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Intensive blood pressure control on arterial stiffness among older patients with hypertension

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中华医学杂志(英文版) 2024年第9期137卷 1078-1087页

作者： Zhang Shuyuan Zhong Yixuan Wu Shouling Wu Hailei Cai Jun Zhang Weili National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Peking Union Medical College &amp chinese Academy of Medical Sciences Beijing China Department of Cardiology State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital Chinese Academy of Medical Sciences &amp Peking Union Medical College Beijing China State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Peking Union Medical College &amp Department of Cardiology Kailuan General Hospital Tangshan Hebei China Central China Subcenter of National Center for Cardiovascular Diseases Henan Cardiovascular Disease Center Fuwai Central-China Cardiovascular Hospital Central China Fuwai Hospital of Zhengzhou University Zhengzhou Henan China

Background: Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease (CVD), but the relationship between blood pressure lowering and arterial stiffening is still uncertain, especially in older people. This study aimed to evaluate the effect of intensive blood pressure treatment on the progression of arterial stiffness and risk of CVD in older patients with hypertension.Methods: The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial was a multicenter, randomized, controlled trial performed at 42 clinical centers throughout China, and 8511 patients aged 60–80 years with essential hypertension were enrolled and randomly assigned to systolic blood pressure (SBP) target of 110 mmHg to study. Changes in arterial stiffness between the intensive and standard treatment groups were analyzed using a multivariate linear regression model. The Cox proportional hazard regression model was used to evaluate the effect of intensive treatment on primary CVD outcomes.Results: The changes in baPWV were 61.5 cm/s (95% confidence interval [CI]: 49.8–73.2 cm/s) in the intensive treatment group and 98.4 cm/s (95% CI: 86.7–110.1 cm/s) in the standard treatment group (P groups, respectively. During a median follow-up period of 3.36 years, primary CVD outcomes occurred in 77 (2.9%) patients in the intensive treatment group compared with 93 (3.5%) in the standard treatment group. Intensive treatment

关键词： Hypertension Arterial stiffness Cardiovascular disease Older people Blood pressure Pulse wave velocity

A cross-sectional study of acute cor pulmonale in acute respiratory distress syndrome patients in China

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chinese Medical Journal 2019年第23期132卷 2842-2847页

作者： Long-Xiang Su Xiu-Ling Shang Ran Zhu Wei He Pan Pan Hong-Min Zhang Li-Na Zhang Da-Wei Liu Rong-Guo Yu Xiao-Ting Wang 无 Department of critical Care Medicine Peking Union Medical College and Chinese Academy of Medical SciencesBeijing 100730China Department of critical Care Medicine Fujian Provincial HospitalFujian Provincial Center for Critical Care MedicineFujian Medical UniversityFuzhouFujian 350001China Department of critical Care Medicine The First Hospital of China Medical UniversityShenyangLiaoning 110001China Department of critical Care Medicine Beijing Tongren HospitalCapital Medical UniversityBeijing 100730China Department of Respiratory and critical Care Medicine Chinese PLA General HospitalBeijing 100853China Department of critical Care Medicine Xiangya HospitalCentral South UniversityChangshaHunan 410008China on behalf of the chinese critical ultrasound study group(CCUSG)

Background:Increased right ventricle afterload during acute respiratory distress syndrome(ARDS)may induce acute cor pulmonale(ACP),which is associated with a poor clinical outcome.Echocardiography is now considered as a rapid and non-invasive tool for diagnosis of ACP.The aims of this study were to investigate the morbidity and mortality rates of ACP in ARDS patients in intensive care units(ICUs)across the mainland of China and to determine the severity and prognosis of ACP in ARDS patients through an ultrasound protocol(TRIP).And the association between ACP related factors and the ICU mortality will be revealed.Methods:This study is a multicenter and cross-sectional study in China which will include ICU participants when diagnosed as ARDS.The ultrasound protocol,known as the TRIP,is proposed as severity assessment for ACP,which includes tricuspid regurgitation velocity(T),right ventricular size(R),inferior vena cava diameter fluctuation(I),and pulmonary regurgitation velocity(P).The 28-day mortality,ICU/hospital mortality,the length of stay in ICU,mechanical ventilation days,hemodynamic parameters and lab parameters of liver function and kidney function are all recorded.Discussion:This large-scale study would give a sufficient epidemic investigation of ACP in ARDS patients in China.In addition,with the TRIP protocol,we expect that we could stratify ACP with more echocardiography parameters.

关键词： Acute respiratory distress syndrome Acute cor pulmonale Echocardiography Outcome

Association between ICU quality and in-hospital mortality of V-V ECMO-supported patients—the ECMO quality improvement action(EQIA)study:a national cohort study in China from 2017 to 2019

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Frontiers of Medicine 2024年第2期18卷 315-326页

作者： Wei Cheng Jieqing Chen Xudong Ma Jialu Sun Sifa Gao Ye Wang Longxiang Su Lu Wang Wei Du Huaiwu He Yujie Chen Zunzhu Li Qi Li Jianhua Sun Hongbo Luo Jinbang Liu Guangliang Shan Bing Du Yanhong Guo Dawei Liu Chang Yin Xiang Zhou on behalf of the China National critical Care Quality Control Center-the ECMO quality improvement action(EQIA)study Department of critical Care Medicine State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing100730China Information Center Department/Department of Information Management State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalPeking Union Medical College&Chinese Academy of Medical SciencesBeijing100730China Department of Medical Administration National Health Commission of the People’s Republic of ChinaBeijing100044China School of Population Medicine and Public Health Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China Department of Epidemiology and Biostatistics Institute of Basic Medicine SciencesChinese Academy of Medical Sciences(CAMS)&School of Basic MedicinePeking Union Medical CollegeBeijing100730China National Institute of Hospital Administration National Health Commission of the People’s Republic of ChinaBeijing100044China 不详

This cohort study was performed to explore the influence of intensive care unit(ICU)quality on in-hospital mortality of veno-venous(V-V)extracorporeal membrane oxygenation(ECMO)-supported patients in China.The study involved all V-V ECMO-supported patients in 318 of 1700 tertiary hospitals from 2017 to 2019,using data from the National Clinical Improvement System and China National critical Care Quality Control Center.ICU quality was assessed by quality control indicators and capacity parameters.Among the 2563 V-V ECMO-supported patients in 318 hospitals,a significant correlation was found between ECMO-related complications and prognosis.The reintubation rate within 48 hours after extubation and the total ICU mortality rate were independent risk factors for higher in-hospital mortality of V-V ECMO-supported patients(cutoff:1.5%and 7.0%;95%confidence interval:1.05–1.48 and 1.04–1.45;odds ratios:1.25 and 1.23;P=0.012 and P=0.015,respectively).Meanwhile,the V-V ECMO center volume was a protective factor(cutoff of≥50 cases within the 3-year study period;95%confidence interval:0.57–0.83,odds ratio:0.69,P=0.0001).The subgroup analysis of 864 patients in 11 high-volume centers further strengthened these findings.Thus,ICU quality may play an important role in improving the prognosis of V-V ECMO-supported patients.

关键词： veno-venous extracorporeal membrane oxygenation in-hospital mortality high-volume centers quality control intensive care unit capacity parameters

Resuscitation fluids as drugs:targeting the endothelial glycocalyx

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chinese Medical Journal 2022年第2期135卷 137-144页

作者： Guangjian Wang Hongmin Zhang Dawei Liu Xiaoting Wang chinese critical ultrasound study group Department of critical Care Medicine Peking Union Medical College HospitalPeking Union Medical College&Chinese Academy of Medical SciencesBeijing 100730China

Fluid resuscitation is an essential intervention in critically ill patients,and its ultimate goal is to restore tissue perfusion.critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions,hypoperfusion,shock,and so forth,leading to disturbed microcirculatory perfusion and organ dysfunction.Therefore,maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy.Like drugs,however,different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx.The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx.Many animal studies have shown that normal saline might be associated with glycocalyx degradation,but clinical studies have not confirmed this finding.Hydroxyethyl starch(HES),rather than other synthetic colloids,may restore the glycocalyx.However,the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies.Some studies have suggested that albumin may restore the glycocalyx,whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation.Notably,most studies did not correct the effects of the infusion rate or fluid volume;therefore,the results of using balanced crystalloids remain unclear.Moreover,mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity,and this still requires confirmation by high-quality clinical studies.

关键词： Fluid resuscitation Resuscitation fluid Fluid therapy Endothelial glycocalyx Glycocalyx

China stroke surveillance report 2021

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Military Medical Research 2024年第3期11卷 374-399页

作者： Wen-Jun Tu Long-De Wang 无 Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China School of Public Health Peking UniversityBeijing 100191China Special Writing group of China Stroke Surveillance Report

Since 2015,stroke has become the leading cause of death and disability in China,posing a significant threat to the health of its citizens as a major chronic non-communicable disease.According to the China Stroke High-risk Population Screening and Intervention Program,an estimated 17.8 million[95%confidence interval(CI)17.6–18.0million]adults in China had experienced a stroke in 2020,with 3.4 million(95%CI 3.3–3.5 million)experiencing their first-ever stroke and another 2.3 million(95%CI 2.2–2.4 million)dying as a result.Additionally,approximately 12.5%(95%CI 12.4%–12.5%)of stroke survivors were left disabled,as defined by a modified Rankin Scale score greater than 1,equating to 2.2 million(95%CI 2.1–2.2 million)stroke-related disabilities in 2020.As the population ages and the prevalence of risk factors like diabetes,hypertension,and hyperlipidemia continues to rise and remains poorly controlled,the burden of stroke in China is also increasing.A large national epidemiological survey initiated by the China Hypertension League in 2017 showed that the prevalence of hypertension was 24.7%;the awareness,treatment,and control rates in hypertensive patients were:60.1%,42.5%,and 25.4%,respectively.A nationally representative sample of the chinese mainland population showed that the weighted prevalence of total diabetes diagnosed by the American Diabetes Association criteria was 12.8%,suggesting there are 120 million adults with diabetes in China,and the awareness,treatment,and control rates in diabetic patients were:43.3%,49.0%,and 49.4%,respectively.The“Sixth National Health Service Statistical Survey Report in 2018”showed that the proportion of the obese population in China was 37.4%,an increase of 7.2 points from 2013.Data from 1599 hospitals in the Hospital Quality Monitoring System and Bigdata Observatory Platform for Stroke of China(BOSC)showed that a total of 3,418,432 stroke cases[mean age±standard error(SE)was(65.700±0.006)years,and 59.1%were male]were admitted during 2020.Of those,over 80.0%(81.9%)were ischemic

关键词： Stroke Epidemiological characteristics Treatment Prognosis China

Focus on host/organ unregulated response:a common cause of critical illness

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chinese Medical Journal 2023年第1期136卷 108-110页

作者： Wei Huang Dawei Liu Hongmin Zhang Xin Ding Xiaoting Wang On behalf of the critical Care ultrasound study group(CCUSG) Department of critical Care Medicine First Affiliated Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityXiamenFujian 361000China Department of critical Care Medicine Peking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100730China 不详

To the Editor:Given the high rates of pre-diseases and various initiating causes,critical illnesses have become the most heterogeneous group in clinical practice,which multiplies treatment challenges.Despite different types of injurious“hit,”this response to various acute critical conditions is relatively homogenous and may eventually progress to a critical illness.

关键词： critical acute diseases

Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection

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Journal of Intensive Medicine 2024年第1期4卷 81-93页

作者： Marie Dejonckheere Massimo Antonelli Kostoula Arvaniti Koen Blot Ben CreaghBrown Dylan Wde Lange Jan De Waele Mieke Deschepper Yalim Dikmen George Dimopoulos Christian Eckmann Guy Francois Massimo Girardis Despoina Koulenti Sonia Labeau Jeffrey Lipman Fernando Lipovestky Emilio Maseda Philippe Montravers Adam Mikstacki JoseArtur Paiva Cecilia Pereyra Jordi Rello JeanFrancois Timsit Dirk Vogelaers Stijn Blot the Abdominal Sepsis study(AbSeS)group on behalf of the Trials group of the European Society of Intensive Care Medicine Department of Internal Medicine and Pediatrics Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium Department of Anesthesiology Intensive Care and Emergency MedicineFondazione Policlinico Universitario A.Gemelli IRCCSRomeItaly UniversitàCattolica del Sacro Cuore RomeItaly Intensive Care Unit Papageorgiou University Affiliated HospitalThessaloníkiGreece Department of Epidemiology and Public Health SciensanoIxellesBelgium Surrey Perioperative Anaesthetic critical Care Collaborative Research group(SPACeR) Royal Surrey County HospitalGuildfordUK Department of Clinical and Experimental Medicine University of SurreyGuildfordUK Department of Intensive Care Medicine University Medical Center UtrechtUniversity UtrechtUtrechtthe Netherlands Department of Intensive Care Medicine Ghent University HospitalGhentBelgium Data Science Institute Ghent University HospitalGhentBelgium Department of Anesthesiology and Reanimation Cerrahpasa School of MedicineIstanbul University-CerrahpasaIstanbulTurkey rd Department of critical Care “EVGENIDIO”HospitalNational and Kapodistrian University of AthensAthensGreece Department of General Visceral and Thoracic SurgeryKlinikum Hannoversch-MuendenGoettingen UniversityGöttingenGermany Division of Scientific Affairs-Research European Society of Intensive Care MedicineBrusselsBelgium Anesthesia and Intensive Care Department University Hospital of ModenaModenaItaly UQ Centre for Clinical Research Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia nd critical Care Department Attikon University HospitalAthensGreece Department of Nursing Faculty of EducationHealth and Social WorkUniversity College GhentGhentBelgium Jamieson Trauma Institute The University of QueenslandBrisbaneQLDAustralia Nimes University Hospital University of MontpellierNimesFrance critical Care Department Hospital of the Interamerican Open University(UAI)Buenos AiresArgentina Surgical critical Care Department of AnesthesiaHospital Universitario

Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)presence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal infection.This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality.Methods:This was a secondary analysis of an international observational study(“AbSeS”)investigating ICU patients with intra-abdominal infection.Only patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU.Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95%confidence interval(CI).Results:The overall mortality was 35.2%(n=58).The independent risk factors for mortality included older age(OR=1.03,95%CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95%CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95%CI:3.8 to 23.9,P<0.001)or after the implementation of additional source control interventions within the first week(OR=4.0,95%CI:1.3 to 12.2,P=0.013).Gramnegative bacteria were most frequently isolated(n=58,49.2%)without clinically relevant differences in microbial etiology between survivors and non-survivors.Conclusions:In pancreatic infection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome.In this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse peritonitis,and severity of disease expression,

关键词： Pancreatic infection Intensive care unit Mortality Intra-abdominal infection Sepsis

chinese expert consensus on sedation and analgesia for neurocritical care patients

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中华医学杂志(英文版) 2024年第11期137卷 2024 Apr 19页

作者： Zhang Linlin Liu Shuai Wang Shuya Zhou Jian-Xin the National Center for Healthcare Quality Management in Neurological Diseases chinese Society of critical Care Medicine Working group of the Expert Consensus on Sedation and Analgesia for Neurocritical Care Patients Department of critical Care Medicine Beijing Tiantan Hospital Capital Medical University Beijing China Department of critical Care Medicine Beijing Shijitan Hospital Capital Medical University Beijing China

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重症医学科医护一体化建设的认知与实践

协和医学杂志 2024年第3期15卷 518-521页

作者：孙建华罗红波李尊柱鲁梅珊廉慧王小亭重症超声研究组中国医学科学院北京协和医院内科ICU 北京100730 中国医学科学院北京协和医院重症医学科北京100730 中国医学科学院北京协和医院保健医疗部北京100730 不详

重症医学科是重症医学的临床基地,以重症医学理论与实践为基础,是重症患者救治的集中管理单元。医学和护理学是两门相互独立的学科,但在面对重症患者时,可从不同层面充分发挥自身作用。随着科学技术的发展和对重症医学认知的进步,“重... 详细信息

重症医学科是重症医学的临床基地,以重症医学理论与实践为基础,是重症患者救治的集中管理单元。医学和护理学是两门相互独立的学科,但在面对重症患者时,可从不同层面充分发挥自身作用。随着科学技术的发展和对重症医学认知的进步,“重症医学科医护一体化”理念应运而生。其以重症疾病的发生、发展规律为核心,以学术发展为导向,通过组织协调、医护协同,基于重症认知、统一的思维模式共同开展临床实践,以实现重症治疗的目的。

关键词：重症医学重症护理医护一体化临床思维临床实践