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World Journal of Gastroenterology 2020年第5期26卷 514-523页

作者： Ling Ding Hong-Yan Chen Jin-Yun Wang Hui-Fang Xiong Wen-Hua He Liang Xia Nong-Hua Lu Yin Zhu Department of Gastroenterology The First Affiliated Hospital of Nanchang University

BACKGROUND Gastrointestinal(GI)dysfunction is a common and important complication of acute pancreatitis(AP),especially in patients with severe AP.Despite this,there is no consensus means of obtaining a precise assessment of GI function.AIM To determine the association between acute gastrointestinal injury(AGI)grade and clinical outcomes in critically ill patients with AP.METHODS Patients with AP admitted to our pancreatic intensive care unit from May 2017 to May 2019 were enrolled.GI function was assessed according to the AGI grade proposed by the European Society of Intensive Care Medicine in 2012,which is mainly based on GI symptoms,intra-abdominal pressure,and feeding intolerance in the first week of admission to the intensive care unit.Multivariate logistic regression analysis was performed to assess the association between AGI grade and clinical outcomes in critically ill patients with AP.RESULTS Among the 286 patients included,the distribution of patients with various AGI grades was 34.62%with grade I,22.03%with grade II,32.52%with grade III,and 10.84%with grade IV.The distribution of mortality was 0%among those with grade I,6.35%among those with grade II,30.11%among those with grade III,and 61.29%among those with grade IV,and AGI grade was positively correlated with mortality(χ2=31.511,Pcritically ill patients with AP.

关键词： Acute pancreatitis Gastrointestinal dysfunction Acute gastrointestinal injury Mortality Predictive factor critically ill

Value of Kidney Disease Improving Global Outcomes Urine Output Criteria in critically III Patients： A Secondary Analysis of a Multicenter Prospective Cohort Study

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Chinese Medical Journal 2016年第17期129卷 2050-2057页

作者： Jun-Ping Qin Xiang-You Yu Chuan-Yun Qian Shu-Sheng Li Tie-He Qin Er-Zhen Chen Jian-Dong Lin Yu-Hang Ai Da-Wei Wu De-Xin Liu Ren-Hua Sun Zhen-Jie Hu Xiang-Yuan Cao Fa-Chun Zhou Zhen-Yang He Li-Hua Zhou You-Zhong An Yan Kang Xiao-Chun Ma Ming-Yan Zhao Li Jiang Yuan Xu Bin Du Medical Intensive Care Unit Peking Union Medical College Hospital Beijing 100730 China Department of Critical Care Medicine Beijing Tongren Hospital Capital Medical University Beijing 100730 China Department of Critical Care Medicine First Affiliated Hospital Xinjiang Medical University Urumqi Xinjiang 830054 China Department of Emergency Medicine and Medical Intensive Care Unit The First Affiliated Hospital of Kunming Medical University Kunming Yunnan 650032 China Department o1 Critical Care Medicine Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei 430030 China Department of Critical Care Medicine Guangdong General Hospital Guangzhou Guangdong 510080 China Department of Emergency Medicine Ruijin Hospital Shanghai Jiao Tong University Shanghai 200025 China Department of Critical Care Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou Fujian 350005 China Department of Critical Care Medicine Xiangya Hospital Central South University Changsha Hunan 410008 China Department of Critical Care Medicine Qilu Hospital Shandong University Jinan Shandong 250012 China Department of Emergency and Critical Care Medicine The Second Hospital of Jilin University Changchun Jilin 130041 China Department of Critical Care Medicine Zhejiang Provincial People's Hospital Hangzhou Zhejiang 310014 China Department of Critical Care Medicine Hebei Medical University Fourth Hospital Shijiazhuang Hebei 050011 China Department of Critical Care Medicine Affiliated Hospital of Ningxia Medical University Yinchuan Ningxia 750004 China Department of Emergency and Intensive Care Medicine The First Affiliated Hospital Chongqing Medical University Chongqing 400016 China Department of Critical Care Medicine Hainan Provincial People's Hospital Haikou Hainan 570311 China Department of Critical Care Medicine The Affiliated Hospital of Inner Mongolia Medical College Hohhot Inner Mongolia 010050 China Department of C

Background： Urine output （UO） is an essential criterion of the Kidney Disease Improving Global Outcomes （KD1GO） definition and classification system tbr acute kidney injury （AKI）, of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria （KDtGOLro） could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria （KDIGOscr）.Methods： We conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group （CCCCTG）, which was a 2-month prospective cohort study （July 1,2009 to August 31,2009） involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOt,o and KDlGOsc,. Hospital mortality of patients with more severe AKI classification based on KDIGOvo was compared with other patients by univariate and multivariate regression analyses. Results： The prevalence of AKl increased from 52.4% based on KDIGOscr to 55.4% based on KD1GOsc~ combined with KDIGOuo. KDIGOv~~ also restllted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AK1 classification based on KDIGOvo. Compared with non-AKI patients or those with maximum AKI classification by KDIGOscr, those with maximum AKI classification by KDIGOuo had a significantly higher hospital mortality of 58.4% （odds ratio [OR]： 7.580, 95% confidence interval [CI]： 4.141-13.873, P 〈 0.001）. In a multivariate logistic regression analysis, AKI based on KDIGOuo （OR： 2.891, 95% CI： 1.964-4.254, P 〈 0.001）, but not based on KDIGOscr （OR： 1.322, 95% CI： 0.902-1.939, P = 0.152）, was an independent risk factor for hospital mortality. Conclusion： UO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.

关键词： Acute Kidney Injury critically ill Mortality Serum Creatinine Urine Output

Significance of low serum vitamin D for infection risk, disease severity and mortality in critically ill patients

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Chinese Medical Journal 2013年第14期126卷 2725-2730页

作者： SU Long-xiang JIANG Zhao-xu CAO Li-chao XIAO Kun SONG Jia-ping LI Hua ZHANG Xin YAN Peng FENG Dan LIU Chang-ting LI Xin XIE Li-xin Department of Respiratory Medicine Chinese People's Liberation Army General Hospital Beijing 100853 China Clinical Division of Internal Medicine Chinese People's Liberation Army General Hospital Beijing 100853 China Department of Medical StatisticsChinese People'sLiberation Army General Hospital Beijing 100853 China Nanlou Department of Espiratory Diseases Chinese People's Liberation Army General Hospital Beijing 100853 China Medical College of Nankai University Tianjin 300071 China Department of Respiratory Medicine Tianjin Chest Hospital Tianjin 300051 China Shenzhen Proteome Engineering Laboratory BGI Shenzhen Shenzhen 518001 China

Background Hospitalized patients often have higher rate of vitamin D deficiency than healthy people. Vitamin D levels below normal are associated with hospital stay, increased incidence of adverse prognosis and increased mortality of a number of diseases. Whether there is a relationship between vitamin D levels and infection or sepsis in the critically ill is still unclear. This study will explore the relationship between vitamin D levels and risk of infection, assessment for disease severity, and predictor of mortality. Methods To evaluate the value of vitamin D in intensive care unit （ICU） cases to sepsis, severity and prognosis assessment, high performance liquid chromatography and tandem mass spectrometry were used to measure the concentrations of vitamin D in sera of critically ill patients. The serum samples were drawn within the first 24 hours of ICU admission. Results The study included 206 people, 50 healthy controls, 51 ICU control patients and 105 ICU diagnosed with sepsis. critically ill ICU patients （ICU sepsis and ICU control group） had lower vitamin D concentration than normal people, but septic patients showed no significant reduction of vitamin D concentration when compared with critically ill patients with no positive etiological evidence. For assessment of disease severity, there were very low negative correlations between APACHE II, SAPS II and SOFA scores and vitamin D level. Additionally, patients of different 25-（OH）D levels showed no difference whether in terms of 28-day survival （χ2=1.78, P=0.776） or 90-day survival （χ2=4.12, P=0.369）. Multivariate Logistic regression demonstrated that APECHE II and SAPS II scores were independent risk factors to deaths caused by sepsis. Conclusion Clinically, serum concentration of vitamin D is not an indicator for diagnosis and assessment in critically ill patients （ClinicalTrial.gov identifier NCT01636232）.

关键词： 25-hydroxy vitamin D infection disease severity mortality critically ill sepsis

Clinical features and risk factors of severely and critically ill patients with COVID-19

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World Journal of Clinical Cases 2022年第3期10卷 840-855页

作者： Xin Chu Gui-Fang Zhang Yong-Ke Zheng Yi-Gang Zhong Li Wen Ping Zeng Chun-Yi Fu Xun-Liang Tong Yun-Fei Long Jing Li Ya-Lin Liu Zhi-Gang Chang Huan Xi Department of Surgical Intensive Care Medicine Beijing HospitalNational Center of GerontologyInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijing 100730China The Key Laboratory of Geriatrics Beijing Institute of GeriatricsInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijing Hospital/National Center of Gerontology of National Health CommissionBeijing 100730China Department of Intensive Care Unit Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhou 310006Zhejiang ProvinceChina Department of Cardiology Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhou 310006Zhejiang ProvinceChina Department of Emergency Beijing HospitalNational Center of GerontologyInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijing 100730China Department of Respiratory and Critical Care Medicine Beijing HospitalNational Center of GerontologyInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijing 100730China Department of Neurology Beijing HospitalNational Center of GerontologyInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijing 100730China Department of Cardiology Beijing HospitalNational Center of GerontologyInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijing 100730China Department of Geriatrics Beijing HospitalNational Center of GerontologyNational Health CommissionInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijing 100730China

BACKGROUND As of June 1,2020,over 370000 coronavirus disease 2019(COVID-19)deaths have been reported to the World Health Organization.However,the risk factors for patients with moderate-to-severe or severe-to-critical COVID-19 remain unclear.AIM To explore the characteristics and predictive markers of severely and critically ill patients with COVID-19.METHODS A retrospective study was conducted at the B11 Zhongfaxincheng campus and E1-3 Guanggu campus of Tongji Hospital affiliated with Huazhong University of Science and Technology in Wuhan.Patients with COVID-19 admitted from 1st February 2020 to 8th March 2020 were enrolled and categorized into 3 groups:The moderate group,severe group and critically ill group.Epidemiological data,demographic data,clinical symptoms and outcomes,complications,laboratory tests and radiographic examinations were collected retrospectively from the hospital information system and then compared between groups.RESULTS A total of 126 patients were enrolled.There were 59 in the moderate group,49 in the severe group,and 18 in the critically ill group.Multivariate logistic regression analysis showed that age[odd ratio(OR)=1.055,95%(confidence interval)CI:1.099-1.104],elevated neutrophil-to-lymphocyte ratios(OR=4.019,95%CI:1.045-15.467)and elevated high-sensitivity cardiac troponin I(OR=10.126,95%CI:1.088-94.247)were high-risk factors.CONCLUSION The following indicators can help clinicians identify patients with severe COVID-19 at an early stage:age,an elevated neutrophil-to-lymphocyte ratio and high sensitivity cardiac troponin I.

关键词： COVID-19 SARS-CoV-2 critically ill Risk factors Aspartate transaminase Amino-terminal pro-brain natriuretic peptide Creatinine Calcium

Acute gastrointestinal injury in critically ill patients with COVID-19 in Wuhan,China

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World Journal of Gastroenterology 2020年第39期26卷 6087-6097页

作者： Jia-Kui Sun Ying Liu Lei Zou Wen-Hao Zhang Jing-Jing Li Yu Wang Xiao-Hua Kan Jiu-Dong Chen Qian-Kun Shi Shou-Tao Yuan Department of Intensive Care Unit Nanjing First HospitalNanjing Medical UniversityNanjing 210006Jiangsu ProvinceChina Department of Isolation Units Tongji HospitalHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina Department of Intensive Care Unit Lishui People's HospitalNanjing 211200Jiangsu ProvinceChina

BACKGROUND The coronavirus disease 2019(COVID-19)is spreading rapidly around the world.Most critically ill patients have organ injury,including acute respiratory distress syndrome,acute kidney injury,cardiac injury,or liver dysfunction.However,few studies on acute gastrointestinal injury(AGI)have been reported in critically ill patients with COVID-19.AIM To investigate the prevalence and outcomes of AGI in critically ill patients with COVID-19.METHODS In this retrospective study,demographic data,laboratory parameters,AGI grades,clinical severity and outcomes were collected.The primary endpoints were AGI incidence and 28-d mortality.RESULTS From February 10 to March 102020,83 critically ill patients out of 1314 patients with COVID-19 were enrolled.Seventy-two(86.7%)patients had AGI during hospital stay,of these patients,30 had AGI gradeⅠ,35 had AGI gradeⅡ,5 had AGI gradeⅢ,and 2 had AGI gradeⅣ.The incidence of AGI gradeⅡand above was 50.6%.Forty(48.2%)patients died within 28 days of admission.Multiple organ dysfunction syndrome developed in 58(69.9%)patients,and septic shock in 16(19.3%)patients.Patients with worse AGI grades had worse clinical variables,a higher incidence of septic shock and 28-d mortality.Sequential organ failure assessment(SOFA)scores(95%CI:1.374-2.860;Pcritically ill patients with COVID-19.SOFA scores,WBC counts,and duration of MV were risk factors for the development of AGI gradeⅡand above.Patients with worse AGI grades had a higher incidence of septic shock and 28-d mortality.

关键词： Gastrointestinal injury Organ dysfunction Septic shock critically ill COVID-19

Is correction of severe hypoalbuminemia necessary in the critically ill？

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Chinese Medical Journal 2008年第22期121卷 2360-2362页

作者： Joachim Boldt Department of Anesthesiology and Intensive Care Medicine Klinikum der Stadt Ludwigshafen Bremserstr. 79 D-67063 Ludwigshafen Germany

The rationale for using albumin in the critically ill intensive care unit （ICU） patient showing hypoalbuminemia is to increase colloid oncotic pressure （COP） to prevent extravasation of fluid from the intra- to the extravascular space. Correction of low albumin plasma levels is also justified by the role of albumin for binding and transportation of drugs and for its possibly beneficial role as an oxygen radical scavenger.

关键词： hypoalbuminemia critically ill volume replacement hydroxyethyl starch hypovolemia

Cytomegalovirus infection in non-immunocompromised critically ill patients:A management perspective

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World Journal of Virology 2024年第1期13卷 38-50页

作者： Madhura Bhide Omender Singh Prashant Nasa Deven Juneja Institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India Department of Critical Care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates

critically ill patients are a vulnerable group at high risk of developing secondary infections.High disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections,including cytomegalovirus(CMV).CMV seroconversion has been reported in up to 33%of ICU patients,but its impact on patient outcomes remains a matter of debate.Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/acquired immuno deficiency syndrome,the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous.Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement.Hence,a better understanding of the symptomatology,diagnostics,and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.

关键词： Cytomegalovirus critically ill Immunocompetent Intensive care unit Virus

Role of cerebrospinal fluid lactate in diagnosing meningitis in critically ill patients

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World Journal of Critical Care Medicine 2023年第1期12卷 1-9页

作者： Devraj Yadav Omender Singh Deven Juneja Amit Goel Sahil Kataria Anisha Beniwal Institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India

BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity.Early diagnosis and specific treatment may improve outcomes.Lack of specific clinical signs or tests make the diagnosis challenging.AIM To assess the efficacy of cerebrospinal fluid(CSF)lactate in diagnosing meningitis in critically ill patients.METHODS A prospective,observational cohort study was carried out in a neuro-medical intensive care unit(ICU)over a 22 mo period.Adult patients,with suspected meningitis admitted in ICU,were serially recruited.Patients who refused consent,those with peripheral sensorineural deficit,or with any contraindication to lumber puncture were excluded.CSF cytology,bio-chemistry,lactates,culture and polymerase chain reaction based meningo-encephalitis panel were evaluated.Patients were divided in two groups based on clinical diagnosis of meningitis.The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests.RESULTS Seventy-one patients were included and 23 were diagnosed with meningitis.The mean values of CSF total leucocyte count(TLC),proteins and lactates were significantly higher in meningitis group.There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel.CSF lactate(>2.72 mmol/L)showed good accuracy in diagnosing meningitis with an area under the curve of 0.81(95% confidence interval:0.69-0.93),sensitivity of 82.6%,and specificity 72.9%.These values were comparable to those of CSF TLC and protein.Twelve patients with bacterial meningitis had significantly higher CSF lactate(8.9±4.7 mmol/L)than those with non-bacterial meningitis(4.2±3.8 mmol/L),P=0.006.CONCLUSION CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients.CSF lactate(>2.72 mmol/L)showed good accuracy,sensitivity,and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.

关键词： Encephalitis Cerebrospinal fluid critically ill CSF lactates Meningitis

Role of bronchoscopy in critically ill patients managed in intermediate care units - indications and complications: A narrative review

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World Journal of Critical Care Medicine 2021年第6期10卷 334-344页

作者： Vincenzo G Menditto Federico Mei Benedetta Fabrizzi Martina Bonifazi Department of Emergency Medicine Azienda Ospedaliero-Universitaria Ospedali Riuniti di AnconaAncona 60126Italy Respiratory Diseases Unit Azienda Ospedaliero-Universitaria Ospedali Riuniti di AnconaAncona 60126Italy Cystic Fibrosis Regional Reference Center Azienda Ospedaliero-Universitaria Ospedali Riuniti di AnconaAncona 60126Italy Department of Biomedical Sciences and Public Health Marche Polytechnic UniversityAncona 60126Italy

Flexible bronchoscopy(FB)has become a standard of care for the triad of inspection,sampling,and treatment in critical care patients.It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit(ICU).Less is known about its role outside the ICU,particularly in the intermediate care unit(IMCU),a specialized environment,where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided.In the IMCU,the leading indications for a diagnostic work-up are:To visualize airway system/obstructions,perform investigations to detect respiratory infections,and identify potential sources of hemoptysis.The main procedures for therapeutic purposes are secretion aspiration,mucus plug removal to solve atelectasis(total or lobar),and blood aspiration during hemoptysis.The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients.Serious adverse events related to FB are relatively uncommon,but they may be due to lack of expertise or appropriate precautions.Finally,nowadays,during dramatic recent coronavirus disease 2019(COVID-19)pandemic,the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined.Hence,we provide a concise review on the role of FB in an IMCU setting,focusing on its indications,technical aspects and complications.

关键词： Flexible bronchoscopy critically ill Bronchoalveolar lavage Indication Complication COVID-19

A Review of Location Methods of Nasogastric Tube in critically ill Patients

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Open Journal of Nursing 2020年第10期10卷 943-951页

作者： Mengqi Duan Xiangwei Chen Xiuqun Qin Qiuju Liang Wanqiu Dong Yang Zhang Jinxiang Lin Department of Pediatrics Intensive Care Unit The Third Affiliated Hospital of Sun Yat-sen University Guangzhou China Department of Medical Oncology The Third Affiliated Hospital of Sun Yat-sen University Guangzhou China

Nasogastric tube is widely used in intensive care units. The complications of misplacement are rare but very dangerous for critically ill patients. Accurate localization of the position of the tip of nasogastric tube can effectively decrease complications and ensure the safety of critically ill patients. There are various methods that can be used to verify the location of the nasogastric tube such as radiography, PH measurement, electromagnetic navigator and ultrasound. However, there is a lack of general consensus regarding a standard method. In this review, we found that the accuracy of nasogastric tube placement can be greatly improved by visual technology such as X-ray, sonography and electromagnetic navigator. However, visual technology has not been widely used to locate the tip of nasogastric tube in critically ill patients. Best practice guidelines based on the available knowledge and evidence of current methods are necessary to increase the accuracy placement of nasogastric tube. It is envisioned that development of visual technologies will determine a new standard of care for verification of placement of nasogastric tube.

关键词： critically ill Nasogastric Tube Placement Visualization