Objective To investigate the efficacy of dexmedetomidine on sedation in post-cardiac surgery patients with NIV intolerance.The changes of respiratory function and hemodynamics of the patients as well as non-invasive ventilation (NIV) failure rate were also under evaluation.Methods Thirty-five post-cardiac surgery patients with NIV intolerance and hypoxemia were enrolled in this prospective study.All patients were sedated with dexmedetomidine.NIV was standardized according to the uniform protocol.The main outcome was NIV success (avoiding endotracheal intubation) or NIV failure (requiring endotracheal intubation or die).The cardiorespiratory parameters (BP,HtR and RR) and artery blood gas analysis were prospectively recorded before and after sedation.The respiratory function and hemodynamics changes in both groups (NIV success group and NIV failure group) were then evaluated.Factors independently associated with NIV failure were identified using a logistic regression model.Results Twenty out of 35 patients (57.14％) survived while 15 (42.86％) patients failed NIV.After 1 h and 4 h of NIV with dexmedetomidine sedation,respiratory rate in both groups were decreased compared with baseline,especially in NIV success group.The PaO2/FiO2 was also improved after 1h and 4h of NIV treatment compared with baseline.The improvement was more significantly in NIV success group.The heart rate was decreased compared with baseline with no differences between two groups.There were no significant changes on PaCO2 and mean arterial pressure (MAP) during the treatment.The respiratory and hemodynamics variables identified as predictors of NIV failure were included in a multivariate logistic regression.RR ＞ 23 time/min (OR =3.2,95％ CI:2.043 ～ 4.301,P ＜ 0.01) 1 h after NIV,RR ＞ 20 time/min (OR =2.1,95％ CI:1.659～3.231,P=0.025) 4 h after NIV,PaO2/FiO2 ＜178 mmHg (OR=2.4,95％CI:1.892 ～ 3.287,P ＜0.01) 1 h after NIV and PaO2/FiO2 ＜ 185 mmHg (OR =1.7,95％ CI:1.243 ～ 2.365,P =0.041) 4 h after NIV independendy predicted NIV failure.Conclusions Dexmedetomidine might be considered as an effective and safe sedative for post-cardiac surgery patients with NIV intolerance.Early identification of predictors of NIV failure may facilitate early intervention.

Objective To investigate the clinical treatment and outcomes of severe community-acquired pneumonia (CAP) complicated with mediastinal emphysema after renal transplantation. Methods Clinical data of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation were retrospectively analyzed. The acute physiology and chronic health evaluationⅡ(APACHEⅡ) and oxygenation index were recorded when the patients were admitted to the intensive care unit (ICU). The complications of mediastinal emphysema and corresponding treatment were observed. The treatment course during the ICU, mortality rate in ICU, ICU stay time and hospital stay time were recorded. All patients underwent pathogenic examinations. Results The APACHEⅡ score of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation was 14 (8-21) scores and the oxygenation index was 150 (133-189) mmHg. Among 9 patients, 3 cases were infected by bacteria alone, 3 cases were infected by bacterial infection combined with viral infection, 1 case was infected by mycobacterium tuberculosis complicated with other bacterial infection and 1 case was viral infection. No pathogenic evidence was detected in the remaining 1 patient. Mediastinal emphysema complicated with subcutaneous emphysema occurred in 7 cases and pneumothorax occurred in 6 cases. Treatment methods included anti-infection, modified immunosuppressive program, mediastinal drainage, thoracic closed drainage, subcutaneous incision and extracorporeal membrane oxygenation (ECMO) treatment. Six patients received invasive mechanical ventilation (IMV), 2 received non-invasive positive pressure ventilation (NIV) and 1 received high-flow nasal oxygen cannula (HFNC). Among 9 patients, the mortality rate in ICU was 6/9, the remaining 3 patients were recovered and discharged, the ICU stay time was 26 (17-40) d, and the total hospital stay time was 27-61 d. Conclusions Mediastinal emphysema is a serious complication of patients presenting with severe CAP after renal transplantation with a high mortality rate. For these patients, imaging evaluation, timely drainage and full sedation should be strengthened, and ECMO treatment should be delivered when necessary.

Objective:To investigate the expression of high mobility group box‐1 (HMGB1) in rat model of ventilator‐induced lung injury (VILI) .Methods :Twenty‐four healthy adult SD rats were randomly divided into three groups ,with 8 rats in each group .The control group:autonomous respiration .The large tidal volume group :tidal volume(TV)= 30 mL/kg .The ethyl pyruvate(EP) intervention group :EP 100 mg/kg via the caudal vein and the same ventilation mode as the large tidal volume group .The levels of HMGB1 and inflammatory factors in serum and bronchoalveolar lavage fluid (BALF)and lung tissues ,as well as in the culture medium of alveolar macrophages before and after mechanical stretching ,were detected with Western blot‐ting ,RT‐PCR and ELISA .Results:The levels of HMGB1 in serum ,BALF and lung tissues of the large tidal volume group were higher than those of the control group .HMGB1 in the culture medium of alveolar macrophages was increased under me‐chanical stretching .The expression of HMGB1 decreased ,and the proteins related to signal pathway of apoptosis as Caspase3 , Caspase9 and PARP increased ,in lung tissues of rat with VILI after EP intervention .Conclusions :The expression of HMGB1 increases in rat model of VILI ,which may be related with the effect of mechanical stretching on alveolar macrophages .EP intervention had certain protective effect on lung tissues with VILI .

Objective To study the incidence,possible risk factors,and influence on patient outcomes of diaphragmatic dysfunction in patients after surgical treatment of type A aortic dissection using ultrasound.Methods Patients who received replacement of hemiarch or total arch with concomitant procedures concerning aortic pathology,and an elephant trunk procedure for the descending aorta were prospectively enrolled in this study from February to May 2017.After surgery,they were transferred to the cardiac surgical intensive care unit.They were divided into two groups based on diaphragmatic excursion:diaphragmatic dysfunction (DD) group and diaphragmatic function normal (DN) grouBilateral diaphragmatic excursions were evaluated using ultrasound during spontaneous breathing trial by T-tube.The differences in demographic characteristics,operation-related variables and outcomes were compared between the two groups.Results A total of 42 patients were enrolled in this study,and 32 of them suffered from diaphragmatic dysfunctions.Compared with DN group,the excursion of the influenced diaphragm in DD group was significantly reduced[(0.450 ± 0.331)cm vs.(1.801 ± 0.616)cm,P＜0.01],while the excursion of the non-influenced diaphragm was not reduced[(2.013±0.655)cm vs.(1.801 ±0.616) cm,P=0.254].Diaphragmatic thickness was comparable [(0.184±0.028)cm vs.(0.189±0.028)cm,P=0.559 ] between the two groups while thickening fraction was significantly reduced in DD group[(4.67％±3.63)％ vs.(23.58％±10.69)％,P＜0.01].Meanwhile,respiratory rate was significantly higher in DD group as compared to DN group [(24.13 ± 4.98)times/min vs.(20.50 ± 3.17)times/min,P=0.037].Patients in DD group showed longer cross-clamp duration[(121.78±27.75)min vs.(93.10±18.84)min,P=0.004] and longer cardiopulmonary bypass duration [(208.09±32.78)min vs.(182.70±24.38)min,P=0.03] than patients in DN grouFurthermore,binary logistic analysis indicated that longer cross-clamp duration was the potential risk factor for diaphragmatic dysfunction after type A aortic dissection surgery.Mechanical ventilation duration was longer in DD group than in DN group (88 h vs.37 h,P=0.194) but without statistical significance.The usage of noninvasive ventilation was significantly increased in DD group as compared to DN group (46.88％ vs.10％,P=0.036).Other outcomes such as post-operative complications,mortality,ICU length of stay were comparable between the two groups.Conclusions Diaphragmatic dysfunction was very common after surgical treatment of type A aortic dissection.Longer duration of cross-clamp was considered as a potential risk factor of diaphragmatic dysfunction.A sequential management of noninvasive ventilation after extubation was feasible for diaphragmatic dysfunction after surgical treatment of type A aortic dissection.

Objective:To investigate the influence of admission to intensive care unit (ICU ) on the postoperative complications in patients with esophageal carcinoma .Methods :A total of 391 patients with esophageal carcinoma confirmed by surgery in Department of Thoracic Surgery ,Zhongshan Hospital ,Fudan University ,from Jan 2009 to Dec 2009 ,were chosen .All the patients had clinical data and postoperative follow‐up data in detail . Patients were divided into postoperative ICU group (treatment group) and postoperative general ward group(control group) .The control group was further classified into control group A(without unplanned ICU admission) and control group B(with unplanned ICU admission) based on whether unplanned admission to ICU was conducted .The occurrence rates of postoperative complications were compared among the three groups . Logistic regression was performed in multivariate analysis of postoperative complications .Results:On Day 1 after surgery ,the APACHE Ⅱ score was higher in treatment group than in control group I(P<0 .05) .However ,there was no increase on rate of postoperative complications in treatment group .The APACHE Ⅱ score ,as well as the occurrence rate of postoperative complications ,was lower in control group A than those in control group B (P<0 .01) .The APACHE Ⅱ score in treatment group was higher than that in control group B (P< 0 .05) .However ,the occurrence rate of postoperative complications in treatment group was lower than that in control group B (P<0 .01) .On Day 1 after surgery ,the higher the postoperative acute physiology and chronic health evaluation(APACHE)Ⅱ score was ,the higher the occurrence rate of postoperative complications was(HR= 0 .631 ,95% CI:0 .405~ 0 .983 ,P< 0 .05) .Postoperative planned ICU admission could diminish postoperative complications ,and it was the independent factor(HR= 1 .588 ,95% CI:1 .147‐2 .199 ,P< 0 .01).Conclusions :If prompt admission to ICU for comprehensive treatment was conducted after esophageal cancer operation , the occurrence rate of complications could be reduced in esophageal cancer patients .

Objective:To investigate the risk factors related to intensive care unit (ICU) readmission .Methods :A total of 2491 patients who had been transferred into Department of Critical Care Medicine of Zhongshan Hospital ,Fudan University from Nov 2008 to Dec 2011 were included .Clinical data of all the patients during their first admission to ICU were collected .All the patients were classified into non‐readmission group(Group A) and readmission group(Group B) on the basis of whether there was readmission to ICU .All the patients’ treatments were conducted under supervision of attending intensivist and in accordance with routine treatment of Department of Critical Care Medicine and related clinical guidelines .Logistic regression was performed in multivariate analyses of ICU readmission .Results:If the first admission to ICU was due to emergency ,then the chance of ICU readmission was raised(HR=4 .929 ,95% CI:1 .936‐12 .549 ,P<0 .01) .If patient underwent tracheotomy during the first ICU stay ,then the chance of ICU readmission increased (HR= 3 .395 ,95% CI:1 .622‐7 .107 , P< 0 .01) . Conclusions :Both the admission to ICU under emergency and the tracheotomy during the first ICU admission are independent risk factors for ICU readmission .

The rapid development of perioperative intensive care in cardiac surgery has greatly improved the prognosis for patients undergoing major cardiovascular surgery.In the field of hemodynamics,besides traditional methods,such as a variety of arterial catheters and central venous catheter,thermodilution and echocardiography have gradually becoming routines in hemodynamic monitoring,but their clinical values require further investigation.At the same time,optimizing micro-circulation,in order to meet the demand of oxygen and metabolism,is the goal of hemodynamic resuscitation.The management of V-A extracorporeal membrane oxygenation(ECMO)in the perioperative period of cardiac surgery depends on persistent hemodynamic monitoring.Volume management,vasoactive drugs,inotropes and vasodilators are still keys in pharmacological management.In addition,many mechanical circulatory assist devices have brought more treatments and hope for end-stage heart failure and severe cardiopulmonary dysfunction.

Background and objective A reasonable and standardized dietary plan and procedure can help patients recovering quickly from lung cancer surgery.The aim of this study is to optimize the diet plan and procedure mainly based on medium chain triglyceride(MCT)diet and explore its clinical advantages for postoperative lung cancer patients.Methods From October 2023 to December 2023,a total of 156 patients were collected,who underwent lung cancer surgery in Lung Cancer Cen-ter,West China Hospital of Sichuan University.The patients were randomized into MCT group(76 cases)and routine diet(RD)group(80 cases).Clinical symptoms,biochemical index,postoperative hospitalization time and cost,dietary satisfaction and hospitalization comfort between the two groups were analyzed.Results The mean anus exhausting time in MCT group[24.00(9.75,36.97)h]was significantly shorter than that in RD group[28.50(24.00,48.00)h](P＜0.001).And the incidence of dizzi-ness(18.42％),nausea and vomiting(6.58％)in MCT group were remarkably lower than those in RD group(51.25％,31.25％)(P＜0.001).Hospitalization comfort score in MCT group[(16.74±1.70)]was significantly higher than that in RD group[(14.83±2.34)](P=0.016).Meanwhile,the average hospitalization cost in MCT group[(39,701.82±8105.47)￥]showed an obvious decrease compared with RD group[(44,511.79±9593.19)￥](P=0.007).Conclusion Optimizing the dietary plan and procedure mainly based on MCT diet for postoperative lung cancer patients can help the recovery of gastrointestinal function and improve hospitalization comfort,which promoted overall postoperative rehabilitation of patients with lung cancer surgery.

Objective To evaluate the advantages about video-assisted thoracoscopic surgery (VATS) lobectomy with optimized management of surgical instruments package. Methods A total of 200 patients with lung cancer were enrolled, which included 78 males and 122 females, aged 24-83 years at median age of 56.8 years. All of them were divided into 2 groups including a routine group (n=100) and an optimized management of surgical instruments group (n=100). The total operation time, bleeding, instrument weights, utilization rate of instruments, counted and cleaning time in 2 groups were recorded and analyzed. Results The average operation time and average lost blood of the routine group was 117.62±42.52 min and 53.14±50.69 ml, respectively, and the one of the optimized instruments group was 120.48±40.62 min, 56.10±49.87 ml, respectively, with no significant difference between the two groups (P=0.112, P=0.231, respectively). The utilization rate of instruments in the routine group (58.02%±2.39%) was significantly lower than that of the optimized instruments group (94.00%±1.48%, P=0.014). The counted time, the loading and unloading time and the cleaning time of instruments in the routine group was 112.00±26.00 s, 70.00±15.00 s, 1 010.00±130.00 s, respectively, much longer than the time of the optimized instruments group, which was 65.00±23.00 s, 20.00±4.00 s, 665.00±69.00 s, respectively. There was a statistical difference between the two groups (P=0.028, P=0.011, P=0.039, respectively). The value of instruments in the routine group (177 574.00±14 438.00 yuan) was apparently higher than that of the optimized instruments group(132 027.00±10 311.00 yuan), with a statistical difference (P=0.032). Conclusion It is demonstrated that optimized management of surgical instruments package in VATS lobectomy can greatly improve the utilization rate of instruments and work efficiency, with no effects on the operation time and amount of bleeding in lobectomy.
Thoracoscopic surgery ; surgical instruments package ; lung cancer

【Objective】 To explore the clinical efficacy and safety of pelvic floor magnetic and electrical stimulation combined with Kegel exercise training in the treatment of stress urinary incontinence (SUI) after minimally invasive surgery for benign prostatic hyperplasia (BPH). 【Methods】 A total of 52 patients with SUI after minimally invasive surgery for BPH treated during Jan.2016 and Feb.2022 were randomly divided into test group (n=26) and control group (n=26). The test group received pelvic floor magnetic and electrical stimulation and Kegel exercise training, while the control group received Kegel exercise training only. The treatment lasted for 3 months. The scores of International Consultation on Incontinence Modular Questionnaire Short Form (ICIQ-SF), 1 h pad test, International Prostate Symptom Score (IPSS) and Incontinence Quality of Life Questionnaire (I-QoL) were recorded and compared between the two groups before and after treatment. The adverse reactions were observed. 【Results】 The scores of ICIQ-SF, IPSS and I-QoL and 1 h pad test significantly decreased in both groups after treatment (P<0.05). Before treatment, there were no significant differences of the above indicators between the two groups (P>0.05), but after treatment, the scores of ICIQ-SF,IPSS,I-QoL and 1 h pad test were significantly lower in the test group than in the control group (P<0.05). No severe adverse reactions were observed. 【Conclusion】 Pelvic floor magnetic stimulation combined with Kegel exercise training is safe and effective for SUI after minimally invasive surgery for BPH.