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Central venous oxygen saturation changes as a reliable predictor of the change of CI in septic shock: To explore potential influencing factors

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中华创伤杂志(英文版) 2025年第01期

作者： An Ran Wan Xi-Xi Chen Yan Dong Run Wang Chun-Yao Jiang Wei Weng Li Du Bin Medical Intensive care Unit State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing China department of critical care Medicine The Second Affiliated Hospital of Jiaxing University Jiaxing Zhejiang province China

Purpose:Assessing fluid responsiveness relying on central venous oxygen saturation (ScvO2) yields varied outcomes across several studies. This study aimed to determine the ability of the change in ScvO2 (ΔScvO2) to detect fluid responsiveness in ventilated septic shock patients and potential influencing ***:In this prospective, single-center study, all patients conducted from February 2023 to January 2024 received fluid challenge. Oxygen consumption was measured by indirect calorimetry, and fluid responsiveness was defined as an increase in cardiac index (CI) ≥ 10% measured by transthoracic echocardiography. Multivariate linear regression analysis was conducted to evaluate the impact of oxygen consumption, arterial oxygen saturation, CI, and hemoglobin on ScvO2 and its change before and after fluid challenge. The Shapiro-Wilk test was used for the normality of continuous data. Data comparison between fluid responders and non-responders was conducted using a two-tailed Studentt-test, Mann Whitney U test, and Chi-square test. Pairedt-tests were used for normally distributed data, while the Wilcoxon signed-rank test was used for skewed data, to compare data before and after fluid ***:Among 49 patients (31 men, aged (59 ± 18) years), 27 were responders. The patients had an acute physiology and chronic health evaluation II score of 24 ± 8, a sequential organ failure assessment score of 11 ± 4, and a blood lactate level of (3.2 ± 3.1) mmol/L at enrollment. After the fluid challenge, the ΔScvO2 (mmHg) in the responders was greater than that in the non-responders (4 ± 6vs. 1 ± 3,p = 0.019). Multivariate linear regression analysis suggested that CI was the only independent influencing factor of ScvO2, withR2 = 0.063,p = 0.008. After the fluid challenge, the change in CI became the only contributing factor to ΔScvO2 (R2 = 0.245,p < 0.001). ΔScvO2 had a good discriminatory ability for the responders and non-responders with a threshold of 4.4% (area un

关键词： Septic shock ScvO2 Fluid responsiveness

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HSA-MIR-203/MyD88 axis mediates the protective effect of hispidulin on LPS-induced apoptosis in a human renal tubular epithelial line,HK-2

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BIOCELL 2022年第1期46卷 149-158页

作者： SICONG WANG RUIJIN LIU QIUYUAN HAN KAIJIANG YU department of critical care Medicine The Second Affiliated Hospital of Harbin Medical UniversityHarbin150001China department of critical care Medicine The Cancer Hospital of Harbin Medical UniversityHarbin150081China department of critical care Medicine The First Affiliated Hospital of Harbin Medical UniversityHarbin150001China

Acute kidney injury(AKI),commonly occurring as complications of sepsis,cardiac surgery,and liver or kidney transplantation,is a critical care *** is well known that lipopolysaccharide(LPS)shock is a common triggering factor for *** study is aimed to examine the effect of flavonoid compound hispidulin on LPS-induced *** this,renal tubular epithelial cell HK-2 was treated with LPS to establish an in vitro model of *** effect of hispidulin on HK-2 cell viability was examined using CCK-8 *** apoptosis was determined by TUNEL and flow *** marker proteins were determined by using western *** levels of pro-inflammatory cytokines were determined by ELISA assay and *** translocation of NF-κB was determined by western *** effect of MyD88 on the cytoprotective activities of hispidulin was examined by overexpressing MyD88 in HK-2 *** results showed that hispidulin was not able to produce a cytotoxic effect on HK-2 cells at tested ***,hispidulin could protect HK-2 cells from LPS-induced cell *** results also showed that hispidulin was able to attenuate LPS-induced HK-2 cell *** addition,LPS led to an inflammatory response in HK-2 cells,evidenced by NF-κB p65 activation as well as increased expression and release of inflammatory cytokine IL-6 and TNF-α,which could be reversed by pretreatment with *** MyD88 was found to significantly dampen the cytoprotective activities of hispidulin against LPS *** importantly,MyD88 was identified as a direct target of hsa-miR-203,and hispidulin was found to regulate the expression of MyD88 via upregulating *** results showed that hispidulin attenuates LPS-induced HK-2 damage via regulating hsa-miR-203/MyD88 axis.

关键词： Hispidulin LPS HK-2 hsa-miR-203 MyD88

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Management of gastrointestinal bleed in the intensive care setting,an updated literature review

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World Journal of critical care Medicine 2025年第1期14卷 20-41页

作者： Vignesh K Nagesh Sai Priyanka Pulipaka Ruchi Bhuju Emelyn Martinez Shruthi Badam Gomathy Aarthy Nageswaran Hadrian Hoang-Vu Tran Daniel Elias Charlene Mansour Jaber Musalli Sanket Bhattarai Lokeash Subramani Shobana Tannishtha Sethi Ritvik Sethi Namrata Nikum Chinmay Trivedi Amer Jarri Colin Westman Nazir Ahmed Shawn Philip Simcha Weissman Jonathan Weinberger Ayrton I Bangolo department of Internal Medicine Palisades Medical CenterNorth BergenNJ 07047United States department of Internal Medicine University of Arkansas for Medical SciencesLittle RockAR 72205United States department of Internal Medicine Hackensack Palisades Medical CenterNorth BergenNJ 07047United States department of Gastroenterology Hackensack University Medical CenterHackensackNJ 07061United States department of Pulmonology and critical care HCA Florida Bayonet Point HospitalHudsonFL 34667United States department of Hematology&Oncology John Theurer Cancer Center at Hackensack University Medical CenterHackensackNJ 07601United States

Gastrointestinal(GI)bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit(ICU).This literature review consolidates current insights on the epidemiology,etiology,management,and outcomes of GI bleeding in critically ill *** bleeding remains a significant concern,especially among patients with underlying risk factors such as coagulopathy,mechanical ventilation,and renal *** GI bleeding in the ICU requires a multidisciplinary approach,including resuscitation,endoscopic intervention,pharmacologic therapy,and sometimes surgical *** with enhanced management strategies,GI bleeding in the ICU is associated with considerable morbidity and mortality,particularly when complicated by multi-organ *** review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients,aiming to enhance survival rates and improve the quality of care within the ICU setting.

关键词： Gastrointestinal bleed Varices Variceal bleeding Diverticular bleed Angiodysplasia Ulcer Hemorrhoids Endoscopy Enteroscopy Embolization

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Effects of viral infection and microbial diversity on patients with sepsis:A retrospective study based on metagenomic next-generation sequencing

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World Journal of Emergency Medicine 2021年第1期12卷 29-35页

作者： Li-wei Duan Jin-long Qu Jian Wan Yong-hua Xu Yi Shan Li-xue Wu Jin-hao Zheng Wei-wei Jiang Qi-tong Chen Yan Zhu Jian Zhou Wen-bo Yu Lei Pei Xi Song Wen-fang Li Zhao-fen Lin department of Emergency and critical care Medicine Changzheng Hospitalthe Second Military Medical UniversityShanghai 200003China department of Emergency and critical care Medicine Pudong New Area People’s HospitalShanghai 201299China

BACKGROUND: The study aims to investigate the performance of a metagenomic next-generationsequencing (NGS)-based diagnostic technique for the identifi cation of potential bacterial and viral infectionsand eff ects of concomitant viral infection on the survival rate of intensive care unit (ICU) sepsis ***: A total of 74 ICU patients with sepsis who were admitted to our institution from February1, 2018 to June 30, 2019 were enrolled. Separate blood samples were collected from patients for bloodcultures and metagenomic NGS when the patients’ body temperature was higher than 38 °C. Patients’demographic data, including gender, age, ICU duration, ICU scores, and laboratory results, were *** correlations between pathogen types and sepsis severity and survival rate were ***: NGS produced higher positive results (105 of 118;88.98%) than blood cultures(18 of 118;15.25%) over the whole study period. Concomitant viral infection correlated closelywith sepsis severity and had the negative effect on the survival of patients with sepsis. However,correlation analysis indicated that the bacterial variety did not correlate with the severity of ***: Concurrent viral load correlates closely with the severity of sepsis and thesurvival rate of the ICU sepsis patients. This suggests that prophylactic administration of antiviraldrugs combined with antibiotics may be benefi cial to ICU sepsis patients.

关键词： Sepsis Metagenomic next-generation sequencing Viral infections Bacterial infections Microbial diversity

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Argon reduces microglial activation and inflammatory cytokine expression in retinal ischemia/reperfusion injury

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Neural Regeneration Research 2021年第1期16卷 192-198页

作者： Ulrich Goebel Stefanie Scheid Sashko Spassov Nils Schallner Jakob Wollborn Hartmut Buerkle Felix Ulbrich department of Anesthesiology and critical care Medical Center–University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany

We previously found that argon exerts its neuroprotective effect in part by inhibition of the toll-like receptors(TLR)2 and *** downstream transcription factors signal transducer and activator of transcription 3(STAT3)and nuclear factor kappa B(NF-κB)are also affected by argon and may play a role in *** also has been demonstrated that argon treatment could mitigate brain damage,reduce excessive microglial activation,and subsequently attenuate brain *** intensive research,the further exact mechanism remains *** this study,human neuroblastoma cells were damaged in vitro with rotenone over a period of 4 hours(to mimic cerebral ischemia and reperfusion damage),followed by a 2-hour post-conditioning with argon(75%).In a separate in vivo experiment,retinal ischemia/reperfusion injury was induced in rats by increasing intraocular pressure for 1 *** reperfusion,argon was administered by inhalation for 2 *** reduced the binding of the transcription factors signal transducer and activator of transcription 3,nuclear factor kappa B,activator protein 1,and nuclear factor erythroid 2-related factor 2,which are involved in regulation of neuronal *** cytometry analysis showed that argon downregulated the Fas *** transcription factors were regulated by toll-like receptors;therefore,their effects could be eliminated,at least in part,by the TLR2 and TLR4 inhibitor oxidized phospholipid 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine(OxPAPC).Argon treatment reduced microglial activation after retinal ischemia/reperfusion *** quantitative polymerase chain reaction analysis revealed a reduction in the pro-inflammatory cytokines interleukin(IL-1α),IL-1β,IL-6,tumor necrosis factorα,and inducible nitric oxide *** results suggest that argon reduced the extent of inflammation in retinal neurons after ischemia/reperfusion injury by suppression of transcription factors crucial for microglial

关键词： argon ischemia/reperfusion injury microglia neuroinflammation neuroprotection noble gas SH-SY5Y toll-like receptor transcription factor

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Hepatic organ protection:From basic science to clinical practice

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World Journal of Gastroenterology 2010年第48期16卷 6044-6045页

作者： Rene Schmidt department of Anesthesiology and critical care Medicine Freiburg University Medical Center

Hepatic ischemia and reperfusion (I/R) injury during liver surgery is still the main cause of postoperative liver failure and the subsequent rise of mortality in these patients. During the last few years, a multitude of underlying mechanisms have been extensively characterized and many different protective approaches have been evaluated under experimental conditions. Some of them have already found their way into small sized clinical trials. In this Topic Highlight series of articles, we present recent insights into promising protective concepts including the regulation and optimization of hepatic blood flow, molecular mechanisms of preconditioning and pharmacological approaches with the aim of limiting hepatic I/R injury. Leading international experts present the latest experimental evidence in their fields stressing clinically relevant ideas, which are now on the edge of entering clinical practice.

关键词： Heme oxygenase-1 Hepatectomy Hepatic organ protection Ischemia/reperfusion injury Liver blood flow Liver transplantation Preconditioning

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Clinical Evaluation of a Vancomycin Dosage Strategy Based on a Serum Trough Concentration Model in Elderly Patients with Severe Pneumonia

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Biomedical and Environmental Sciences 2023年第5期36卷 397-405页

作者： YAN Wei SUN Xiao Yan WANG Meng ZHAO Fei Fan ZHOU Qing Tao department of Respiratory and critical care Medicine Peking University Third HospitalBejing 100191China

Objective This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly *** This prospective single-center, open-label, randomized controlled trial categorized 66 elderly patients with severe pneumonia into study and control groups. The control group received vancomycin using a regimen decided by the attending physician. Meanwhile, the study group received individualized vancomycin therapy with a dosing strategy based on a serum trough concentration model. The primary endpoint was the proportion of patients with serum trough concentrations reaching the target *** secondary endpoints were clinical response, vancomycin treatment duration, and vancomycinassociated acute kidney injury(VA-AKI) *** All patients were at least 60 years old(median age = 81 years). The proportion of patients with target trough concentration achievement(≥ 15 mg/L) with the initial vancomycin regimen was significantly higher in the study group compared to the control group(75.8% vs. 42.4%, P = 0.006).Forty-five patients(68.2%) achieved clinical success, the median duration of vancomycin therapy was10.0 days, and VA-AKI occurred in eight patients(12.1%). However, there were no significant differences in these parameters between the two groups. The model for predicting vancomycin trough concentrations was upgraded to: serum trough concentration(mg/L) = 17.194-0.104 × creatinine clearance rate(mL/min) + 0.313 × vancomycin daily dose [mg/(kg·d)].Conclusion A vancomycin dosage strategy based on a serum trough concentration model can improve the proportion of patients achieving target trough concentrations in elderly patients with severe pneumonia.

关键词： Pneumonia Clinical trials Vancomycin Trough concentration Elderly patients

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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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Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics

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World Journal of Clinical Cases 2022年第21期10卷 7314-7323页

作者： Bing-Yin Niu Guan Wang Bin Li Gen-Shen Zhen Yi-Bing Weng department of critical care Medicine Beijing Luhe HospitalBeijing 101100China

BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance,alveolar capillary injury,pulmonary edema,refractory hypoxemia,and reduced lung *** hypoxia can cause acid-base balance disorder,peripheral circulatory failure,blood-pressure reduction,arrhythmia,and other adverse *** To investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory *** We selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive care Unit and divided them into sequential and regular groups according to a randomized trial,with each group comprising 54 *** sequential group received invasive and non-invasive sequential mechanical ventilation,whereas the regular group received invasive mechanical ***-gas parameters,hemodynamic parameters,respiratory mechanical parameters,inflammatory factors,and treatment outcomes were compared between the two groups before and after mechanical-ventilation *** The arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24,48,and 72 h of treatment were higher than those of the conventional group(P<0.05).The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group(P<0.05).The pH value of the sequential group at 24 and 72 h of treatment,the central venous pressure value of the treatment at 24 h,and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group(P<0.05).The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group(P<0.05),the measured values of i

关键词： Sequential treatment Mechanical ventilation Severe pneumonia Respiratory failure Compliance

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Prognostic value of red blood cell distribution width for severe acute pancreatitis

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World Journal of Gastroenterology 2019年第32期25卷 4739-4748页

作者： Fang-Xiao Zhang Zhi-Liang Li Zhi-Dan Zhang Xiao-Chun Ma department of critical care Medicine First Affiliated Hospital of China Medical University

BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high *** evaluation of the severity and prognosis is very important for SAP ***,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of ***,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP *** To investigate the prognostic value of RDW for SAP *** We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June *** to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival *** was extracted from a routine blood *** parameters and RDW were recorded and compared between the two *** receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP *** In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two *** coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,*** areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the *** results demonstrated that RDW had better prognostic value for predicting the mortality of SAP *** the RDW-SD was greater than 45.5,the sensitivity f

关键词： Red blood cell distribution width Severe acute pancreatitis Prognosis Acute Physiology and Chronic Health Evaluation II score Sequential Organ Failure Assessment score

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