Non-invasive Assisted Ventilation Research Articles

Kangaroo mother care enhances exclusive breastmilk feeding and shortens time to achieve full enteral feeding in extremely preterm infants requiring non-invasive assisted ventilation

BackgroundExtremely preterm infants (EPIs) frequently encounter challenges in feeding due to their underdeveloped digestive systems. Attaining full enteral feeding at the earliest possible stage can facilitate the removal of vascular catheters and decrease catheter-related complications.MethodsWe performed a retrospective cohort study comprising 145 extremely preterm infants with a gestational age < 28 weeks who underwent non-invasive mechanical ventilation at Shenzhen Maternity & Child Healthcare Hospital between January 2019 and June 2020. The KMC group received standard nursing care along with KMC, while the control group received standard nursing care without KMC. KMC initiation took place three weeks after admission and continued for a period of two weeks or more while maintaining stable vital signs. We evaluated the rate of exclusive breastmilk feeding within 24 h prior to discharge and the time to full enteral feeding throughout hospitalization. Additionally, we conducted a multiple linear regression analysis to identify the independent factors associated with exclusive breastmilk feeding rates and the time to full enteral feeding.ResultsThe KMC group exhibited a significantly higher rate of exclusive breastmilk feeding in the 24 h before discharge in comparison to the Non-KMC group (52.8% vs. 31.5%, OR 2.43; 95% CI 1.24, 4.78). Moreover, the KMC group achieved full enteral feeding in a shorter duration than the Non-KMC group (43.1 ± 9.6 days vs. 48.7 ± 6.9 days, p < 0.001). Multiple linear regression analysis revealed that KMC was an independent protective factor associated with improved exclusive breastmilk feeding rates (OR 2.43; 95% CI 1.24, 4.78) and a reduction in the time to full enteral feeding (β -5.35, p < 0.001) in extremely preterm infants.ConclusionKangaroo Mother Care (KMC) can expedite the achievement of full enteral feeding and enhance exclusive breastmilk feeding rates in extremely preterm infants receiving non-invasive assisted ventilation. These findings highlight the beneficial effects of KMC on the feeding outcomes of this vulnerable population, underscoring the importance of implementing KMC as a part of comprehensive care for extremely preterm infants.

Effect analysis of information-guided enteral nutrition-associated diarrhea treatment process in patients with chronic obstructive pulmonary disease undergoing continuous non-invasive assisted ventilation: a mixed cohort study of pre- and post-control

To clarify the application effect of information-guided enteral nutrition-associated diarrhea (ENAD) management process in patients with chronic obstructive pulmonary disease (COPD) undergoing non-invasive assisted ventilation. A mixed cohort study of pre- and post-control was conducted. Thirty-nine patients with COPD who were admitted to the emergency intensive care unit (ICU) of Huzhou First People's Hospital from July 1, 2021 to July 31, 2022 were enrolled. Taking the completion of the software development of ENAD management software for critically ill patients on January 28, 2022 as the time node, 20 patients admitted from July 1, 2021 to January 28, 2022 were set as the control group, and 19 patients admitted from January 29 to July 31, 2022 were set as the observation group. The two groups of patients received the same enteral nutrition support treatment, and the control group implemented the conventional ENAD treatment process with enteral nutrition intolerance disposal process as the core. On the basis of the control group, the observation group implemented the information-guided ENAD treatment process, and the system software actively captured the information of ENAD patients and reminded the medical team to improve the patient's diarrhea-related examination and provide alternative treatment plans. The duration of antidiarrhea, feeding interruption rate, and energy and protein intake, blood biochemical indexes, incidence of abnormal blood electrolyte metabolism, daily continuous non-invasive assisted ventilation and endotracheal intubation after 7 days of targeted diarrhea intervention were compared between the two groups. Except for the basal pulse rate, there were no significant differences in gender distribution, age, and vital signs, basic nutritional status, arterial blood gas analysis and blood biochemistry at admission between the two groups, indicating comparability between the two groups. When ENAD occurred, the patients in the observation group obtained earlier cessation of diarrhea than those in the control group [days: 3.00 (2.00, 3.25) vs. 4.00 (3.00, 5.00), P < 0.01], and the feeding interruption rate was significantly lower than that in the control group [10.53% (2/19) vs. 65.00% (13/20), P < 0.01]. After 7 days of diarrhea intervention, the energy intake of the observation group was significantly higher than that of the control group [kJ×kg-1×d-1: 66.28 (43.34, 70.36) vs. 47.88 (34.60, 52.32), P < 0.01], the levels of hemoglobin (Hb), albumin (Alb) and serum prealbumin (PAB) were significantly higher than those in the control group [Hb (g/L): 119.79±10.04 vs. 110.20±7.75, Alb (g/L): 36.00 (33.75, 37.25) vs. 31.00 (30.00, 33.00), PAB (mg/L): 155.79±25.78 vs. 140.95±14.97, all P < 0.05], the daily continuous non-invasive assisted ventilation duration was significantly shorter than that of the control group [hours: 14 (12, 16) vs. 16 (14, 18), P < 0.01], and the arterial partial pressure of carbon dioxide (PaCO2) was significantly lower than that of the control group [mmHg (1 mmHg ≈ 0.133 kPa): 66.00 (62.00, 70.00) vs. 68.00 (67.50, 70.05), P < 0.05]. However, there were no significant differences in protein intake, incidence of abnormal electrolyte metabolism, and incidence of endotracheal intubation due to acute respiratory failure between the two groups. The information-guided ENAD treatment process can enable the COPD patients undergoing continuous non-invasive assisted ventilation who experience ENAD to receive earlier cessation of diarrhea, and improve the protein energy metabolism and respiratory function of the patients.

Two children with late-onset congenital central hypoventilation syndrome

Two children with late-onset congenital central hypoventilation syndrome were reported, one of whom was male and had no abnormal manifestations after birth, respiratory failure occurs at the age of 1 year and 6 months. After being hospitalized, he was treated with oxygen inhalation and non-invasive ventilation, but carbon dioxide retention could not be corrected. After one month of tracheal intubation, he was failure to wean from ventilator, so tracheostomy was performed. He needs a ventilator to help breath while sleeping, and can breath autonomously during the day without ventilator. The other case was a female, with no abnormalities after birth. At the age of 11 months, she developed respiratory failure. During sleep, the child needs non-invasive assisted ventilation through a nasal mask, and during the day, she breathed autonomously.Two patients were followed up forever 2 years and their growth and development were normal.

Analysis of the treatment of a premature infant with critical coronavirus disease caused by the Omicron variant of SARS-CoV-2

The patient is a female infant who was born at a gestational age of 30+4 weeks in the breech position and was delivered by assisted vaginal delivery. She was admitted to the neonatal department of Tianjin First Central Hospital for 44 days, during which she had stable respiration, oxygen saturation, and regular weight gain. The patient was discharged home by her family. The infant was readmitted to the hospital due to poor appetite for 15 hours and irregular breathing with weak response for 4 hours at the corrected gestational age of 37+2 weeks at 47 days after birth. The day before admission, the patient's mother experienced throat discomfort, and on the day of admission, the mother had a fever, with the highest temperature of 37.9 centigrade (she later tested positive for SARS-CoV-2 antigen). About 15 hours before admission, the family noticed that the patient had poor milk intake and weakened suction. About 4 hours before admission, the patient developed irregular breathing and weakened responses. After admission, the patient presented frequent apnea, and it was not relieved by adjusting the respiratory mode and parameters of non-invasive assisted ventilation, as well as caffeine citrate to stimulate the respiratory center. The patient was eventually given mechanical ventilation and other symptomatic support treatments. The pharyngeal swab was positive for COVID nucleic acid testing with a Ct value of 20.1 for the N gene. And the chest X-ray showed multiple patchy shadows in both lungs. The patient was diagnosed with critical coronavirus disease (COVID) caused by the Omicron variant in premature infants. After treatment, the child was clinically cured and discharged 8 days after hospitalization. Symptoms of COVID in premature infants may be atypical, and the condition can deteriorate rapidly. During the Omicron variant epidemic, we should pay more attention to premature infants so as to detect severe and critical cases as early as possible, and treat them actively to improve the prognosis.

Efficacy of noninvasive high-frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation as post-extubation respiratory support in preterm infants: a Meta analysis

To systematically evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (NHFOV) versus nasal intermittent positive pressure ventilation (NIPPV) as post-extubation respiratory support in preterm infants. China National Knowledge Infrastructure, Wanfang Data, Chinese Journal Full-text Database, China Biology Medicine disc, PubMed, Web of Science, and the Cochrane Library were searched for articles on NHFOV and NIPPV as post-extubation respiratory support in preterm infants published up to August 31, 2022. RevMan 5.4 software and Stata 17.0 software were used for a Meta analysis to compare related indices between the NHFOV and NIPPV groups, including reintubation rate within 72 hours after extubation, partial pressure of carbon dioxide (PCO2) at 6-24 hours after switch to noninvasive assisted ventilation, and the incidence rates of bronchopulmonary dysplasia (BPD), air leak, nasal damage, periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP). A total of 9 randomized controlled trials were included. The Meta analysis showed that compared with the NIPPV group, the NHFOV group had significantly lower reintubation rate within 72 hours after extubation (RR=0.67, 95%CI: 0.52-0.88, P=0.003) and PCO2 at 6-24 hours after switch to noninvasive assisted ventilation (MD=-4.12, 95%CI: -6.12 to -2.13, P<0.001). There was no significant difference between the two groups in the incidence rates of complications such as BPD, air leak, nasal damage, PVL, IVH, and ROP (P>0.05). Compared with NIPPV, NHFOV can effectively remove CO2 and reduce the risk of reintubation, without increasing the incidence of complications such as BPD, air leak, nasal damage, PVL, and IVH, and therefore, it can be used as a sequential respiratory support mode for preterm infants after extubation.

Morphological changes in the epithelium of the auditory tube with prolonged respiratory support in children of the first year of life

To analyze the condition of the epithelium of the cartilaginous part of the auditory tube in premature and full-term infants with prolonged respiratory support using noninvasive assisted ventilation (continuous positive airway pressure - CPAP) and artificial lung ventilation (ventilator). All the obtained material is distributed relative to the gestation period into the main and control groups. The main group (25 children) is represented by premature and full-term live-born children who were on respiratory support for a period of several hours to 2 months, the average gestation period of which was 30 weeks and 40 weeks, respectively. The control group (8 children) is represented by stillborn newborns with an average gestation period of 28 weeks. The study was conducted posthumously. Prolonged use of respiratory support in premature and full-term children, regardless of the type (CPAP or ventilator), leads to a violation of the row of cilia of the ciliated epithelium, various inflammatory processes, as well as to the expansion of the ducts of the mucous glands of the epithelium of the auditory tube, which affects its drainage system. Prolonged respiratory support causes destructive changes in the epithelium of the auditory tube, which make it difficult to evacuate the mucous discharge from the tympanic cavity. This negatively affects the ventilation function of the auditory tube and in the future may lead to the development of chronic exudative otitis media.

Effect of Simultaneous Multiplane Surgery on Cardiopulmonary Function in Patients with Moderate to Severe Obstructive Sleep Apnea-Hypopnea Syndrome and Its Curative Effect.

Objective To investigate the changes in cardiopulmonary function in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) by one-stage multiplane surgery. Methods 70 patients with moderate and severe OSAHS underwent nasal in our hospital from July 2017 to February 2021, palatopharyngeal, and/or tongue operations simultaneously and were followed up for 6 months. The Epworth Sleeping Scale (ESS) scores of patients before and after surgery were compared to observe the surgical efficacy, and the changes in the cardiopulmonary function of patients before and after surgery were detected. The static and dynamic indexes of cardiopulmonary function, respiratory disturbance index (AHI), and blood oxygen saturation (SaO2) were compared before and after the operation. Results After surgery, all patients' indexes of static lung function were improved compared with that before surgery. After surgery, the percentage of maximal oxygen uptake peak to the predicted value, percentage of oxygen pulse to the predicted value, the ratio of oxygen uptake power, anaerobic threshold, and maximum ventilatory capacity per minute/maximum exercise volume were increased compared with that before surgery, and AHI and SaO2 were improved compared with that before surgery. Conclusion This study suggests that it is feasible for patients with OSAHS who are unable to tolerate or unwilling to undergo noninvasive assisted ventilation to undergo simultaneous surgery for multiplane stenosis. It can reduce clinical symptoms and improve cardiopulmonary function.

Risk factors for prolonged intensive care unit stays in patients after cardiac surgery with cardiopulmonary bypass: A retrospective observational study

ObjectivesPatients after cardiac surgery with cardiopulmonary bypass (CPB) require a stay in the ICU postoperatively. This study aimed to investigate the incidence of prolonged length of stay (LOS) in the ICU after cardiac surgery with CPB and identify associated risk factors. MethodsThe current investigation was an observational, retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017. Data were obtained from the hospital database. Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS. ResultsOf 395 patients, 137 (34.7%) had a prolonged ICU LOS (>72.0 h), and the median ICU LOS was 50.9 h. Several variables were found associated with prolonged ICU LOS: duration of CPB, prolonged mechanical ventilation and non-invasive assisted ventilation use, PaO2/FiO2 ratios within 6 h after surgery, type of surgery, red blood cell infusion during surgery, postoperative atrial arrhythmia, postoperative ventricular arrhythmia (all P < 0.05). ConclusionsThese findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS, enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.

Evaluation of the effects of immunotherapy and mesenchymal stem cells transplantation in the treatment of critically ill coronavirus disease 2019 patients

To analyze the immunotherapy and clinical characteristics of coronavirus disease 2019 (COVID-19) patients, and focus on exploring the effects of immunotherapy and mesenchymal stem cells (MSC) transplantation in the critically ill patients' treatment. Fity-five COVID-19 patients were admitted to the Fifth People's Hospital of Wuxi from January 23rd to March 31st, 2020 as the research object. The demographic characteristics of the cases and the methods of immunotherapy were analyzed, focusing on the immunized indicators, positivity of pathogens and clinical indicators of critically ill COVID-19 patient, and the effects of immunotherapy and stem cell transplantation were evaluated. Aged, male and people with comorbidities were the main risk factors in the development of severe and critical COVID-19. All of confirmed COVID-19 cases (n = 55) had been treated with interferon-α (IFN-α), of which 81.8% (n = 45, mild and ordinary) of the patients were recovered, 14.6% (n = 8) of the patients were converted to severe, 3.6% (n = 2) of the patients were converted to critical, and some severe patients were treated with gamma globulin and albumin as adjuvant treatment. Critically ill patients were not only treated with IFN-α, gamma globulin and albumin, but also treated with convalescent plasma and MSC transplantation. Due to pulmonary hemorrhage and persistently low blood oxygen saturation, terminal lung transplantation therapy was implemented. The total number of lymphocytes, CD4+, CD8+ T lymphocytes, natural killer (NK) cells and B cells in peripheral blood of the two critical COVID-19 patients were significantly reduced, and the functions of lung, liver, and kidney were severely damaged on admission, manifested as significant increase of the levels of blood C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and blood urea nitrogen (BUN), etc. and decrease of blood oxygen saturation, and type I respiratory failure, and the noninvasive assisted ventilation was needed to improve. After adjuvant immunotherapy such as gamma globulin, the nucleic acid of 2019 novel coronavirus (2019-nCoV) turned into negative. The CRP of one critically ill patient was significantly lower than the value at admission (minimum of 21 mg/L). But the lung inflammation progressed rapidly, and the pathological results of the lung tissue from the lung transplantation showed hemorrhage and irreversible fibrosis. The ability to secrete immunoglobulin A (IgA) was significantly reduced. Liver function had been significantly improved and stabilized after treatment with convalescent plasma during the recovery period. MSC transplantation treatment reduced the BUN level by > 50% compared with the previous period, and the total number of lymphocytes in the patient increased by more than 2 times (rose from 0.23×109/L to 0.57×109/L), but the total amount of lymphocytes was still lower than the normal reference value (< 1.1×109/L). The lung inflammation lesions were obviously absorbed, and the vital signs were stable. In addition to IFN, gamma globulin, antiserum and MSC transplantation therapy can help clear the virus and reduce inflammation. Although MSC transplantation fail to completely change the immunecompromised state of critically ill patients, it controlled the progression of inflammation in the liver and kidneys.

Clinical efficacy of assisted intranasal ventilation after polysegmental pneumonia caused by the SARS-CoV-2 virus

BACKGROUND: The development of ways of rehabilitation of patients after polysegmental viral pneumonia that enable the collapsed alveoli being transferred to a ventilated and actively perfused state is certainly relevant. In this regard, non-invasive respiratory support can be considered as a reasonable additional method of treatment for these patients.&#x0D; AIMS: Assess the feasibility of non-invasive assisted ventilation of the lungs after suffering polysegmental pneumonia caused by the SARS-CoV-2 virus.&#x0D; MATERIALS AND METHODS: The study included 40 patients after bilateral polysegmental pneumonia caused by the SARS-CoV-2 virus. The first group of patients (21 people), in addition to the standard treatment, underwent non-invasive assisted intranasal ventilation in the BiPAP mode with a final expiratory pressure of 48 cm of water. Art. 60 minutes three times a day for 1012 days. The second group (19 people) did not receive ventilation benefits. Before the start of therapy and at the end of the course, spirometry, computed tomography of the chest organs were performed with the calculation of the volume of the affected lung tissue according to the Thoracic VCAR program.&#x0D; RESULTS: Upon completion of the course of treatment and rehabilitation measures in patients of the first group, the following was observed: a decrease in atelectatic changes and pneumofibrosis, an increase in the volume of ventilated areas of the lungs, the volume of the affected lung tissue according to computed tomography significantly decreased (on average, up to 269.8%; p 0.05). There was a significant improvement in the indicators of spirometry in the first group. The increase in the volume of forced exhalation in one second was 2532%, while vital capacity of the lungs was 2731%. When evaluating long-term pulse oximetry, the average saturation at night in these patients increased from 91.22.1 to 96.41.8 (p 0.05). Clinical improvement in patients of the first group led to a decrease in bed-days to an average of 15.4, while in patients of the second group it averaged 23.4 days.&#x0D; CONCLUSION: The use of assisted intranasal ventilation restores the ventilation-perfusion ratio, which is confirmed by a significant improvement in clinical and instrumental parameters.

Heart Disease Associated with COVID-19 in Children

Introduction: Heart disease in children associated with COVID-19 is described during acute infection or in the context of the Multisystem inflammatory syndrome in children (MIS-C), and in patients with and without previous heart disease. It has different manifestations: asymptomatic, with alterations in complementary tests (elevated troponins, arrhythmias, imaging changes), up to severe forms: myocardial infarction, heart failure, cardiogenic shock, sudden death. We report a schoolgirl who had severe COVID-19, with cardiac, digestive, and respiratory manifestations. Clinical case: 10-year-old girl, carrier of disabling chronic disease. In the course of severe COVID-19, she added shock and respiratory failure, elevated inflammatory markers, increased troponins, and dilated cardiac cavities, with functional compromise of the left ventricle. She received non-invasive ventilatory assistance, antibiotics, and systemic corticosteroids. Cardiac manifestations reversed, with a decrease in inflammatory parameters. Discussion: The heart is frequently affected in COVID-19. Cardiac injury may be due to: viral replication, systemic inflammatory response, respiratory failure, or myocardial stress. The severity will depend on the extent of the damage and the inflammatory response. Cardiac involvement is more common in those who meet MIS-C criteria. Most recover cardiac function. The case report contributes to the knowledge of SARS-CoV-2 infection, and the severe forms of presentation with cardiac involvement in children highlight the need to advance in primary prevention by vaccines in the pediatric population.

Manifestations of digestive system of hospitalized patients with coronavirus disease 2019 in Wuhan, China: a single-center descriptive study

Objective To study the manifestations of digestive system of hospitalized patients with coronavirus disease 2019 (COVID-19) in Wuhan, China, and to provide a reference for disease control and treatment. Methods The data of hospitalized patients with COVID-19 in the Sino-French Branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 27 to February 14, 2020 were retrospectively analyzed, which included general information, positive rate of nucleic acid test, severity of disease, incubation period, initial symptoms and manifestations of digestive system. The general information, positive rate of nucleic acid detection, and manifestations of digestive system were compared between critical patients who required non-invasive or invasive assisted ventilation (critical group) and non-critical patients without assisted ventilation (non-critical group). Continuous corrected Chi-square test and independent sample median Chi-square test were used for statistical analysis. Results Among the 305 patients, there were 146 males (47.9%) and 159 females (52.1%), and the median age was 57 years old. Nucleic acid assay of nasopharyngeal swabs or pharyngeal swabs were positive in 84.1% (228/271) patients including 46 patients (15.1%) of critical group and 259 patients (84.9%) of non-critical group. The incubation period was one to fifteen days, and the median period was six days. The initial symptoms were mainly fever (81.1%, 163/201), cough (39.3%, 79/201), fatigue (54.7%, 110/201), and loss of appetite (50.2%, 101/201). In one to ten days after the disease onset, 79.1% (159/201) of patients developed gastrointestinal symptoms including nausea (29.4%, 59/201), vomiting (15.9%, 32/201), or abdominal pain (6.0%, 12/201). 49.5% (146/295) of patients had diarrhea, with a median time of 3.3 days, (3.3±1.6) times per day, and a duration of (4.1±2.5) days. After excluding possible drug-related diarrhea, the incidence of diarrhea was still 22.2%. Only 6.9% (4/58) of patients had positive fecal leukocytes or fecal occult blood test. Alanine aminotrans ferase (ALT), aspartate aminotransferase (AST), or total bilirubin (TBil) increased in 39.1% (119/304) of patients on admission. Patients with ALT or AST ≥ 80 U/L only accounted for 7.9% (24/304) and 6.3% (19/304), respectively. About 2.0% (6/304) of patients also had increased TBil level, and the average level was (37.4±21.1) μmol/L. The median age of critical group was older than that of non-critical group (65 years vs. 56 years), the proportion of patients with abnormal liver function and slightly increased AST (40- 0.05). Conclusions The manifestation of digestive system of hospitalized COVID-19 patients in Wuhan is significant, the proportion of patients with diarrhea and abnormal aminotransferase level is high. And on admission the proportion of patients with abnormal liver function of critical group is higher than that of non-critical group, which will provide reference for the prevention and treatment of COVID-19. Key words: 2019-nCoV; COVID-19; Diarrhea; Liver function; Gastrointestinal tract

Manifestations of Digestive system in hospitalized patients with novel coronavirus pneumonia in Wuhan, China: a single-center, descriptive study

Objective To study the manifestations of digestive system of hospitalized patients with novel coronavirus pneumonia (NCP) in Wuhan, China, and to provide reference for disease control and treatment. Methods The data of hospitalized patients with NCP in the Sino-French Branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology was retrospectively analyzed, which included general information, nucleic acid test, severity degree of disease, incubation period, initial symptoms and manifestations of digestive system. The general information, positive rate of nucleic acid detection, and manifestations of digestive system were compared between critical patients who required non-invasive or invasive assisted ventilation (critical group) and non-critical patients without assisted ventilation (non-critical group). Continuous corrected chi-square test and independent sample median test were performed for statistical analysis. Results Among the 305 patients there were 146 males (47.9%) and 159 females (52.1%), median age 57 years old. Nucleic acid assay of nasopharynx swab or pharynx swab of 84.1% (228/271) patients were positive. Forty-six patients (15.1%) were in critical group and 259 patients (84.9%) were in non-critical group. The incubation period was one to fifteen days, and the median period was six days. The initial symptoms mainly were fever (81.1%, 163/201), cough (39.3%, 79/201), fatigue (54.7%, 110/201), and loss of appetite (50.2%, 101/201). In one to ten days after the disease onset, 79.1% (159/201) of patients developed gastrointestinal symptoms including nausea (29.4%, 59/201), vomiting (15.9%, 32/201), or abdominal pain (6.0%, 12/201). 49.5% (146/295) of patients had diarrhea, median time was 3.3 days, (3.3±1.6) times per day, and a duration of (4.1±2.5) days. Excluding possible drug-related diarrhea, the incidence of diarrhea still was 22.2%. Only 6.9% (4/58) of patients were found leukocytes or fecal occult blood positive in regular stool test. ALT, AST, or bilirubin increased in 39.1% (119/304) of patients at admission. Patients with ALT or AST ≥ 80 U/L only accounted for 7.9% (24/304) and 6.3% (19/304), respectively. About 2.0% (6/304) of patients also had increased bilirubin level, average level was (37.4 ± 21.1) μmol/L. The median age of critical group was older than that of non-critical group (65.5 years vs. 56 years), at admission the rates of abnormal liver function test abnormal and slightly increased AST (40~80 U/L) of critical group were both higher than those of non-critical group (67.4% (31/46) vs. 34.1% (88/258) and 47.8% (22/46) vs. 21.7% (56/228)), and the differences were statistically significant (x2=5.885, 18.154 and 15.723;all P 0.05). Conclusions The manifestation of digestive system of hospitalized NCP patients in Wuhan is significant, the ratio of patients with diarrhea and abnormal aminotransferase level is high. And at admission the rate of patients with abnormal liver function rate of critical group is higher than that of non-critical group, which will provide reference for the prevention and treatment of NCP. Key words: 2019-nCoV; Novel coronavirus pneumonia; Corona virus disease 2019; Diarrhea; Liver function; Gastrointestinal tract; Wuhan

Clinical effect of BiPAP non-invasive ventilation on acute exacerbation of chronic obstructive pulmonary disease with acute left heart failure

Objective To observe the effect of BiPAP non-invasive assisted ventilation on acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with acute left heart failure. Methods From January 2017 to December 2018, 100 AECOPD patients with acute left heart failure admitted to the Central Hospital of Yiwu were randomly divided into observation group and control group according to random number table method, with 50 cases in each group.The control group received routine treatment such as oxygen inhalation, anti-infection, spasmolysis and asthma relief, phlegm resolving, diuresis and cardiotonic therapy.The observation group used BiPAP non-invasive auxiliary ventilation therapy on the basis of routine treatment.The basic vital signs[heart rate(HR), systolic blood pressure(SBP), respiratory rate(RR)] and blood gas analysis[partial pressure of arterial oxygen(PaO2), partial pressure of carbon dioxide(PaCO2), oxygen saturation(SaO2), pH value] before treatment and 48h after treatment were compared between the two groups.The levels of N-terminal pro-brain natriuretic peptide were observed and compared before treatment and 24h, 48h after treatment.The therapeutic effect of the two groups was compared. Results The basic vital signs(HR, SBP, RR) and blood gas analysis (PaO2, PaCO2, SaO2, pH value) of the two groups were improved after treatment, and the improvement degrees of the observation group were better than those of the control group(control group: HR t=12.352, P=0.000; RR t=7.872, P=0.000; SBP t=10.469, P=0.000; observation group: HR t=20.032, P=0.000; RR t=12.319, P=0.000; SBP t=13.911, P=0.000; intergroup comparison after treatment: HR t=6.711, P=0.000; RR t=3.742, P=0.000; SBP t=4.172, P=0.000; the control group: pH t=13.115, P=0.000, SaO2t=3.134, P=0.001; PaO2t=3.812, P=0.000; PaCO2t=5.335, P=0.000; the observation group: pH t=24.980, P=0.000; SaO2t=5.305, P=0.000; PaO2t=7.357, P=0.000; PaCO2t=10.172, P=0.000; intergroup comparison after treatment: pH t=7.394, P=0.000; SaO2t=2.851, P=0.002; PaO2t=3.467, P=0.000; PaCO2t=4.063, P=0.000). The N-terminal pro-brain natriuretic peptide in the observation group decreased significantly after 24 hours of treatment compared with the control group, but the difference was no statistically significant(t=0.996, P=0.161). The N-terminal pro-brain natriuretic peptide levels in the observation group were significantly lower than those in the control group at 48 and 72 hours after treatment(t=6.043, P=0.000; t=12.897, P=0.000). The effective rate in the observation group was 88.00%(44/50), which was higher than 72.00%(36/50) in the control group(χ2=4.000, P=0.046). Conclusion BiPAP noninvasive assisted ventilation can effectively relieve symptoms, lessen the work of respiratory muscles, reduce cardiac load, improve myocardial oxygen supply, improve cardiac function, improve patients' oxygenation, improve hypoxemia and hypercapnia, reduce mortality and improve prognosis of AECOPD patients complicated with acute left heart failure. Key words: Pulmonary disease, chronic obstructive; Ventilators, mechanical; Continuous positive airway pressure; Heart failure; Blood gas analysis; Natriuretic peptide, brain; Prognosis; Comparative effectiveness research

Pycnodysostosis: Natural history and management guidelines from 27 French cases and a literature review.

Pycnodysostosis is a lysosomal autosomal recessive skeletal dysplasia characterized by osteosclerosis, short stature, acro-osteolysis, facial features and an increased risk of fractures. The clinical heterogeneity of the disease and its rarity make it difficult to provide patients an accurate prognosis, as well as appropriate care and follow-up. French physicians from the OSCAR network have been asked to fill out questionnaires collecting molecular and clinical data for 27 patients issued from 17 unrelated families. All patients showed short stature (mean = -3.5 SD) which was more severe in females (P = .006). The mean fracture rate was moderate (0.21 per year), with four fractures in total average. About 75% underwent at least one surgery, with an average number of 2.1 interventions per patient. About 50% required non-invasive assisted ventilation due to sleep apnea (67%). About 29% showed psychomotor difficulties and 33% needed a school assistant or adapted schooling. No patient had any psychological evaluation or follow-up. Molecular data were available for 14 families. Growth hormone administration was efficient on linear growth in 40% of cases. We propose several axis of management, such as systematic cerebral MRI for Chiari malformation screening at diagnosis and regular psychological follow-up.

Noninvasive Ventilatory Support for Acute Hypercapnic Respiratory Failure.

Noninvasive ventilation is well established as the ventilatory modality of first choice to treat acute or acute-on-chronic hypercapnic respiratory failure in patients with COPD by improving dyspnea and gas exchange, avoiding the need for intubation, and reducing morbidity and mortality rates. Noninvasive ventilation also offers benefit for patients with COPD and with accompanying pneumonia or with hypercapnic respiratory failure in postextubation, postoperative, and do not intubate settings. Noninvasive ventilation, in addition, offers benefit in other forms of acute hypercapnic respiratory failure, including those caused by asthma, cystic fibrosis, and obesity hypoventilation. A newer form of noninvasive ventilatory assistance, high-flow nasal cannula, has emerged in recent years as a technique to not only oxygenate effectively but also to improve ventilatory efficiency and reduce the work of breathing in patients with severe COPD. Results of recent studies indicate that high-flow nasal cannula therapy can benefit some patients with acute hypercapnic respiratory failure, either instead of or in combination with noninvasive ventilation, but more study is needed.

Calidad del sueño en cuidadores informales de niños con ventilación mecánica invasiva y no invasiva

Background: Sleep disturbances are one of the symptoms that have the highest correlation with caregiving. Among the population of Chile, 63.2% reports having sleep disturbances. Objective: To identify sleep characteristics and habits in the caregivers of children belonging to the National Program of Invasive and Non-Invasive Ventilatory Assistance at Home of the Ministry of Health of Chile. Methodology: A quantitative, descriptive, cross-sectional study with 82 family caregivers. The Pittsburgh Scale is applied, as well as a questionnaire about habits, nutrition, exercise, and stimulant intake. Results: Age 41.5 (SD = 9.4) years; mean number of hours of sleep of 6.29 hours; 52.4% are short sleepers; according to the Pittsburgh scale, 81.7% have sleeping problems. The higher the educational level and the scheduled physical activity, the lower the risk of presenting sleeping problems. Living alone with children without any other supportive family member presents additional problems. Conclusion: The care for the child with high technological dependence at home must have a multidisciplinary approach, considering the satisfaction of basic needs of caregivers, such as sleep

Evaluation of the timing of application of nasal continuous positive airway pressure in critically ill children

Objective To study the clinical data of patients treated with nasal continuous positive airway pressure (NCPAP) in PICU, and to explore the application time and range of NCPAP in critically ill children. Methods A prospective study was conducted to collect clinical data of 192 severe patients admitted to PICU from January 2016 to June 2017 who had shortness of breath after giving oxygen through nasal catheter for 1 hour and then switched to NCPAP.According to using NCPAP oxygen partial pressure, children were divided into three groups: group A[ shortness of breath (PaO2≥70 mmHg, 1 mmHg=0.133 kPa) ], group B[shortness of breath combined, reduced oxygen partial pressure(50mmHg<PaO2<70 mmHg)], and group C[shortness of breath combined respiratory failure(PaO2≤50 mmHg)]. The indicators of three groups of children at different time points of NCPAP were compared. Results Among 192 children, 161 (83.85%) had respiratory diseases, 14 (7.29%) had severe hand-foot-mouth disease, 10 (5.21%) had severe sepsis, and 7 (3.65%) had other multiple organ disorders.PaO2/FiO2 gradually increased after using NCPAP for 1 hour and 4 hours, and the improvement of oxygenation in group A was most obvious, there was significant difference among the three groups (P<0.05). There were significant differences in heart rate, shortness of breath after using NCPAP for 1 hour and 4 hours among the three groups (P<0.05). There were 2 cases of ventilation failure in group A (failure rate 3.57%), 9 cases (11.11%) of ventilation failure in group C, 30 cases (54.55%) of ventilation failure in group C, and there was significant difference in the failure rate of noninvasive ventilation among the three groups (χ2=51.684, P<0.001). There were significant differences in the discharge rate among the three groups (P<0.05). Conclusion NCPAP has obvious effect on the critically ill children with conventional oxygen remaining respiratory abnormalities; Children with respiratory failure under nasal catheter are prone to suffer from the failure of noninvasive assisted ventilation when using NCPAP assisted ventilation, closely monitor of the disease condition is needed. Key words: Critically illness; Children; Nasal continuous positive airway pressure; Timing of application

An Evaluation of a Continuing Education Program for Family Caregivers of Ventilator-Dependent Children with Spinal Muscular Atrophy (SMA).

Until 25 years ago, there were limited options for long-term mechanical ventilation of children, and the majority of children were cared for in hospitals. However, with improving technology, the pediatric intensive care unit has moved from the hospital to a home setting, as children with increasingly complex healthcare needs are now often cared for by family members. One of the most complex care conditions involves ventilator and tracheostomy support. Advanced respiratory technologies that augment natural respiratory function prolong the lives of children with respiratory compromise; however, this care often comes with serious risks, including respiratory muscle impairment, respiratory failure, and chronic pulmonary disease. Both non-invasive assisted ventilation and assisted ventilation via tracheostomy can prolong survival into adulthood in many cases; however, mechanical ventilation in the home is a high-stakes, high risk intervention. Increasing complexity of care over time requires perpetual skill training of family caregivers that is delivered and supported by professional caregivers; yet, opportunities for additional training outside of the hospital rarely exist. Recent data has confirmed that repetitive caregiver education is essential for retention of memory and skills in adult learners. This study analyzes the use of continued education and training in the community for family caregivers of ventilator-dependent children diagnosed with spinal muscular atrophy (SMA).

First Cluster of Acute Flaccid Myelitis Related to Enterovirus D-68 in Argentinean Children

BackgroundAcute flaccid Myelitis(AFM) related to enterovirus D68(EVD68) has been reported as sporadic cases worldwide since the outbreak of respiratory illness in USA in 2014. Objective: To describe the first cluster of AFM by EVD68 in Argentina.Methodsprospective-observational study in children admitted to Hospital de Niños “Ricardo Gutiérrez” by Acute Flaccid Paralysis(AFP) from April-August 2016. AFM was defined as AFP with MRI lesions affecting the gray matter of the spinal cord as defined by CDC. RT-PCR was used to identify EVD68 in NPS, CSF, stool samplesResultsNineteen children were admitted by AFP. Six confirmed as AFM: age 40(±22.6) months; 66% female, 50% had history of recurrent wheezing. Prodrome: 100% Upper Respiratory Tract Infection(URTI); 4/6(66%) fever; 1/6(16%) vomiting and abdominal pain. Neurological symptoms appeared 5.2(±6) days after prodrome. All children had acute progressive asymmetric limbs weakness, areflexia, intact sensitivity and severe muscles pain; 5/6(83%) had neck muscles weakness; 3/6(50%) had severe respiratory failure: 2 mechanical ventilation and 1 noninvasive ventilatory assistance; 3/6(50%) needed feeding support; 2/6(33.3%) had cranial nerve dysfunction. None had cognitive disability. CFS findings: 5/6 mononuclear pleocytosis; 2/6 increase of proteins and 1/6 albuminocytological dissociation. Spinal cord lesions in MRI was observed in all patients. EMG showed early signs of denervation and low motor neuron in 5/5 patient. Virology: enterovirus could be identified by RT-nested – PCR and genomic sequencing from nasopharyngeal-swab in 5/6(83%); 4/5 typified as EVD68, in 1/5 viral charge was low for typing. Stool samples: EVD68 was identified in 2/6(33%). CSF samples were negative. Treatment: IV immunoglobulin 5/6(83%) patient; 2/6(33%) systemic corticosteroids; 3/6(50%) required ICU admission. All patients had neurologic motor sequelae; 2/6 remain with chronical ventilatory assistance after 6 months of follow-up. None patient dye.Conclusionthis is the first cluster reported from South America and support evidence for the association of EVD68 and AFM in children.Disclosures All authors: No reported disclosures.