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Prevalence, risk factors, clinical course, and outcome of acute kidney injury in Chinese intensive care units： a prospective cohort study

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Chinese Medical Journal 2013年第23期126卷 4409-4416页

作者： WEN Ying JIANG Li XU Yuan QIAN Chuan-yun LI Shu-sheng QIN Tie-he CHEN Er-zhen LIN Jian-dong AI Yu- hang WU Da-wei WANG Yu-shan SUN Ren-hua HU Zhen-jie CAO Xiang-yuan ZHOU Fa-chun HE Zhen-yang ZHOU Li-hua AN You-zhong KANG Yan MA Xiao-chun YU Xiang-you ZHAO Ming-yan XI Xiu-ming DU Bin Department of Critical care Medicine Fuxing Hospital Capital Medical University Beijing 100038 China Department of Critical care Medicine Beijing Tongren HospitalCapital Medical University Beijing 100730 China Department of Emergency Medicine First Affiliated Hospital of Kunming Medical College Kunming Yunnan 650032 China Department of Critical care Medicine Tongji Hospital Tongji Medical College Huazhong University of Science & TechnologyWuhan Hubei 430030 China Department of Critical care Medicine Guangdong General HospitalGuangzhou Guangdong 510080 China Department of Emergency Medicine Ruijin Hospital Shanghai Jiao Tong University Shanghai 200025 China Department of Critical care Medicine First Affiliated Hospital ofFuiian Medical University Fuzhou Fujian 350005 China Department of Critical care Medicine Xiangya Hospital CentralSouth University Changsha Hunan 410008 China Department of Critical care Medicine Qilu Hospital Shandong University Jinan Shandong 250012 China Department of Emergency and Critical care Medicine The Second Hospital of Jilin University Changchun Jilin 130041 China Department of Critical care Medicine Zhejiang Provincial People's Hospital Hangzhou Zhejiang 310014 China Department of Critical care Medicine Hebei Medical University Fourth Hospital Shijiazhuang Hebei 050011 China Department of Critical care Medicine Affiliated Hospital of Ningxia Medical University Yinchuan Ningxia 750004 China Department of Critical care Medicine First Affiliated Hospital Chongqing Medical University Chongqing 400016 China Department of Critical care Medicine Hainan Provincial People's Hospital Haikou Hainan 570311 China Department of Critical care Medicine Affiliated Hospital of Inner Mongolia Medical College Huhhot Inner Mongolia 010050 China Department of Critical care Medicine Peking University People's Hospital Beijing 100044 China Department of Critical care Medicine West China Hospital Sichuan University Chengdu Sichuan 61004

Background Acute kidney injury （AKI） has been recognized as a major healthcare problem affecting millions of patients ***,epidemiologic data concerning AKI in China are still *** objectives of this study were to characterize AKI defined by RIFLE criteria,assess the association with hospital mortality,and evaluate the impact of AKI in the context of other risk *** This prospective multicenter observational study enrolled 3,063 consecutive patients from 1 July 2009 to 31 August 2009 in 22 ICUs across China's *** excluded patients who were admitted for less than 24 hours （n=1623）,younger than 18 years （n=127）,receiving chronic hemodialysis （n=29）,receiving renal transplantation （n=1） and unknown reasons （n=28）.There were 1255 patients in the final *** was diagnosed and classified according to RIFLE *** There were 396 patients （31.6％） who had AKI,with RIFLE maximum class R,I,and F in 126 （10.0％）,91 （7.3％）,and 179 （14.3％） patients,*** function deteriorated in 206 patients （16.4％）.In comparison with non AKI patients,patients in the risk class on ICU admission were more likely to progress to the injury class （odds ratio （OR） 3.564,95％ confidence interval （CI） 1.706-7.443,P =0.001],while patients in the risk class （OR 5.215,95％ CI 2.798-9.719,P ＜0.001） and injury class （OR 13.316,95％ CI 7.507-23.622,P ＜0.001） had a significantly higher probability of deteriorating into failure *** adjusted hazard ratios for 90-day mortality were 1.884 for the risk group,3.401 for the injury group,and 5.306 for the failure *** The prevalence of AKI was high among critically ill patients in Chinese *** comparison with non-AKI patients,patients with RIFLE class R or class I on ICU admission were more susceptibility to progression to class I or class *** RIFLE criteria were robust and correlated well with clinical deterioration and mortality.

关键词： acute kidney injury intensive care units mortality prevalence risk factors

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Effects of L-carnitine on treatment outcomes of COVID-19 patients hospitalized in intensive care units:A double-blind randomized clinical trial

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Journal of Acute Disease 2024年第3期13卷 100-105页

作者： Hesameddin Modir Behnam Mahmoudieh Seyed Yousef Shahtaheri Fariba Farokhi Department of Anesthesiology and Critical care Arak University of Medical SciencesArakIran Clinical Research Development Valiasr HospitalArak University of Medical SciencesArakIran

Objective:To assess the effects of L-carnitine on the outcomes of patients with moderate to severe coronavirus disease 2019(COVID-19)in intensive care unit(ICU).Methods:This double-blind clinical trial was carried out in 2022-2023.64 Patients with COVID-19 were selected from Amiralmomenin and Khansari hospitals in Arak,*** were randomly assigned to the control and the L-carnitine treatment group via block *** blood gases,disease severity,and levels of D-dimer,lactate dehydrogenase,ferritin,and C-reactive protein were daily assessed during the seven days of the intervention,and the length of ICU stay,the need for endotracheal intubation,and mortality rate were ***:There were significant differences in length of ICU stay,the need for endotracheal intubation,and levels of D-dimer,lactate dehydrogenase,ferritin,APACHE栻score,and C-reactive protein between the two groups(P0.05).Conclusions:L-carnitine can improve outcomes of patients with ***,it can be used as an adjuvant therapy for these patients.

关键词： L-carnitine COVID-19 ICU Critically ill Mortality Clinical outcome

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Generalizable items and modular structure for computerised physician staffing calculation on intensive care units

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World Journal of Critical care Medicine 2017年第3期6卷 153-163页

作者： Manfred Weiss Gernot Marx Thomas Iber Department of Anesthesiology University Hospital Ulm Klinik für Operative Intensivmedizin und Intermediate care Uniklinik RWTH Aachen Department of Anesthesia and intensive care Klinikum Mittelbaden Baden-Baden/Bühl

intensive care medicine remains one of the most costdriving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks(performed in every patient) and additional tasks(necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society ofAnesthesiology and intensive care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

关键词： Budgets Critical care Economics Humans intensive care units Personnel hospital Personnel staffing and scheduling Physicians Workload Quality of health care

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Implementation experience of a 12-month intervention to introduce intermittent kangaroo mother care to eight Chinese neonatal intensive care units

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World Journal of Pediatrics 2022年第12期18卷 849-853页

作者： Xin Liu Xiao-Hui Chen Zhan-Kui Li Bei Cao Shao-Jie Yue Qiong-Yu Liu Chuan-Zhong Yang Chang-Yi Yang Ying-Xi Zhao Geng-Li Zhao Qi Feng Neonatal intensive care Unit Department of PediatricsPeking University First HospitalBeijing 100034China Department of Neonatology Nanjing Maternity and Child Health Care HospitalNanjingChina Department of Neonatology Northwest Women’s and Children’s HospitalXi’anChina Department of Neonatology The Maternal and Child Health Care Hospital of Hunan ProvinceChangshaChina Department of Neonatology Xiangya Hospital Central South UniversityChangshaChina Department of Neonatology Women&Children’s Health Care Hospital of LinyiLinyiChina Department of Neonatology Shenzhen Maternity&Child Healthcare HospitalShenzhenChina Department of Neonatology Fujian Provincial Maternity and Children’s HospitalFuzhouChina Nuffield Department of Medicine University of OxfordOxfordUK Department of Obstetrics and Gynecology Peking University First HospitalBeijingChina

Kangaroo mother care(KMC)is recommended by the World Health Organization for the care of preterm and low-birth-weight *** has been shown to increase survival rates and the quality of life of preterm and low-birth-weight infants,including improved clinical outcomes,weight gain and thermoregulation when compared to conventional care[1,2,3].More recent research focused on KMC in high-risk preterm,critically ill newborns and newborns requiring special care,which suggested that KMC helped to stabilize the vital signs of preterm infants[4,5].KMC is well accepted and promoted by medical associations and professional organizations around the world[6,7].In November 2015 with support from the National Health Commission of China,participants from ten hospitals based in different areas of China received theoretical and practical training on *** a four-year period,health professionals from these hospitals participated in theoretical and practical training,which included two operation training from foreign experts,two academic lectures,and three study tours to hospitals in the UK,Sweden and the *** this period,the KMC Operational Manual for Premature Infants in China was developed,and a 12-month prospective multicenter study of KMC for preterm infants was conducted in the eight *** the present study,we further examine whether KMC was sustained as a practice during a 12-month period from April 2018 to March 2019 and the characteristics of preterm infants that received KMC.

关键词： mother sustained promoted

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Improvement of the nutritional support management system for patients in intensive care units

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World Journal of Psychiatry 2024年第1期14卷 44-52页

作者： Yuan-Yuan Zhang Chun-Yi Wang Dong-Xian Guo Hai-Nu Gao Xian-Shan Jin Yan-Li Wu Lu-Han Chen Zhi-Xian Feng Department of Critical care Medicine Shulan(Hangzhou)HospitalZhejiang Shuren University Shulan International Medical CollegeHangzhou 310022Zhejiang ProvinceChina Department of Information Shulan(Hangzhou)HospitalZhejiang Shuren University Shulan International Medical CollegeHangzhou 310022Zhejiang ProvinceChina Department of Pharmacy Shulan(Hangzhou)HospitalZhejiang Shuren University Shulan International Medical CollegeHangzhou 310022Zhejiang ProvinceChina Department of Nutrition Shulan(Hangzhou)HospitalZhejiang Shuren University Shulan International Medical CollegeHangzhou 310022Zhejiang ProvinceChina Administrative Office Shulan(Hangzhou)HospitalZhejiang Shuren University Shulan International Medical CollegeHangzhou 310022Zhejiang ProvinceChina

BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation *** To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological *** The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU *** Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively *** proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 *** The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.

关键词： Closed-loop information Psychological counseling intensive care unit patients Nutritional support Management system

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Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

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World Journal of Gastroenterology 2020年第3期26卷 266-278页

作者： Venkat Rajasurya Salim Surani Department of Pulmonary and Critical care Novant Health SystemWinston-SalemNC 27103United States Department of Pulmonary Critical care and Sleep Medicine Texas A&M Health Science CenterBryanTX 77807United States

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical ***,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for *** is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and *** it is underdiagnosed and undertreated in this patient *** intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic *** intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and *** volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal *** article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

关键词： Intra-abdominal pressure Intra-abdominal hypertension Abdominal compartment syndrome Acute kidney injury Large volume resuscitation Open abdomen Bladder pressure Medical intensive care unit

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Infection management strategy based on prevention and control of nosocomial infections in intensive care units

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Chinese Medical Journal 2019年第1期132卷 115-119页

作者： Long-Xiang Su Xiao-Ting Wang Pan Pan Wen-Zhao Chai Da-Wei Liu Department of Critical care Medicine Peking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100730China Department of Critical care Medicine Beijing Tiantan HospitalCapital Medical UniversityBeijing 100071China

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection,which is clinical problem often faced by intensive care units (ICU) *** positive treatment,the incidence and mortality of sepsis are high.^[1]As hospital infection control plays an essential role in treating the nosocomial infections in the ICU,and according to the clinical presentation of critically ill patients,the biological characteristics of pathogenic microorganisms and the ICU environment,this article put forward a strategy for the nosocomial infections in the ICU.

关键词： nosocomial infections intensive care units prevention control

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Remimazolam besylate for sedation of postoperative patients in intensive care units: a phase I, open label, dose-finding study

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Chinese Medical Journal 2022年第17期135卷 2134-2136页

作者： Yun Tang Xiaobo Yang Huaqing Shu Yuan Yu Jiqian Xu Shangwen Pan Xiaojing Zou Shiying Yuan You Shang Department of Critical care Medicine Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430022China

To the Editor:Remimazolam besylate is a novel,ultrashort-acting benzodiazepine with a rapid and a predictable onset and offset profile,no accumulation and extended effect,and independence of organ elimination.

关键词： finding independence elimination

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Aerosol therapy during mechanical ventilation in intensive care units: A questionnaire-based survey of 2203 ICU medical staffin China

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Journal of intensive Medicine 2022年第3期2卷 189-194页

作者： Qin Sun Wei Chang Xu Liu Jianfeng Xie Haibo Qiu Yi Yang Ling Liu Department of Critical care Medicine Jiangsu Provincial Key Laboratory of Critical Care MedicineZhongda HospitalSchool of MedicineSoutheast UniversityGulou DistrictNanjingJiangsu 210009China School of Medicine Southeast UniversityGulou DistrictNanjingJiangsu 210009China

Background:To describe the current status of aerosol therapy during mechanical ventilation(MV)and the prac-tice,knowledge,and beliefs about aerosol therapy in physicians working in the intensive care unit(ICU)in ***:A physician self-administered questionnaire-based cross-sectional survey was carried out from January 2019 to July *** electronic questionnaire was designed,and physicians who worked regularly in ICUs across several hospitals were contacted through *** to all questions and the general characteristics of physicians who answered the questionnaire were collected and ***:A total of 2203 medical staffwho regularly worked in the ICUs completed this questionnaire(9.0%missing data);87.7%of the participants were *** respondents claimed that they often administered aerosolization *** atomizer(50.7%)and jet nebulizer(48.6%)were the most commonly used atomization ***(65.8%)and steroids(66.3%)were the most frequently aerosolized drugs during *** nebulization,ventilator settings were never changed by 32.7%of *** 49.1%of respondents knew the appropriate place for a ***,62.7%of respondents using heated humidifiers reported turning them offduring *** knowledge about droplet size and nebulization yield was *** from tertiary hospitals and those with higher technical title or work experience tended to have better accuracy than those from primary hospitals or with lower technical titles(P<0.050).Conclusions:Aerosol therapy was commonly used during MV,and the most frequent drugs were bronchodila-tors and *** knowledge about the optimal implementation of aerosol therapy during MV seemed deficient.

关键词： Inhalation administration Nebulizers and vaporizers Aerosolized drugs Medical training

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Management of renal replacement therapy among adults in French intensive care units: A bedside practice evaluation

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Journal of intensive Medicine 2023年第2期3卷 147-154页

作者： Florian Jolly Marine Jacquier Delphine Pecqueur Marie Labruyère Christophe Vinsonneau Isabelle Fournel Jean-Pierre Quenot The READIAL Study group Service de Médecine intensive-Réanimation CHU Dijon-BourgogneDijon 21000France Equipe Lipness Centre de recherche INSERM UMR1231 et LabEx LipSTICUniversitéde Bourgogne-Franche ComtéDijon 21000France INSERM CIC 1432Module Epidémiologie CliniqueDijon 21000France CHU Dijon-Bourgogne Centre d’Investigation CliniqueModule Epidémiologie Clinique/Essais CliniquesDijon 21000France Service de Médecine intensive Réanimation-Unitéde Sevrage Ventilatoire et Réhabilitation CH de BethuneBethune 62408France 不详

Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the ***:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, ***:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.

关键词： Renal replacement therapy Acute kidney injury intensive care unit Practice evaluation Bedside

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