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Background: Severe pneumonia continues to be a prominent cause of hospitalization and global mortality. There is ongoing debate regarding the effectiveness of different oxygen therapy modalities, particularly high-flow nasal cannula (HFNC) oxygen therapy and invasive mechanical ventilation (IMV), in the treatment of severe pneumonia., Objective: This study investigated the risk factors associated with mechanical ventilation in pediatric patients with severe pneumonia., Methods: This retrospective study included a cohort of 240 pediatric patients with severe pneumonia treated at Zhangzhou Hospital, affiliated with Fujian Medical University, from January 2019 to December 2020. Patients were categorized into two groups: the HFNC group and the IMV group. Comparative analysis was performed on general patient information, infection markers, arterial blood gas values, as well as the prevalence of underlying conditions and complications between the two groups. Multivariate logistic regression analysis was employed to identify the risk factors for invasive mechanical ventilation in children with severe pneumonia., Results: Patients in the HFNC group experienced shorter hospitalization durations, and the average age in this group was lower compared to the IMV group (P < .05). Upon admission, respiratory rate and heart rate were higher in the HFNC group compared to the IMV group (P < .05). The IMV group demonstrated higher oxygenation index (OI) and infection markers, while the pH level was lower in the IMV group than in the HFNC group (P < .05). The prevalence of underlying conditions and complications in the IMV group was significantly higher than in the HFNC group (P < .05). Basic conditions such as heart disease, prematurity, heart failure, low OI, toxic encephalopathy, and influenza virus infection were identified as risk factors for IMV., Conclusions: High-flow nasal cannula therapy has shown therapeutic efficacy in pediatric patients with severe pneumonia. However, children with underlying medical conditions may require prompt tracheal intubation and invasive mechanical ventilation.

Tracheostomy is a very common airway procedure in the treatment of critically ill neurological patients. At present, the traditional tracheal cannula fixation belt is easy to be contaminated, difficult to disinfect, and needs to be replaced regularly. It is prone to infection, skin injury, unplanned extubation and other adverse events, which cannot meet the clinical treatment effect and patient safety management. In order to overcome the above problems, the medical staff of the neurology intensive care unit of Henan Provincial People's Hospital designed a new type of tracheal cannula fixation belt to increase patient comfort and reduce complications, and obtained a National Utility Model Patent of China (ZL 2022 2 0855188.8). The main structure of the device includes a following shaped bending plate, a fastening belt, a locking pin, and a distance adjustment hole. The left and right sides of the shaped bending plate are equipped with fastening belts with breathable and anti-wear pads. The inner side of the left fastening belt is equipped with two sets of locking pins, and the outer surface of the right fastening belt and breathable and anti-wear pad is equipped with multiple sets of distance adjustment holes. Additionally, the back of the shaped bending plate is equipped with breathable buffer pads. The fastening belt can drive the following bending plate to stick tightly to the patient's neck. The operator installs the locking pin card into the distance adjustment hole according to the "one back" principle, and the fastening belts on both sides fix the device with the cooperation of the locking pin, greatly reducing the probability of excessive displacement of the tracheal tube during use, effectively improving the fixation effect of the device, strengthening the adaptability of the device to different personnel, and thus enhancing the practicality of the device. The new type of tracheal cannula fixation band is convenient, safe and efficient, which can increase patient comfort, reduce complications. It has certain clinical value and is suitable for clinical promotion.

Difficulty in swallowing is a common symptom in stroke patients, and nasogastric tubes are routinely used to solve the nutritional support problem of these patients. The existing nasogastric tube have the disadvantages of causing aspiration pneumonia and patient discomfort. The traditional transoral gastric tube has no one-way valve switch and gastric content storage device, and cannot be fixed in the stomach, resulting in reflux of gastric contents, inability to fully understand the digestion and absorption of gastric contents, and accidental dislocation of the gastric tube, affecting further feeding and gastric content detection. For these reasons, the medical staff of the department of gastroenterology and colorectal surgery of Jilin University China-Japan Union Hospital designed a new transoral gastric tube that can extract and store gastric contents, and was granted a national utility model patent of China (ZL 2020 2 1704393.1). The device consists of collection, cannula and fixation modules. The collection module includes three parts. Gastric contents storage capsule, which can clearly visualize the gastric contents; three-way switch, which can be controlled by rotating the pathway, makes the pathway exist in different states, which is convenient for medical personnel to extract gastric juice, as well as perform intermittent oral tube feeding on the patient or close the pipeline, and reduce contamination and prolong the service life of the gastric tube; one-way valve, which can effectively avoid the contents of the reflux back into the stomach. The tube insertion module includes three parts. A graduated tube, which can enable the medical staff to effectively identify the insertion depth; a solid guide head, which makes the insertion of the tube through the mouth more smoothly; the gourd-shaped passageway, which effectively avoids the blockage of the tube. The fixation module is a water-filled balloon, which is properly filled with water and air. After the pipe is inserted through the mouth, it can be injected with water and gas properly to avoid accidental withdrawal of the gastric tube. Intermittent oroesophageal tube feeding of patients with dysphagia after stroke through a transoral gastric tube that can extract and store gastric contents can not only accelerate the recovery process of patients and shorten the hospitalization time, but also transoral enteral nutrition can effectively promote the recovery of patients' systemic systems, which has certain clinical use value.

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a life support technique for patients with severe respiratory failure. In the past, single lumen cannula was mostly used to constract the vascular pathway of extracorporeal membrane oxygenation. Compared with single-lumen cannula, double lumen cannula (DLC) can reduce recirculation fraction, reduce complications such as infection and bleeding, and facilitate patient's rehabilitation. DLC requires accurate positioning of the catheter. It has been gradually applied in China. This paper will review the key points related to the use of DLC, such as the insertion, position, and complications, etc. to provide guidance for clinical application practice.

Background: High-flow nasal cannula (HFNC) is a new type of oxygen therapy, but its application in surgery remains unclear, we tried to describe the application of HFNC in microlaryngoscopic surgery for the Chinese population., Methods: Nineteen adults, American society of anesthesiology class (ASA) 1-2 patients with body mass index < 30 kg.m -2 underwent microlaryngoscopic surgery using HFNC for airway management. Outcomes included apnoea time, intraoperative oxygenation, carbon dioxide value, lactate value, and the relationship between the duration of apnoea time and carbon dioxide levels., Results: A total of 19 patients underwent vocal cord tumor resection under a microlaryngoscope with HFNC as the sole method of ventilation. The mean age was 39.7 years old, and the mean BMI was 23.9 kg.m -2 . The mean apnea time was 21.5 min. The SpO 2 of 18 patients remained above 90%, and only 1 patient dropped to 88%. The average basal lactate and highest lactate value was 0.58 mmol. L -1 and 0.68 mmol.L -1 . The difference between basal and highest lactate values was statistically significant (P < 0.05). The average highest PaCO 2 value was 79.4 mmHg. The PaCO 2 increased by 1.68 ± 0.12 mmHg every minute linearly., Conclusions: In the case series we have observed that HFNC would be safe and effective oxygenation and ventilation technique for selected Chinese patients undergoing non-laser microlaryngoscopic surgery within 30 min. The tubeless technology reduces the complications of tracheal intubation and jet ventilation and clears the surgical field of vision., Trial Registration: Chinese Clinical Trial Registry ( ChiCTR100049144 )., (© 2022. The Author(s).)

Background: Hypoxemia frequently occurs during bronchoscopy. High-flow nasal cannula (HFNC) oxygen therapy may be a feasible alternative to prevent the deterioration of gas exchange during bronchoscopy. With the convenience of clinical use in mind, we modified an HFNC using a single cannula. This clinical trial was designed to test the hypothesis that a modified HFNC would decrease the proportion of patients with a single moment of peripheral arterial oxygen saturation (SpO 2 ) < 90% during bronchoscopy., Methods: In this single-center, prospective randomized controlled trial, hospitalized patients in the respiratory department in need of diagnostic bronchoscopy were randomly assigned to a modified HFNC oxygen therapy group or a conventional oxygen therapy (COT) group. The primary outcome was the proportion of patients with a single moment of SpO 2  < 90% during bronchoscopy., Results: Eight hundred and twelve patients were randomized to the modified HFNC (n = 406) or COT (n = 406) group. Twenty-four patients were unable to cooperate or comply with bronchoscopy. Thus, 788 patients were included in the analysis. The proportion of patients with a single moment of SpO 2  < 90% during bronchoscopy in the modified HFNC group was significantly lower than that in the COT group (12.5% vs. 28.8%, p < 0.001). There were no significant differences in the fraction of inspired oxygen between the two groups. The lowest SpO 2 during bronchoscopy and 5 min after bronchoscopy in the modified HFNC group was significantly higher than that in the COT group. Multivariate analysis showed that a baseline forced vital capacity (FVC) < 2.7 L (OR, 0.276; 95% CI, 0.083-0.919, p = 0.036) and a volume of fluid instilled > 60 ml (OR, 1.034; 95% CI, 1.002-1.067, p = 0.036) were independent risk factors for hypoxemia during bronchoscopy in the modified HFNC group., Conclusions: A modified HFNC could decrease the proportion of patients with a single moment of SpO 2  < 90% during bronchoscopy. A lower baseline FVC and large-volume bronchoalveolar lavage may predict desaturation during bronchoscopy when using a modified HFNC. Trial registration ClinicalTrials. Gov: NCT02606188. Registered 17 November 2015., (© 2021. The Author(s).)

Purpose: This study aimed to analyze a Chinese institution's experience with managing cervical necrotizing fasciitis (CNF) and observe the effects of a new therapeutic approach for postoperative drainage system., Methods: A retrospective study was established including a total of 46 CNF patients who underwent surgical debridement between April 2006 and April 2018. Analyses of demographic data, etiology, comorbidity, microbiology, complications, treatment methods, duration of treatment, and treatment outcomes were obtained., Results: There were 16 kinds of microbes cultured in 29 patients. Diabetic patients were more commonly infected by microbes (P < 0.05). There was a significant reduction in the number of operative time (P < 0.05) and length of hospitalization (P < 0.01) with postoperative therapy of double-cannula irrigation-drainage (DCID) system., Conclusion: CNF management includes controlling for comorbidities especially glycemic control and reasonable utilization of antibiotics and aggressive postoperative therapy. DCID system can effectively reduce operative frequency and duration of hospitalization.

Coronavirus disease-2019 (COVID-19) has rapidly spread worldwide and causes high mortality of elderly patients. High-flow nasal cannula therapy (HFNC) is an oxygen delivery method for severely ill patients. We retrospectively analyzed the course of illness and outcomes in 110 elderly COVID-19 patients (≥65 years) treated with HFNC from 6 hospitals. 38 patients received HFNC (200 mmHg < PaO 2 /FiO 2 ≤ 300 mmHg, early HFNC group), and 72 patients received HFNC (100 mmHg < PaO 2 /FiO 2 ≤ 200 mmHg, late HFNC group). There were no significant differences of sequential organ failure assessment (SOFA) scores and APECH II scores between early and late HFNC group on admission. Compared with the late HFNC group, patients in the early HFNC group had a lower likelihood of developing severe acute respiratory distress syndrome (ARDS), longer time from illness onset to severe ARDS and shorter duration of viral shedding after illness onset, as well as shorter lengths of ICU and hospital stay. 24 patients died during hospitalization, of whom 22 deaths (30.6%) were in the late HFNC group and 2 (5.3%) in the early HFNC group. The present study suggested that the outcomes were better in severely ill elderly patients with COVID-19 receiving early compared to late HFNC.

Objective: To investigate the efficacy of high flow nasal cannula (HFNC) in children with acute respiratory failure. Methods: A prospective study was conducted. A total of 153 patients aged from 1 to 14 years with acute respiratory failure were enrolled, who were admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from January 2018 to December 2019. HFNC success was defined as no need for invasive mechanical ventilation and successfully withdrawn from HFNC, while HFNC failure was defined as need for invasive mechanical ventilation. HFNC at a flow rate of 2 L/(kg·min) (maximum ≤ 60 L/min) with inhaled oxygen concentration (FiO 2 ) between 0.30 and 1.00 was applied to maintain percutaneous oxygen saturation (SpO 2 ) of 0.94-0.97. Parameters including arterial partial pressure of oxygen (PaO 2 ), partial pressure of carbon dioxide in artery (PaCO 2 ), SpO 2 and PaO 2 /FiO 2 were collected before and during the application of HFNC at 1 h, 6 h, 12 h, 24 h and 48 h, as well as over 48 h after HFNC withdrawn. Comparison between the groups was performed by student t test, Mann-Whitney U test or chi-square test. The sensitivity and specificity of the above parameters in predicting HFNC success were evaluated by receiver operating characteristic (ROC) curve. Results: A total of 153 children (70 males and 83 females) were enrolled. Among them, 131 (85.6%) cases were successfully weaned off from HFNC and 22 (14.4%) failed. The duration of HFNC was 57 (38, 95) hours in the successful group, and the PaO 2 /FiO 2 before HFNC application and after HFNC was withdrawn were 187 (170, 212) mmHg (1 mmHg=0.133 kPa) and 280 (262, 292) mmHg, respectively. The duration of HFNC in the failure group was 19 (9, 49) hours, and the PaO 2 /FiO 2 before HFNC application and after HFNC withdrawn were 176 (171, 189) mmHg and 159 (156, 161) mmHg, respectively. The values of PaO 2 /FiO 2 were significantly higher in the successful group than those in the failed group at using HFNC initially 1 h (196 (182, 211) vs. 174 (160, 178) mmHg, Z =-5.105, P< 0.01), 6 h (213 (203, 220) vs. 168 (157, 170) mmHg, Z =-6.772, P< 0.01), 12 h (226 (180, 261) vs. 165 (161, 170) mmHg, Z =-4.308, P< 0.01), 24 h (229 (195, 259) vs. 165 (161, 170) mmHg, Z =-4.609, P< 0.01) and 48 h (249 (216, 273) vs. 163 (158, 169) mmHg, Z =-4.628, P< 0.01) after the HFNC application, and over 48 h after HFNC was withdrawn (277 (268, 283) vs. 157 (154, 158) mmHg, Z =-3.512, P< 0.01). Moreover, the PaO 2 levels were significantly higher in the successful group than those in the failed group using HFNC initially at 1 h (73.7 (71.0, 76.7) vs. 70.0 (66.2, 71.2) mmHg, Z =-4.587, P< 0.01) and 6 h (79.0 (75.0, 82.0) vs. 71.0 (62.0, 72.0) mmHg, Z =-5.954, P< 0.01) after HFNC application. Also, the SpO 2 levels showed the same differences at 1 h (0.96 (0.95, 0.96) vs. 0.94 (0.92, 0.94), Z =-4.812, P< 0.01) and 6 h (0.96 (0.95, 0.97) vs. 0.94(0.91, 0.95), Z =-5.024, P< 0.01) after HFNC application. Forty eight hours after HFNC was withdrawn, the PaO 2 (88.0 (81.7, 95.0) vs. 63.7 (63.3, 66.0) mmHg, Z =-3.032, P< 0.01) and SpO 2 (0.96 (0.94, 0.98) vs. 0.91 (0.90, 0.92), Z =-3.957, P< 0.01) were also significantly higher in the successful group. Regarding the HFNC complications, there was one case with atelectasis and one with pneumothorax in the failure group. HFNC was used as sequential oxygen therapy after extubation in 79 children, successful in all. ROC curve showed that the area under curve of PaO 2 /FiO 2 in predicting HFNC success was 0.990, and the optimal cut-off value was 232 mmHg with the 95 %CI of 0.970-1.000 ( P< 0.01). Conclusions: HFNC could be used as a respiratory support strategy for children with mild to moderate respiratory failure and as a sequential oxygen therapy after extubation. The PaO 2 /FiO 2 when HFNC withdrow is the optimal index to evaluate the success of HFNC application.

Objective: To systematically evaluate the efficacy and safety of high-flow nasal cannula (HFNC) therapy versus nasal continuous positive airway pressure (nCPAP) in the treatment of respiratory distress syndrome (RDS) in neonates., Methods: PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine disc, Wanfang Database, CNKI, and Weipu Database were searched for the randomized controlled trials (RCTs) of HFNC versus nCPAP in the treatment of neonatal RDS published up to April 1, 2020. RevMan5.3 software was used to perform a Meta analysis of the eligible RCTs., Results: A total of 12 RCTs were included, with 2 861 neonates in total, among whom 2 698 neonates (94.30%) had a gestational age of ≥28 weeks and 163 (5.70%) had a gestational age of <28 weeks. For primary respiratory support, the HFNC group had a significantly higher rate of treatment failure than the nCPAP group (RR=1.86, 95%CI: 1.53-2.25, P<0.001), but there were no significant differences between the two groups in the rate of invasive mechanical ventilation (P=0.40) and the rate of use of pulmonary surfactant (P=0.77). For post-extubation respiratory support, there were no significant differences between the two groups in the treatment failure rate, reintubation rate, and total oxygen supply time (P>0.05). For primary respiratory support and post-extubation respiratory support, the HFNC group had a significantly lower incidence rate of nasal injury than the nCPAP group (P<0.001), and there were no significant differences between the two groups in the mortality rate and incidence rates of the complications such as air leak syndrome, bronchopulmonary dysplasia, and necrotizing enterocolitis (P>0.05)., Conclusions: Based on the current clinical evidence, HFNC has a higher failure rate than nCPAP when used as primary respiratory support for neonates with RDS, and therefore it is not recommended to use HFNC as the primary respiratory support for neonates with RDS. In RDS neonates with a gestational age of ≥28 weeks, HFNC can be used as post-extubation respiratory support in the weaning phase.