Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive...Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in the high-risk CAP sub-group.The 30-day mortality of patients who underwent ICU treatment on admission was also higher than for non-ICU treatment,but much lower than for those patients who took ICU treatment subsequent to the failure of non-ICU treatment.Conclusions Each severity score system,CURB-65,sepsis severity score and especially PSI,was capable of effectively predicting CAP mortality.Delayed ICU admission was related to higher mortality rates in severe CAP patients.展开更多
Background At present, the most effective treatment for pulmonary alveolar proteinosis （PAP） remains whole-lung lavage in spite of the usually accompanying severe hypoxemia, which is expected to be prevented by hype...Background At present, the most effective treatment for pulmonary alveolar proteinosis （PAP） remains whole-lung lavage in spite of the usually accompanying severe hypoxemia, which is expected to be prevented by hyperoxygenated solution improving oxygen supply during lavage. In this study, the efficacy and safety of the effect of hyperoxygenated solution were evaluated. Methods Five patients underwent whole-lung lavage over a 28-month period. Each lung was lavaged with hyperoxygenated （HO） and normal saline solution （plain lactated Ringer＇s solution, NO） randomly and alternatively until the reclaimed fluid was clear. Random number was generated by computer before every cycle of lavage. If the number was odd, the patient was assigned to receive a lavage cycle with hyperoxygenated solution （HO group, n=-109）; if the number was even, normal saline solution was used （NO group, n=-115）. Data of saturation of peripheral oxygen （SPO2）, mean arterial pressure （MAP）, central venous pressure （CVP）, heart rate （HR） and end-tidal carbon dioxide tension （PETCO2） were taken down at 0, 30, 60, 90, 120, 150, 180, 210 and 240 seconds from the beginning of the instillation of solution, and frequency and volume of unilateral lung lavage were also recorded. Time interval between the leR and the right lung lavage was 1 week. Results No patient was withdrawn from the study due to low SPO2 or leakage. Oxygen pressure was （730.21±7.43） mmHg in the hyperoxygenated solution against （175.73±5.92） mmHg in the normal saline solution （P 〈0.01）. Compared with baseline, 8PO2 increased significantly as the instillation of solution began （P〈0.01）, leveled for about 30 seconds （P 〉0.05）, and then decreased significantly to the lowest at the time of drainage （compared with 120 seconds or peak, P 〈0.01）. SPO2 was higher in HO group than in NO group （P 〈0.01）. There were no significant differences in MAP, HR, CVP and PETCO2 between HO group and NO group （P 〉0.05） and also among different time points （P 〉0.05）. Conclusion During the lung lavage for pulmonary alveolar proteinosis, hyperoxygenated solution could significantly improve oxygen supply in comparison with normal saline solution without obvious side effects.展开更多
基金This study was supported by grants from the National Natural Science Foundation of China （No.30871130 and 30500229）,the Qianjiang Talent Project of Science and Technology Department of Zhejiang Province （No.2010R10080）,and the Youth Talent Fund of Health Bureau of Zhejiang Province,China （No.2008QN016）.
文摘Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in the high-risk CAP sub-group.The 30-day mortality of patients who underwent ICU treatment on admission was also higher than for non-ICU treatment,but much lower than for those patients who took ICU treatment subsequent to the failure of non-ICU treatment.Conclusions Each severity score system,CURB-65,sepsis severity score and especially PSI,was capable of effectively predicting CAP mortality.Delayed ICU admission was related to higher mortality rates in severe CAP patients.
文摘Background At present, the most effective treatment for pulmonary alveolar proteinosis （PAP） remains whole-lung lavage in spite of the usually accompanying severe hypoxemia, which is expected to be prevented by hyperoxygenated solution improving oxygen supply during lavage. In this study, the efficacy and safety of the effect of hyperoxygenated solution were evaluated. Methods Five patients underwent whole-lung lavage over a 28-month period. Each lung was lavaged with hyperoxygenated （HO） and normal saline solution （plain lactated Ringer＇s solution, NO） randomly and alternatively until the reclaimed fluid was clear. Random number was generated by computer before every cycle of lavage. If the number was odd, the patient was assigned to receive a lavage cycle with hyperoxygenated solution （HO group, n=-109）; if the number was even, normal saline solution was used （NO group, n=-115）. Data of saturation of peripheral oxygen （SPO2）, mean arterial pressure （MAP）, central venous pressure （CVP）, heart rate （HR） and end-tidal carbon dioxide tension （PETCO2） were taken down at 0, 30, 60, 90, 120, 150, 180, 210 and 240 seconds from the beginning of the instillation of solution, and frequency and volume of unilateral lung lavage were also recorded. Time interval between the leR and the right lung lavage was 1 week. Results No patient was withdrawn from the study due to low SPO2 or leakage. Oxygen pressure was （730.21±7.43） mmHg in the hyperoxygenated solution against （175.73±5.92） mmHg in the normal saline solution （P 〈0.01）. Compared with baseline, 8PO2 increased significantly as the instillation of solution began （P〈0.01）, leveled for about 30 seconds （P 〉0.05）, and then decreased significantly to the lowest at the time of drainage （compared with 120 seconds or peak, P 〈0.01）. SPO2 was higher in HO group than in NO group （P 〈0.01）. There were no significant differences in MAP, HR, CVP and PETCO2 between HO group and NO group （P 〉0.05） and also among different time points （P 〉0.05）. Conclusion During the lung lavage for pulmonary alveolar proteinosis, hyperoxygenated solution could significantly improve oxygen supply in comparison with normal saline solution without obvious side effects.
