Incidence Of MODS Research Articles

A new sight to acute pancreatitis through paracolic gutter exudation, a multicenter retrospective study

ObjectivesParacolic gutter exudation (PGE) may influence the severity of acute pancreatitis, but no study has explored it extensively. The objective of this study was to evaluate PGE for assessing the severity of disease. MethodsWe performed a retrospective analysis of 488 patients from three tertiary hospitals in Guangxi, China. General clinical information, severity, and clinical courses were recorded. The PGE score were classified as follows: 0 for no exudation, 1 for unilateral exudation, and 2 for bilateral exudation. We used ROC curves to assess the predictive value of the PGE score, and logistic regression analysis to determine risk factors associated with death, ICU admission, and the occurrence of MODS. ResultsThis study included 352 patients with moderately severe acute pancreatitis (MSAP) and 136 patients with severe acute pancreatitis (SAP). Patients who had PGE experienced higher total hospitalization costs, longer hospital stays, a higher incidence of SAP, higher mortality rates, higher ICU admission rates, a higher incidence of MODS, and higher incidence of infections than those without (P < 0.05). Diagnostic efficacy in predicting severity in patients with MSAP and SAP increased after BISAP, MCTSI, modified Marshall, and SOFA scores combined with PGE score respectively. The PGE score of >1 is an independent risk factor for ICU admission and MODS occurrence. (P < 0.05). ConclusionThe PGE provides reliable and objective information for assessing severity and clinical course of patients with MSAP and SAP.

Transcranial Doppler Ultrasound for Monitoring the Cerebral Hemodynamic Changes and Prognosticating Outcomes in Venoarterial Extracorporeal Membrane-Oxygenated Patients.

Objective Patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) support may have cerebral hemodynamic changes whose impact on patient outcome are not fully elucidated. This study aims to evaluate the correlation between cerebral hemodynamic changes and prognostic outcome in patients during VA-ECMO. Methods Transcranial Doppler (TCD) ultrasound examination was performed to attain the systolic velocity (Vs), diastolic velocity (Vd), mean velocity (Vm), and pulsatility index (PI) of patients undergoing VA-ECMO. Cardiac ultrasound was also performed to assess the correlation between the left ventricular outflow tract velocity time integral (LVOT VTI), left ventricular ejection fraction (LVEF), and middle cerebral artery (MCA) with the systolic peak. Moreover, we assessed the predictive value of LVOT VTI and LVEF in patients with the systolic peak. Patients were divided into survival and death groups according to the 28-day survival period. Clinical data were compared between the two groups to investigate the effects of cerebral hemodynamic changes on the prognosis of VA-ECMO patients. Results We found that the patient's LVOT VTI and LVEF had high predictive values for the systolic peak of the right middle cerebral artery. The initial LVEF, Vs, Vd and PI, and lactate level as well as the MODS incidence rate difference were significantly different between the survival and death groups. In addition, the results showed that the initial Vs value was an independent risk factor for the prognosis of patients undergoing VA-ECMO. Conclusions Cerebral hemodynamic changes may occur in patients supported by VA-ECMO. In addition, a poor cerebral arterial pulsatile blood flow was closely correlated with an unfavorable outcome in these patients.

Prediction of mortality on seventh day with PELOD scoring on day-0 and day-2 in children with multi organ dysfunction syndrome in a tertiary care PICU

Background: In a PICU set up the reported incidence of MODS is 11-56% and the Odds of death in children with MODS 11.3. In a resource limited setting, mortality prediction becomes important within the first 3 days of PICU stay for financial burden plays a big role in these decisions. The PELOD score has been validated as an outcome measure when recorded daily. In this study, validation of the PELOD score on just 2 days i.e. at baseline (day 0) and after 48hrs (day 2) and the difference between the two was studied to predict short term mortality as an outcome by the end of 7 days. Aim: Prediction of mortality on seventh day with PELOD scoring on Day-0 and Day-2 in children with Multi Organ Dysfunction Syndrome in a tertiary care PICU. Materials &amp; Methods: A prospective longitudinal observational cohort study was carried out in a 20 bedded Indian PICU. Inclusion criteria included children age 1 month to 12 years, the presence of MODS and a PICU stay &gt; 24 hrs. Once an inclusion criterion is met data was collected from the patients in PICU &amp; entered in EXCEL 2013 for calculation of PELOD &amp; PRSIM.

Multiple Organ Dysfunction in Older Major Trauma Critical Care Patients

Severely injured older people present an increasing challenge for trauma systems. Recovery for those who require critical care may be complicated by MODS. In older trauma patients, MODS may not be predictable based on chronological age alone and factors associated with its development and resolution are unclear. Consecutive adult patients (aged ≥16 years) admitted to 4 level 1 major trauma center critical care units were enrolled and reviewed daily until discharge or death. MODS was defined by a daily total sequential organ failure assessment score of >5. One thousand three hundred sixteen patients were enrolled over 18 months and one-third (434) were aged ≥65 years. Incidence of MODS was high for both age groups (<65 years: 64%, ≥65 years: 70%). There were few differences in severity, patterns, and duration of MODS between cohorts, except for older traumatic brain injury (TBI) patients who experienced a prolonged course of MODS recovery (TBI: 9 days vs no TBI: 5 days, P < 0.01). Frailty rather than chronological age had a strong association with MODS development (odds ratio [OR], 6.9; 95% confidence intervals [CI], 3.0-12.4; P < 0.001) and MODS mortality (OR, 2.1; 95% CI, 1.31-3.38; P = 0.02). Critical care resource utilization was not increased in older patients, but MODS had a substantial impact on mortality (<65 years: 17%; ≥65 years: 28%). The majority of older patients who did not develop MODS survived and had favorable discharge outcomes (home discharge ≥65 years NoMODS: 50% vs MODS: 15%; P < 0.01). Frailty rather than chronological age appears to drive MODS development, recovery, and outcome in older cohorts. Early identification of frailty after trauma may help to predict MODS and plan care in older trauma.

Information sensing application of integrated trauma first aid measurement model under trauma scoring system software in severe multiple injuries

• Provided a fast and effective treatment model. • Integrated trauma first aid model moves the first aid resources forward. • Apply trauma scoring system software to severe multiple injuries. The thesis makes a comparative study on the treatment effect of patients with severe multiple injuries by the traditional specialist treatment measurement model and the integrated trauma first aid measurement model, with a view to providing a theoretical basis for the treatment of clinical multiple injury patients with a fast and effective treatment model. The paper takes the pre- and post-establishment measurement model in our hospital as a dividing point, retrospectively analyses the clinical data of 221 patients with severe multiple injuries, and divides the patients into a control group and a research group. Before the establishment, 129 patients with severe multiple injuries were treated with a specialist treatment model. The study group was 92 cases of patients with severe multiple injuries treated with the integrated trauma emergency mode; Our hospital trauma scoring system software used injury severity score (ISS) for patients with multiple injuries. Observation of in-hospital emergency time, length of stay, mortality, incidence of MODS, and incidence of shock in the two groups. The study found that the incidence of MODS, the incidence of shock, and the mortality of the study group were significantly lower than those of the control group after receiving the respective rescue modes, and the differences between the two groups were statistically significant (P ≤ 0.05). The in-hospital emergency time in the study group was longer than that in the control group, and the difference was statistically significant (P ≤ 0.01). There was no significant difference in the average hospital stay time between the two groups (P > 0.05). Therefore, the integrated trauma first aid model moves the first aid resources forward and implements injury control in the early stage, which can significantly improve the prognosis of patients, reduce mortality, the incidence of MODS and the incidence of shock. It is an efficient and rapid treatment method. The clinical value is worthy of promotion and application.

Clinical characteristics and prognosis in patients with high plasma level of procalcitonin: an analysis in 188 patients

To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin (PCT > 100 μg/L), and to improve the clinician's understanding, diagnosis and treatment of this kind of patients. A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 μg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed. The patients were divided into survival and death groups according to 28-day prognosis. The general data and laboratory parameters including vital signs, 24-hour urine output, routine blood test, blood biochemical tests, coagulation parameters, myocardial enzymes and arterial blood gas analysis were collected. The risk factors of mortality were analyzed using multi-logistic regression analysis. 188 patients with high level of plasma PCT were enrolled. There were 128 male patients (68.1%) with the average age of 62 (49, 75) years. Most patients were admitted in intensive care unit (ICU, 70.7%, 133/188). Major diagnosis was sepsis (91.0%), followed by multiple organ dysfunction syndrome (MODS, 57.4%), post large operation of thorax and abdomen (20.7%), trauma/burns (13.8%) and post-cardiopulmonary resuscitation (CPR, 6.4%). Of all the 188 patients, 115 patients survived and 73 died with a mortality of 38.8%. The parameters in the death group, including the percentages of MODS (84.9% vs. 40.0%), trauma/burns (26.0% vs. 6.1%), post-CPR (13.7% vs. 1.7%), ventilator support (82.2% vs. 40.9%) and shock (100.0% vs. 60.0%), the numbers of principal diagnosis [2.0 (2.0, 3.0) vs. 2.0 (1.0, 2.0)], acute physiology and chronic health evaluation II score [APACHE II score: 24 (19, 28) vs. 14 (10, 16)] and sequential organ failure assessment (SOFA) score [16.0 (12.5, 18.0) vs. 9.0 (6.0, 12.0)], as well as liver function, coagulation parameters, myocardial enzymes and lactic acid (Lac) levels were significantly higher than those in the survival group, but the platelet (PLT) count in the death group was significantly lower than that in the survival group [×109/L: 62.00 (21.50, 111.00) vs. 93.00 (53.00, 136.00), all P < 0.05]. The parameters with statistical significance in the univariate analysis were enrolled in the multiple factor logistic regression analysis, which showed that patient with a high score of APACHE II [odds ratio (OR) = 1.290, 95% confidence interval (95%CI) = 1.121-1.484, P = 0.000] or the occurrence of MODS (OR = 7.264, 95%CI = 1.762-29.941, P = 0.006) at admission had a poor prognosis. The primary patients with high levels of plasma PCT (> 100 μg/L) were diagnosed with sepsis, MODS, trauma and post-CPR, complicated with respiratory and circulatory insufficiency. These factors of trauma, MODS and cardiac arrest, and some laboratory parameters including PLT, Lac, liver function, coagulation spectrum, and cardiac enzymes were correlated with the prognosis of the patients with high levels of plasma PCT. High APACHE II score and the incidence of MODS might be independent predictors of poor prognosis in the patients with high levels of plasma PCT.

Changes levels of serum interleukin 6, tumor necrosis factor α and procalcitonin and prognosis of patients with septic shock with the treatment of combination of ulinastatin and Atomolan

Objective To investigate the changes levels of serum interleukin 6(IL-6), tumor necrosis factor α(TNF-α) and procalcitonin(PCT) and prognosis of patients with septic shock with the treatmentof ulinastatin and Atomolan. Methods Sixty cases patients with septic shock in Fifth Hospital Affiliated to Guangzhou Medical University from May 2015 to April 2016 were selected, and divided into ulinastatin group, Atomolan group and combined group according to the table of random numbers, each group with 20 cases.Hospital stay in ICU, mechanical ventilation time, APACHEⅡ score after treatment, the level of IL-6, TNF-α, PCT, malondialdehyde(MDA), superoxide dismutase(SOD) before and after treatment, and prognosis of patients of three groups were compared. Results Hospital stay in ICU, mechanical ventilation time, APACHEⅡ score after treatment of combined group were significantly lower than ulinastatin group and Atomolan group, the differences were statistically significant(P 0.05). After treatment, the level of IL-6, TNF-α, PCT and MDA of the combined group were significantly lower than that of ulinastatin group and Atomolan group, while SOD was significantly higher than the other two groups, the differences were statistically significant(P<0.05). The MODS incidence, mortality rates of ulinastatin group were 30.00%(6/20), 20.00%(4/20), of Atomolan group were 35.00%(7/20), 15.00%(3/20), of combined group were 5.00%(1/20), 5.00%(1/20). The MODS incidence, mortality rates of combined group were lower than the other two groups(P<0.05). Conclusion Ulinastatin combined with Atomolan in treatment of septic shock with remarkable results, can significantly improve the serum IL-6, TNF-α, PCT and other important factors, optimize the prognosis, it is worthy of promotion. Key words: Ulinastatin; Atomolan; Septic shock; Interleukin -6; Tumor necrosis factor α; Procalcitonin; Prognosis

Study in the validity of risk assessment table used for patients with cerebrovascular disease referred from EICU to ward observation room to assess the risk during the transition period

Objective To explore the validity of the potential risk assessment table used for patients with severe cerebrovascular disease referred from EICU to ward observation room under intensive nursing care to assess the risk during the transition period. Methods There were two groups of patients with severe cerebrovascular disease referred to ward observation room from EICU (n= 200 in each). The patients of first group admitted from January 2015 to June 2015 as a control group, and the patients of second group were admitted from July 2015 to December 2015 as a assessment group. The potential risk assessment table was developed by the Nurse Department in July 2015 based on three kinds of risky morbidity to be susceptible to in those patients and the specific nursing strategy was worked out to deal with these kinds of morbidity. Results Compare with control group, the success rate of resuscitation and patients' satisfaction were significantly higher in assessment group. The unexpected extubation, aspiration, lung infections, respiratory failure, the incidence of MODS, stress ulcer incidence in assessment group were lower than those in control group (P <0.01). Conclusions The risk assessment table is practicable and useful for patients with severe cerebrovascular disease referred from EICU to ward observation room under intensive nursing care in respects of early detection of patients condition deteriorated, saving the golden time for resuscitation, avoidance of morbidity, guarantee of nursing safety, improving the quality of nursing care and the degree of patients' satisfaction. Key words: The risk assessment table; Emergency room under observation; Cerebrovascular disease; Transitional care

The discussion of risk factors of severe head injury with multiple organ dysfunction syndrome

Objective To investigate the discussion of risk factors of severe head injury with multiple organ dysfunction syndrome. Methods The clinical data of 149 cases with severe traumatic brain injury patients were retrospectively analyzed, and the risk factors in patients with severe traumatic brain injury were collected, which may affect MODS, such as gender, age, GCS score,associated injuries, chronic underlying diseases, infections and other details, statistically analyzed were combined with incidence of MODS. Results (1)Univariate analysis results could be seen, age, chronic underlying diseases, admission GCS score, extensive brain parenchymal damage, merge large organ damage, brain herniation, concurrent infection, massive blood transfusion were risk factors of MODS severe traumatic brain injury(χ2=12.962,11.725,11.021,13.894,11.486,12.031, 12.967,13.078,P=0.023,0.025,0.027,0.017,0.023,0.018,0.021,0.019).(2)MODS rate and the number of risk factors were positive correlation(r=0.528,P=0.021).(3)With the increase of the number of mortality in patients with MODS organ dysfunction occurred significantly increased,MODS patients in this group,the two organs mortality was 17.4%,the three organs were 46.7%,four or more mortality was 87.5%(χ2=11.735,13.933,12.748,P=0.028,0.019,0.025). Conclusion Age, chronic underlying diseases, GCS low, extensive parenchymal injury, combined injury, the occurrence of hernia, complicated by infection, massive blood transfusion were independent risk factors for brain injury,which should be payed attention. Key words: Craniocerebral trauma; Multiple organ failure; Risk factors

The effect of anticoagulant therapy on coagulation and inflammation markers in sepsis patients and its significance

To study the effect of anticoagulant therapy with low molecular weight heparin (LMWH) on coagulation and inflammation markers in sepsis patients. A prospective randomized controlled trial ( RCT ) was conducted. Eighty-seven patients suffering from septic shock undergoing mechanical ventilation in Department of Critical Care Medicine of Subei People's Hospital from June 2012 to September 2014 were enrolled. The hemodynamic changes before and after PLR were monitored by pulse indicated continuous cardiac output ( PiCCO ) and PVI monitoring. Responsive group: positive fluid response was defined as an increase in cardiac index ( CI )≥10% after PLR. Unresponsive group: negative fluid response was defined as an increase in CI<10% after PLR. The hemodynamic parameters, including heart rate ( HR ), mean arterial pressure ( MAP ), central venous pressure ( CVP ), stroke volume variation ( SVV ), CI and PVI, and the changes in cardiac parameters (ΔHR, ΔMAP, ΔCVP, ΔSVV, ΔCI, and ΔPVI ) before and after PLR were determined. The relations between hemodynamic parameters and their changes with ΔCI were analyzed by the Pearson analysis. The role of the parameters for volume responsiveness prediction was evaluated by receiver operating characteristic ( ROC ) curves. There were no significant differences in values of all parameters, including CD62p, D-dimmer, IL-6, TNF-α, and APACHE II score at 1 day of treatment. The values of all parameters in observation group were gradually decreased. CD62p at 3 days of treatment and D-dimmer, IL-6, TNF-α, and APACHE II score at 5 days of treatment were significantly lower than those at 1 day of treatment. The values in the control group were decreased at first and then increased, as D-dimmer, IL-6 and TNF-α were significantly higher on the 5th day than those at 1 day of treatment. Compared with control group, CD62p, D-dimmer, IL-6, TNF-α and APACHE II score on the 7th day of treatment were significantly lowered in observation group [CD62 (μg/L): 22.64±2.88 vs. 31.52±2.81, D-dimmer (g/L): 1.32±0.46 vs. 4.79±0.82, IL-6 (ng/L): 5.84±1.87 vs. 49.64±3.12, TNF-α (ng/L): 21.04±3.15 vs. 130.58±6.26, APACHE II score: 9.71±2.02 vs. 14.17±2.38, all P < 0.05]. Correlation analysis showed that in observation group, CD62p, D-dimmer, IL-6, and TNF-α were positively correlated with APACHE II score (r value was 0.907, 0.868, 0.880, 0.693, respectively, all P=0.000). The incidence of MODS in observation group was significantly lower than that in the control group [26.7% (8/30) vs. 46.7% (14/30), χ (2)=3.943, P = 0.028]. LMWH, which was given early in sepsis, can significantly down-regulate the expression of CD62p, D-dimmer, IL-6 and TNF-α, and reduce the incidence of MODS. Some indicators regarding coagulation and inflammation can be used as supplementary indicators to severity scores, and it may be able to improve the accuracy of scoring systems for sepsis.

Effects of early oral administration of mixed enteral nutritional agent on intestinal mucosal barrier of patients with severe burn injury

To explore the effects of oral administration of mixed enteral nutritional agent on intestinal mucosal barrier of patients with severe burn injury at early stage. Twenty-four patients with severe burn injury admitted to our burn ward from August 2013 to September 2014, conforming to the study criteria, were divided into conventional therapy group (n = 12) and early enteral feeding group (n = 12) according to the random number table. Patients in conventional therapy group received conventional treatment immediately after admission, while those in early enteral feeding group were orally given 100 mL of a mixture of glutamine, probiotics, and prebiotics once a day besides conventional treatment for 7 days. Serum levels of diamine oxidase (DAO) and procalcitonin (PCT) and plasma level of LPS were determined by ELISA before treatment and on treatment day (TD) 1, 3, 7, 14, and 21. Wound secretion and blood samples were collected for bacterial culture within the 21 TD. The incidence of MODS within the 21 TD was observed. Data were processed with Fisher's exact test, rank sum test, analysis of variance for repeated measurement, and LSD-t test. (1) Serum levels of DAO in patients of early enteral feeding group on TD 7, 14, and 21 were respectively (14.9 ± 3.7), (12.4 ± 3.1), and (9.5 ± 0.7) ng/mL, which were significantly lower than those of conventional therapy group [(17.5 ± 4.0), (16.3 ± 3.3), and (13.0 ± 1.1) ng/mL, with t values from 2.913 to 15.304, P values below 0.01]. Serum levels of DAO at the other time points were close between the two groups (with t values from -0.598 to 0.139, P values above 0.05). (2) Compared with serum levels of PCT in patients of conventional therapy group [(11.7 ± 20.9) and (12.9 ± 23.9) ng/mL], those of early enteral feeding group were significantly lower on TD 7 and 14 [(2.7 ± 8.1) and (2.0 ± 5.6) ng/mL, with Z values respectively -2.919 and -2.139, P < 0.05 or P < 0.01]. Serum levels of PCT at the other time points were close between the two groups (with Z values from -1.833 to -0.346, P values above 0.05). (3) Plasma level of LPS in patients of early enteral feeding group on TD 7 was (33 ± 56) pg/mL, which was significantly lower than that of conventional therapy group [(102 ± 108) pg/mL, Z = -2.046, P < 0.05]. Plasma levels of LPS at the other time points between the two groups showed no significant difference (with Z values from -2.003~-0.526, P values above 0.05). (4) Positive results in bacterial culture of wound secretion were approximately the same between the two groups (P > 0.05). Bacterial culture of blood was positive in 7 patients of conventional therapy group and 1 patient of early enteral feeding group, showing significantly statistical difference (P < 0.05). MODS was observed in 1 patient of conventional therapy group, showing no significantly statistical difference with that of early enteral feeding group (no patient, P > 0.05). Early intestinal feeding of mixed enteral nutritional agent in addition to conventional therapy can effectively promote repair of the impairment of intestinal mucosal barrier, protect integrity of intestinal mucosa, reduce damage to intestines, and alleviate inflammatory response in patients suffering from severe burn injury.

Analysis of the effect and safety of atorvastatin in the treatment of septic shock

Objective To explore the clinical efficacy and safety of atorvastatin in the treatment of patients with septic shock.Methods 67 patients with septic shock were randomly divided into the treatment group （34 cases） and control group（33 cases）.The control group was treated with conventional therapy ,and the observation group was administered with atorvastatin based on the control group .Before and after treatment ,the inflammatory index ,cytokines levels,the number of MODS cases,the number of deaths at 28th day,and the incidence of adverse reactions were com-pared between the two groups .Results The heart rate ,respiratory rate ,white blood cell count of the treatment group were significantly better than the control group ,the cytokines levels were significantly lower than the control group ,the differences were statistically significant （t=4.181,3.622,4.879,all P〈0.05）.The incidence rate of MODS of treat-ment group was significantly lower than that of the control group （χ2 =7.153,P〈0.05）.The average hospital stay of the treatment group was （9.3 ±3.1）d,which was significantly less than （12.4 ±3.3）d of the control group（t=3.964,P〈0.05）.The incidence rate of adverse reaction in the treatment group was significantly lower than that of the control group（χ2 =4.566,P〈0.05）.The 28 d mortality rate of the two groups had no significant difference （χ2 =3.345,P〉0.05）.Conclusion Atorvastatin can effectively reduce the degree of inflammatory reaction in patients with septic shock ,decrease the incidence of MODS , and has potential benefits on the prognosis of patients , but still need to be further confirmed by clinical research . Key words: Shock; Infection; Atorvastatin

Interleukin-6 as inflammatory marker referring to multiple organ dysfunction syndrome in severely injured children

BackgroundDespite the suggestion that the inflammatory response in traumatized children is functionally unique, prognostic markers predicting pediatric multiple organ failure are lacking. We intended to verify whether Interleukin-6 (IL-6) displays a pivotal role in pediatric trauma similar to adults.MethodsTraumatized children less than 18 years of age with an Injury Severity Score >9 points and consecutive admission to the hospital’s pediatric intensive care unit were included. Organ function was evaluated according to the score by Marshall et al. while IL-6 levels were measured repetitively every morning.Results59 traumatized children were included (8.4 ± 4.4 years; 57.6% male gender). Incidence of MODS was 11.9%. No differences were found referring to age, gender, injury distribution or overall injury severity between children with and without MODS. Increased IL-6 levels during hospital admission were associated with injury severity (Spearman correlation: r = 0.522, p < 0.001), while an inconsistent association towards the development of MODS was proven at that time point (Spearman correlation: r = 0.180, p = 0.231; Pearson's correlation: r = 0.297, p = 0.045). However, increased IL-6 levels during the first two days were no longer associated with the injury severity but a significant correlation to MODS was measured.ConclusionsThe presented prospective study is the first providing evidence for a correlation of IL-6 levels with injury severity and the incidence of MODS in traumatized children.

Clinical correlative study on high mobility group box 1 protein after traumatic acute lung injury

Objective To study the changes of serum high mobility group box 1 protein ( HMGB-1 ) in patients with traumatic acute lung injury (ALI) and determine its correlations with MODS,acute physiology and chronic health evaluation ( APACHE Ⅱ ) scores and whether it can predict the incidence of MODS and mortality.Methods Forty cases of ALI were divided into MODS group (n =13) and nonMODS group (n =27) according to the MODS evaluation standard.The serum HMGB-1 was determined in the control group ( 10 healthy persons) and the MODS and non-MODS groups at days 1,4 and 7.The MODS and APACHE Ⅱ scores were also evaluated.Results Between the groups,the HMGB-1 level at days 1,4 and 7 in non-MODS group was higher than that in the control group,while lower than that in MODS group (P＜0.05).Within the non-MODS group,the expression of HMGB-1 showed a high level at day 4 compared with that at day 1 ( P ＜0.01 ) ; the HMGB-1 showed a low level at day 7 with clinical symptom improvement compared with that at day 4,and was even lower than that at day 1 ( P ＜ 0.01 ).Within the MODS group,the serum HMGB-1 level was significantly increased,and continued for several days; the HMGB-1 was decreased slightly at day 7 in comparison with that at day 4,but was still higher than that at day 1.The difference of MODS and APACHE Ⅱ score was significant,with the dynamic change of HMGB-1 level at days 1,4 and 7 after traumatic ALI.The correlative analysis showed that HMGB-1 expression level was remarkably related with MODS score and APACHE Ⅱ score.Conclusions HMGB-1 shows a high expression in patients with traumatic ALI.As a late mediator of inflammation,HMGB-1 usually increases relatively late and lasts for a long duration.HMGB-I level and concurrency MODS are closely related.Routine test of serum HMGB-1 level and joint assessment of MODS and APACHE Ⅱ score are contributive to the prediction of organ dysfunction after traumatic ALI. Key words: Respiratory distress syndrome, adult; Multiple organ failure; High mobility group proteins

Cinical observation on early fluid resuscitation in treatment of septic shock

Objective To evaluate the effect of early fluid resuscitation in treatment of septic shock.Methods 56 patients with septic shock in ICU were divided into two groups by the method of the treatment. Early goal-directed therapy were given in the early fluid resuscitation group except anti-infective treatment, and the traditional therapy were given in the traditional group. The CVP,MAP,ScvO2 ,SaO2 of 6h and 12h of intra-treatment were observed in the two groups, and the incidence of MODS and the mortality rate were observed also. Results The CVP,MAP, ScvO2, SaO2 of the early fluid resuscitation group were improved better than that in the traditional group. The incidence of MODS and the mortality rate in the early fluid resuscitation group were lower than that in the traditional group. Conclusion The prognosis of septic shock was better for the early fluid resuscitation, and it could lower the incidence of MODS and the mortality rate. Key words: Shock; Fluid Therapy

Effect of continuous venous-venous hemofiltration on patients with severe acute pancreatitis and nursing

Objective To observe continuous venous-venous hemofiltration (CVVH) for treatments and cares of severe acute pancreatitis(SAP). Methods From August 2004 to August 2006, 15 cases with SAP were in conventional treatment (the control group), from September 2006 to August 2010, 20 cases with SAP were nursed with CVVH(the observation group). We surveyed patients' vital signs (including body temperature, heart rate, breathing and blood pressure),mental symptoms, abdominal signs and monitored liver and kidney functions. Additionally we executed APACHE Ⅱ scores. We analyzed them retrospectively. Results The afore - mentioned indexes of two groups were significant in statistics, the observation group had lower incidence of MODS、MOF than the control group after 10 days caring. Conclusions The CVVH could correct systemic inflammatory reaction of SAP and prevent complications. Standard technical operation and intensive nursing can ensure smooth process of CVVH and decrease complications caused by CVVH. Key words: Severe acute pancreatitis; Continuous venous-venous hemofiltration; Nursing

The influence of different asphyxia time on the reproduction of multiply organ dysfunction model after cardiopulmonary resuscitation following cardiac arrest in rabbit

To explore the effects of different asphyxia time on the reproduction of multiply organ dysfunction syndrome in rabbit after cardiopulmonary resuscitation (CPR-MODS) for cardiac arrest, in order to provide a method to reproduce an animal model of CPR-MODS for further research of cardiopulmonary resuscitation (CPR). The rabbit cardiac arrest was caused by asphyxia as a result of clamping the trachea. Thirty rabbits were divided into 7-minute asphyxia group and 8-minute asphyxia group by means of random number table with 15 rabbits in each group. The rate of resumption of spontaneous circulation (ROSC), the mortality at different time points and the occurrence incidence of systemic inflammatory response syndrome (SIRS) of two groups were observed after CPR and the ROSC. The levels of serum tumor necrosis factor-α (TNF-α), myocardial MB-isoenzyme of creatine kinase (CK-MB), alanine aminotransferase (ALT), creatinine (Cr), glucose (Glu) and arterial partial pressure of oxygen (PaO₂) before resuscitation and 12, 24 and 48 hours after ROSC were measured simultaneously in the two groups. The incidence of CPR-MODS was calculated. The CPR time (seconds) in 7-minute asphyxia group was significantly shorter than that in 8-minute asphyxia group (147.60±22.09 vs. 193.08±23.07, P<0.01). The ROSC rate of 7-minute asphyxia group and 8-minute asphyxia group was 100.00% and 86.67%, respectively, and there was no significant difference. The incidence of MODS in the rabbits surviving more than 24 hours after ROSC was 100% in both groups. The mortality at 6 hours after ROSC in 7-minute asphyxia group was remarkably lower than that of 8-minute asphyxia group (6.67% vs. 46.67%, P<0.05). All the rabbits in 8-minute asphyxia group died at 48 hours. The incidence of SIRS after ROSC was 100% in both groups. Compared with that before asphyxiation, the level of serum TNF-α (ng/L) as well as CK-MB (U/L) increased significantly at 12 hours after ROSC in both groups (TNF-α in 7-minute asphyxia group: 100.71±20.43 vs. 49.13±8.64, in 8-minute asphyxia group: 118.09±21.90 vs. 48.48±6.70; CK-MB in 7-minute asphyxia group: 786.88±211.84 vs. 468.20±149.45, in 8-minute asphyxia group: 894.88±248.80 vs. 462.11±115.15, all P<0.05). There was a significant elevation of ALT (U/L) and Glu (mmol/L) at 24 hours after ROSC (ALT in 7-minute asphyxia group: 174.25±36.28 vs. 50.27±9.37, in 8-minute asphyxia group: 205.50±10.61 vs. 51.13±10.37; Glu in 7-minute asphyxia group: 11.21±1.14 vs. 5.59±1.10, in 8-minute asphyxia group: 11.55±0.35 vs. 6.41±1.23, all P<0.05). Cr (μmol/L) was significantly higher at 12 hours after ROSC in 8-minute asphyxia group (98.83±16.70 vs. 65.93±13.81), while it was elevated at 24 hours in 7-minute asphyxia group (144.25±41.64 vs. 67.71±16.47, both P<0.05). PaO₂ in both groups was significantly higher at 12 hours after ROSC and significantly decreased at 24 hours. The model of cardiac arrest caused by 7 minutes asphyxia provided more possibility and feasibility for the subsequent study of reproducing CPR-MODS model.

Clinical Significance of blood lactic acid dynamic monitoring in the prognosis evaluation of critically ill pediatric

Objective To study the correlation between blood lactic acid level and PCIS scroing system.To study the relationship between dynamic lactic acid monitoring indexes and prognosis of critical patients.Methods Differences of mortality,incidence of MODS and shock,PCIS score between two groups were compared.The patients were divided into 3 groups by PCIS score to compare pathogenetic conditions prognosis, then to study the were divided into death group and survival group by the hospital prognosis. Differences of their lactic indexes and other clinical indicators which reflected organ/system status were compared, prognostic-significant lactic indexes were selected by mu fti-variable logistic analysis. Results Patients with elevated lactic acid level had more incidence of shock and MODS, higher PCIS scores and higher mortality, the differences had statistical significance compared with the normal lactic acid group. There were significant linear correlation between ICU lactic acid level, peak lactic acid level and PCIS scores respectively. For the patients with elevated lactic acid level, peak lactic acid level, 12h lactic clearance had significant correlation with prognosis. Conclusion PCIS scoring system had a significant linear correlation with lactic acid level. For the patients with elevated lactic acid level,peak lactic acid level,12h lactic clearance were good indicators to evaluate patients' prognosis. Key words: Lactate; Monitoring, pediatric; Critical illness; Evaluation studies

1218 Differences in Organ Dysfunctions Between Neonates and Other Children

The PEdiatric Logistic Organ Dysfunction (PELOD) score has been validated as a score to describe and quantify the severity of organ dysfunctions (ODs). Several neonatal pathophysiological and immunological particularities make a rationale for differences in ODs between neonates and other children (non-neonates). Objective: To find out if there are important differences in mortality, OD incidence and OD contribution to mortality between neonates (age< 28 days) and non-neonates, using the PELOD score. Methods: Prospective, observational study in seven PICUs of university-affiliated hospitals (09/98 - 02/2000). No intervention was done. Results: 1806 patients were included, 171 (9.5%) were full-term neonates. Mortality rate and incidence of MODS were higher in neonates than in nonneonates (14.6% vs. 5.5%, p< 10-7; 75.4%, vs.50.9%, p< 10-4 respectively). Daily PELOD (dPELOD) scores were significantly higher in neonates from day 1 to day 4. Daily cardiovascular, respiratory and renal dysfunction scores from day 1 to day 4, and the entire stay dysfunction scores of these three organs were significantly higher in neonates than in non-neonates. The ODs that significantly contributed to mortality in neonates were neurological, cardiovascular, and hepatic dysfunctions. In non-neonates, all ODs significantly contributed to mortality. Conclusion: Our data demonstrate that mortality in neonates was higher as compared with nonneonates. Neurological, cardiovascular, and hepatic dysfunctions were the only significant contributors to neonatal mortality, while other ODs were also associated with mortality in non-neonates. (PELOd group: we thank Jacques Cotting, Ronald Gottesman, Ari Joffe, Bendicht Wagner, Philippe Hubert, Alain Martinot for their contribution in data collection).

Clinical analysis of multiple organ dysfunction syndrome after cardiopulmonary resuscitation

Objective To enhance the cognition on the clinical features of post resuscitation multiple organ dysfunction syndrome (PR-MODS) in patients after cardiac arrest, and provide the basis for integrated control. Method Based on the retrospective analysis, the clinical data of 72 patients with cardiac arrest with restoration of spontaneous circulation (ROSC) in ICU were collected, including happening place of cardiac arrest, the type of rhythm first monitored after cardiac arrest, cause of cardiac arrest, incidence of SIRS and MODS, the position and number of organ dysfunction, success rate of CPR, the rate of survival to hospital discharge and cerebral performance categories(CPC) of discharged patients. Results ①In patients with ROSC after cardiac arrest, male to female ratio was 1.18:1,55 cases was happened in hospital and 17 cases was happened out of hospital,and the ratio was 3.24:1. ②The distribution of cardiac arrest place: ICU,emergency room and operating room were the major places of in-hospital cardiac arrest, adding up to 41 cases and accounting for 74.55% (41/55); the major places of outhospital cardiac arrest were on the way to hospital and in the ambulance, and accounting for 64.71% (11/ 17). ③According to the rhythm first monitored after cardiac arrest, there were 38 cases using shock and 32 cases using non-shock, the ratio was 1.12: 1. Cardiac arrest causes of cardiogenic and on-cardiogenic factors are 37 cases and 35 cases, a ratio of 1.06:1 .④All of the 72 cases, 16 cases died within 24 h, and 56 cases were successfully resuscitated, but 51 cases occurred SIRS after ROSC, 42 cases had combined MODS (42/56,75%), 27 cases(27/42,64.29%)died.The most involving organs in sequence were brain (38 cases, 90.48%), heart (35 cases,83.33%) and lung (28 cases, 66.67%). ⑤Among the 56 successfully resuscitated patients, MODS ( - ) group (14 cases) all survived, 15 cases in MODS ( + ) group (42 cases) survived, a total rate of survived to hospital dischargewas 40.28%(29/72). All the MODS ( - ) group ( 14 cases) got CPC 1 point. In MODS ( + ) group, there were 7 cases getting CPC 1-2 point, 35 cases getting CPC 3-5 point. There were no significant difference between sex and age in the two groups (P > 0.05), while the comparison of CPC and survived to hospital discharge rate had statistically significance (P < 0.001). Conclusions The occurrence of SIRS in cardiac arrest patients with ROSC was common and there was high incidence of MODS subsequently. Theheart and brain were the mostly involved dysfunctional organs. PR-MODS was an important factor influencing the prognosis of patients with cardiac arrest. Key words: Cardiac arrest; Cardiopulmonary resuscitation; Systemic inflammatory response syndrome; Multiple organ dysfunction syndrome; Clinical analysis; Prognosis