但在上机治疗1 d后PCO、PO、FiO三项指标水平上对照组患儿明显不及试验组;且对照组患儿上机治疗时间为（127.5±32.10） h,试验组患儿上机治疗时间为（89.3±13.34） h;另外,在住院时间以及上机花费上,对照组也明显高于试验组,以上各项数据的差异有统计学意义（P＜0.05）。结论应用高频振荡呼吸机治疗新生儿的呼吸衰竭,可以使患儿呼吸功能得到明显改善,节省治疗、住院时间以及治疗费用。     

BiPAP呼吸机治疗82例COPD合并Ⅱ型呼吸衰竭的护理体会

目的:总结临床上使用无创呼吸机治疗呼吸衰竭的护理体会。方法:回顾性分析2011-2013年82例COPD合并Ⅱ型呼吸衰竭患者使用Bi PAP呼吸机治疗及护理的全过程。结果:82例患者67例好转出院,15例改为气管插管,其中11例拔管后好转出院,4例又行气管切开,均因气胸或病情危重而死亡。结论:无创正压通气应用逐年增加,成功率也逐渐上升,正确掌握适应证和操作程序,严密监测并防治并发症的发生,做好治疗前、治疗中及治疗后的护理,是确保成功使用Bi PAP呼吸机的重要环节。     

Management of ventilator-associated pneumonia: Need for a personalized approach

Introduction: Optimizing management of ventilator-associated pneumonia (VAP) should focus on the accurate identification of true lung infection, determination of the etiological agent, and early institution of adequate empirical therapy and de-escalation. Local adaptation of the standard guidelines leads to favorable outcome in the management of VAP

Areas covered: In this review, we present the concepts of early adequate therapy and the key considerations such as patient characters, clinical and etiological diagnosis, and assessment of patients for de-escalation that favor optimization of therapy. We highlight the issues that need a personalized approach in the management of VAP emphasizing on various patient categories for reassessment and tailoring the therapy.

Expert commentary: Rapid diagnostic techniques and non-invasive metabolomics will identify phenotypes which will shift the traditional paradigm based on conventional cultures. A personalized approach taking into account baseline resistance epidemiology, underlying disease (and comorbidities), duration of hospitalization, and prior antimicrobial exposure should guide targeted therapy.     

Flexible selection of a single treatment incorporating short‐term endpoint information in a phase II/III clinical trial

Seamless phase II/III clinical trials in which an experimental treatment is selected at an interim analysis have been the focus of much recent research interest. Many of the methods proposed are based on the group sequential approach. This paper considers designs of this type in which the treatment selection can be based on short‐term endpoint information for more patients than have primary endpoint data available. We show that in such a case, the familywise type I error rate may be inflated if previously proposed group sequential methods are used and the treatment selection rule is not specified in advance. A method is proposed to avoid this inflation by considering the treatment selection that maximises the conditional error given the data available at the interim analysis. A simulation study is reported that illustrates the type I error rate inflation and compares the power of the new approach with two other methods: a combination testing approach and a group sequential method that does not use the short‐term endpoint data, both of which also strongly control the type I error rate. The new method is also illustrated through application to a study in Alzheimer's disease. © 2015 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.     

Start‐up designs for response‐adaptive randomization procedures with sequential estimation

Response‐adaptive randomization procedures are appropriate for clinical trials in which two or more treatments are to be compared, patients arrive sequentially and the response of each patient is recorded before the next patient arrives. However, for those procedures that involve sequential estimation of model parameters, start‐up designs are commonly required in order to provide initial estimates of the parameters. In this paper, a suite of such start‐up designs for two treatments and binary patient responses are considered and compared in terms of the numbers of patients required in order to give meaningful parameters estimates, the number of patients allocated to the better treatment, and the bias in the parameter estimates. It is shown that permuted block designs with blocks of size 4 are to be preferred over a wide range of parameter values. For the case of two treatments, normal responses and selected start‐up procedures, a design incorporating complete randomization followed appropriately by repeats of one of the treatments yields the minimum expected number of patients and is to be preferred. Copyright © 2015 John Wiley & Sons, Ltd.     

呼吸机常见报警原因分析及处理措施

机械通气作为生命支持和呼吸治疗的有效手段,已广泛应用于临床各个领域,特别是近年来二级甲等医院急诊科建设不断完善、ICU陆续成立,使呼吸机的应用进一步普及。呼吸机报警是机械通气中经常发生的问题,如果处理不当,不仅影响到呼吸机的使用,而且有可能危及到患者的生命,因此正确判断和及时排除报警是极为重要的。对于不是非常熟悉呼吸机应用的临床医护人员对呼吸机报警感到紧张和压力,甚至对报警感到束手无策,不能迅速明确原因,及时正确处理。对呼吸机报警原因进行归纳分析,旨在为临床医护人员处理常见的呼吸机报警提供帮助,进一步提高危重症患者的抢救成功率。     

Medical Rehabilitation: Guidelines to Advance the Field With High-Impact Clinical Trials

The purpose of this Special Communication is to summarize guidelines and recommendations stemming from an expert panel convened by the National Institutes of Health, National Center for Medical Rehabilitation Research (NCMRR) for a workshop entitled The Future of Medical Rehabilitation Clinical Trials, held September 29-30, 2016, at the NCMRR offices in Bethesda, Maryland. The ultimate goal of both the workshop and this summary is to offer guidance on clinical trials design and operations to the medical rehabilitation research community, with the intent of maximizing the effect of future trials.     

The controversial role of dual sequential defibrillation in shockable cardiac arrest

Background

In the United States, over 350,000 cardiac arrests occur outside of the hospital and 209,000 occur in the hospital. Shockable rhythms such as ventricular fibrillation (VF) have a survival rate of 20–30% outside of the hospital setting. Dual Sequential Defibrillation (DSD) has demonstrated success in terminating VF that is refractory to multiple attempts using a single defibrillator.

序贯式精准化非人工气道管理在老年颅后窝神经病变术后病人中的应用

目的探讨序贯式精准化非人工气道管理在老年颅后窝神经病变开颅术后病人中的应用效果。方法选取2018年1~12月开颅术后意识障碍进行常规气道管理的病人70例作为对照组,同时选取2019年1~12月开颅术后意识障碍采用序贯式精准化气道管理的病人67例作为研究组,比较2组病人吸痰并发症发生率、肺部感染发生率、气管插管率和平均住院天数。结果研究组病人吸痰并发症发生率、肺部感染发生率和平均住院天数明显低于对照组,差异具有统计学意义(P<0.05);2组间的气管插管率差异无统计学意义(P>0.05)。结论序贯式精准化非人工气道管理有助于减少神经外科意识障碍病人的吸痰并发症,降低肺部感染发生率和住院天数,是一种安全有效的气道管理方法。