经鼻(面)罩机械通气治疗慢性阻塞性肺疾病呼吸衰竭

目的观察慢性阻塞性肺疾病（ＣＯＰＤ）呼吸衰竭患者经鼻（面）罩机械通气的效果。方法对２９例慢性阻塞性肺疾病呼吸衰竭患者行经鼻（面）罩机械通气。结果治疗后２小时、２４小时、４８小时、１周后,ｐＨ从７．２８±０．１上升至７．３４±０．０７、７．３５±０．０６、７．３８±０．０５、７．３７±０．０７（Ｐ＜０．０１）,ＰａＣＯ２从９４．６９±１８．４ｍｍＨｇ下降至８６．０５±２４．６ｍｍＨｇ（Ｐ＜０．０１）、７７．７６±１９．３ｍｍＨｇ（Ｐ＜０．０１）、６８．６０±１１．４ｍｍＨｇ（Ｐ＜０．００１）、６６．６９±２６．９ｍｍＨｇ（Ｐ＜０．００１）,ＰａＯ２从５２．７２±１３．１ｍｍＨｇ上升至６４．２５±２４．５ｍｍＨｇ（Ｐ＜０．０５）、６９．０１±１６．６ｍｍＨｇ（Ｐ＜０．００２）、７５．２７±３２．８ｍｍＨｇ（Ｐ＜０．００１）、９１．１６±４０．４ｍｍＨｇ（Ｐ＜０．００１）。临床症状明显改善,有效率７５．９％。结论经鼻（面）罩机械通气对轻、中度的患者有较好的疗效。     

HFJV联合药物治疗兔海水淹溺肺水肿

目的：观察高频喷射通气（HFJV）联合4种药物治疗海水淹溺肺水肿（PE-SWD）的效果并探讨其作用机制。方法：用海水灌注的方法诱导PE-SWD模型,采用HFJV联合地塞米松、东莨菪碱、尼莫地平和果糖二磷酸钠4种药物进行治疗,观察记录相关的生理、生化指标。结果：HFJV联合4种药物治疗能明显改善PE-SWD相关指标。结论：HFJV联合4种药物治疗能有效治疗PE-SWD,可作为其基础治疗。     

开肺化痰解毒法治疗小儿病毒性肺炎痰热壅肺证临床观察

目的：应用开肺化痰解毒活血的清肺口服液方治疗小儿病毒性肺炎痰热壅肺证。方法：观察治疗组用清肺口服液（麻黄、杏仁、石膏、葶苈子、虎杖等）;对照组辨证用药加用头孢菌素Ｖ等抗生素,２组对照观察。结果：观察组显效率及有效率分别为８６．７％和９６．７％,同中药辨证加西药抗生素的对照组相比,疗效无显著性差异。观察组的咳嗽咯痰好转时间为（６．９０±２．０６）ｄ,显著短于对照组的（９．９３±２．９３）ｄ（Ｐ＜０．０５）;观察组治疗后的甲皱微循环总积分为０．５１±０．３９,显著小于对照组的１．８３±１．１９（Ｐ＜０．０１）。结论：清肺口服液方治疗小儿病毒性肺炎痰热壅肺证具有肯定的疗效。     

慢性阻塞性肺疾病继发急性呼吸衰竭机械通气治疗10例分析

目的：探讨慢性阻塞性肺疾病（ＣＯＰＤ）所致急性呼吸衰竭行机械通气（ＭＶ）治疗的转归及其影响因素。方法：通过对１０例ＣＯＰＤ所致急性呼吸衰竭患者的资料分析,评价ＭＶ治疗的临床疗效。结果：９例２￣４２天内撤机并拔管存活。结论：适宜的ＭＶ参数调节,良好的呼吸道管理,预防感染和营养支持对尽早撤机非常重要,其预后较好。     

小潮气量通气在急性呼吸窘迫综合征中的应用

应用小潮气量通气致容许性高碳酸血症方法对11例急性呼吸窘迫综合征（ARDS）进行临床观察。设定潮气量为6．4±1．1ml／kg,保持动脉血二氧化碳（PaCQ2）为5．97±1．41kPa,血氧分压8．54±3．19kPa。结果7例存活,未发现气压伤。说明小潮气量通气致一定程度高碳酸血症是临床上值得推荐使用的方法。     

Effects of ventilatory pattern on exhaled nitric oxide in mechanically ventilated rabbits

BACKGROUND: Nitric oxide [NOexp] is present in exhaled air in many species. During experiments on pressure-controlled inverse ratio ventilation (PCIRV) in rabbits, increased [NOexp] was observed during PCIRV. The present study was undertaken to clarify which component of PCIRV increased [NOexp]. METHODS: Three groups of six New Zealand White rabbits were anaesthetised and mechanically ventilated. Exhaled nitric oxide, lung mechanics and gas exchange were measured using an experimental protocol designed to assess the effects of variations in 1) flow profile, 2) inspiratory time and 3) time-weighted tidal volume. Ventilator settings used were volume and pressure control ventilation at I:E ratios of 1:2 and 4:1. RESULTS: Constant and decelerating flow gave comparable [NOexp] levels (20.0 +/- 6.4 vs. 21.9 +/- 7.7 ppb, n.s.) when time-weighted tidal volume was kept constant. Using conventional (I:E 1:2) or inverted (I:E 4:1) I:E ratios in combination with decelerating flow and constant time-weighted tidal volumes did not alter [NOexp] (26.0 +/- 3.6 vs. 24.0 +/- 5.8 ppb, n.s.). An increased time-weighted tidal volume produced by pressure control with an I:E ratio of 4:1 increased [NOexp] (29.6 +/- 7.4) in comparison to constant (19.3 +/- 4.1, P < 0.05) and decelerating flow ventilation (19.6 +/- 3.6, P < 0.05) with I:E ratios of 1:2. CONCLUSION: The exhaled NO concentration was affected by ventilator setting. Increased levels of [NOexp] were observed with increases in time-weighted tidal volume, whereas changes in flow pattern and inspiratory time did not seem to influence airway NO production or release.     

Inspiratory pressure/maximal inspiratory pressure: does it predict successful extubation in critically ill infants and children?

Objective To evaluate the accuracy of the initial negative inspiratory pressure (PI) to maximal negative inspiratory pressure (PI_max) ratio in predicting extubation outcome for intubated infants and children.Design A prospective study. Setting: Pediatric intensive care unit.Patients A sample of 50 stable intubated pediatric patients who were judged clinically ready for extubation.Methods Using a one-way valve,PI andPI_max were measured in all patients, after which the ratioPI/PI_max was calculated and its accuracy in predicting extubation outcome evaluated.Measurements and results A total of 39 patients (78%) were successfully extubated and 11 patients (22%) were not. The meanPI/PI_max ratio was not significantly different between extubation successes (0.36±0.14) and failures (0.45±0.1) (P>0.05). The cut-off value of 0.3 forPI/PI_max identified in adult patients did not discriminate between extubation success and failure in children. Furthermore, a discriminatory cut-off value other than 0.3 could not be identified for infants and children.Conclusion ThePI/PI_max ratio cannot be used to predict extubation outcome in pediatric patients. Indices that predict extubation outcome in adults should not be extrapolated to infants and children before testing and validation.     

Continuous infusion of rocuronium in a paediatric intensive care unit

Purpose  

To evaluate prospectively the efficacy and dose requirements of rocuronium administered by continuous infusion for neuromuscular blockade in a paediatric ICU population.     

High-frequency ventilation and conventional mechanical ventilation in newborn babies with respiratory distress syndrome: A prospective,randomized trial

Objective Morbidity and mortality remain high amongst babies ventilated for a respiratory distress syndrome (RDS). Whether newly developed ventilators allowing high frequency ventilation such as high frequency flow interrupted ventilation (HFFIV) could decrease the morbidity and the mortality was investigated in a randomized study.Design Preterm babies weighing 1800g suffering from RDS and ventilated by conventional mechanical ventilation (CMV) were randomized to be further ventilated either by CMV (group CMV) or by HFFIV (group HFFIV) when peak inspiratory pressure (PIP) on CMV was 20cmH₂O.Setting The study was undertaken in the neonatal intensive care unit of the Erasmus Hospital.Patients 24 patients entered into the investigation and were randomized but 2 patients were removed from the study because the switch over to HFFIV failed. Eight of the 12 CMV patients and 5 of the 10 HFFIV patients completed the study.Measurements and results Clinical variables, blood gas analysis and ventilatory variables were looked at. There were no differences in mortality, in incidence of air leaks and pulmonary complications or in blood gas analysis. Bronchopulmonary dysplasia was not decreased by the use of HFFIV.Conclusion It is concluded that HFFIV is safe although it offers no concrete advantages over CMV when applied as we did in a low pressure approach.     

Plasma catecholamines and oxygen consumption during weaning from mechanical ventilation

Previous studies on oxygen consumption ( ) during weaning from mechanical ventilation assumed that an increase in ( ) reflected oxygen consumption by respiratory muscles ( ), and proposed as a weaning predictor. We measured CO₂ production ( ) and plasma catecholamines in 20 short-term ventilated patients during weaning by SIMV and CPAP. as a percentage of during spontaneous ventilation ( %) ranged from 4.8% to 41.5%. also increased and correlated with . Plasma adrenaline and noradrenaline increased significantly to levels known to produce considerable increases in metabolic rate. Mean arterial pressure and heart rate concomitantly increased, but spontaneous minute ventilation decreased. Thus, since the increased plasma catecholamines are calorigenic, the assumption that represents is incorrect. Although mean % of successfully weaned patients was significantly less than that of failure-to-wean patients, the wide scatter of individual values in the latter group excludes % as an accurate weaning predictor.