Objective To study the efficacy of invasive ventilation in critical severe acute respiratory syndrome (SARS). Methods Retrospective analysis was applied to study the efficacy of invasive ventilation and the effect of isolating and protecting measures in 6 critical SARS patients and the effect of isolation measures in ICU from November 2002 to April 2003. Results Six SARS patients were successfully weaned from mechanical ventilation and left hospital. Hypoxemia and oxygenation index（PaO2/FiO2）improved significantly after ventilation (Plt;0.01), peak inspiratory airway pressure (P=0.002), mean airway pressure (P=0.004), and the level of positive expiration end pressure decreased significantly (Plt;0.001). Ventilator-associated pneumonia occurred in 5 patients. Sedatives were used less and the duration of ventilation was shorter when using PRVC compared with SIMV. There was no SARS nosocomial infection among medical staff, other patients and their families. Conclusions Application of invasive ventilation and effective isolation measures could reduce the death rate, shorten the duration of ventilation, and also decrease SARS nosocomial infection.
[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
ObjectiveTo evaluate the effect of driving pressure-guided lung protective ventilation strategy on lung function in adult patients under elective cardiac surgery with cardiopulmonary bypass.MethodsIn this randomized controlled trial, 106 patients scheduled for elective valve surgery via median sternal incision under cardiopulmonary bypass from July to October 2020 at West China Hospital of Sichuan University were included in final analysis. Patients were divided into two groups randomly. Both groups received volume-controlled ventilation. A protective ventilation group (a control group, n=53) underwent traditional lung protective ventilation strategy with positive end-expiratory pressure (PEEP) of 5 cm H2O and received conventional protective ventilation with tidal volume of 7 mL/kg of predicted body weight and PEEP of 5 cm H2O, and recruitment maneuver. An individualized PEEP group (a driving pressure group, n=53) received the same tidal volume and recruitment, but with individualized PEEP which produced the lowest driving pressure. The primary outcome was oxygen index (OI) after ICU admission in 30 minutes, and the secondary outcomes were the incidence of OI below 300 mm Hg, the severity of OI descending scale (the Berlin definition), the incidence of pulmonary complications at 7 days after surgery and surgeons’ satisfaction on ventilation.ResultsThere was a statistical difference in OI after ICU admission in 30 minutes between the two groups (273.5±75.5 mm Hg vs. 358.0±65.3 mm Hg, P=0.00). The driving pressure group had lower incidence of postoperative OI<300 mm Hg (16.9% vs. 49.0%, OR=0.21, 95%CI 0.08-0.52, P=0.00) and less severity of OI classification than the control group (P=0.00). The incidence of pulmonary complications at 7 days after surgery was comparable between the driving pressure group and the control group (28.3% vs. 33.9%, OR=0.76, 95%CI 0.33-1.75, P=0.48). The atelectasis rate was lower in the driving pressure group (1.0% vs. 15.0%, OR=0.10, 95%CI 0.01-0.89, P=0.01).ConclusionApplication of driving pressure-guided ventilation is associated with a higher OI and less lung injury after ICU admission compared with the conventional protective ventilation in patients having valve surgery.
Objective To investigate the effects of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery. Methods The patients who underwent upper abdominal surgery under general anesthesia in Chengdu Office Hospital of the People’s Government of Tibet Autonomous Region between February 2020 and February 2021 were selected. Patients were randomly divided into volume controlled ventilation (VCV) group, pressure controlled ventilation (PCV) group, and pressure controlled ventilation-volume guarantee (PCV-VG) group according to the random number table method. All the three groups adopted the internationally recognized lung protective ventilation strategy. The transcutaneous arterial oxygen saturation and respiratory mechanics indicators of three different time periods, as well as pulmonary symptoms and signs and laboratory imaging examinations 7 days after surgery were recorded. The incidence of postoperative pulmonary complications in the three groups of patients were evaluated using the Melbourne Group Scale Version 2. Results A total of 120 patients were included, with 40 in each group. There was no statistically significant difference in the general situation of the three groups of patients (P>0.05). The platform pressure and compliance of three different time periods all changed over time (P<0.05). There were statistically significant differences in the occurrence of pulmonary complications and hospital stay among the three groups 7 days after surgery (P<0.05). Conclusion Under the internationally recognized lung protective ventilation strategy, PCV-VG mode can significantly reduce the incidence of pulmonary complications 7 days after abdominal surgery, shorten the length of hospital stay, and improve the quality of life in elderly patients.
Objective To evaluate the efficacy of lung-protective strategies of ventilation (LPSV) in acute respiratory distress syndrome (ARDS) patients after thoracic operation. Methods-Thirtyseven ARDS patients without preoperative complications who had underwent thoracic surgery successfully were divided into the conventional mechanical ventilation group (CMV group, n=20) and lungprotective strategies of ventilation group (LPSV group，n=17). Results of arterial blood gas, index of oxygenation (PaO2/FiO2), airway plateau pressure (Pplat), inspiration peak pressure (PIP), PEEP, after ventilation treatment 24 h and mechanical ventilation time， pulmonary barotrauma and so on were observed. Results The mechanical ventilation time， pulmonary barotrauma and mortality of the LPSV group were 7.3d, 5.9％ and 29.4％ respectively, which were significantly better than those in the CMV group(17.6d，15.0％ and 60.0％, Plt;0.05). peak inflation pressure (PIP)，Pplat(plat pressure) in the LPSV group were significantly lower than those in the CMV group (Plt;0.05). However, there were no significant differences including arterial oxygen saturation (SaO2),pH, partial pressure of carbon dioxide in artery (PaCO2) and PaO2/FiO2 in two groups. Conclusion LPSV is more effective for the patients in the ARDS patients after thoracic operation compared to CMV, which can markedly reduce the ventilatorinduced lung injuryand (VILI) and mortality.
Abstract： Ischemia postconditioning is a new concept based on ischemic preconditioning. It has become a hot topic in protection of ischemic-reperfusion injury because of its effective protection, relative ease of application, and postconditioning. However, its precise mechanisms and most effective application methods are still unclear. This review covers recent progress in the understanding, developments (in remote postconditioning and pharmacological postconditioning), applications to the protection of heart, lung, liver, kidney, and brain, mechanisms and appropriate protocol of ischemic post-conditioning.
Acute lung injury is a kind of common complication after cardiopulmonary bypass. Acute lung injury is attributed to the ischemia-reperfusion injury and systemic inflammatory response syndrome. Several factors common in cardiac surgery with cardiopulmonary bypass may worsen the risk for acute lung injury including atelectasis, transfusion requirement, older age, heart failure, emergency surgery and prolonged duration of bypass. Targets for prevention of acute lung injury include mechanical, surgical and anesthetic interventions that aim to reduce the contact activation, systemic inflammatory response, leukocyte sequestration and hemodilution associated with cardiopulmonary bypass. We aim to review the etiology, risk factors and lung protective strategies for acute lung injury after cardiopulmonary bypass.
Objective To systematically review the efficacy of ambroxol for lung protection in perioperative period. Methods We followed the Cochrane Collaboration methodology to conduct systematic reviews. We searched relevant randomized controlled trials (RCTs) from The Cochrane Library, PubMed, Embase, CBM, CNKI and VIP. We assessed the methodological quality for each outcome by grading the quality, and used RevMan5.0.0 to perform meta-analysis. Results Eight RCTs were eligible and included 669 patients. All of these trials used randomization but the quality scales were B. Compared to the control group, the ambroxol group had a statistically significant benefit in atelectasis, pulmonary complications, cough and expectoration degree. The RR (95%CI) were 0.44 (0.25, 0.78), 0.51 (0.34, 0.75), 0.39 (0.16, 0.94) and 0.22 (0.09, 0.53), respectively. The ambroxol group was also better than the control group in sputum volume, sputum characteristics, rales and pulmonary surfactant. Conclusion Ambroxol can improve respiratory system symptoms post-operatively, reduce pulmonary complications, and prevent pulmonary surfactant from decreasing during operation. Ambroxol has a satisfactory lung protective effect in the preoperative period, but we can’t define a proper dose and usage time.