Use of the modified Glasgow Coma Scale score to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with AECOPD and respiratory failure

Nursing strategies for the mechanically ventilated patient

The goal of this manuscript is to provide a comprehensive and multi-disciplinary review of the best nursing practices of caring for mechanically ventilated patients. By reviewing human medicine literature, the authors will extrapolate procedures that have been found to be most effective in reducing the risk of mechanical ventilation (MV) complications. Paired with review of the current standards in veterinary medicine, the authors will compile the best practice information on mechanically ventilated patient care, which will serve as a detailed resource for the veterinary nursing staff. Written from a nursing standpoint, this manuscript aims to consolidate the nursing assessment of a mechanically ventilated patient, addressing both systemic and physical changes that may be encountered during hospitalization. The goal of this review article is to present information that encourages a proactive approach to nursing care by focusing on understanding the effects of polypharmacy, hemodynamic changes associated with MV, complications of recumbent patient care, and sources of hospital acquired infections. When applied in conjunction with the more technical aspects of MV, this manuscript will allow veterinary technicians involved in these cases to understand the dynamic challenges that mechanically ventilated patients present, provide guidance to mitigate risk, address issues quickly and effectively, and create an up-to date standard of practice that can be implemented.

Relationship between human serum albumin and in-hospital mortality in critical care patients with chronic obstructive pulmonary disease

Background

The relationship between human serum albumin levels and the prognosis of critical care patients with chronic obstructive pulmonary disease (COPD) remains controversial.

Objective

To investigate the relationship between serum albumin levels and in-hospital mortality in critical care patients with COPD. METHODS: This study used a retrospective observational cohort from the Medical Information in Intensive Care database (MIMIC-IV) in the United States. Multivariate Cox regression analysis was used to assess the relationship between serum albumin levels and in-hospital mortality. A restricted cubic spline line was also used to explore nonlinear relationship.

Results

A total of 3,398 critical care patients with COPD were included. The overall in-hospital mortality was 12.4%. We found a negative relationship between human serum albumin and in-hospital mortality (HR = 0.97, 95% CI 0.96-0.99, p = 0.002).

Conclusion

In critical care patients with COPD, there was a negative association between human serum albumin and in-hospital mortality.

Application of improved Glasgow coma scale score as switching point for sequential invasive-noninvasive mechanical ventilation on chronic obstructive pulmonary disease (COPD) with respiratory failure

BACKGROUND

To compare the efficacy and feasibility of using a modified Glasgow coma scale (GCS) score of 13 or 15 as the criterion for switching chronic obstructive pulmonary disease (COPD) patients with respiratory failure to sequential invasive-noninvasive ventilation.

METHODS

COPD patients with respiratory failure who had undergone endotracheal intubation and invasive mechanical ventilation (IMV) between June 2017 and June 2020 at 4 different hospitals in China were included. A total of 296 patients were randomly divided into 2 groups. In group A, the patients were extubated and immediately placed on noninvasive ventilation (NIV) when the modified GCS score reached 13. In group B, the same was done when the modified GCS score reached 15.

RESULTS

No significant differences in the mean blood pressure, oxygenation index, arterial partial pressure of oxygen, and arterial partial pressure of carbon dioxide were seen between groups A and B before extubation and 3 hours after NIV. The re-intubation times were also similar in the 2 groups. Compared to group B, the length of hospital stay, incidence of ventilator associated pneumonia, and time of invasive ventilation were all significantly lower in group A (P = .041, .001, <.001).

CONCLUSION

Using a modified GCS score of 13 as the criterion for switching from IMV to NIV can significantly reduce the duration of IMV, length of hospital stay, and incidence of ventilator associated pneumonia in COPD patients with respiratory failure.

Evaluation of progressive early rehabilitation training mode in intensive care unit patients with mechanical ventilation

BACKGROUND

Mechanical ventilation is a common resuscitation method in the intensive care unit (ICU). Unfortunately, this treatment process prolongs the ICU stay of patients with an increased incidence of delirium, which ultimately affects the prognosis.

AIM

To evaluate the effect of progressive early rehabilitation training on treatment and prognosis of patients with mechanical ventilation in ICU.

METHODS

The convenience sampling method selected 190 patients with mechanical ventilation admitted to the Fourth Hospital of Hebei Medical University from March 2020 to March 2021. According to the random number table method, they were divided into the control and intervention groups. The control group received routine nursing and rehabilitation measures, whereas the intervention group received progressive early rehabilitation training. In addition, the incidence and duration of delirium were compared for the two groups along with mechanical ventilation time, ICU hospitalization time, functional independence measure (FIM) score, Barthel index, and the incidence of complications (deep venous thrombosis, pressure sores, and acquired muscle weakness).

RESULTS

In the intervention group, the incidence of delirium was significantly lower than in the control group (28% vs 52%, P < 0.001). In the intervention group, the duration of delirium, mechanical ventilation time, and ICU stay were shorter than in the control group (P < 0.001). The FIM and Barthel index scores were significantly higher in the intervention group than the control group (P < 0.001). The total incidence of complications in the intervention group was 3.15%, which was lower than 17.89% in the control group (P < 0.001).

CONCLUSION

Progressive early rehabilitation training reduced the incidence of delirium and complications in ICU patients with mechanical ventilation, which improved prognosis and quality of life.

Bone Marrow Mesenchymal Stem Cell Transplantation in Combination with Nasal Continuous Positive Airway Pressure Improves Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)

We aimed to explore the efficacy of bone marrow mesenchymal stem cell (BMSC) transplantation combined with nasal continuous positive airway pressure (nCPAP) for treating severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD). SD rat AECOPD model was established by injecting endotoxin and Staphylococcus aureus and then treated with nCPAP, BMSCs, or nCPAP combined with BMSCs (n = 20) and their conditions were evaluated with BBB score at 1 d, 3 d, 7 d, 14 d, 28 d after treatment along with analysis of apoptosis and BrdU-positive cells as well as NF200 expression by TUNEL kit staining and levels of Th1, Th7 and Th12 before and after treatment. As revealed by BBB score and HE staining, all treatments significantly alleviated the symptom of severe APEOPD (p < 0.05), while compared with nCPAP, the combined treatment exhibited higher efficacy. Besides, upon treatment, apoptosis and level of Th1, Th7 and Th12 was reduced but N200 absorbance value was elevated, with significant difference in combination group (p < 0.05). In conclusion, BMSC transplantation in combination with nCPAP alleviates severe AECOPD by reducing cell apoptosis, repairing cell damage, and regulating T-cell subsets.

Procalcitonin kinetics to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: procalcitonin's adjunct role

How to identify the optimum switch point of sequential invasive and noninvasive ventilation is the focus of clinical attention on the patients suffering from acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by acute respiratory failure (ARF). This study aims to explore the clinical significance of taking the change rate of procalcitonin (PCT) as identifying the timing of weaning on the mechanical ventilation for the patients of AECOPD followed by ARF as a complication. There were altogether 140 patients of AECOPD complicated with ARF, who were randomly selected and divided into a study group and a control group respectively. A change rate of serum PCT level exceeding 50% was taken as the switch point selection of tracheal intubation removal for the patients of the study group, while the ‘pulmonary infection control (PIC) window’ was done for those in the control group. With CRP, IL-6, TNF-a, PaCO_2, PaO_2, and Lac having been detected before and after treatment to them all, clinical indexes were obtained and compared between these two groups. The CRP, TNF-a, and IL-6 levels of the patients in the study group after treatment (p < 0.05) were lower than those in the control group. There was no significant difference in PaCO_2, PaO_2, and Lac between these two groups before and after treatment (p > 0.05). Even so, some other indexes available for the study group of patients were found to be lower than those for the control group (p < 0.05) in the following aspects: duration of invasive ventilation support, total time of mechanical ventilation support, incidence rate of ventilator-associated pneumonia, 48-hour reintubation rate, incidence rate of upper gastrointestinal bleeding, hospitalization time of critical respiratory illness, total hospitalization time, RICU treatment cost, total treatment cost, and mortality. It is preferable to take the change rate of PCT level exceeding 50% as the switch point of weaning time in sequential mechanical ventilation rather than the PIC window.

Abbreviations

AECOPD: acute exacerbation of chronic obstructive pulmonary disease; ARF: acute respiratory failure; PCT: procalcitonin; PaO₂: the oxygen partial pressure; PaCO₂: the partial pressure of carbon dioxide; TNF-a: serum tumor necrosis factor-a; IL-6: interleukin-6; CRP: serum C-reactive protein; PIC window: pulmonary infection control window; RICU: respiration and intensive care unit