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俯卧位通气装置的研制及联合生命支持技术在危重症患者中应用效果的研究。

Development of Prone Position Ventilation Device and Study on the Application Effect of Combined Life Support Technology in Critically Ill Patients.

机构信息

Department of Intensive Care Unit Xuzhou Central Hospital, Xuzhou 221009, China.

Department of Operating Room Xuzhou Central Hospital, Xuzhou 221009, China.

出版信息

Can Respir J. 2024 Aug 19;2024:5812829. doi: 10.1155/2024/5812829. eCollection 2024.

Abstract

OBJECTIVE

This study aims to evaluate a novel prone position ventilation device designed to enhance patient safety, improve comfort, and reduce adverse events, facilitating prolonged tolerance in critically ill patients.

METHODS

A randomized controlled trial was conducted on 60 critically ill patients from January 2020 to June 2023. Of which, one self-discharged during treatment and another was terminated due to decreased oxygenation, leaving an effective sample of 58 patients. Patients were allocated to either a control group receiving traditional prone positioning aids (ordinary sponge pads and pillows) or an intervention group using a newly developed adjustable prone positioning device. A subset of patients in each group also received life support technologies such as extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). We assessed prone position ventilation tolerance, oxygen saturation increments postintervention, duration of prone positioning, CRRT filter lifespan, and the incidence of adverse events.

RESULTS

The intervention group exhibited significantly longer average tolerance to prone positioning (16.6 hours vs. 8.3 hours, < 0.001 with a difference of 8.3 (4.4, 12.2) hours), higher increases in oxygen saturation postventilation (9% vs. 6%, < 0.001 with a difference of 3.0 (1.5, 4.5)), and reduced time required for medical staff to position patients (11.7 min vs. 21.8 min, < 0.001 with a difference of -10.1 (-11.9, -8.3)). Adverse events, including catheter displacement or blockage, facial edema, pressure injuries, and vomiting or aspiration, were markedly lower in the intervention group, with statistical significance ( < 0.05). In patients receiving combined life support, the intervention group demonstrated improved catheter blood drainage and extended CRRT filter longevity.

CONCLUSION

The newly developed adjustable prone ventilation device significantly improves tolerance to prone positioning, enhances oxygenation, and minimizes adverse events in critically ill patients, thereby also facilitating the effective application of life support technologies.

摘要

目的

本研究旨在评估一种新型俯卧位通气设备,旨在提高患者安全性、改善舒适度并减少不良事件,从而使危重症患者能够耐受更长时间的俯卧位。

方法

本研究于 2020 年 1 月至 2023 年 6 月期间对 60 名危重症患者进行了一项随机对照试验。其中 1 名患者在治疗期间自行出院,另 1 名患者因氧合下降而终止治疗,最终有效样本为 58 例患者。将患者分为对照组(接受传统俯卧位辅助装置,即普通海绵垫和枕头)和观察组(使用新开发的可调节俯卧位通气装置)。每组中的一部分患者还接受了体外膜肺氧合(ECMO)和连续肾脏替代治疗(CRRT)等生命支持技术。我们评估了俯卧位通气的耐受性、干预后血氧饱和度的增加、俯卧位的持续时间、CRRT 过滤器的寿命以及不良事件的发生率。

结果

观察组的平均俯卧位耐受时间明显更长(16.6 小时 vs. 8.3 小时, < 0.001,差异为 8.3(4.4,12.2)小时),通气后血氧饱和度的增加更高(9% vs. 6%, < 0.001,差异为 3.0(1.5,4.5)%),并且医务人员为患者定位的时间更短(11.7 分钟 vs. 21.8 分钟, < 0.001,差异为-10.1(-11.9,-8.3)分钟)。观察组的不良事件,包括导管移位或堵塞、面部水肿、压疮、呕吐或误吸等,明显更低,具有统计学意义( < 0.05)。在接受联合生命支持的患者中,观察组显示出改善的导管血液引流和延长的 CRRT 过滤器寿命。

结论

新开发的可调节俯卧位通气装置显著提高了危重症患者对俯卧位的耐受性,增强了氧合作用,减少了不良事件,从而也促进了生命支持技术的有效应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac81/11347033/cf21e289a0bd/CRJ2024-5812829.001.jpg

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