Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study

Influence of comprehensive nursing cooperation on complications and quality of life in patients with video laryngoscope-guided orotracheal intubation in lateral decubitus position

OBJECTIVE

To retrospectively analyze the influence of nursing cooperation on complications and quality of life (QoL) in patients with video laryngoscope-guided orotracheal intubation in a lateral decubitus position (LDP).

METHODS

A total of 130 patients with orotracheal intubation under general anesthesia in LDP from January 2020 to December 2021 were included and grouped based on the nursing model they received, with 65 patients receiving routine nursing cooperation during operation being included in a control group (the Con), and 65 patients receiving comprehensive nursing cooperation on the basis of the Con being included in an observation group (the Obs). The effect of the two nursing intervention models on acute pressure ulcer degree, complications, doctor-patient satisfaction, duration and area of pressure injury, nursing costs, and QoL were compared.

RESULTS

The incidence of intraoperative acute pressure injury differed significantly between the Obs (3.08%) and the Con (21.54%) (P<0.05). The Obs also showed lower incidences of complications such as pressure injury, limb swelling, limb numbness and muscle soreness than the Con did (P<0.05). The satisfaction of nurses, patients, anesthesiologists and surgeons in the Obs group were all 100.00%, which was higher than those in the Con (93.85%, 89.23%, 92.31% and 90.77%, respectively). Patients in the Obs had shorter duration of pressure injury, smaller pressure injury area and less nursing cost (P<0.05). After nursing, the scores of social/physical functioning, vitality, role-emotional/physical, mental health, and bodily pain were all better in the Obs than in the Con (P<0.05).

CONCLUSIONS

The implementation of comprehensive nursing cooperation for patients with video laryngoscope-guided orotracheal intubation in LDP can reduce the incidence of complications, lower the degree of acute pressure injury, improve doctor-patient satisfaction, and enhance the QoL of patients.

Automatic air volume control system for ventilation of two patients using a single ventilator: a large animal model study

The COVID-19 pandemic outbreak led to a global ventilator shortage. Hence, various strategies for using a single ventilator to support multiple patients have been considered. A device called Ventil previously validated for independent lung ventilation was used in this study to evaluate its usability for shared ventilation. We performed experiments with a total number of 16 animals. Eight pairs of pigs were ventilated by a ventilator or anesthetic machine and by Ventil for up to 27 h. In one experiment, 200 ml of saline was introduced to one subject's lungs to reduce their compliance. The experiments were analyzed in terms of arterial blood gases and respiratory parameters. In addition to the animal study, we performed a series of laboratory experiments with artificial lungs (ALs). The resistance and compliance of one AL (affected) were altered, while the tidal volume (TV) and peak pressure (Ppeak) in the second (unaffected) AL were analyzed. In addition, to assess the risk of transmission of pathogens between AL respiratory tracts, laboratory tests were performed using phantoms of virus particles. The physiological level of analyzed parameters in ventilated animals was maintained, except for CO₂ tension, for which a permissive hypercapnia was indicated. Experiments did not lead to injuries in the animal's lungs except for one subject, as indicated by CT scan analysis. In laboratory experiments, changes in TV and Ppeak in the unaffected AL were less than 11%, except for 2 cases where the TV change was 20%. No cross-contamination was found in simulations of pathogen transmission. We conclude that ventilation using Ventil can be considered safe in patients undergoing deep sedation without spontaneous breathing efforts.

Positional impairment of gas exchange during diaphragm pacing alleviated by increasing amplitude settings in congenital central hypoventilation syndrome

None

Diaphragm pacing (DP) by phrenic nerve stimulation is a modality of chronic ventilatory support in individuals with congenital central hypoventilation syndrome (CCHS). We report a 9-year-old girl with CCHS who uses DP without tracheostomy during sleep. Her parents report hypoxemia and hypercapnia related to positional changes of the body during sleep requiring frequent adjustment of pacer settings. Overnight polysomnography was performed to titrate DP settings that showed adequate gas exchange in the supine position, but intermittent hypoxemia and hypercapnia were noted in the left decubitus position without obstructive sleep apnea occurring. Subsequently, the DP amplitude settings were increased during polysomnography, thereby identifying and treating positional hypoxemia and hypercapnia in various body positions. Our case emphasizes the importance of polysomnography in children with CCHS using DP to monitor for sleep-disordered breathing and titration of DP settings to achieve optimal oxygenation and ventilation with different body positions during sleep.