ObjectiveTo observe the clinical effect of retrograde lacrimal intubation under endoscope in the treatment of chronic dacryocystitis. MethodsWe retrospectively analyzed the clinical data of 83 patients (103 eyes) with chronic dacryocystitis treated in our department from March 2011 to January 2013. They underwent retrograde lacrimal intubation under endoscope. The postoperative follow-up continued 9 months and the curative effect was observed. ResultsEighty-eight eyes were cured, accounting for 85.44%; improvement occurred in 10 eyes, accounting for 9.71%; five eyes were not cured, accounting for 4.85%. As a result, the total effective rate was 95.15%. ConclusionRetrograde lacrimal intubation under endoscope is a safe and effective surgical method for the treatment of chronic dacryocystitis.
ObjectiveTo observe the effect of different preoxygenation methods for emergency intubation in severe patients in intensive care unit (ICU). MethodsProspective randomized study was performed in the intensive care unit between June 2013 and January 2014. Forty patients were randomly divided into 4 groups:group A (control group, n=10), group B (bag-valve-mask preoxygenation group, n=10), group C (noninvasive ventilator-mask preoxygenation group, n=10), and group D (invasive ventilator-mask preoxygenation group, n=10). Standardized rapid sequence intubation was performed without preoxygenation in group A; preoxygenation was performed by using a bag-valve-mask rose pulse oxygen saturation (SpO2) to 90% before a rapid sequence intubation in group B; preoxygenation was performed by using noninvasive ventilator through a face mask rose SpO2 to 90% before a rapid sequence intubation in group C; and preoxygenation was performed by using invasive ventilator through a face mask rose SpO2 to 90% before a rapid sequence intubation in group D. We recorded the time when SpO2 was more than or equal to 90% in group B, C, and D, and arterial blood gases and complications were observed. ResultsThere was no significant difference in the basic indexes before preoxygenation among the four groups (P>0.05). The time of the patients in group D and C was significantly lower than that of group B. The arterial oxygen saturation (SaO2) and arterial oxygen partial pressure (PaO2) in the group C and D were higher than those in group B after preoxygenation (P<0.05). After intubation, SpO2 in group B, C and D was significantly higher than that in group A (P<0.05). At the same time, SpO2 in group C and D was higher than that in group B (P<0.05); PaO2 and SaO2 in group C and D were higher than in those in group A and B (P<0.05); SaO2 in group D was higher than that in group B (P<0.05). The incidence of abdominal distension in group D was significantly lower than that of group B and C (P<0.05). ConclusionFor emergency tracheal intubation in critically ill patients in the ICU, preoxygenation is more effective than the rapid sequence intubation without preoxygenation in improving oxygenation indicators. Invasive ventilator-mask preoxygenation efficacy and safety are superior to other methods.
ObjectiveTo identify the incidence of postintubation hypotension (PIH) in critically ill patients and evaluate the responsive risk factors and prognosis. MethodsThe data of intubation patients with normal blood pressure before intubation were collected and analyzed in Intensive Care Unit (ICU) in the latest two years and divided into two groups. One contained PIH patients and the other one contained patients with no change in blood pressure after intubation. The primary outcome measure was 28-day mortality and secondary outcome measure was length of stay (LOS) in ICU and hospital. ResultsThere were 25(31.65%) PIH patients in included 79 patients. The patients in PIH group had significantly higher 28-day mortality (40.00% vs 14.81%, P=0.01) and there were no difference in LOS in ICU and hospital. Risk factors were age (OR:1.1, 95% CI:1.00-1.12), chronic respiratory diseases (OR:3.0, 95% CI:1.13-8.07) and complication with over two chronic diseases (OR:3.6, 95% CI:1.18-11.03). ConclusionPIH is more common in old patients complicated with chronic diseases and results in higher 28-day mortality.
Objective To investigate the efficacy and influential factors of interventional therapy for post-intubation tracheal stenosis. Methods The clinical data of 69 patients with tracheal stenosis after tracheal intubation in the First Affiliated Hospital of Guangzhou Medical University from February 2010 to March 2015 were retrospectively analyzed. The effects of interventional treatment for tracheal stenosis after intubation were evaluated by reviewing the medical records and telephone follow-up for more than 1 year. Multivariate logistic regression model was used to analyze the influential factors. Results The study recruited 69 patients with the median age of 44 years. After the interventional treatment, ATS dyspnea score decreased from (2.41±0.76) points to (0.65±0.62) points ( P<0.01), the diameter of airway lumen increased from (4.24±2.05)mm to (10.57±3.14)mm ( P<0.01). The short-term effective rate of interventional therapy was 92.8% (64/69) but the restenosis rate in 1 month, 3 months and 1 year after interventional treatment were 56.5%, 26.1% and 36.2%, respectively. Multivariate logistic regression analysis showed that diabetes (OR=2.819, 95%CI 1.973-4.062）, shortness of breath score >3 points (OR=13.816, 95%CI 5.848-32.641）, trachea stenosis diameter <4.5 mm (OR=7.482, 95%CI 4.015-13.943), tracheal stenosis grade ≥4 (OR=3.815, 95%CI 2.258-6.447), stenosis in the upper trachea (OR=5.173, 95%CI 3.218-8.316) were risk factors of interventional therapy for post-intubation tracheal stenosis. Conclusions The general efficacy of interventional treatment for tracheal stenosis after tracheal intubation is poor, and the recurrence rate is still high. The high degree of tracheal stenosis, diabetes mellitus and upper tracheal stenosis are important factors that affect the efficacy of respiratory interventional therapy.
ObjectiveTo investigate whether noninvasive positive pressure ventilation (NIV) will improve preoxygenation in critically ill patients in intensive care unit (ICU) before intubation, when compared with bag-valve-mask (BVM).MethodsThis was a single-centered, prospective and randomized study. The patients in the study were those who required tracheal intubation in the ICU of the First Affiliated Hospital of Guangzhou Medical University and Guangzhou Institute of Respiratory Health from June 2015 to June 2017. These critically ill patients were provided with BVM or NIV assisted preoxygenation randomly. The data of the NIV group and the control group were compared and the application values of NIV in preoxygenation of critically ill patients were evaluated.ResultsA total of 106 patients participated in this study, including 75 males and 31 females and with an average age of (65.0±12.6) years. The patients were classified either into the control group (BVM assisted preoxygenation, n=53), or the NIV group (NIV assisted pre-oxygenation, n=53). The causes of intubation in the control group and the NIV group were as follows: pneumonia [40 patients (75.5%) vs. 39 patients (73.6%)], chronic obstructive pulmonary disease [12 patients (22.6%) vs. 11 patients (20.8%)], and other disease [1 patient (1.9%) vs. 3 patients (5.7%)], which showed no significant difference between the two groups. The scores of the Acute Physiology and Chronic Health Evaluation System Ⅱ of the control group and the NIV group were 20 (17, 26) vs. 20 (16, 26), P=0.86, which also showed no significant difference. The oxygen saturation of the pulse (SpO2) before preoxygenation were similar in both the control group and the NIV group 92% (85%, 98%) vs. 91% (85%, 98%), P=0.87. After preoxygenation, SpO2 was significantly higher in the NIV group than in the control group 99% (96%, 100%) vs. 96% (90%, 99%), P=0.001. For the subgroup of patients with SpO2 less than 90% before preoxygenation, the respective SpO2 in the control group and the NIV group were 83% (73%, 85%) vs. 81% (75%, 86%), P=0.75; after preoxygenation, SpO2 in the NIV group was significantly higher than in the control group 99% (96%, 100%) vs. 94%(90%, 99%), P=0.000. For the subgroup of patients with SpO2 of 90% or more before preoxygenation, the respective SpO2 in the control group and the NIV group were similar 95.5% (92%, 99%) vs. 96% (94%, 99%), P=0.52; and continued to be similar after preoxygenation 98% (95%, 100%) vs. 99% (96%, 100%), P=0.1. The duration of mechanical ventilation of the control group and the NIV group was 17 (10, 23)d vs. 19 (11, 26)d (P=0.86). The 28 days survival rate of the control group and the NIV group was 73.6% vs. 71.7% (P=0.34). The mortality rate in the control group and NIV group were 31.3% and 31.7% (P=0.66).ConclusionsWhen compared with the use of BVM, NIV assisted preoxygenation is effective and safe for critically ill patients. Critically ill patients with severe hypoxemia will benefit more from NIV assisted preoxygenation.
ObjectiveTo explore the risk factors for tracheal stenosis caused by tracheotomy or intubation.MethodsFrom July 2010 to July 2020, a total of 44 patients were suffered with tracheal stenosis caused by tracheotomy or intubation at the First Affiliated Hospital of Hunan Normal University as case group (n=44), and 34 patients were suffered tracheotomy or intubation without tracheal stenosis as control group (n=34). The clinical application of intratracheal tube cuff diameter was investigated by univariate comparison, ROC analysis and multivariate logistic regression analysis.ResultsUnivariate analysis showed intratracheal tube cuff diameter (C)/transverse diameter at the level of the clavicle >150%, intubation time>7d, tracheal intubations/tracheostomy ≥2, recurrent respiratory tract infections and replacement of tracheal tube≥ 2 were the influence factors of posttracheostomy tracheal stenosis (PTTS) and postintubation tracheal stenosis (PITS) (P<0.005). Multivariate Logistic regression analysis showed C/T>150% (OR=6.681, 95%CI: 1.164 - 38.363), intubation time>7d (OR=4.723, 95%CI: 1.413 - 15.779), tracheal intubations/tracheostomy ≥2 (OR=4.526, 95%CI: 1.133 - 18.083) and recurrent respiratory tract infections (OR=3.681, 95%CI: 1.177 - 11.513) were positively correlated with PTTS and PITS. The area under the ROC curve (AUC) of C/T>150% was 0.665 with the sensitivity of 0.364 and the specificity of 0.033 (95%CI: 0.555 - 0.775). AUC of intubation time>7 d was 0.717 with the sensitivity of 0.568 and the specificity of 0.133 (95%CI: 0.613 - 0.821). AUC of tracheal intubations/tracheostomy ≥2 was 0.683 with the sensitivity of 0.432 and the specificity of 0.067 (95%CI: 0.574 - 0.791). AUC of recurrent respiratory tract infections was 0.707 with the sensitivity of 0.614 and the specificity of 0.200 (95%CI: 0.603 - 0.811). However, there was no statistically significant difference C/T>150% and those clinical data in Z test (Z=0.839, P=0.402; Z=0.302, P=0.763; Z=0.751, P=0.453).ConclusionIntubation time>7 d, tracheal intubations/tracheostomy ≥2, recurrent respiratory tract infections, replacement of tracheal tube≥ 2 and C/T>150% are risk factors for PTTS and PITS.