Objective To explore the effect of budesonide nebulization in the treatment of mechanically ventilated patients with chronic obstructive pulmonary disease(COPD).Methods A total of 25 intubated and ventilated COPD patients complicated with respiratory failure was randomly divided into two groups.The control group consisted of 12 patients received salbutamol nebulization on the routine treatment.The budesonide group consisted of 13 patients received budesonide plus salbutamol nebulization on the routine treatment.Variables such as tumor necrosis factor-α(TNF-α) and interleukin-8(IL-8) in the bronchoalveolar lavage fluid(BALF) ， incidence of ventilation-associated lung injury(VALI) ， days of mechanical ventilation ，， days of hospitalization and survival rate were measured and compared.Results The survival rate and incidence of VALI were not different significantly between the two groups.However ， the levels of TNF-α and IL-8 in BALF of the control patients were significantly lower than those in the budesonide group[ （ 1.2±0.2 ） mg/L vs （ 1.5±0.4 ） mg/L ，（ 85.7±26.5 ）（ 125.6±30.4 ）， both Plt;0.05).And the days of mechanical ventilation and hospitalization were statistically shorter in the budesonide group compared with the control group[ (7.2±2.5 ） d vs （ 10.5±6.2 ） d ， (10.5±4.7 ） d vs (15.8±6.6 ） d ， both Plt;0.05].Conclusion Our data suggest that nebulization of budesonide can suppressed the pulmonary inflammation and decreased days of the mechanical ventilation and hospitalization in mechanically ventilated COPD patients.
Objective To analyze the relationship between end-tidal carbon dioxide partial pressure (PETCO2) and arterial CO2 pressure (PaCO2) in invasive ventilated patients. Methods An observational study was conducted in adult patients admitted to Intensive Care Unit (ICU) between June 2016 and March 2017. Samples were immediately analyzed for PaCO2 using a blood gas analyzer. At the same time the arterial to end-tidal CO2 gradient was determined. Relationship in different mechanical ventilation modes, disease categories and PaO2/FiO2 were analyzed in this study. Results A total of 225 arterial blood gases were obtained from the 104 patients. In each of these modes the PETCO2 was generally lower than the PaCO2. There was a positive correlation between PaCO2 and PETCO2 regardless of different mode (r=0.70, Y=11.08+0.77X). A positive correlation was found in SIMV and SPONT modes, but not in A/C mode. The relationship between PaCO2 and PETCO2 in COPD, trauma, cerebrovascular disease and severe pneumonia patients shown a positive correlation (r value was 0.76, 0.64, 0.53, and 0.56, respectively). There was a significant correlation whether PaCO2/FiO2<200 mm Hg (r=0.69, P<0.001) or ≥200 mm Hg (r=0.71, P<0.001). Conclusions The results of this study show that PETCO2 monitoring accurately reflects PaCO2 during mechanical ventilation. A positive correlation is found in different ventilation modes, regardless of disease categories or PaCO2/FiO2.
Objective To investigate the safety of high fraction of inspired oxygen (FiO2)during noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)and carbon dioxide (CO2)retention. Methods Fifty-six AECOPD patients with CO2 retention admitted between March 2013 and August 2015 were recruited in the study.All patients received noninvasive ventilation treatment with FiO2<0.5.After stabilization of acute respiratory crisis,FiO2 was increased to 1.0 and lasted for 40 minutes.The changes of tidal volume,respiratory frequency,minute volume,Glasgow coma score,arterial blood gas and SpO2 were observed before and after the FiO2 reset. Results The mean PaO2 increased from (83±14)mm Hg to (165±41)mm Hg and the mean SpO2 increased from (92.4±3.1)% to (97.8±1.9)% significantly (both P<0.001).The mean PaCO2 did not changed obviously from (72±15)mm Hg to (72±14)mm Hg (P=0.438).There were also no significant changes in any of the other parameters. Conclusion During noninvasive ventilation with an FiO2 sufficient to maintain a normal PaO2,an increase in FiO2 does not further increase PaCO2 level in AECOPD patients with CO2 retention.
Objective To analyze the quantitative relationship between respiratory effort and inferior vena cava (IVC) diameter variability in healthy adults, and explore the effects of respiratory effort on the fluid responsiveness with IVC diameter variability. Methods From October 2022 to May 2023, a cross-sectional study was conducted in healthy young subjects who met the criteria. Respiratory effort was evaluated by using portable pulmonary function to measure the subjects’ inspiratory conditions in three states (quiet breathing, moderate inspiration, and maximal inspiration). At the same time, the IVC internal diameter was measured by bedside ultrasound and the IVC diameter variability was calculated. The correlation between inspiratory volume and IVC diameter variation was analyzed, and the receiver operator characteristic (ROC) curve was drawn. The sensitivity and specificity of fluid responsiveness induced by inspiratory effort were predicted according to the area under the ROC curve (AUC). Results A total of 95 subjects were screened, aged 27.13±5.77 years, of whom 30 (32%) subjects were males. During quiet breathing, 41.1% of subjects had IVC inner diameter variation ≥50%. For moderate inspiration, it was 68.4%. At maximum inspiration, this proportion is more than 85%. Inspiratory volume was moderately positively correlated with IVC diameter variation, and the correlation coefficient r=0.45. With the IVC diameter variation ≥50% as the positive criterion for fluid responsiveness, the AUC of fluid responsiveness induced by inspiratory effort was 0.73 (95% confidence interval 0.67 - 0.78, P<0.001), and the inspiratory volume threshold was 13 mL/kg ideal body weight when the maximum Youden index was 0.41. That is, moderate force breathing can induce fluid responsiveness, with sensitivity of 79.57% and specificity of 61.62%. Conclusion The degree of respiratory effort significantly affects the IVC inner diameter variation, and there may be false positives in the evaluation of fluid responsiveness according to IVC inner diameter variation in the case of spontaneous breathing.