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Optimizing artificial intelligence in sepsis management: Opportunities in the present and looking closely to the future

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Journal of intensive Medicine 2024年第1期4卷 34-45页

作者： Darragh O’Reilly Jennifer McGrath Ignacio Martin-Loeches department of intensive care Medicine Multidisciplinary Intensive Care Research Organization(MICRO)St James’HospitalDublinIreland department of respiratory intensive care Hospital ClinicUniversitat de BarcelonaIDIBAPSCIBERESBarcelonaSpain

Sepsis remains a major challenge internationally for healthcare *** incidence is rising due to poor public awareness and delays in its recognition and subsequent *** sepsis,mortality increases with every hour left *** intelligence(AI)is transforming worldwide healthcare delivery at *** review has outlined how AI can augment strategies to address this global disease *** and machine learning(ML)algorithms can analyze vast quantities of increasingly complex clinical datasets from electronic medical records to assist clinicians in diagnosing and treating sepsis earlier than traditional *** review highlights how these models can predict the risk of sepsis and organ failure even before it *** gives providers additional time to plan and execute treatment plans,thereby avoiding increasing complications associated with delayed diagnosis of *** potential for cost savings with AI implementation is also discussed,including improving workflow efficiencies,reducing administrative costs,and improving healthcare *** these advantages,clinicians have been slow to adopt AI into clinical *** of the limitations posed by AI solutions include the lack of diverse data sets for model building so that they are widely applicable for routine clinical ***,the subsequent algorithms are often based on complex mathematics leading to clinician hesitancy to embrace such ***,we highlight the need for robust political and regulatory frameworks in this area to achieve the trust and approval of clinicians and patients to implement this transformational technology。

关键词： Artificial intelligence Data science Machine learning intensive care unit(ICU) Critical care Sepsis

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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 *** 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 *** 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

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Prevention of ventilator-associated pneumonia with inhaled antibiotics

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World Journal of Emergency Medicine 2024年第3期15卷 165-168页

作者： Stephan Ehrmann Jie Li intensive care Medicine INSERM CIC 1415CRICS-TriggerSep FCRIN research networkUniversity Hospital Center in ToursTours 37044France respiratory Pathology Research Center National Institute of Health and Medical ResearchTours 37000France department of Cardiopulmonary Sciences Division of Respiratory CareRush UniversityChicago 60612USA

The direct delivery of inhaled antibiotics to the respiratory tract has been a subject of enduring interest among medical practitioners and researchers due to the associated favorable *** interest has been particularly pronounced in the context of critically illpatients,wherehealthcare-associatedpulmonary infections represent a significant challenge,driving continued exploration of inhaled antibiotics for intubated *** high-level evidence has shown a very promising application in the field of ventilator-associated pneumonia (VAP) prevention.^([1]).

关键词： pneumonia ventilator respiratory

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Prediction of mechanical ventilation outcome by early abdominal-visceral-blood-flow-and-function score in critically ill patients after cardiopulmonary bypass in the ICU: A prospective observational study

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Journal of intensive Medicine 2024年第1期4卷 101-107页

作者： Chaofu Yue Longxiang Su Jun Wang Na Cui Yuankai Zhou Wei Cheng Bo Tang Xi Rui Huaiwu He Yun Long department of intensive care Unit Peking Union Medical College HospitalBeijingChina department of intensive care Unit Qujing First People’s HospitalQujingYunnanChina department of intensive care Unit Shiyan People’s Hospital of Bao’an DistrictShenzhenGuangdongChina

Background:Abdominal organs are important organs that sense and respond to ischemia and hypoxia,but there are few evaluation *** use ultrasonography to evaluate abdominal organ function and blood flow in patients with mechanical ventilation(MV)after cardiopulmonary bypass and to obtain a semiquantitative score for abdominal organ function and blood ***:Patients with cardiopulmonary bypass in the Critical care department of Peking Union Medical College Hospital in China from March to July 2021 were enrolled in this prospective observational *** correlation of the abdominal-visceral-blood-flow-and-function score(AVBFS)with the duration of MV,number of days spent in the intensive care unit(ICU),acute physiology and chronic health evaluation II(APACHE-II),sequential organ failure assessment(SOFA),lactate,epinephrine,and norepinephrine use was analyzed,and the results were used to assess the predictive value of the receiver operating characteristic curve(ROC)regression analysis score for the duration of ***:Of the 92 patients who underwent cardiopulmonary bypass,41 were finally *** AVBFS were significantly correlated with the duration of MV,number of days spent in the ICU,APACHE-II score,SOFA score,and norepinephrine use *** AVBFS in a group of patients using ventilators≥36 h were significantly higher than those obtained for a group of patients using ventilators<36 h(P<0.05).The evaluation results for the AVBFS at 0-12 h after ICU admission were as follows:area under the ROC curve(AUC)=0.876(95%confidence interval[CI]:0.767 to 0.984),cut-off value=2.5,specificity=0.842,and sensitivity=***:Abdominal visceral organ function and blood perfusion can be used to evaluate gastrointestinal *** is related to early and late extubation after cardiac surgery.

关键词： Ultrasonic evaluation Abdominal-visceral-blood-flow-and-function score(AVBFS) Gastrointestinal dysfunction Mechanical ventilation Cardiopulmonary bypass

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The 6-hour lactate clearance rate in predicting 30-day mortality in cardiogenic shock

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Journal of intensive Medicine 2024年第3期4卷 393-399页

作者： Junfeng Wang Mingxia Ji department of intensive care Unit Yiwu Central HospitalYiwuZhejiangChina

Background Early evaluation of prognosis in cardiogenic shock(CS)is crucial for tailored treatment *** lactate clearance and lactate levels are considered useful prognostic biomarkers in patients with ***,there is yet no literature comparing the 6-hour lactate clearance rate(Δ6Lac)with lactate levels measured at admission(L1)and after 6 h(L2)to predict 30-day mortality in *** In this observational cohort study,95 patients with CS were treated at department of intensive care Unit,Yiwu Central Hospital between January 2020 and December *** these,88 patients met the eligibility *** lactate levels were measured after admission(L1)as the baseline lactate value,and were measured after 6 h(L2)following *** primary endpoint of the study was survival rate at 30 days.A receiver operating characteristic curve was used for data *** and multivariate Cox regression analyses were performed based onΔ***–Meier(KM)survival curves were generated to compare the 30-day survival rates among L1,L2,andΔ*** TheΔ6Lac model showed the highest area under the curve value(0.839),followed by the L2(0.805)and L1(0.668)***Δ6Lac model showed a sensitivity of 84.2%and specificity of 75.4%.The L1 and L2 models had sensitivities of 57.9%each and specificities of 89.9%and 98.6%,*** cut-off values forΔ6Lac,L1,and L2 were 18.2%,6.7 mmol/L,and 6.1 mmol/L,*** Cox regression analysis revealed a significant association betweenΔ6Lac and 30-day *** adjusting for five models in multivariate Cox regression,Δ6Lac remained a significant risk factor for 30-day mortality in patients with *** our fifth multivariate Cox regression model,Δ6Lac remained a risk factor associated with 30-day mortality(hazard ratio[HR]=5.14,95%confidence interval[CI]:1.48 to 17.89,P=0.010)as well as L2(HR=8.42,95%CI:1.26 to 56.22,P=0.028).The KM survival curve analysis revealed that L1>6.7 mmol/L(HR=8.08,95%

关键词： Lactates The 6-h lactate clearance rate Cardiogenic shock Mortality Cox regression

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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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Profibrotic role of the SOX9-MMP10-ECM biosynthesis axis in the tracheal fibrosis after injury and repair

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Genes & Diseases 2024年第5期11卷 360-373页

作者： Lei Gu Anmao Li Chunyan He Rui Xiao Jiaxin Liao Li Xu Junhao Mu Xiaohui Wang Mingjin Yang Jinyue Jiang Yang Bai Xingxing Jin Meiling Xiao Xia Zhang Tairong Tan Yang Xiao Jing Lin Yishi Li Shuliang Guo department of respiratory and Critical care Medicine The First Affiliated Hospital of Soochow UniversitySuzhou 215006China department of respiratory and Critical care Medicine The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China department of Infection Disease The First Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang 325000China

Fibroblast activation and extracellular matrix(ECM)deposition play an important role in the tracheal abnormal repair process and *** a transcription factor,SOX9 is involved in fibroblast activation and ECM ***,the mechanism of how SOX9 regulates fibrosis after tracheal injury remains *** investigated the role of SOX9 in TGF-b1-induced fibroblast activation and ECM deposition in rat tracheal fibroblast(RTF)***9 overexpression adenovirus(Ad-SOX9)and siRNA were transfected into RTF *** found that SOX9 expression was up-regulated in RTF cells treated with ***9 overexpression activated fibroblasts and promoted ECM *** SOX9 inhibited cell proliferation,migration,and ECM deposition,induced G2 arrest,and increased apoptosis in RTF ***-seq and chromatin immunoprecipitation sequencing(ChIP-seq)assays identified MMP10,a matrix metalloproteinase involved in ECM deposition,as a direct target of SOX9,which promotes ECM degradation by increasing MMP10 expression through the Wnt/b-catenin signaling ***,in vivo,SOX9 knockdown ameliorated granulation proliferation and tracheal fibrosis,as manifested by reduced tracheal *** conclusion,our findings indicate that SOX9 can drive fibroblast activation,cell proliferation,and apoptosis resistance in tracheal fibrosis via the Wnt/b-catenin signaling *** SOX9eMMP10 eECM biosynthesis axis plays an important role in tracheal injury and *** SOX9 and its downstream target MMP10 may represent a promising therapeutic approach for tracheal fibrosis.

关键词： Extracellular matrix deposition Fibroblast activation MMP10 SOX9 Tracheal fibrosis

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Septic shock due to Capnocytophaga canimorsus treated with IgM-enriched immunoglobulin as adjuvant therapy in an immunocompetent woman

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Journal of intensive Medicine 2024年第2期4卷 265-268页

作者： Josephine Braunsteiner Stephanie Siedler Dominik Jarczak Stefan Kluge Axel Nierhaus department of intensive care Medicine University Medical Centre Hamburg-EppendorfHamburgGermany

Background Capnocytophaga canimorsus(***)belongs to the family *** is a facultative anaerobic Gram-negative bacillus and belongs to the normal oral microbiota of some mammals,such as cats and *** to humans can occur through the skin after skin abrasion caused by a scratch or a bite.[1]Based on polymerase chain reaction(PCR)analysis,*** is present in saliva in 70%-74%of dogs and 55%-57%of cats.

关键词： belongs enriched scratch

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Bronchobiliary fistula in a patient with liver cancer

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Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 523-525页

作者： Yao-Xin Chen Zhi-Hua Deng Hao Zhao Bi-Ying Zhou Jing-Jing Guo Gang Zeng Jin-Xian Qian department of respiratory and Critical care Medicine Suzhou Municipal Hospital Affiliated to Nanjing Medical UniversitySuzhou 215000China

Bronchobiliary fistula(BBF) is a pathologic channel between the biliary tract and bronchial tree. In general, congenital BBF is relatively rare in adult patients. There are a few case reports suggesting that BBF is mainly secondary to hepatobiliary diseases, such as biliary obstruction, tumor, surgery, or liver abscess, and liver tumor is the predominant causative factor [1]. In addition, with the increasing number of liver and biliary surgeries and interventional therapies in recent years, more cases of BBF were reported as a postoperative complication [ 2, 3 ]. In this case, we presented a patient who underwent interventional treatment for liver tumor and was treated for his respiratory symptoms but diagnosed with BBF finally. Here, we summarized the clinical features and main diagnostic procedures of the case, aiming to provide evidence for early identification and diagnosis of BBF.

关键词： biliary fistula diagnosis

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Predictive performance of the variation rate of the driving pressure on the outcome of invasive mechanical ventilation in patients with acute respiratory distress syndrome

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Chinese Journal of Traumatology 2024年第2期27卷 107-113页

作者： Hui-Dan Jing Jun-Ying Tian Wei Li Bing-Ling He Hong-Chao Li Fu-Xia Jian Cui Shang Feng Shen department of intensive care Unit The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550004China department of intensive care Unit Army Medical Center of PLAChongqing400042China College of Foreign Languges Chongqing Medical UniversityChongqing400016China

Purpose:To assess the value of the driving pressure variation rate(ΔP%)in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress ***:In this case-control study,a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were *** were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 *** measures including driving pressure,PaO2:FiO2,and positive end-expiratory pressure,*** assessed every 24 h from day 0 to day 14 until successful weaning was *** measurement data of non-normal distribution were presented as median(Q1,Q3),and the differences between groups were compared by Wilcoxon rank sum *** categorical data use the Chi-square test or Fisher's exact test to *** predictive value ofΔP%in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic ***:Of the total 35 patients included in the study,17 were successful vs.18 failed in weaning from a ventilator after 14 days of mechanical *** cut-off values of the medianΔP%measured by Operator 1 *** 2 in the first 4 days were≥4.17%and 4.55%,respectively(p<0.001),with the area under curve of 0.804(sensitivity of 88.2%,specificity of 64.7%)and 0.770(sensitivity of 88.2%,specificity of 64.7%),*** was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group(8(6,13)vs.12(7.5,17.3),p=0.043).The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group(0.2‰vs.2.3‰,p=0.001).There was a significant difference noted between these

关键词： Driving pressure Driving pressure variation rate Acute respiratory distress syndrome Mechanical ventilation

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