A case series of paediatric high flow nasal cannula therapy

IntroductionHigh flow nasal cannula is an emerging treatment option in Paediatric Intensive Care Units for paediatric patients in acute respiratory distress. Yet there is a paucity of literature describing its clinical application in various presenting pathophysiologies.AimTo describe three cases with differing underlying pathophysiologies and their response to high flow nasal cannula oxygen therapy.MethodPatients admitted to the Paediatric Intensive Care Unit with bronchiolitis, asthma and cardiomyopathy, and treated with high flow nasal cannula therapy were searched in the Paediatric Intensive Care database. The most representative cases were chosen to review.ResultsOne infant and two children were reviewed. All were commenced on high flow nasal cannula therapy in the Paediatric Intensive Care Unit and all demonstrated an improvement in their work of breathing. There was also a substantial improvement in their haemodynamic status. No patient required escalation to other forms of respiratory therapy.ConclusionHigh flow nasal cannula therapy is a viable treatment option for a range of patients presenting to the Paediatric Intensive Care Unit with acute respiratory distress. More invasive methods of respiratory support may be avoided by the use of high flow nasal cannula therapy.     

大鼠尾壳核微量注射锂盐对痛反应的影响

本工作利用慢性埋置导管的方法将氯化锂直接注射于大鼠尾壳核头前区及头中心区,在核团水平分析锂盐影响动物痛阈的机制.结果表明:(1)尾壳核头前区注射锂盐可产生明显的镇痛作用,并可分别被纳洛酮、阿托品、酚妥拉明、心得安、荷包牡丹碱和二乙基麦角酰胺所对抗,但不能被氟哌啶醇所阻断.(2)尾壳核头中心区微量注射锂盐不能产生镇痛作用     

Septal release of vasopressin in response to osmotic, hypovolemic and electrical stimulation in rats

The central release of vasopressin was studied in anesthetized rats using push-pull perfusions and radioimmunoassay of the hormone. A basal release was observed in the lateral septum and in the lateral ventricle, whereas no vasopressin was detected in the perfusates from the caudate nucleus. Under osmotic stimulation, vasopressin release increased up to 12 and 60 times basal levels following i.p. injections of 5 ml and 10 ml/kg b.wt. of 2 M NaCl, respectively. This increase was blocked by using a calcium-free perfusion medium containing 0.1 mM EGTA. In the lateral ventricle, osmotic stimulation (5 ml/kg of 2 M NaCl i.p.) had the same effect as in the septum. In the caudate nucleus, no release was observed. Hemorrhage also increased the septal release of vasopressin in 5 out of 6 animals tested. Electrical stimulation of the pituitary stalk and of the supraoptic nucleus was used to evoke the release of vasopressin into the bloodstream. Septal release slightly decreased during pituitary stalk stimulation, whereas it did increase during stimulation of the supraoptic region. Our results show that systemic stimuli for vasopressin release evoke both a peripheral and a septal release of the hormone. The dissociation of the effects of electrical stimulation of the pituitary stalk and of the supraoptic nucleus suggests, however, that the vasopressinergic neurones responsible for septal release are distinct from those which project to the neurohypophysis.     

Carotid occlusion increases the release of endogenous GABA in the nucleus of the solitary tract

Summary In anaesthetized cats, the nucleus of the solitary tract was bilaterally superfused through push-pull cannulae with artificial cerebrospinal fluid (CSF) and the effect of carotid occlusion on the release of endogenous GABA was investigated.Bilateral carotid occlusion led to a rise in blood pressure which was associated with a very pronounced increase in the release rate of GABA in the nucleus of the solitary tract. The results demonstrate the hypertensive function of GABA in the nucleus of the solitary tract and the importance of GABAergic neurons of this nucleus for the central cardiovascular control.This work was supported by the Fonds zur Fbrderung der wissenschaftlichen Forschung Send offprint requests to A. Philippu at the above address     

肝硬化难治性腹水结肠透析时间和插管深度的临床研究

[目的]研究结肠透析时间和插管深度对肝硬化难治性腹水治疗效果的影响。[方法]将100例肝硬化难治性腹水病人随机分成两组,每组50例。观察组结肠透析时间80min,插管深度55cm~60cm;对照组结肠透析时间40min,插管深度25cm~30cm。[结果]观察组结肠透析后中药灌肠保留时间、腹水消退、清除肌酐与尿素氮以及病人症状改善明显优于对照组(P<0.01)。[结论]选择结肠透析时间80min、插管深度55cm~60cm对难治性腹水治疗效果好。     

气管套管内管消毒时间间隔的临床研究

目的探讨合理的气管套管内管消毒间隔时间。方法随机选择2002年1月至2004年6月因喉咽疾病而行气管切开术后带气管套管的住院患者共119例,双月住院患者为观察组共67例,消毒内管1次/8h;单月住院患者为对照组共52例,消毒内管1次/6h。结果观察组患者满意度高达86%,睡眠时间和质量明显提高,与对照组相比有统计学意义(P<0.01)。结论内管消毒时间间隔8h符合患者的临床需要,值得推广应用。     

全麻术后患者鼻塞给氧效果的观察

为防止全麻术后机械通气撤机后的低氧血症，应合理使用氧疗。对术前通气功能正常的患者，可给予鼻塞吸氧，３Ｌ／ｍｉｎ，氧分压及二氧化碳分压均可达到满意的效果。     

Evaluation of two commercially available carbon dioxide sampling nasal cannulae

Our study compared two commercially available carbon dioxide sampling nasal cannulae for efficacy of oxygenation and relationship of end-tidal carbon dioxide (Petco ₂) to arterial carbon dioxide (Paco₂). The two-prong nasal cannula (2PNC) has one prong dedicated to delivering O₂ via one naris and the second prong dedicated to sampling exhaled gases via the other naris. The four-prong nasal cannula (4PNC) delivers O₂ via a prong in each naris, and samples exhaled gases via another set of prongs in each naris. Forty six patients were divided into three groups, which received either 2 (n = 15), 3 (n = 16), or 4(n = 15) L/min O₂, respectively, and were studied sequentially with standard nasal cannula (SNC), the 2PNC, and then the 4PNC. At each O₂ flow rate, Pao₂ was equivalent regardless of whether the SNC, 2PNC, or 4PNC was used. Seventy-four percent (34/46) of the 2PNC and 0% (0/46) of the 4PNCPetco2 values were within ±4 torr of the Paco₂ value. The authors conclude that the 2PNC and 4PNC are equally effective compared with an SNC in oxygenating patients, but thePetco2 measured by the 2PNC provides a superior quantitative estimate of the Paco₂ than that obtained by the 4PNC.