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Nasogastric tube syndrome:A Meta-summary of case reports

World Journal of Clinical Cases 2024年第1期12卷 119-129页

作者： Deven Juneja Prashant Nasa Gunjan Chanchalani Ravi Jain department of critical care Medicine Max Super Speciality HospitalNew Delhi 110017India department of critical care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates department of critical care Medicine Karamshibhai Jethabhai Somaiya Hospital and Research CentreMumbai 400022India department of critical care Medicine Mahatma Gandhi Medical College and HospitalJaipur 302022RajasthanIndia

BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its placement are often underes-timated.Upper airway obstruction with a NGT is an uncommon but potentially life-threatening complication.NGT syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually bilateral.It is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway obstruction.However,fewer cases may have been reported than might have occurred,primarily due to the clinicians'unawareness.The lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite challenging.AIM To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway obstruction.METHODS We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://***/)and Google scholar,from all the past studies till August 2023.The search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further prepared.RESULTS Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our search.There was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 years.Ten patients had diabetes mellitus(37.04%),and nine were hypertensive(33.33%).Only three(11.11%)patients were reported to be immunocompromised.

关键词： Nasogastric tube Nasogastric tube syndrome Ryle’s tube Sofferman syndrome Vocal cord paralysis

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Clinical practice of sepsis-induced immunosuppression:Current immunotherapy and future options

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Chinese Journal of Traumatology 2024年第2期27卷 63-70页

作者： Fei Pei Bin Gu Shu-Min Miao Xiang-Dong Guan Jian-Feng Wu department of critical care Medicine The First Affiliated HospitalSun Yat-sen UniversityGuangzhou510080China Guangdong Clinical Research Center for critical care Medicine Guangzhou510080China

Sepsis is a potentially fatal condition characterized by the failure of one or more organs due to a disordered host response to infection.The development of sepsis is closely linked to immune dysfunction.As a result,immunotherapy has gained traction as a promising approach to sepsis treatment,as it holds the potential to reverse immunosuppression and restore immune balance,thereby improving the prognosis of septic patients.However,due to the highly heterogeneous nature of sepsis,it is crucial to carefully select the appropriate patient population for immunotherapy.This review summarizes the current and evolved treatments for sepsis-induced immunosuppression to enhance clinicians'understanding and practical application of immunotherapy in the management of sepsis.

关键词： Sepsis Sepsis-induced immunosuppression Immunotherapy Enrichment Classifier

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Gastrointestinal manifestations of critical ill heatstroke patients and their associations with outcomes:A multicentre,retrospective,observational study

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World Journal of Gastroenterology 2024年第4期30卷 346-366页

作者： Yu-Cong Wang Xin-Yang Jin Zheng Lei Xiao-Jiao Liu Yu Liu Bang-Guo Zhang Jian Gong Lie-Tao Wang Lv-Yuan Shi Ding-Yuan Wan Xin Fu Lu-Ping Wang Ai-Jia Ma Yi-Song Cheng Jing Yang Min He Xiao-Dong Jin Yan Kang Bo Wang Zhong-Wei Zhang Qin Wu department of critical care Medicine West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina School of Pharmacy Macao University of Science and TechnologyMacao 999078China department of critical care Medicine The First People's Hospital of Ziyang CityZiyang 641399Sichuan ProvinceChina department of critical care Medicine The First People's Hospital of Guanghan CityChengdu 618399Sichuan ProvinceChina department of critical care Medicine Lezhi County Traditional Chinese Medicine HospitalChengdu 641599Sichuan ProvinceChina department of critical care Medicine Chengdu Qingbaijiang District People's HospitalChengdu 610399Sichuan ProvinceChina department of critical care Medicine Ziyang People's HospitalChengdu 641399Sichuan ProvinceChina

BACKGROUND Extreme heat exposure is a growing health problem,and the effects of heat on the gastrointestinal(GI)tract is unknown.This study aimed to assess the incidence of GI symptoms associated with heatstroke and its impact on outcomes.AIM To assess the incidence of GI symptoms associated with heatstroke and its impact on outcomes.METHODS Patients admitted to the intensive care unit(ICU)due to heatstroke were included from 83 centres.Patient history,laboratory results,and clinically relevant outcomes were recorded at ICU admission and daily until up to day 15,ICU discharge,or death.GI symptoms,including nausea/vomiting,diarrhoea,flatulence,and bloody stools,were recorded.The characteristics of patients with heatstroke concomitant with GI symptoms were described.Multivariable regression analyses were performed to determine significant predictors of GI symptoms.RESULTS A total of 713 patients were included in the final analysis,of whom 132(18.5%)patients had at least one GI symptom during their ICU stay,while 26(3.6%)suffered from more than one symptom.Patients with GI symptoms had a significantly higher ICU stay compared with those without.The mortality of patients who had two or more GI symptoms simultaneously was significantly higher than that in those with one GI symptom.Multivariable logistic regression analysis revealed that older patients with a lower GCS score on admission were more likely to experience GI symptoms.CONCLUSION The GI manifestations of heatstroke are common and appear to impact clinically relevant hospitalization outcomes.

关键词： Extreme heat Flatulence Sunstroke Intensive care units Diarrhea

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Early systemic anticoagulation reduces hospital readmission in acute necrotizing pancreatitis patients:A retrospective cohort study

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 77-82页

作者： Wen-Jian Mao Jing Zhou Guo-Fu Zhang Fa-Xi Chen Jing-Zhu Zhang Bai-Qiang Li Lu Ke Wei-Qin Li department of critical care Medicine Jinling HospitalNanjing Medical UniversityNanjing 210002China department of critical care Medicine Jinling HospitalMedical School of Nanjing UniversityNanjing 210002China National Institute of healthcare Data Science Nanjing UniversityNanjing 210010China

Background:Early systemic anticoagulation(SAC)is a common practice in acute necrotizing pancreatitis(ANP),and its impact on in-hospital clinical outcomes had been assessed.However,whether it affects long-term outcomes is unknown.This study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP patients.Methods:During January 2013 and December 2018,ANP patients admitted within 7 days from the onset of abdominal pain were screened.The primary outcome was 90-day readmission after discharge.Cox proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day readmission.Results:A total of 241 ANP patients were enrolled,of whom 143 received early SAC during their hospitalization and 98 did not.Patients who received early SAC experienced a lower incidence of splanchnic venous thrombosis(SVT)[risk ratio(RR)=0.40,95%CI:0.26-0.60,P<0.01]and lower 90-day readmission with an RR of 0.61(95%CI:0.41-0.91,P=0.02)than those who did not.For the quality of life,patients who received early SAC had a significantly higher score in the subscale of vitality(P=0.03)while the other subscales were all comparable between the two groups.Multivariable Cox regression model showed that early SAC was an independent protective factor for 90-day readmission after adjusting for potential confounders with a hazard ratio of 0.57(95%CI:0.34-0.96,P=0.04).Mediation analysis showed that SVT mediated 37.0%of the early SAC-90-day readmission causality.Conclusions:The application of early SAC may reduce the risk of 90-day readmission in the survivors of ANP patients,and reduced SVT incidence might be the primary contributor.

关键词： Anticoagulation Splanchnic venous thrombosis Acute necrotizing pancreatitis Readmission Long-term outcomes

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Atherosis-associated lnc_000048 activates PKR to enhance STAT1-mediated polarization of THP-1 macrophages to M1 phenotype

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Neural Regeneration Research 2024年第11期19卷 2488-2498页

作者： Yuanyuan Ding Yu Sun Hongyan Wang Hongqin Zhao Ruihua Yin Meng Zhang Xudong Pan Xiaoyan Zhu department of Neurology The Affiliated Hospital of Qingdao UniversityQingdaoShandong ProvinceChina Qingdao Cadre health care Service Center The Affiliated Hospital of Qingdao UniversityQingdaoShandong ProvinceChina department of critical care Medicine The Affiliated Hospital of Qingdao UniversityQingdaoShandong ProvinceChina

Our previous study has demonstrated that lnc_000048 is upregulated in large-artery atherosclerotic stroke and promotes atherosclerosis in ApoE^(-/-)mice.However,little is known about the role of lnc_000048 in classically activated macrophage(M1)polarization.In this study,we established THP-1-derived testing state macrophages(M0),M1 macrophages,and alternately activated macrophages(M2).Real-time fluorescence quantitative PCR was used to verify the expression of marker genes and the expression of lnc_000048 in macrophages.Flow cytometry was used to detect phenotypic proteins(CD11b,CD38,CD80).We generated cell lines with lentivirus-mediated upregulation or downregulation of lnc_000048.Flow cytometry,western blot,and real-time fluorescence quantitative PCR results showed that down-regulation of lnc_000048 reduced M1 macrophage polarization and the inflammation response,while over-expression of lnc_000048 led to the opposite effect.Western blot results indicated that lnc_000048 enhanced the activation of the STAT1 pathway and mediated the M1 macrophage polarization.Moreover,catRAPID prediction,RNA-pull down,and mass spectrometry were used to identify and screen the protein kinase RNA-activated(PKR),then catRAPID and RPIseq were used to predict the binding ability of lnc_000048 to PKR.Immunofluorescence(IF)-RNA fluorescence in situ hybridization(FISH)double labeling was performed to verify the subcellular colocalization of lnc_000048 and PKR in the cytoplasm of M1 macrophage.We speculate that lnc_000048 may form stem-loop structure-specific binding and activate PKR by inducing its phosphorylation,leading to activation of STAT1 phosphorylation and thereby enhancing STAT1 pathway-mediated polarization of THP-1 macrophages to M1 and inflammatory factor expression.Taken together,these results reveal that the lnc_000048/PKR/STAT1 axis plays a crucial role in the polarization of M1 macrophages and may be a novel therapeutic target for atherosclerosis alleviation in stroke.

关键词： atherosclerosis inflammation lnc_000048 lncRNA macrophage polarization protein kinase RNA-activated(PKR) STAT1

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Prognostic value of time-varying dead space estimates in mechanically ventilated patients with acute respiratory distress syndrome

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Journal of Intensive Medicine 2024年第2期4卷 187-193页

作者： Lianlian Jiang Hui Chen Jianfeng Xie Ling Liu Yi Yang Jiangsu Provincial Key Laboratory of critical care Medicine Department of Critical Care MedicineZhongda HospitalSchool of MedicineSoutheast UniversityNanjingJiangsuChina department of critical care Medicine The First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouJiangsuChina

Background The dead space fraction(VD/VT)has proven to be a powerful predictor of higher mortality in acute respiratory distress syndrome(ARDS).However,its measurement relies on expired carbon dioxide,limiting its widespread application in clinical practice.Several estimates employing routine variables have been found to be reliable substitutes for direct measurement of VD/VT.In this study,we evaluated the prognostic value of these dead space estimates obtained in the first 7 days following the initiation of ventilation.Methods This retrospective observational study was conducted using data from the Chinese database in intensive care(CDIC).Eligible participants were adult ARDS patients receiving invasive mechanical ventilation while in the intensive care unit between 1st January 2014 and 31st March 2021.We collected data during the first 7 days of ventilation to calculate various dead space estimates,including ventilatory ratio(VR),corrected minute ventilation(V_(Ecorr)),VD/VT(Harris–Benedict),VD/VT(Siddiki estimate),and VD/VT(Penn State estimate)longitudinally.A time-dependent Cox model was used to handle these time-varying estimates.Results A total of 392 patients(median age 66[interquartile range:55–77]years,median SOFA score 9[interquartile range:7–12])were finally included in our analysis,among whom 132(33.7%)patients died within 28 days of admission.VR(hazard ratio[HR]=1.04 per 0.1 increase,95%confidence interval[CI]:1.01 to 1.06;P=0.013),V_(Ecorr)(HR=1.08 per 1 increase,95%CI:1.04 to 1.12;P1.3,V_(Ecorr)>7.53,and VD/VT(Harris–Benedict)>0.59 was independently

关键词： Acute respiratory distress syndr ome Mechanical ventilation Dead space 28-day mortality

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Fangji Fuling Decoction Alleviates Sepsis by Blocking MAPK14/FOXO3A Signaling Pathway

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Chinese Journal of Integrative Medicine 2024年第3期30卷 230-242页

作者： WANG Yi CHEN Ming-qi DAI Lin-feng ZHANG Hai-dong WANG Xing department of critical care Medicine Changzhou Hospital of Traditional of Chinese Medicine Affiliated to Nanjing University of Chinese MedicineChangzhouJiangsu Province213000China department of critical care Medicine Jiangsu Province Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese MedicineNanjing210029China

Objective:To examine the therapeutic effect of Fangji Fuling Decoction(FFD) on sepsis through network pharmacological analysis combined with in vitro and in vivo experiments.Methods:A sepsis mouse model was constructed through intraperitoneal injection of 20 mg/kg lipopolysaccharide(LPS).RAW264.7 cells were stimulated by 250 ng/m L LPS to establish an in vitro cell model.Network pharmacology analysis identified the key molecular pathway associated with FFD in sepsis.Through ectopic expression and depletion experiments,the effect of FFD on multiple organ damage in septic mice,as well as on cell proliferation and apoptosis in relation to the mitogen-activated protein kinase 14/Forkhead Box O 3A(MAPK14/FOXO3A) signaling pathway,was analyzed.Results:FFD reduced organ damage and inflammation in LPS-induced septic mice and suppressed LPS-induced macrophage apoptosis and inflammation in vitro(P<0.05).Network pharmacology analysis showed that FFD could regulate the MAPK14/FOXO signaling pathway during sepsis.As confirmed by in vitro cell experiments,FFD inhibited the MAPK14 signaling pathway or FOXO3A expression to relieve LPS-induced macrophage apoptosis and inflammation(P<0.05).Furthermore,FFD inhibited the MAPK14/FOXO3A signaling pathway to inhibit LPS-induced macrophage apoptosis in the lung tissue of septic mice(P<0.05).Conclusion:FFD could ameliorate the LPS-induced inflammatory response in septic mice by inhibiting the MAPK14/FOXO3A signaling pathway.

关键词： sepsis Fangji Fuling Decoction mitogen-activated protein kinase 14/Forkhead Box O 3A signaling pathway inflammatory response apoptosis lung injury Chinese medicine

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Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China

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Journal of Intensive Medicine 2024年第2期4卷 137-159页

作者： Xiangdong Guan Dechang Chen Yuan Xu Chinese Society of critical care Medicine department of critical care Medicine The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina department of critical care Medicine Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina department of critical care Medicine Beijing Tsinghua Changgung HospitalBeijingChina 不详

The Chinese Society of critical care Medicine(CSCCM)has developed clinical practice guidelines for nutrition assessment and monitoring for patients in adult intensive care units(ICUs)in China.This guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill patients.This guideline was developed by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough review of the system and a summary of relevant trials or studies published from 2000 to July 2023.A total of 18 recommendations were formed and consensus was reached through discussions and reviews by expert groups in critical care medicine,parenteral and enteral nutrition,and surgery.The recommendations are based on currently available evidence and cover several key fields,including screening and assessment,evaluation and assessment of enteral feeding intolerance,metabolic and nutritional measurement and monitoring during nutrition therapy,and organ function evaluation related to nutrition supply.Each question was analyzed according to the Population,Intervention,Comparison,and Outcome(PICO)principle.In addition,interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value.The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3–5 years.

关键词： adults critical illness Intensive care unit Nutriti on Nutriti on assessment and monitoring Guideline Recommendations Chinese Society of critical care Medicine-Chinese Medical Association(CSCCM-CMA)

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Early prediction and prevention of infected pancreatic necrosis

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World Journal of Gastroenterology 2024年第9期30卷 1005-1010页

作者： Cheng Lv Zi-Xiong Zhang Lu Ke department of critical care Medicine Jinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjing 210000Jiangsu ProvinceChina Research Institute of critical care Medicine and Emergency Rescue Nanjing UniversityNanjing 210000Jiangsu ProvinceChina

Approximately 20%-30%of patients with acute necrotizing pancreatitis develop infected pancreatic necrosis(IPN),a highly morbid and potentially lethal complication.Early identification of patients at high risk of IPN may facilitate appropriate preventive measures to improve clinical outcomes.In the past two decades,several markers and predictive tools have been proposed and evaluated for this purpose.Conventional biomarkers like C-reactive protein,procalcitonin,lymphocyte count,interleukin-6,and interleukin-8,and newly developed biomarkers like angiopoietin-2 all showed significant association with IPN.On the other hand,scoring systems like the Acute Physiology and Chronic health Evaluation II and Pancreatitis Activity Scoring System have also been tested,and the results showed that they may provide better accuracy.For early prevention of IPN,several new therapies were tested,including early enteral nutrition,anti-biotics,probiotics,immune enhancement,etc.,but the results varied.Taken together,several evidence-supported predictive markers and scoring systems are readily available for predicting IPN.However,effective treatments to reduce the incidence of IPN are still lacking apart from early enteral nutrition.In this editorial,we summarize evidence concerning early prediction and prevention of IPN,providing insights into future practice and study design.A more homo-geneous patient population with reliable risk-stratification tools may help find effective treatments to reduce the risk of IPN,thereby achieving individualized treatment.

关键词： Acute pancreatitis Infected pancreatic necrosis Biomarker Scoring system Nutrition therapy Selective digestive decontamination Probiotics Antibiotics Immune enhancement therapy

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Effect of norepinephrine on host immunity and bacterial infection

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Chinese Medical Journal 2024年第3期137卷 362-364页

作者： Jia Wang Zhiyao Fang Xue Dong Wenwen Li Xianyao Wan department of critical care Medicine The First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning 116021China

To the Editor:Norepinephrine(NE),which belongs to the catecholamine family,is increasingly produced by the sympathetic nervous system and adrenal medulla when the host is under stress.It has been demonstrated that NE has a significant anti-inflammatory effect.In addition,increasing evidence has indicated that stress hormones are directly involved in the interaction between bacteria and the host.A variety of bacteria can exhibit changes in growth,virulence,and biofilm by high concentrations of NE.Therefore,this article aimed to summarize the main research developments regarding the effects of NE on host immunity and bacterial infection,as well as the attendant molecular mechanisms[Figure 1].

关键词： effect. Figure stress

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