OBJECTIVES: To study the application value of transport ventilator in the inter-hospital transport of critically ill children. METHODS: The critically ill children in Hunan Children's Hospital who were transported with or without a transport ventilator were included as the observation group (from January 2019 to January 2020; n=122) and the control group (from January 2018 to January 2019; n=120), respectively. The two groups were compared in terms of general data, the changes in heart rate, respiratory rate, and blood oxygen saturation during transport, the incidence rates of adverse events, and outcomes. RESULTS: There were no significant differences between the two groups in sex, age, oxygenation index, pediatric critical illness score, course of disease, primary disease, heart rate, respiratory rate, and transcutaneous oxygen saturation before transport (P>0.05). During transport, there were no significant differences between the two groups in the changes in heart rate, respiratory rate, and transcutaneous oxygen saturation (P>0.05). The incidence rates of tracheal catheter detachment, indwelling needle detachment, and sudden cardiac arrest in the observation group were lower than those in the control group during transport, but the difference was not statistically significant (P>0.05). Compared with the control group, the observation group had significantly shorter duration of mechanical ventilation and length of stay in the pediatric intensive care unit and significantly higher transport success rate and cure/improvement rate (P<0.05). CONCLUSIONS The application of transport ventilator in the inter-hospital transport can improve the success rate of inter-hospital transport and the prognosis in critically ill children, and therefore, it holds promise for clinical application in the inter-hospital transport of critically ill children.
Child ; Humans ; Critical Illness ; Respiration, Artificial/adverse effects* ; Intensive Care Units, Pediatric ; Ventilators, Mechanical ; Prognosis

The need for mechanical ventilation due to severe hypoxemia and acute respiratory distress syndrome has increased dramatically in the global pandemic of severe respiratory infectious diseases. In clinical scenarios, it is sometimes necessary to briefly disconnect the ventilator pipeline from the artificial airway. Still, this operation can lead to a sharp drop in airway pressure, which is contrary to the protective lung ventilation strategy and increases the risk of environmental exposure to bioaerosol, posing a serious threat to patients and medical workers. At present, there is yet to be a practical solution. A new artificial airway device was designed by the medical staff from the department of critical care medicine of Beijing Tiantan Hospital, Capital Medical University, based on many years of research experience in respiratory support therapy, and recently obtained the National Utility Model Patent of China (ZL 2019 2 0379605.4). The device comprises two connecting pipes, the sealing device body, and the globe valve represented by the iridescent optical ring. It has a simple structure, convenient operation, and low production cost. The device is installed between the artificial airway and the ventilator pipeline and realizes the instantaneous sealing of the artificial airway by adjusting the shut-off valve. Using this device to treat mechanically ventilated patients can minimize the ventilator-induced lung injury caused by the repeated disconnection of pipelines, avoid iatrogenic transmission of bioaerosols, and realize dual protection for patients and medical workers. It has extensive clinical application prospects and high health and economic value.
Humans ; Respiration, Artificial/adverse effects* ; Ventilators, Mechanical/adverse effects* ; Respiratory Distress Syndrome/therapy* ; Ventilator-Induced Lung Injury/prevention & control* ; Hypoxia/complications*

OBJECTIVEThe catheter-related infections caused by mechanical ventilation have become a intractable clinical problem, and it is related to the formation of bacterial biofilm (BF) on the surface of the implanted material. The majority of natural biofilms are formed by multiple bacterial species. However, there always only one or limited species were detected on tracheal tubes removed from intubated neonates by using traditional methods including bacterium culture and antigen detection. The aims of this study were to observe the bacterial communities diversity of BF on endotracheal tube (ETT), and discuss the difference between traditional bacterium culture methods and the use of molecular biology techniques on the basis of denatured gradient gel electrophoresis (DGGE), to provide new ideas for clinical prevention, diagnosis and treatment of bacterial infections.

METHODThirty-five ETTs were obtained from 26 neonates on mechanical ventilator (from October 2012 to March 2013) in Department of Neonatology of Children's Hospital. Among the patients, 18 were boys and 8 girls, and 19 patients were < 37 weeks gestational age and 7 patients ≥ 37 weeks. DGGE profiling of 16S rDNA gene amplicons was used to assess the diversity of the bacterial population by using the software of quantity one. TA Cloning Kit and sequencing were used to investigate the distribution of bacteria and common dominant bacteria in ETT-BF.

RESULTThe mean bands of 35 ETTs cases were 13.8 ± 5.4 from 16S rDNA PCR-DGGE, and the mean Shanon-Wiener indexes was 2.42 ± 0.38. The 16 ETTs were collected in different stages of diseases from the 7 patients. The indwelling days of 6/7 patients' ETTs increased, the Shanon-siener indexes were decreased. Among the 6 cases from different basic illnesses, and there were different Shanon-siener indexes. The result of molecular cloning and sequencing for 24 dominant bands showed that 35 cases (100%) contained Klebsiella SP·, 28 cases (80%) had Pseudomonas SP·, 27 cases (77%) had Streptococcus SP·, and 32 cases (91%) had Uncultured bacterium, while more than 2 bacterial species were found in 34 cases (97%). 28/35 (80%) Klebsiella SP· and 22/27(82%) Streptococcus SP· were accompanied by Pseudomonas SP·. There were 22 positive results of sputum culture from 26 newborns, including 10 strains (45%) of Klebsiella pneumoniae, 2 strains (9%) of Acinetobacter baumannii, Enterobacter cloacae and non-cultured bacterium in each patient (5%), but only one bacterium isolated from every sputum. Eight sputum samples had normal flora only, corresponding to the ETTs on which Klebsiella and other bacterial genuses were found.

CONCLUSIONThe diversity of microbiota in BF on ETT was confirmed. 16S rDNA PCR-DGGE could produce a more complete picture of bacterial community than traditional bacterium culture method. Klebsiella, Pseudomonas and Streptococcus were common dominant bacteria in ETT-BF, and there might be interactions among them in the formation of BF.

Bacteria ; classification ; genetics ; isolation & purification ; Biodiversity ; Biofilms ; Catheter-Related Infections ; microbiology ; DNA, Bacterial ; analysis ; genetics ; Denaturing Gradient Gel Electrophoresis ; Female ; Humans ; Infant, Newborn ; Intubation, Intratracheal ; adverse effects ; Klebsiella ; genetics ; isolation & purification ; Male ; Polymerase Chain Reaction ; Pseudomonas ; genetics ; isolation & purification ; RNA, Ribosomal, 16S ; genetics ; Respiration, Artificial ; adverse effects ; Sputum ; microbiology ; Streptococcus ; genetics ; isolation & purification ; Ventilators, Mechanical ; microbiology

The risk analysis of clinical claims of mechanical ventilator can provide the useful information to the application of the availability and safety of mechanical ventilators. This paper classifies the clinical claims of two types of mechanical ventilations, and tries to find the distribution characteristics of the failure rate of the clinical claims by using the hazard analysis method. All of the distribution characteristics are related to the factors as ventilator design, environment human factors, etc. The method of risk analysis, combining with the classification of clinical claims, is useful for the clinical application and engineering services of mechanical ventilation.
Data Interpretation, Statistical ; Equipment Failure Analysis ; statistics & numerical data ; Humans ; Respiration, Artificial ; adverse effects ; instrumentation ; standards ; Risk Assessment ; Ventilators, Mechanical ; adverse effects ; standards

Animals ; Bronchoalveolar Lavage Fluid ; chemistry ; Chemokine CCL2 ; analysis ; Immunohistochemistry ; Lipopolysaccharide Receptors ; analysis ; genetics ; Lipopolysaccharides ; toxicity ; Lung ; pathology ; Male ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; analysis ; Ventilators, Mechanical ; adverse effects

OBJECTIVETo observe the incidence of double-lumen endobronchial tubes (DLT) malposition caused by body position change or surgical manipulation and its impact on the efficacy of lung separation and ventilation.

METHODSTotally 688 patients undergoing thoracic surgery were enrolled in this study. The patients were intubated with Mallinckrodt DLT following intravenous anesthesia induction. The DLT position was corrected with fiberoptic bronchoscope (FOB), and successful lung separation and satisfactory ventilation were ensured during one-lung ventilation in the supine position. Bronchoscopy was performed immediately and the DLT position was corrected 15 minutes after dependent lung ventilation in the lateral position or in case of ineffective lung separation or SpO(2) declination to below 90%.

RESULTSDLT malposition occurred after lateralization in 112 (16.3%) patients, of whom 12.8% developed hypoxemia and 3.3% encountered air leak. The incidence of left-sided DLT malposition after lateralization was higher than that of right-sided DLT malposition (19.7% vs 12.2%, P<0.01). DLT malposition occurring in 112 patients after lateralization reoccurred in 16 (14.3%) patients during surgery, and the malposition incidence was significantly higher than that of malposition occurring only during surgery (1.2%, P<0.01).

CONCLUSIONMalposition of Mallinckrodt double-lumen tubes for lung separation during thoracic anesthesia occurs in 16.3% patients when shifting to lateral position, may reoccur in 14.3% of the patients despite previous FOB positioning.

Bronchoscopy ; Fiber Optic Technology ; Humans ; Intraoperative Complications ; diagnosis ; etiology ; Intubation, Intratracheal ; adverse effects ; methods ; Respiration, Artificial ; methods ; Thoracic Surgical Procedures ; adverse effects ; methods ; Ventilators, Mechanical

BACKGROUNDWith the widespread use of ventilators in treating critically ill patients, the morbidity of ventilator-induced lung injury (VILI) is increasing accordingly. VILI is characterized by a considerable increase in microvascular leakiness and activation of inflammatory processes. In this study we investigated the effects of inflammatory mediators in VILI rat serum on endothelial cytoskeleton and monolayer cellular permeability, as well as the therapeutic effect of ulinastatin, to explore the pathogenesis and the relationship between biotrauma and lung oedema induced by VILI.

METHODSThirty healthy male Sprague-Dawley rats were randomly divided into three groups: group A (normal tidal volume ventilation), group B (high tidal volume ventilation) and group C (high tidal volume ventilation plus ulinastatin). The serum of each rat after ventilation was added to endothelial cell line ECV-304 medium for two hours to observe the effects of serum and/or ulinastatin on endothelial fibrous actin and permeability.

RESULTSCompared to rats ventilated with normal tidal volume, serum of rats ventilated with high tidal volume caused a striking reorganization of actin cytoskeleton with a weakening of fluorescent intensity at the peripheral filament bands and formation of the long and thick stress fibres in the centre resulting in endothelial contraction and higher permeability. Prior treatment with ulinastatin lessened the above changes significantly. The changes of permeability coefficient of endothelial permeability after group A, B or C rats serum stimulation were (6.95 +/- 1.66)%, (27.50 +/- 7.77)% and (17.71 +/- 4.66)% respectively with statistically significant differences (P < 0.05) among the three groups.

CONCLUSIONSThe proinflammatory mediators in the serum of the rats given high tidal volume ventilation increases endothelial permeability by reorganizing actin cytoskeleton, and pretreatment with ulinastatin lessens the permeability by inhibiting of proinflammatory mediators.

Actins ; analysis ; metabolism ; Animals ; Anti-Inflammatory Agents ; therapeutic use ; Cell Membrane Permeability ; drug effects ; Cells, Cultured ; Endothelial Cells ; drug effects ; metabolism ; physiology ; Glycoproteins ; therapeutic use ; Humans ; Lung ; drug effects ; metabolism ; Lung Diseases ; etiology ; physiopathology ; prevention & control ; Lung Injury ; Male ; Microscopy, Fluorescence ; methods ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Respiration, Artificial ; adverse effects ; Tidal Volume ; drug effects ; Ventilators, Mechanical ; adverse effects

Acute Disease ; Humans ; Pneumonia ; prevention & control ; Pulmonary Disease, Chronic Obstructive ; complications ; Respiration, Artificial ; Respiratory Insufficiency ; therapy ; Ventilators, Mechanical ; adverse effects

OBJECTIVETo study the epidemiology of Acinetobacter baumannii infection in patients with ventilator-associated pneumonia (VAP).

METHODSProspective clinical study was carried out with 176 episodes of VAP with etiologic diagnosis being followed in two groups.

RESULTSTwenty-six episodes were caused by Acinetobacter baumannii and one hundred-fifty episodes were caused by "other" organisms. Using logistic regression analysis, the risk of VAP due to Acinetobacter baumannii was found to be high in patients with head trauma [odds ratio (OR) = 4.20, 95% confidence interva (CI): 2.72 to 6.48], surgery (OR = 2.88, 95% CI: 1.78 to 4.66), acute respiratory dispnea syndrome (OR = 2.81, 95% CI: 1.19 to 6.64), and large-volume pulmonary aspiration (OR = 6.71, 95% CI: 3.91 to 11.50).

CONCLUSIONSAcinetobacter baumannii pulmonary infection in incubated patients had an epidemiological pattern that different from "other" organisms. Patients with high risk identified in our study might mark the existence of cross-infection during airway manipulation.

Acinetobacter ; classification ; isolation & purification ; Acinetobacter Infections ; epidemiology ; etiology ; Aged ; Aged, 80 and over ; China ; epidemiology ; Cross Infection ; epidemiology ; etiology ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Male ; Middle Aged ; Pneumonia, Bacterial ; etiology ; microbiology ; Prospective Studies ; Respiration, Artificial ; adverse effects ; Respiratory Distress Syndrome, Adult ; complications ; Risk Factors ; Time Factors ; Ventilators, Mechanical ; adverse effects

Burn Units ; Cross Infection ; therapy ; Drug Resistance ; Humans ; Pneumonia ; etiology ; therapy ; Respiratory Tract Infections ; etiology ; therapy ; Ventilators, Mechanical ; adverse effects