Evaluation of a protocol for rifaximin discontinuation in critically ill patients with liver disease receiving broad-spectrum antibiotic therapy

BACKGROUND Rifaximin is frequently administered to critically ill patients with liver disease and hepatic encephalopathy,but patients currently or recently treated with antibiotics were frequently excluded from studies of rifaximin efficacy.Due to overlapping spectrums of activity,combination therapy with broad-spectrum antibiotics and rifaximin may be unnecessary.A pharmacist-driven protocol was piloted to reduce potentially overlapping therapy in critically ill patients with liver disease.It was hypothesized that withholding rifaximin during broad-spectrum antibiotic therapy would be safe and reduce healthcare costs.AIM To determine the clinical,safety,and financial impact of discontinuing rifaximin during broad-spectrum antibiotic therapy in critically ill liver patients.METHODS This was a single-center,quasi-experimental,pre-post study based on a pilot pharmacist-driven protocol.Patients in the protocol group were prospectively identified via the medical intensive care unit(ICU)(MICU)protocol to have rifaximin withheld during broad-spectrum antibiotic treatment.These were compared to a historical cohort who received combination therapy with broadspectrum antibiotics and rifaximin.All data were collected retrospectively.The primary outcome was days alive and free of delirium and coma(DAFD)to 14 d.Safety outcomes included MICU length of stay,48-h change in vasopressor dose,and ICU mortality.Secondary outcomes characterized rifaximin cost savings and protocol adherence.Multivariable analysis was utilized to evaluate the association between group assignment and the primary outcome while controlling for potential confounding factors.RESULTS Each group included 32 patients.The median number of delirium-and coma-free days was similar in the control and protocol groups[3 interquartile range(IQR 0,8)vs 2(IQR 0,9.5),P=0.93].In multivariable analysis,group assignment was not associated with a reduced ratio of days alive and free of delirium or coma at 14 d.The protocol resulted in a reduced median duration of rifaximin use during broad-spectrum antibiotic therapy[6 d control(IQR 3,9.5)vs 1 d protocol(IQR 0,1);P<0.001].Rates of other secondary clinical and safety outcomes were similar including ICU mortality and 48-h change in vasopressor requirements.Overall adherence to the protocol was 91.4%.The median estimated total cost of rifaximin therapy per patient was reduced from$758.40(IQR$379.20,$1200.80)to$126.40(IQR$0,$126.40),P<0.01.CONCLUSION The novel pharmacist-driven protocol for rifaximin discontinuation was associated with significant cost savings and no differences in safety outcomes including DAFD.

Histone methylation in Huntington's disease:are bivalent promoters the critical targets?

Huntington’s disease（HD）is a currently incurable,late onset,progressive,ultimately fatal neurological disorder（Bates et al.,2015）.We have recently published the results of comprehensive genetic interaction tests aimed at identification of histone methyltransferases and demethylases involved in HD pathogenesis in a Drosophila model of the disease（Song et al.,2018）.

Critical respiratory failure due to pregnancy complicated by COVID-19 and bacterial coinfection:A case report

BACKGROUND In the past 3 years,the global pandemic of coronavirus disease 2019(COVID-19)has posed a great threat to human life and safety.Among the causes of death in COVID-19 patients,combined or secondary bacterial infection is an important factor.As a special group,pregnant women experience varying degrees of change in their immune status,cardiopulmonary function,and anatomical structure during pregnancy,which puts them at higher risk of contracting COVID-19.COVID-19 infection during pregnancy is associated with increased adverse events such as hospitalisation,admission to the intensive care unit,and mechanical ventilation.Therefore,pregnancy combined with coinfection of COVID-19 and bacteria often leads to critical respiratory failure,posing severe challenges in the diagnosis and treatment process.CASE SUMMARY We report a case of COVID-19 complicated with Staphylococcus aureus(S.aureus)coinfection in a pre-gnant woman at 34 wk of gestation.Her rapid progression of pulmonary lesions caused severe respiratory failure,and she received noninvasive ventilator-assisted respiratory treatment.Subsequently,we delivered a foetus via emergency caesarean section after accelerating the maturity of the foetal pulmonary system,and the respiratory condition of the puerperant woman significantly improved after the delivery of the foetus.Lavage fluid was taken under tracheoscopy to quickly search for pathogens by the metagenomic nextgeneration sequencing(mNGS),and both COVID-19 and S.aureus were detected.After targeted anti-infective treatment,the maternal condition gradually improved,and the patient was discharged from the hospital.CONCLUSION The coinfection of pregnancy with COVID-19 and bacteria often leads to critical respiratory failure,which is a great challenge in the process of diagnosis and treatment.It is crucial to choose the right time to deliver the foetus and to quickly find pathogens by mNGS.

Current situation and prospect for the diagnosis and treatment of pediatric critical rare diseases in China

The onset of critical rare diseases(RDs)in children is rapid and dangerous,accompanied by a high mortality rate,which brings a heavy burden to both families and society.Multiple malformations,neuromuscular diseases,metabolic diseases,and heart diseases are the most common types of RDs in children of China,often manifesting with multiple organ dysfunction.At present,the diagnosis and treatment of critical RDs in children face challenges such as prolonged diagnosis time,a high misdiagnosis rate,limited treatment modalities,and a significant disease burden.However,with the progress in genetic testing technology,the establishment of multidisciplinary diagnosis and treatment platforms,and the implementation of relevant RD policies in China,children with critical RDs will received enhanced medical services,experience improved prognoses,and reintegrate into social life.

Prognosis and outcome of intrauterine treatment of fetuses with critical congenital heart disease

Background:Intrauterine valvuloplasty is an innovative therapy,which promotes ventricular growth and function in some congenital heart diseases(CHDs).The technique remains challenging and can only be performed in a few centers.This study aimed to assess the feasibility and mid-term outcomes of fetal cardiac intervention(FCI)in fetuses with critical CHD in an experienced tertiary center.Methods:Five fetal aortic valvuloplasty(FAV)or fetal pulmonary valvuloplasty(FPV)procedures were performed in our fetal heart center between August 2018 and May 2022.Technical success was defined as crossing the aortic or pulmonary valve and balloon inflation,followed by evidence of increased blood flow across the valve and/or new regurgitation.Follow-up clinical records and echocardiography were obtained during the prenatal and postnatal periods.Results:Five fetuses received FAV or FPV,including critical aortic stenosis(n=2)and pulmonary atresia with intact ventricular septum(n=3).The mean maternal age was 33.0±2.6 years.The median gestational age(GA)at diagnosis was 24 weeks(range,22-26 weeks).The median GA at intervention was 29 weeks(range,28-32 weeks).All five cases underwent successful or partially successful procedures.One patient had pulmonary valve perforation without balloon dilation.No procedure-related deaths or significant complications occurred.However,one neonatal death occurred due to heart and renal failure.The median follow-up period was 29.5 months(range,8.0-48.0 months).The four surviving patients had achieved biventricular circulation,exhibited improved valve,and ventricular development at the last follow-up visit.Conclusion:Intrauterine FCI could be performed safely with good prognosis in critical CHD.

Effects of lonicera granules + symptomatic treatment on serum indexes and immune function in children with hand-foot-and-mouth disease

Objective:To investigate the effects of lonicera granules + symptomatic treatment on serum indexes and immune function in children with hand-foot-and-mouth disease.Methods: A total of 120 children with HFMD who were treated between April 2016 and September 2017 were divided into the control group (n=60) and lonicera granules group (n=60) by random number table method. Control group received clinical symptomatic treatment for hand-foot-mouth disease, lonicera granules group received symptomatic treatment combined with lonicera granules therapy, and the treatment lasted for 7 d. The differences in serum levels of inflammatory factors, myocardial enzyme spectrum indexes and immunoglobulin were compared between the two groups before treatment and after 7 d of treatment.Results: Before treatment, there was no statistically significant difference in serum levels of inflammatory factors, myocardial enzyme spectrum indexes and immunoglobulin between the two groups. After 7 d of treatment, serum inflammatory cytokines IL-6, IL-10, IL-12 and TNF-α levels of lonicera granules group were lower than those of control group;serum myocardial enzyme spectrum indexesα-HBDH, LDH, AST and cTnⅠ levels were lower than those of control group;serum immunoglobulin IgA, IgG and IgM levels were higher than those of control group.Conclusion: Symptomatic treatment combined with lonicera granules therapy can further inhibit the systemic inflammatory response, protect the myocardial cells and enhance the immunity of children with HFMD.

Critical illness polyneuropathy and myopathy:a systematic review

Critical illness polyneuropathy and critical illness myopathy are frequent complications of severe illness that involve sensorimotor axons and skeletal muscles, respectively. Clinically, they manifest as limb and respiratory muscle weakness. Critical illness polyneuropathy/myopathy in isolation or combination increases intensive care unit morbidity via the inability or difficulty in weaning these patients off mechanical ventilation. Many patients continue to suffer from decreased exercise capacity and compromised quality of life for months to years after the acute event. Substantial progress has been made lately in the understanding of the pathophysiology of critical illness polyneuropathy and myopathy. Clinical and ancillary test results should be carefully interpreted to differentiate critical illness polyneuropathy/myopathy from similar weaknesses in this patient population. The present review is aimed at providing the latest knowledge concerning the pathophysiology of critical illness polyneuropathy/myopathy along with relevant clinical, diagnostic, differentiating, and treatment information for this debilitat- ing neurological disease.

Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients:A systematic review

AIM: To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy(FFB) in critically ill children. METHODS: We searched Pub Med, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children < 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data. We examined the diagnostic yield of FFB among upper and lower airway evaluations, as well as the utility of bronchoalveolar lavage(BAL). RESULTS: We found that FFB led to a change in medical management in 28.9%(range 21.9%-69.2%) of critically ill children. The diagnostic yield of FFB was 82%(range 45.2%-100%). Infectious organisms were identified in 25.7%(17.6%-75%) of BALs performed, resulting in a change of antimicrobial management in 19.1%(range: 12.2%-75%). FFB successfully reexpanded atelectasis or removed mucus plugs in 60.3%(range: 23.8%-100%) of patients with atelectasis. Adverse events were reported in 12.9%(range: 0.5%-71.4%) of patients. The most common adverse effects of FFB were transient hypotension, hypoxia and/or bradycardia that resolved with minimal intervention, such as oxygen supplementation or removal of the bronchoscope. Serious adverse events were uncommon; 2.1% of adverse events required intervention such as bag-mask ventilation or intubation and atropine for hypoxia and bradycardia, normal saline boluses for hypotension, or lavage and suctioning for hemorrhage. CONCLUSION: FFB is safe and effective for diagnostic and therapeutic use in critically ill pediatric patients.

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.

Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency

BACKGROUND:This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.METHODS:The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed.The data of 321 patients with no acute respiratory insufficiency as controls were also collected.Clinical variables of the first 24 hours after admission to intensive care unit were collected,including age,sex,comorbid disease,type of surgery,admission type,presence of shock,presence of acute kidney injury,presence of acute lung injury/acute respiratory distress syndrome,acute physiologic and chronic health evaluation(APACHE Ⅱ) score,sepsis-related organ failure assessment(SOFA),and PaO_2/FiO_2 ratio.Duration of mechanical ventilation,length of intensive care unit stay,intensive care unit death,length of hospitalization,hospital death and one-year survival were calculated.RESULTS:The incidence of acute respiratory insufficiency was 37.2%(190/321).Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases(P=0.001),surgeryrelated infection(P=0.004),hypo-volemic shock(P<0.001),and emergency surgery(P=0.018),were independent risk factors of postoperative acute respiratory insufficiency.Compared with the patients without acute respiratory insufficiency,the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay(P<0.001),a prolonged length of hospitalization(P=0.006),increased intensive care unit mortality(P=0.001),and hospital mortality(P<0.001).Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency(P=0.029,RR:8.522,95%CI:1.243-58.437,B=2.143,SE=0.982,Wald=4.758).Compared with the patients without acute respiratory insufficiency,those with acute respiratory insufficiency had a shortened one-year survival rate(78.7%vs.97.1%,P<0.001).CONCLUSION:A history of chronic obstructive pulmonary diseases,surgery-related infection,hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency.Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency.Compared with patients without acute respiratory insufficiency,those with acute respiratory insufficiency had adverse shortterm outcome and a decreased one-year survival rate.

Revisiting endovascular treatment in below-the-knee disease. Are drug-eluting stents the best option？

Patients with below-the-knee arterial disease are primarily individuals suffering from critical limb ischemia(CLI), while a large percentage of these patients are also suffering from diabetes or chronic renal failure or both. Available data from randomized controlled trials and their meta-analysis demonstrated that the use of infrapopliteal drug-eluting stents(DES), in short-to medium-length lesions, obtains significantly better results compared to plain balloon angioplasty and bare metal stenting with regards to vascular restenosis, target lesion revascularization, wound healing and amputations. Nonetheless, the use of this technology in every-day clinical practice remains limited mainly due to concerns regarding the deployment of a permanent metallic scaffold and the possibility of valid future therapeutic perspectives. However, in the majority of the cases, these concerns are not scientifically justified. Large-scale, multicenter randomized controlled trials, investigating a significantly larger number of patients than those already published, would provide more solid evidence and consolidate the use of infrapopliteal DES in CLI patients. Moreover, there is still little evidence on whether this technology can be as effective for longer below-the-knee lesions, where a considerable number of DES is required. The development and investigation of new, longer balloon-expanding or perhaps selfexpanding DES could be the answer to this problem.

A Systematic Review of the Literature on the Relationships between Chronic Diseases and Food Insecurity

Background: The association between food insecurity (FI) and obesity is now so well documented that scholars have dubbed it the “‘new’ food insecurity” and cited it as a leading cause of increased chronic disease (CD) risk. Here, the chain of causality is assumed to be FI → obesity → CD. However, this model overlooks the possible direct associations between FI and CD independent of obesity. Aim: This study assessed the literature on relationships between FI and CD. Methods: We conducted a systematic literature review of electronic databases. Selection criteria were designed to elicit studies that assessed FI and CD using a measure of CD other than obesity. Results: Fifty-one articles met the inclusion criteria. Forty-five studies (87%) reported a statistically significant association between FI and CD, but only 15 adjusted for obesity. The association was less consistent for asthma and dyslipidemia than for diabetes, hypertension, and other dietrelated CDs, and most were conducted in the USA or Canada. Conclusion: There is a body of literature documenting relationships between FI and CD, but it is heavily biased toward Western nations, ecological study designs, and type 2 diabetes as the CD of focus. A small subset of the literature controls for BMI, demonstrating that a portion of the FI-CD relationship cannot be fully explained by obesity. Possible direct pathways linking FI and CD include systematic effects of poverty that accompanies FI, micronutrient deficiencies, and environmental exposure to toxins;however, exploration of these alternative pathways is limited by study designs that fail to include obesity as a control variable.

COVID-19: Lymphocyte Subpopulations Monitoring in Critically Ill Patients

Background: The alteration of lymphocyte subpopulations can help to predict the severity and the prognosis of severe Coronavirus disease 2019 (COVID-19). Our goal was to describe the kinetics of lymphocyte subsets, and their impact on the severity and mortality in critically ill COVID-19 patients. Methods: We collected demographic data, comorbidities, clinical signs on admission, laboratory findings on admission then a follow-up during hospitalization. Lymphocyte subsets including CD3+ T cells, CD4+ T cells, CD8+ T cells, B cells, and natural killer (NK) cells were counted by flow cytometer. Results: On admission, we observed lymphopenia in 57% of cases, decreased CD3+ T cells in 76% of cases, decreased CD4+ T cells in 81% of cases, decreased CD8+ T cells in 62% of cases, decreased B cells in 52% of cases, and decreased natural killer (NK) cells in 33% of cases. After treatment, decreased CD3+ T cells, decreased CD4+ T cells, decreased CD8+ T cells, and decreased natural killer cells were predictor factors of mortality, in the univariable analysis. Conclusion: CD3+ T cells, CD4+ T cells, CD8+ T cells, and natural killer cells were predictor factors of severity, ICU mortality, and also a useful tool for predicting disease progression.

Invasive Procedures and Length of Stay among Critically Ill Patients in ICU over Three Years: A Retrospective Study

Introduction: Intensive care unit (ICU) provides advanced specialized medical and nursing care for critically ill patients. Advanced monitoring techniques are needed to prevent physiologic deterioration, while the underlying disease treated and resolved. Frequents invasive procedure and treatment are used and affect the death rate and length of hospitalization. This study aimed to describe the variables associated with critically ill patients and describe the standard invasive procedures or treatments used among patients in ICU. Method: A retrospective comparative study which utilized the ICU electronic database. The data of 446 dead patients who have admitted to ICU between January 2014 and December 2016 as a case of sepsis, heart failure or COPD exacerbation were enrolled. Result: Almost of all patients had received intravenous fluid and vasoactive drugs. The mechanical ventilation support and insertion of the indwelling urethral catheter commonly used among patients with critical illnesses;78.3%, 41.3% respectively. One-third of all sepsis and heart failure patients were received CVC during ICU stay;patients with sepsis illness had less hospital length of stay than patients with heart failure and COPD (p Conclusion: We found a reduction in the death number among sepsis, heart failure and COPD patients with move forwards in years, the variety of death rate depends on the type of invasive procedure and treatment performed for each illness, mechanical ventilation support and insertion of indwelling urethral catheter commonly used among patients with critical illnesses.

Hematological and Biochemical Profile of Sickle Cell Patients in Critical and Inter-Critical Periods in Brazzaville, Republic of Congo

Introduction: Sickle cell disease is a public health problem in the Republic of Congo where the prevalence of sickle cell trait is estimated at 1.25%. The objective of this study is to describe the variations of hematological and biochemical parameters of hemolysis in sickle cell patients in critical and inter-critical periods. Methods: This is a descriptive cross-sectional study including sickle cell patients followed regularly at the National Reference Center for Sickle Cell Disease (CNRDr) from November 2019 to March 2020. A sample of 167 patients (sickle cell subjects in crisis and in steady state as well as control subjects) was randomly selected during the study period. The blood count was performed using a Sysmex-XN 350 automated system and the biochemical parameters were determined using the Cobas e 311 automated system. Statistical analysis was performed with SPSS version 22 software. Results: The study showed that the mean cholesterol level in controls was 4.16 ± 0.77 ul compared with 9.64 ± 4.34 ul in sickle cell crisis subjects. Hb and HCT levels were significantly higher in controls compared with sickle cell subjects in crisis. During crisis, total bilirubin, direct bilirubin, triglycerides, LDH, AST, and CRP were significantly elevated. Hematological parameters such as Hb and HCT were elevated in controls, while the mean WBC value and RET were higher in sickle cell patients in steady state. The mean values of the biochemical parameters were higher in sickle cell patients in steady state. Conclusion: Evaluation of the influence of sickle cell trait on biochemical and hematological parameters showed significant differences between sickle cell and control subjects.

Intensive care outcome of left main stem disease surgery: A single center three years’ experience

BACKGROUND Left main coronary artery(LMCA)supplies more than 80%of the left ventricle,and significant disease of this artery carries a high mortality unless intervened surgically.However,the influence of coronary artery bypass grafting(CABG)surgery on patients with LMCA disease on morbidity intensive care unit(ICU)outcomes needs to be explored.However,the impact of CABG surgery on the morbidity of the ICU population with LMCA disease is worth exploring.AIM To determine whether LMCA disease is a definitive risk factor of prolonged ICU stay as a primary outcome and early morbidity within the ICU stay as secondary outcome.METHODS Retrospective descriptive study with purposive sampling analyzing 399 patients who underwent isolated urgent or elective CABG.Patients were divided into 2 groups;those with LMCA disease as group 1(75 patients)and those without LMCA disease as group 2(324 patients).We correlated ICU outcome parameters including ICU length of stay,post-operative atrial fibrillation,acute kidney injury,re-exploration,perioperative myocardial infarction,post-operative bleeding in both groups.RESULTS Patients with LMCA disease had a significantly higher prevalence of diabetes(43.3%vs 29%,P=0.001).However,we did not find a statistically significant difference with regards to ICU stay,or other morbidity and mortality outcome measures.CONCLUSION Post-operative performance of Patients with LMCA disease who underwent CABG were comparable to those without LMCA involvement.Diabetes was more prevalent in patients with LMCA disease.These findings may help in guiding decision making for future practice and stratifying the patients’care.

Predictive value of initial procalcitonin level in perioperative period of critically ill cancer patients

The predictive value of the initial procalcitonin(PCT)level was explored in the perioperative peniod of citically ill cancer patients.Background:It is quite important to predict infections in patients in the intensive care unit (ICU).Cancer surgery is characterized by large trauma,long duration,and wide operation scope;and there are many inflammatory factors in the tumor.Common manifestations of systermic inflammatory response syndrome(SIRS)。such as fever,elevated white blood cells,and elevated infammatory indicators,frequently occur in patients during the penioperative period as a result of the above factors.These factors are diverse and complex;additionally,advanced cancer and the trauma of major surgery are important factors that influence PCT blood levels.Because all of the aforementioned factors make it dificult to distinguish the postoperative inflammatory response fom the true infection in clinical practice,conventional methods cannot prediet disease sevenity or disease course.Methods:A total of 53 patients with endotracheal intubation admitted to the ICU of Tianjin Medical University Cancer Institute and Hospital from January 2020 to May 2020,were retrospectively selected.According to the patient source,35 cases were assigned to ORIG(Operating Room to ICU Group),and 18 cases were assigned to General Ward to ICU group(GWO).At the ICU admission,the patient's age,sex,surgical site of tumor,reason for ICU and other data were recorded to form a database;PCT,B-type natiuretic peptide(BNP),high sensitivity toponin I(hsTni),serumn creatinine(Cr),serum cystatin C(Cys-c)and other laboratory indicators were detected;scores of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)and sequential organ failure assessment(SOFA)were marked 24 h after ICU admission;Proportion of Antibiotics,Time Antibiotic Application,and Time Indicators(Ventilator support Time,Endotracheal Intubation Time,ICU Stay Time)were recorded during the period from ICU admission to ICU discharge.Results:APAHCE Ⅱ score and SOFA score increased significantly in the GWIG,compared with the ORIG,and the differences were statistically significant(P<0.01);the GWIG had a significantly longer Time Antibiotic Application than the ORIG,and the difference was statistically significant(P<0.01);in tems of blood indicators,the PCT,BNP,and hsTNi levels were elevated in the GWIG compared with the ORIG,and the differences were statistically significant(p<0.01);no statistical differences were found in Cr and Cys-C levels(P>0.05).In terms of time indicators,the Ventilator support Time,Endotracheal Intubation Time,and ICU Stay Time were prolonged in the GWIG compared with the ORIG,and the differences were statistically significant(P<0.01).The PCT level was statistically signifcant(P<0.01)when correlated with the Ventilator Supporting Time and Endotracheal Intubation Time;however,the PCT level was negatively correlated with the ICU Stay Time,with a small r(correlation cofficient)value and no statistical significance(P>0.05)when correlated with the ICU Stay Time.Conclusion:The initial PCT level can predict the disease severity in critically ill cancer patients treated with mechanical ventilation during the perioperative period.

改良鼻胃肠双腔管两步置管法在神经外科重症患者中的应用

目的探索一种改良的鼻胃肠双腔管置管两步法,可以床旁徒手完成置管应用于神经外科重症患者;方法收集需行肠内营养的神经外科重症患者120例,采用随机数表法分为传统鼻肠管组(对照组)和改良鼻肠双腔管组(改良组),各60例,分别记录入组时的APACHEⅡ评分及GCS评分、年龄、体质量指数(BMI),收集每例患者鼻肠管置管操作时间,置管前心率及置管过程中的最高心率变化,置管前和置管后14 d的鼻窦CT、胸部CT及营养指标,判断是否出现鼻窦炎、吸入性肺炎、消化道出血、营养液潴留及心律失常等并发症。结果2组入组时APACHEⅡ评分,GCS评分,年龄,BMI比较,差异均无统计学意义(t=1.0598,1.2073,0.3104,0.9268;P=0.2914,0.2297,0.7568,0.3559,P均>0.05)。改良组置管时间(54.4±13)min,对照组置管时间(49.4±12.9)min,改良组置管时间略长于对照组(t=2.1334,P=0.035,P<0.05)。置管过程中,改良组和对照组在心率变化方面比较,差异无统计学意义(P>0.05)。改良组控制鼻窦炎(20.0%,12/60)方面优于对照组(36.7%,22/60)(P<0.05),改良组控制肺炎(26.7%,16/60)方面优于对照组(46.7%,28/60)(P<0.05),改良组控制胃液潴留(5.0%,3/60)方面优于对照组(16.7%,10/60)(P<0.05);2组胃肠道出血及心律失常方面比较,差异无统计学意义(P>0.05)。经过14 d的肠内营养治疗后,改良组白蛋白、前白蛋白、血红蛋白及淋巴细胞计数均好于对照组。结论改良的鼻胃肠双腔管两步置管法可在床头徒手完成,与传统方法比较,尽管置管时间略有延长,但鼻窦炎、吸入性肺炎的发生率明显降低,不增加置管相关并发症发生,同时改良组营养指标明显优于对照组。该两步法安全、有效、便捷,值得临床推广。

跨区域重症远程协同服务平台设计与应用

目的:建设跨区域重症远程协同服务平台,推动优质医疗资源下沉与均衡分布,探索专科医联体建设新路径。方法:依托5G技术、KVM等技术建设跨区域重症远程协同服务平台。结果:四川大学华西医院重症医学学科与信息中心,联合第三方医学信息服务商共同建设华西医院重症医学学科联盟远程重症协同系统,破解医疗信息跨院安全传输障碍,开发远程监护、远程会诊、远程实操、远程教育、远程质控5大功能模组,服务13省140家成员单位,提供会诊查房约250例/年,教学直播约200场/年。结论:现有通信相关技术可以成功建设跨区域重症远程协同服务平台,保障患者数据安全,提高远程协同效率,实现医疗资源、教学资源共享。

单核细胞减少与分枝杆菌感染综合征患儿的护理

总结1例单核细胞减少与分枝杆菌感染综合征患儿的护理体会。针对患儿疾病罕见、移植高风险、预后未知等特点,采取降低有创诊疗风险等级,协助诊断、明确移植需求;居家肺部治疗联合远程康复,寻找最佳移植时机;双学科协同长程随访,优化患者预后等措施。患儿多次住院经反复穿刺活检及病理会诊,提示鸟分枝杆菌感染,PAS(+),DPAS(+),GATA2基因2号外显子插入突变,确诊为单核细胞减少与分枝杆菌感染综合征合并肺泡蛋白沉积症。于2022年10月行造血干细胞移植术,术后继续抗感染治疗。随访至今,间质性病变较移植前明显改善,继续抗排异治疗,现居家学习中。