Department Of Critical Care Medicine Research Articles

Pulmonary mucoepidermoid carcinoma in the Chinese population: A clinical characteristic and prognostic analysis.

BackgroundMucoepidermoid carcinoma is dominant in salivary glands and rarely occurs in the lung. Primary pulmonary mucoepidermoid carcinoma is a type of non-small-cell lung cancer, but the prognostic factors in Chinese patients remain controversial. This investigation aimed to review cases of pulmonary mucoepidermoid carcinoma, analyse the prognosis of this disease.MethodsPatients with pathologically proven pulmonary mucoepidermoid carcinoma were screened at the Department of Respiratory and Critical Care Medicine at the Peking University Third Hospital, Beijing Friendship Hospital Affiliated to Capital Medical University, and Peking University Cancer Hospital for inclusion in this retrospective study. Demographic data, including age, sex, clinical symptoms, smoking, alcohol consumption, allergies, family history, imaging findings, fibrobronchoscopy findings, surgical procedures, tumour location and pathologic stage, were collected. Telephone follow-up was conducted for all patients not lost to follow-up. The associations of sex, age, smoking, tumour differentiation, tumour size, lymph node metastasis, pathologic stage, and patient survival were retrospectively analysed. Kaplan–Meier, univariate and multivariate analysis curves were used to analyse patient prognosis and prognostic factors.ResultsThirty-one patients, comprising 23 males and 8 females, were enrolled in the analysis. The mean age was 60.77 ± 11.44 years. The first symptom was nonspecific, with cough being the most common (21/31, 67.77%); smokers accounted for 16 of the 31 patients, and ten patients had a history of alcohol consumption. Overall, the tumours could occur in either lobe of the lungs; tumours occurred in the right lung in 19/31 patients, and tumours occurred in the left lung in 12/31 patients. Regarding TNM stage, 10 patients had stage I (5 with stage 1a, 5 with stage 1b), 5 had stage II (1 with stage 2a, 4 with stage 2b), 3 had stage III (1 with stage 3a, 2 with stage 3b), and 13 had stage IV (10 with stage 4a, 3 with stage 4b). In our Cox univariate survival analysis of patients with pulmonary mucoepidermoid carcinoma, we found that TNM stage IV, degree of differentiation and lymph node metastasis were risk factors for pulmonary mucoepidermoid carcinoma and that degree of differentiation was an independent risk factor.ConclusionThe clinical, radiographical and pathological features of pulmonary mucoepidermoid carcinoma were systemically analysed and summarized, and the degree of differentiation and lymph node metastasis, as well as prognostic factors in addition to clinical stage, were confirmed.

Design and application of an extension tube for ventilator pipeline

At present, the extension tube of the ventilator, a long corrugated tube used in clinical practice, needs to be disconnected from the endotracheal tube when performing open sputum suction. Under positive pressure, the condensed water containing pathogenic microorganisms in the ventilator will be splashed. Some will form aerosol suspended in the air, pollute the air, increase the risk of cross-infection and operator pollution, while the ventilator will emit a corresponding alarm sound, resulting in noise pollution. Based on the above factors, a ventilator pipeline extension tube was designed by the medical staff of department of critical care medicine of the Eighth Medical Center of People's Liberation Army General Hospital and department of critical care medicine of Beijing Friendship Hospital of Capital Medical University, and was obtained the National Utility Model Patent of China (ZL 2020 2 1476518.X). The device consists of the main pipe, first pipe sleeve, second pipe sleeve, valve body, joystick, axial sleeve, etc., which can not only effectively avoid air pollution and reduce the risk of cross-infection, but also reduce noise pollution and the negative impact of loud noise on patients and medical staff.

Application of traditional medicine in emergency and critical care “1st International Symposium on Kampo Medicine”

Traditional & Kampo MedicineVolume 9, Issue 2 p. 119-120 LETTER TO THE EDITOR Application of traditional medicine in emergency and critical care “1st International Symposium on Kampo Medicine” Hajime Nakae, Corresponding Author Hajime Nakae nakaeh@doc.med.akita-u.ac.jp orcid.org/0000-0003-3733-3530 Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan Correspondence Hajime Nakae, Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan. Email: nakaeh@doc.med.akita-u.ac.jpSearch for more papers by this authorTomomichi Kan'o, Tomomichi Kan'o Shinmachi Clinic, Tokyo, JapanSearch for more papers by this authorYasuhito Irie, Yasuhito Irie orcid.org/0000-0002-1628-9262 Advanced Emergency and Critical Care Center, Akita University Hospital, Akita, JapanSearch for more papers by this authorKenichiro Tokunaga, Kenichiro Tokunaga Department of Rheumatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, JapanSearch for more papers by this authorMasayuki Kashima, Masayuki Kashima Department of General Internal Medicine Japanese Red Cross Kumamoto Hospital, Kumamoto, JapanSearch for more papers by this authorLiu Xuezheng, Liu Xuezheng First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, ChinaSearch for more papers by this author Hajime Nakae, Corresponding Author Hajime Nakae nakaeh@doc.med.akita-u.ac.jp orcid.org/0000-0003-3733-3530 Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan Correspondence Hajime Nakae, Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan. Email: nakaeh@doc.med.akita-u.ac.jpSearch for more papers by this authorTomomichi Kan'o, Tomomichi Kan'o Shinmachi Clinic, Tokyo, JapanSearch for more papers by this authorYasuhito Irie, Yasuhito Irie orcid.org/0000-0002-1628-9262 Advanced Emergency and Critical Care Center, Akita University Hospital, Akita, JapanSearch for more papers by this authorKenichiro Tokunaga, Kenichiro Tokunaga Department of Rheumatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, JapanSearch for more papers by this authorMasayuki Kashima, Masayuki Kashima Department of General Internal Medicine Japanese Red Cross Kumamoto Hospital, Kumamoto, JapanSearch for more papers by this authorLiu Xuezheng, Liu Xuezheng First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, ChinaSearch for more papers by this author First published: 11 August 2022 https://doi.org/10.1002/tkm2.1324Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume9, Issue2August 2022Pages 119-120 RelatedInformation

Survey and analysis on digital construction of primary hospitals in Guizhou Province

To investigate the utilization status and awareness of digital hospital construction among medical staff in critical care department of primary hospitals, so as to promote the process of digital medical health. One to two doctors and nurses (in the department on that day) from public hospitals in 88 counties and urban areas in 9 cities of Guizhou Province were enrolled of field investigation. The questionnaires form were filled in on-site and sorted out and analyzed by special personnel. A total of 297 medical staff from the department of critical care medicine of 146 hospitals were included. All the questionnaires were filled in with their real names, including 152 doctors and 145 nurses. There were 24 class III Grade A hospitals and 122 class II and all the hospitals had implemented digital information management. The awareness of hospital digital information management system was generally low among the surveyed medical staff, and the awareness of hospital information system (HIS) was the highest (86.5%), followed by laboratory information management system (LIS, 41.4%) and image archiving and communication system (PACS, 40.7%). The awareness of hospital management system (HERP) was the lowest (7.7%). The total number of remote consultations conducted by hospitals using big data Internet was 25 428 times in 2020, with a median of 24.5 (88.0, 240.0) times in each hospital. From 2018 to 2020, the total number of patients admitted to the intensive care unit of the hospital was 50 473, 57 565 and 57 907, respectively, of which the number of patients over 65 years old accounted for 37.47%, 41.26% and 43.31%, respectively (all P > 0.05). There were 4 242 cases of remote consultation using big data Internet in the department every year, with a median of 257.50 (96.50, 958.25) cases. 12.12% of the departments had independent critical monitoring systems, and 8.75% of them could capture data automatically to form tables. 96.30% of the medical staff participated in systematic and professional training on basic knowledge, basic theory and basic medical care skills through the Internet platform, and the number of meetings, studies and training in the provinces and prefectures were 282 and 357 times per year, respectively. More than 90% of the departments initiated remote consultation, arranged referral or admitted patients who had improved status after treatment in superior hospitals through the Internet platform. Most of the patients (69.02%) were from the lower level of the hospital. The total number of out-patient consultations was 2 959 times per year, with a median of 296 (185 473) times. 54.79% of the departments had fixed service villages, and 28.08% of the departments had fixed service population. The median furthest visit distance was 52.5 (30.0, 80.0) kilometers, and the median average visit distance was 30.0 (20.0, 50.0) kilometers. 54.88% of medical staff believed that the biggest difficulties encountered during house visits were insufficient energy and too large service groups or regions. More than 90% of medical staff had been exposed to cloud learning and cloud training, and most of the surveyed medical staff believed that cloud learning and cloud training greatly improved medical service capacity and service efficiency of medical institutions (71.04% and 67.01%, respectively). Meanwhile, they believe that "Internet+health big data" projects from various aspects brought advantage to medical institutions, but there are also low utilization rate of Internet medical equipment by village doctors, low acceptance for telemedicine and mobile hospitals by farmers. Guizhou public hospitals have implementation of digital information management at the grass-roots level, the surveyed health care workers have a relatively low awareness of the digital information management system, hospital use big data Internet for remote consultation is uneven, intensive care medicine is a clinical discipline used in most remote consultation information system, and can complete two-way referrals. In the past three years, the discipline operation showed an upward trend year by year. Medical staff use artificial intelligence devices such as cloud learning and training to improve medical service capacity and efficiency. The digital transformation of primary hospitals is being continuously improved.

Clinical value of pulse pressure/central venous pressure ratio in low cardiac output syndrome after cardiac surgery

To explore the relationship between the pulse pressure/central venous pressure (PP/CVP) ratio and the cardiac output (CO) of patients after cardiac surgery from the basic principles of hemodynamics, and to further evaluate the predictive value of PP/CVP ratio in patients with secondary low cardiac output syndrome (LCOS) after cardiac surgery. A retrospective study was conducted, and patients who received pulse indicator continuous cardiac output (PiCCO) monitoring were enrolled at the department of critical care medicine of Peking Union Medical College Hospital from January 1, 2016, to September 1, 2021. Patients were divided into two groups: the LCOS group [cardiac index (CI) < 33.34 mL×s-1×m-2, 25 cases] and the non-LCOS group (CI ≥ 33.34 mL×s-1×m-2, 125 cases) according to the CI at 6 hours after surgery. The general clinical data and hemodynamic parameters were collected. Correlations between PP/CVP ratio and PiCCO monitoring indicators were performed with Pearson or Spearman correlation test. Receiver operator characteristic curve (ROC curve) analysis was carried out to evaluate the predictive value of the parameters in patients with LCOS after cardiac surgery. A total of 150 patients with PiCCO monitoring after cardiac surgery were included. There were no differences in baseline characteristics between the two groups, while PP in the LCOS group was lower than that in the non-LCOS group [mmHg (1 mmHg ≈ 0.133 kPa): 40 (37, 44) vs. 55 (46, 64)], CVP was higher than that in the non-LCOS group [mmHg: 12 (11, 14) vs. 10 (8, 12)], and PP/CVP ratio in the LCOS group was lower than that in the non-LCOS group [3.3 (2.9, 3.7) vs. 5.5 (4.6, 6.8)], with significant differences (all P < 0.05). Correlation analysis results showed that PP/CVP ratio was positively correlated with CI, CO, and stroke volume index (SVI), respectively (rs = 0.660, 0.592, 0.600, all P < 0.001). CI was negatively correlated with PP (rs = 0.509, P < 0.001) and positively correlated with CVP (rs = -0.297, P < 0.001). ROC curve analysis revealed that compared with PP, CVP, SVI and cardiac function index (CFI), PP/CVP ratio was the best predictor of LCOS after cardiac surgery [area under the ROC curve (AUC) was 0.94±0.02, P < 0.001], when the optimum cut-off value was 4.41, the sensitivity was 80.00%, and the specificity was 96.00%. PP/CVP ratio was moderately positively correlated with CO after cardiac surgery, and PP/CVP ratio could be used as a prognostic predictor for LCOS after cardiac surgery.

Analysis of treatment for 360 critically ill pregnant and parturient women in intensive care unit

To analyze the clinical characteristics and outcomes of critically ill pregnant and parturient women in intensive care unit (ICU), and to provide clinical experience for the subspecialty construction of critical obstetrics. The clinical data of critically ill pregnant and parturient women admitted to the department of critical care medicine, the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2019 were collected. The main reasons for maternal transfer to ICU, the causes of maternal death, and organ support measures, etc. were summarized. A total of 39 567 critically ill pregnant and parturient women were admitted to the department of obstetrics in our hospital, and 360 were transferred to ICU, with an average ICU transfer rate of 0.91%. Since 2016, the number of obstetric admissions, the number of ICU transfers and the ICU transfer rate had increased significantly. The average age of severe maternals admitted to ICU was (30.9±5.7) years old. The average acute physiology and chronic health evaluation II (APACHE II) score was 7 (4, 10). The average length of ICU stay was 1 (1, 2) day. The average ventilator duration was 9.0 (3.0, 17.5) hours. The main delivery mode of pregnant women in ICU was cesarean section (84.72%). Forty-eight patients (13.33%) underwent hysterectomy, of which 42 (87.5%) due to postpartum hemorrhage. The top 3 causes of ICU admission were severe postpartum hemorrhage [36.94% (133/360)], hypertensive disorders of pregnancy [21.67% (78/360)], pregnancy with cardiac disease [15.00% (54/360)]. The leading cause of postpartum hemorrhage in women transferred to ICU was placental abnormality [63.98% (103/161)], followed by uterine atony [28.57% (46/161)]. The average blood loss was (4 019±2 327) mL within 24 hours after delivery, and the number of women who underwent hysterectomy due to postpartum hemorrhage decreased year by year. During the study period, there were 2 maternal deaths, which were indirect obstetric deaths, 3 cases were discharged against-advice (expected death), including 1 indirect death and 2 direct obstetric death; the mortality in ICU was 1.39% (5/360). The most common reasons for pregnant and parturient women to be admitted to ICU were severe postpartum hemorrhage and hypertensive disorders of pregnancy. The leading cause of postpartum hemorrhage was placental problem. Indirect obstetric deaths exceeded direct obstetric deaths, mainly due to pregnancy complicated with cardiac disease and severe pneumonia. ICU has become an important battlefield for rescuing critically ill maternal and an important guarantee for reducing the maternal mortality.

Comparison of IVC Diameter and Pro-BNP for Judgeouos use of IV Fluids in Critical ill Patients on IPPV

Aim: To compare the diameter of IVC and levels of Pro-BNP for use of IV fluids in critical ill patients on IPPV Study Design: Descriptive cross sectional study Place and duration of study: At the department of Critical Care Medicine the Services hospital, Lahore from April 2021 to March 2022 Methodology: The study was conducted after the approval of hospital ethical committee and from each patient written consent form was also obtained we enrolled 77 patients in our study after fulfilling of inclusion criteria. The base line and echocardiographic characteristics were analyzed including NT–proBNP and inferior vena cava diameter. IVC diameter was determined with the help of echocardiography. NT–proBNP was determined with the help of ELISA kit. For statistical analysis we used SPSS 23 version. Pearson correlation test was also used to check the relation between NT–proBNP and inferior vena cava diameter. Correlation was significant at p &lt; 0.05. Results: The mean age of patients was 62.06 ± 7.54. 37 (48.1 %) were male and 40 (51.9 %) were female. The results of brain natriuretic peptide (pg/mL) was 280. 58 ± 40.82 and NT–proBNP (pg/mL) was 1981.25 ± 278.88. The Inferior Vena Cava size was 1.86 ± 0.77 cm. The results of correlation was significant (p &lt; 0.01) in between the inferior vena cava size and NT–proBNP. The value of correlation was 0.753. Conclusion: Natriuretic peptides are linked to IVC size in patients with congestive heart failure. These findings imply that left-sided echocardiography and the biomarker assessment have a complimentary purpose. IVC diameter can be beneficial in assessing volume status and discriminating between congestion and non-congestion heart failure. Keywords: IVC diameter, levels of Pro-BNP, IV fluids, IPPV

Phenylephrine Boluses Vs Noradrenaline Boluses for Hypotension after Spinal Anesthesia in LSCS

Background: Hypotension is a frequent complication highly associated with spinal anesthesia during lower segment cesarean section that imposed adverse effects related to maternal as well as fetal. Purpose: The purpose: of this study is to lighten the comparison of vasopressor (Phenylephrine boluses vs. noradrenaline boluses) use to treat hypotension after spinal anesthesia in LSC patients Study design: randomized double-blind study design. Method: This randomized double-blind study was performed at the department of anesthesia, critical care, and pain medicine at Aziz Bhatti Shaheed Teaching Hospital, Gujrat Pakistan, and was conducted from Jun 2020 to Jun 2021. The patients aged between 20 to 40 years who went through lower segment cesarean section were part of this study. A total of 60 patients were divided into two groups namely groups A and B. Group A contain 30 patients in the same way group occupied with 30 patients and by using a random allocation procedure or protocol, the randomized number was assigned to all patients via the computer-generated system. Group A received phenylephrine and Group B received noradrenaline. Results: Statically analysis was performed using SPSS software. In the case of group A, the mean arterial pressure was measured at 115.03 ± 8.69, heart rate, beats/min was measured at 65.72 ± 9.46, and bradycardia was found in 14 (46.6%) patients out of 30 of group A with a mean value of beats 43.65 ± 3.23, hypotension was found in 4.31 ± 2.11 cases and to treat its repeated episodes with phenylephrine boluses was used 4.21 ± 1.21. In the case of group B, the mean arterial pressure was measured at 121± 9.86, heart rate, beats/min was measured at 80.42± 8.01, and bradycardia was found in 8 (26.6%) patients out of 30 of group B with a mean value of beats 45.23± 2.13, hypotension was found in 2.21± 1.03 cases and to treat its repeated episodes with noradrenaline boluses was used 3.98± 1.32 and all the variables was found with significant results. Conclusion: We conclude that noradrenaline shows ameliorated response to handle the hypotension situation after spinal anesthesia as compared to phenylephrine. Keywords: Spinal anesthesia, phenylephrine bolus, noradrenaline bolus, lower segment cesarean section (LSCS)

Prophylactic Intravenous Vs Topical Lidocaine to Blunt Stress Response During Laryngoscopy

Background: The stress response is a common phenomenon occurred during laryngoscopy. Although this response can be transient and less harmful in healthy individuals, it might be hazardous among the many patients with underline disorders. Aim of the study: The purpose of the study was to compare the two different routes for lidocaine to determine the blunt stress response during laryngoscopy. Study design: A randomized control study was designed. Method: This randomized control study design was performed in the Department of Anesthesia, Critical Care, and Pain Medicine at Aziz Bhatti Shaheed Teaching Hospital, Gujrat. The duration of the study was from February 2021 to Jun 2022. The participant of this study was 70 in number having age between 30-60 years and was divided into two groups via a computer-generated randomization sheet. The first group name, group-A contains 35 patients, single dose of 200mg intravenous lidocaine was given before the laryngoscopy procedure. The second group was group B consisted of 35 patients who had to receive the topical (spray) lidocaine in a single dose of 200mg. Results: Group-A patients who had received the IV, lidocaine had a systolic blood pressure mean ± SD value of 120.03 ± 9.72 with a p-value of 0.021 which indicate the systolic was under control. Diastolic pressure means ± SD value was 75.81 ± 10.46 with a P-value of 0.012 which shows the significant effect of lidocaine to reduce the pressure. Arterial pressure was measured with mean ± SD = 75.34 ± 9.61 value. Group B patients who received the topical lidocaine dose, shows a 140 ± 10.87 mean ± SD value of systolic blood pressure and diastolic blood pressure mean ± SD value was 85.42 ± 11.01 recorded. Arterial pressure with mean ± SD = 98.34± 9.13 value and significant p-value shows the higher arterial pressure. The use of topical lidocaine was not effectively controlling heart rate as indicated by mean ± SD = 99.87±10.14. Conclusion: Overall, the study suggests that prophylactic intravenous given laryngoscopy will provide a significantly positive response to handle the blunt stress response in a better way as compared to topical use of lidocaine. Keywords: laryngoscopy, Intravenous lidocaine, Topical lidocaine, Stress response

Design and Clinical Application Effect Analysis of a New Type of Oral Fluid Suction Device for Patients with Orotracheal Intubation.

Tracheal intubation is an important access to general anesthesia surgery or respiratory support in critically ill patients. Orotracheal intubation is the most common method of establishing artificial airways in clinical practice. Tracheal intubation and mechanically assisted breathing are among the important steps in the clinical rescue of critically ill patients. During tracheal intubation, it easily causes iatrogenic skin damage, unclear mouth, ulcer, and other oral mucosal complications due to the improper fixation method and excellent dental pads. Therefore, the purpose of this study was to design a novel oral suction device for patients with orotracheal intubation and explore its safety, convenience, and comfort in the clinical application of orotracheal intubation patients. From October 2016 to April 2017, a total of 232 patients with mechanical ventilation through orotracheal intubation in the Department of Surgery and Critical Care Medicine were selected by the convenience sampling method. According to the random number table method, 232 cases were divided into the experimental group and control group, with 116 cases in each group. The experimental group used a self-designed oral fluid suction device to fix the tracheal intubation; the control group used the traditional method, placing ordinary disposable tooth pads, and then using 3M tape to fix the tracheal intubation. The incidence of oral mucosa and lip pressure ulcers, patient comfort, and tracheal tube displacement were observed and compared between the two groups. The incidence of oral mucosa and lip pressure ulcers in the observation group using the self-designed oral fluid suction device to fix the tracheal intubation was significantly lower than that in the control group. At the same time, the comfort of the patients was significantly higher than that of the control group, the incidence of tracheal tube displacement was significantly lower than that of the control group, and the differences between the above indicators were statistically significant (P < 0.05). For patients with orotracheal intubation, using a new oral fluid suction device to fix the tracheal intubation can effectively prevent the displacement of the tracheal intubation, protect the oral mucosa and lips, and reduce the pain of the patient. At the same time, the oral fluid suction device designed in this study has low production cost, strong practicability, and is suitable for clinical promotion.

Study on the relationship between ventricular function parameters obtained by echocardiography and prognosis of patients with sepsis

To investigate the epidemiological characteristics of septic cardiomyopathy and explore the relationship between the relevant indexes measured by echocardiography and the prognosis of patients with sepsis. A case-control study was conducted. The data of patients with sepsis admitted to the department of critical care medicine of Jiangsu Subei People's Hospital Affiliated to Yangzhou University and the department of critical care medicine of Beijing Electric Power Hospital of State Grid Corporation of China from June 2018 to June 2021 were enrolled. The general information and 28-day prognosis were recorded. At the same time, ultrasonic parameters obtained by transthoracic echocardiography within 24 hours after intensive care unit (ICU) admission were recorded. The differences in ultrasound indexes between the death group and the survival group on 28 days were compared. Parameters with significant statistical differences between the death group and the survival group were included in the Logistic regression analysis to find the independent risk factors for the prognosis of patients with sepsis, the predictive value of each index for the prognosis of patients with sepsis was evaluated by receiver operator characteristic curve (ROC curve). A total of 145 patients with sepsis were enrolled, including 106 patients with septic shock. Among the 145 patients, septic cardiomyopathy was found in 73 patients, with the incidence of 50.3%. The incidence of left ventricular diastolic dysfunction cardiomyopathy was 41.4% (n = 60), the incidence of left ventricular systolic dysfunction cardiomyopathy was 24.8% (n = 36), and the incidence of right ventricular systolic dysfunction cardiomyopathy was 12.4% (n = 18). At 28 days, 98 patients survived and 47 died, with the mortality of 32.4%. The peak e' velocity by tissue Doppler imaging (e') and right ventricular myocardial systolic tricuspid annulus velocity (RV-Sm) of the death group were significantly lower than those of the survival group [e' (cm/s): 7.81±1.12 vs. 8.61±1.02, RV-Sm (cm/s): 12.12±2.04 vs. 13.73±1.74, both P < 0.05], left ventricular ejection fraction (LVEF) and left ventricular systolic mitral annulus velocity (LV-Sm) in the death group were slightly higher than those in the survival group [LVEF: 0.550±0.042 vs. 0.548±0.060, LV-Sm (cm/s): 8.92±2.11 vs. 8.23±1.71], without significant differences (both P > 0.05). Parameters with significant statistical differences between the two groups were included in the Logistic regression analysis and showed that e' and RV-Sm were independent risk factors for the 28-day prognosis of patients with sepsis [e': odds ratio (OR) = 0.623, 95% confidence interval (95%CI) was 0.410-0.947, P = 0.027; RV-Sm: OR = 0.693, 95%CI was 0.525-0.914, P = 0.010]. ROC curve analysis showed that the area under the ROC curve (AUC) of e' for predicting the 28-day prognosis of patients with sepsis was 0.657, 95%CI was 0.532-0.781, P = 0.016, the best cut-off value was 8.65 cm/s, the sensitivity was 62.1%, and the specificity was 73.4%. The AUC of RV-Sm for predicting the 28-day prognosis of patients with sepsis was 0.641, 95%CI was 0.522-0.759, P = 0.030, the best cut-off value was 14.80 cm/s, the sensitivity was 96.6%, and the specificity was 26.6%. The incidence of septic cardiomyopathy is high. The LVEF measured by early echocardiography has no predictive value for 28-day prognosis in septic patients, while RV-Sm and e' are important predictors for 28-day prognosis.

Design and application of extracorporeal membrane oxygenation transport vehicle

With the widespread application of extracorporeal membrane oxygenation (ECMO) technology, ECMO centers have been established in most regions of China, and the demand for ECMO transport is also increasing. Critically ill patients with ECMO carry many catheters. ECMO devices and accessories are cumbersome and numerous, requiring a large amount of manpower to assist in the transfer. At present, most of ECMO transport equipment are vertical carts provided by equipment suppliers, which cannot accommodate all ancillary equipment and are difficult to be loaded into ambulances for transportation. Therefore, critically ill patients face many risks if they need to be transported inter-hospital. A specific vehicle for ECMO patients was designed by the medical staff of the department of critical care medicine of Zhujiang Hospital of Southern Medical University, which integrates the ECMO host, oxygenator, centrifugal pump, portable ventilator, coagulation instrument, injection pump, monitor, oxygen cylinder, and etc., to greatly facilitate the transportionation. This invention obtained the National Utility Model Patent of China (ZL 2019 2 1201261.4). The new ECMO transport vehicle can facilitate the interhospital transport of critically ill patients, reduce the occurrence of accidents, shorten the transport time and reduce the number of transport personnel, and has a good clinical application value.

Editor's Choice Articles for July.

1 orcid.org/0000-0003-3647-8113 2 Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 3 Selwyn College, Cambridge University, Cambridge, United Kingdom Editor-in-Chief, Pediatric Critical Care Medicine

Effect of anticoagulants on plasma concentration of macrophage migration inhibitory factor: A pilot study

International Journal of Laboratory HematologyVolume 44, Issue 5 p. e236-e238 LETTER TO THE EDITOR Effect of anticoagulants on plasma concentration of macrophage migration inhibitory factor: A pilot study Huiyuan Zhu, Corresponding Author Huiyuan Zhu huiyuan1[email protected] orcid.org/0000-0002-0634-8687 Department of Pulmonary and Critical Care Medicine, Zhengzhou Second People's Hospital, Zhengzhou Affiliated Hospital of Jinan University, Zhengzhou, China Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China Correspondence Huiyuan Zhu, Department of Pulmonary and Critical Care Medicine, Zhengzhou Second People's Hospital, Zhengzhou Affiliated Hospital of Jinan University, Zhengzhou 450006, China. Email: [email protected] Aiguo Xu, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China. Email: [email protected]Search for more papers by this authorShaochun Yan, Shaochun Yan Department of Cell Biology, School of Basic and Forensic Medicine, Baotou Medical College, Baotou, ChinaSearch for more papers by this authorJingshuo Wu, Jingshuo Wu Department of Pulmonary and Critical Care Medicine, Zhengzhou Second People's Hospital, Zhengzhou Affiliated Hospital of Jinan University, Zhengzhou, ChinaSearch for more papers by this authorZhong Zhang, Zhong Zhang Department of Pulmonary and Critical Care Medicine, Zhengzhou Second People's Hospital, Zhengzhou Affiliated Hospital of Jinan University, Zhengzhou, ChinaSearch for more papers by this authorAiguo Xu, Corresponding Author Aiguo Xu [email protected] Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China Correspondence Huiyuan Zhu, Department of Pulmonary and Critical Care Medicine, Zhengzhou Second People's Hospital, Zhengzhou Affiliated Hospital of Jinan University, Zhengzhou 450006, China. Email: [email protected] Aiguo Xu, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China. Email: [email protected]Search for more papers by this author Huiyuan Zhu, Corresponding Author Huiyuan Zhu [email protected] orcid.org/0000-0002-0634-8687 Department of Pulmonary and Critical Care Medicine, Zhengzhou Second People's Hospital, Zhengzhou Affiliated Hospital of Jinan University, Zhengzhou, China Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China Correspondence Huiyuan Zhu, Department of Pulmonary and Critical Care Medicine, Zhengzhou Second People's Hospital, Zhengzhou Affiliated Hospital of Jinan University, Zhengzhou 450006, China. Email: [email protected] Aiguo Xu, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China. Email: [email protected]Search for more papers by this authorShaochun Yan, Shaochun Yan Department of Cell Biology, School of Basic and Forensic Medicine, Baotou Medical College, Baotou, ChinaSearch for more papers by this authorJingshuo Wu, Jingshuo Wu Department of Pulmonary and Critical Care Medicine, Zhengzhou Second People's Hospital, Zhengzhou Affiliated Hospital of Jinan University, Zhengzhou, ChinaSearch for more papers by this authorZhong Zhang, Zhong Zhang Department of Pulmonary and Critical Care Medicine, Zhengzhou Second People's Hospital, Zhengzhou Affiliated Hospital of Jinan University, Zhengzhou, ChinaSearch for more papers by this authorAiguo Xu, Corresponding Author Aiguo Xu [email protected] Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China Correspondence Huiyuan Zhu, Department of Pulmonary and Critical Care Medicine, Zhengzhou Second People's Hospital, Zhengzhou Affiliated Hospital of Jinan University, Zhengzhou 450006, China. Email: [email protected] Aiguo Xu, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China. Email: [email protected]Search for more papers by this author First published: 08 June 2022 https://doi.org/10.1111/ijlh.13905 Huiyuan Zhu and Shaochun Yan contributed equally to this work. Funding information: Henan Province Medical Science and Technology Research Project, Grant/Award Number: 2018020737 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume44, Issue5October 2022Pages e236-e238 RelatedInformation

Clinical characteristics and risk factors of early septic patients complicated with bloodstream infection

To analyze the clinical characteristics, risk factors and prognosis of early septic patients with bloodstream infection (BSI) in department of critical care medicine of Ningxia Medical University General Hospital. Patients with sepsis admitted to department of critical care medicine of Ningxia Medical University General Hospital from November 1, 2019 to August 31, 2021 were included in a prospective observational study. Blood samples were collected for culture within 24 hours of sepsis diagnosis. General information, laboratory test indicators and blood culture results within 24 hours of sepsis diagnosis were recorded. Patients were followed up and prognostic indicators [mechanical ventilation time, length of intensive care unit (ICU) stay, and 28-day survival] were observed. According to blood culture results, patients were divided into BSI group and non-BSI group. Univariate and multivariate Logistic regression analysis were performed on the general clinical characteristics of patients in the two groups to screen the risk factors of early BSI in septic patients. Receiver operator characteristic curve (ROC) was drawn to evaluate the predictive value of risk factors for early BSI in septic patients. A total of 202 septic patients were included in this study, with 62 patients in BSI group and 140 patients in non-BSI group. The majority of patients in the BSI group were associated with abdominal infection (61.3%), and the majority of patients in the non-BSI group were associated with pulmonary infection (49.3%). A total of 76 strains were isolated from septic patients in BSI group, and the most common pathogens were Escherichia coli (26 strains, 34.2%), Klebsiella pneumoniae (11 strains, 14.4%), Enterococcus (7 strains, 9.2%), Bacteroides fragilis (6 strains, 7.9%) and Staphylococcus aureus (6 strains, 7.9%). There were no significant differences in mechanical ventilation time, the length of ICU stay and 28-day mortality between the BSI group and the non-BSI group. The difference of variables was statistically significant between two group according to Univariate analysis, which included body temperature, acute physiology and chronic health score II (APACHE II), use of antibiotics before admission to ICU, abdominal infection, hypersensitivity C-reactive protein (hs-CRP), serum creatinine (SCr), total bilirubin (TBil), platelet count (PLT), blood lactic acid (Lac) and hypercalcitonin (PCT). Multivariate analysis showed that low PLT [odds ratio (OR) = 1.004, P = 0.019], high Lac (OR = 1.314, P = 0.002), high body temperature (OR = 1.482, P = 0.027), concomitant abdominal infection (OR = 2.354, P = 0.040), no use of antibiotics before admission to ICU (OR = 2.260, P = 0.049) were independent risk factors for early BSI in septic patients. The area under ROC curve (AUC) of PLT, Lac, body temperature, abdominal infection and no use of antibiotics before admission to ICU for predicting early BSI in septic patients were 0.711, 0.686, 0.594, 0.592 and 0.590, respectively. Youden index was used to calculate the optimal cut-off values, which was PLT 122.50×109/L, Lac 2.95 mmol/L, body temperature 39.45 centigrade, respectively. The highest level of AUC was 0.754, the PI guidance group was expected to achieve PI the sensitivity was 75.8%, and the specificity was 68.8%, which were observed when the 5 items were combined. Early septic patients with BSI are more serious than those without BSI. Low PLT, high Lac, high temperature, concomitant abdominal infection and no use of antibiotics before admission to ICU are independent risk factors for early BSI in septic patients, and the combination of these five factors has good predictive value.

Prognostic value of PCSK9 and blood lipid in patients with sepsis

To investigate the prognostic value of proprotein convertase subtilisin/kexin type 9 (PCSK9) and blood lipid indexes in patients with sepsis. Patients with sepsis or septic shock who were ≥ 18 years old and met the Sepsis-3.0 diagnostic criteria admitted to the department of critical care medicine of Binzhou Medical University Hospital from January to October 2021 were enrolled. Healthy adults at the same period were selected as healthy control group. Baseline characteristics, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) score were recorded. Venous blood samples were collected within 24 hours after diagnosis, and serum PCSK9 was determined by enzyme-linked immunosorbent assay (ELISA) at 1, 3 days and 5 days. Meanwhile, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG) and lipoprotein A were detected. The differences of each index between sepsis group (28-day death group and survival group) and healthy control group were compared. Meanwhile, the indexes of patients with different severity and 28-day prognosis in sepsis group were compared. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of PCSK9 and blood lipid for the prognosis of sepsis. Multivariate Logistic regression was used to analyze the influencing factors for the prognosis of sepsis, and the Kaplan-Meier survival curve at 28th day was drawn. There were 50 patients in sepsis group (including 19 patients with sepsis, 31 patients with septic shock) and 27 patients in healthy control group. In the sepsis group, 19 patients died and 31 patients survived within 28 days. The serum PCSK9 in the sepsis group was significantly higher than that in the healthy control group [μg/L: 223.09 (198.47, 250.82) vs. 188.00 (165.27, 214.90), P < 0.01], and HDL-C, LDL-C, TC and lipoprotein A were significantly lower than those in the healthy control group [HDL-C (mmol/L): 0.82±0.35 vs. 1.45±0.24, LDL-C (mmol/L): 1.53 (1.14, 2.47) vs. 2.89 (2.55, 3.19), TC (mmol/L): 2.03 (1.39, 2.84) vs. 4.24 (3.90, 4.71), lipoprotein A (g/L): 8.80 (5.66, 17.56) vs. 27.03 (14.79, 27.03), all P < 0.01]. PCSK9 in the sepsis death group was higher than that in the survival group [μg/L: 249.58 (214.90, 315.77) vs. 207.01 (181.50, 244.95), P < 0.01], and the HDL-C, LDL-C and TC were lower than those in the survival group [HDL-C (mmol/L): 0.64±0.35 vs. 0.93±0.30, LDL-C (mmol/L): 1.32±0.64 vs. 2.08±0.94, TC (mmol/L): 1.39 (1.01, 2.23) vs. 2.69 (1.72, 3.81), all P < 0.01]. With the progression of the disease, the PCSK9 in the sepsis death group and the survival group was significantly lower than that within 1 day of diagnosis (all P < 0.05). ROC curve analysis showed that PCSK9 had higher predictive value of 28-day death than HDL-C, LDL-C, TC [area under ROC curve (AUC) and 95% confidence interval (95%CI): 0.748 (0.611-0.885) vs. 0.710 (0.552-0.868), 0.721 (0.575-0.867), 0.702 (0.550-0.854)]. Multivariate Logistic regression analysis showed that PCSK9 was an independent risk factor affecting the 28-day prognosis of sepsis (β value was 1.014, P = 0.020). Kaplan-Meier survival curve analysis showed that when PCSK9 ≥ 208.97 μg/L, with the increase of PCSK9, the 28-day survival rate of sepsis patients decreased significantly. PCSK9, HDL-C, LDL-C and TC can all predict the 28-day prognosis of patients with sepsis. The prognostic value of PCSK9 is the highest. PCSK9 is an independent risk factor affecting the prognosis of sepsis. In the early stage of the disease, PCSK9 may have a good predictive value for the prognosis of sepsis. When PCSK9 ≥ 208.97 μg/L, the 28-day survival rate decreased significantly.

Clinical study of fluid resuscitation guided by peripheral perfusion index in patients with septic shock

To explore the guiding effect of peripheral perfusion index (PI) on fluid resuscitation in patients with septic shock. Sixty-five patients with septic shock who were diagnosed according to relevant criteria of septic shock and admitted to the department of critical care medicine of the Affiliated Hospital of Hangzhou Normal University from September 2017 to December 2020 were included. Patients were divided into the conventional treatment group (30 cases) and PI guidance group (35 cases) by random number method. Both groups of patients were treated with the bundle according to clinical guidelines. Sputum, urine and blood were collected for pathogenic microorganism culture before the application of antibiotics, and vasoactive drugs were given. Both groups need to achieve all the following resuscitation goals within 6 hours: urine output > 0.5 mL×kg-1×h-1, mean arterial pressure (MAP) ≥ 65 mmHg (1 mmHg ≈ 0.133 kPa), central venous pressure (CVP) was 8-12 mmHg, and central venous oxygen saturation (ScvO2) ≥ 0.70. There was no further resuscitation in the conventional treatment group after the goals were achieved. In addition to these four goals, the PI guidance group was expected to achieve PI ≥ 1.4. Heart rate (HR), CVP, MAP, ScvO2, blood lactic acid (Lac), the time of fluid negative balance, intensive care unit (ICU) mortality and 28-day mortality between the two groups were compared before and after 6 hours of fluid resuscitation. Before fluid resuscitation, there were no statistically significant differences in all indicators between two groups. After 6 hours fluid resuscitation, the four treatment goals in PI guidance group were slightly lower than those of the conventional treatment group [HR (times/min): 96.5±12.1 vs. 97.7±7.9, MAP (mmHg): 83.2±6.2 vs. 82.1±7.5, ScvO2: 0.661±0.077 vs. 0.649±0.051, CVP (mmHg): 10.8±2.7 vs. 10.4±2.1], there were no statistically significant differences between the two groups (all P > 0.05); the Lac level of the PI guidance group after resuscitation was lower than that of the conventional treatment group, and the difference was statistically significant (mmol/L: 4.8±1.3 vs. 5.9±1.4, P < 0.05); the duration of fluid negative balance in the PI guidance group was earlier than that in the conventional treatment group [days: 3.0 (2.0, 3.0) vs. 3.5 (3.0, 4.0), P < 0.05]. The ICU mortality and 28-day mortality in the PI guidance group were lower than those in the conventional treatment group [ICU mortality rate: 37.1% (13/35) vs. 50.0% (15/30), 28-day mortality rate: 57.1% (20/35) vs. 60.0% (18/30)], but the differences were not statistically significant (both P > 0.05). The peripheral PI can be used as an important indicator of fluid resuscitation in patients with septic shock. PI guiding fluid resuscitation in patients with septic shock can reduce Lac levels, shorten the duration of fluid negative balance and reduce the risk of fluid overload.

Analysis of influencing factors of community-acquired pneumonia with deep venous thrombosis in elderly communities

Community-acquired pneumonia (CAP) is one of the common infectious diseases that threaten human health, venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE), is a global health care problem. Acute infection and age ≥70 years are important risk factors for VTE in internal medicine inpatients. There is increasing evidence that acute infectious diseases caused by bacterial and viral infections can induce coagulation, platelet (PLT) activation and inhibit the activity of anticoagulant factors. However, there is no consensus on whether patients with CAP suffer from DVT. Finding out the clinical characteristics and risk factors of DVT in elderly patients with CAP is helpful for early identification of high-risk patients with VTE and timely prevention, which can significantly reduce the occurrence of VTE in hospitals. Data was collected from 505 patients with CAP aged ≥70 years old hospitalized in the Department of Respiratory and Critical Care Medicine. 133 patients with DVT were selected as the DVT group. DVT score and risk grading were performed for all patients using Padua. Fifty-seven cases were diagnosed as having severe pneumonia, including 50 cases diagnosed as having septic shock. Padua, D-dimer, between the DVT group and the control group, the severe pneumonia group and the non-severe pneumonia group, and the severe pneumonia DVT group and the control group were compared. (I) The incidence of DVT with severe pneumonia was much higher than with non-severe pneumonia (P<0.001). The incidence of DVT in patients with septic shock and non-septic shock was 74.0% (37/50) and 28.6% (2/7) respectively (P=0.0154). (II) There were significant differences in Padua scores between the DVT group and the control group and between the severe pneumonia group and non-severe pneumonia group (P<0.001). (III) There were significant differences in D-dimer level between the DVT group and the control group and between the severe pneumonia group and the non-severe pneumonia group (P<0.001). (IV) Regression analysis indicated the central venous catheter (CVC), D-dimer value, and Padua score were significantly correlated with thrombosis (P=0.042, <0.001, 0.043). Severe pneumonia in elderly patients and septic shock may be complicated by DVT, and central venous catheterization and D-dimer are closely related to thrombosis.

Risk factors and prognosis in critical patients with sepsis-related cardiomyopathy

Objective: To explore the risk factors and prognosis of sepsis-related cardiomyopathy. Methods: Patients with sepsis and septic shock admitted to the Critical Care Medicine Department at Peking Union Medical College Hospital from October 2017 to February 2021 were enrolled. Echocardiographic parameters including left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and cardiac index (CI) were obtained within 24 h after admission. Hemodynamic parameters including heart rate, mean arterial pressure and central venous pressure were also collected. The risk factors of 45-day mortality were analyzed using Cox regression analysis. Kaplan-Meier survival analysis was performed to compare 45-day mortality among patients with normal left ventricle (LV) systolic function group, sepsis-related takotsubo cardiomyopathy (ST) and septic cardiomyopathy (SC) group as well as between patients with normal right ventricular (RV) function and patients with RV dysfunction. Results: According to LV systolic function, patients were categorized into three groups: normal group [174 (66.9%)], SC group [66 (25.4%)] and ST group [66 (25.4%)]. In comparison with those in normal group, patients in SC group and ST group had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score (P<0.05). No difference was found between SC group and ST group regarding APACHE Ⅱ score and SOFA score(P>0.05). ST group had lower LVEF [33(28, 41)% vs. 45(38, 48)%, P<0.05], CI [2.29 (1.99, 2.53)L·min-1·m-2 vs. 3.04(2.61, 3.61) L·min-1·m-2, P<0.05] higher TAPSE [18.6(16.0, 21.2)mm vs. 15.1(12.5, 19.0)mm, P<0.05] than SC group. A Cox regression survival analysis showed that right ventricular dysfunction (RVD) was an independent predictor of 45-day mortality (HR=1.992, 95%CI 1.088-3.647, P=0.025). A Kaplan-Meier analysis revealed no significant difference regarding 45-day mortality among ST group [25.0%(5/20)], SC group [30.3%(20/66)] and normal group 18.4%(32/174)(P=0.158). RVD patients [38.0%(30/79)] had significantly higher 45-day mortality than patients with normal RV function [14.9%(27/181),P<0.001]. Conclusions: In comparison with SC patients, ST patients tend to have worse LV systolic function, lower cardiac output and better RV function. However, neither ST nor SC is associated with 45-day mortality. RVD is a risk predictor of 45-day mortality, which should be monitored in septic patients.

Septic shock with Chlamydia abortus infection

A 65-year-old man presented with an acute onset of fever (39·8°C), dizziness, and headache without evident predisposition. A CT scan showed left upper lobe pneumonia and he received imipenem–cilastatin (2 g every 8 h), but his symptoms did not improve. However, on day 3 of admission, he rapidly developed refractory hypoxaemia, respiratory failure, and septic shock. He then presented to the Department of Critical Care Medicine at Guangdong Provincial People's Hospital (Guangzhou, China). The severity of hypoxia and multiple organ dysfunction syndrome did not match the pulmonary imaging changes from day 4 to day 9 (figure).