呼吸机相关肺炎30例研究

目的 了解呼吸机相关肺炎(VAP)病例的临床病原学特点、影响预后的因素等。方法采用回顾性资料分析方法。结果 混合感染在死亡组显著高于存活的患者,药敏试验显示革兰阴性菌对第三代先锋霉素耐药情况增加,对亚胺培南敏感性最佳;且很多革兰阴性杆菌对多种抗生素产生耐药性,VAP的预后受多种因素影响。结论 使用呼吸机1周内是VAP易感期,应作为预防的重点期,预防应从防止外源性致病菌进入和减少内源性致病菌定植两方面着手,对VAP的治疗特别要强调降阶梯治疗。     

双水平气道正压呼吸机治疗重症支气管哮喘的临床观察

【目的】研究双水平气道正压（BiPAP）呼吸机在治疗重症支气管哮喘的临床疗效。【方法】将31例重症支气管哮喘发作患者随机分为治疗组16例,对照组15例。治疗组在常规药物治疗的基础上,同时予BiPAP呼吸机经鼻（面）罩辅助通气治疗;对照组给予常规药物加氧疗。观察两组治疗前后患者的临床表现、心率、呼吸频率及动脉血气等指标的变化。【结果】治疗组与对照组在治疗后临床症状明显改善,各参数（PH除外）比较差异有显著性（P〈0．01）。【结论】在常规治疗的基础上合用BiPAP呼吸机治疗重症支气管哮喘安全有效。     

A low flow open circle system for anaesthesia Part I: Laboratory evaluation at normal and high frequencies

A circle breathing system was connected by deadspace tubing to an open system valveless ventilator. The minimum volume of this tubing, required to prevent dilution of anaesthetic gas in the breathing system by the driving gas of the ventilator, was determined at frequencies of 15, 30, 60, 100 and 150 breaths/minute, with tidal volumes that ranged from 100 to 1100 ml and a fresh gas supply to the circle system of 1, 2 and 4 litres/minute. At 15 breaths/minute, tidal volumes equal to or less than the deadspace volume could be used safely without any mixing with the ventilator driving gas, when a fresh gas flow of 2 litres/minute or above is supplied to the circle system. At 1 litre/minute of fresh gas flow, mixing occurred at tidal volumes less than the deadspace volume. Mixing of gas occurred in the system at frequencies greater than 30 breaths/minute even when the tidal volume was much less than the deadspace volume. However, at high frequencies of ventilation, since the tidal volume requirement decreases, deadspace tubing with a safe internal volume, that is greater than 600 ml, may be used up to 100 breaths/minute.     

New ventilators for the ICU--usefulness of lung performance reporting

Monitoring the functional and mechanical properties of the lungsduring positive pressure ventilation may assist in confirmingthe underlying pulmonary diagnosis, allow therapeutic interventionsto be accurately assessed and provide information that ensuresthe optimal setting of the ventilator parameters and encouragestimely weaning. This article reviews the range of lung functionmeasurements, both continuous and intermittent, that may beundertaken during mechanical ventilation. The monitoring capabilityof ICU ventilators is increasing in complexity.     

Ventilators,Guidelines, Judgment,and Trust

Covid-19 confronts us with tragic choices, in which every option is unacceptable. On the New York State Task Force on Life and the Law, I worked on guidelines for such situations. We did not envision the scale or character of Covid-19. To minimize fear that the decisions made in these situations might be unfair, we all must know what guidelines or mandates inform them. Only with transparency about how decisions will be made, by whom, and according to what requirements can we have confidence that fairness prevails. We now face many related questions about process, goals, leadership, and trust. For example, how might ethical guidelines evolve as scientific understanding advances? Should guidelines vary with different venues? And if, as I have argued, judgment is necessary even with the best of guidelines, how can we prepare clinicians to make good judgments? Are there implications for better training of personnel in nonemergency times for what they might face in the worst of times?     

晚期早产儿RDS机械通气并发症相关因素分析

目的分析晚期早产儿呼吸窘迫综合征（RDS）机械通气并发症相关影响因素。方法收集新生儿重症监护室（NICU）机械通气RDS晚期早产儿60例,根据是否发生机械通气并发症分为无并发症组（42例）和并发症组（18例）,比较两组病儿基本情况、围生期因素、孕母基本情况、机械通气情况的差异,采用Logistic回归方法对影响因素进行多元回归分析。结果两组病儿呼吸窘迫评分、新生儿危重病例评分、未足月胎膜早破发生率、肺表面活性物质（PS）使用率、机械通气前动脉血pH值、机械通气前动脉肺泡氧分压比值（a/A PO2）、母亲年龄方面比较差异有显著性（t或χ2=-2.371-5.080,P〈0.05）;Logistic回归分析显示,呼吸窘迫评分、新生儿危重病例评分、机械通气前a/A PO2、机械通气前动脉血pH值、未足月胎膜早破对并发症发生有一定影响（OR=0.017-9.503E36）。结论 RDS晚期早产儿机械通气并发症发生与多种因素有关。其中呼吸窘迫评分、新生儿危重病例评分、未足月胎膜早破、机械通气前a/A PO2及动脉血pH值与并发症发生密切相关。