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Effect of dietary fibre on the gastrointestinal microbiota during critical illness:A scoping review

World Journal of critical Care Medicine 2025年第1期14卷 49-59页

作者： Angajendra N Ghosh Calum J Walsh Matthew J Maiden Tim P Stinear Adam M Deane Department of Intensive Care The Northern HospitalEpping 3076VictoriaAustralia Department of Microbiology and Immunology The Peter Doherty Institute for Infection and ImmunityMelbourne 3052VictoriaAustralia Department of Intensive Care The Royal Melbourne HospitalThe University of MelbourneParkville 3050VictoriaAustralia Department of Intensive Care Medicine The Royal Melbourne HospitalParkville 3050VictoriaAustralia

The systemic effects of gastrointestinal(GI)microbiota in health and during chronic diseases is increasingly *** strategies to modulate the GI microbiota during chronic diseases have demonstrated *** changes in dietary intake can rapidly change the GI microbiota,the impact of dietary changes during acute critical illness on the microbiota remain *** fibre is metabolised by carbohydrate-active enzymes and,in health,can alter GI *** aim of this scoping review was to describe the effects of dietary fibre supplementation in health and disease states,specifically during critical *** controlled trials and prospective cohort studies that include adults(>18 years age)and reported changes to GI microbiota as one of the study outcomes using non-culture methods,were *** show dietary fibres have an impact on faecal microbiota in health and *** fibre,inulin,has a marked and specific effect on increasing the abundance of faecal *** chain fatty acids produced by Bifidobacteria have been shown to be beneficial in other patient *** few trials have evaluated the effect of dietary fibre on the GI microbiota during critical *** research is necessary to establish optimal fibre type,doses,duration of intervention in critical illness.

关键词： Gastrointestinal microbiota Dietary fibre Health critical illness Short chain fatty acids

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Artificial intelligence and computer simulation models in critical illness

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World Journal of critical Care Medicine 2020年第2期9卷 13-19页

作者： Amos Lal Yuliya Pinevich Ognjen Gajic Vitaly Herasevich Brian Pickering Department of Medicine Division of Pulmonary and Critical Care MedicineRochesterMayo ClinicMN 55905United States Multidisciplinary Epidemiology and Translational Research in Intensive Care Group Mayo ClinicRochesterMN 55905United States Department of Anesthesiology and Perioperative Medicine Division of Critical CareMayo ClinicRochesterMN 55905United States

Widespread implementation of electronic health records has led to the increased use of artificial intelligence(AI)and computer modeling in clinical *** early recognition and treatment of critical illness are central to good outcomes but are made difficult by,among other things,the complexity of the environment and the often non-specific nature of the clinical ***,AI applications are being proposed as decision supports for busy or distracted clinicians,to address this *** driven“associative”AI models are built from retrospective data registries with missing data and imprecise *** AI models lack transparency,often ignore causal mechanisms,and,while potentially useful in improved prognostication,have thus far had limited clinical *** be clinically useful,AI tools need to provide bedside clinicians with actionable *** addressing causal mechanisms not only increases validity and replicability of the model,but also adds transparency and helps gain trust from the bedside clinicians for real world use of AI models in teaching and patient care.

关键词： Artificial intelligence Digital twin critical illness Predictive enrichment Causation Simulation models

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Characterization and determinant factors of critical illness and in-hospital mortality of COVID-19 patients: A retrospective cohort of 1,792 patients in Kenya

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Biosafety and Health 2022年第5期4卷 330-338页

作者： Isinta M Elijah Endawoke Amsalu Xuening Jian Mingyang Cao Eric K Mibei Danvas O Kerosi Francis G Mwatsahu Wei Wang Faith Onyangore Youxin Wang Beijing Key Laboratory of Clinical Epidemiology School of Public HealthCapital Medical UniversityBeijing 100069China Armauer Hansen Research Institute Ministry of HealthAddis Ababa 1005Ethiopia University of Kabianga School of Health SciencesKericho 2030-20200Kenya Medical Genetics Laboratory School of Life ScienceCentral South UniversityChangsha 410083China Department of Environmental Health and Disease Control School of Public HealthJomo Kenyatta University of Agriculture and TechnologyNairobi 62000–00200Kenya Centre for Precision Medicine Edith Cowan UniversityPerth WA 6027Australia

Limited data is available on the coronavirus disease 2019(COVID-19),critical illness rate,and in-hospital mortality in the African *** study investigates determinants of critical illness and in-hospital mortality among COVID-19 patients in *** conducted a retrospective cohort study at Kenyatta National Hospital(KNH)in *** logistic regression and Cox proportional hazard regression were employed to determine predictor factors for intensive care unit(ICU)admission and in-hospital mortality,*** addition,the Kaplan-Meier model was used to compare the survival times using log-rank *** a result,346(19.3%)COVID-19 patients were admitted to ICU,and 271(15.1%)*** majority of those admitted to the hospital were male,1,137(63.4%)and asymptomatic,1,357(75.7%).The most prevalent clinical features were shortness of breath,fever,and dry *** addition,older age,male,health status,patient on oxygen(O2),oxygen saturation levels(SPO2),headache,dry cough,comorbidities,obesity,cardiovascular diseases(CVDs),diabetes,chronic lung disease(CLD),and malignancy/cancer can predicate the risk of ICU admission,with an area under the receiver operating characteristic curve(AUC-ROC)of 0.90(95%confidence interval[CI]:0.88–0.92).Survival analysis indicated 271(15.1%)patients died and identified older age,male,headache,shortness of breath,health status,patient on oxygen,SPO2,headache,comorbidity,CVDs,diabetes,CLD,malignancy/cancer,and smoking as risk factors for mortality(AUC-ROC:0.90,95%CI:0.89–0.91).This is the first attempt to explore predictors for ICU admission and hospital mortality among COVID-19 patients in Kenya.

关键词： Comorbidities critical illness ICU COVID-19 SARS-CoV-2

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Sleep during and following critical illness:A narrative review

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World Journal of critical Care Medicine 2023年第3期12卷 92-115页

作者： Laurie Showler Yasmine Ali Abdelhamid Jeremy Goldin Adam M Deane Intensive Care Medicine The Royal Melbourne HospitalParkville 3050VictoriaAustralia Sleep and Respiratory Medicine The Royal Melbourne HospitalParkville 3050VictoriaAustralia

Sleep is a complex process influenced by biological and environmental *** of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 *** disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive *** review will outline the predisposing and precipitating factors for sleep disturbance,categorised into patient,environmental and treatment-related *** objective and subjective methodologies used to quantify sleep during critical illness will be *** polysomnography remains the gold-standard,its use in the critical care setting still presents many *** methodologies are needed to better understand the pathophysiology,epidemiology and treatment of sleep disturbance in this *** outcome measures,including the Richards-Campbell Sleep Questionnaire,are still required for trials involving a greater number of patients and provide valuable insight into patients’experiences of disturbed ***,sleep optimisation strategies are reviewed,including intervention bundles,ambient noise and light reduction,quiet time,and the use of ear plugs and eye *** drugs to improve sleep are frequently prescribed to patients in the ICU,evidence supporting their effectiveness is lacking.

关键词： critical illness critical care Sleep Sleep deprivation Polysomnography Melatonin

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Deciphering the iron enigma: Navigating the complexities of iron metabolism in critical illness

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World Journal of Clinical Cases 2024年第27期12卷 6027-6031页

作者： Anjali Mishra Deven Juneja Department of critical Care Medicine Holy Family HospitalDelhi 110025India Department of critical Care Medicine Max Super Speciality HospitalNew Delhi 110017India

Iron is a double-edged sword!Despite being essential for numerous physiological processes of the body,a dysregulated iron metabolism can result in tissue da-mage,exaggerated inflammatory response,and increased susceptibility to infection with certain pathogens that thrive in iron-rich *** sepsis,there is an alteration of iron metabolism,leading to increased transport and uptake into *** increase in labile iron may cause oxidative damage and cellular injury(ferroptosis)which progresses as the disease *** ill patients are often complicated with systemic inflammation which may contribute to multiple organ dysfunction syndrome or sepsis,a common cause of mortality in intensive care ***,ferritin was known to play an important role in the hematopoietic system for its iron storage ***,its role has emerged as a predictor of poor prognosis in chronic inflammation and critical *** from predicting the disease outcome,serum ferritin can poten-tially reflect disease activity as well.

关键词： critical illness Ferritin Inflammation Iron Mortality Sepsis

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Transient extreme insulin resistance in a critically ill patient:A case report

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World Journal of Clinical Cases 2025年第8期13卷 35-40页

作者： Xiu-Yu Wei Hsiu-Nien Shen Department of Internal Medicine Taichung Veterans General HospitalTaichung 407TaiwanChina Department of Intensive Care Medicine Chi Mei Medical CenterTainan 710TaiwanChina

BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin ***,the occurrence of transient extreme insulin resistance(EIR)requiring exceptional high-dose insulin is *** SUMMARY We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest,subsequently developing transient EIR following a new episode of ***,insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour(a total of 18224 units on that day),and it was promptly titrated down to zero upon achieving the target glucose *** Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR,which is typically *** should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.

关键词： Hyperglycemia Insulin Insulin resistance Sepsis critical illness Case report

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Association of interleukin-6 with acute lung injury risk and disease severity in sepsis

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World Journal of Clinical Cases 2025年第8期13卷 49-52页

作者： Imshaal Musharaf Abdulqadir J Nashwan Department of Medicine Jinnah Sindh Medical UniversityKarachi 75510Pakistan Department of Nursing and Midwifery Research Hamad Medical CorporationDoha 3050Qatar

Sepsis is a life-threatening condition caused by a dysregulated response of the body in response to an infection that harms its tissues and ***-6(IL-6)is a significant component of the inflammatory response as part of the pa-thogenesis of *** aids in the development of Acute lung injury and,subse-quently,multiple organ dysfunction *** letter probes into the corre-lation between plasma IL-6 levels and the risk of developing acute lung injury and multiple organ dysfunction syndrome in critically ill patients with *** it shows promising results,limitations like its observational study design,a limited sample size,a single center involvement,single-time-point measurement,and a lack of a control group restrain its *** study is a big step in identifying IL-6 as a biomarker to improve patient care.

关键词： Sepsis Acute lung injury Multiple organ dysfunction syndrome Interleukin-6 Biomarker critical illness

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How albumin administration for cirrhosis impacts on hospital albumin consumption and expenditure

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World Journal of Gastroenterology 2011年第30期17卷 3479-3486页

作者： Federica Mirici-Cappa Paolo Caraceni Marco Domenicali Ernesto Gelonesi Barbara Benazzi Giacomo Zaccherini Franco Trevisani Cristina Puggioli Mauro Bernardi Department of Clinical Medicine Alma MaterS tudiorumUniversity of Bologna40126 BolognaItaly UO Pharmacology S Orsola-Malpighi University Hospital40138 BolognaItaly

AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver ***:Although randomized trials and guidelines support albumin administration for some complications of cirrhosis,the high cost of albumin greatly limits its use in clinical *** 2003,a multidisciplinary panel at Sant'Orsola-Malpighi University Hospital(Bologna,Italy)used a literature-based consensus method to list all the acute and chronic conditions for which albumin is indicated as first-or second-line *** in hepatology included prevention of post-paracentesis circulatory dysfunction and renal failure induced by spontaneous bacterial peritonitis,and treatment of hepatorenal syndrome and refractory *** still debated,albumin administration in refractory ascites is accepted by the Italian health care *** analyzedalbumin prescription and related costs before and after implementation of the new ***:While albumin consumption and costs doubled from 1998 to 2002,they dropped 20%after 2003,and remained stable for the following 6 *** of cirrhosis,namely refractory ascites and paracentesis,represented the predominant indications,followed by major surgery,shock,enteric diseases,and *** consumption increased significantly after guideline implementation in the liver units,whereas it declined elsewhere in the ***,extra-protocol albumin prescription was estimated as<10%.CONCLUSION:Albumin administration in cirrhosis according to international guidelines does not increase total hospital albumin consumption if its use in settings without evidence of efficacy is avoided.

关键词： Human serum albumin Cost analysis Livercirrhosis critical illness Ascites

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Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery

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World Journal of Gastroenterology 2006年第4期12卷 582-587页

作者： Robert J Fraser Marc Ritz Addolorata C Di Matteo Rosalie Vozzo Monika Kwiatek Robert Foreman Brendan Stanley Jack Walsh Jim Burnett Paul Jury John Dent Department of Medicine University of AdelaideSouth Australia Department of Gastroenterology Royal Adelaide HospitalAdelaide South Australia Vascular Unit Royal Adelaide Hospital AdelaideSouth Australia Gastrointestinal Investigation Unit Repatriation General Hospital Daw Park South Australia Vascular Unit Repatriation General Hospital Daw Park SouthAustralia

AIM： To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm （AAA） repair surgery, METHODS： Nine patients （aged 35-78 years; body mass index （BMI） range： 23-36 kg/m2） post-surgery for AAA repair, and seven healthy control subjects （20-50 years; BMI range： 21-29 kg/m^2） were studied, Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding （Nutrison）. Recordings were analyzed for the frequency, odgin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the ^13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200μL ^13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for ^13CO2 concentration. RESULTS： The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions （P〈 0.005）. In patients there was a higher proportion of abnormally propagated bursts （71% abnormal）, which began to normalize by d 3 （25% abnormal） *** absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients, absorption on d 1 post-surgery was half that of healthy control subjects （AUC ^13CO2 1323±244 vs 2646±365; P〈0.05, respectively）, and was reduced to the one-fitch that of healthy controls by d 3 （AUC ^13CO2 470±832 vs 2646±365; P〈 0.05, respectively）. CONCLUSION： Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery, with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when intralumi

关键词： critical illness Small intestine Motility Lipid absorption

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Clinical characteristics of critical patients with pandemic influenza A(H1N1) virus infection in Chengdu,China

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2012年第1期13卷 49-55页

作者： Li-hui DENG1,2,Yi-lan ZENG3,Ping FENG1,Ya-ling LIU3,Li-chun WANG1,2,Yun BAI3,Hong TANG1,2(1Center of Infectious Diseases,West China Hospital of Sichuan University,Chengdu 610041,China)(2Division of Infectious Diseases,State Key Laboratory of Biotherapy,Sichuan University,Chengdu 610041,China)(3Chengdu Infectious Disease Hospital,Chengdu 610041,China) Center of Infectious Diseases West China Hospital of Sichuan University Chengdu 610041 China.

Objective： The critical illness of pandemic influenza A （H1N1） virus infection may be associated with relatively poor outcomes. The objective of this study is to describe clinical features and factors associated with the deaths of critical patients. Methods： Medical records of 26 critical patients with H1N1 infection admitted from Sept. 1 to Dec. 31, 2009, were retrospectively reviewed. Diagnosis was established by real-time reverse transcdptase- polymerase chain reaction （RT-PCR） assay. Results： The mean age of the patients was （40.4＋18.4） years and 73.1% of them were male. Clinical manifestations included fever, cough, and sputum production. The laboratory findings included leukocytosis, lymphopenia, C-reaction protein, and lactic dehydrogenase elevation. In this series, 17 subjects survived and 9 died. The parameters between the deaths and survivors were compared, which included acute physiology and chronic health evaluation II （APACHE II） scores （23.8＋10.1 vs. 14.3_＋6.6, P〈0.05）, sequential organ failure assessment （SOFA） scores （13.3_＋3.0 vs. 6.6_＋3.3, P〈0.05）, and multiple organ dysfunction syndrome （MODS） scores （7.4＋2.5 vs. 3.3＋1.7, P〈0.05）. The cases of deaths had higher incidences of cardiovascular failure （100% vs. 41.2%, P〈0.05）, renal failure （55.6% vs. 11.7%, P〈0.05）, encephalopathy （44.4% vs. 5.9%, P〈0.05）, hepatic failure （33.3% vs. 5.9%, P〈0.05）, and septic shock （33.3% vs. 17.6%, P〈0.05）. Conclusions： The critical patients with H1 N1 infection have high APACHE II, SOFA, and MODS scores, which may be associated with an increased risk of death and complex clinical courses.

关键词： critical illness H1N1 Infection Influenza A virus Mortality

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