Objective. To compare the safety and efficacy of transnasal high-flow oxygen therapy (HFNT) and noninvasive positive pressure ventilation (NIV) in the treatment of chronic obstructive pulmonary disease (COPD) with type II respiratory failure. Methods. PubMed, the Cochrane Library, Embase, CBM, CNKI, and other databases were searched for randomized controlled trials (RCTS) on the efficacy of HFNT and NIV in the treatment of COPD. Meta-analysis was conducted using RevMan 5.3 software after two researchers screened literatures, extracted data, and evaluated the methodological quality of the included studies according to inclusion and exclusion criteria. Results. A total of 948 patients were included in 12 RCTS. Comprehensive analysis results showed that the HFNC group had higher levels of 12 h-PAO2, 48 h-PACO2 and, 48 h-pH than the NIV group, and the differences were statistically significant ( P < 0.05 ). There were no significant differences in 24 h-PAO2 and 72 h-PAO2, 12 h-PACO2, 24 h-PACO2 and 72 h-PACO2, 24 h-pH, 48 h-pH, and 72 h-pH between the two groups after treatment ( P > 0.05 ). Conclusions. Compared with NIV, HFNC does not increase the treatment failure rate in COPD patients with type II respiratory failure, and HFNC has better comfort and tolerance, which is a new potential respiratory support treatment for COPD patients with type II respiratory failure.
Objective. To explore the efficacy and safety of chlorhexidine oral care in the prevention of ventilator-associated pneumonia (VAP) by means of meta-analysis. Methods. Randomized controlled trials on the effect of chlorhexidine oral care on the incidence of VAP in patients on mechanical ventilation were searched in PubMed, Scopus, Cochrane Library, and Embase from May 1, 2022. Two researchers independently screened and included the study, extracted the data, and evaluated the literature quality. RevMan5.3 software was used for meta-analysis. Results. Meta-analysis of 13 included literature studies involving 1533 patients showed that oral care with chlorhexidine solution could reduce the incidence of VAP in patients with mechanical ventilation and the difference was statistically significant (RR = 0.61, 95% CI (0.46, 0.82), P = 0.04 ). However, the results showed that the incidence of VAP of low concentration (0.02%, 0.12%, and 0.2%) and high concentration (2%) of chlorhexidine in the intervention group was lower than that in the control group and the difference was statistically significant (RR = 0.70, 95% CI (0.51, 0.96), P = 0.03 ; RR = 0.41, 95% CI (0.27, 0.62)). There was no significant difference in mortality between the two groups (RR = 1.01, 95% CI (0.85, 1.21), P = 0.87 ). There was no statistical significance in days ventilated or days in ICU between the two groups (RR = −0.02, 95% CI (−0.19, 0.16), P = 0.84 ; RR = 0.01, 95% CI (−0.11, 0.14), P = 0.85 ). Conclusion. Existing evidence shows that chlorhexidine used for oral care of patients with mechanical ventilation can reduce the incidence of VAP, and high concentration of chlorhexidine (2%) or low concentration of chlorhexidine (0.02%, 0.12%, 0.2%) has a significant effect on the prevention of VAP. Considering the safety of clinical application, it is recommended to use 0.02%, 0.12%, and 0.2% chlorhexidine solution for oral care.
Objective. To explore the application of pulmonary ultrasound in visual nursing of artificial airway in patients with acute respiratory distress syndrome (ARDS). Methods. Seventy-eight ARDS patients with mechanical ventilation admitted from February 2021 to January 2022 were included and divided into the intervention group and the control group. The control group was given routine airway nursing, and the intervention group was given visual airway nursing management through lung ultrasound. The arterial blood gas analysis indexes, mechanical ventilation time, ICU treatment time, total hospitalization time, aspiration, and the incidence of ventilator-associated pneumonia (VAP) were compared between the two groups. Results. After treatment, PaO2, PaCO2, SPO2, and oxygenation indexes were significantly improved compared with those before treatment, and the indexes in the intervention group were better than those in the control group after treatment, and the differences were statistically significant ( P < 0.05 ). The mechanical ventilation time ( 5.39 ± 0.68 vs. 7.92 ± 0.59 days), ICU treatment time ( 8.05 ± 1.14 vs. 10.71 ± 1.16 days), and total hospitalization time ( 12.05 ± 2.20 vs. 15.68 ± 2.18 days) in the intervention group were significantly shorter than those in the control group ( P < 0.05 ). The incidences of aspiration (2.56% vs. 15.38%) and VAP (5.13% vs. 20.51%) in the intervention group was significantly lower than that in the control group ( P < 0.05 ). Conclusion. The application of visual artificial airway management assisted by lung ultrasound in ARDS patients can shorten the treatment time and hospitalization time of mechanical ventilation, reduce the incidence of aspiration and VAP, and improve the prognosis of patients.
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