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Preventive use of NIV after extubation in patients who passed spontaneous breathing trial did not show benefits in decreasing extubation failure rate or the mortality rate.

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Exploring the characteristics and prognosis of unplanned readmissions of patients using a home ventilator and analyzing relevant pre-discharge factors that affect such unplanned readmissions.A retrospective study was conducted to collect medical record data for 2013–2017 on the readmission of home-ventilated patients in a medical center in northern Taiwan. The average intervals of home care for the early readmission group (≤ 30 days) and the late readmission group (≥ 31 days) were 15.1 ± 9.2 and 164.8 ± 143.2 days, respectively. Regarding risk factors of early and late unplanned hospital readmission, the odds ratio (OR) for patients with chronic cardiovascular disease compared with those without this disease was 4.535 (95% CI 1.253 -16.413). For maximum inspiratory pressure ≦ −30 cmH2O compared with > −30 cmH2O, the OR for early readmission was 0.207 (95% CI 0.056 - 0.767). For hemoglobin ≥ 10.1 g/dL compared with < 10.1 g/dL, the OR of early readmission was 0.280 (95% CI 0.082 - 0.958). So, pre-discharge problems, including chronic cardiovascular disease, maximum inspiratory pressure, and reduced hemoglobin, are risk factors for unplanned early hospitalization readmission of patients using a ventilator at home. Therefore, attention should be paid to these risk factors during discharge planning.

BACKGROUND: In low flow oxygen therapy, FIO2 is difficult to measure in spontaneously breathing patients due to room air dilution and dead space rebreathing, especial in impairments respiratory mechanics. This study determined oxygen concentrations with different tidal volumes and respiratory rates among different lung mechanics and provided equations to estimate oxygen concentrations during standard nasal cannula oxygen therapy. METHODS: Two Training & Test Lung models were used in this study. One simulated spontaneous breathing, whereas the other included an expiratory gas modification bellow. Three lung mechanics [normal (R5/C60), restrictive (R20/C80) and obstructive (R5/C40)] were designed, and spontaneous breathing settings for different tidal volumes(VT) and respiratory rates(f) were simulated by the mechanical ventilator. The nasal cannula used flows of 1, 3 and 5L/min; peak inspired oxygen concentration (FO2 insp.) and pre-inspired oxygen concentration (FO2 pre-insp.) were measured. RESULTS: Increased VT caused a decreased FO2 insp. and FO2 pre-insp., except at 1L/min oxygen flow with a high f (30breaths/min). Multiple regression analysis showed oxygen flow rate, VT and f as the most important factors in predicting oxygen delivery during nasal cannula therapy. Therefore, we provided equations to predict oxygen concentration for managing patients with acute and chronic lung diseases. CONCLUSIONS: Our study suggested that under low-flow nasal cannula therapy, various lung mechanics and respiratory patterns in the normal, restrictive and obstructive lung models will affect the oxygen concentration.