OBJECTIVES: To systematically evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (NHFOV) versus nasal intermittent positive pressure ventilation (NIPPV) as post-extubation respiratory support in preterm infants. METHODS: China National Knowledge Infrastructure, Wanfang Data, Chinese Journal Full-text Database, China Biology Medicine disc, PubMed, Web of Science, and the Cochrane Library were searched for articles on NHFOV and NIPPV as post-extubation respiratory support in preterm infants published up to August 31, 2022. RevMan 5.4 software and Stata 17.0 software were used for a Meta analysis to compare related indices between the NHFOV and NIPPV groups, including reintubation rate within 72 hours after extubation, partial pressure of carbon dioxide (PCO₂) at 6-24 hours after switch to noninvasive assisted ventilation, and the incidence rates of bronchopulmonary dysplasia (BPD), air leak, nasal damage, periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP). RESULTS: A total of 9 randomized controlled trials were included. The Meta analysis showed that compared with the NIPPV group, the NHFOV group had significantly lower reintubation rate within 72 hours after extubation (RR=0.67, 95%CI: 0.52-0.88, P=0.003) and PCO₂ at 6-24 hours after switch to noninvasive assisted ventilation (MD=-4.12, 95%CI: -6.12 to -2.13, P<0.001). There was no significant difference between the two groups in the incidence rates of complications such as BPD, air leak, nasal damage, PVL, IVH, and ROP (P>0.05). CONCLUSIONS Compared with NIPPV, NHFOV can effectively remove CO₂ and reduce the risk of reintubation, without increasing the incidence of complications such as BPD, air leak, nasal damage, PVL, and IVH, and therefore, it can be used as a sequential respiratory support mode for preterm infants after extubation.
Infant ; Infant, Newborn ; Humans ; Infant, Premature ; Intermittent Positive-Pressure Ventilation ; Airway Extubation ; Noninvasive Ventilation ; Bronchopulmonary Dysplasia ; High-Frequency Ventilation ; Respiratory Distress Syndrome, Newborn/therapy* ; Continuous Positive Airway Pressure

Humans ; Child ; Glucocorticoids/therapeutic use* ; Airway Extubation ; Airway Obstruction/prevention & control* ; Intubation, Intratracheal/adverse effects*

This patient suffered from severe subglottic stenosis(grade Ⅳb). During partial cricotracheal resection, we cut through the cricothyroid membrane and the cricoid arch along the line from the lower edge of the thyroid cartilage to 5 mm of the inferior thyroid cartilage corner anteromedially. This can protect the cricothyroid joint, effectively protect the recurrent laryngeal nerve, and also support the airway. Strictly adhere to airway separation, avoid excessive separation of scars, and combine with reasonable postoperative management to achieve a safe extubation.
Humans ; Constriction, Pathologic/surgery* ; Trachea/surgery* ; Airway Extubation ; Laryngostenosis/surgery* ; Larynx/surgery* ; Cricoid Cartilage/surgery* ; Treatment Outcome

Humans ; Noninvasive Ventilation ; Cannula ; Airway Extubation ; Retrospective Studies ; Pulmonary Disease, Chronic Obstructive/therapy* ; Hypercapnia/therapy* ; Oxygen Inhalation Therapy ; Respiratory Insufficiency/therapy*

Congenital cystic adenomatoid malformation (CCAM) is a rare developmental entity. Symptomatic patients must undergo thoracic surgery for lobectomy. Perioperative anesthetic management is challenging because it involves
thoracotomy in a young patient that may lead to hemodynamic compromise and inadequate ventilation. We present 3 cases of pediatric patients (6 months - 2 years old) with CCAM who underwent lobectomy.

INTRODUCTION: Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC. METHODS: We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC. RESULTS: Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83-3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days, CONCLUSION Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure.
Adult ; Airway Extubation ; Cannula ; Critical Care ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Respiratory Insufficiency/therapy* ; Singapore/epidemiology*

OBJECTIVE: To study and compare the effect of indwelling drainage tube and extubation time on occult hemorrhage and functional recovery after total hip arthroplasty(THA). METHODS: From July 2017 to June 2018, 123 patients who underwent THA in our hospital for the first time were selected as the subjects of study. According to whether the drainage tube was retained or not and the time of extubation, they were divided into three groups:in group A, 41 patients (24 males, 17 females, age 53 to 77 years) did not put drainage tube after THA;in group B, 41 patients were removed 24 hours after THA, 26 males and 15 females, aged 55 to 74 years;in group C, 41 patients were removed 48 hours after THA, 25 males and 16 females, aged 52 to 75 years. The VAS score of pain 72 hours after THA, the total and recessive blood loss, the time of starting functional exercise, and the incidence of postoperative limb swelling were recorded. All the patients were followed up for one year after discharge. Harris hip score was used to evaluate the degree of hip function recovery one year after operation. RESULTS: The occult blood loss of group A, B and C were(513.6±25.3), (521.7±33.4), (519.3±29.8) ml, respectively, with no significant difference(>0.05). There was no significant difference in blood loss in operation among the three groups(>0.05). In group B and C, the postoperative apparent blood loss was more than that in group A (<0.05). There was no significant difference in VAS scores of the three groups before and 72 hours after operation (>0.05). The time of getting out of bed in group A was shorter than that in group B and C (<0.05), and that in group B was shorter than that in group C(<0.05). The Harris hip score at 1 year after operationof the three groups was significantly higher than that of before operation (<0.05). There was no significant difference in Harris hip score before and after operation among three groups (>0.05). There was no significant difference in the incidence of complications among three groups (>0.05). CONCLUSION Whether the drainage tube is left or not and the time of extubation have no significant effect on the latent blood loss and functional recovery after THA, but without drainage tube after THA can reduce the apparent blood loss, patients can get out of bed at 6 hours after THA, which is more conducive to the recovery and nursing of patients.
Aged ; Airway Extubation ; Arthroplasty, Replacement, Hip ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Recovery of Function ; Treatment Outcome

extubation, intraoperative occurrence of atrioventricular block, postoperative presence of agitation, seizures, use of labetalol and dexmedetomidine infusion were also recorded. Data from the two groups were compared with Fisher's exact test and unpaired t tests with Welch's correction. Odds ratio (OR) and 95% confidence interval (CI) were calculated for categorical variables. Intra-operatively, MAP was lower in Sevo-Op [85 (± 6.54) vs. 97.69 (± 7.8) mmHg, p = 0.0009]. Time to extubation was longer in Sevo-Dex [37.69 (10–70) vs. 19.63 (10–25), p = 0.0033]. No differences were found for the other intra-operative and post-operative variables investigated. Post-operative hypertension and agitation were the most common complications (11 and 12 out of 21 animals, respectively). These results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.]]>
Airway Extubation ; Anesthesia ; Animals ; Arterial Pressure ; Atrioventricular Block ; Bradycardia ; Brain Neoplasms ; Carbon Dioxide ; Dexmedetomidine ; Dihydroergotamine ; Dogs ; Fever ; Heart Rate ; Hypertension ; Hypotension ; Hypothermia ; Labetalol ; Neurosurgery ; Observational Study ; Odds Ratio ; Retrospective Studies ; Seizures ; Tachycardia

BACKGROUND: Maintenance of tracheal intubation is associated with use of sedatives, stress due to mechanical ventilation, or respiratory complications. The aim of this study is to compare the incidence of delirium between early and late extubation groups after liver transplantation (LT). METHODS: Medical records from 247 patients who received LT from January 2010 to July 2017 in a single university hospital were retrospectively reviewed. Patients were divided with 2 groups: Those who underwent early extubation after LT (E group, n = 52) and those who underwent extubation within few hours of intensive care unit (ICU) admission after surgery (C group, n = 195). The patients’ demographic data, perioperative managements and postoperative complications were collected. Early extubation was defined as performing extubation in the operating room after LT. A propensity score matching analysis was performed to reduce the effects of selection bias. RESULTS: Among them, 4/52 (7.69%) in E group and 30/195 (15.38%) in C group occurred postoperative delirium after LT, respectively (P = 0.180). After propensity score matching, there was no difference of the period of hospitalization in ICU (P = 0.961), time to discharge after surgery (P = 0.117) and incidence of delirium between groups (P = 1.000). CONCLUSIONS: Although this study is a retrospective study and limited by the small number of subjects, early extubation does not affect the incidence of delirium after LT. Therefore, further prospective studies on this were needed.
Airway Extubation ; Delirium ; Hospitalization ; Humans ; Hypnotics and Sedatives ; Incidence ; Intensive Care Units ; Intubation ; Liver Transplantation ; Liver ; Medical Records ; Operating Rooms ; Postoperative Complications ; Propensity Score ; Prospective Studies ; Respiration, Artificial ; Retrospective Studies ; Selection Bias

Chordoma is a slow-growing, locally invasive, lowgrade malignant tumor with a prevalence of one in 100 000, accounting for 1%-4% of all malignant bone tumors. At present, it is considered that chordoma originates from ectopic embryonic chordal tissue and can occur in any part of the spine from the skull base to the sacrum. About 50% of chordoma occurs in the sacrococcygeal region, about 30% in the skull base, and the rest occurs in the active spinal region. Cervical chordoma is rare, but it may be accompanied by difficult airways. The tumors compress the pharynx and throat forward, which can cause upper airway obstruction. If the anesthesia is not properly handled, the patient may die of asphyxia. The core issues of airway management during the perioperative period of cervical chordoma surgery involve three main parts: preoperative airway evaluation, airway management and extubation management. Difficult airway assessment often relies on physical examination indicators, such as inter-incisor gap, thyromental distance, neck circumference, Mallampati test, etc. But the accuracy is insufficient. The application of imaging examination in the observation of different tissues can make up for the inaccurate evaluation of the internal structure of the airway. Because chordoma destroys cervical vertebral body and accessories, cervical stability is impaired. Excessive cervical vertebral extention should be avoided during tracheal intubation to prevent severe compression of the spinal cord. It is better to fix the head by an assistant and perform neutral tracheal intubation. Considering that the patient with a difficult airway that could be predicted before operation, the strategy of tracheal intubation under conscious sedation with topical anesthesia was selected. After sedation and topical anesthesia, the patient was successfully intubated with optical stylet. After operation, the patient returned to ICU with tracheal catheter. On the 4th day after operation, the tracheal tube was pulled out. On the 5th day after operation, the patient was transferred to the orthopaedic ward and discharged on the 7th day after operation. It is of great significance to establish specific strategies for such operations to reduce related complications, speed up post-operative rehabilitation and save medical resources. We reported the anesthetic management of cervical chordoma cured in Peking University Third Hospital.
Airway Extubation ; Cervical Vertebrae ; Chordoma ; Humans ; Intubation, Intratracheal ; Neck