Objective To explore the impact of neurally adjusted ventilatory assist(NAVA)mode on the weaning outcomes of patients with severe cerebrovascular disease who have weaning difficulty from mechanical ventilation.Methods Patients with severe cerebrovascular disease who had weaning difficulty from mechanical ventilation and were admitted to the Intensive Care Unit(ICU)of Neurosurgery Departement,the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital of Wannan Medical College)from November 2019 to November 2021 were prospectively and consecutively included.They were randomly divided into the NAVA group and the pressure support ventilation(PSV)group using a random number table,with 28 patients in each group.Baseline and clinical data of the two groups were collected,including gender,age,main diagnosis,past medical history(hypertension,stroke,respiratory diseases,diabetes,coronary heart disease),body mass index,acute physiology and chronic health evaluation(APACHE)Ⅱ score,Glasgow coma scale(GCS)score,types of difficult weaning(failure of the first spontaneous breathing trial[SBT],re-intubation within 48 h after the first weaning attempt),and mechanical ventilation time before randomization.SBT and weaning-related indicators after randomization were collected,including respiratory mechanics and parameters before SBT implementation after randomization(peak airway pressure,expiratory tidal volume,positive end-expiratory pressure,inspired oxygen concentration,minute ventilation,mean airway pressure,diaphragmatic electrical activity signal value,neural ventilation efficiency,neural mechanical efficiency),basic vital signs(mean arterial pressure,respiratory heart rate)before weaning after passing SBT,blood routine(white blood cells,hemoglobin)and biochemical tests(albumin,creatinine,troponin,B-type natriuretic peptide)within 48 h before weaning,and arterial blood gas within 30 min before weaning(pH,partial pressure of carbon dioxide,partial pressure of oxygen,bicarbonate ion,oxygenation index).The primary outcome measures included the time required for successful weaning from randomization to day 28(if the patient died or failed to wean successfully before day 28 after randomization,the time required for weaning was defined as 28 d),total mechanical ventilation time after randomization,total weaning success rate from randomization to day 28,total weaning-free time at 7,14,and 28 d after randomization,survival time at 28 d and 90 d after randomization,ICU length of stay,total hospital length of stay,and cumulative weaning success rate from randomization to day 28 in both groups.The secondary outcome measures included tracheotomy rate after randomization,ICU mortality rate,mortality rate at 28 d and 90 d after randomization,incidence of mechanical ventilation-related complications(ventilator-associated pneumonia,acute respiratory distress syndrome,pneumothorax,pleural effusion)during mechanical ventilation after randomization,and cumulative survival rate at 90 d after randomization.The human-machine coordination within 24 h after randomization was recorded in both groups including the number and index of ineffective triggering,false triggering,double triggering,premature switching from inspiration to expiration,delayed switching from inspiration to expiration,and triggering delay,as well as the total asynchrony index,with one record every 8 h,each record lasting for 1 min,for a total of 3 min.Results A total of 56 patients with severe cerebrovascular disease who had weaning difficulty from mechanical ventilation were included,with 28 patients in each of the PSV group and the NAVA group.There were no statistically significant differences between the two groups in terms of gender,age,main diagnosis,past medical history,body mass index,APACHE Ⅱ score,GCS score,types of difficult weaning,mechanical ventilation time before randomization,indicators before SBT implementation after randomization and after SBT before weaning(all P＞0.05).(1)The time required for successful weaning from randomization to day 28(9.00[7.00,15.50]d vs.15.50[10.25,22.75]d)and total mechanical ventilation time after randomization(8.50[7.00,12.75]d vs.13.50[10.00,20.00]d)were both lower in the NAVA group than those in the PSV group(all P＜0.05).The cumulative weaning success rate of the NAVA group was higher than that of the PSV group at 28 d after randomization(P=0.039),but there was no statistically significant difference in the total weaning success rate between the two groups from randomization to the day 28(92.9％[26/28]vs.85.7％[24/28],P=0.669).The NAVA group had longer periods without mechanical ventilation within 14 d(5.00[0.00,7.00]d vs.0.00[0.00,3.75]d)and within 28 d(18.00[9.25,20.75]d vs.10.50[0.25,17.75]d)after randomization compared with the PSV group(all P＜0.05),but there was no statistically significant difference in the period without mechanical ventilation within 7 d after randomization between the two groups(P=0.159).The ICU stay of the NAVA group was shorter than that of the PSV group(9.00[6.25,16.75]d vs.14.00[10.25,22.50]d,P=0.015),but there were no statistically significant difference in the total hospital stay and survival time within 28 d and 90 d after randomization between the two groups(all P＞0.05).(2)There was no statistically significant difference between the two groups in tracheotomy rate,ICU mortality rate,mortality rate at 28 d and 90 d after randomization,complications during mechanical ventilation after randomization,and cumulative survival rate at 90 d after randomization(all P＞0.05).(3)In terms of human-machine coordination,the NAVA group had lower frequencies and indices of false triggering(frequency:0.00[0.00,0.00]time/min vs.0.00[0.00,0.58]time/min;index:0.00[0.00,0.00]vs.0.00[0.00,0.02]),ineffective triggering(frequency:0.00[0.00,0.33]time/min vs.1.00[0.33,2.17]time/min;index:0.00[0.00,0.02]vs.0.05[0.02,0.09]),premature switching(frequency:0.00[0.00,0.33]time/min vs.0.33[0.33,1.00]time/min;index:0.00[0.00,0.01]vs.0.02[0.02,0.05]),delayed switching(frequency:0.00[0.00,0.00]time/min rs.1.17[0.00,5.67]time/min;index:0.00[0.00,0.00]rs.0.06[0.00,0.29]),and delayed triggering(frequency:0.00[0.00,0.58]time/min vs.0.67[0.33,1.67]time/min;index:0.00[0.00,0.02]vs.0.05[0.02,0.10])compared with the PSV group(all P＜0.01).The NAVA group had higher frequencies and indices of double triggering(frequency:1.17[0.33,2.00]time/min vs.0.00[0.00,0.00]time/min;index:0.06[0.02,0.11]vs.0.00[0.00,0.00];all P＜0.01),but the total asynchrony index of the NAVA group was lower than that of the PSV group(0.08[0.04,0.14]vs.0.24[0.19,0.51],P＜0.01).Conclusion The NAVA mode can shorten the weaning and mechanical ventilation time of patients with severe cerebrovascular disease who have weaning difficulty from mechanical ventilation,improve human-machine coordination,and has potential advantages in increasing the weaning success rate.

Objective To explore the impact of neurally adjusted ventilatory assist(NAVA)mode on the weaning outcomes of patients with severe cerebrovascular disease who have weaning difficulty from mechanical ventilation.Methods Patients with severe cerebrovascular disease who had weaning difficulty from mechanical ventilation and were admitted to the Intensive Care Unit(ICU)of Neurosurgery Departement,the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital of Wannan Medical College)from November 2019 to November 2021 were prospectively and consecutively included.They were randomly divided into the NAVA group and the pressure support ventilation(PSV)group using a random number table,with 28 patients in each group.Baseline and clinical data of the two groups were collected,including gender,age,main diagnosis,past medical history(hypertension,stroke,respiratory diseases,diabetes,coronary heart disease),body mass index,acute physiology and chronic health evaluation(APACHE)Ⅱ score,Glasgow coma scale(GCS)score,types of difficult weaning(failure of the first spontaneous breathing trial[SBT],re-intubation within 48 h after the first weaning attempt),and mechanical ventilation time before randomization.SBT and weaning-related indicators after randomization were collected,including respiratory mechanics and parameters before SBT implementation after randomization(peak airway pressure,expiratory tidal volume,positive end-expiratory pressure,inspired oxygen concentration,minute ventilation,mean airway pressure,diaphragmatic electrical activity signal value,neural ventilation efficiency,neural mechanical efficiency),basic vital signs(mean arterial pressure,respiratory heart rate)before weaning after passing SBT,blood routine(white blood cells,hemoglobin)and biochemical tests(albumin,creatinine,troponin,B-type natriuretic peptide)within 48 h before weaning,and arterial blood gas within 30 min before weaning(pH,partial pressure of carbon dioxide,partial pressure of oxygen,bicarbonate ion,oxygenation index).The primary outcome measures included the time required for successful weaning from randomization to day 28(if the patient died or failed to wean successfully before day 28 after randomization,the time required for weaning was defined as 28 d),total mechanical ventilation time after randomization,total weaning success rate from randomization to day 28,total weaning-free time at 7,14,and 28 d after randomization,survival time at 28 d and 90 d after randomization,ICU length of stay,total hospital length of stay,and cumulative weaning success rate from randomization to day 28 in both groups.The secondary outcome measures included tracheotomy rate after randomization,ICU mortality rate,mortality rate at 28 d and 90 d after randomization,incidence of mechanical ventilation-related complications(ventilator-associated pneumonia,acute respiratory distress syndrome,pneumothorax,pleural effusion)during mechanical ventilation after randomization,and cumulative survival rate at 90 d after randomization.The human-machine coordination within 24 h after randomization was recorded in both groups including the number and index of ineffective triggering,false triggering,double triggering,premature switching from inspiration to expiration,delayed switching from inspiration to expiration,and triggering delay,as well as the total asynchrony index,with one record every 8 h,each record lasting for 1 min,for a total of 3 min.Results A total of 56 patients with severe cerebrovascular disease who had weaning difficulty from mechanical ventilation were included,with 28 patients in each of the PSV group and the NAVA group.There were no statistically significant differences between the two groups in terms of gender,age,main diagnosis,past medical history,body mass index,APACHE Ⅱ score,GCS score,types of difficult weaning,mechanical ventilation time before randomization,indicators before SBT implementation after randomization and after SBT before weaning(all P＞0.05).(1)The time required for successful weaning from randomization to day 28(9.00[7.00,15.50]d vs.15.50[10.25,22.75]d)and total mechanical ventilation time after randomization(8.50[7.00,12.75]d vs.13.50[10.00,20.00]d)were both lower in the NAVA group than those in the PSV group(all P＜0.05).The cumulative weaning success rate of the NAVA group was higher than that of the PSV group at 28 d after randomization(P=0.039),but there was no statistically significant difference in the total weaning success rate between the two groups from randomization to the day 28(92.9％[26/28]vs.85.7％[24/28],P=0.669).The NAVA group had longer periods without mechanical ventilation within 14 d(5.00[0.00,7.00]d vs.0.00[0.00,3.75]d)and within 28 d(18.00[9.25,20.75]d vs.10.50[0.25,17.75]d)after randomization compared with the PSV group(all P＜0.05),but there was no statistically significant difference in the period without mechanical ventilation within 7 d after randomization between the two groups(P=0.159).The ICU stay of the NAVA group was shorter than that of the PSV group(9.00[6.25,16.75]d vs.14.00[10.25,22.50]d,P=0.015),but there were no statistically significant difference in the total hospital stay and survival time within 28 d and 90 d after randomization between the two groups(all P＞0.05).(2)There was no statistically significant difference between the two groups in tracheotomy rate,ICU mortality rate,mortality rate at 28 d and 90 d after randomization,complications during mechanical ventilation after randomization,and cumulative survival rate at 90 d after randomization(all P＞0.05).(3)In terms of human-machine coordination,the NAVA group had lower frequencies and indices of false triggering(frequency:0.00[0.00,0.00]time/min vs.0.00[0.00,0.58]time/min;index:0.00[0.00,0.00]vs.0.00[0.00,0.02]),ineffective triggering(frequency:0.00[0.00,0.33]time/min vs.1.00[0.33,2.17]time/min;index:0.00[0.00,0.02]vs.0.05[0.02,0.09]),premature switching(frequency:0.00[0.00,0.33]time/min vs.0.33[0.33,1.00]time/min;index:0.00[0.00,0.01]vs.0.02[0.02,0.05]),delayed switching(frequency:0.00[0.00,0.00]time/min rs.1.17[0.00,5.67]time/min;index:0.00[0.00,0.00]rs.0.06[0.00,0.29]),and delayed triggering(frequency:0.00[0.00,0.58]time/min vs.0.67[0.33,1.67]time/min;index:0.00[0.00,0.02]vs.0.05[0.02,0.10])compared with the PSV group(all P＜0.01).The NAVA group had higher frequencies and indices of double triggering(frequency:1.17[0.33,2.00]time/min vs.0.00[0.00,0.00]time/min;index:0.06[0.02,0.11]vs.0.00[0.00,0.00];all P＜0.01),but the total asynchrony index of the NAVA group was lower than that of the PSV group(0.08[0.04,0.14]vs.0.24[0.19,0.51],P＜0.01).Conclusion The NAVA mode can shorten the weaning and mechanical ventilation time of patients with severe cerebrovascular disease who have weaning difficulty from mechanical ventilation,improve human-machine coordination,and has potential advantages in increasing the weaning success rate.

Objective To investigate the application technology and effect of Navien catheter in intracranial aneurysms embolization.Methods The clinical data of 15 patients with intracranial aneurysm treated with Navien catheter in Department of Neurosurgery of Yijishan Hospital Affiliated to Wannan Medical College from March to December 2016 were analyzed retrospectively. The extracranial segments of internal carotid arteries were seriously tortuous in all patients. The coaxial system was used during procedure. Whether the Navien catheter could be smoothly placed into the target artery or not was observed,and the coils or stent-assisted coils were used to embolize the intracranial aneurysms in the corresponding positions. The immediate embolization results were assessed by the Raymond grading. The intraoperative and postoperative complications were observed and the patients were followed up by imaging.Results All 15 patients had abnormal tortuosity of extracranial segments of internal carotid arteries. The Navien catheter was able to smoothly pass through the tortuous vessels and reach the desired position. The stent-assisted coil embolization was used in 9 patients,and the coil embolization was used in 6 patients. The success rate of the coil and stent placement technology was 100%. The stents were all accurately put in place without shift. According to the Raymond grading,the immediate embolization rate of aneurysms showed that 15 patients achieved Raymond gradeⅠ. One case developed internal carotid spasm during the procedure. The patient was improved after giving papaverine. Others did not have intraoperative complications,such as cerebral vasospasm,vascular dissection,in-stent thrombosis,and intraoperative aneurysm rupture. Five patients were followed up for 3 to 6 months with digital subtraction angiography (DSA). There was no recurrence of aneurysm and no in-stent stenosis and shift,No rebleeding or cerebral ischemia was observed.Conclusion Forpatients with severely tortuous in extracranial segments of internal carotid artery,using the Navien catheter may overcome artery tortuosity and other unfavorable factors of the patients and successfully reach the target vessel position,enable the embolization of intracranial aneurysms to be completed successfully.

Objective To investigate the risk factors for influencing recrudescence after endovascular embolization of posterior communicating artery aneurysms.Methods From January 2014 to December 2014,71 consecutive patients (a total of 74 aneurysms) with posterior communicating artery aneurysm treated with endovascular treatment at the Department of Neurosurgery,Yijishan Hosptial of Wannan Medical College were enrolled retrospectively.The aneurysms were calculated as the number of cases (n=74).The aneurysms were divided into two groups according to whether they had recrudescence or not,including recurrent group (n=18) and non-recurrent group (n=56).The differences of the clinical data and aneurysm characteristics between the two groups were compared.Multivariate logistic regression was used to analyze the risk factors for recrudescence after endovascular embolization of posterior communicating artery aneurysms.Results Of the 74 patients with aneurysm,51 were treated with simple coil embolization and 23 were treated with stent-assisted coil embolization.All the coils were released satisfactorily.There were significant difference in the size of aneurysms and Raymond grade between the two groups (all P<0.01).The incidence of aneurysms with daughter cysts (55.6% [10/18] and the rate of non-stent-assisted coil embolization (88.9% [16/18]) in the recurrent group were significantly higher than those in the non-recurrent group (23.2% [13/56],62.5% [35/56]).The difference between the two groups was statistically significant (all P<0.05).There was no significant difference in other aneurysm features between the two groups (all P>0.05).After variable selection,the Raymond grade was referred to Raymond gradeⅠ.Multivariate logistic regression analysis showed that the non-stent-assisted coil embolization (OR,4.789,95%CI 1.207-19.009,P=0.026),Raymond grade Ⅱ (OR,12.326,95%CI 3.838-39.592,P<0.01),Raymond grade Ⅲ (OR,36.884,95%CI 2.892-470.454,P=0.005) were the independent risk factors for recrudescence after embolization of posterior communicating artery aneurysms.Conclusion Non-stent-assisted coil embolization,Raymond Ⅱ and Ⅲ may cause recrudescence of posterior communicating artery aneurysms.

Objective To investigate the feasibility and effectiveness of endovascular treatment of posterior communicating artery aneurysm (PcoAA)in keeping the fetal posterior cerebral artery (FPCA) patency. Methods Form January 2014 to December 2015,14 patients with ruptured PcoAA enrolled retrospectively were treated with endovascular embolization. Six of them were treated with simple coil embolization,3 with stent-assisted coil embolization,3 with double catheter-assisted coil embolization,1 with stent-assisted coil embolization + double catheter technique,and 1 with Y-stent in Yijishan Hospital, Wannan Medical College. The immediate embolization rate of PcoAA (using Raymond grade),prognosis of the patients (the modified Rankin scale score at 6 months after procedure),complications,and imaging follow-up results were analyzed. Results The success rate of coil and stenting was 100% . All the stents were accurately released in place without displacement. The immediate Raymond grading of the aneurysms displayed that Raymond grade Ⅰ was in 8 cases,Raymond grade Ⅱ was in 4 cases,and Raymond grade Ⅲ was in 2 cases. All FPCA were kept patent. A coil protruded into internal carotid artery in one case during the procedure. Others did not have any complications,such as intraoperative cerebral vasospasm,in-stent thrombosis,and rupture. All 14 patients were followed up for 3 -24 months after procedure. Two had recurrence. Both were aneurysms embolized with coils only. No rebleeding and ischemic
complications were observed. The modified Rankin scale scores in 13 cases were 0 -2 at 6 months after procedure,1 was 4. Conclusions Endovascular embolization for the treatment of PcoAA and keeping FPCA patency are safe and feasible. A variety of endovascular treatment modalities are necessary in order to keep FPCA patency.

Objective To analyze the intraoperative and postoperative common complications of Enterprise stent-assisted embolization of intracranial aneurysms and the causes and preventive measures. Methods One hundred forty-three patients with intracranial aneurysm treated with Enterprise stent-assisted embolization at the Department of Neurosurgery,Yijishan Hospital,the First Hospital Affiliated to Wannan Medical College from January 2012 to March 2014 were analyzed retrospectively. The common intraoperative and postoperative complications and its possible causes,as well as the appropriate management were analyzed,and the prognoses were observed. Results A total 143 patients(205 aneurysms)with intracranial aneurysm were enrolled,included 43 with unruptured aneurysm,12 with recurrent aneurysm,and 88 with ruptured aneurysm. A total of 170 Enterprise stents were used. Twenty-two patients (15. 4%)had complications. Among them,2 had intraoperative aneurysm rupture,and they recovered well and discharged after active treatment. Thirteen patients had acute thrombosis,11 of the patients completely restored blood flow immediately after tirofiban and/or urokinase,microcatheter and guidewire-contact thrombolysis. The thrombolysis failed in 1 patient,and the blood flow was slow in 1 patient. Six patients had different degrees of cerebral infarction after procedure,and 1 died (peroperative Hunt-Hess grade Ⅳ). Three patients had vasospasm and they were improved after reducing blood vessel wall irritation and papaverine infusion. The introperative stent guidewire was broken and the stent in place was difficult in 1 case. The last coil packed difficultly during the procedure,and it protruded into the parent artery in 1 case. Two patients had non-aneurysmal hemorrhage after procedure. After conservative treatment,one left unilateral limb muscle strength decline and the other was stable after craniotomy,but leaving aphasia and hemiplegia. Conclusion When using the Enterprise stent-assisted embolization for complex aneurysms,grasping the indications strictly,strengthening the perioperative management and improving the operative skills may reduce or avoid the occurrence of complications.