Objectives To investigate the effects of artificial nose, Venturi device+thermostatic humidification T-tube, Venturi device+thermostatic humidification T-tube+PEEP valve in patients with tracheotomy in ICU.Design: Cohort study.Setting: Tertiary academic medical center.Patients: A total of 215 patients were engaged in this study. Clinical and laboratory examination data were used to determine the heating and humidification efficiency of 3 different methods.Methods: We conducted randomized controlled trial. Patients who successfully weaned from mechanical ventilation were enrolled, and every patient was randomized to receive one of the above three interventions. Three groups of patients were compared in terms of vital signs, the effect of artificial airway heating and humidification, and blood gas indicators. Basic patient data (age, gender, mechanical ventilation duration, ICU stay, disease type) were recorded. Vital signs include heart rate, blood pressure, respiratory rate, oxygen saturation; The effect of heating and humidifying the artificial airway were defined as the number of sputum suction and coughing within 24 hours, sputum characteristics, whether there is bloody sputum formation, whether there is phlegm callus formation; Blood gas indicators include pH, oxygen partial pressure, carbon dioxide partial pressure, lactic acid, residual base, and bicarbonate.Results: In terms of the heating and humidification effect of patients in ICU, the heating and humidification effect of the Venturi device+T-tube method and the Venturi device+the T-tube +PEEP valve method were significantly superior to those of artificial nasal method (sputum suction number: P =0.0001; sputum scab: P =0.03; Number of cough: P =0.007).SpO2 was significantly higher (P =0.004) in the Venturi device+T tube+PEEP valve than that in the Venturi device+T tube.Conclusion: Compared with the artificial nose method, the T-piece+venturi device and thermostatic heating and humidifying T-tube +PEEP valve method is better. In terms of improving oxygenation, the Venturi device and the thermostatic humidification T tube +PEEP valve could improve the patient's oxygen sum more than the Venturi device and the thermostatic humidification T tube.

ObjectivePressure-supported ventilation is widely used in critically ill patients, and the patient's effort in spontaneous breathing is an important predictor of the success rate of weaning, but this index is difficult to measure accurately under clinical conditions. It has been demonstrated that the absolute value of diaphragm excursion is influenced by multiple factors and cannot be used as a predictor of weaning from mechanical ventilation. This study aims to reveal the characteristics of diaphragm excursion changes (respiratory excursion) at different levels of pressure support, and explore whether it can predict the weaning from mechanical ventilation.DesignProspective cohort study.SettingSingle-center.PatientsPatients admitted to the ICU who were mechanically ventilated and had met the criteria to perform an autonomic breathing test were enrolled. Patients with tracheal obstruction or after thoracic/gastric/esophageal surgery were excluded. InterventionsDifferent levels of pressure support (20,15,10,5 and 0 cm H2O) were applied in pressure-assisted ventilation mode, and the effort of each patient's inspiratory muscles at different support levels was observed by B- and M-mode ultrasonography to assess right side diaphragm mobility. Measurements and Main ResultsRespiratory mechanics parameters under deep/calm breathing, dynamic changes in diaphragm movement, diaphragm excursion inflection points and whether the patients were successfully deconditioned were recorded. Forty-one patients were enrolled, and the results showed that 78.6% (22/28) of patients with a deep breathing inflection point of 10 cmH2O (nadir of 5 cmH2O) and 33.3% (4/12) of patients with a deep breathing inflection point of 15 cmH2O (nadir of 10 cmH2O) successfully weaned from mechanical ventilation, with the former having a significantly higher rate than the latter. The success rate was statistically significant (Chi-square=7.556 P=0.006); 77.8% (21/27) of patients with calm breathing inflection point of 10 cmH2O (lowest point of 5 cmH2O) and 38.5% (5/13) of patients with calm breathing inflection point of 15 cmH2O (lowest point of 10 cmH2O). 13), the former had a statistically significant higher off-boarding success rate than the latter (Chi-square=5.962 P=0.0146).ConclusionsIn the process of weaning from mechanical ventilation patients, when performing a spontaneous breathing test, the right diaphragm excursion inflection point during deep/calm breathing can be measured by ultrasound to assess the patient's spontaneous breathing effort component, and this study found that the weaning success rate was lower in the group with an inflection point of 15 cm H2O than in the group with an inflection point of 10 cm H2O, so the diaphragm excursion inflection point may be a reliable indicator to predict the deconditioning success.

Objectives Adequate humidity and temperature of the inhaled mixed air are important for patients weaning from ventilators. It can not only prevent the damage of dry gas on respiratory tract, but also facilitate the discharge of sputum. We aim to investigate the humidification and heating effects of artificial nose, Venturi device plus thermostatic humidification T-tube (referred as VT), Venturi device plus thermostatic humidification T-tube and PEEP valve (referred as VTP) in critical ill patients with tracheotomy in ICU.Design:Retrospective cohort study.Setting: Tertiary academic medical center.Patients: A total of 166 patients were engaged in this study. Clinical and laboratory examination data were used to determine the heating and humidification performance of 3 different methods.Methods A retrospective, single-center cohort study was conducted in all critically ill patients ready to be weaned from mechanical ventilators. Three groups of patients were compared in terms of vital signs, the effect of artificial airway heating and humidification, and blood gas indicators. Basic patient data (age, gender, mechanical ventilation duration, ICU stay, disease type) were recorded. Vital signs include heart rate, blood pressure, respiratory rate, oxygen saturation; The performance of heating and humidifying the artificial airway were defined as the number of sputum suction and coughing within 24 hours, sputum characteristics, whether there is bloody sputum formation, whether there is phlegm callus formation; Blood gas indicators include pH, oxygen partial pressure, carbon dioxide partial pressure, lactic acid, residual base, and bicarbonate.Results In terms of the heating and humidification performance of patients in ICU, the VT method and the VTP method were significantly superior to those of artificial nasal method.SpO2 was significantly higher in patients treated with the VTP method than that in patients treated with VT.ConclusionCompared with the artificial nose method, the VTP method and VT methods are better. In terms of improving oxygenation, the VTP method could improve the patient's oxygen sum more than the VT mothod.