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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 *** estimates employing routine variables have been found to be reliable substitutes for direct measurement of VD/*** this study,we evaluated the prognostic value of these dead space estimates obtained in the first 7 days following the initiation of *** 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 *** 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 *** 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 ***(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,a

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

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Nasogastric tube syndrome:A Meta-summary of case reports

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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 ***,the risks associated with its placement are often *** airway obstruction with a NGT is an uncommon but potentially life-threatening *** syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually *** is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway ***,fewer cases may have been reported than might have occurred,primarily due to the clinicians'*** lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite *** 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 *** 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 *** 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 *** Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our *** was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 *** patients had diabetes mellitus(37.04%),and nine were hyperte

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

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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 *** guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill *** 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 *** 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 *** question was analyzed according to the Population,Intervention,Comparison,and Outcome(PICO)*** addition,interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research *** 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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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 *** study aimed to assess the incidence of GI symptoms associated with heatstroke and its impact on *** To assess the incidence of GI symptoms associated with heatstroke and its impact on *** Patients admitted to the intensive care unit(ICU)due to heatstroke were included from 83 *** history,laboratory results,and clinically relevant outcomes were recorded at ICU admission and daily until up to day 15,ICU discharge,or *** symptoms,including nausea/vomiting,diarrhoea,flatulence,and bloody stools,were *** characteristics of patients with heatstroke concomitant with GI symptoms were *** regression analyses were performed to determine significant predictors of GI *** 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 *** with GI symptoms had a significantly higher ICU stay compared with those *** mortality of patients who had two or more GI symptoms simultaneously was significantly higher than that in those with one GI *** logistic regression analysis revealed that older patients with a lower GCS score on admission were more likely to experience GI *** 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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Bibliometric study of sepsis-associated liver injury from 2000 to 2023

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World Journal of Gastroenterology 2024年第30期30卷 3609-3624页

作者： Zheng Zhang Xiao-Jiao Tan Hai-Qing Shi Huan Zhang Jian-Bo Li Xue-Lian Liao department of critical care Medicine West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina department of critical care Medicine West China Tianfu Hospital of Sichuan UniversityChengdu 610200Sichuan ProvinceChina

BACKGROUND Sepsis-associated liver injury(SLI)is a severe and prevalent complication of *** To explore the literature on SLI via a bibliometric *** Reviews and articles correlated with SLI published from January 1,2000 to October 28,2023 were searched from the Web of Science Core ***,the searched data were analyzed using VOSviewer,CiteSpace,and R *** There were 787 publications involved in this paper,comprising 745 articles and 42 ***,the United States,and Germany are the primary publication sources in this *** related to SLI primarily focused on mechanisms of pathogenesis,as evidenced by analyzing keywords,references,and the counting of original *** studies mainly involved tumor necrosis factor alpha,inflammation,oxidative stress,and nuclear factor-kappa *** There is significant growth in the research on *** investigations primarily involve basic experiments that aimed at uncovering pathogenic *** to the analyzed literature,the identified pathogenic mechanisms and potential therapeutic targets serve as the foundation for translating findings from basic research to clinical applications.

关键词： Sepsis Liver injury Bibliometric analysis Cite space VOS viewer

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Prediabetes in children and adolescents:A ticking bomb!

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World Journal of Clinical Pediatrics 2024年第2期13卷 11-15页

作者： Anju Gupta Nitin Choudhary Nishkarsh Gupta department of anesthesiology Pain Medicine and Critical CareAll India Institute of Medical ScienceNew Delhi 110076India department of Onco-anesthesiology and Palliative Medicine All India Institute of Medical ScienceNew Delhi 110029India

Prediabetes in children and adolescents is on the rise which has drawn significant attention over the past *** is an early warning sign of the underlying pathophysiological changes which in due course of time might compound into type II diabetes *** incidence of prediabetes in adolescents ranges from 4%-23%which is alarmingly high and requires active intervention from the *** have discussed early identification of high-risk patients,prompt screening and active intervention to manage this growing problem.

关键词： Prediabetes Children Adolescents Glucose metabolism Complications

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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 ***,whether it affects long-term outcomes is *** study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP ***:During January 2013 and December 2018,ANP patients admitted within 7 days from the onset of abdominal pain were *** primary outcome was 90-day readmission after *** proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day ***:A total of 241 ANP patients were enrolled,of whom 143 received early SAC during their hospitalization and 98 did *** 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 *** 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 *** 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 ***: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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Tissue-resident macrophages exacerbate lung injury after remote sterile damage

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Cellular & Molecular Immunology 2024年第4期21卷 332-348页

作者： Hanhui Zhong Jingjing Ji Jinling Zhuang Ziying Xiong Pengyun Xie Xiaolei Liu Jundi Zheng Wangli Tian Xiaoyang Hong Jing Tang The department of anesthesiology Affiliated Hospital of Guangdong Medical UniversityZhanjiangGuangdongChina The department of critical care Medicine General Hospital of Southern Theater Command of PLAGuangzhouChina The department of Respiratory Medicine Guangdong Provincial Hospital of Integrated Chinese and Western MedicineFoshanChina Pediatric Intensive care Unit Senior Department of Pediatricsthe Seventh Medical Center of PLA General HospitalBeijingChina

Remote organ injury,which is a common secondary complication of sterile tissue damage,is a major cause of poor prognosis and is difficult to ***,we report the critical role of tissue-resident macrophages in lung injury after trauma or stroke through the inflammatory *** found that depleting tissue-resident macrophages rather than disrupting the recruitment of monocyte-derived macrophages attenuated lung injury after trauma or *** findings revealed that the release of circulating alarmins from sites of distant sterile tissue damage triggered an inflammatory response in lung-resident macrophages by binding to receptor for advanced glycation end products(RAGE)on the membrane,which activated epidermal growth factor receptor(EGFR).Mechanistically,ligand-activated RAGE triggered EGFR activation through an interaction,leading to Rab5-mediated RAGE internalization and EGFR phosphorylation,which subsequently recruited and activated P38;this,in turn,promoted RAGE translation and trafficking to the plasma membrane to increase the cellular response to RAGE ligands,consequently exacerbating *** study also showed that the loss of RAGE or EGFR expression by adoptive transfer of macrophages,blocking the function of RAGE with a neutralizing antibody,or pharmacological inhibition of EGFR activation in macrophages could protect against trauma-or stroke-induced remote lung ***,our study revealed that targeting the RAGE-EGFR signaling pathway in tissue-resident macrophages is a potential therapeutic approach for treating secondary complications of sterile damage.

关键词： tissue-resident macrophage RAGE remote sterile damage

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Upregulation of circ0000381 atienuates microglial/macrophage pyroptosis after spinal cord injury

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Neural Regeneration Research 2024年第6期19卷 1360-1366页

作者： Yan Zhang Wenkai Zhang Tao Liu Ziqian Ma Wenxiu Zhang Yun Guan Xueming Chen Central Laboratory Beijing Luhe Hospital Capital Medical University department of Orthopedics Beijing Luhe Hospital Capital Medical University department of Emergency Medicine Aerospace Center Hospital department of anesthesiology and critical care Medicine Johns Hopkins University School of Medicine department of Neurological Surgery Johns Hopkins University School of Medicine

Neuroinflammation exacerbates secondary damage after spinal cord injury, while microglia/macrophage pyroptosis is important to neuroinflammation. Circular RNAs(circRNAs) play a role in the central nervous system. However, the functional role and mechanism of circRNAs in regulating microglia/macrophage pyroptosis after spinal cord injury are still poorly studied. In the present study, we detected microglia/macrophage pyroptosis in a female rat model of spinal cord injury, along with upregulated levels of circ0000381 in the spinal cord. Our further experimental results suggest that circ0000381 may function as a sponge to sequester endogenous microRNA423-3p(miR-423-3p), which can increase the expression of NOD-like receptor 3(NLRP3), a pyroptosis marker. Therefore, upregulation of circ0000381 may be a compensatory change after spinal cord injury to attenuate microglia/macrophage pyroptosis. Indeed, knockdown of circ0000381 expression exacerbated microglia/macrophage pyroptosis. Collectively, our findings provide novel evidence for the upregulation of circ0000381, which may serve as a neuroprotective mechanism to attenuate microglia/macrophage pyroptosis after spinal cord injury. Accordingly, circ0000381 may be a novel therapeutic target for the treatment of spinal cord injury.

关键词： circ0000381 inflammasome macrophage microglia miR-423-3p neuroinflammation neuroprotection NLRP3 pyroptosis RNA-Seq spinal cord injury

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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 ***: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 *** pharmacology analysis identified the key molecular pathway associated with FFD in *** 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 ***: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 *** 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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