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Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis:a retrospective analysis from the MIMIC-IV database

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Burns & Trauma 2022年第1期10卷 283-293页

作者： Zhi-ye Zou Jia-jia Huang Ying-yi Luan Zhen-jia Yang Zhi-peng Zhou Jing-jing Zhang Yong-ming Yao Ming Wu Department of Critical Care Medicine and Hospital Infection Prevention and Control Shenzhen Second People’s Hospital&First Affiliated Hospital of Shenzhen UniversityShenzhen 518035China Postgraduate Education Shantou University Medical CollegeShantou 515041China Department of Central Laboratory Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijing 100026China Trauma Research Center Medical Innovation Research Department and Fourth Medical Center of the Chinese PLA General HospitalBeijing 100048China Guangxi University of Chinese Medicine Nanning 530200China

Background:Minimal data exist on anticoagulation use and timing and the dose of heparin in patients with sepsis,and whether heparin use improves sepsis survival remains largely *** study was performed to assess whether heparin administration would provide a survival advantage in critically ill patients with ***:A retrospective cohort study of patients with sepsis in the Medical Information Mart for Intensive Care(MIMIC)-IV database was *** proportional hazards model and propensity score matching(PSM)were used to evaluate the outcomes of prophylactic anticoagulation with heparin administered by subcutaneous injection within 48 h of intensive care unit(ICU)*** primary outcome was in-hospital *** outcomes included 60-day mortality,length of ICU stay,length of hospital stay and incidence of acute kidney injury(AKI)on day *** analysis were used for unmeasured ***:A total of 6646 adult septic patients were included and divided into an early prophylactic heparin group(n=3211)and a nonheparin group(n=3435).In-hospital mortality in the heparin therapy group was significantly lower than that in the nonheparin group(prematched 14.7 vs 20.0%,hazard ratio(HR)0.77,95%confidence interval(CI)[0.68-0.87],ppatients in different adjusted covariates(HR 0.71-0.78,ppatients with sepsis-induced coagulopathy,septic shock,sequential organ failure assessment score≥10,A

关键词： Early prophylactic anticoagulation Heparin Mortality Sepsis critically ill patients

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Modified B-ultrasound method for measurement of antral section only to assess gastric function and guide enteral nutrition in critically ill patients

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World Journal of Gastroenterology 2017年第28期23卷 5229-5236页

作者： Ying Liu Ya-Kun Gao Lei Yao Li Li Department of Ultrasound Cangzhou Central Hospital

AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patients. METHODS First,30 healthy volunteers were selected. The modified B-ultrasound method and the traditional B-ultrasound method were applied to assess gastric function. The correlation of indices of gastric function between the two groups was analyzed statistically. In addition,64 critically ill patients were selected,and the modified B-ultrasound method and the gastric juice withdrawal method were applied to guide the implementation of EN. Daily caloric value,the time required to achieve complete EN,ICU stay,hospitalization time,and serum prealbumin and albumin levels were recorded and compared between the two groups. Kaplan-Meier survival curve was used to compare the complications of EN between the two groups. RESULTS In healthy subjects,there was a good correlation among gastric emptying time,antral contraction frequency andantral motility index between the two groups(r = 0.57,0.61 and 0.54,respectively). The study on critically ill patients also revealed that a better effect of EN was achieved in the modified B-ultrasound method group,in which patients had shorter ICU stay and hospitalization time and higher levels of serum prealbumin and albumin. The Kaplan-Meier survival analysis revealed that the improved B-ultrasound method was associated with significantly fewer EN complications(P = 0.031).CONCLUSION The modified B-ultrasound method can provide a good real-time assessment of gastric function and has a better effect than the traditional method in guiding EN in critically ill patients.

关键词： Gastric emptying Real-time ultrasound critically ill patients Enteral nutrition

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Pharmacodynamic profiling of optimal sulbactam regimens against carbapenem-resistant Acinetobacter baumannii for critically ill patients

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Asian Pacific Journal of Tropical Biomedicine 2018年第1期8卷 14-18页

作者： Weerayuth Saelim Wichai Santimaleeworagun Sudaluck Thunyaharn Dhitiwat Changpradub Piraporn Juntanawiwat Department of Pharmacy Faculty of Pharmacy Silpakorn University The College of Pharmacotherapy of Thailand The Pharmacy Council Antibiotic Optimization and Patient Care Project by Pharmaceutical Initiative for Resistant Bacteria and Infectious Diseases Working Group Faculty of Medical Technology Nakhonratchasima College Division of Infectious Diseases Department of Medicine Phramongkutklao Hospital Division of Microbiology Department of Clinical Pathology Phramongkutklao Hospital

Objective: To study the minimum inhibitory concentration(MIC) of sulbactam against carbapenem-resistant Acinetobacter baumannii(CR-AB) and to determine the dosage regimens reaching target time of free drug concentration remaining above the MIC(f T>MIC). Methods: Clinical isolates of CR-AB from patients admitted to Phramongkutklao Hospital, Thailand from January 2014 to December 2015 were obtained. The MIC of sulbactam for each CR-AB isolate was determined using the agar dilution method. Each sulbactam regimen was simulated using the Monte Carlo technique to calculate the probability of target attainment(PTA) and the cumulative fraction of response(CFR) in critically ill patients. PTA was defined by how likely a specific drug dose was to reach 40% and 60% f T>MIC. The CFR was the probability of drug dose covering the MIC range of CR-AB. Dosing regimens reaching above 80% of PTA and CFR, were considered as the optimal dosage for documented and empirical therapy, respectively. Results: A total of 118 CR-AB isolates were included in the study. The percentile at the fiftieth and ninetieth MIC of sulbactam were 64 and 192 μg/m L, respectively. For a MIC of sulbactam of 4 μg/m L, all dosage regimens achieved PTA target. However, only a sulbactam dosage of 12 g intravenous daily using 2-4 h infusion or continuous infusion that covered for isolates with a sulbactam MIC of 96 μg/m L, met the PTA or CFR targets. Conclusions: The MIC of sulbactam against CR-AB is quite high. The sulbactam dose of 12 g/day using prolonged infusion was required to achieve the target f T>MIC for CR-AB treatment.

关键词： Acinetobacter baumannii critically ill patients Monte Carlo simulation MIC

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Predicting critically ill patients Short-Term Mortality Risk Using Routinely Collected Data:Deep Learning Model Development,Validation,and Explanation

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Journal of Systems Science and Information 2023年第3期11卷 365-377页

作者： Shangping ZHAO Pan LIU Guohui LI Yanming GUO Guanxiu TANG Laboratory for Big Data and Decision National University of Defense TechnologyChangsha 410003China Department of Critical Care Medicine the Third Xiangya HospitalCentral South UniversityChangsha 410013China Nursing Department the Third Xiangya HospitalCentral South UniversityChangsha 410013China

This paper aims to develop and validate a deep learning-based short-term mortality risk prediction model for critically ill patients by using routinely collected data in a large Chinese cohort and explore the explainability of the model decision.A total of 10925 critically ill patients between January 2014 and June 2020 are included in this *** routinely collected in the electronic health records(EHRs)system are extracted and used to develop a short-term mortality risk prediction model based on a deep artificial neural network(ANN).The features include demographic characteristics,vital signs,laboratory tests,and the daily dose of intravenous *** developed deep learning model(AUROC:0.88,AUPRC:0.63,Brier score:0.108)is superior to the model based on APACHEⅡscores(AUROC:0.78,AURPC:0.52,Brier score:0.124)in the prediction of hospital mortality for critically ill *** attribution analysis based on the integrated gradients method shows that measurements observed at a later time seem to have a more significant influence on mortality,while earlier usage of amiodarone or dexmedetomidine contributed to lower *** well-performing and interpretable model may have practical implications for improving the quality of care for critically ill patients.

关键词： critically ill patients deep learning artificial neural network mortality prediction APACHEⅡ

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Rifaximin discontinuation during broad-spectrum antibiotic treatment in critically ill patients with hepatic encephalopathy

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World Journal of Hepatology 2024年第11期16卷 1356-1360页

作者： Lorenzo Ridola Alessandro Mari Department of Medical and Surgical Sciences and Biotechnologies Sapienza University of RomePolo PontinoRome 00185Italy

Hepatic encephalopathy(HE)is one of the main complications of cirrhosis,characterized by a wide spectrum of neuropsychiatric alterations that lead to an increase in mortality,morbidity and recurrent *** to the central role in HE pathogenesis of ammonia and other neurotoxins primarily produced by the gut microbiota,the main therapeutic approaches for the treatment of HE are based on the modulation of the gut *** is a non-absorbable broad-spectrum antibiotic,that is effective against ammonia-producing grampositive,gram-negative,and anaerobic species,approved for the treatment of HE in secondary *** chronic administration of rifaximin in this setting is associated with a lower risk of HE recurrence and mortality,while the role of rifaximin for the treatment of an overt-HE episode in inpatients is still *** data exist about the coadministration of rifaximin and broad-spectrum antibiotics commonly used to treat concomitant infections,as patients receiving or recently treated with antibiotics were frequently excluded from clinical *** this editorial we comment on the article by Ward et al published in the recent issue of the World Journal of *** is a single center,retrospective,quasiexperimental,pharmacist-driven protocol,with the aim to evaluate the feasibility and safety of rifaximin discontinuation in critically ill patients with HE and chronic liver disease receiving broad-spectrum antibiotic therapies in intensive care *** study revealed no differences between the protocol and control group in terms of primary outcome(days alive and free of delirium and coma to day 14)and secondary outcomes which include:Intensive care mortality,intensive care length of stay,intravenous vasopressor requirement changes and adverse effects ***,rifaximin discontinuation during broad-spectrum antibiotic therapy does not appear to negatively impact the clinical status of critically ill liver patient

关键词： Hepatic encephalopathy Rifaximin discontinuation Broad-spectrum antibiotics critically ill patients Intensive care unit

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Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult critically ill patients

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Yangtze Medicine 2024年第1期8卷 8-19页

作者： Yujiao Yan Jing Wu Juan Liu Yanting Yuan Lixin Liu Huaxin Ye Juan Ding Nursing Department of Hubei Aerospace Hospital Xiaogan China School of Stomatology Hubei Vocational and Technical College Xiaogan China Department of Medicine Yangtze University Jingzhou China

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

关键词： critically ill patients Airway Management Be Evidence-Based Quality Control Circle Intensive Care Unit (ICU)

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Immunomodulatory therapy for the management of critically ill patients with COVID-19:A narrative review

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World Journal of Critical Care Medicine 2022年第4期11卷 269-297页

作者： David Andaluz-Ojeda Pablo Vidal-Cortes Álvaro Aparisi Sanz Borja Suberviola Lorena Del Río Carbajo Leonor Nogales Martín Estefanía Prol Silva Jorge Nieto del Olmo JoséBarberán Ivan Cusacovich Department of Critical Care Hospital Universitario HM SanchinarroHospitales MadridMadrid 28050Spain Department of Intensive Care Complejo Hospitalario Universitario de OurenseOurense 32005Spain Department of Cardiology Hospital del MarBarcelona 08003Spain Department of Intensive Care Hospital Universitario Marqués de ValdecillaSantander 39008Spain Department of Intensive Care Hospital Clínico Universitario de ValladolidValladolid 47005Spain Department of Internal Medicine Hospital Universitario HM MontepríncipeHospitales MadridBoadilla del Monte 28860MadridSpain Department of Internal Medicine Hospital Clínico Universitario de ValladolidValladolid 47005Spain

BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the causative agent of the ongoing coronavirus disease 2019(COVID-19)*** the physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective *** To describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of hyperinflammation and abnormal immune responses to disease progression together with a complete narrative review of the different immunoadjuvant treatments used so far in COVID-19 and their indication in severe and life-threatening *** A comprehensive literature search was *** reviewed the selected manuscripts following the PRISMA recommendations for systematic review and meta-analysis documents and selected the most ***,a recommendation of the use of each treatment was established based on the level of evidence of the articles and documents *** recommendation was made based on the consensus of all the *** A brief rationale on the SARS-CoV-2 pathogenesis,immune response,and inflammation was *** usefulness of 10 different families of treatments related to inflammation and immunopathogenesis of COVID-19 was reviewed and ***,based on the level of scientific evidence,a recommendation was established for each of *** Although several promising therapies exist,only the use of corticosteroids and tocilizumab(or sarilumab in absence of this)have demonstrated evidence enough to recommend its use in critically ill patients with *** including both,clinical and biological characteristics can constitute specific targets for better select certain therapies based on an individualized approach to treatment.

关键词： COVID-19 critically ill patients Treatment Immunomodulary drugs Phenotype Immunosupression

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Glycated hemoglobin A1C and diabetes mellitus in critically ill patients

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World Journal of Emergency Medicine 2013年第3期4卷 201-204页

作者： Hai-yan Zhang Cai-jun Wu Chun-sheng Li Department of Emergency Medicine Shunyi HospitalChina Medical University Department of Emergency Medicine Chaoyang HospitalCapital Medical University

BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency *** its mechanism and prognosis have not been well *** this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the ***:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes *** glucose and HbA1 c were measured in all *** in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were ***:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,Ppatients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,Ppatients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes *** of hyperglycemia may vary among critically ill patients.

关键词： Glycosylated hemoglobin A1C Diabetes mellitus Hyperglycemia Prognosis critically ill patients

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Research on Nursing Effect of Individualized Nursing Intervention on critically ill patients with Continuous Blood Purification

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Journal of Clinical and Nursing Research 2023年第5期7卷 97-103页

作者： Daxing Shao The Fifth Affiliated Hospital of Sun Yat-sen University Zhuhai 519000Guangdong ProvinceChina

Objective:This paper aims to investigate the value of individualized care for critically ill patients receiving continuous blood purification ***:89 cases of critically ill patients who were treated from June 2021 to June 2023 were randomly divided into groups,with individualized care in group A and routine care in group *** differences in clinical indicators,purification effect,quality of life,and complications of blood purification were compared between the ***:Heart rate,respiration,body temperature,and other indicators in group A were better than those in group B,Pcritically ill patients,individualized nursing intervention can enhance the effect of blood purification,improve the physiological indicators of patients,and reduce the complications of blood purification,which is highly effective and feasible.

关键词： critically ill patients Continuous blood purification Individualized nursing Nursing value

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The intensity of organ support: Restrictive or aggressive therapy for critically ill patients

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Journal of Intensive Medicine 2023年第4期3卷 298-302页

作者： Hongxiang Li Yuting Li Yao Fu Xinyu Zhang Dong Zhang Department of Intensive Care Medicine The First Hospital of Jilin UniversityChangchun 130021JilinChina

The intensity of organ support has received attention in recent years. To make better clinical decisions, we should understand the mechanisms and benefits, and disadvantages of the different intensities of organ support in critically ill patients. Therapeutic strategies such as supplemental oxygen therapy, mechanical ventilation, respiratory stimulant, vasoactive agents, transfusion, albumin infusion, fluid management, renal placement, and nutrition support, if they are implemented in accordance with an aggressive strategy, could result in side effects and/or complications, resulting in iatrogenic harm in critically ill patients. It is found that the intensity of organ support is not a determining factor in prognosis. A normal rather than supernormal physiological target is recommended for support therapy.

关键词： critically ill patients Organ support Aggressive therapy Restrictive therapy Prognosis

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