Objective: To explore the experience with and complications of extracorporeal membrane oxygenation (ECMO)combined with continuous renal replacement therapy (CRRT) for treatment of critically ill patients with severe a...Objective: To explore the experience with and complications of extracorporeal membrane oxygenation (ECMO)combined with continuous renal replacement therapy (CRRT) for treatment of critically ill patients with severe acuterespiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.Methods: The data on critically ill COVID-19 patients who received ECMO/CRRT at Tongji Hospital, which isaffi liated with Huazhong University of Science and Technology, in February and March 2020 were collected andanalyzed. All three patients were male, and the mean age was 50.6 years (range 44 – 58 years). The indications forECMO in critically ill SARS-CoV-2 pneumonia patients at our center were severe acute respiratory distress syndromewith Pa o 2 /F i o 2 below 100 mmHg under an effective protective pulmonary ventilation strategy and infl ammatory stormaccompanied by acute kidney injury. One patient, with severe heart failure, was selected for venoarterial ECMO, andthe other two patients were selected for venovenous ECMO.Results: In the three patients who received ECMO combined with bedside CRRT, the mean duration was 9.7 days(range 7 – 13 days). Four complications occurred during ECMO/CRRT, especially thrombocytopenia. Laboratorytesting showed increased counts of leukocytes and lymphocytes and decreased levels of infl ammatory factors. LungCT was suggestive of signifi cantly absorbed and reduced lesions and interstitial fi brosis.Conclusions: The survival rate of patients with cardiopulmonary failure treated with ECMO/CRRT in whomconventional treatment failed in this group was 100%, which indicates that combined treatment with ECMO and CRRTis an important treatment technique.展开更多
Background:Microbial dysbiosis in critically ill patients is a leading cause of mortality and septic complications.Probiotics and synbiotics have emerged as novel therapy on gut microbiota to prevent septic complicati...Background:Microbial dysbiosis in critically ill patients is a leading cause of mortality and septic complications.Probiotics and synbiotics have emerged as novel therapy on gut microbiota to prevent septic complications.However,current evidence on their effects is conflicting.This work aims to systematically review the impact of probiotics or synbiotics in critically ill adult patients.Methods:A comprehensive search of the PubMed,CBM,Embase,CENTRAL,ISI,and CNKI databases was performed to identify randomized controlled trials that evaluate probiotics or synbiotics in critically ill patients.The quality assessment was based on the modified Jadad’s score scale and the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1.The major outcome measure was mortality.Secondary outcomes included incidence of septic complications,sepsis incidence,length of intensive care unit(ICU)stay,incidence of non-septic complication,and ventilator day.Data synthesis was conduct by Review Manager 5.4.Results:A total of 25 randomized controlled trials reporting on 5049 critically ill patients were included.In the intervention group,2520 participants received probiotics or synbiotics,whereas 2529 participants received standard care or placebo.Pooling data from randomized controlled trials demonstrated a significant reduction in the incidence of ventilator-associated pneumonia(VAP)in the treatment group[(risk ratio(RR)0.86;95%confidence interval(CI):0.78-0.95;p<0.003,I^(2)=85%)].However,in the subgroup analysis,the reduction of incidence of VAP was only significant in patients receiving synbiotics(RR=0.61,95%CI:0.47-0.80,p=0.0004,I^(2)=40%)and not significant in those receiving only probiotics(RR=0.91,95%CI:0.82-1.01,p=0.07,I^(2)=65%).Moreover,sepsis incidence of critically ill patients was only significantly reduced by the addition of synbiotics(RR=0.41;95%CI:0.22-0.72,p=0.005,I^(2)=0%).The incidence of ICU-acquired infections was significantly reduced by the synbiotics therapy(RR=0.72;95%CI:0.58-0.89,p=0.0007,I^(2)=79%).There was no significant difference in mortality,diarrhea,or length of ICU stay between the treatment and control groups.Conclusions:Synbiotics is an effective and safe nutrition therapy in reducing septic complications in critically ill patients.However,in such patients,administration of probiotics alone compared with placebo resulted in no difference in the septic complications.展开更多
文摘Objective: To explore the experience with and complications of extracorporeal membrane oxygenation (ECMO)combined with continuous renal replacement therapy (CRRT) for treatment of critically ill patients with severe acuterespiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.Methods: The data on critically ill COVID-19 patients who received ECMO/CRRT at Tongji Hospital, which isaffi liated with Huazhong University of Science and Technology, in February and March 2020 were collected andanalyzed. All three patients were male, and the mean age was 50.6 years (range 44 – 58 years). The indications forECMO in critically ill SARS-CoV-2 pneumonia patients at our center were severe acute respiratory distress syndromewith Pa o 2 /F i o 2 below 100 mmHg under an effective protective pulmonary ventilation strategy and infl ammatory stormaccompanied by acute kidney injury. One patient, with severe heart failure, was selected for venoarterial ECMO, andthe other two patients were selected for venovenous ECMO.Results: In the three patients who received ECMO combined with bedside CRRT, the mean duration was 9.7 days(range 7 – 13 days). Four complications occurred during ECMO/CRRT, especially thrombocytopenia. Laboratorytesting showed increased counts of leukocytes and lymphocytes and decreased levels of infl ammatory factors. LungCT was suggestive of signifi cantly absorbed and reduced lesions and interstitial fi brosis.Conclusions: The survival rate of patients with cardiopulmonary failure treated with ECMO/CRRT in whomconventional treatment failed in this group was 100%, which indicates that combined treatment with ECMO and CRRTis an important treatment technique.
基金supported by grants from the Sichuan Provincial Department of Science and Technology(No.2020YFS0006 to HJ and No.2018JY0050 to QZ)National Natural Science Foundation of China(No.71974200 to HJ)+3 种基金Sichuan Provincial People’s Hospital(No.2021ZX01 to KW)Health Commission of Sichuan Province(No.20PJ102 to KW)Education Department of Sichuan Province(No.18ZA0155)Funders played no role in the study design,conduct or manuscript writing.
文摘Background:Microbial dysbiosis in critically ill patients is a leading cause of mortality and septic complications.Probiotics and synbiotics have emerged as novel therapy on gut microbiota to prevent septic complications.However,current evidence on their effects is conflicting.This work aims to systematically review the impact of probiotics or synbiotics in critically ill adult patients.Methods:A comprehensive search of the PubMed,CBM,Embase,CENTRAL,ISI,and CNKI databases was performed to identify randomized controlled trials that evaluate probiotics or synbiotics in critically ill patients.The quality assessment was based on the modified Jadad’s score scale and the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1.The major outcome measure was mortality.Secondary outcomes included incidence of septic complications,sepsis incidence,length of intensive care unit(ICU)stay,incidence of non-septic complication,and ventilator day.Data synthesis was conduct by Review Manager 5.4.Results:A total of 25 randomized controlled trials reporting on 5049 critically ill patients were included.In the intervention group,2520 participants received probiotics or synbiotics,whereas 2529 participants received standard care or placebo.Pooling data from randomized controlled trials demonstrated a significant reduction in the incidence of ventilator-associated pneumonia(VAP)in the treatment group[(risk ratio(RR)0.86;95%confidence interval(CI):0.78-0.95;p<0.003,I^(2)=85%)].However,in the subgroup analysis,the reduction of incidence of VAP was only significant in patients receiving synbiotics(RR=0.61,95%CI:0.47-0.80,p=0.0004,I^(2)=40%)and not significant in those receiving only probiotics(RR=0.91,95%CI:0.82-1.01,p=0.07,I^(2)=65%).Moreover,sepsis incidence of critically ill patients was only significantly reduced by the addition of synbiotics(RR=0.41;95%CI:0.22-0.72,p=0.005,I^(2)=0%).The incidence of ICU-acquired infections was significantly reduced by the synbiotics therapy(RR=0.72;95%CI:0.58-0.89,p=0.0007,I^(2)=79%).There was no significant difference in mortality,diarrhea,or length of ICU stay between the treatment and control groups.Conclusions:Synbiotics is an effective and safe nutrition therapy in reducing septic complications in critically ill patients.However,in such patients,administration of probiotics alone compared with placebo resulted in no difference in the septic complications.
