scholarly journals Inserting a Drainage Strip into the Pre-tracheal Space to Treat Tension Pneumomediastinum: A Case-control Study

2021 ◽  
Author(s):  
Qianli Liu ◽  
Song Wu ◽  
Chun Hong ◽  
Xiaohui Li
Keyword(s):  
Mechanical Ventilation ◽  
Chest Radiography ◽  
Total Duration ◽  
Severe Pneumonia ◽  
Control Group ◽  
Excessive Pressure ◽  
Arterial Blood ◽  
Surgery Group ◽  
Mechanical Ventilation Duration ◽  
Control Study

Abstract Background: A Severe tension pneumomediastinum can result in respiratory and circulatory dysfunction. Common etiologies include severe pneumonia such as COVID-19 pneumonia, asthma, excessive pressure from a ventilator, etc. we describe a method for draining tension pneumomediastinum by inserting a drainage strip into the pre-tracheal space.Methods:Design: Case-control.Setting: Data from a medical institution in southern China.Participants: 30 patients with tension pneumomediastinum and comorbid type II respiratory failure.Interventions: 15 patients (surgery group) were treated with a drainage strip being inserted into the pre-tracheal space while other 15 patients (control group) were treated without drainage.Outcome measures: Arterial blood pO2 and pCO2 after 30 minutes and 12 hours of mechanical ventilation, total duration of mechanical ventilation, and chest radiography results after 12 hours of mechanical ventilation.Results: Chest radiography after 12 hours of mechanical ventilation showed that the pneumomediastinum basically disappeared in the surgery group but did not decrease significantly in the control group. The arterial blood pCO2 after 12 hours of mechanical ventilation and total duration of mechanical ventilation were significantly lower in the surgery group than in the control group (95% CI -3.31 to -1.36, p<0.001; 95% CI -5.56 to -2.84, p<0.001), while the arterial blood pO2 after 12 hours of mechanical ventilation was significantly higher in the surgery group than in the control group (95% CI 1.76 to 7.57, p=0.004). There were no significant intergroup differences in other variables. No recurrence occurred in either group during 7–14 days after discharge, and all patients recovered.Conclusions: Our method for draining tension pneumomediastinum improved respiratory function and shortened mechanical ventilation duration.Trial registration: ChiCTR2000039496Data sharing statement: Technical appendix, statistical code, and dataset available from the FigShare repository, https://doi.org/10.6084/m9.figshare.13487295.

scholarly journals Inserting a Drainage Strip into the Pre-tracheal Space to Treat Tension Pneumomediastinum: A Case-control Study

2021 ◽  
Author(s):  
Qianli Liu ◽  
Xiaohui Li ◽  
Zhengzheng Han ◽  
Chun Hong
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Chest Radiography ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Arterial Blood ◽  
Surgery Group ◽  
Surgical Methods ◽  
Control Study

Abstract Background: Pneumomediastinum is an emergency pediatric disease. A severe tension pneumomediastinum can result in respiratory and circulatory dysfunction. However, few papers describe surgical methods to treat tension pneumomediastinum in a normative manner.Methods: We did a case-control study of 104 pediatric patients with tension pneumomediastinum and comorbid type II respiratory failure. Fifty-two patients were treated with a drainage strip being inserted into the pre-tracheal space while other 52 patients were treated without drainage. Arterial blood pO2 and pCO2 after 30 minutes and 12 hours of mechanical ventilation, chest radiography results after 12 hours of mechanical ventilation, and the length of stay in PICU of the two groups were analyzed by paired t-tests and Chi-square.Results: Chest radiography after 12 hours of mechanical ventilation showed that the pneumomediastinum basically disappeared in the surgery group but did not decrease significantly in the control group. The arterial blood pCO2 after 12 hours of mechanical ventilation and the length of stay in PICU were significantly lower in the surgery group than in the control group (p<0.001, p<0.001), while the arterial blood pO2 after 12 hours of mechanical ventilation was significantly higher in the surgery group than in the control group (p<0.001). There were no significant intergroup differences in other variables. No recurrence occurred in either group during 7–14 days after discharge, and all patients recovered.Conclusions: Our method for draining tension pneumomediastinum improved respiratory function and shortened the length of stay in PICU.Trial registration: ChiCTR2000039496. Date of registration: 2021/2/25 (retrospectively registered).

scholarly journals Effects of Donepezil and Medroxyprogesterone Versus Placebo on Weaning in Adult Patients With Non-Pulmonary Etiologies Receiving Invasive Mechanical Ventilation: A triple‐blind Randomized Clinical Trial

2021 ◽  
Vol 12 ◽  
Author(s):  
Zahra Alizadeh ◽  
Adeleh Sahebnasagh ◽  
Navid Hadadzadegan ◽  
Farhad Mohammadi ◽  
Fatemeh Saghafi
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Sofa Score ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Control Group ◽  
P Value ◽  
Arterial Blood ◽  
Successful Weaning ◽  
Ventilated Patients

Background: Medroxyprogesterone and donepezil could be used as respiratory stimulants in ventilated patients. However, no randomized placebo-controlled trial is available to confirm this approach and compare these drugs. The aim of the current study was to evaluate the effects of donepezil or medroxyprogesterone compared to the placebo in improvement in respiratory status and weaning facilitation in critically ill adult patients receiving mechanical ventilation.Material and Methods: This randomized, triple-blind trial was conducted on 78 ventilated patients in intensive care units (ICU). Patients who were intubated due to pulmonary disorders were ruled out. Patients were randomized in a 1:1:1 ratio to receive 5 mg donepezil (n = 23) or 5 mg medroxyprogesterone (n = 26), or placebo (n = 24) twice a day until weaning (maximum 10 days). The primary endpoints were weaning duration, and duration of invasive mechanical ventilation. Secondary endpoints included rate of successful weaning, changes in arterial blood gas (ABG) parameters, GCS and sequential organ failure assessment (SOFA) score, hemoglobin (Hgb), ICU-mortality, and duration of ICU stay, were measured before and after the intervention and if successful weaning was recorded.Results: Of 78 studied patients who were randomized, 59 weaned successfully. 87% patients in donepezil and 88.5% patients in medroxyprogesterone groups were successfully weaned compared to 66.7% patients in the placebo group. However, this difference was not statistically significant (p-Value = 0.111). Changes in pH, mean duration of intubation, and weaning duration were statistically different in donepezil compared with the control group (p-Value &lt; 0.05). No significant difference in ABG, Hgb, GCS and SOFA score, and duration of intubation were seen in the medroxyprogesterone group, but weaning duration was significantly reduced to 1.429 days compared with the control group (p-Value = 0.038).Conclusion: The results of this clinical trial have demonstrated that the administered dose of medroxyprogesterone and donepezil can expedite the weaning process by reducing the weaning duration compared to placebo. Furthermore, the total duration of invasive ventilation was significantly lower in the donepezil group compared to the control group. Future clinical trials with a larger sample size will determine the exact role of medroxyprogesterone and donepezil in mechanically ventilated patients.Clinical Trial Registration:https://irct.ir/IRCT20190810044500N2 (April 1, 2020).

scholarly journals The Efficacy and Safety of Pulmonary Vasodilators in Pediatric Pulmonary Hypertension (PH): A Systematic Review and Meta-analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Tingting Shu ◽  
Huaqiao Chen ◽  
Lu Wang ◽  
Wuwan Wang ◽  
Panpan Feng ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Hypertension ◽  
Meta Analysis ◽  
Control Group ◽  
Efficacy And Safety ◽  
Pulmonary Vasodilators ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Pulmonary Arterial

Background: We performed a meta-analysis to evaluate the efficacy and safety of pulmonary vasodilators in pediatric pulmonary hypertension (PH) patients.Methods: We searched electronic databases including PubMed, EMBASE, and the Cochrane Library up to May 2020, and conducted a subgroup analysis for pulmonary vasodilators or underlying disease.Results: Fifteen studies with 719 pediatric PH patients were included in the meta-analysis. Adverse events did not differ (p = 0.11, I2 = 15%) between the pulmonary vasodilators group and the control group, neither in the subgroups. In total, compared with the control group treatment, pulmonary vasodilators significantly decreased the mortality (p = 0.002), mean pulmonary artery pressure (mPAP, p = 0.02), and mechanical ventilation duration (p = 0.03), also improved the oxygenation index (OI, p = 0.01). In the persistent pulmonary hypertension of the newborn (PPHN) subgroup, phosphodiesterase type 5 inhibitors (PDE5i) significantly reduced mortality (p = 0.03), OI (p = 0.007) and mechanical ventilation duration (p = 0.004). Administration of endothelin receptor antagonists (ERAs) improved OI (p = 0.04) and mechanical ventilation duration (p &lt; 0.00001) in PPHN. We also found that in the pediatric pulmonary arterial hypertension (PPAH) subgroup, mPAP was pronouncedly declined with ERAs (p = 0.006). Systolic pulmonary artery pressure (sPAP, p &lt; 0.0001) and pulmonary arterial/aortic pressure (PA/AO, p &lt; 0.00001) were significantly relieved with PDE5i, partial pressure of arterial oxygen (PaO2) was improved with prostacyclin in postoperative PH (POPH) subgroup (p = 0.001). Compared with the control group, pulmonary vasodilators could significantly decrease PA/AO pressure (p &lt; 0.00001) and OI (p &lt; 0.00001) in the short-term (duration &lt;7 days) follow-up subgroup, improve mPAP (p = 0.03) and PaO2 (p = 0.01) in the mid-term (7–30 days) follow-up subgroup, also decrease mortality, mPAP (p = 0.0001), PA/AO pressure (p = 0.0007), duration of mechanical ventilation (p = 0.004), and ICU stay (p &lt; 0.00001) in the long-term follow subgroup (&gt;30 days).Conclusion: Pulmonary vasodilators decrease the mortality in pediatric PH patients, improve the respiratory and hemodynamic parameters, reduce the mechanical ventilation duration.

scholarly journals COVID-19-associated ARDS treated with DEXamethasone (CoDEX): Study design and rationale for a randomized trial

2020 ◽  
Author(s):  
Bruno M. Tomazini ◽  
Israel S. Maia ◽  
Flavia R. Bueno ◽  
Maria Vitoria A.O. Silva ◽  
Franca Pellison Baldassare ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Standard Treatment ◽  
Invasive Mechanical Ventilation ◽  
Intervention Group ◽  
Data Monitoring Committee ◽  
Ordinal Scale ◽  
Control Group ◽  
Once Daily ◽  
Mechanical Ventilation Duration ◽  
Icu Discharge

ABSTRACTOBJECTIVESThe infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) spreads worldwide and is considered a pandemic. The most common manifestation of SARS-CoV2 infection (Coronavirus disease 2019 - COVID-19) is viral pneumonia with varying degrees of respiratory compromise and up to 40% of hospitalized patients might develop Acute Respiratory Distress Syndrome (ARDS). Several clinical trials evaluated the role of corticosteroids in non-COVID-19 ARDS with conflicting results. We designed a trial to evaluate the effectiveness of early intravenous dexamethasone administration on the number of days alive and free of mechanical ventilation within 28 days after randomization in adult patients with moderate or severe ARDS due to confirmed or probable COVID-19.METHODSThis is a pragmatic, prospective, randomized, stratified, multicenter, open-label, controlled trial including 350 patients with early-onset (less than 48h before randomization) moderate or severe ARDS, defined by the Berlin criteria, due to COVID-19. Eligible patients will be randomly allocated to either standard treatment plus dexamethasone (intervention group) or standard treatment without dexamethasone (control group). Patients in the intervention group will receive dexamethasone 20mg IV once daily for 5 days, followed by dexamethasone 10mg IV once daily for additional 5 days or until Intensive Care Unit (ICU) discharge, whichever occurs first. The primary outcome is ventilator-free days within 28 days after randomization, defined as days alive and free from invasive mechanical ventilation. Secondary outcomes are all-cause mortality rates at day 28, evaluation of the clinical status at day 15 assessed with a 6-level ordinal scale, mechanical ventilation duration from randomization to day 28, Sequential Organ Failure Assessment (SOFA) Score evaluation at 48h, 72h and 7 days and ICU-free days within 28.ETHICS AND DISSEMINATIONThis trial was approved by the Brazilian National Committee of Ethics in Research (Comissão Nacional de Ética em Pesquisa - CONEP) and National Health Surveillance Agency (ANVISA). An independent data monitoring committee will perform interim analyses and evaluate adverse events throughout the trial. Results will be submitted for publication after enrolment and follow-up are complete.ClinicalTrials.gov identifierNCT04327401

scholarly journals Risk factors of bronchopulmonary dysplasia in premature infants under 32 weeks of gestation: A retrospective case-control study

2020 ◽  
Author(s):  
Li Yue ◽  
Shu Dong Cui
Keyword(s):  
Risk Factors ◽  
Premature Infants ◽  
Gestational Age ◽  
Invasive Mechanical Ventilation ◽  
Calorie Intake ◽  
Control Group ◽  
Retrospective Case ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Control Study

Abstract Background: Bronchopulmonary dysplasia (BPD) in preterm infants is one of the most serious complications in neonatology, as it significantly affects the quality of life of preterm children. We retrospectively analyze the incidence and risk factors of BPD in premature infants under 32 weeks of gestation age.Methods: Clinical data of premature infants with gestational age ≤32 weeks admitted to the neonatal intensive care unit of the First Affiliated Hospital of Nanjing Medical University from 2015 to 2017 were selected for this retrospective case-control study. The patients were classified into the BPD and control groups based on the clinical diagnosis. We compared the general condition, treatments, complications, and clinical outcome of premature infants in both groups. Student’s t-test, non-parametric test, and binary logistic regression were used to analyze the occurrence of BPD and its potential risk factors.Results: A total of 213 premature infants aged ≤32 gestational weeks were included in the study; of these, 81 (38%) were diagnosed with BPD. The gestational age (29.14±1.88 weeks vs. 30.82±0.98 weeks, P<0.001) and weight (1240±314.87 g vs. 1584.77±318.18 g, P<0.001) in the BPD group were lower than those in the control group. The liquid quantity, urine volume, and calorie intake of preterm infants in the BPD group within one week after birth were significantly lower than those of infants in the control group. Logistic regression analysis showed that invasive mechanical ventilation (OR=5.065, 95% CI: 1.680–15.266); use of erythrocyte suspension (OR=10.146, 95% CI: 1.860–55.336); and PCO2 in early postnatal arterial blood gas (OR=1.122, 95% CI: 1.024–1.229) were risk factors for BPD. On the other hand, gestational age (OR=0.657, 95% CI: 0.460–0.937); calorie intake (OR=0.917, 95% CI: 0.874–0.963); PO2 (OR=0.925, 95% CI: 0.870–0.985); and pH in early postnatal arterial blood gas (OR<0.001, 95% CI: 0.000–0.156) were protective factors for BPD.Conclusion: The incidence of BPD in very low and extremely low birth weight infants is high. Maintaining early internal environment stability, increasing early calorie intake, shortening invasive mechanical ventilation time, reducing blood transfusion, and closing patent ductus arteriosus could likely reduce the incidence of BPD.

Acute lung injury from mechanical ventilation at moderately high airway pressures

1990 ◽  
Vol 69 (3) ◽  
pp. 956-961 ◽  
Author(s):  
K. Tsuno ◽  
P. Prato ◽  
T. Kolobow
Keyword(s):  
Mechanical Ventilation ◽  
Peak Inspiratory Pressure ◽  
Blood Gases ◽  
Inspiratory Pressure ◽  
Control Group ◽  
Arterial Blood Gases ◽  
Lung Weight ◽  
Pulmonary Atelectasis ◽  
Arterial Pco2 ◽  
Arterial Blood

We have explored adverse pulmonary effects of mechanical ventilation at a peak inspiratory pressure of 30 cmH2O in paralyzed and anesthetized healthy sheep. A control group of eight sheep (group A) was mechanically ventilated with 40% oxygen at a tidal volume of 10 ml/kg, a frequency of 15 breaths/min, a peak inspiratory pressure less than 18 cmH2O, and a positive end-expiratory pressure of 3-5 cmH2O. During the ensuing 48 h, there were no measurable deleterious changes in lung function or arterial blood gases. Another 19 sheep were ventilated with 40% oxygen at a peak inspiratory pressure of 30 cmH2O under a different set of conditions and were randomly assigned to two groups. In group B, the respiratory rate was kept near 4 breaths/min to keep arterial PCO2 in the normal range; in group C, the frequency was kept near 15 breaths/min by including a variable dead space in the ventilator circuit to keep arterial PCO2 near baseline values. There was a progressive deterioration in total static lung compliance, functional residual capacity, and arterial blood gases. After some hours, there were abnormal chest roentgenographic changes. At time of death we found severe pulmonary atelectasis, increased wet lung weight, and an increase in the minimum surface tension of saline lung lavage fluid.

scholarly journals Different Tidal Volumes May Jeopardize Pulmonary Redox and Inflammatory Status in Healthy Rats Undergoing Mechanical Ventilation

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Leandro da Silva Cândido ◽  
Natália Alves de Matos ◽  
Thalles de Freitas Castro ◽  
Laisy Cristina de Paula ◽  
Aline Maria dos Santos ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Lung Tissue ◽  
Tissue Homogenate ◽  
Control Group ◽  
Adult Rats ◽  
Redox Imbalance ◽  
Inflammatory Status ◽  
Arterial Blood ◽  
Lung Tissue Homogenate

Mechanical ventilation (MV) is essential for the treatment of critical patients since it may provide a desired gas exchange. However, MV itself can trigger ventilator-associated lung injury in patients. We hypothesized that the mechanisms of lung injury through redox imbalance might also be associated with pulmonary inflammatory status, which has not been so far described. We tested it by delivering different tidal volumes to normal lungs undergoing MV. Healthy Wistar rats were divided into spontaneously breathing animals (control group, CG), and rats were submitted to MV (controlled ventilation mode) with tidal volumes of 4 mL/kg (MVG4), 8 mL/kg (MVG8), or 12 mL/kg (MVG12), zero end-expiratory pressure (ZEEP), and normoxia ( Fi O 2 = 21 % ) for 1 hour. After ventilation and euthanasia, arterial blood, bronchoalveolar lavage fluid (BALF), and lungs were collected for subsequent analysis. MVG12 presented lower PaCO2 and bicarbonate content in the arterial blood than CG, MVG4, and MVG8. Neutrophil influx in BALF and MPO activity in lung tissue homogenate were significantly higher in MVG12 than in CG. The levels of CCL5, TNF-α, IL-1, and IL-6 in lung tissue homogenate were higher in MVG12 than in CG and MVG4. In the lung parenchyma, the lipid peroxidation was more important in MVG12 than in CG, MVG4, and MVG8, while there was more protein oxidation in MVG12 than in CG and MVG4. The stereological analysis confirmed the histological pulmonary changes in MVG12. The association of controlled mode ventilation and high tidal volume, without PEEP and normoxia, impaired pulmonary histoarchitecture and triggered redox imbalance and lung inflammation in healthy adult rats.

Efficacy of Bronchoalveolar Lavage as Adjunct Therapy in the Treatment of Neonatal Severe Pneumonia: A Prospective Case–Control Study

2020 ◽  
Vol 66 (5) ◽  
pp. 528-533 ◽  
Author(s):  
Jing Liu ◽  
Hui-Rong Zhao ◽  
Hua-Li Wei ◽  
Chen Chen ◽  
Ru-Xin Qiu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Side Effects ◽  
Bronchoalveolar Lavage ◽  
Invasive Mechanical Ventilation ◽  
Vital Signs ◽  
Length Of Hospital Stay ◽  
Severe Pneumonia ◽  
Control Group ◽  
Adverse Side Effects ◽  
Before And After

Abstract Objective The aim of this study was to investigate the efficacy and safety of bronchoalveolar lavage (BAL) in the treatment of neonatal severe pneumonia (NSP). Methods One hundred patients with severe pneumonia were randomly divided into two groups, the BAL and control groups, with 50 patients in each group. In the BAL group, normal saline was instilled into the endotracheal tube for BAL. Before and after lavage, lung ultrasound (LUS) monitoring was performed to observe the lung pathological changes. Conventional treatment was administered in the control group. The need for and duration of invasive mechanical ventilation, the complication rate, the duration and cost of hospitalization and the mortality rate were compared between the two groups. Results The results of this study showed that there were 35 (70%) patients who meet the indications of the invasive mechanical ventilation (IMV) at admission in the BAL group, while there were only 15 (30%) patients still requiring IMV after BAL therapy. The duration of IMV was 41.7 ± 7.5 vs. 97.7 ± 12.9 h in BAL and controls, the incidence rate of complications was 8.0% vs. 20.0% in both groups, the length of hospital stay was 9.2 ± 1.9 vs. 14.1 ± 2.1 days in both groups, and the expense of hospital cost was 12 557 ± 832 vs. 19 121 ± 929 Chinese Yuan in both groups. All patients had stable vital signs during lavage, and no significant adverse side effects were observed. Conclusion BAL was significantly beneficial for NSP with no significant adverse side effects; LUS is a useful tool for the timely detection of BAL effects.

Rorschach Characteristics in Adolescents with Systemic Lupus Erythematosus

2006 ◽  
Vol 28 (1) ◽  
pp. 100-118 ◽  
Author(s):  
J. Santoantonio ◽  
L. Yazigi ◽  
E. I. Sato
Keyword(s):  
Lupus Erythematosus ◽  
Case Control Study ◽  
Activity Index ◽  
Disease Activity Index ◽  
Female Adolescents ◽  
Control Group ◽  
Intelligence Scale ◽  
The Mean ◽  
Experimental Group ◽  
Control Study

The purpose of this study was to investigate the personality characteristics in adolescents with SLE. The research design is a case-control study by means of the Rorschach Method and the Wechsler Intelligence Scale. Study group: 30 female adolescents with lupus, 12–17 years of age. The SLE Disease Activity Index was administered during the period of psychological evaluation. Control group: 32 nonpatient adolescents were matched for age, sex, and socioeconomic level. In the Wechsler Intelligence Scale the mean IQ of the experimental group was significantly lower than that of the control group (77 and 98, respectively, p < .001). In the Rorschach, the lupus patients showed greater difficulty in interpersonal interactions, although they displayed the resources to process affect and to cope with stressful situations. A positive moderate correlation (p = .069) between the activity index of the disease and the affect constriction proportion of the Rorschach was observed: the higher the SLEDAI score, the lower the capacity to process affect. There is a negative correlation between the activity index of the disease and the IQ (p = .001): with a higher activity index of the disease, less intellectual resources are available.

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