OBJECTIVE:To compare the effectiveness of cylindrical-shaped and conical-shaped cuff catheters for airway closure using different pressure measurement methods at the lowest safe pressure and to guide the clinical application.METHODS:Twenty-four patients with endotracheal intubation admitted to the intensive care unit (ICU) of Guangxi Medical University Cancer Hospital from December 2021 to January 2022 were enrolled. Leakage test in vitro was performed on the secretion on the patients' cuff. The needle and plunger from 20 mL syringe was separated, the syringe was sealed with adhesive, and the syringe nozzle was filled thoroughly to create a tracheal model. Consecutively, both cylindrical-shaped and conical-shaped cuff catheters were inserted into the simulated trachea, and the cuff pressure was calibrated to 20 cmH2O (1 cmH2O ≈ 0.098 kPa) before commencing the experiment. The viscosity of the secretion on the patients' cuff was classified (grade I was watery subglottic secretion, grade II was thick subglottic secretion, grade III was gel-like subglottic secretion), and the same viscosity secretion was injected into the catheter cuff. Utilizing a self-control approach, intermittent pressure measurement was initially conducted on both the cylindrical-shaped and conical-shaped cuff by improved pressure measurement method (intermittent pressure measurement group), followed by continuous pressure measurement experiment (continuous pressure measurement group). The leakage volume of the three viscosity subglottic secretions and the values of cuff pressure measurement of different shaped cuff catheters at 4, 6, 8 hours of inflation were recorded.RESULTS:A total of 180 retention samples were extracted from 24 patients with tracheal intubation during ventilation, with 90 samples in each of the two groups using different pressure measurement methods, and 30 samples of retention materials with different viscosities in each group. In the intermittent pressure measurement group, at 4 hours of inflation, all samples of secretion with grade I and grade II on cylindrical-shaped cuff leaked, while 3 samples of secretion with grade III also leaked. For conical-shaped cuff, 28 samples of secretion with grade I leaked, only 2 samples of secretion with grade II leaked, and there was no leak for secretion with grade III. At 6 hours of inflation, all samples of the three viscosity secretions on different shaped cuffs leaked. The leakage was gradually increased with the prolongation of inflation time. In the continuous pressure measurement group, at 4 hours of inflation, all samples of secretion with grade I on cylindrical-shaped cuff leaked, while 29 samples of secretion with grade II leaked, and there was no leak for secretion with grade III. For the conical-shaped cuff, 26 samples of secretion with grade I leaked, and there was no leak for secretion with grade II and grade III. At 6 hours of inflation, the conical-shaped cuff still had no leak for secretion with grade III. As the inflation time prolonged, the leakage of subglottic secretion on different shaped cuffs in both groups was gradually increased. At 8 hours of inflation, all samples experienced leakage, but the leakage of subglottic secretion on different shaped cuffs in the continuous pressure measurement group was significantly reduced as compared with the intermittent pressure measurement group [leakage for secretion with grade III (mL): 1.00 (0.00, 1.25) vs. 2.00 (1.00, 2.00) on the cylindrical-shaped cuff, 1.00 (0.00, 1.00) vs. 2.00 (2.00, 2.00) on the conical-shaped cuff, both P < 0.01]. The values of pressure measurement of cuffs with different shapes at different time points of inflation in the continuous pressure measurement group were within the set range (20-21 cmH2O). The cuff pressure at 4 hours of inflation in the intermittent pressure measurement group was significantly lower than the initial value (cmH2O: 18.3±0.6 vs. 20.0±0.0 in the cylindrical-shaped cuff, 18.4±0.6 vs. 20.0±0.0 in the conical-shaped cuff, both P < 0.01), and the cuff pressure in both shaped cuffs showed a significant decrease tendency as inflation time prolonged. However, there was no statistically significant difference in values of pressure measurement between the different shaped cuff catheters.CONCLUSIONS:Continuous pressure monitoring devices can maintain the effective sealing of conical-shaped cuff catheters at the lowest safe pressure. When using an improved pressure measurement method for intermittent pressure measurement and/or using a cylindrical cuff catheter, the target pressure should be set at 25-30 cmH2O, and the cuff pressure should be adjusted regularly.

Objective: To investigate the resilience of medical workers from other provinces to Wuhan to support fighting against 2019 novel coronavirus pneumonia (COVID-19). Methods : In February 2020, medical works supporting Wuhan in the fighting against COVID-19 were eligible to complete an online survey made up of Connor Davidson Resilience Scale (CD-RISC), Hospital Anxiety Depression Scale (HADS) and Simplified Coping Style Questionnaire (SCSQ). Results : A total of 114 medical workers were investigated. The CD-RISC scores of medical workers were at a high level (67.03±13.22). The resilience level was highest for physicians (73.48±11.49), followed by supporting staff, including health care assistants, technicians (67.78±12.43) and nurses (64.86±13.46). There were also significant differences in education, training and support from hospital, adequate preparation and confidence to complete support tasks (P<0. 05). Resilience was negatively correlated with anxiety (r=-.498, P<0.01) and depression (r=-.471, P<0.01), but positively correlated with active coping styles (r=.733, P<0.01). Multiple regression analysis showed that active coping (β=1.314, p<0.05), depression (β= -.806, p<0.05), anxiety (β= -1.091, p<0.05) and training and support from hospital (β= -3.510, p<0.05) were significant influence factors of resilience. Conclusion : The manager of the health management system should be aware that active coping, depression, anxiety and training, and support from hospitals are the influential factor of resilience. In addition, it is necessary to need to take these preferences into account and develop psychosocial interventions to help reinforce the resilience of medical works fighting emerging contagious diseases such as COVID-19.

Background To investigate the resilience of non-local medical workers sent to support local medical workers in treating the outbreak of 2019 novel coronavirus disease (COVID-19). Methods In February 2020, non-local medical workers who had been sent to Wuhan as support staff to respond to the COVID-19 outbreak were asked to complete an online survey composed of the Connor Davidson Resilience Scale (CD-RISC), Hospital Anxiety Depression Scale (HADS) and Simplified Coping Style Questionnaire (SCSQ). Results Survey responses from 114 non-local medical workers were analyzed. CD-RISC scores were high (67.03 ± 13.22). The resilience level was highest for physicians (73.48 ± 11.49), followed by support staff, including health care assistants, technicians (67.78 ± 12.43) and nurses (64.86 ± 13.46). Respondents differed significantly in the levels of education, training/support provided by the respondent’s permanent hospital (where he or she normally works), and in their feelings of being adequately prepared and confident to complete tasks ( P < 0.05). Resilience correlated negatively with anxiety ( r = −.498, P < 0.01) and depression ( r = −.471, P < 0.01) but positively with active coping styles ( r = .733, P < 0.01). Multiple regression analysis showed that active coping ( β = 1.314, p < 0.05), depression ( β = −.806, p < 0.05), anxiety ( β = − 1.091, p < 0.05), and training/support provided by the respondent’s permanent hospital ( β = 3.510, p < 0.05) were significant associated with resilience. Conclusion Our data show that active coping, depression, anxiety, and training/support provided by the respondent’s permanent hospital are associated with resilience. Managers of medical staff should use these data to develop psychosocial interventions aimed at reinforcing the resilience of medical workers during highly stressful and prolonged medical emergencies, as seen during the COVID-19 outbreak.

OBJECTIVE:To compare the intra cuff pressure changes during improved and the traditional method of cuff pressure measurement, then evaluate the effects of ventilator-associated pneumonia (VAP) prevention. The results highlighted practical recommendations in the process of ETT cuff pressure measurement.METHODS:(1) Experimental studies were carried out on the tracheal model with two groups: traditional pressure measurement group and improved pressure measurement group. The traditional pressure measurement group was connected to a handheld pressure gauge with the indicate cuff to get the intra-cuff pressure. The improved method was to insert a 3-way stopcock between the handheld pressure gauge and the indicate cuff. The 3-way stopcock to stabilize handheld pressure gauge reading at 32 cmH2O (1 cmH2O = 0.098 kPa) before measure the intra-cuff pressure. The pressure loss caused by two pressure measurement methods and the leakage of liquid on the balloon after 10 minutes was compared. (2) Clinical researches: a historic cohort study, patients with mechanical ventilation (MV) admitted to intensive care unit (ICU) of Guangxi Medical University Cancer Hospital from June 2014 to May 2018 were enrolled. The control group (249 cases) was treated with traditional method during June 2014 to May 2016, and the observation group (314 cases) was treated with improved method during June 2016 to May 2018. Clusters of strategies and actions of VAP prevention were applied in both groups. Incidence of VAP, duration of MV, and the length of ICU stay were compared between the two groups.RESULTS:(1) Experimental study: the pressure leakage of the traditional pressure measurement group was (10.18±0.47) cmH2O, and that of the improved pressure measurement group was (1.33±0.42) cmH2O, with statistically significant difference between the two groups (t = 32.535, P = 0.000). All fluid on the cuffs leak after 10 minutes of traditional ways of measurement, however, no visible fluid on the cuffs leaked with improved procedures. (2) Clinical research: the incidence of VAP in the observation group was slightly lower than that in the control group, however there was no significant difference [5.10% (16/314) vs. 8.43% (21/249), P > 0.05]. The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group (days: 9.93±3.14 vs. 16.77±5.45, 11.63 ±2.28 vs. 19.12±5.10, both P < 0.01).CONCLUSIONS:The improved procedures of intra-cuff pressure measurement is a practical method to avoid the pressure leakage and fluid leakage, and the clinical course of MV patients can be significantly improved by combining the clusters of nursing strategies and actions.