[Measurement of peak velocity variation of common carotid artery with bedside ultrasound to estimate preload in surgery ICU].

OBJECTIVE: To investigate the feasibility and accuracy of bedside ultrasound measuring peak velocity variation of common carotid artery to estimate preload of the patients in surgery ICU. METHODS: In this prospective cohort study, SICU patients with sinus rhythm and positive pressure ventilation were included. The peak velocity variation in common carotid artery (delta V peak) during each respiratory circle was measured by ICU resident with short-term training and experienced attending songrapher. Stroke volume before and after the fluid challenge was also measured by the experienced songrapher as the gold standard of fluid responsiveness. Then the ROC, feasibility and accuracy of the diagnosis trial were analyzed. RESULTS: There were 46 patients included. The peak velocity variation of common carotid artery measured by the attending (delta V peak) is highly related with delta SV (r1 = 0.76, P < 0.05). Area under the receiver operating characteristic curve was 0.95 (P < 0.05). The peak velocity variation of common carotid artery (delta V peak) > 12.1% predicted fluid responsiveness with sensitivity of 90.9%, specificity of 83.3%, positive predictive value of 83.3% and negative predictive value of 90.9%. The peak velocity variation of common carotid artery measured by the resident (delta V peak2) were highly related with delta V peak1 (R2 = 0.68, P < 0.05), the AUC was 0.94. CONCLUSION: Measurement of peak velocity variation of common carotid artery with bedside ultrasound can accurately estimate the volume status of the patients in surgery ICU, and it is easy to be performed by the residents of ICU.

[Relationship between early serum albumin variation and prognosis in patients with severe acute pancreatitis treated in ICU].

OBJECTIVE: To investigate the relationship between serum albumin variation within 24 hours of ICU admission and prognosis in critically ill patients with sever acute pancreatitis (SAP). METHODS: We retrospectively analyzed all the clinical data of the patients with SAP treated in ICU from Jul. 2005 to Jun. 2010. The patients were divided into two groups, survival group (n = 131) and death group (n = 108). Clinical and laboratory data, outcomes, and serum albumin within 24 hours after admission to ICU of those patients were evaluated respectively, and Logistic regression analysis was performed. RESULTS: Significant differences were existed between two groups (P < 0.01) in average age, the score of acute physiology and chronic health evaluation II (APACHE II), Ranson criteria, the score of sequential organ failure assessment (SOFA), and albumin variation within 24 hours (Serum albumin descent degree and ratio in early stage). However, sex ratio, mean serum albumin concentration within 24 hours, and onset time did not have significant differences (P > 0.05). The area under ROC curve for albumin variation within 24 hours were 0. 728 and 0. 742, the best cut-off values were 4.25 g/L (sensitivity 61.45%, specificity 81.67%) and 13.5% (sensitivity 62.65%, specificity 78.33%), respectively. Multiple logistic regression analysis showed that albumin variation within 24 hours was associated with death. CONCLUSION: The albumin variation within 24 hours was the risk factors for poor prognosis of critically ill SAP in early stage.

[Short-term intensive glucose control in patients with severe acute pancreatitis].

OBJECTIVE: To investigate effects of intensive glucose control (IGC) on glucose variability (GV) and clinical outcomes in patients with severe acute pancreatitis (SAP), and to assess predictive values of different measures of GV on intensive care unit (ICU) death. METHODS: A prospective, randomized, non-blinded clinical trial was conducted. All adult patients with diagnosis of SAP, who were admitted to ICU of West China Hospital between July 1st 2010 and July 1st 2011, were enrolled. Eligible patients were randomly assigned to receive either IGC to maintain glucose level between 6.1 mmol/L and 8.3 mmol/L or control group (none intervention was given). GV, ICU mortality, the incidence of infection, length of mechanical ventilation and ICU stay of the two groups were compared. The standard deviation of blood glucose level [GLU(SD)], mean amplitude of glycemic excursion [GLU(MAGE)] and glycemic lability index [GLU(GLI)] were chosen as measures of GV to analyze the multi variable correlation between them and ICU mortality, and the ability of these three parameters was assessed in predicting ICU death using area under a receiver operating characteristic curve (AUC). RESULTS: One hundred and twenty-two patients were eligible for the study, and 30 patients with SAP were enrolled in the study, with 15 cases in each group. The basic data of the two groups were comparable. Compared with control group, IGC showed an effect to reduce GV, including GLU(SD) [mmol/L: 1.81 (0.97, 2.65) vs. 2.48 (1.29, 2.87)], GLU(MAGE) [mmol/L: 3.76 (3.67, 5.85) vs. 5.30 (4.35, 6.80)], GLU(GLI) [306.8 (220.6, 613.3) vs. 339.5 (218.4, 423.1)], and lower ICU mortality (13.3% vs. 40.0%), but the difference showed no significant difference (all P > 0.05). It could also shorten the length of ICU stay (days: 11.3 ± 9.9 vs. 15.8 ± 7.6, P < 0.01), decrease the incidence of infection of blood stream and the lung (6.7% vs. 40.0%; 33.3% vs. 73.3%, both P < 0.05). A positive correlation between GLU(GLU) and ICU mortality was found (r = 0.371, P = 0.044), but no correlation was found between GLU(SD) or GLU(MAGE) and ICU mortality (r value was -0.144 and -0.065, P value was 0.448 and 0.731). AUC for GLU(SD), GLU(MAGE) and GLU(GLI) was 0.594 [95% confidence interval (95%CI) 0.382-0.805], 0.543 (95%CI 0.287-0.798) and 0.751 (95%CI 0.548-0.954) respectively, and GLU(GLI) was the best predictor of ICU death. CONCLUSIONS: IGC had an effect to reduce GV, decrease ICU mortality, shorten length of ICU stay, and lower the incidence of infection. Compared with GLU(SD) and GLU(MAGE), GLU(GLI) was the best predictor of ICU death.

The association of mean glucose level and glucose variability with intensive care unit mortality in patients with severe acute pancreatitis.

PURPOSE: The objective of this study was to retrospectively analyze the association of mean glucose level (MGL) and glycemic lability index (GLI; as a measure of glucose variability) with intensive care unit (ICU) mortality in patients with severe acute pancreatitis (SAP). MATERIALS AND METHODS: Paper-based medical records of patients with SAP who were admitted to the ICU of West China Hospital between July 1, 2005, and July 1, 2010, were analyzed. Glucose measurements, demographic characteristics, clinical features, data on the first and second 24-hour Acute Physiology and Chronic Health Evaluation (APACHE) II scores, and outcomes were obtained. Time-weighted glucose parameters were used. We statistically analyzed the relationship between these variables and both ICU and hospital mortality. RESULTS: A total of 294 patients with 34,796 glucose measurements were included in the final analysis. The time-weighted MGL was 9.31 ± 1.91 mmol/L, and the median of GLI was 55.27 (mmol/L)(2) h-(1) wk-(1). Intensive care unit mortality was 43.5% and increased progressively as GLI increased, reaching 62.5% of patients with GLI above 115.89 (mmol/L)(2) h-(1) wk-(1). The highest odds ratio for ICU death was found in patients with the highest quartile of GLI: odds ratio, 3.47 (95% confidence interval, 1.76-6.86; P < .000). No such relationship could be found with MGL. Glycemic lability index was better able to predict ICU death than was MGL (the area under the curves were 0.642 vs 0.561, respectively; z test was 2.677; P = .0074). The logistic regression analysis showed that GLI, the second 24-hour APACHE II score, and the number of organ failures upon ICU admission contributed independently to the risk of mortality. CONCLUSIONS: We observed that GLI was a better predictor of ICU and hospital mortality than was MGL. Together with the second 24-hour APACHE II score and the number of organ failures upon ICU admission, GLI is an independent predictor of mortality in patients with SAP.