[The application of extracorporeal membrane oxygenation in critically ill patient].

OBJECTIVE: To evaluate the supportive effects on cardiopulmonary failure in critically ill patients treated with extracorporeal membrane oxygenation (ECMO). METHODS: A retrospective observational study of 9 patients treated in intensive care unit (ICU) of Peking University Third Hospital and Beijing Ditan Hospital from October 1, 2007 to December 26, 2009 with ECMO for various diseases was conducted. Clinical data was analyzed. RESULTS: Of 9 patients [mean age (26.8 ± 7.0) years, body mass index (28.3 ± 9.1) kg/m(2)] were enrolled, 3 were male and 6 were female. Two patients were treated with veno-arterial(V-A) ECMO for severe heart failure, and 7 with veno-venous(V-V) ECMO due to refractory acute respiratory distress syndrome ARDS caused by 2009 novel H1N1 virus infection. The doses of vasoactive agents and cardiac parameters changed greatly after the V-A mode. The setting of ventilator support were significantly decreased, and arterial oxygen saturation [SaO(2)], arterial blood carbon dioxide partial pressure [PaCO(2)] and blood pH value were improved significantly after the V-V mode ECMO. Acute renal insufficiency occurred in 5 patients, hyperbilirubinemia in 6 patients, and catheter related blood stream infection in 4 patients. Five patients were weaned from ECMO successfully and 4 of them rehabilitated, the treatment was withdrawn in 2 patients, and the other 2 patients died during the procedure. The mean amount of red blood cell suspension administered per patients was (15.1 ± 9.9) U, and length of ICU stay was (18.9 ± 15.7) days. CONCLUSIONS: ECMO has a rapid effect to temporarily support heart or lung function (partially or totally) during cardiopulmonary failure, leading to organ recovery. Attempts to reduce the incidence of complications might improve the prognosis of critically ill patients.

[The analysis of the clinical features between survivors and non-survivors with the severe form of new influenza A (H1N1) viral infection].

OBJECTIVE: To understand the clinical features of critically ill patients with pandemic 2009 influenza A (H1N1) and investigate the risk factors associated with death cases. METHODS: The clinical features of 55 critically ill patients with pandemic 2009 influenza A (H1N1) viral infection hospitalized at Beijing Ditan Hospital from October 3 to December 15, 2009 were retrospectively analyzed, and a comparative analysis was performed on the manifestations of the survival and the death groups of patients. RESULTS: There were 31 males and 24 females. The age ranged from 10 months to 84 year old, and the mean (SD) was 38 (20) year old. The critically ill cases were more in patients under age 65 (48/55), with obesity (33/49), with underlying diseases (26/49), and pregnancy (6/24). Both the survivors and non-survivors of patients had high fever, cough, sputum (some sputum with blood), dyspnea, räles of both lungs fields, and all further developed severe pneumonia. The patients also showed respiratory failure (54/55) and ARDS (26/55). All of them received oseltamivir therapy, and 38 patients received mechanical ventilation and 30 were given steroid therapy. Secondary infection occurred in 27 cases, and ventilator-associated pneumonia happened in 10 patients. In the early stage of onset, C-reactive protein (CRP) increased [(131 ± 130) mg/L] and low counts of T lymphocytes were present [CD(4)(+), CD(8)(+) T was (217 ± 139)/µl and (162 ± 82)/µl]. With the progress of disease, the non-survival cases had persistently increased CRP and the counts of T lymphocytes did not recover, while the secondary fungal infection was significantly higher than in the survivor cases (P < 0.05). By using BMI, underlying diseases, ARDS, the day of Oseltamivir initiated, steroid therapy, following bacterial and fungal infection as variables through logistic regression analysis, it was shown that higher BMI and following fungal infection were associated with higher fatal risks (OR was 6.512, 19.631 respectively, both of P value was low than 0.05). There was no death case who received oseltamivir treatment within 48 hours of onset of disease. CONCLUSIONS: Critical illness in pandemic 2009 influenza A (H1N1) was associated with patients under age 65, with obesity, underlying diseases, and pregnancy. Persistently increased CRP and lower counts of T lymphocytes were associated with unfavorable prognosis. The patients with higher BMI and secondary fungal infection had higher fatal risks. Oseltamivir treatments at early stage would probably reduce mortality.

[The treatment of molecular adsorbents recirculating system artificial liver in severe liver failure patients with multiple organ dysfunction syndrome].

OBJECTIVE: To evaluate the effectiveness and mechanisms of molecular adsorbents recirculating system (MARS) treatment in severe liver failure patients with multiple organ dysfunction syndrome (MODS). METHODS: 60 single MARS treatments were performed for 6 - 24 hours on 24 severe liver failure patients with MODS. RESULTS: MARS therapy was associated with marked reduction of albumin bound toxins and water soluble toxins, together with a significant removal of NO and certain cytokines, such as TNF-alpha, IL-6, IL-8, and INF-gamma. These were associated with a improvement of the patients' clinical conditions including hepatic encephalopathy, deranged hemodynamic situation, as well as renal and respiratory function, thus resulted into marked decrease of sequential organ failure assessment (SOFA) score (from 9.72+-1.89 to 6.98+-2.34), and improving outcome: 9 patients were able to be discharged from the hospital or bridged to successful liver transplantation. The overall survival rate of 24 patients was 37.5%. CONCLUSIONS: There is positive therapeutic impact and safety to use MARS on liver failure patients with MODS. The effectiveness of MARS is correlated with reducing the levels of NO and cytokines, except for completely removing of accumulated toxins in liver failure patients.

Application of Molecular Adsorbents Recirculating System to remove NO and cytokines in severe liver failure patients with multiple organ dysfunction syndrome.

BACKGROUND: Molecular Adsorbents Recirculating System (MARS) is a new promising artificial liver support therapy, the aim of this study was to assess the effectiveness of MARS to remove nitrous oxide (NO) and cytokines in severe liver failure patients with multiple organ dysfunction syndrome (MODS). METHODS: Sixty single MARS treatments were performed with length of 6-24 h on 24 severe liver failure patients (18 males/6 females) with MODS. RESULTS: The MARS therapy was associated with a significant removal of NO and certain cytokines such as TNF-alpha, IL-6, IL-8, and INF-gamma, together with marked reduction of other non-water-soluble albumin bound toxins and water-soluble toxins, these were associated with a improvement of the patients' clinical conditions including hepatic encephalopathy, deranged hemodynamic situation and as well as renal and respiratory function, thus resulted into marked decrease of Sequential Organ Failure Assessment (SOFA) score and improved outcome: nine patients were able to be discharged from the hospital or bridged to successful liver transplantation, the overall survival of 24 patients was 37.5%. CONCLUSION: We can confirm the positive therapeutic impact and safety to use MARS on liver failure patients with MODS associated with elevated levels of NO and cytokines.