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《Anaesthesia and Intensive Care Medicine》2019,20(11):644-650
This article focuses on the functional features of positive-pressure ventilators, the modes of invasive and non-invasive mechanical ventilation, and the main ventilator settings. It also highlights the potential complications of mechanical ventilation, the basic principles of weaning, and the pathophysiological basis of patient-ventilator dyssynchrony. 相似文献
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The interactive role of mucosal T lymphocytes in intestinal growth, development and enteropathy 总被引:2,自引:0,他引:2
Abstract Over the past 15–20 years, research has progressively focused on the mucosal T cell as the central factor in the initiation of physiological or pathological changes, first in the growth and maturation of the early (postnatal) intestine, and second in adult-type enteropathies resulting from sensitivity to either food or pathogen-derived antigens. T cell-mediated events may be measured, for example, in terms of specific immunopathologic patterns of change and injury, such as type 1 (lymphocyte infiltration), type 2 (crypt hyperplasia) and type 3 (flat-destructive), which can be recognized and quantitated microscopically; by determination of lymphocyte reactivity through secretion of interleukin-2 receptors (IL-2R) into plasma or expression by mucosal lymphocytes; by quantitation of lymphocyte subsets emigrating into inflamed tissues by immunoperoxidase-labelled monoclonal antibodies; or by the determination of T cell receptor polymorphisms. Alterations in intestinal growth, structure and function at weaning are likely to be T cell-mediated as they are analogous to the same type 1/2 lesions that reflect modulation of adult mucosal architecture in food and parasite-induced hypersensitivity reactions. Enteropathies associated with HIV infection and T cell deficiency display a milder degree of villous flattening and impaired crypt hyperplasia than that typical of gluten-sensitivity, suggesting a reversion to lesser degrees of mucosal pathology (type 1/2). Clearly more information will accrue; meanwhile the remarks in this brief survey should provide a firm basis whereby clinician and scientist can meet, and together recognize and further dissect the modulatory effect of T lymphocytes on mucosal structure and function. 相似文献
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Abstract Several methods have been used to predict successful weaning and extubation among chronic obstructive pulmonary disease (COPD) patients. The objective of this study is to determine whether carbon dioxide recruitment threshold (PCO2 RT) can be used as adjunct to conventional weaning parameters to predict early weaning and successful extubation. Twelve COPD patients who were ready to be extubated based on conventional weaning parameters were divided into group A ( n = 7) and group B ( n = 5). Group A were those patients with better weaning parameters and hence a higher probability of successful extubation as compared to group B. Carbon dioxide apnoeic threshold (PCO2 AT) was obtained by hyperventilating the patient using an increment of two breaths per min until apnoea occurs. At this point, the PCO2 AT or the PaCO2 during said apnoeic period was recorded. A dead space of 150 cc is then added to the circuit until the patient starts to breathe as evidenced by the sensitivity trigger indicator. The PCO2 obtained at this period is termed PCO2 RT. After weaning for 30 min on a T-tube, another arterial blood gas is determined and this is called the PCO2 SB or the CO2 level after 30 min on spontaneous breathing. If the PCO2 SB-PCO2 RT difference is high with a sensitivity of 85.71% and specificity of 100% vs sensitivity of 57.14% and specificity of 60% using the conventional weaning parameters. Thus an increase in PCO2 SB at 30 min T-tube is indicative of impending respiratory pump failure and that other causes of failure to wean must be investigated. 相似文献
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哌拉西林/他唑巴坦治疗呼吸机相关性肺炎的临床疗效观察 总被引:11,自引:4,他引:7
目的 评价哌拉西林/他唑巴坦治疗呼吸机相关性肺炎的安全性和有效性。方法 对33例呼吸机相关性肺炎患者采用哌拉西林/他唑巴坦治疗,每次4.5g,q8h~q12h静脉滴注,疗程7~14d。结果 治疗总有效率84.85%,细菌清除率88.23%,不良反应率3.03%。结论 哌拉西林/他唑巴坦具有安全、低毒、抗菌谱广的特点,是治疗呼吸机相关性肺炎的良效药物。 相似文献
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Haberthür C Elsasser S Eberhard L Stocker R Guttmann J 《Acta anaesthesiologica Scandinavica》2000,44(6):749-757
BACKGROUND: In tracheally intubated or tracheostomized spontaneously breathing patients, tube resistance can highly increase the patient's work of breathing. In this study we focused upon the relationship between total (WOBtot) and tube-related additional inspiratory work of breathing (WOBadd) and compared different ventilatory modalities for proper tube compensation. METHODS: In ten tracheostomized spontaneously breathing patients we measured WOBtot and WOBadd in the continuous positive airway pressure (CPAP) mode, under inspiratory pressure support of 5, 10, and 15 cmH2O in the pressure support ventilation (PSV) mode, and under flow-adjusted pressure support in the automatic tube compensation (ATC) mode. WOBadd and WOBtot were calculated on the basis of measured tracheal pressure and esophageal pressure, respectively. Inspiratory peak tracheal pressure above PEEP was taken as an estimate of pressure support beyond mere tube compensation (i.e., overcompensation). RESULTS: The percentage of the tube-related WOBadd on WOBtot in the CPAP mode was 52%. It decreased with increasing pressure support in the PSV mode from 32% (PSV 5 cmH2O) to 17% (PSV 15 cmH2O). WOBadd was only 15% of WOBtot in the ATC mode. In contrast to the other ventilatory modes, reduction of WOBadd in the ATC mode was achieved with the smallest amount of overcompensation, i.e. with minimal pressure assist beyond mere tube compensation. CONCLUSION: In tracheally intubated or tracheostomized spontaneously breathing patients, adequate compensation of tube resistance (i.e. with minimal overcompensation and minimal undercompensation) is best done by the ATC mode. 相似文献
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目的研究不同因素对左向右分流型先心病新生儿呼吸机撤离(简称撤机)成功率的影响。方法收集左向右分流型先心病机械通气新生儿95例,定义48 h内无需重新插管者属撤机成功。以撤机成功率为因变量,以新生儿胎龄、体重、肺动脉压力水平、肺血流量、缺损大小、缺损类型、合并心衰、肺炎为自变量进行多元线性逐步回归,筛选出可能的影响因素,进一步研究不同影响因素对撤机成功率的影响。结果肺动脉压力、肺血流量大小和缺损类型是影响撤机成功率的重要因素(P均<0.05)。中重度肺动脉高压组的撤机成功率低于轻度肺动脉高压组(P均<0.05),差异有统计学意义。高肺血流量组的撤机成功率低于无高肺血流量组(P均<0.05),差异有统计学意义。联合缺损组的撤机成功率低于单纯缺损组(P均<0.05),差异有统计学意义。结论肺动脉压、肺血流量、缺损类型是影响撤机成功率的重要因素。 相似文献
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目的:研究早期饲料构成对高脂膳食大鼠体重、体脂含量、血糖、甲状腺素FT4及肝脏肉碱棕榈酰转移酶-Ⅰ(CPT-Ⅰ)mRNA水平的影响。方法:新生Wistar雄性大鼠24d断乳,按体重随机分为A、B、C、D四组,分别给予高碳水化合物构成的基础饲料、高蛋白质、高不饱和脂肪酸、与高饱和脂肪酸构成的饲料喂养3w后,基础饲料喂养2w。按体重将A组随机分为A1、A2两组。A1组喂饲基础饲料作为对照组,A2与B、C、D组给予高脂饲料喂养6w,结束实验;A2组为高碳水化合物对照组。每组32头大鼠,动态观察体重、体脂含量、血糖、甲状腺素(FT4)及肝脏CPT-ⅠmRNA水平。结果:实验末期,C组大鼠体重、体脂含量和血糖显著低于A2组(P<0.05)、甲状腺素FT4水平明显高于A2组(P<0.05);B组体重、体脂含量明显低于A2组(P<0.05),甲状腺素FT4水平明显高于A2组(P<0.05),但血糖水平高于A2组(P>0.05);D组大鼠体重明显低于A2组(P<0.05),血糖、体脂含量和甲状腺素FT4水平与A2无差异(P>0.05)。动态观察表明,实验中C组大鼠肝脏CPT-ⅠmRNA水平持续升高。结论:早期饲料构成可能通过影响甲状腺素水平、持续改变CPT-Ⅰ基因表达,影响高脂膳食大鼠的体重和体脂含量。 相似文献