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Integrated emergency department and general intensive care unit management on health outcomes

中华医学会急诊医学分会第十六次全国急诊医学学术年会

作者： wenfang li zhaofen lin department of emergency and intensive care unit Changzheng Hospital Second Military Medical University

Objectives Evaluating data of quality control in a large cohort of integrated in-hospital emergency department (ED) and intensive care unit(ICU) projects to improve the outcome of rescue on acutely critical patients. ...

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Chinese Medical Journal 2021年第21期134卷 2553-2555页

作者： Shan-Lin Mao Zi Ge Hui Zhao Yan-Xue Wang Jun Cao Zhi-Jie Xia emergency and Acute Critical care department Huashan Hospital NorthFudan UniversityShanghai 201907China

The emergency department(ED)should reliably provide the required medical treatment to patients who are in an emergency or are critically ill.However,the ED faced two challenges in China.

关键词： China department critically

Trends in point-of-care ultrasound protocols in the emergency department and intensive care unit:a review

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emergency and Critical care Medicine 2023年第2期3卷 64-69页

作者： Xinhui Fan Yuan Bian Guoying Wang Weikang Liu Luyao Gao Yuhui Pan Shengchuan Cao Qiuhuan Yuan Shujian Wei Feng Xu Yuguo Chen department of emergency and Chest Pain Center Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineInstitute of Emergency and Critical Care Medicine of Shandong UniversityKey Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceKey Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong ProvinceQilu Hospital of Shandong UniversityJinanChina.

Together with the development of the focused assessment with sonography for trauma protocol for ultrasound in trauma patients,point-of-care ultrasound is widely used in the field of emergency and critical care medicine.Researchers have established several classic operating protocols for different diseases,such as acute respiratory failure,shock,and cardiac arrest,in the emergency department and intensive care unit.With further development in the portability and popularity of ultrasonic equipment,it is expected to be used as a new type of technology for physical examination,including inspection,palpation,percussion,auscultation,and insonation,which will improve the clinical medicine practice in the future.

关键词： Auscultation and insonation Inspection Palpation Percussion Point-of-care ultrasound Protocol Seven-point and nineplane protocol

Legionella pneumonia complicated with rhabdomyolysis and acute kidney injury diagnosed by metagenomic nextgeneration sequencing: a case report

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World Journal of emergency Medicine 2023年第4期14卷 322-324页

作者： Bin Deng Junjie Hua Yufei Zhou Duoxian Zhan Lijuan Zhu Yixing Zhan Yumin Fang Yun Ji Libin Li department of intensive care unit Suichang People's HospitalLishui 323300China department of emergency Medicine Suichang People's HospitalLishui 323300China department of Surgical intensive care unit the Second Affiliated Hospital Zhejiang University School of MedicineHangzhou 310009China

The triad of Legionella pneumonia,rhabdomyolysis,and acute kidney injury(AKI)is uncommon but can be devastating.[1]It is vital to recognize Legionella species early as a potential cause of pneumonia.Legionella infection remains underdiagnosed because of the nonspecific nature of clinical features and the shortcomings of routinely available diagnostic tests.[2]Metagenomic next-generation sequencing(mNGS)is a culture-free and hypothesis-free diagnostic method that can rapidly identify almost all known pathogens in a sample.[3]Here,we present a successfully cured case of rhabdomyolysis and AKI caused by Legionella pneumophila with etiologic diagnosis aided by the use of mNGS.

关键词： pneumonia routine kidney

A comprehensive neuromonitoring approach in a large animal model of cardiac arrest

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Animal Models and Experimental Medicine 2022年第1期5卷 56-60页

作者： Filippo Annoni Lorenzo Peluso Lucas Akira Hirai Giovanni Babini Amina Khaldi Antoine Herpain Lorenzo Pitisci Lorenzo Ferlini Bruno Garcia Fabio Silvio Taccone Jacques Creteur Fuhong Su intensive care Experimental Laboratory Intensive Care UnitErasme HospitalBrusselBelgium intensive care unit São Domingos HospitalSão LuísBrazil department of Pathophysiology and Transplants University of MilanMilanItaly department of Anesthesiology Intensive Care and Emergency Fondazione IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilanItaly

Background:Anoxic brain injuries represent the main determinant of poor outcome after cardiac arrest(CA).Large animal models have been described to investigate new treatments during CA and post-resuscitation phase,but a detailed model that includes extensive neuromonitoring is lacking.Method:Before an electrically-induced 10-minute CA and resuscitation,46 adult pigs underwent neurosurgery for placement of a multifunctional probe(intracranial pressure or ICP,tissue oxygen tension or PbtO_(2) and cerebral temperature)and a bolt-based technique for the placement and securing of a regional blood flow probe and two sEEG electrodes;two modified cerebral microdialysis(CMD)probes were also inserted in the frontal lobes and accidental misplacement was prevented using a perforated head support.Result:42 animals underwent the CA procedure and 41 achieved the return of spontaneous circulation(ROSC).In 4 cases(8.6%)an adverse event took place during preparation,but only in two cases(4.3%)this was related to the neurosurgery.In 6 animals(13.3%)the minor complications that occurred resolved after probe repositioning.Conclusion:Herein we provide a detailed comprehensive neuromonitoring approach in a large animal model of CA that might help future research.

关键词： anoxic injury heart arrest ischemiareperfusion post-arrest resuscitation

Extracorporeal membrane oxygenation as a bridging therapy for patients with thiamine deficiency-induced pulmonary arterial hypertension

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World Journal of emergency Medicine 2024年第2期15卷 147-149页

作者： Fangfang Qiu Weixing Dai Tengyue Huang Min Li department of intensive care unit the Fourth Affiliated Hospital of Zhejiang University School of MedicineYiwu 322000China department of intensive care unit the Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou 310009China

Thiamine deficiency is characterized by a deficiency of thiamine(vitamin B1),lactic acidosis,pulmonary arterial hypertension(PAH),right-sided heart failure,and peripheral nerve damage.Thiamine deficiency is easily misdiagnosed and missed during clinical practice and is associated with death in severe cases.[1,2]Here we reported a patient who was admitted to the hospital with severe metabolic acidosis and pulmonary hypertension and finally diagnosed with thiamine deficiency by detecting plasma vitamin B1 levels.Since clinically obvious thiamine deficiency is rare,and cases of thiamine deficiency requiring extracorporeal membrane oxygenation(ECMO)treatment are rarer,we believe that our case will be helpful for emergency clinicians.

关键词： vitamin hypertension arterial

Opinions and attitudes toward targeted temperature management in the emergency department and intensive care unit in a developing country: a survey study

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World Journal of emergency Medicine 2023年第2期14卷 138-142页

作者： Abdullah Bakhsh Hadeel Alotaibi Sara Alothman Abdulrahman Alothman Rahaf Alothman Abdulrahman Alsulami Malak Alamoudi Ali Alothman Ali Al-Shareef department of emergency Medicine the King Abdulaziz UniversityJeddah 21589Saudi Arabia Faculty of Medicine the King Abdulaziz UniversityJeddah 21589Saudi Arabia department of Anesthesia Intensive Care Unitthe King Abdulaziz UniversityJeddah 21589Saudi Arabia College of Medicine King Saud Bin Abdulaziz University for Health SciencesCollege of MedicineJeddah 21589Saudi Arabia King Abdulaziz Medical City Jeddah 21589Saudi Arabia King Abdullah International Medical Research Center Jeddah 21589Saudi Arabia

INTRODUCTION The past two decades have witnessed one of the most contentious scientific debates in the field of temperature management after cardiac arrest in adults.It started in 2002,following the publication of two groundbreaking trials showing lower mortality rates and improved neurologic recovery with the use of active cooling.[1,2]International recommendations advocate active cooling in the range of 32–34℃for comatose survivors of out-of-hospital cardiac arrest (OHCA).[3,4]The year2013 marked the tipping point with the release of the TTM 1 trial.

关键词： breaking release showing

Biliary tract external drainage protects against intestinal barrier injury in hemorrhagic shock rats

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World Journal of Gastroenterology 2015年第45期21卷 12800-12813页

作者： Lu Wang Bing Zhao Ying Chen Li Ma Er-Zhen Chen En-Qiang Mao Department of Emergency Intensive Care Unit Ruijin Hospital Shanghai Jiao Tong University School of Medicine

AIM: To investigate the effects of biliary tract external drainage(BTED) on intestinal barrier injury in rats with hemorrhagic shock(HS). METHODS: BTED was performed via cannula insertion into the bile duct of rats. HS was induced by drawing blood from the femoral artery at a rate of 1 m L/min until a mean arterial pressure(MAP) of 40 ± 5 mm Hg was achieved. That MAP was maintained for 60 min. A total of 99 Sprague-Dawley rats were randomized into a sham group, an HS group and an HS + BTED group. Nine rats in the sham group were sacrificed 0.5 h after surgery. Nine rats in each of the HS and HS + BTED groups were sacrificed 0.5 h, 1 h, 2 h, 4 h and 6 h after resuscitation. Plasma tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), and lipopolysaccharide(LPS) levels were analyzed using enzyme-linked immunosorbent assay. Plasma D-lactate levels were analyzed using colorimetry. The expression levels of occludin and claudin-1 in the ileum were analyzed using Western blot and immunohistochemistry. Histology of the ileumwas evaluated by hematoxylin and eosin staining. RESULTS: Plasma TNF-α levels in the HS + BTED group decreased significantly compared with the HS group at 1 h and 6 h after resuscitation(P < 0.05). Plasma IL-6 levels in the HS + BTED group decreased significantly compared with the HS group at 0.5 h, 1 h and 2 h after resuscitation(P < 0.05). Plasma D-lactate and LPS levels in the HS + BTED group decreased significantly compared with the HS group at 6 h after resuscitation(P < 0.05). The expression levels of occludin in the HS + BTED group increased significantly compared with the HS group at 4 h and 6 h after resuscitation(P < 0.05). The expression levels of claudin-1 in the HS + BTED group increased significantly compared with the HS group at 6 h after resuscitation(P < 0.05). Phenomena of putrescence and desquamation of epithelial cells in the ileal mucosa were attenuated in the HS + BTED group. Ileal histopathologic scores in the HS + BTED group decreased significantly compared with the HS group at

关键词： Hemorrhagic shock Biliary tract external drainage

Molecular mechanism and therapeutic targeting of necrosis,apoptosis,pyroptosis,and autophagy in cardiovascular disease

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Chinese Medical Journal 2021年第22期134卷 2647-2655页

作者： Pan Li Xiao-Rong Dong Bei Zhang Xin-Tong Zhang Jing-Zhuo Liu De-Sheng Ma Li Ma department of emergency Hong Hui HospitalXi’an Jiaotong UniversityXi’anShaanxi 710054China Department of Emergency Intensive Care Unit Lanzhou University of Second HospitalLanzhouGansu 730030China

Cell death occurs in various tissues and organs in the body.It is a physiological or pathological process that has different effects.It is of great significance in maintaining the morphological function of cells and clearing abnormal cells.Pyroptosis,apoptosis,and necrosis are all modes of cell death that have been studied extensively by many experts and scholars,including studies on their effects on the liver,kidney,the heart,other organs,and even the whole body.The heart,as the most important organ of the body,should be a particular focus.This review summarizes the mechanisms underlying the various cell death modes and the relationship between the various mechanisms and heart diseases.The current research status for heart therapy is discussed from the perspective of pathogenesis.

关键词： Cell death Apoptosis Necrosis Pyroptosis Autophagy Pathogenesis Treatment

Continuous renal replacement therapy with oXiris®in patients with hematologically malignant septic shock:A retrospective study

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世界临床病例杂志 2023年第26期11卷 6073-6082页

作者： Juan Wang Shu-Run Wei Tong Ding Li-Ping Zhang Zhi-Hua Weng Ming Cheng Yang Zhou Meng Zhang Fang-Jun Liu Bei-Bei Yan Dan-Feng Wang Ming-Wen Sun Wei-Xin Cheng intensive care unit Hebei Yanda HospitalLangfang 065201Hebei ProvinceChina department of emergency Peking University International HospitalBeijing 102206China

BACKGROUND The mortality rate from septic shock in patients with hematological malignancies(HMs)remains significantly higher than that in patients without HMs.A longer resuscitation time would definitely be harmful because of the irreversibly immunocompromised status of the patients.Shortening the resuscitation time through continuous renal replacement therapy(CRRT)with oXiris^(■)would be an attractive strategy in managing such patients.AIM To explore the effects of CRRT and oXiris^(■)in shortening the resuscitation time and modifying the host response by reducing inflammation mediator levels.METHODS Forty-five patients with HM were diagnosed with septic shock and underwent CRRT between 2018 and 2022.Patients were divided into two groups based on the hemofilter used for CRRT(oXiris^(■)group,n=26;M150 group,n=19).We compared the number of days of negative and total fluid balance after 7 d of CRRT between the groups.The heart rate,norepinephrine dose,Sequential Organ Failure Assessment(SOFA)score,and blood lactic acid levels at different time points in the two groups were also compared.Blood levels of inflammatory mediators in the 26 patients in the oXiris^(■)group were measured to further infer the possible mechanism.RESULTS The average total fluid balance after 7 d of CRRT in the oXiris^(■)group was significantly lower than that of patients in the M150 hemofilter group.The SOFA scores of patients after CRRT with oXiris^(■)therapy were significantly lower than those before treatment on day 1(d1),d3 and d7 after CRRT;these parameters were also significantly lower than those of the control group on d7.The lac level after oXiris^(■)therapy was significantly lower than that before treatment on d3 and d7 after CRRT.There were no significant differences in the above parameters between the two groups at the other time points.In the oXiris^(■)group,procalcitonin levels decreased on d7,whereas interleukin-6 and tumor necrosis factor levels decreased significantly on d3 and d7 after treatment.CONCLUSION CRRT with oXiris^(■)

关键词： Hematological malignancy Septic shock oXiris®hemofilter Blood purification Fluid balance