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Venovenous extracorporeal membrane oxygenation for COVID-19 and influenza H1N1 associated acute respiratory distress syndrome:A comparative cohort study in China

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Journal of Intensive Medicine 2023年第4期3卷 326-334页

作者： Yonghao Xu Yin Xi Shuijiang Cai Yuheng Yu Sibei Chen Weijie Guan Weibo Liang Hongkai Wu Weiqun He Xilong Deng Yuanda Xu Rong Zhang Manshu Li Jieyi Pan Zhenting Liang Ya Wang Shaofeng Kong Xiaoqing Liu Zheng Lv Yimin Li department of critical care Medicine The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory DiseasesNational Clinical Research Center for Respiratory DiseaseGuangzhou Institute of Respiratory HealthGuangzhouGuangdongChina department of critical care Medicine Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina department of critical care Medicine Guangzhou Eighth People's HospitalGuangzhou Medical UniversityGuangzhouGuangdongChina department of Radiology The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina

Background Venovenous extracorporeal membrane oxygenation(VV-ECMO)has been demonstrated to be effective in treating patients with virus-induced acute respiratory distress syndrome(ARDS).However,whether the management of ECMO is different in treating H1N1 influenza and coronavirus disease 2019(COVID-19)-associated ARDS patients remains unknown.Methods This is a retrospective cohort study.We included 12 VV-ECMO-supported COVID-19 patients admitted to The First Affiliated Hospital of Guangzhou Medical University,Guangzhou Eighth People's Hospital,and Wuhan Union Hospital West Campus between January 23 and March 31,2020.We retrospectively included VV-ECMO-supported patients with COVID-19 and H1N1 influenza-associated ARDS.Clinical characteristics,respiratory mechanics including plateau pressure,driving pressure,mechanical power,ventilatory ratio(VR)and lung compliance,and outcomes were compared.Results Data from 25 patients with COVID-19(n=12)and H1N1(n=13)associated ARDS who had received ECMO support were analyzed.COVID-19 patients were older than H1N1 influenza patients(P=0.004).The partial pressure of arterial carbon dioxide(PaCO_(2))and VR before ECMO initiation were significantly higher in COVID-19 patients than in H1N1 influenza patients(Pcare unit and ventilator-free days than H1N1.Conclusions Compared with H1N1 influenza patients,COVID-19 patients were older and presented with increased PaCO_(2) and VR values before ECMO initiation.The differences between ARDS patients with COVID-19 and influenza on VV-ECMO detailed herein could be helpful for obtaining a better understanding of COVID-19 and for better clinical management.

关键词： Coronavirus disease 2019 H1N1 influenza Acute respiratory distress syndrome

Low diastolic blood pressure and adverse outcomes in inpatients with acute exacerbation of chronic obstructive pulmonary disease: A multicenter cohort study

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Chinese Medical Journal 2023年第8期136卷 941-950页

作者： Chen Zhou Qun Yi Yuanming Luo Hailong Wei Huiqing Ge Huiguo Liu Xianhua Li Jianchu Zhang Pinhua Pan Mengqiu Yi Lina Cheng Liang Liu Jiarui Zhang Lige Peng Adila Aili Yu Liu Jiaqi Pu Haixia Zhou West China School of Medicine Sichuan UniversityChengduSichuan 610041China department of respiratory and critical care Medicine West China HospitalSichuan UniversityChengduSichuan 610041China Sichuan Cancer Hospital and Institution Sichuan Cancer CenterCancer Hospital Affiliated to School of MedicineUESTCChengduSichuan 610041China State Key Laboratory of respiratory Disease Guangzhou Medical UniversityGuangzhouGuangdong 510120China department of respiratory and critical care Medicine People’s Hospital of LeshanLeshanSichuan 614000China department of respiratory and critical care Medicine Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouZhejiang 310016China department of respiratory and critical care Medicine Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430030China department of respiratory and critical care Medicine The First People’s Hospital of Neijiang CityNeijiangSichuan 641000China department of respiratory and critical care Medicine Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430022China department of respiratory and critical care Medicine Xiangya HospitalCentral South UniversityChangshaHunan 410008China department of Emergency the First People’s Hospital of JiujiangJiujiangJiangxi 332000China department of respiratory and critical care Medicine The Affiliated Hospital of Chengdu UniversityChengduSichuan 610041China

Background:Although intensively studied in patients with cardiovascular diseases(CVDs),the prognostic value of diastolic blood pressure(DBP)has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).This study aimed to reveal the prognostic value of DBP in AECOPD patients.Methods:Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021.DBP was measured on admission.The primary outcome was all-cause in-hospital mortality;invasive mechanical ventilation and intensive care unit(ICU)admission were secondary outcomes.Least absolute shrinkage and selection operator(LASSO)and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio(HR)and 95%confidence interval(CI)for adverse outcomes.Results:Among 13,633 included patients with AECOPD,197(1.45%)died during their hospital stay.Multivariable Cox regression analysis showed that low DBP on admission(<70 mmHg)was associated with increased risk of in-hospital mortality(HR=2.16,95%CI:1.53–3.05,Z=4.37,P<0.01),invasive mechanical ventilation(HR=1.65,95%CI:1.32–2.05,Z=19.67,P<0.01),and ICU admission(HR=1.45,95%CI:1.24–1.69,Z=22.08,P<0.01)in the overall cohort.Similar findings were observed in subgroups with or without CVDs,except for invasive mechanical ventilation in the subgroup with CVDs.When DBP was further categorized in 5-mmHg increments from<50 mmHg to≥100 mmHg,and 75 to<80 mmHg was taken as reference,HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs;higher DBP was not associated with the risk of in-hospital mortality.Conclusion:Low on-admission DBP,particularly<70 mmHg,was associated with an increased risk of adverse outcomes among inpatients with AECOPD,with or without CVDs,which may serve as a convenient predictor of poor prognosis in these patients.Clinical Trial Registration:Chinese Clinical Trail Registry,No.ChiCTR

关键词： Acute exacerbation of chronic obstructive pulmonary disease Diastolic blood pressure Prognostic factors Inpatients In-hospital mortality

Clinical features and risk factors for viral pneumonia complicated with invasive pulmonary aspergillosis in adult patients

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Chinese Medical Journal 2023年第11期136卷 1361-1363页

作者： Lijuan Li Chuan Wang Yali Ren Jiangbo Liu Feifei Liu Xiaoqi Zhang department of Pulmonary and critical care Medicine National Centre for Clinical Research on Respiratory DiseasesChina-Japan Friendship HospitalBeijing 100029China department of Pulmonary and critical care Medicine First Hospital of ShijiazhuangShijiazhuangHebei 050011China department of Pulmonary and critical care Medicine Second Hospital of Hebei Medical UniversityShijiazhuangHebei 050000China department of Pulmonary and critical care Medicine Tianjin First Central HospitalTianjin 300192China department of respiratory and critical care Medicine First Hospital of Qin Huang DaoQinhuangdaoHebei 066000China department of Pulmonary and critical care Medicine Second People’s Hospital of WeifangWeifangShandong 261041China

Viral pneumonia has recently been defined as a risk factor for invasive pulmonary aspergillosis(IPA).Wauters et al[1]reported that 23%of critically ill patients who were admitted to the intensive care unit(ICU)with swine-origin influenza A(H1N1)viral infection had developed invasive aspergillosis.IPA was diagnosed in 83 of 432(19%)patients who were admitted with influenza;for patients with influenza who were immunocompromised,the incidence of IPA reached up to 32%(38 of 117 patients).

关键词： patients admitted pneumonia

Metastatic infection caused by hypervirulent Klebsiella pneumonia and co-infection with Cryptococcus meningitis: A case report

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World Journal of Clinical Cases 2019年第22期7卷 3812-3820页

作者： Yun-Feng Shi Yu-Kai Wang Yan-Hong Wang Hui Liu Xiao-Han Shi Xiao-Jie Li Ben-Quan Wu Medical Intensive care unit Department of Respiratory and Critical Care MedicineThird Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630Guangdong ProvinceChina Institute of respiratory diseases Sun Yat-Sen UniversityGuangzhou 510630Guangdong ProvinceChina department of Laboratory Medicine Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630Guangdong ProvinceChina

BACKGROUND Klebsiella pneumoniae(K.pneumoniae)used to affect mainly people with compromised immunity or weakened by other infections,but recent emergence of hypervirulent strains has increased infections even in healthy individuals.These infections include liver abscess,pneumonia,bacteremia,meningitis,necrotizing fasciitis,and endophthalmitis.Although metastatic infection by hypervirulent K.pneumoniae(hvKP)is increasingly recognized,co-infection with Cryptococcus neoformans(C.neoformans)meningitis in immunocompetent hosts is rare but fatal.So,it is necessary to determine the risk factors,complications,and comorbidity of this disease.CASE SUMMARY This report describes a 58-year-old man with hvKP pulmonary abscess,bacteremia,and meningitis,accompanied by fatal Cryptococcus meningitis.This patient presented with fever for 1 wk and drowsiness for 3 d.Laboratory findings revealed pulmonary abscess and bacteremia of K.pneumoniae.He was given intravenous antibiotic therapy,and the infection was under control for about 1 wk.However,his condition deteriorated rapidly because of metastatic purulent meningitis.Although hvKP and C.neoformans were isolated and confirmed,the patient died of spontaneous respiratory and cardiac arrest caused by cerebral hernia.CONCLUSION HvKP has emerged as a cause of metastatic infections in immunocompetent hosts.polymicrobial co-infections should be taken into consideration when metastatic infection is present.

关键词： Hypervirulent Klebsiella pneumoniae Metastatic infection Cryptococcusneoformans meningitis Comorbidity Case report

Pioneering role of machine learning in unveiling intensive care unitacquired weakness

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World Journal of Clinical Cases 2024年第13期12卷 2157-2159页

作者： Silvano Dragonieri department of respiratory diseases University of BariBari 70124Italy

In the research published in the World Journal of Clinical Cases,Wang and Long conducted a quantitative analysis to delineate the risk factors for intensive care unit-acquired weakness(ICU-AW)utilizing advanced machine learning methodologies.The study employed a multilayer perceptron neural network to accurately predict the incidence of ICU-AW,focusing on critical variables such as ICU stay duration and mechanical ventilation.This research marks a significant advancement in applying machine learning to clinical diagnostics,offering a new paradigm for predictive medicine in critical care.It underscores the importance of integrating artificial intelligence technologies in clinical practice to enhance patient management strategies and calls for interdisciplinary collaboration to drive innovation in healthcare.

关键词： Intensive care unit-acquired weakness Machine learning Multilayer perceptron neural network Predictive medicine Interdisciplinary collaboration

A retrospective analysis of carbapenem-resistant Acinetobacter baumannii infections in critically ill patients:Experience at a tertiary-care teaching hospital ICU

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Journal of Intensive Medicine 2024年第2期4卷 181-186页

作者： Leyla Ferlicolak Neriman Defne Altintas Fugen Yoruk department of Internal Medicine Division of Intensive care unit Ankara University Faculty of MedicineAnkaraTurkey department of Infectious diseases and Clinical Microbiology Ankara University Faculty of MedicineAnkaraTurkey

Background Acinetobacter baumannii is a clinically significant pathogen with a high incidence of multidrug resistance that is associated with life-threatening nosocomial infections.Here,we aimed to provide an insight into the clinical characteristics and outcomes of a unique group of A.baumannii infections in which the isolates were resistant to carbapenems and most other antibiotic groups in a tertiary-care intensive care unit(ICU).Methods We performed a retrospective observational study in which records of patients hospitalized in the ICU between June 1,2021 and June 1,2023 were reviewed.We checked the clinical,laboratory,and microbiological records of all adult patients who had carbapenem-resistant A.baumannii(CRAB)infections.Prior antibiotic treatments and definitive antibiotic treatments after culture positivity and susceptibility test results were recorded.C-reactive protein(CRP)and procalcitonin levels and leukocyte counts were noted.Length of ICU stay and 30-day mortality were defined as the outcome parameters.Results During the study period,57 patients were diagnosed with CRAB infections.The respiratory tract was the leading infection site(80.7%).In non-survivors,bloodstream infections(21.9%vs.4.0%P=0.05)and colistin-resistant(col-R)CRAB infections(43.8%vs.24.0%,P=0.12)were more common than in survivors,but these parameters were not statistically significant.The length of ICU stay was not different between survivors and non-survivors.Overall,the rate of col-R among CRAB clinical isolates was 35.1%.The 30-day mortality in all patients with CRAB infection was 56.1%.Mortality in col-R CRAB and colistin-susceptible(col-S)CRAB infections was 70.0%and 48.6%,respectively(P=0.12).Prior carbapenem use was 56.1%.Prior colistin use before col-R and col-S CRAB infections was not significant(35.0%vs.27.0%,P=0.53).Conclusions Our study provides real-world data on highly resistant A.baumannii infections and shares the characteristics of infections with such resistant strains.Unfortunately,carbapenem resistance in A.bau

关键词： Mortality Colistin-resi stant Gram-negative bacteria MDR Intensive care unit

Clinical characteristics and risk factors associated with secondary bloodstream infection in patients with intensive care unit-acquired pneumonia due to carbapenem-resistant Klebsiella pneumoniae

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Chinese Medical Journal 2021年第14期134卷 1735-1737页

作者： Xin-Yun Zhu Hong-Bin Wang Ye-Han Zhu Yan-Bin Chen Bei-Lei Zhang Cheng Chen department of respiratory and critical Medicine The First Affiliated Hospital of Soochow UniversitySuzhouJiangsu 215006China Institute of respiratory diseases Soochow UniversitySuzhouJiangsu 215006China

The global spread of carbapenem-resistant Klebsiella pneumoniae(CRKP)has become a major healthcare burden because of the limited therapeutic options and poor prognosis,and this situation gets worse among patients admitted to intensive care unit(ICU).[1]CRKP can cause a range of infections,including pneumonia,urinary tract infection(UTI),and bloodstream infection(BSI).BSI is one of the most serious infections caused by CRKP and associated with high mortality ranging from 39%to 82%.[2]BSI due to CRKP could be primary infection or secondary infection that originated from primary infections in the lungs or bladder,and 50%of CRKP-BSIs originated from primary infections in the lungs.[3]Although previous studies have explored several risk factors for CRKP infections,the association between CRKP pneumonia and the development of secondary CRKP-BSI was not fully revealed thus far.The aim of this study was to predict risk factors of 28-day mortality and the development of secondary CRKP-BSI in ICU-acquired pneumonia caused by CRKP.

关键词： pneumonia infection patients

National survey of the awareness and implementation status of early pulmonary rehabilitation for patients with critical illness in departments of pulmonary and critical care medicine in 2019

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Chinese Medical Journal 2023年第2期136卷 227-229页

作者： Qing Zhao Liyuan Tao Quanguo Li Sinan Wu Dingyi Wang Peng Feng Nan Luo Yuxiao Xie Siyuan Wang Cunbo Jia Gang Zeng Hongmei Zhao department of Pulmonary and critical care Medicine Center of Respiratory MedicineChina–Japan Friendship HospitalBeijing 100029China National Clinical Research Center for respiratory diseases Beijing 100029China Institute of respiratory Medicine Chinese Academy of Medical SciencesBeijing 100029China National Center for respiratory Medicine Beijing 100029China Research Center of Clinical Epidemiology Peking University Third HospitalBeijing 100091China department of Pulmonary and critical care Medicine Weifang Respiratory Disease HospitalWeifang No.2 Renmin HospitalWeifangShandong 261041China department of Clinical Research and Data management Center of Respiratory MedicineChina-Japan Friendship HospitalBeijing 100029China department of Hospital Development Office China–Japan Friendship HospitalBeijing 100029China department of Medical Rehabilitation China–Japan Friendship HospitalBeijing 100029China department of respiratory Medicine North District of Suzhou Municipal HospitalNanjing Medical UniversitySuzhouJiangsu 215000China

To the Editor:The aim of early pulmonary rehabilitation(PR)in the intensive care unit(ICU)is to reduce the incidence of post-ICU syndrome,increase the number of ventilator-free days,reestablish and improve functional capacity,improve health-related life quality,promote mental health,and enhance participation in everyday life.PR in the ICU is highly effective and plays an important role in recovery of patients with reduced exercise endurance,functional capacity,and health-related life quality.Several surveys outside China have assessed the implementation of early rehabilitation in the ICU,[1]but there are few data from China.This study aimed to investigate the awareness and implementation of early PR in secondary-and tertiary-class hospitals with pulmonary and critical care medicine(PCCM)standardized certification.PCCM staff members were recruited to fill out a selfdesigned questionnaire.We defined early PR as PR within 5 days of ICU admission.

关键词： critical survey everyday

Advances in severe community-acquired pneumonia

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Chinese Medical Journal 2019年第16期132卷 1891-1893页

作者： Jian Wang Yuan-Lin Song department of respiratory and critical care Medicine. Zhongshan Hospital Fudan UniversityShanghai 200032China

Introduction Community-acquired pneumonia (CAP) is a common respiratory disease and is considered to be the leading cause of mortality among various infectious diseases.[1,2] A large population-based study showed that among hospitalized patients diagnosed with pneumonia, 21% of them required the intensive care unit (ICU) admission, 6% required invasive mechanical ventilation, and 2% died.[3] Although therapeutic strategies have been significantly improved over recent years, the morbidity and mortality of CAP, especially severe CAP (SCAP), remain high. Mortality of SCAP has been reported to range from 17% to 49% by different multi-center cohort studies.[4] The Infectious diseases Society of America (IDSA), American Thoracic Society (ATS) and the Infectious Disease Assembly, Chinese Thoracic Society, have published consensus guidelines for CAP (IDSA/ATS 2007, CTS 2016), which clearly defined SCAP criteria.[5] According to IDSA/ATS SCAP criteria, patients with SCAP requiring ICU admission should have at least one major criteria (invasive mechanical ventilation or septic shock with the need for vasopressors) or at least three minor criteria (respiratory rate ≥30 breaths/min, oxygenation index (PaO2/FiO2) ratio ≤250, multi-lobe infiltrates, hypothermia (core temperature <36°C), leukopenia (white blood cell count <4000 cells/mm3), thrombocytopenia (platelet count <100,000 cells/mm3), hypotension requiring aggressive fluid resuscitation, confusion/disorientation, and uremia (blood urea nitrogen (BUN)≥20 mg/dL).

关键词： pneumonia community-acquired