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1.
Timing of recovery of lung function after severe hypoxemic respiratory failure in children 总被引:2,自引:0,他引:2
Objective: To describe the timing of recovery of lung function after severe acute hypoxemic respiratory failure (AHRF) in children.
Design: A serial observational follow-up study of clinical and lung function measurements up to 53 months after acute illness. Setting: University pediatric intensive care unit in a national children's hospital. Patients: Five critically ill children aged 5–14 years. Interventions: None Results: Clinical recovery: each patient required a 3–5 month convalescence before being able to attend full-time school because
of lethargy and dyspnea. All patients developed wheeze 3–12 months after illness and four received long-term bronchodilator
therapy. Lung function recovery: for both the forced vital capacity (FVC) and forced vital capacity in the first second (FEV1) four patients had abnormally low values, regaining only 60–70 % of predicted values for their height and sex, and all of
this improvement had occurred by 6–12 months after illness. Beyond this interval, patients remained on their same FVC and
FEV1 centile. FEV1/FVC ratios were consistently within the normal range, indicating a predominantly restrictive defect. Changes in peak expiratory
flow exhibited a time course of improvement similar to the other lung function tests. Conclusion: In children, pulmonary recovery after severe AHRF may occur for 6–12 months. A 1-year follow-up could offer a rational single
point for assessment of outcome and long-term counselling of child and parents.
Received: 10 November 1997 Accepted: 20 January 1998 相似文献
2.
BACKGROUND:
Mechanical ventilation is a double-edged sword to acute respiratory distress syndrome (ARDS) including lung injury, and systemic inflammatory response high tidal volumes are thought to increase mortality. The objective of this study is to evaluate the effects of dynamic ventilatory factors on ventilator induced lung injury in a dog model of ARDS induced by hydrochloric acid instillation under volume controlled ventilation and to investigate the relationship between the dynamic factors and ventilator-induced lung injuries (VILI) and to explore its potential mechanisms.METHODS:
Thirty-six healthy dogs were randomly divided into a control group and an experimental group. Subjects in the experimental group were then further divided into four groups by different inspiratory stages of flow. Two mL of alveolar fluid was aspirated for detection of IL-8 and TNF-α. Lung tissue specimens were also extracted for total RNA, IL-8 by western blot and observed under an electronic microscope.RESULTS:
IL-8 protein expression was significantly higher in group B than in groups A and D. Although the IL-8 protein expression was decreased in group C compared with group B, the difference was not statistically significant. The TNF-α ray degree of group B was significantly higher than that in the other groups (P<0.01), especially in group C (P>0.05). The alveolar volume of subjects in group B was significantly smaller, and cavity infiltration and cell autolysis were marked with a significant thicker alveolar septa, disorder of interval structures, and blurring of collagenous and elastic fiber structures. A large number of necrotic debris tissue was observed in group B.CONCLUSION:
Mechanical ventilation with a large tidal volume, a high inspiratory flow and a high ventilation frequency can cause significant damage to lung tissue structure. It can significantly increase the expression of TNF-α and IL-8 as well as their mRNA expression. Furthermore, the results of our study showed that small tidal ventilation significantly reduces the release of pro-inflammatory media. This finding suggests that greater deterioration in lung injury during ARDS is associated with high inspiratory flow and high ventilation rate.KEY WORDS: Acute respiratory distress syndrome, Dynamic factors, Inspiratory flow, Ventilator-induced lung injury 相似文献3.
目的 探讨26家医院小儿重症监护室(PICU)患者呼吸支持相关的预后之差异及影响因素.方法 多中心前瞻性临床协作研究,研究时间为2005年12月至2006年11月连续12个月,研究对象为29 d至15周岁的PICU患儿.患儿纳入后记录其基本情况、疾病诊断、治疗及预后等数据,汇总后分析不同PICU其患者预后及呼吸治疗的差异.结果 在研究期间,26家PICU共收治危重病例11521例,占PICU收治患者总数的70%,不同单位该比例从14%到98%.26家单位共纳入小儿低氧性呼吸衰竭(AHRF)病例461例,患病率4%,各单位AHRF患病率中位值4.7%(Qr:2.4%~7.1%).AHRF总病死率41.6%,26家PICU病死率中位值39.8%(四分位数间距22%~57%).AHRF病死率在大学附属医院低于非大学附属医院(37%vs.46%,x~2=4.16,P:0.04),经济发达地区低于欠发达地区医院(38%vs.46%,x~2=3.1,P=0.08).结论 我国不同地区及不同类别医院PICU危重病例及AHRF呼吸支持相关的预后存在较大差异.PICU所在医院的学术背景及地区经济发展水平是影响患者预后的两个重要原因.在开展提高PICU的呼吸支持治疗水平和AHRF生存率的干预性研究设计中应予考虑. 相似文献
4.
Pieter O. Depuydt Dominique D. Benoit Carl D. Roosens Fritz C. Offner Lucien A. Noens Johan M. Decruyenaere 《Journal of critical care》2010
Purpose
The aim of this study was to assess the impact of the 3 types of initial respiratory support (noninvasive positive pressure ventilation vs invasive positive pressure ventilation vs supplemental oxygen only) in hematological patients with acute hypoxemic respiratory failure (ARF).Materials and Methods
This study is a retrospective analysis of a cohort of hematological patients admitted to the intensive care unit (ICU) of a tertiary care hospital between January 1, 2002, and June 30, 2006.Results
One hundred thirty-seven hematological patients were admitted at the ICU with ARF (defined as Pao2/Fio2 <200): within the first 24 hours, 24 and 67 patients received noninvasive positive pressure ventilation and invasive positive pressure ventilation, respectively, and 46 received supplemental oxygen only. Intensive care unit mortality in the 3 patient categories was 71%, 63%, and 32%, respectively (P = .001), and in-hospital mortality was 75%, 80%, and 47%, respectively (P = .001). In multivariate regression analysis, increasing cancer-specific severity-of-illness score upon admission and more organ failure after 24 hours of ICU admission, but not the type of initial respiratory support, were significantly associated with ICU or in-hospital mortality.Conclusions
Intensive care unit and in-hospital mortality in our population of hematological patients with hypoxemic ARF was determined by severity of illness and not by the type of initial respiratory support. 相似文献5.
陈贤楠 《中国危重病急救医学》1996,8(4):210-213
气管内肺通气(ITPV)是一种新的持续正压通气方式。本研究应用直流和反流两种气管插管内导管进行ITPV,并与压力控制通气(PCV)进行比较。结果显示:直流ITPV的PaCO2下降0.69~0.93kPa(1kPa=7.5mmHg,P<0.05),生理死腔(VD)减少0.8ml/kg;反流ITPV的PaCO2下降1.07~1.33kPa(P<0.01),VD减少1.0ml/kg;在维持PaCO25.07±0.44kPa条件下,反流ITPV气管内吸气压峰压(PIP)下降33%,平均气道压(Paw)下降约50%;PaO2和血流动力学参数均无显著变化(P>0.05)。提示:ITPV通过减少生理死腔使通气效率提高,可以用较低的PIP和Paw维持肺的正常气体交换;反流ITPV比直流ITPV显示更有效的通气效率 相似文献
6.
Effects of ventilatory pattern on experimental lung injury caused by high airway pressure 总被引:2,自引:0,他引:2
Simonson DA Adams AB Wright LA Dries DJ Hotchkiss JR Marini JJ 《Critical care medicine》2004,32(3):781-786
OBJECTIVE: To determine the influence of clinician-adjustable ventilator settings on the development of ventilator-induced lung injury, as assessed by changes in gas exchange (Pao2), compliance, functional residual capacity, and wet weight to dry weight ratio. DESIGN: Randomized in vivo rabbit study. SETTING: Hospital research laboratory. SUBJECTS: Forty-four anesthetized, mechanically ventilated adult rabbits. INTERVENTIONS: Ventilation for 2 hrs with pressure control ventilation at 45 cm H2O, Fio2 = 0.6, and randomization to one of five ventilatory strategies using combinations of positive end-expiratory pressure (3 or 12 cm H2O), inspiratory time (0.45, 1.0, or 2.0 secs), and frequency (9 or 23/min). MEASUREMENTS AND MAIN RESULTS: Among the ventilator strategies applied, PEEP at 12 cm H2O (elevated positive end-expiratory pressure) and inspiratory time at 0.45 secs (reduced inspiratory time) best preserved Pao2 (p <.003) and compliance (p <.035). During injury development, two consistent changes were observed: Tidal volume increased, and airway pressure waveform was transformed by extending the time to attain target pressure. CONCLUSIONS: In this preclinical model, lung injury was attenuated by decreasing inspiratory time. As lung injury occurred, tidal volume increased and airway pressure waveform changed. 相似文献
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8.
目的 探讨雷公藤内酯醇对重症急性胰腺炎(SAP)肺损伤大鼠的保护作用及其可能机制.方法 将36只雄性Wistar大鼠随机分为假手术组(sham组)、模型组和雷公藤内酯醇处理组(Tri组)3组,每组6只.sham组仅行剖腹术;Tri组和模型组采用牛磺胆酸钠胰胆管逆行注射法复制SAP肺损伤模型,然后分别腹腔注射雷公藤内酯醇0.2 mg/kg或等量生理盐水.制模后6 h处死动物,取肺组织测定肺组织肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)的mRNA表达、蛋白含量及核转录因子-κB(NF-κB)活性.结果 与sham组比较,模型组肺组织TNF-α mRNA与IL-1β mRNA表达及蛋白含量、NF-κB活性均显著升高;与模型组比较,Tri组上述指标均明显降低,差异均有统计学意义(P均<0.01).结论 雷公藤内酯醇对SAP肺损伤大鼠具有一定保护作用,与抑制NF-κB活性进而下调TNF-α、IL-1β等炎症因子表达有关. 相似文献
9.
10.
Partitioning the work-sparing effects of partial ventilatory support in airflow obstruction
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John J Marini 《Critical care (London, England)》2003,8(2):101
Sweeping conclusions regarding the utility or nonutility of elevating expiratory pressure are not warranted. The effects of
manipulating airway pressure in the setting of airflow obstruction depend heavily on the nature and severity of disease, as
well as on the presence of airflow limitation during tidal breathing. 相似文献
11.
Marini JJ 《Critical care (London, England)》2004,8(2):101-102
Sweeping conclusions regarding the utility or nonutility of elevating expiratory pressure are not warranted. The effects of manipulating airway pressure in the setting of airflow obstruction depend heavily on the nature and severity of disease, as well as on the presence of airflow limitation during tidal breathing. 相似文献
12.
目的:观察高压氧联合呼吸训练对颈脊髓损伤患者肺功能的影响。方法:选取2018年3月—2019年5月在我院住院的颈脊髓损伤患者共60例,用随机数字表法将上述60例患者随机分为对照组和观察组(每组各30例),对照组给予常规药物、康复治疗,并给予PT呼吸训练每日1次,观察组在对照组治疗的基础上同时给予高压氧治疗,每日1次,分别于治疗前及治疗4周后检查肺功能,重点评估用力肺活量(FVC),第一秒用力呼气容积(FEV1),最大通气量(MVV)的变化。结果:与治疗前比较,对照组的FVC、FEV1、MVV分别增加了0.45±0.41L、0.27±0.36L、16.53±22.06L/min,FVC%pred、FEV1%pred、MVV%pred分别提高了11.33±9.41%、8.85±10.38%、12.78±16.77%;观察组治疗前后FVC、FEV1、MVV分别增加了1.20±0.39L、0.86±0.29L、42.40±23.81L/min,FVC%pred、FEV1%pred、MVV%pred分别提高了24.27±7.70%、24.27±7.07%、33.47±19.75%。治疗前后比较,... 相似文献
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14.
Peter M Spieth Andreas Güldner Robert Huhle Alessandro Beda Thomas Bluth Dierk Schreiter Max Ragaller Birgit Gottschlich Thomas Kiss Samir Jaber Paolo Pelosi Thea Koch Marcelo Gama de Abreu 《Critical care (London, England)》2013,17(5):R261
Introduction
This study aims at comparing the very short-term effects of conventional and noisy (variable) pressure support ventilation (PSV) in mechanically ventilated patients with acute hypoxemic respiratory failure.Methods
Thirteen mechanically ventilated patients with acute hypoxemic respiratory failure were enrolled in this monocentric, randomized crossover study. Patients were mechanically ventilated with conventional and noisy PSV, for one hour each, in random sequence. Pressure support was titrated to reach tidal volumes approximately 8 mL/kg in both modes. The level of positive end-expiratory pressure and fraction of inspired oxygen were kept unchanged in both modes. The coefficient of variation of pressure support during noisy PSV was set at 30%. Gas exchange, hemodynamics, lung functional parameters, distribution of ventilation by electrical impedance tomography, breathing patterns and patient-ventilator synchrony were analyzed.Results
Noisy PSV was not associated with any adverse event, and was well tolerated by all patients. Gas exchange, hemodynamics, respiratory mechanics and spatial distribution of ventilation did not differ significantly between conventional and noisy PSV. Noisy PSV increased the variability of tidal volume (24.4 ± 7.8% vs. 13.7 ± 9.1%, P <0.05) and was associated with a reduced number of asynchrony events compared to conventional PSV (5 (0 to 15)/30 min vs. 10 (1 to 37)/30 min, P <0.05).Conclusions
In the very short term, noisy PSV proved safe and feasible in patients with acute hypoxemic respiratory failure. Compared to conventional PSV, noisy PSV increased the variability of tidal volumes, and was associated with improved patient-ventilator synchrony, at comparable levels of gas exchange.Trial registration
ClinicialTrials.gov, NCT00786292相似文献15.
Giorgio A. Iotti Andrea Polito Mirko Belliato Daniela Pasero Gaetan Beduneau Marc Wysocki Josef X. Brunner Antonio Braschi Laurent Brochard Jordi Mancebo V. Marco Ranieri Jean-Christophe M. Richard Arthur S. Slutsky 《Intensive care medicine》2010,36(8):1371-1379
Objective
To compare the short-term effects of adaptive support ventilation (ASV), an advanced closed-loop mode, with conventional volume or pressure-control ventilation in patients passively ventilated for acute respiratory failure.Design
Prospective crossover interventional multicenter trial.Setting
Six European academic intensive care units.Patients
Eighty-eight patients in three groups: patients with no obvious lung disease (n = 22), restrictive lung disease (n = 36) or obstructive lung disease (n = 30).Interventions
After measurements on conventional ventilation (CV) as set by the patients’ clinicians, each patient was switched to ASV set to obtain the same minute ventilation as during CV (isoMV condition). If this resulted in a change in PaCO2, the minute ventilation setting of ASV was readjusted to achieve the same PaCO2 as in CV (isoCO2 condition).Measurements and results
Compared with CV, PaCO2 during ASV in isoMV condition and minute ventilation during ASV in isoCO2 condition were slightly lower, with lower inspiratory work/minute performed by the ventilator (p < 0.01). Oxygenation and hemodynamics were unchanged. During ASV, respiratory rate was slightly lower and tidal volume (Vt) slightly greater (p < 0.01), especially in obstructed patients. During ASV there were different ventilatory patterns in the three groups, with lower Vt in patients with restrictive disease and prolonged expiratory time in obstructed patients, thus mimicking the clinicians’ choices for setting CV. In three chronic obstructive pulmonary disease patients the resulting Vt was unacceptably high.Conclusions
Comparison between ASV and CV resulted either in similarities or in minor differences. Except for excessive Vt in a few obstructed patients, all differences were in favor of ASV. 相似文献16.
17.
目的探讨脑外伤后并发急性肺损伤(acute lung injury,ALI)及急性呼吸窘迫综合征(acute respiratory distresssyndrome,ARDS)的病理机制、诊断标准及治疗方法。方法对我院自2005年2月至2011年2月收治的重型颅脑损伤并发ALI患者27例和并发ARDS患者19例的临床资料进行回顾性分析。结果并发ALI的27例患者中,GOS评分I级9例,II级0例,III级1例,IV级7例,V级10例。并发ARDS的19例患者中,GOS评分I级10例,II级2例,III级4例,IV级2例,V级1例。结论 ALI及ARDS病死率高,严重影响脑外伤患者的生存率,临床上须给予足够的重视,积极预防、早期诊断、早期使用呼吸机及药物治疗,以提高患者的治愈率。 相似文献
18.
Anna Maria Brambilla Stefano Aliberti Elena Prina Francesco Nicoli Manuela Del Forno Stefano Nava Giovanni Ferrari Francesco Corradi Paolo Pelosi Angelo Bignamini Paolo Tarsia Roberto Cosentini 《Intensive care medicine》2014,40(7):942-949
Purpose
The efficacy of noninvasive continuous positive airway pressure (CPAP) to improve outcomes in severe hypoxemic acute respiratory failure (hARF) due to pneumonia has not been clearly established. The aim of this study was to compare CPAP vs. oxygen therapy to reduce the risk of meeting criteria for endotracheal intubation (ETI).Methods
In a multicenter randomized controlled trial conducted in four Italian centers patients with severe hARF due to pneumonia were randomized to receive helmet CPAP (CPAP group) or oxygen delivered with a Venturi mask (control group). The primary endpoint was the percentage of patients meeting criteria for ETI, including either one or more major criteria (respiratory arrest, respiratory pauses with unconsciousness, severe hemodynamic instability, intolerance) or at least two minor criteria (reduction of at least 30 % of basal PaO2/FiO2 ratio, increase of 20 % of PaCO2, worsening of alertness, respiratory distress, SpO2 less than 90 %, exhaustion).Results
Between February 2010 and 2013, 40 patients were randomized to CPAP and 41 to Venturi mask. The proportion of patients meeting ETI criteria in the CPAP group was significantly lower compared to those in the control group (6/40 = 15 % vs. 26/41 = 63 %, respectively, p < 0.001; relative risk 0.24, 95 % CI 0.11–0.51; number needed to treat, 2) two patients were intubated in the CPAP group and one in the control group. The CPAP group showed a faster and greater improvement in oxygenation in comparison to controls (p < 0.001). In either study group, no relevant adverse events were detected.Conclusions
Helmet CPAP reduces the risk of meeting ETI criteria compared to oxygen therapy in patients with severe hARF due to pneumonia. 相似文献19.
Effects of noninvasive positive pressure ventilatory support in non-COPD patients with acute respiratory insufficiency after early extubation 总被引:1,自引:0,他引:1
Kilger E Briegel J Haller M Frey L Schelling G Stoll C Pichler B Peter K 《Intensive care medicine》1999,25(12):1374-1380
Objective: To investigate the effects of noninvasive positive pressure ventilation (NPPV) on pulmonary gas exchange, breathing pattern,
intrapulmonary shunt fraction, oxygen consumption, and resting energy expenditure in patients with persistent acute respiratory
failure but without chronic obstructive pulmonary disease (COPD) after early extubation. Design: Prospective study. Setting: Multidisciplinary intensive care unit of a university hospital. Patients: 15 patients after prolonged mechanical ventilation (> 72 h) with acute respiratory insufficiency after early extubation.
Interventions: Criteria for early extubation were arterial oxygen tension (PaO2) L 40 mm Hg (fractional inspired oxygen 0.21), arterial carbon dioxide tension (PaCO2) K 55 mm Hg, pH > 7.32, respiratory rate K 40 breaths per min, tidal volume (VT) L 3 ml/kg, rapid shallow breathing index K 190 and negative inspiratory force L 20 cmH2O. After extubation, two modes of NPPV were applied [continuous positive airway pressure (CPAP) of 5 cmH2O and pressure support ventilation (PSV) with 15 cmH2O pressure support]. Measurements and main results: Oxygenation and ventilatory parameters improved during both modes of NPPV (p < 0.05): increase in PaO2 of 11 mm Hg during CPAP and 21 mm Hg during PSV; decrease in intrapulmonary shunt fraction of 7 % during CPAP and 12 % during
PSV; increase in tidal volume of 1 ml/kg during CPAP and 4 ml/kg during PSV; decrease in respiratory rate 6 breaths/min during
CPAP and 9 breaths/min during PSV. Oxygen consumption (15 % during CPAP, 22 % during PSV) and resting energy expenditure (12
% during CPAP, 20 % during PSV) were reduced (p < 0.05). PaCO2 decreased, whereas minute ventilation and pH increased during PSV (p < 0.05). The median duration of NPPV was 2 days. Two patients had to be reintubated. Conclusions: In non-COPD patients with persistent acute respiratory failure after early extubation, NPPV improved pulmonary gas exchange
and breathing pattern, decreased intrapulmonary shunt fraction, and reduced the work of breathing.
Received: 14 May 1999 Final revision received: 25 June 1999 Accepted: 6 July 1999 相似文献
20.
Nasal ventilation is becoming increasingly recognised as an effective therapeutic strategy to minimise or correct hypercapnia in patients with respiratory failure. Intervention may be required on a short or long term basis. In the majority of patients, respiratory failure develops initially during sleep. Assessing patients at risk of nocturnal hypoventilation, and instituting appropriate therapy, is becoming an increasingly important aspect of respiratory care. This review outlines methods and practices involved in commencing nasal ventilation therapy. Twenty-nine patients presenting with hypercapnic respiratory failure were managed with nocturnal nasal ventilation over a 12 month period. With the use of this therapy PaCO2 fell from 64(2) to 50(1)mmHg (Mean(SE)) (p<0.001), while PaO2 improved from 55(2) to 68(2)mmHg (p<0.001) during a mean ventilation time of 10(0.8) days. Those factors which must be addressed for a successful program outcome are discussed. 相似文献