[Efficacy and safety of simulated artificial pancreas in modulating stress hyperglycemia in critically ill patients: a prospective randomized controlled study].

OBJECTIVE: To explore efficacy and safety of simulated artificial pancreas in modulating stress hyperglycemia in critically ill patients. METHODS: A prospective randomized controlled study was performed. Seventy-two critically ill patients with stress hyperglycemia, aged 18-85 years, acute physiology and chronic health evaluation II (APACHE II) score over 15, two consecutive random blood glucose 11.1 mmol/L or higher, glycated hemoglobin (HbA1C) below 0.065, unable to eat food for 3 days after inclusion, or only accepting parenteral nutrition, admitted to intensive care unit (ICU) in Shanghai Punan Hospital of Pudong New District from January 1st, 2015 to June 30th, 2017 were enrolled. The patients were divided into three groups according to the random number table method, high-intensity group and low-intensity group were injected Novolin R (high-intensity group 2/3 dosage, low-intensity group 1/3 dosage) to modulate stress hyperglycemia by simulated artificial pancreas. Simulated artificial pancreas consisted of Guardian real time glucose monitoring system (GRT system), close-circle control algorithm and micro-pump; subcutaneous injection of Humulin 70/30 was applied to modulate stress hyperglycemia in humulin group. Real-time glucose levels of interstitial fluid in abdominal wall, equivalent to blood glucose levels, 10 minutes each time, were monitored by using of GRT system for all patients in three groups. Fasting serum levels of stress hormones including epinephrine and cortisol and insulin resistance index (IRI) were recorded within 24 hours after inclusion. Mean blood glucose, blood glucose variation coefficient, blood glucose target-reaching rate, blood glucose target-reaching time, hypoglycemia rate and 6-month mortality were measured. Twenty healthy adults from health administration department of the hospital were recruited as healthy control group. RESULTS: A total of 60 eligible critically ill patients were included in this study, each group with 20 patients. There was no significant difference in gender, age, APACHE II scores among three groups. The levels of serum epinephrine, cortisol and IRI within 24 hours after inclusion in the three groups were significantly higher than those in healthy control group. The mean blood glucose levels of humulin group, low-intensity group, high-intensity group were decreased (mmol/L: 10.2±3.2, 8.4±2.6, 8.1±2.2), the blood glucose target-reaching rate were increased [40.2% (3 295/8 196), 71.1% (5 393/7 585), 80.4% (6 286/7 818)], the blood glucose target-reaching time were shortened (hours: 49.1±5.8, 24.6±4.6, 17.5±4.2), the hypoglycemia rates were increased respectively [1.3% (108/8 196), 2.8% (211/7 585), 4.0% (313/7 818)], with statistically significant differences (all P = 0.000). There was no significant difference in blood glucose variation coefficient and 6-month mortality among three groups [blood glucose variation coefficient: (29.4±3.7)%, (28.5±5.3)%, (26.1±4.6)%, 6-month mortality: 55.0%, 45.0%, 40.0%, all P > 0.05]. CONCLUSIONS: Simulated artificial pancreas could effectively and safely modulate stress hyperglycemia in critically ill patients, high-intensity modulation could bring about better efficacy in the regulation of hyperglycemia. High-frequency blood glucose monitoring by using GRT system could promptly identify hypoglycemia and help it to be corrected.

Pilot Study of the Association of Anemia with the Levels of Zinc, Copper, Iron, Calcium, and Magnesium of Children Aged 6 Months to 3 Years in Beijing, China.

This study sought to explore the relationship between anemia in children and levels of five minerals in blood. A sample consisted of 242 normal and 304 anemic children paired by sex and age. Hematological parameters were assessed using the Sysmex xs-800i hematology analyzer. Levels of zinc (Zn), copper (Cu), iron (Fe), magnesium (Mg), and calcium (Ca) were measured by polarographic analysis. Differences in these elements between the anemic and normal groups were compared by ANOVA. Relationships between Ca, Zn, Fe, Cu, Mg, and Hb levels were tested by Pearson's correlation analysis. The Mg level (1.51 ± 0.30 mmol/L) of the moderately anemic group (≤90 g/L) was significantly higher than that (1.36 ± 0.30 mmol/L) of the mildly anemic (90 g/L ≤Hb <110 g/L) and normal groups (1.31 ± 0.30 mmol/L) (p < 0.05). The rate of moderate anemia (13.7 %) in the higher Mg group (Mg >1.57 mmol/L) was higher than that (5.3 %) of the lower Mg group (Mg ≤1.57 mmol/L) (p < 0.01). The rate of moderate anemia (12.8 %) in the lower Fe group (≤78.4 umol/L) was higher than that (6.2 %) of the higher Fe group (>78.4 umol/L) (p < 0.05). Hemoglobin was inversely correlated with Mg levels in the anemic group (p < 0.05). These results indicate that blood levels of Mg and Fe were correlated with anemic children aged 6 months to 3 years. To prevent and treat anemia better, a combination of the levels of Hb, Mg, and Fe in whole blood is required.

[The influence of positive end-expiratory pressure on central venous pressure in patients with severe craniocerebral injury].

OBJECTIVE: To observe the impact of positive end-expiratory pressure (PEEP) on central venous pressure (CVP) in mechanically ventilated patients with severe craniocerebral injury. METHODS: A prospective, interventional, self-control study was conducted. Thirty severe craniocerebral injury patients with central respiratory failure were enrolled. The changes in CVP, mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation [SpO2] were monitored at different PEEP levels [0, 3, 6, 9, 12, 15 cm H2O; 1 cm H2O=0.098 kPa] during mechanical ventilation and after weaning of mechanical ventilation. The influences of PEEP and its discontinuance on haemodynamics and oxygenation were analyzed. RESULTS: The values of CVP [cm H2O] were increased when PEEP increased (from 7.9±3.1 to 13.1±3.7), a linear correlation was found (R=0.509, P=0.000), and linear regression equation was CVP [cm H2O]=7.774+0.368×PEEP [cm H2O]; CVP was elevated about 0.368 cm H2O when PEEP increased 1 cm H2O. CVP values significantly decreased during discontinuance of mechanical ventilation, as compared to those measured at different PEEP levels during mechanical ventilation (F=24.429, P=0.000). The values of MAP, HR and SpO2 showed no significant change with increase of PEEP levels [MAP (mm Hg, 1 mm Hg=0.133 kPa): from 81.6±10.4 to 85.6±10.6; HR (beats per minute): from 79.9±13.5 to 88.1±15.4; SpO2: from 0.968±0.036 to 0.975±0.033, all P>0.05] in mechanically ventilated patients, but discontinuance of mechanical ventilation could significantly increase the levels of MAP and HR (95.3±8.4 and 94.9±10.3, respectively) and lower SpO2 levels (0.928±0.036, all P=0.000). CONCLUSIONS: CVP values were overestimated during an increase in PEEP in mechanically ventilated patients with severe craniocerebral injury. CVP was increased about 0.368 cm H2O following an increase of PEEP of 1 cm H2O, whereas the values of MAP, HR and SpO2 showed no significant change with increase in PEEP levels. This study could offer a theoretical base in the correct assessment of CVP values at different PEEP levels without discontinuation of mechanical ventilation.