Publications (7)3.55 Total impact
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Article: Impact of positive end-expiratory pressure on cerebral injury patients with hypoxemia.
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ABSTRACT: Traumatic brain injury or intracranial hemorrhage patients with acute lung injury/acute respiratory distress syndrome need mechanical ventilation. The use of positive end-expiratory pressure (PEEP) in this situation remains controversial. This study explored the impact of PEEP on intracranial pressure (ICP), cerebral perfusion pressure (CPP), central venous pressure (CVP), and mean arterial pressure (MAP) in cerebral injury patients. Nine cerebral injury patients with lung injury who needed mechanical ventilation and met the criteria for ICP monitoring were included in this study. Intraventricular catheters were positioned in 1 of the bilateral ventricles and connected to pressure transducers. Invasive arterial pressure and CVP were monitored continuously. Pressure control ventilation was applied during this clinical trial in a stepwise recruitment maneuver (RM) with 3 cm H₂O intermittent increments and decrements of PEEP. A total of 28 RMs were completed in 9 patients. Mean values of MAP, CVP, ICP, and CPP 5 minutes after RMs showed no significant differences compared with baseline (P > 0.05). Correlation analysis of all the mean values of MAP, CVP, ICP, and CPP showed significant correlation between MAP and CPP, PEEP and CVP, PEEP and ICP, and PEEP and CPP with all P values less than 0.05. The impact of PEEP on blood pressure, ICP, and CPP varies greatly in cerebral injury patients. Mean arterial pressure and ICP monitoring is of benefit when using PEEP in cerebral injury patients with hypoxemia.The American journal of emergency medicine 09/2011; 29(7):699-703. · 1.54 Impact Factor -
Article: Effects of a flutter mucus-clearance device on pulmonary function test results in healthy people 85 years and older in China.
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ABSTRACT: To investigate the impact of a new flutter-type mucus-clearance device on pulmonary function test results in people ≥ 85 years old. We conducted a randomized controlled trial with 60 people ≥ 85 years old. The subjects were distributed randomly into an intervention group and a control group. Spirometry was performed at baseline and after 28 days of using the flutter mucus-clearance device. We recorded peak expiratory flow (PEF), FEV₁, forced vital capacity (FVC), and FEV₁/FVC. The intervention group used the flutter mucus-clearance device during pulmonary exercises. The control group had no interventions other than routine healthcare. We recorded episodes of fever, antibiotic therapy, and hospital visits during the 28 days of the study. PEF, FEV₁, FVC and FEV₁/FVC showed no significant differences between the 2 groups at baseline. The mean ± SD baseline values were: PEF 103.2 ± 43.0 L/min, FEV₁ 0.98 ± 0.43 L, and FVC 1.76 ± 0.68 L. Compared to baseline, on day 28 there was no significant difference in PEF, FEV₁, or FEV₁/FVC, in either group. The mean ± SD difference in FVC between baseline and day 28 was 0.33 ± 0.30 L in the intervention group, and 0.20 ± 0.14 L in the control group (P = .03). There were no significant differences in the number of cases of fever, antibiotic therapy, or hospital visits between the groups. The new flutter mucus-clearance device improved elderly patients' FVC.Respiratory care 11/2010; 55(11):1449-52. · 2.01 Impact Factor -
Article: [The impact of positive end-expiratory pressure on cerebral perfusion pressure and hemodynamics in patients receiving lung recruitment maneuver].
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ABSTRACT: To explore the impact of lung recruitment maneuver (RM) on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and mean arterial pressure (MAP). RM was performed and ICP, MAP, central venous pressure (CVP), saturation of arterial oxygen (SpO2) were monitored continuously in 6 severe cerebral injury patients combined with lung injury, who were indicated for mechanical ventilation and meeting the criteria for intracranial pressure monitoring. RM included pressure control ventilation with stepwise increase in positive end-expiratory pressure (PEEP). RM was performed for 22 times in 6 patients, among them two were moribund due to sharp drop of blood pressure and CPP. In the remaining 20 attempts, the mean values of MAP, CVP, ICP, CPP measured at each PEEP level showed no significant difference compared with baseline values (all P>0.05). MAP was significantly correlated with CPP (r=0.706, P=0.000). In the remaining RMs, a correlation between MAP and CPP accounted for 85% (17/20) of total RMs, that between PEEP and CVP accounted for 75% (15/20), that between PEEP and ICP accounted for 75% (15/20), and that between PEEP and CPP existed in 40% (8/20). In a total of 22 cases, there were 6 patterns of response of MAP to alteration in PEEP: MAP maintained relatively stable in 8 case, MAP decreased when PEEP increased and increased when PEEP decreased in 6 case; in 2 cases MAP elevated with increase in PEEP, and drop to baseline with decrease in PEEP, in 2 cases it fell with increase in PEEP but it did not rise with decrease in PEEP, in 2 cases it rose with increase in PEEP but remained at a high level with PEEP decreased to baseline, in 2 cases, MAP dropped abruptly with increase in PEEP resulting in termination of RM. In 11 cases, ICP increased with increase in PEEP and decreased with lowering of PEEP. ICP maintained stable in 6 cases, and ICP maintained at a high level and did not return to baseline after RM in 3 cases. CPP decreased with increase in PEEP and increased when PEEP decreased, and it returned to baseline when PEEP was back to baseline in 12 case. CPP kept constant in 6 case. In 2 cases, CPP remained at a low level, and it returned to baseline 10-20 minutes after PEEP was lowered to baseline. There is considerable individual difference in impact of RM on MAP, ICP and CPP in patients with cerebral. ICP monitoring is helpful to assure safety of RM in patients with cerebral injury complicated with lung injury.Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 10/2008; 20(10):588-91. -
Article: [Epidemiology of unpleasant experiences in conscious critically ill patients during intensive care unit stay].
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ABSTRACT: To survey the incidences of psychological and physiological unpleasant experiences in conscious critically ill patients during their intensive care unit (ICU) stay, and investigate the inducing factors. A two-month consecutive nationwide investigation was prospectively performed in 31 academic hospital ICUs. An in-person questionnaire interview to each conscious patient was performed by specific trained staff from RMC-ROMIT Healthcare Consulting Company within 2 days after the patient was transferred from ICU. Two hundred and thirty-four cases were interviewed in this survey. One hundred and sixty-three of the 234 patients (69.6%) appeared psychological unpleasant experience. The ratio of patients with physiological unpleasant experience was as high as 97.0%, and 74.8% of whom were with serious physiological unpleasant experiences. The incidence of serious physiological unpleasant experiences was markedly higher in patients with than without psychological unpleasant experience (46.5% vs. 86.5%). The difference was shown to be statistical significant (P < 0.01). The percentage of patients complained of ICU noise and medical or nursing manipulations not tolerable was 65.8% and 74.8%, respectively. Compared with the tolerable cases, the incidences of psychological and physiological unpleasant experiences were significantly increased in those patients (P < 0.05 or P < 0.01). Acute physiology and chronic health evaluation II (APACHE II) score was the independent high risk factor inducing psychological unpleasant experience through multiple factor analysis [odds ratio (OR) = 1.070, 95% confidence interval (CI) = 1.020-1.130, P < 0.05]. Age was the high risk factor inducing physiological unpleasant experience (OR = 0.936, 95% CI = 0.879-0.998, P < 0.05). In addition, adequate sedation significantly reduced the incidence of the psychological and physiological unpleasant experiences. A high incidence of unpleasant experience is found in conscious critically ill patients during their ICU stay. Patients with psychological unpleasant experiences are with higher possibility of occurring physiological unpleasant experiences. The data show that APACHE II score is the independent high risk factor inducing psychological unpleasant experiences. ICU environment, noise for instance, and medical or nursing manipulations are closely related with the incidence of psychological and physiological unpleasant experiences. Meanwhile, adequate sedation is one of the effective methods to reduce the incidences of them.Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 10/2008; 20(9):553-7. -
Article: [Prospective, multi-center investigation on safety of critical patients in intensive care units].
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ABSTRACT: To perform a prospective, multi-center investigation of the incidence and causes of medical errors happened in intensive care unit (ICU). This investigation was performed in eight ICUs in level A, grade 3 teaching hospitals from October 23 to December 23, 2006. One attending physician and the head nurse in each center were entrusted with the responsibility for this project. Medical errors were identified as (1) type of errors (happened in diagnosis, medication, caring procedures or monitoring etc.); (2)characteristics of errors (related to complications, emergency intervention, low ability or carelessness of care givers and others); (3) consequence of errors (resulted in non-serious influence, vital signs fluctuation, alternation of respiratory or circulatory function, organ injury or death). Besides the medical errors, data included ICU beds, numbers of doctors or nurses, numbers of critical patients receiving intensive care during the investigation period and their acute physiology and chronic health evaluation II (APACHE II) scores, the academic degree and title and years of ICU working experience of doctors or nurses who made medical errors. Data from three of eight centers were excluded due to lack of objectivity. A total number of 232 critical patients were surveyed in 1 319 ICU patient x days. Two hundred and ninety-six ICU errors were found. One error occurred in average of 4.46 patient x days. Medical errors happened in 157 patients (67.6%). The percentage of error related to nursing (74.3%) was significantly higher than that made by doctor's caring (25.7%). Two hundred and twelve errors (71.6%) were devoid of serious effects to patients. However, Eighty-two errors were followed by vital signs instability. Medical errors occurred more frequently in patients with the higher (greater than 20) than the lower (less than 20) APACHE II score. The frequency of nursing oriented errors was closely positively correlated with the rates of shortage of working force, low educational level and working years less than 3 years respectively. Our survey indicates that critical patients are facing high medical error risk in the higher level Chinese teaching hospitals. There is a close relationship between ICU errors and severity of patient's disease, inadequate training and less working experience.Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 11/2007; 19(10):614-8. -
Article: [The analysis of 252 episodes of recruitment maneuver during mechanical ventilation in surgery intensive care unit].
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ABSTRACT: To analyze the clinical effects of recruitment maneuver and the impacts on blood pressure and oxygen saturation in patients with mechanical ventilation. To analyze all related data from 252 episodes of recruitment maneuver of 46 patients admitted from July 2005 to February 2007. Recruitment maneuver method: the drive pressure constant was kept at 15 cm H(2)O (1 cm H(2)O=0.098 kPa) and the positive end-expiratory pressure (PEEP) level was increased gradually. Of the 252 episodes of recruitment maneuver, this procedure was effective in 91% of the patients, with pneumothorax and pneumo-mediastinum occurred in a patient with legionnaire pneumonia, and no improvement of oxygen saturation in one patient with patent foramen ovale. The value of effective PEEP used ranged from a minimum of 8 cm H(2)O to a maximum of 30 cm H(2)O and the duration of satisfactory oxygen saturation ranged from a minimum of 0.4 hour to a maximum of 368 hours. On average, each patient received 5.48 episodes of recruitment maneuver with one of the patients received 16 episodes of recruitment maneuver. Twenty-three out of the 46 patients (50%) had experienced an episode of hypoxemia. One hundred and one episodes of hypoxemia occurred in 252 recruitment maneuver (40%) and the minimum PEEP inducing hypoxemia is 8 cm H(2)O, and the maximum PEEP was 22 cm H(2)O, with an average value of 12.7 cm H(2)O. Twenty-five of the 46 patients (54%) had experienced transient hypotension with 93 episodes of hypoxemia in 252 episodes of recruitment maneuver (37%), and the minimum PEEP inducing hypotension was 6 cm H(2)O and the maximum PEEP was 23 cm H(2)O, with an average value of 13.9 cm H(2)O. Recruitment maneuver could effectively improve oxygenation while the value of PEEP used should be individualized according to clinical condition.Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 10/2007; 19(9):539-41. -
Article: [Perioperative nitric oxide inhalation therapy for open heart surgery patients with pulmonary hypertension].
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ABSTRACT: To investigate effectiveness and safety of perioperative nitric oxide (NO) inhalation therapy for open heart surgery patients with pulmonary hypertension. Servo 300A and Pulmonox Aeronox were used for NO delivery and monitoring. NO was used perioperatively in 27 adult and 1 pediatric open heart surgery patients with pulmonary hypertension which were not effectively relieved by conventional treatment. At the beginning of NO inhalation therapy, the dose of NO was (5-10) x 10(-6), and mildly elevated to 20 x 10(-6). Pulmonary arterial pressure (PAP), arterial pressure (AP), pulmonary vascular resistance (PVR) and oxygenation index (PaO(2)/FiO(2)) of patients were monitored before and after treatment. Criterion for NO responsiveness was: AP/PAP or PaO(2)/FiO(2) improved more than 20% within 1 hour. NO inhalation therapy was discontinued if there was no response within 1.5 hours. Responsive rate in these adult patients was 77.8% (21/27 cases). Duration of NO therapy was 12-96 (32.6+/-10.3) hours. One 4-year-old atrial septal defect child with medium severity of pulmonary artery hypertension showed deterioration of pulmonary hypertension with serious hypoxemia [PaO(2)/FiO(2)=40 mm Hg (1 mm Hg=0.133 kPa), fractional concentration of inspired oxygen (FiO(2)) was 1.00] post operatively. NO inhalation therapy showed a very marked response and effect. The child was weaned from mechanical ventilation in four days. No adverse event was detected in patients and caregivers during and after NO inhalation therapy. NO inhalation therapy is effective in cardiac surgery patients with deteriorating pulmonary artery hypertension perioperatively. Further clinical investigation is urgently needed for promoting it to become a clinical routinely available therapy.Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 10/2007; 19(9):546-8.
Top co-authors
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Institutions
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2011
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Tongji Medical University
Shanghai, Shanghai Shi, China
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2007
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Tongji University
Shanghai, Shanghai Shi, China
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