Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed rapidly in the field of critical care in recent years.Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator.Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into a successful ventilation group(68 cases)and a failed ventilation group(26 cases)according to the outcome of ventilation.The clinical data of patients with successful and failed noninvasive ventilation were compared,and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.RESULTS There were no significant differences in gender,age,body mass index,complications,systolic pressure,heart rate,mean arterial pressure,respiratory rate,oxygen saturation,partial pressure of oxygen,oxygenation index,or time of inspiration between patients with successful and failed mechanical ventilation(P>0.05).The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide(PaCO_(2))than those with failed treatment,while potential of hydrogen(pH),diaphragm thickening fraction(DTF),diaphragm activity,and diaphragm movement time were significantly higher than those with failed treatment(P<0.05).pH[odds ratio(OR)=0.005,P<0.05],PaCO_(2)(OR=0.430,P<0.05),and DTF(OR=0.570,P<0.05)were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.

Clinical Efficacy and Safety Analysis of Tigecycline in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Combined with Multidrug-Resistant Acinetobacter baumannii Infection

Objective:To study the clinical efficacy and safety of tigecycline in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD)combined with multidrug-resistant Acinetobacter baumannii infection.Methods:113 patients with acute exacerbation of COPD combined with multidrug-resistant Acinetobacter baumannii infection were recruited between January 2021 and January 2023,and given tigecycline treatment.The total effective rate,lung function indexes,related biochemical index levels,and the incidence rate of adverse reactions were observed after the treatment.Results:After the treatment,100 patients were cured,1 case with apparent effect,2 cases were effective,10 cases were ineffective,and the total effective rate was 91.15%.The post-treatment CRP(21.22±3.35 mg/L),PCT(3.18±1.11 ng/L),CRE(76.36±9.24μmol/L),and ALT(37.76±6.99 U/L)were significantly improved as compared to the pre-treatment(P<0.05).After treatment,10 cases of vomiting(8.85%),13 cases of nausea(11.50%),4 cases of diarrhea(3.53%),1 case of abdominal pain(0.88%),and 2 cases of allergy(1.77%)were observed in 113 patients.Conclusion:Tigecycline therapy for patients with acute exacerbation of COPD combined with multidrug-resistant Acinetobacter baumannii infection not only has significant therapeutic efficacy but also has a high degree of safety.

Analysis of the Effect of Traditional Chinese Medicine Nursing Intervention Combined with Acupoint Application in The Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective:To study the effect of Traditional Chinese medicine(TCM)nursing intervention combined with acupoint patch in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods:A total of 60 patients with acute exacerbation of COPD admitted between September 2022 and September 2023 were selected and randomly grouped into a control group(conventional care and treatment)and an observation group(joint interventions:traditional Chinese medicine nursing interventions,acupoint compresses),with 30 patients each.The arterial blood gas indexes of the two groups,hospitalization time,pulmonary function indexes,and TCM symptom scores were analyzed and compared between the two groups.Results:The arterial oxygen pressure(PaO_(2))(9.52±1.02 kPa)and partial pressure of carbon dioxide(PaCO_(2))(5.01±1.02 kPa)of the observation group were better than those of the control group after the intervention(P<0.05).The forced expiratory volume(FEV1)(3.38±0.15%),the FEV1% prediction value(72.52±2.25),and the FEV1/forced vital capacity(FVC)(79.52±1.41%)were higher than those of the control group(P<0.05).The hospitalization time(12.16±1.02 d)and TCM symptom score(4.12±1.26)of the observation group were better than those of the control group(P<0.05).Conclusion:Significant nursing effects were achieved by carrying out combined interventions(Chinese medicine nursing intervention and acupoint application)during the acute exacerbation of COPD.

Eff ects of early standardized enteral nutrition on preventing acute muscle loss in the acute exacerbation of chronic obstructive pulmonary disease patients with mechanical ventilation

BACKGROUND:To investigate the eff ects of early standardized enteral nutrition(EN)on the crosssectional area of erector spine muscle(ESMcsa),plasma growth diff erentiation factor-15(GDF-15),and 28-day mortality of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients with invasive mechanical ventilation(MV).METHODS:A total of 97 AECOPD patients with invasive MV were screened in the ICUs of the First People's Hospital of Lianyungang.The conventional EN group(stage Ⅰ)and early standardized EN group(stage Ⅱ)included 46 and 51 patients,respectively.ESMcsa loss and GDF-15 levels on days 1 and 7 of ICU admission and 28-day survival rates were analyzed.RESULTS:On day 7,the ESMcsa of the early standardized EN group was significantly higher than that of the conventional EN group,while the plasma GDF-15 levels were significantly lower than those in the conventional EN group(ESMcsa:28.426±6.130 cm^(2) vs.25.205±6.127 cm^(2);GDF-15:1661.608±558.820 pg/mL vs.2541.000±634.845 pg/mL;all P<0.001).The 28-day survival rates of the patients in the early standardized EN group and conventional EN group were 80.40%and 73.90%,respectively(P=0.406).CONCLUSION:ESMcsa loss in AECOPD patients with MV was correlated with GDF-15 levels,both of which indicated acute muscular atrophy and skeletal muscle dysfunction.Early standardized EN may prevent acute muscle loss and intensive care unit-acquired weakness(ICU-AW)in AECOPD patients.

Clinical study of NFNC in the treatment of acute exacerbation chronic obstructive pulmonary disease patients with respiratory failure

BACKGROUND Most patients with acute exacerbation chronic obstructive pulmonary disease(AECOPD)have respiratory failure that necessitates active correction and the improvement of oxygenation is particularly important during treatment.High flow nasal cannula(HFNC)oxygen therapy is a non-invasive respiratory aid that is widely used in the clinic that improves oxygenation state,reduces dead space ventilation and breathing effort,protects the loss of cilia in the airways,and improves patient comfort.AIM To compare HFNC and non-invasive positive pressure ventilation in the treatment of patients with AECOPD.METHODS Eighty AECOPD patients were included in the study.The patients were in the intensive care department of our hospital from October 2019 to October 2021.The patients were divided into the control and treatment groups according to the different treatment methods with 40 patients in each group.Differences in patient comfort,blood gas analysis and infection indices were analyzed between the two groups.RESULTS After treatment,symptoms including nasal,throat and chest discomfort were significantly lower in the treatment group compared to the control group on the 3rd and 5th days(P<0.05).Before treatment,the PaO_(2),PaO_(2)/FiO_(2),PaCO_(2),and SaO_(2)in the two groups of patients were not significantly different(P>0.05).After treatment,the same indicators were significantly improved in both patient groups but had improved more in the treatment group compared to the control group(P<0.05).After treatment,the white blood cell count,and the levels of C-reactive protein and calcitonin in patients in the treatment group were significantly higher compared to patients in the control group(P<0.05).CONCLUSION HFNC treatment can improve the ventilation of AECOPD patients whilst also improving patient comfort,and reducing complications.HFNC is a clinically valuable technique for the treatment of AECOPD.

Acute exacerbation of idiopathic pulmonary fibrosis treated using the Feibi recipe:Two case reports

BACKGROUND Rationale:No other treatment besides lung transplant is effective for idiopathic pulmonary fibrosis(IPF).Patients with IPF have poor prognosis,which may eventually lead to death.Patient concerns:Two female patients were diagnosed with IPF.In our recent follow-up,both these patients maintained a good quality of life.CASE SUMMARY Diagnosis:Both patients had dry cough and progressive dyspnea.Interventions:The first patient was treated with prednisone,and the second patient was treated with prednisone and tripterygium glycosides.However,the symptoms did not improve and fibrosis was not controlled.Thus,the Feibi recipe was used.Outcomes:No deterioration was observed after the treatment,and the dry cough and its effect were ameliorated.Furthermore,they are still alive and the quality of their lives has improved.CONCLUSION These two cases suggest that the Feibi recipe and other traditional Chinese medicine therapies could be beneficial for IPF treatment.

Acute exacerbation of interstitial lung disease in the intensive care unit:Principles of diagnostic evaluation and management

Interstitial lung disease(ILD)is typically managed on an outpatient basis.Critical care physicians manage patients with ILD in the setting of an acute exacerbation(ILD flare)causing severe hypoxia.The principles of management of acute exacerbation of ILD are different from those used to manage patients with acute respiratory distress syndrome from sepsis,etc.Selected patients may be candidates for aggressive measures like extracorporeal membrane oxygenation and lung transplantation,while almost all patients will benefit from early palliative care.This review focused on the types of ILD,diagnosis,and management pathways for this challenging condition.

Effects of acetylcysteine on micro-inflammation and pulmonary ventilation in chronic obstructive pulmonary disease exacerbation

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is a serious complication of chronic obstructive pulmonary disease,often characterized by increased morbidity and mortality.In traditional Chinese medicine,AECOPD is linked to phlegm-heat and blood-stasis,presenting symptoms like thick sputum,fever,and chest pain.It has been shown that acetylcysteine inhalation in conjunction with conventional therapy significantly reduced inflammatory markers and improved lung function parameters in patients with AECOPD,suggesting that acetylcysteine may be an important adjunctive therapy for patients with phlegm-heat-blood stasis type AECOPD.AIM To investigate the effect of acetylcysteine on microinflammation and lung ventilation in patients with phlegm-heat and blood-stasis-type AECOPD.METHODS One hundred patients with phlegm-heat and blood-stasis-type AECOPD were randomly assigned to two groups.The treatment group received acetylcysteine inhalation(10%solution,5 mL,twice daily)along with conventional therapy,whereas the control group received only conventional therapy.The treatment duration was 14 d.Inflammatory markers(C-reactive protein,interleukin-6,and tumor necrosis factor-alpha)in the serum and sputum as well as lung function parameters(forced expiratory volume in one second,forced vital capacity,and peak expiratory flow)were assessed pre-and post-treatment.Acetylcysteine inhalation led to significant reductions in inflammatory markers and improvements in lung function parameters compared to those in the control group(P<0.05).This suggests that acetylcysteine could serve as an effective adjunct therapy for patients with phlegm-heat and blood-stasis-type AECOPD.RESULTS Acetylcysteine inhalation significantly reduced inflammatory markers in the serum and sputum and improved lung ventilation function parameters in patients with phlegm-heat and blood-stasis type AECOPD compared with the control group.These differences were statistically significant(P<0.05).The study concluded that acetylcysteine inhalation had a positive effect on microinflammation and lung ventilation function in patients with this type of AECOPD,suggesting its potential as an adjuvant therapy for such cases.CONCLUSION Acetylcysteine inhalation demonstrated significant improvements in reducing inflammatory markers in the serum and sputum,as well as enhancing lung ventilation function parameters in patients with phlegm-heat and bloodstasis type AECOPD.These findings suggest that acetylcysteine could serve as a valuable adjuvant therapy for individuals with this specific type of AECOPD,offering benefits for managing microinflammation and optimizing lung function.

The Value of MLPR,NLR,and RDW in the Assessment of Combined Pulmonary Embolism in Elderly Patients with AECOPD

Objective:To investigate the diagnostic value of the monocyte-to-large-platelet ratio(MLPR),neutrophil-to-lymphocyte ratio(NLR),and red blood cell distribution width(RDW)for pulmonary embolism(PE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 60 elderly AECOPD patients were enrolled and divided into embolus group(12 cases)and thrombus group(48 cases)according to whether they were combined with pulmonary embolism and the MLPR,NLR,and RDW values of the two groups were determined respectively.Results:The patients in the two groups had different degrees of vascular structural and functional abnormalities,and the MLPR,NLR,and RDW in the embolus group were significantly higher than those in the thrombus group(P<0.05);while the differences in NLR and RDW between the two groups were not significant.Conclusion:MLPR,NLR,and RDW can provide an objective basis for assessing PE in elderly AECOPD patients.

Value of refined care in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND Under physiological conditions,sputum produced during acute exacerbation of chronic obstructive pulmonary disease(AECOPD)can move passively with the cilia in the airway;the sputum is gradually excreted from the depth of the airways through the stimulation of the coughing reflex on the sensory nerve on the surface of the airway.However,when the sputum is thick,the cough is weak,or the tracheal cilia are abnormal,sputum accumulation may occur and affect the exchange of oxygen and carbon dioxide in the lung.Furthermore,the presence of pathogenic microorganisms in sputum may cause or aggravate the symptoms of pulmonary infection in patients,which is the main factor leading to AECOPD.Therefore,promoting effective drainage of sputum and maintaining airway opening are key points requiring clinical attention.AIM To explore the effect of refined nursing strategies in patients with AECOPD and dysphagia.METHODS We selected 126 patients with AECOPD and difficulty of expectoration at our hospital,and divided them into a refined care group and a routine care group,with 63 cases each,using a random number table.The two groups of patients were treated with expectorant,anti-infection,oxygen inhalation,and other basic treatment measures;patients in the refined care group were given refined nursing intervention during hospitalization,and the routine care group received conventional nursing intervention.The differences in sputum expectoration,negative pressure suction rate,blood gas parameters,dyspnea score measured through the tool developed by the Medical Research Council(MRC),and quality of life were compared between the two groups.RESULTS After 7 d of intervention,the sputum expectoration effect of the refined care group was 62.30%,the effective rate was 31.15%,and the inefficiency rate was 6.56%.The sputum expectoration effect of the routine care group was 44.07%,the effective rate was 42.37%,and the inefficiency rate was 13.56%.The refined care group had better sputum expectoration than the routine care group(P<0.05).The negative pressure suction rate in the refined care group was significantly lower than that of the routine care group during the treatment(22.95%vs 44.07%,P<0.05).Before the intervention,the arterial oxygen saturation(PaO2)and arterial carbon dioxide saturation(PaCO2)values were not significantly different between the two groups(P>0.05);the PaO2 and PaCO2 values in the refined care group were comparable to those in the routine care group after 7 d of intervention(P>0.05).Before the intervention,there was no significant difference in the MRC score between the two groups(P>0.05);the MRC score of the refined care group was lower than that of the routine care group after 7 d of intervention,but the difference was not statistically significant(P>0.05).Before intervention,there was no significant difference in the symptoms,activities,disease impact,or St.George’s Respiratory questionnaire(SGRQ)total scores between the two groups(P>0.05).After 7 days of intervention,the symptoms,activities,and total score of SGRQ of the refined care group were higher than those of the routine care group,but the difference was not statistically significant(P>0.05).CONCLUSION AECOPD with thick sputum,weak coughing reflex,and abnormal tracheal cilia function will lead to sputum accumulation and affect the exchange of oxygen and carbon dioxide in the lung.Patients with AECOPD who have difficulty expectorating sputum may undergo refined nursing strategies that will promote expectoration,alleviate clinical symptoms,and improve the quality of life.

Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation

BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.

Diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia and acute exacerbation of chronic obstructive pulmonary disease in Gansu Province:A case report

BACKGROUND In December 2019,the first patient with 2019-novel coronavirus(2019-nCoV)was reported in Wuhan,China,and the disease spread rapidly across the country and surrounding countries within 2 mo.As of February 29,2020,a total of 91 confirmed cases had been reported in Gansu Province.This case report of the diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia complicated by acute exacerbation of chronic obstructive pulmonary disease in Gansu Province aims to provide a better reference for the treatment of patients in the future.CASE SUMMARY The patient,a 94-year-old female,lived in Maiji District of Tianshui,Gansu Province,China.On January 30,2020,she was admitted to the Fourth People’s Hospital of Tianshui after 9 d of close contact with a patient with 2019-nCoV pneumonia.She was subsequently admitted to Gansu Provincial Hospital of Traditional Chinese Medicine for isolation and transferred to Tianshui Gansu Provincial Hospital of Infectious Diseases on February 3,2020 for treatment.Upon initial examination,her body temperature was 36.7°C,pulse was 80,breathing was 20,and blood pressure was 130/80 mmHg.She was conscious with normal development and normal nutrition.The pharynx was not red,and bilateral tonsils were not red and swollen.The lungs sounded slightly coarse with no dry or wet rales.The first symptoms were cough and fatigue on 2 February.The patient was hospitalized for 12 d.After active treatment,she was discharged on February 14 with a good prognosis.CONCLUSION A history of exposure to the affected area or patient is a major cause of 2019-nCoV infection,and population clustering is a high risk factor for transmission.Patients may not necessarily have respiratory system symptoms as the only clinical manifestation but may also have concomitant or first onset digestive symptoms.Attention should be paid to the prevention and treatment of multiple organ dysfunction syndrome.Nucleic acid testing is extremely important and needs to be repeated several times.Laboratory and auxiliary examination indicators during the first week of admission are extremely important.It is feasible to carry out dynamic and continuous index monitoring,which can predict and guide the prevention and treatment of multiple organ dysfunction and the prognosis of the disease.

Centrilobular necrosis in acute presentation of Japanese patients with type 1 autoimmune hepatitis

AIM: To compare clinicopathological features of acute presentation of type 1 autoimmune hepatitis (AIH) with or without centrilobular necrosis (CN). METHODS: Our study comprised 41 patients with biopsy-proven acute presentation (acute exacerbation phase 36, acute hepatitis phase 5) of type 1 AIH at our hospital from 1975 to 2009. Elevated serum alanine aminotransferase (ALT) (> 5x upper limit of normal) identified acute presentation of the disease. We compared clinicopathological features of these AIH patients with or without CN. The data used for analysis included patient background (age, sex, type of disease, presence of complications with other autoimmune diseases, human leukocyte antigen, and International Autoimmune Hepatitis Group score), clinical parameters at presentation (ALT, alkaline phosphatase, IgG, anti-nuclear antibodies, and anti-smooth muscle antibodies), histology and therapy. RESULTS: CN was found in 13 (31.7%) patients with acute presentation (acute exacerbation phase 10, acute hepatitis phase 3) of AIH. Serum IgG levels of patients with CN were significantly lower than those of patients without CN (mean: 2307 mg/dL vs 3126 mg/dL, P < 0.05), while antinuclear antibody-negative rates were significantly higher (30.7% vs 3.5%, P < 0.05). However, other clinical features were similar between the two groups. The frequency of advanced fibrosis in patients with CN was significantly lower than in patients without CN (F0-2: 84.6% vs 35.7%, F3-4: 15.4% vs 64.3%, P < 0.05). Other histological features were similar between the two groups. Although there was no significant difference between groups when evaluated using the revised original score (12 vs 14), the simplified AIH score of patients with CN was significantly lower (6 vs 7, P < 0.05). Frequency of DR4 was similar between patients with and without CN. CONCLUSION: CN is observed in both Japanese patients with acute hepatitis phase and acute exacerbation phase of type 1 AIH, although AIH with CN often shows clinical features of the genuine acute form.

Effect of low-dose glucocorticoid on corticosteroid insufficient patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND: This study aimed to investigate the prevalence rate of critical illness-related corticosteroid insuffi ciency(CIRCI) and the effect of low-dose glucocorticoid on prognosis of CIRCI in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).METHODS: Since January 2010 to December 2012, 385 patients, who met the criteria of AECOPD, were enrolled in the Intensive Care Unit(ICU) of the First People's Hospital and Municipal Central Hospital of Xiangtan City. The AECOPD patients complicated with CIRCI screened by an adrenalcorticotrophic hormone test within 12 hours after admission to ICU were divided into a treatment group(n=32) and a control group(n=31) for a prospective, randomized and controlled clinical trial. Hydrocortisone(150 mg/d) or normal saline was injected intravenously for 7 days. The patients were followed up for 28 days after injection. The endpoint included 28-day survival time, non-shock time, ICU stay and the period of non-mechanical ventilation. The markers ofinfl ammation C-reactive protein, tumor necrosis factor-α, interleukin 6 and procalcitonin were measured at baseline and 7 days after treatment. The variables were analyzed by Student's t test, the non-parametric statistical test, the Chi-square test or the Kaplan-Meier method with SPSS18.0 statistic software. A P value <0.05 was considered statistically signifi cant.RESULTS: Totally 63 patients were diagnosed with CIRCI by an adrenalcorticotrophic hormone test and the prevalence rate was 16.4%. The shock rate of the AECOPD patients complicated with CIRCI was higher than that of the AECOPD patients without CIRCI(23.8% vs. 8.7%, P<0.01). KaplanMeier analysis revealed that the 28-day survival time of the treatment group was obviously longer than that of the control group(P<0.05). Compared with the control group, shock-free days within 28 days was longer in the treatment group(18.2±9.5 vs. 25.8±4.1, P<0.05). Treatment with low-dose glucocorticoid obviously decreased the markers ofinfection and inflammation(P<0.01), such as C-reactive protein(13.2±5.5 mg/L vs. 8.3±3.1 mg/L for the control group; 13.5±5.9 mg/L vs. 5.1±2.3 mg/L for the treatment group), tumor necrosis factor-α(26.1±16.2 g/L vs. 17.5±11.7 g/L for the control group; 25.0±14.8 g/L vs. 10.4±7.8 g/L for the treatment group) and procalcitonin(3.88 g/L vs. 2.03 g/L for the control group; 3.77 g/L vs. 1.26 g/L for the treatment group). Furthermore, the markers in the treatment group decreased more obviously than those in the control group(P<0.01).CONCLUSION: The prevalence rate of CIRCI was higher in the patients with AECOPD in the department of critical medicine, and low-dose glucocorticoid treatment for one week reduced the 28-day mortality, shock time and markers ofinfection and infl ammation.

Ambient Temperature and Outpatient Visits for Acute Exacerbation of Chronic Bronchitis in Shanghai: A Time Series Analysis

The association between ambient temperature and acute exacerbation of chronic bronchitis （AECB） was still unknown. Therefore, we performed an epidemiological study in a large hospital of Shanghai to explore the relationship about temperature and outpatient visit for AECB. We adopted a quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on AECB across multiple days. We found significant non-linear effects of cold temperature on hospital visits for AECB, and the potential effect of cold temperature might last more than 2 weeks. The relative risks of extreme cold （first percentiles of temperature throughout the study period） and cold （10th percentile of temperature） temperature over lags 0-14 d were 2.98 [95% confidence intervals （CI）： 1.77, 5.04] and 1.63 （95% Ch 1.21, 2.19）, compared with the 25th percentile of temperature. However, we found no positive association between hospital visits and hot weather. This study showed that exposure to both extreme cold and cold temperatures were associated with increased outpatient visits for AECB in a large hospital of Shanghai.

Helmet-based noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease: A case report

BACKGROUND Noninvasive ventilation(NIV)reduces intubation rates,mortalities,and lengths of hospital and intensive care unit stays in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Helmet-based NIV is better tolerated than oronasal mask-based ventilation,and thus,allows NIV to be conducted for prolonged periods at higher pressures with minimal air leaks.CASE SUMMARY A 73-year-old man with a previous diagnosis of COPD stage 4 was admitted to our medical intensive care unit with chief complaints of cough,sputum,and dyspnea of several days’duration.For 10 mo,he had been on oxygen at home by day and had used an oronasal mask-based NIV at night.At intensive care unit admission,he breathed using respiratory accessory muscles.Hypercapnia and signs of infection were detected,and infiltration was observed in the right lower lung field by chest radiography.Thus,we diagnosed AECOPD by communityacquired pneumonia.After admission,respiratory distress steadily deteriorated and invasive mechanical ventilation became necessary.However,the patient refused this option,and thus,we selected helmet-based NIV as a salvage treatment.After 3 d of helmet-based NIV,his consciousness level and hypercapnia recovered to his pre-hospitalization level.CONCLUSION Helmet-based NIV could be considered as a salvage treatment when AECOPD patients refuse invasive mechanical ventilation and oronasal mask-based NIV is ineffective.

Effect of ivabradine in the treatment of acute exacerbation of chronic obstructive pulmonary disease with heart failure

Objective: To observe the effectiveness and safety of ivabradine in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and heart failure. Methods:Patients who were admitted to hospital with AECOPD during the period from August 2017 to July 2018. Then those both had heart failure with reduced ejection fraction(HFrEF) and a resting heart rate>70 beats/min were enrolled. A total of 86 cases were screened and completed, which were randomly divided into two groups for treatment. The control group(41 cases) received standard treatments, such as oxygen, anti-infection, anti-spasmodic, hormone, diuretic, ACEI/ARB, recombinant human brain natriuretic peptide (rhBNP), etc. The bisoprolol was given 2.5~5 mg orally once a day to control heart rate, and the test group(45 cases) was further treated with ivabradine 2.5~5 mg orally twice a day on the basis of the control group. The average heart rate, cardiac function, lung function, and 6-minute walking test were compared between the two groups. Results: After treatment, the average heart rate of the test group was lower than the control group, and the heart rate control rate(<70 beats/min%) of the test group was superior to the control group. The level of N-terminal B-type natriuretic peptide(NT-proBNP) in test group was significantly lower than that in control group. The distance of the 6-minute walking test in e test group was significantly longer than that in control group. Conclusion: Ivabradine combined with bisoprolol could help patients with AECOPD and heart failure to further reduce the heart rates, improve heart function and exercise tolerance. Moreover, the therapeutic safety was acceptable during the short term.

Diagnostic accuracy of C-reactive protein for bacterial infections in acute exacerbation of chronic obstructive pulmonary disease: A meta-analysis

Objective:The clinical diagnostic accuracy of C-reactive protein(CRP)for bacterial infections in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is still controversial.This study evaluated its accuracy through Meta-analysis.Methods:Studies on the diagnostic value of CRP for bacterial infections in AECOPD were searched form Web of Science,PubMed,Cochrane library,EMBASE,WANFANG DATA,CNKI and China Biology Medicine disc.The included studies were evaluated according to QUADAS-2 assessment tool.Stata 12.0 software was used for meta analyses to summarize the sensitivity and the specificity of the included studies,and the heterogeneity test was conducted.The symmetric receiver operating characteristic curves(SROC)was drawn and the area under the curve(AUC)was calculated,and the funnel plot was drawn to determine publication bias.Results:664 studies were initially identified,20 of which met the inclusion criteria(9 in English and 11 in Chinese).Meta-analysis results showed that the summary sensitivity and specificity of CRP in diagnosing bacterial infections in AECOPD were 0.84,95%CI(0.77-0.90)and 0.76,95%CI(0.67-0.82),respectively.The AUC of SROC was 0.87,95%CI(0.83-0.89).Conclusion:CRP has high accuracy,sensitivity and specificity in distinguishing AECOPD bacterial infections from non-bacterial infection.

TCM aerosol inhalation treatment in acute exacerbations of chronic bronchitis： a meta-analysis

Objectives： To determine whether traditional Chinese medicine （TCM） aerosol inhalation treatment is effective inthe treatment of acute exacerbation of chronic bronchitis. Methods： Search double-blind randomised clinical trials（RCT） about the use of TCM aerosol inhalation in patient with acute exacerbation of chronic bronchitis via database including Chinese biomedicine literature database, Wanfang Data, CNKI, Pubmed, EMBASE and CochraneLibrary from the beginning to October 2016. Quality evaluation, data extraction and data analysis of these RCT wascarried out with reference to the Cochrane systematic review. Results： 16 studies with 738 patients in TCM aerosolinhalation group and 675 in control group were included. The results of meta-analysis showed, （1） TCM aerosolinhalation group could improve the total cure rate. （2） TCM aerosol inhalation could increase the expression of IL-2while decrease the expression of IL-8 and MDA in sputum and blood. （3） TCM aerosol inhalation could improvethe symptoms of cough, cough with sputum, cough with dyspnea and lung wet rales. It also improve the symptomsof cough, expectorate and lung wet rales. （4） Shorten the time of cough and lung rale. （5） The adverse reactionswere light only with 1 occurrence of nausea and vomiting. Conclusions： The use of TCM aerosol inhalation in thetreatment of acute exacerbation of chronic bronchitis was effective. However, the inclusion researches quality werenot very high, which only provided limited evidence for clinical application. Higher-quality randomized controlledtrials were needed for further study.

Utilising network pharmacology and molecular dockingtoexplore the mechanism of Sangbaipi Decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease

Objective To explore themechanism of Sangbaipi Decoction(SBPD)in the treatment of acute exacer-bation of chronic obstructive pulmonary disease(AECOPD).Methods The active compounds of SBPD and targets of those active compounds were collectedfrom the TCMSP database.Then we built the AECOPD target database by OMIM,GeneCards,PharmGKB and DrugBank.The intersectional targets arethep-otentialtargets of SBPD in the treatment ofAECOPD.We built"Potential Active Compounds-Drug-AECOPDTargets"Network via Cytoscape software.Weconstruct the Protein-Protein Inter-action(PPI)network through STRING database.We analyze the PPI network and“Potential Active Compounds-Drug-AECOPD Targets”Network via CytoNCA,then we got the core targets and key active compounds of SBPDin the treatment ofAE-COPD.TheGeneOntology(GO)function enrichment and KEGG pathway enrichment on the intersection targets were analyzed by R software.The key active compounds is molecularly docked with the core target protein receptors through AutoDock Vina soft-ware,and the 2D ligand-protein interaction diagramsare drawn through LigPlot 2.2 software.ResultsThere were 109 active compounds,205 targets of SBPD.2837 targetsrelated to AECOPD were picked out.157 intersectional targets were obtained from the two datas.We get 3 coretargets(TP53,JUN,VEGFA)and five key active compounds(quercetin,luteolin,kaempferol,wogonin,arachidonic acid)of SBPD.The GO function enrichment analysis showed that 2552 entries(P<0.05),of which there were 2261 biological processes(BP)items,and 84 related items of cell composition(CC),and 207 molecular function(MF)items.KEGG pathway enrichment analysis showed that 167 signaling path-ways(P<0.05),mainly including IL 17 signaling pathway,TNF signaling pathway,HIF-1 signaling pathway.The molecular dock-ing structure shows that the key active compounds of SBPD have good affinities with the core targets.ConclusionSBPD may treatAECOPD by anti-inflammatory,anti-oxidation,airway mucus secretion reduction,and pulmonary vascular remodeling reduction.