Neuromuscular blocking agents for acute respiratory distress syndrome: an updated meta-analysis of randomized controlled trials.

BACKGROUNDS: The aim of this study is investigating the benefits and harms of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS). METHODS: We comprehensively searched PubMed, EMBASE, and Cochrane library for randomized controlled trials comparing NMBAs to any other comparator. We pooled data using relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes, with 95% confidence intervals. We assessed the quality of included studies using the Cochrane tool and levels of evidence using the GRADE method. RESULTS: Finally, six RCTs (n = 1557 patients) were eligible for analysis. The results showed NMBAs use was not associated with reduced 28 days mortality (RR 0.78; 95% CI, 0.58 to 1.06; P = 0.11), 90 days mortality (RR, 0.92; 95% CI, 0.81 to 1.04; P = 0.16), and intensive care unit (ICU) mortality (RR, 0.90; 95% CI, 0.79 to 1.03; P = 0.13) in patients with ARDS. However, 21-28 days mortality was slightly lower in patients received NMBAs (RR 0.73; 95% CI, 0.54 to 0.99; P = 0.04; I2 = 53%). Besides, NMBAs use could improve the PaO2/FiO2 ratio at 48 and 72 h, decrease plateau pressure and PEEP at 72 h. Additionally, NMBAs had no significant effects on days free of ventilation at day 28 (WMD, 0.55; 95% CI, - 0.46 to 1.57; P = 0.29), days not in ICU at day 28 (WMD, 0.12; 95% CI, - 0.85 to 1.08; P = 0.82), ICU-acquired weakness (RR, 1.23; 95% CI, 0.99 to 1.93; P = 0.06). Finally, NMBAs use was associated with a lower risk of barotrauma (RR, 0.55; 95% CI, 0.35 to 0.85; P = 0.007). CONCLUSION: In patients with respiratory distress syndrome, NMBAs may be beneficial in reverse refractory hypoxemia and may be associated with reduced short-term mortality and incidence of barotrauma. However, there is no significant effects of NMBAs on mid-term and long-term mortality, and further studies are required.

The effects and safety of vasopressin receptor agonists in patients with septic shock: a meta-analysis and trial sequential analysis.

BACKGROUND: The aim of this study was to evaluate the effects and safety of vasopressin receptor agonists in patients with septic shock. METHODS: PubMed, EMBASE, and Cochrane library were searched for randomized controlled trials evaluating the effects of vasopressin receptor agonists in septic shock patients. Two reviewers performed literature selection, data extraction, and quality evaluation independently. The primary outcome was mortality. And secondary outcomes included intensive care unit (ICU) length of stay, duration of mechanical ventilation, and incidence of adverse events. In addition, a trial sequential analysis (TSA) was performed. RESULTS: Twenty studies were eligible for meta-analysis. The results showed vasopressin receptor agonists use was associated with reduced mortality (relative risk (RR) 0.92; 95% confidence interval (CI) 0.84 to 0.99; I2 = 0%). Nevertheless, they had no significant effects on ICU length of stay (mean deviation (MD) - 0.08, 95% CI, - 0.68 to 0.52, I2 = 0%) and duration of mechanical ventilation (MD - 0.58, 95% CI - 1.47 to 0.31, I2 = 57%). Additionally, there was no significant difference in total adverse events between two groups (RR 1.28, 95% CI 0.87 to 1.90, I2 = 57%), but vasopressin receptor agonists administration could significantly increase the risk of digital ischemia (RR 4.85, 95% CI 2.81 to 8.39, I2 = 26%). Finally, there was no statistical difference of cardiovascular events (RR 0.91, 95% CI 0.53 to 1.57, I2 = 1%), arrhythmia (0.77, 95% CI 0.48 to 1.23, I2 = 23%), mesenteric ischemia (0.83, 95% CI 0.44 to 1.55, I2 = 0%), diarrhea (2.47, 95% CI 0.77 to 7.96, I2 = 49%), cerebrovascular events (1.36, 95% CI 0.18 to 10.54, I2 = 0%), and hyponatremia (1.47, 95% CI 0.84 to 2.55, I2 = 0%) between two groups. Egger's test showed there was no significant publication bias among studies (P = 0.36). CONCLUSIONS: The use of vasopressin might result in reduced mortality in patients with septic shock. An increased risk of digital ischemia must be taken into account.

A Convenient Palladium-Catalyzed Carbonylative Suzuki Coupling of Aryl Halides with Formic Acid as the Carbon Monoxide Source.

A practical palladium-catalyzed carbonylative Suzuki coupling of aryl halides under carbon monoxide gas-free conditions has been developed. Here, formic acid was utilized as the carbon monoxide source for the first time with acetic anhydride as the additive. A variety of diarylketones were produced in moderate to excellent yields from the corresponding aryl halides and arylboronic acids.

Ideal target arterial pressure after control of bleeding in a rabbit model of severe traumatic hemorrhagic shock: results from volume loading-based fluid resuscitation.

BACKGROUND: Previously reported ideal target mean arterial pressure (MAP) after control of bleeding in traumatic hemorrhagic shock (THS) requires further verification in more clinically related models. The authors explored this issue via gradient volume loading without vasopressor therapy. As certain volume loading can induce secretion of atrial natriuretic peptide (ANP), which has been shown to be protective, the authors also observed its potential role. MATERIALS AND METHODS: Fifty male New Zealand rabbits were submitted to 1.5 h of uncontrolled THS (with another eight rabbits assigned to the sham group). After bleeding control, treated rabbits were randomly (n = 10, respectively) resuscitated with blood and Ringer lactate (1:2) to achieve target MAP of 50, 60, 70, 80, and 90 mm Hg within 1 h. During the following 2 h, they were resuscitated toward baseline MAP. Rabbits were observed until 7 h. RESULTS: After resuscitation, infused fluid was lower and oxidative stress injury was milder in the 70 mm Hg group. Fluid volume loaded during the initial hour after hemostasis was negatively correlated with pH, oxygen saturation, and base excess at the end of resuscitation. It also correlated positively with proinflammatory responses in bronchoalveolar lavage fluid at 7 h and 7-h mortality. Moreover, after volume loading, the 80 mm Hg group showed significantly increased serum ANP level, which correlated with the expression of Akt protein in the jejunum at 7 h. CONCLUSIONS: In rabbits the ideal target MAP during the initial resuscitation of severe THS after hemostasis was 70 mm Hg. ANP may have a critical role in gut protection.

[A comparison of the acute physiology and chronic health evaluation II score and the trauma-injury severity score for outcome assessment in intensive care unit trauma patients: a meta-analysis].

OBJECTIVE: To assess the ability of the acute physiology and chronic health evaluation II (APACHE II) and trauma-injury severity score (TRISS) in predicting mortality in intensive care unit (ICU) trauma patients. METHODS: Databases of PubMed, Cochrane Library, SinoMed, CNKI were retrieved from January 1980 to December 2020. The ability of the APACHE II and the TRISS to predict mortality in the ICU trauma patients was compared in the retrieval literatures. The relevant literatures were screened by two researchers independently. The data of the included literatures were extracted, and the quality of the included literatures was evaluated. MetaDiSc 1.4 software was used to test the heterogeneity among studies. Meta-analysis was performed on diagnostic accuracy indicators and the summary receiver operator characteristics curve (SROC curve) was fitted. The area under SROC curve (AUC) of the two scores was compared. Deek test was used to analyze literature publication bias. RESULTS: Six studies were selected with 4 054 patients involved with medium and high quality. Meta-analysis results showed that APACHE II and TRISS had low sensitivity [the pooled sensitivity and 95% confidence interval (95%CI) was 0.48 (0.41-0.55) and 0.51 (0.41-0.62)], high specificity [the pooled specificity and 95%CI was 0.96 (0.93-0.97) and 0.98 (0.95-0.99)], the pooled diagnostic odds ratio (DOR) and 95%CI was 20 (14-28) and 46 (18-120), and overall good performance in terms of AUC [the AUC and 95%CI was 0.79 (0.75-0.82) and 0.80 (0.76-0.83)] in predicting the prognosis of ICU trauma patients. There was no statistical difference in AUC between the two scores (Z = 1.542, P > 0.05). Deek funnel plot showed little publication bias. CONCLUSIONS: Both APACHE II and TRISS scores could accurately predict mortality in ICU trauma patients.

Efficacy comparison of restrictive versus massive fluid resuscitation in patients with traumatic hemorrhagic shock.

OBJECTIVE: To compare the therapeutic effect and safety of restrictive versus massive fluid resuscitation in patients with traumatic hemorrhagic shock (TSH). METHODS: Ninety TSH patients treated in the ICU of the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2020 to January 2021 were recruited for this retrospective study. Among them, 47 cases received restrictive fluid resuscitation (RFR) after admission who were considered as the observation group (OG), while the other 43 cases were given massive fluid resuscitation (MFR) who were treated as the control group (CG). The clinical indices, coagulation function, blood gas analysis, mortality within 72 h, duration of mechanical ventilation, and ICU stay were compared between the two groups, and the amount of resuscitation fluid given and complications that occurred during treatment were recorded. Multivariate logistic regression analysis was used to screen the independent risk factors for complications. RESULTS: In comparison to the CG, the resuscitation time, infusion volume, and lactate level in the OG were lower after treatment, while the hemoglobin level and blood gas residual base value (BE) were higher. Besides, the activated partial thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT) levels and arterial blood carbon dioxide partial pressure (PaCO2) in the OG were lower, while arterial blood oxygen partial pressure (PaO2) and pH were higher. The duration of mechanical ventilation and ICU stay in the OG after treatment were lower, and there was no statistical difference in mortality and complication rates within 72 h. Lower mean arterial pressure (MAP), higher APACHE II (Acute Physiology and Chronic Health Evaluation II) and longer resuscitation time were independent risk factors for complications in patients with traumatic shock. CONCLUSION: TSH treatment with RFR can effectively accelerate patients' resuscitation with less volume of infusion of resuscitation fluid, reduced time of mechanical ventilation and ICU hospitalization, and promote the recovery of coagulation function. It has good effects and is very suitable for clinical application.

Research on Dewatering Characteristics of Waste Slurry from Pipe Jacking Construction.

A large amount of waste slurry is produced during the construction of pipe jacking projects. To avoid the waste slurry occupying too much urban land, it needs to be rapidly reduced. Due to the complex composition of waste slurry, the existing dewatering methods face the problem of low efficiency, and the soil after dewatering is difficult to recycle as soil materials due to high water content and low strength. There is currently a lack of research on dewatering and resource utilization of waste slurry from pipe jacking projects. In response to this problem, this paper studies the flocculation-settling characteristics of waste slurry and the mechanical properties of solidified sediment. It was found that the anionic polyacrylamide (APAM) 7126 obtained the best separation effect if the waste slurry contains bentonite, which increases the zeta potential, resulting in poor separation. Thus, FeCl3·6H2O and APAM 7126 can be used as compound conditioners. The sediment after settling was further added with 20-30% sulphate aluminum cement (SAC), and the unconfined compressive strength of the solidified sediment for 3 days could exceed 30 kPa. After flocculation-settling and solidification treatment, the waste pipe jacking slurry can be quickly dewatered into a soil material with a certain strength, which provides a reference for engineering applications.

The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients.

PURPOSE: The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients. METHODS: Annual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level I trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated. RESULTS: The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE II, and SAPS II in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715, and 0.725, respectively. CONCLUSION: The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.