Objective To investigate the prevalent condition of endotracheal cuff pressure and risk factors for under inflation. Methods A prospective cohort study was conducted. Patients admitted to the Department of Critical Care Medicine of Fuxing Hospital Affiliated to Capital Medical University,who were intubated with a high-volume low-pressure endotracheal tube,and had undergone mechanical ventilation for at least 48 hours,were enrolled. The endotracheal cuff pressure was determined every 8 hours by a manual manometer connected to the distal edge of the valve cuff at 07:00,15:00,and 23:00. Measurement of the endotracheal cuff pressure was continued until the extubation of endotracheal or tracheostomy tube,or death of the patient. According to the incidence of under inflation of endotracheal cuff,patients were divided into the incidence of under inflation lower than 25%group(lower low cuff pressure group)and higher than 25% group(higher low cuff pressure group). The possible influencing factors were evaluated in the two groups,including body mass index(BMI),size of endotracheal tube,duration of intubation,use of sedative or analgesic,number of leaving from intensive care unit(ICU),the number of turning over the patients, and aspiration of sputum. Logistic regression analysis was used to determine risk factors for under-inflation of the endotracheal cuff. Results During the study period,53 patients were enrolled. There were 812 measurements,and 46.3%of them was abnormal,and 204 times(25.1%)of under inflation of endotracheal cuff were found. There were 24 patients(45.3%)in whom the incidence of under inflation rate was higher than 25%. The average of under inflation was 7(4,10)times. Compared with the group with lower rate of low cuff pressure,a longer time for intubation was found in group with higher rate of low cuff pressure〔hours:162(113,225)vs. 118(97,168),Z=-2.034,P=0.042〕. There were no differences between the two groups in other factors,including size of endotracheal tube,the time from intubation to first measurement of endotracheal cuff pressure,number of leaving from ICU during admission, use of sedative agent or analgesic,and the number of body turning and aspiration(all P>0.05). No risk factor was found resulting from under inflation of the endotracheal cuff by logistic regression analysis. No significant difference was found in the incidence of ventilator associated pneumonia,duration of mechanical ventilation,successful rate of weaning on 28th day,or 28-day mortality after weaning from mechanical ventilation,and ICU mortality between the two groups. However,patients in the group of higher rate of low cuff pressure had a longer ICU stay compared with that in the group of lower rate of low cuff pressure group〔days:13(8,21)vs. 10(6,18),Z=-2.120,P=0.034〕. Conclusions Abnormal endotracheal cuff pressure is common in critically ill patients with intratracheal intubation. Duration of intubation is associated with under inflation of the cuff,and it calls for strengthening monitoring and management.

Objective To compare the early and delayed tracheostomy in patients treated with prolonged mechanical ventilation in respects of mortality.incidence of nosocomial pneunonia and length of ICU stay.Methods Randomized controlled trials(RCTs)and quasi-randomized controlled trials(quasi-RCTs)were performed by searching throush the Ovide MEDLINE(1996-2006.7),EMBASE(1980-2006.7),Cochrane Database(Issue 2,2006),Chinese Cochrane Centre Database and CBMdisc(1978-2006.7).The published and unpublished data and their references were searched.All RCTs and quasi-RCT of tracheostomy for critically ill patients treated withprolonged mechanical ventilation were included.Data were collected and evaluated by two reviewers independently and separately.RevMan version 4.2 software was used for data analysis.Results Two hundred and eighty-six patients from 4 RCTs and 106 cases from one quasi-RCT were taken for meta analysis.The meta-analysis showed that the early tracheostomy could reduce mortality(OR 0.69,95%CI 0.51,0.95),significantly shorten the duration of mechanical ventilation(WMD-8.49,95%CI-15.32,-1.66)and shorten the length of ICU stay as well(WMD-15.33,95%CI-24.58,-6.08)in patients treated with prolonged mechanical ventilation.but the incidence of nosocemial pneumonia was not different between two sorts of patients(OR 0.91,95%CI 0.70,1.18).Conclusions In case of prolonged mechanical ventilation,the tracheostomy performed at earlier stage may decrease the mortality,and shorten the duration of mechanical ventilation and the length of ICU stay.but cannot reduce the incidence of nosocomial pneumonia.

Objective To compare the manipulation of two different methods of percutaneous dilatational tracheostomy (PDT),the guidewire dilating forceps (Portex method) and the modified onestep dilation technique (Ciaglia Blue Rhino method,CBR method).Methods From March 2013 to February 2014,48 patients eligible to meet the criteria of tracheostomy in ICU were collected and were divided into two groups at random.The length of time consumed for operation,amount of blood lost during operation and the operation complications were compared between two groups.The participant surgeons were asked which method they preferred,Portex or CBR.Results Of them,the mean age was 76.7 ± 11.6 years old,and 25 patients (52.1％) were male.The reasons for tracheotomy were the length of time needed for mechanical ventilation support expected to be longer than 2 weeks (n =30),severe disturbance of consciousness (n =17),and upper airway obstruction (n =1).The patients enrolled in the study were randomly divided into Portex and CBR groups.There were no significant differences in age,gender,APACHE Ⅱ score,the reason of tracheotomy,the length of time for mechanical ventilation support before tracheotomy,and the preoperative coagulation function between two groups.CBR method can easily be done with less operation time required than Portex [(5.9 ±4.3) min vs.(9.9 ± 1.5) min,P ＜0.01],and had obviously fewer operation complications and less amount of blood lost than Portex method (P ＜ 0.05).The male surgeons with a slew of surgical practice were in preference to Portex,whereas female doctors with less work experience and without surgical practice preferred CBR.Conclusions The CBR method can easier be done and was better than the Portex method in minimizing operative trauma and reducing the complications,especially it can easily be accepted by female doctors with less work experience and without surgical practice and it is worth using widely in clinic.

Objective To compare the incidences of agitation and circulatory fluctuation in mechanically ventilated patients receiving different sedatives for daily arousal,and develop a safe sedation strategy.Methods Ninety four patients in ICU,who received mechanical ventilation over 24 hours,were selected from five clinical centers.Based on the analgesia with continuous pumping of fentanyl,patients were randomly given midazolam(M group),propofol(P group)or sequential midazolam-propofol(M-P group)for sedation.The depth of sedation was maintained within SAS 2-4 by close monitoring.The administration of all sedatives and analgesics was terminated at 9:00 am till patients were fully waked up.The incidence of agitation,blood pressure,heart rate fluctuation,patients' arousal time,and their recollection to actual mechanical ventilation events after been transferred out of ICU were investigated.Results The mean SAS scores showed no difference in each group.The arousal time was significantly longer in group M than that in other two groups(P

Objective To investigate the etiology,clinical features and outcome of hospitalized patients with bloodstream infections (BSIs) in a tertiary hospital.Methods Positive blood cultures were obtained from the microbiological laboratory in Fuxing Hospital,Capital Medical University from January 1,2012 to December 31,2012.BSIS events were identified and the epidemiology data were collected.Results A total of 149 patients and 154 BSIs events were confirmed by pathogenic and clinical evidence.The inpatients' BSIs rate was 0.8％ in our hospital in 2012.According to the disease entities of the first BSIs onset,15 patients (10.1％) were from surgical departments,83 patients (55.7％) from the medical departments,and 51 patients (34.2％) from ICU.Thirty-three patients (22.1％) were diagnosed as septic shock.Sixty-eight patients died during hospital stay.The in-hospital mortality rate was 45.6％.Among the 154 BSIs events,125 (81.2％) were nosocomial and 29 (18.8％) were community-acquired.A total of 188 strains were isolated from all BSIs,including 106 strains of (56.4％) gram-negative bacilli,67 (35.6％) strains of gram-positive bacteria,and 15 (8.0％) strains of fungi.One hundred and fifty-nine strains of bacteria (84.6％) were isolated from 125 events of hospital-acquired BSIs.Twenty-six strains of bacteria were from catheter related bloodstream infections (CRBSIs).In gram-negative BSIs,there were more enterobacteriaceae in community-acquired BSIs.More non-fermentative bacteria were found in hospitalacquired BSIs than in community-acquired ones.The distribution of gram-negative bacilli was quite different between surgical departments,non-surgical departments and ICU (P =0.049).Conclusions Pathogens of BSIs are quite different according to disease entities and where the patients are from.Local epidemiology of BSIs and distribution of related pathogens are helpful to physicians searching the optimal empirical antibiotics and improving the outcome.

Objective To evaluate the value of the change of B-type natriuretic peptide(BNP) in predicting weaning outcome of patients with mechanical ventilation in ICU.Methods We carried out a prospective cohort study on patients in ICU at Fuxing Hospital from July 2013 to January 2014.Patients expected to use mechanical ventilation for more than 24 hours were enrolled in our study.The plasma concentration of BNP was measured at the beginning of spontaneous breathing trial(SBT) and 2 hours after.According to the outcome of SBT,patients were divided into SBT failure group (group A),weaning failure group (group B) and weaning success group (group C).The levels of BNP before and after the SBT were compared among three groups.The receiver operating characteristic (ROC) curve analysis was used to evaluate the changes of BNP (△BNP) and the rate of change (△BNP％) in predicting weaning outcome.Results A total of 56 patients were enrolled in our study,12 in group A,11 in group B and 33 in groupC.In groupC,both△BNPand△BNP％ [7.0,(-1.2,45.5) ng/L;6.1 (-2.1,11.5)％]were significantly lower than those in group A [88.0 (58.0,140.0) ng/L,P ＜ 0.05;20.5 (15.3,40.3) ％,P＜0.001]and group B[46.0 (17.5,91.2) ng/L,P＜0.001;24.3(13.0,32.5) ％,P＜0.001].The area under ROC curve (AUC) of △BNP％ to predict weaning success was 0.88 [95％ CI 0.79-0.97;P ＜0.001] and the cut-off value is 13.4％ with relatively high sensitivity(84.8％)and specificity(82.6％).The AUC of △BNP to predict weaning success was 0.80 [95％ CI 0.69-0.92;P ＜ 0.001] and the cut-off value is 80ng/L with high sensitivity 93.4％ and mediocre specificity (47.9％).Conclusion Either △BNP％ or △BNP in the SBT can predict weaning outcome,in which △BNP％ seems better than △BNP.

AIM: To observe the relationship between the immune deviation of Th1 and Th2 cell clones and class Ⅱ major histocompatibility complex (MHC) antigen expression in different stages of acute rejection in transplanted hearts. METHODS: Heart transplantation were performed in rats.Isografts and non-transplanted animals were used as control group. Donor class II MHC antigen expression were detected with monoclonal antibodies and immunostaining technique and the amount of type Ⅰ and Ⅱ cytokines mRNA expression were detected by semiquantitative RT-PCR in cardiac allografts. RESULTS: Myocardial IL-2 mRNA and donor class Ⅱ MHC antigen expression were significantly in creased, accompanied with development of acute rejection( P

Objective To approach the evaluative effect of respiratory variation of superior vena cava peak flow velocity measured using transthoracic echocardiography (TTE) on fluid responsiveness in patients with mechanical ventilation.Methods A prospective cohort study was conducted.All mechanical ventilated critically ill patients whose fluid therapy was planned due to hypovolemia in Department of Critical Care Medicine of Beijing Tongren Hospital of Capital Medical University from April 2011 to April 2013 were enrolled.Volume expansion was performed with 500 mL Linger solution within 30 minutes.Patients were classified as responders if pulse pressure variation (PPV) increased ≥ 13％ before volume expansion.The respiratory variation in superior vena cava peak velocity was calculated as the difference between maximum and minimum values of velocity in peak A,peak S and peak D over a single respiratory circle,and their variations (ΔA,ΔS,ΔD) were also calculated.The receiver operating characteristic curve (ROC curve) was plotted to assess the evaluative effect of respiratory variation of superior vena cava peak velocity on fluid responsiveness.Results Twenty-seven patients were enrolled in this study.Volume expansion increased PPV ≥ 13％ happened in 14 patients (responders).The velocity of superior vena cava in peak A,peak S,peak D was significantly increased after volume expansion compared with that before volume expansion in responders [peak A (cm/s):34.6 ± 2.2 vs.31.3 ±2.1,t=-2.493,P=0.027; peak S (cm/s):39.1 ± 1.3 vs.35.3 ±2.1,t=-2.564,P=0.024; peak D (cm/s):28.1 ± 1.2 vs.23.3 ± 1.4,t=-4.995,P=0.000],but there was no significant difference in ΔA,ΔS and ΔD between before and after volume expansion.The ΔA,ΔS and ΔD were positively correlated with PPV (r＝0.040,P=0.854; r=0.350,P=0.074; r=0.749,P=0.000).The area under ROC curve (AUC) of peak S was 0.36 [95％ confidence interval (95％CI):0.11-0.52],but the AUC of ΔS was 0.68 (95％CI 0.47-0.89),the AUC of peak D was 0.41 (95％CI 0.19-0.63),but the AUC of ΔD was 0.95 (95％CI 0.86-1.00),so the aberration rate of superior vena cava in respiration was better than the flow rate in superior vena cava.When the cut-off value of ΔS was 20.7％ for predicting fluid responsiveness,the sensitivity was 78.6％ and the specificity was 61.5％.When the cut-off value of ΔD was 12.7％ for predicting fluid responsiveness,the sensitivity was 92.0％ and the specificity was 92.3％.Conclusion Respiratory variations in superior vena cava peak velocity measured by TTE could assess fluid responsiveness in patients with mechanical ventilation.

Objective: To observe the incidence of intensive care unit-acquired weakness (ICU-AW) of mechanically ventilated patients, and to identify the relevant risk factors. Methods: A prospective cohort study was conducted. The patients admitted to intensive care unit (ICU) of Fuxing Hospital, Capital Medical University, aged 18 years old or older, with the duration of mechanical ventilation ≥ 24 hours and expected to stay in ICU for ≥ 7 days from May 2015 to January 2016 were enrolled. From the 7th day after ICU admission, the patients were evaluated for consciousness every day. If the patient was awake and could cooperate with muscle strength measurement, the day was recorded as T1, and the patient's muscle strength was measured using the Medical Research Council scale (MRC) and recorded, then all patients were divided into two groups according to MRC score, ICU-AW group (MRC score < 48) and non-ICU-AW group (MRC score ≥ 48). The death, transfer or the 28th day of ICU admission were regarded as the end of observation. The data from the first day of ICU admission to T1 (before T1), including metabolic factors (the lowest value of blood sodium, blood potassium, blood calcium, albumin, and the highest value of blood glucose), mechanical ventilation factors (mode and duration of mechanical ventilation), organ dysfunction factors [occurrence and duration of sepsis, multiple organ dysfunction syndrome (MODS)], and drug factors (whether the patients used aminoglycoside, sedative, muscle relaxant or glucocorticoids, etc., the time of these drugs usage and the cumulative dose) of the patients were observed, recorded and analyzed, as well as the data from T1 to the end of the observation period, including the duration of mechanical ventilation, incidence of ventilator associated pneumonia (VAP), 28-day mortality, the length of ICU stay, and the cost of ICU and hospitalization. The relevant factors with statistical significance in univariate analysis were enrolled in multivariate analysis, and Logistic regression equation was established to screen the independent risk factors that might lead to ICU-AW. Results: 486 patients with mechanical ventilation were enrolled in this study, and 37 patients were enrolled according to the inclusion and exclusion criteria, including 15 patients with ICU-AW (with ICU-AW incidence of 40.5%) and 22 patients without ICU-AW. In the univariate analysis, ICU-AW group patients showed statistical differences in following factors as compared with the non-ICU-AW group: age, and the duration of invasive ventilation and the total duration of mechanical ventilation, braking time, sepsis, MODS and duration of them, the usage days and dosage of sedative and glucocorticoid before T1. The total duration of mechanical ventilation from T1 to the end of the observation period, total duration of mechanical ventilation during the observation period, and length of ICU stay of the ICU-AW group were significantly longer than those of the non-ICU-AW group [hours: 190 (110, 274) vs. 4 (0, 57), hours: 337 (237, 477) vs. 78 (43, 170), days: 20±7 vs. 14±7, all P < 0.05], the incidence of VAP, 28-day mortality and total hospitalization expenses were significantly higher than those of the non-ICU-AW group [26.7% (4/15) vs. 0% (0/22), 53.3% (8/15) vs. 9.1% (2/22), 10 thousands Yuan: 18.7±7.7 vs. 12.1±10.8, all P < 0.05]. Multivariate Logistic regression analysis showed that the total duration of mechanical ventilation between the patient awake and ICU admission [odds ratio (OR) = 1.03, 95% confidence interval (95%CI) was 1.01-1.05, P = 0.011] and the duration of MODS (OR = 1.79, 95%CI was 1.17-2.72, P = 0.007) were the independent risk factors for ICU-AW in mechanically ventilated patients. Conclusions ICU-AW is quite common in patients with mechanical ventilation and has a higher incidence. The risk factors associated with ICU-AW were the total duration of mechanical ventilation and duration of MODS.

Objective To observe the early morbidity of ICU-acquired weakness (ICU-AW) in mechanical ventilation patients, and to analyze the risk factors and prognosis of ICU-AW. Methods A prospective cohort study was conducted. The patients undergoing mechanical ventilation admitted to intensive care unit (ICU) of Fu Xing Hospital of Capital Medical University from April 2016 to February 2017 were enrolled. The peroneal nerve test was performed on (3±1) days of mechanical ventilation, and complete neuro-electrophysiological examination was performed next on the patients with positive result of peroneal nerve test. The abnormal cases were enrolled in the observation group, others were enrolled in the control group, then the early incidence of ICU-AW was obtained. The control group reviewed the peroneal nerve test after 10 days, and the late ICU-AW incidence was obtained. Death, ICU discharge, or over 60 days of ICU stay were set to the endpoints of observation. Demographic data, basic indicators, drug usage, comorbidities and metabolic markers during the study period, outcome data were collected and analyzed, and risk factors and of early ICU-AW in mechanical ventilation patients were identified by multivariate Logistic regression analysis. Results A total of 60 patients were enrolled in the study, with 19 patients in the observation group, and 41 in the control group, with the early ICU-AW incidence of 31.7%. In the control group, 8 patients reviewed the peroneal nerve test after 10 days, of