Conservation of oxygen supply using a reservoir nasal cannula in hypoxemic patients at rest and during exercise

A reservoir nasal cannula which stores oxygen during exhalation and delivers it as a bolus during inhalation has been reported to conserve oxygen delivery in patients with chronic obstructive pulmonary disease (COPD) at rest. We compared the effects upon arterial oxygen saturation (SaO2) of the reservoir cannula and a standard nasal cannula in hypoxemic obstructed and restricted patients at rest and during exercise. The SaO2 was monitored by ear oximeter. While at rest, 13 obstructed and four restricted patients breathed oxygen from the reservoir cannula at 0.5, 1.0, 1.5, and 2.0 L/min and from a standard cannula at 0.5, 1.0, 2.0, 3.0, and 4.0 L/min. Mean SaO2 was significantly higher with the reservoir cannula compared to the standard cannula at 1.0 and 2.0 L/min (p less than 0.0006) and tended to be higher at 0.5 L/min (p less than 0.1). Seven obstructed patients walked on a level treadmill at 0.75 mph while breathing oxygen at 0.5 and 1.5 L/min from the reservoir cannula and at 1.0 and 3.0 L/min from the standard cannula. The SaO2 during exercise with the reservoir cannula was comparable to that with the standard cannula at approximately half of the oxygen flow rate. The ratio of the oxygen flow rate of the standard to the reservoir cannula to produce 90 percent saturation was estimated and found to be 2.5 +/- 0.8 (mean +/- SD) for patients at rest and 2.9 +/- 1.8 during exercise. We conclude that in hypoxemic patients at rest and during exercise, the reservoir cannula uses less than half the oxygen of a standard cannula to produce similar improvement in SaO2 and thus has advantages of a reduced cost of ambulatory therapy with low-flow oxygen and a longer time permitted away from a stationary source of oxygen.     

床旁纤维支气管镜引导下经鼻气管插管治疗COPD并发呼吸衰竭的临床研究

目的 探讨床旁纤维支气管镜引导下经鼻气管插管治疗COPD并发呼吸衰竭的临床应用价值.方法 对35例COPD合并呼吸衰竭的患者采用床旁纤维支气管镜引导下经鼻气管插管建立人工气道,机械通气.结果 35例患者均为一次性插管成功,插管时间小于2分钟,无严重并发症发生.结论 床旁纤维支气管镜引导下经鼻气管插管操作简单,安全,成功率高,并发症少.     

Use of nasal cannula for detecting sleep apneas and hypopneas in infants and children

We evaluated tolerance of nasal cannula (NC) by 14 infants (median age, 2.6 months) and 16 children (median age, 5.5 years) with suspected obstructive sleep apnea syndrome and compared the efficacy of the NC with that of a nasobuccal thermistor in detecting obstructive apneas (OA) and obstructive hypopneas (OH) on polysomnography traces. The relationship between cannula flow and esophageal pressure was assessed in six patients. Time spent with an uninterpretable flow signal was longer when using a cannula than when using a thermistor in infants (p < 0.05) and children (p < 0.01), and it was longer in the younger patients (p < 0.05). Among the 650 OA-OH detected by either method, only 38% were detected by both, and 58% were detected by the cannula and missed by the thermistor, so that the apnea-hypopnea index was higher with cannula than with thermistor in each age group (p < 0.01). More hypopneas than apneas were detected by the cannula and missed by the thermistor (p < 0.001). Out-of-phase thoracic and abdominal motions and/or changes in the end-tidal CO(2) signal shape were associated with 86% of OH identified by cannula. In the six patients whose esophageal pressure was measured, all respiratory events identified using a cannula were associated with increased "airway resistance." Thus, the NC is more likely than the thermistor to detect OA and OH in infants and children, and this superiority is particularly marked for hypopneas.     

Distal carotid perfusion in combined carotid endarterectomy and OP-CABG

An alternative method of maintaining carotid perfusion during combined carotid endarterectomy and off-pump coronary artery bypass grafting involves insertion of a cannula in the ascending aorta after a median sternotomy. This cannula is connected to a perfusion cannula, the distal end of which is inserted into the carotid artery beyond the carotid arteriotomy. This technique of aortico-carotid shunting and carotid perfusion was utilized in nine patients who underwent successful combined carotid endarterectomy and off-pump coronary artery bypass grafting.     

An indwelling subcutaneous FEP cannula for intermittent insulin injection: patient experience and effect on diabetic control

The acceptability and efficacy of injecting insulin through a subcutaneous FEP cannula (to reduce the frequency of needle pricks) compared with conventional multiple injection therapy was examined in a cross-over study. Thirty-two insulin-dependent diabetic patients injected through the cannula for 10 weeks using a pen injector, followed by 10 weeks using the injector alone, or vice versa. Rapid-acting insulin was given before meals and intermediate-acting insulin at bedtime. Blood glucose control was not affected by cannula use (glycosylated haemoglobin: cannula, 8.6 +/- 0.3%; no cannula, 8.6 +/- 0.3%). Twenty-two of the 30 patients completing the study preferred to use the cannula and 21 requested to continue using it. There were no complications associated with its use.     

Surgical complications of the Thomas pancreatic fistula

This report describes the surgical complications of the Thomas pancreatic fistula in 23 dogs used for experiments for up to 1 year. Twenty animals survived the operation of cannula placement. The two complications noted were subcutaneous retraction of the cannula (nine of 40 cannulas) between 2 and 6 weeks, which was easily corrected, and displacement of the cannula from the gut lumen, which occurred eight times. Complete loss of the duodenal cannula was rapidly fatal. Partial displacement was corrected four times, with one death, using a specially developed technique. One lost gastric cannula was also replaced successfully. Corrective surgery for surgical complications of the Thomas fistula is feasible and has a high success rate. The preparation has a good long-term survival and so is suitable when repeated experiments in the same animals are required over a period of several months.     

双腔管冲洗引流并尿激酶溶解术治疗高血压脑出血

目的:探讨双腔管冲洗引流并尿激酶溶解术治疗高血压脑出血的方法及效果.方法:回顾性分析38例在CT定位钻孔抽吸部分血肿后行双腔管冲洗引流并尿激酶注入治疗的高血压脑出血病人的临床特点及疗效.结果: 血肿清除率高,病人恢复良好,死亡率低,并发症少.结论:双腔管冲洗引流并尿激酶溶解术是高血压脑出血的一种简单、有效的治疗方法.     

Possible role of the stomach in enteroinsular axis in rats

To elucidate the possible role of the stomach in enteroinsular axis, rats had both an inflow gastric cannula and an outflow diversion cannula and a duodenal inflow cannula. The effects of intragastric infusion of glucose (1 mL in 10% solution) or mannitol (1 mL in 10% solution) on blood and plasma insulin responses to subsequent intraduodenal glucose (1.5 g/kg in 10% solution) or amino acids (1.0 g/kg in 10% solution) infusion were investigated. Blood glucose and plasma insulin responses to intraduodenal amino acids were not altered by intragastric infusion of glucose or mannitol. However, higher blood glucose and lower plasma insulin responses to intraduodenal glucose were observed in the rat with intragastric infusion of glucose or mannitol compared with controls (intragastric infusion of distilled water). This phenomenon was abolished in the rat with preadministration of phentolamine. These results suggest that intragastric tonicity may suppress glucose-induced insulin secretion, probably through the alpha-adrenergic mechanism in the rat.     

Transthoracic Echocardiography of the HeartWare Left Ventricular Assist Device

BackgroundThe unique findings on transthoracic echocardiography of the HeartWare left ventricular assist device (LVAD) have not been previously described.Methods and ResultsHeartWare LVADs were implanted in 19 patients from May 2009 through December 2010; 152 comprehensive transthoracic echocardiograms (TTEs) performed postoperatively on these patients were retrospectively analyzed for device component visualization, inlet cannula/outflow conduit flow velocities, and imaging artifacts. The inlet cannula was adequately visualized in 66% of studies, incompletely visualized in 14%, and not visualized in 20%. Spectral Doppler interrogation of inlet cannula flow velocity was always uninterpretable due to artifact. Standard parasternal long-axis and apical views always included the inlet cannula in the imaging sector, resulting in a prominent “waterfall” color Doppler artifact obscuring the mitral valve. Inclusion of the inlet cannula in the imaging sector also precluded spectral Doppler interrogation of the mitral valve owing to artifact. The outflow conduit was partially visualized and interrogated by spectral Doppler in 68% of studies, and the average measured peak flow velocity was 1.4 m/s (range 1.0–1.9 m/s).ConclusionsThe HeartWare LVAD inlet cannula and outflow conduit are both readily visualized by TTE in a majority of patients. However, significant color and spectral Doppler artifacts occur when the inlet cannula is visualized in the imaging sector, necessitating routine off-axis Doppler interrogation of the mitral valve.     

应用临床护理路径对全麻术后气管导管患者预防呼吸机相关性肺炎的研究

目的探讨临床护理路径应用于全麻术后气管导管患者预防呼吸相关性肺炎(VAP)的临床效果。方法将150例全麻术后患者随机分为试验组和对照组。对照组77例,采用传统全麻术后气管导管护理方法;试验组73例,采用临床护理路径行全麻术后气管导管护理。拔管后进行临床护理效果评价。结果与对照组比较,试验组患者降低了住院时间和医疗费用、缩短了机械通气时间、提高了护理质量满意度和术后自理能力恢复率,使VAP的发生率明显降低。结论临床护理路径应用于全麻术后气管导管患者能使患者得到有效的气管导管护理,预防VAP的发生,同时提高了护士工作的主观能动性及护理工作的目标性和计划性。     

Combined high flow nasal cannula and negative pressure ventilation as a novel respiratory approach in a patient with acute respiratory failure and limb-girdle muscular dystrophy

We describe the case of a 56-year-old-man with limb-girdle muscular dystrophy affected by acute hypercapnic failure secondary to pneumonia treated with high flow nasal cannula, intermittent abdominal ventilation, and negative pressure ventilation. The patient did not tolerate noninvasive positive pressure ventilation and refused invasive ventilation and tracheostomy. We successfully experienced a novel approach combining high flow nasal cannula with cycles of intermittent abdominal pressure ventilation and negative pressure ventilation.Key words: high flow nasal cannula, intermittent abdominal pressure ventilation, negative pressure ventilation, limb-girdle muscular dystrophy     

卒中急性期肺部感染的原因分析

目的探索脑卒中急性期并发肺部感染可能的原因。方法分析297例脑卒中患者的临床资料,依照可能的原因分组分析。结果年龄、饮水试验、意识状态、气管插管、慢性肺病、留置胃管组间差异显著,均P<0.01;多元Logistic回归分析显示:高龄、饮水呛咳、意识障碍、气管插管、慢性肺病与肺部感染的发生显著相关。结论意识障碍、饮水呛咳、高龄、气管插管、慢性肺病是脑卒中急性期并发肺部感染的独立危险因素。     

经鼻气管插管机械通气抢救呼吸衰竭97例临床分析

目的探讨经鼻气管插管机械通气治疗呼吸衰竭的应用价值。方法对97例慢性呼衰急性加重或急性呼衰患者行纤维支气管镜引导下经鼻气管插管机械通气治疗。结果88例抢救成功，顺利脱机拔管，死亡9例。抢救成功率90．7％。结论通过该法建立人工气道并机械通气抢救呼吸衰竭疗效满意。     

CentriMag left ventricular assist system: cannulation through a right minithoracotomy

The CentriMag left ventricular assist system can be used for perioperative or postcardiotomy circulatory support of the failing heart. The device resides at the patient's bedside, and the cannulae are usually inserted through a midline sternotomy, with the inflow cannula in the left ventricle or right superior pulmonary vein and the outflow cannula in the aorta. In a patient whose chest has been closed and who has a delayed need for temporary mechanical support, a less invasive method of left ventricular assist device cannula insertion is preferred. In these cases, the CentriMag cannulae can be inserted through a right minithoracotomy with the inflow cannula in the right superior pulmonary vein and the outflow cannula in the aorta, with no heparinization. Herein, we describe this approach in a patient who experienced postcardiotomy cardiogenic shock after aortocoronary bypass surgery. This technique may facilitate ambulation and recovery in selected patients.     

Fatal sepsis following peripheral intravenous cannula embolus.

This is a case report of multiple septic complications of a peripheral intravenous cannula as a direct result of proximal embolization of a fragment of the cannula to the heart and major vessels.     

Performance of a demand oxygen saver system during rest, exercise, and sleep in hypoxemic patients

Demand oxygen systems have been shown to be effective in treating hypoxemia during seated rest and during exercise, but the performance of these systems during sleep has not been previously studied. We compared the efficacy of a new demand oxygen saver system with that of continuous flow nasal oxygen during the usual activities of daily life including sleep, seated rest, and exercise. Six hypoxemic patients were studied. All six had chronic obstructive pulmonary disease, though one patient had kyphoscoliosis with mixed obstructive and restrictive lung disease. Patients were studied during each activity of daily life while receiving supplemental oxygen by continuous flow nasal cannula at 2 liters per minute and during use of the demand oxygen saver system. The demand oxygen system produced arterial oxygenation equivalent to continuous flow nasal cannula under all conditions while utilizing substantially less oxygen. When compared with administration of oxygen by continuous flow nasal cannula, the demand oxygen saver cannula utilized only 45 percent as much oxygen during seated rest, 44 percent as much oxygen during exercise, and 39 percent as much oxygen during sleep. Our data support the use of demand oxygen systems for treatment of hypoxemia in patients with chronic obstructive lung disease.     

Percutaneous cannulation of large pericardial effusions

A rapid, easy, and safe method of introducing a large cannula into the pericardial space for drainage of large pericardial effusions using conventional catheter introducers and catheters is described. Confirmation of the presence of a sizeable pericardial effusion is essential before insertion of a percutaneous cannula.     

80岁以上老年人长期气管切开术后并发症的原因分析

目的探讨≥80岁老年患者长期气管切开术后并发症发生的原因及防治措施。方法回顾性分析2004年2月至2011年8月我院收治的≥60岁资料完整的行气管切开术350例患者临床资料,其中就气管切开后带套管较长时间的80例≥80岁老年患者的主要并发症原因及防治进行分析。结果 80例长期带管≥80岁老年患者其并发症最多见为反复肺部感染38例(47.50%),其合并多种致病菌,致病菌以铜绿假单胞菌为主,治疗棘手,是死亡的主要原因。其后依次为拔管困难15例(18.75%)、气管内出血14例(17.50%)、伤口渗血5例(6.25%)、套管堵塞4例(5.00%)、肺大泡3例(3.75%)、气管食管瘘1例(1.25%)。结论≥80岁老年气管切开术后带套管患者由于多种疾病并存,常合并多器官功能不全,凝血机制障碍,长期带管等都是气管切开术后并发症发生的主要危险因素。针对危险因素,做好并发症预防,可延缓患者生命。     

Percutaneous cannulation of large pericardial effusions.

A rapid, easy, and safe method of introducing a large cannula into the pericardial space for drainage of large pericardial effusions using conventional catheter introducers and catheters is described. Confirmation of the presence of a sizeable pericardial effusion is essential before insertion of a percutaneous cannula.     

Endovascular repair of ventricular assist device outflow cannula stenosis

This report describes a case of endovascular repair of an outflow cannula obstruction in a heart failure patient with biventricular assist devices. The patient presented with cardiogenic shock and was diagnosed via multimodality imaging with outflow cannula obstruction of the left ventricular assist device, likely from a hematoma. A transesophageal echocardiogram‐guided endovascular approach was undertaken. A 10.0 mm × 38 mm covered stent was successfully deployed and post‐dilated. Normal flow in the outflow cannula was restored. Hemodynamic and left ventricular flow parameters returned close to baseline post‐procedure. The growth in ventricular assist device implantation and associated complications will create new opportunities for endovascular repair. © 2016 Wiley Periodicals, Inc.