Unplanned extubation (UE) may cause considerable adverse effects in patients receiving mechanical ventilation (MV). Previous literature showed inconsistent prognosis in patients with UE. This study aimed to evaluate the clinical implications and outcomes of UE.The intubated adult patients with MV support in our hospital were enrolled, and they were divided into the UE and non-UE groups. Demographic data, admission unit, MV duration, overall weaning rate, and mortality rates were compared. The outcomes of UE in ordinary ward and intensive care unit (ICU) were also assessed.Totally 9245 intubated adult patients were included. UE occurred in 303 (3.5%) patients, and the UE events were 0.27 times/100 MV days. Old age, nonoperation related MV cause, and admission out of the ICU were significant factors associated with UE events. UE patients showed a trend of better overall weaning rate (71.9% vs 66.7%, P = .054) than non-UE. However, the in-hospital mortality rate (25.7% vs 24.8%, P = .713) were similar between the UE and non-UE patients. The reintubation rate of UE patients was 44.1% (142/322). Successful UEs were associated with patients in weaning process (52.8% vs 38.7%, P = .012), and patients received non-invasive positive pressure ventilation (NIPPV) support after UE (19.4% vs 3.5%, P < .001). Patients with successful UE had significantly shorter MV days, higher overall weaning rate, and lower mortality than those with unsuccessful UE. Outcomes of UE in ordinary ward and in ICU had similar MV duration, reintubation rate, overall weaning rate, and in-hospital mortality rate.The overall weaning rate and in-hospital mortality rates of the UE and non-UE patients were similar. UE occurred in ordinary ward had similar outcomes to those in ICU. Patients receiving MV should be assessed daily for weaning indications to reduce delayed extubation, and therefore, may decrease UE occurrence. Once the UE happened, NIPPV support may reduce the reintubation rate.
Cardiac radiotherapy is rarely used in clinical practice because of concern of adverse effects on the heart. We present a case of a 64-year-old man with advanced small cell lung cancer (SCLC) treated with chemo-radiotherapy who attained partial remission initially but had disease progression to bulky cardiac metastasis and significant pericardial effusion. Severe heart failure with hepatic failure was found.Chemotherapy and pericardiocentesis were contraindicated because of the associated high risk and bleeding tendency. Emergent palliative cardiac radiotherapy resulted in rapid improvements of dyspnea, liver function, and urine output. Pericardiocentesis was performed 5 days later and effusion cytology confirmed metastatic SCLC. To our knowledge, this is the first case of effective cardiac radiotherapy for SCLC with life-threatening cardiac metastasis. Palliative cardiac radiotherapy may be an effective alternative treatment for radiosensitive malignancy with cardiac metastasis in cases of multiple organ dysfunction and unsuitability for chemotherapy and pericardiocentesis.
Background: Pulmonary rehabilitation (PR) effectively improves symptoms and exercise ability in patients with stable chronic obstructive pulmonary disease (COPD). However, the effectiveness and timing of early PR on hospitalized patients with acute exacerbation of COPD (AECOPD) is still debated. Methods: This study conducted a meta-analysis to compare the outcome benefits between early PR and usual care for patient hospitalized due to AECOPD. A systematic search was performed for retrieving randomized control trials (RCTs) from the PubMed, Embase, and Cochrane library until November 2021. RCTs reporting early PR for AECOPD with hospitalization, either during admission or within four weeks of discharge, were enrolled for systematic review and meta-analysis. Results: Twenty RCTs (1274 participants) were included. Early PR showed significantly improved readmission rate (ten trials, risk ratio 0.68, 95% confidence interval (CI) 0.50-0.92), 6-minute walking distance (6MWD, twelve trials, MD 59.73, 95% CI 36.34-83.12), St George's Respiratory Questionnaire score (eight trials, MD −10.65, 95% CI −14.78 to −6.52), Borg score (eight trials, MD −0.79, 95% CI −1.26 to −0.32), and modified Medical Research Council dyspnea scale (eight trials, MD −0.38, 95% CI −0.5 to −0.25). However, the trend of mortality (six trials, risk ratio 0.72, 95% CI 0.39-1.34) benefit was not significant. The subgroup analysis showed non-significant trends of better effect in early PR during admission than those after discharge for outcomes of 6MWD, quality of life, and dyspnea. However, non-significant trends of less benefits on mortality and readmission rate were found in early PR during the admission. Conclusion: Overall, early PR is beneficial for AECOPD with hospitalization, and there was no significant outcome difference between PR initiated during admission or within 4 weeks of discharge.
High-efficiency particulate air (HEPA) filters is a potential tool used to remove fine particles and improve indoor air quality. This study aims to analyze the real-world efficacy of portable HEPA air cleaners in a household environment. Laser light dispersion PM2.5 sensors are used to continuously monitor the indoor and outdoor PM2.5 level before and after HEPA air cleaner filtration. Overall, HEPA air cleaners significantly reduce the indoor PM2.5 level (33.5 ± 10.3 vs. 17.2 ± 10.7 µg/m3, mean difference (MD) = −16.3 µg/m3, p < 0.001) and indoor/outdoor PM2.5% (76.3 ± 16.8 vs. 38.6 ± 19.8%, MD = −37.7%, p < 0.001). The efficacy to reduce PM2.5 is strongest in three machines with medium-flow setting group (indoor PM2.5 MD: −26.5 µg/m3, indoor/outdoor PM2.5 percentage MD: −56.4%). Multiple linear regression demonstrates that outdoor PM2.5, machine number, airflow speed, and window ventilation are significant factors associated with indoor PM2.5 concentrations (R = 0.879) and percentage of the indoor/outdoor PM2.5 ratio (R = 0.808). HEPA air cleaners can effectively improve indoor PM2.5 air pollution. Adequate air cleaner machine numbers, appropriate airflow, and window ventilation limitations are important to achieve the best efficacy of the HEPA air cleaner.
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