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Objective:To explore the correlation between different types of microcirculation alterations and the prognosis in patients with septic shock.Methods:This research employed a prospective observational study methodology for selecting subjects with septic shock. Side-stream dark field(SDF) was used to monitor the sublingual microcirculation to determine the total vascular density (TVD), perfused vessel density (PVD), the proportion of perfused vessels (PPV), and the microvascular flow index (MFI), heterogeneity index (HI) indicators. At the bedside, patients with microcirculation disorders were divided into four types: stasis, dilution, heterogeneity, and hyperdynamic. The 30-day survival status after enrollment and hemodynamics parameters were recorded.Results:A total of 64 patients with septic shock were selected in the study, including 18 cases of stasis type, 11 of dilution type, 18 of heterogeneous type, and 17 of hyperdynamic type. There were statistical differences in the mean arterial pressure (MAP) [stasis:(77±9) mmHg (1 mmHg=0.133 kPa), dilution:(80±11) mmHg, heterogeneity: (78±12) mmHg, hyperdynamic:(88±12) mmHg], TVD [ stasis:(10.84±3.01) mm/mm 2, dilution:(9.64±1.72) mm/mm 2, heterogeneity:(11.39±2.18) mm/mm 2, hyperdynamic: (11.87±2.67) mm/mm 2 ], PVD [stasis:(5.93±1.94) mm/mm 2, dilution:(6.86±1.48) mm/mm 2, heterogeneity: (8.31±1.78) mm/mm 2, hyperdynamic:(9.68±2.46) mm/mm 2], PPV [stasis:52.45 (46.25, 63.33)%, dilution:73.70 (61.50, 75.20)%, heterogeneity: 71.25 (67.95, 77.00)%, hyperdynamic:80.70 (77.25, 86.45)%], MFI(stasis:1.34±0.45, dilution: 1.70±0.38, heterogeneity:1.82±0.28, hyperdynamic:2.25±0.33), and HI [stasis:0.68 (0.51, 1.87), dilution: 0.57 (0.49, 0.64), heterogeneity:0.70 (0.59, 0.91), hyperdynamic: 0.40 (0.37, 0.52)] of the four types of microcirculation alterations. The cumulative survival rates in stasis, dilution, heterogeneity and hyperdynamic types at 30 day were 7/18, 4/11, 10/18 and 14/17, respectively, which in stasis and dilution types was significantly lower than that of hyperdynamic type (χ2=7.221, P=0.007;χ 2=6.764, P=0.009). Multivariate Cox regression analysis showed the type of microcirculation alterations (stasis: RR=4.551, 95 %CI 1.228-16.864, P=0.023; dilution: RR=4.086, 95 %CI 1.011-16.503, P=0.048), acute physiology and chronic health evaluation Ⅱ ( RR=1.077, 95 %CI 1.006-1.153, P=0.032) were independent prognostic risk factors. Conclusions:Microcirculation alterations are common in patients with septic shock, and it is hard to predict the types of microcirculation alterations with hemodynamics parameters. The prognosis of patients with septic shock is related to the types of microcirculation alterations, suggesting that routine monitoring of microcirculation might be helpful to guide hemodynamic therapy.
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OBJECTIVES@#Sepsis associated encephalopathy (SAE) is a common neurological complication of sepsis. Delirium is a common symtom of SAE. The pathophysiology of SAE is still unclear, but several likely mechanisms have been proposed, such as mitochondrial and endothelial dysfunction, neurotransmission disturbances, derangements of calcium homeostasis, cerebral microcirculation dysfunction, and brain hypoperfusion. Near-infrared spectroscopy (NIRS) is a non-invasive measure for regional cerebral oxygen saturation (rSO@*METHODS@#A total of 48 septic patients who admitted to the intensive care unit (ICU) of Xiangya Hospital, Central South University from August 2017 to May 2018, were retrospectively study. Septic shock was diagnosed according to the criteria of sepsis 3.0 defined by the American Association of Critical Care Medicine and the European Society of Critical Care Medicine. NIRS monitoring was performed during the first 6 hours admitted to ICU with sensors placed on the bilateral forehead of patients. The maximum (rSO@*RESULTS@#The overall 28-day mortality of septic shock patients was 47.92% (23/48), and the incidence of delirium was 18.75% (9/48). The rSO@*CONCLUSIONS@#Cerebral anoxia and hyperoxia, as well as the large fluctuation of cerebral oxygen saturation are important factors that affect the outcomes and the incidence of delirium in septic shock patients, which should be paid attention to in clinical practice. Dynamic monitoring of cerebral oxygen saturation and maintain its stability may be of great significance in patients with septic shock.
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Humans , APACHE , Intensive Care Units , Oxygen Saturation , Prognosis , Retrospective Studies , Sepsis , Shock, SepticABSTRACT
Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.
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Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care.
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Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care.
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Objective@#To investigate the clinical significance of transcranial Doppler (TCD) in early diagnosis of sepsis-associated encephalopathy(SAE).@*Methods@#Septic patients admitted to the intensive care unit(ICU) were recruited at Xiangya Hospital, Central South University from July 2015 to March 2016. Clinical data and TCD parameters during 24 hours after admission were collected. All patients were screened for delirium using the confusion assessment method for the intensive care unit (CAM-ICU) twice a day. The gold standard of the diagnosis of SAE was positive CAM-ICU evaluation. Patients were divided into SAE group and the non-SAE group. TCD data including systolic velocity (Vs), diastolic velocity (Vd), mean velocity (Vm), pulsatility index (PI) and resistant index (RI) were analyzed to determine the optimal diagnostic cut-off value.@*Results@#A total of 43 patients were enrolled including 12 in SAE group and 31 in non-SAE group. Vm and Vd were lower in SAE group [Vm: (53.50±12.22) cm/s vs. (61.68±9.63) cm/s, P<0.05; Vd: (33.42±10.87) cm/s vs. (43.16±7.84) cm/s, P<0.01] but PI and RI were significant higher in SAE group[PI:(1.16±0.2) vs. (0.90±0.15), P<0.01;RI:(0.65±0.08) vs. (0.56±0.06), P<0.01] than in non-SAE group. The cut-off values of Vs, Vm, Vd, PI and RI for the diagnosis of SAE were 112cm/s, 55.50cm/s, 34.50cm/s, 1.16, 0.65, respectively, with the relevant sensitivities of 19.4%, 83.9%, 93.5%, 58.3%, 58.3% and the specificities of 100.0%, 50.0%, 58.3%, 96.8%, 96.8%, respectively. The diagnostic AUC of Vd, PI and RI were 0.741, 0.808 and 0.808 respectively.@*Conclusions@#The parameter changes of TCD suggest that the pathogenesis of SAE is related to cerebral hypoperfusion, TCD is a helpful method for the early diagnosis of SAE.
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By observing the expression of peripheral blood lymphocyte programmed death-1 (PD-1) in patients with aneurysm subarachnoid hemorrhage (aSAH), the expression characteristics and significance in patients with aSAH were explored. Methods A total of 21 patients with aSAH were selected and were divided into neurological symptoms group [ Glaskow Coma Scale ( GCS) <15, 10 cases] and non-neurological symptoms group (GCS=15, 11 cases) according to GCS. And 6 health human were selected as the control group. The expression of CD4 + and CD8 + T lymphocytes in peripheral blood of patients in each group was detected by flow cytometry, and its characteristics and significance were analyzed. Results The percentages of PD-1 + CD4 + T lymphocyte and PD-1 +CD8 + T lymphocytein of non-neurological symptoms group were significantly higher than those in control group, while significantly lower than those in neurological symptoms group ( all P< 0.05 ). The percentages of PD-1 +CD4 + T lymphocyte and PD-1 +CD8 + T lymphocytein were significantly correlated with the GCS score, and the Spearson coefficients were 0.87 and 0.83, respectively (all P<0.05). In the aSAH patients, the incidence of pulmonary infection in neurological symptoms group was significantly higher than that in non-neurological symptoms group (P<0.05), and the percentages of PD-1 +CD4 + T lymphocyte and PD-1 +CD8 + T lymphocytein in pulmonary infection group was significantly higher than that in non-pulmonary infection group ( all P< 0.05 ). Conclusion In patients with aSAH, especially those with neurological symptoms, the expression intensity of CD4 +and CD8 + T lymphocyte PD-1 is significantly increased, which is correlated with the severity of neurological symptoms after aSAH and pulmonary infection after hemorrhage.
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Objective To evaluate the role of combining relative alpha variability and electroencephalogram (EEG) reactivity to predict the prognosis of hypoxic?ischemic encephalopathy(HIE) in adult patients. Methods A total of 28 adult patients with HIE admitted to general intensive care unit at Xiangya Hospital in Central South University were enrolled in this observational study from January2016 to April 2017. These patients with body temperature over 35℃after 72?hour admission could be continuously monitored at least 12 hours byEEG.At the same time,each patient was assessed for EEG reactivity.Then we analyzed the correlation between EEG reactivity, relative alpha variability and clinical prognosis. Results EEG reactivity was elicited in 15/28 patients, among whom 12 patients had a good outcome. While in the other 13 patients, EEG reactivity was not elicited, among whom only 3 patients had a good outcome. As to the results ofrelative alpha variability,11/13 patients with degree 3?4were of good prognosis; while only 3/15 patients with degree 1?2 were of good prognosis. Glasgow coma scale(GCS), EEG reactivity, and relative alpha variability were correlated with clinical outcome(χ2=5.073,9.073,-3.626, respectively,all P<0.05). The sensitivity of GCS, EEG reactivity,and relative alpha variability to predict the poor prognosis were 69.2%, 76.9%, 84.6%, respectively. The specificity were 73.3%, 80.0%, 73.3%, respectively. The consistency rates were 71.4%, 78.6%, 78.6%, respectively. The positive predictive values were 69.2%, 76.9%, 73.3%, respectively. The negative predictive values were 73.3%, 80.0%, 84.6%, respectively. More importantly, the accuracy of the relative alpha variability combined with EEG reactivity for the prediction of poor prognosis was much higher with the positive predictive value of 90.0%,the specificity of 93.3%,the sensitivity of 69.2%, the consistency rate of 82.1%,and the negative predictive values of 77.8%. Conclusions The combination of relative alpha variability and EEG reactivityis reliable to predict clinical outcome of patients with HIE.
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To investigate the changes of myocardial glucose metabolism in rabbit cardiac arrest models and the effect of hydrogen intervention by 18F-fluroro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) imaging. Methods: Fifteen male New Zealand white rabbits were randomly divided into a hydrogen group (n=6), a control group (n=6) and a sham group (n=3). Cardiac arrest (CA) was induced by intravenous injection of potassium chloride. Conventional cardiopulmonary resuscitation (CPR) was initiated after five-minutes CA. The hydrogen group and the control group were mechanically ventilated into mixed gas with 4% hydrogen+96% oxygen and pure oxygen, respectively, for 30 minutes after CPR. Rats in the sham group was performed the same surgical procedure and was injected adrenaline and potassium chloride but did not induce CA. The vital signs at basic state and 30 min after return of spontaneous circulation (ROSC) were recorded in each group. The parameters of CPR were recorded in two CA groups. Myocardial glucose metabolism was assessed by positron emission tomography (PET) at basic state, 2 h and 24 h after ROSC. The maximum standardized uptake value (SUVmax) of 18F-FDG was measured. Results: There were no significant differences in the basal body weight and vital signs among the three groups. There was no significant difference in the blood glucose level before PET examination. The 18F-FDG SUVmax in the sham group at three time points was not significantly changed. In the hydrogen group and the control group, the 18F-FDG SUVmax at 2 h after ROSC were significantly higher than the basic level (1.89±0.47 vs 3.47±1.24 and 1.90±0.36 vs 4.26±0.80, respectively). Compared with the control group, the 18F-FDG SUVmax in the hydrogen group was lower at the point at 2 h after ROSC. The 18F-FDG SUVmax in the 2 CA group were down to the basic level at 24 h after ROSC (hydrogen group 2.02±0.64, control group 2.07±0.61). Conclusion: Myocardial glucose metabolism in CA rabbits was increased significantly after ROSC, and hydrogen intervention can reduce the degree of glucose metabolism.
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Animals , Male , Rabbits , Rats , Cardiopulmonary Resuscitation , Glucose , Metabolism , Heart Arrest , General Surgery , Myocardium , Metabolism , Positron-Emission Tomography , Random AllocationABSTRACT
To explore the present status of fluid therapy and clinical outcome in critically ill patients in intensive care units (ICU).ICU patients consecutively admitted to our ICU were prospectively enrolled.Patients' demographics,laboratory data,fluid record and clinical outcome were collected.Fluid intake quantity of all patients was at peak on the fifth day which was 2 806 (1 997,3 582)ml.From the fourth day in ICU,fluid balance started to benegative as-84 (-1 127,612)ml and gradually increased.Crystalloid solution was the main components.For treatment purposes,medication injections and nutrients were major fluids.Positive correlations were found between total fluid intake quantity,total crystalloid volume,total colloidal volume and hospital stay,ICU stay,duration of intubation (r values as 0.211,0.686,0.282,0.155,0.506,0.174,0.209,0.072,0.292,respectively P＜0.05).Moreover,positive correlations were also demonstrated between total colloidal volume and total bilirubin,direct bilirubin,alanine transaminase,aspartate transaminase,blood urea nitrogen,serum creatinine (r values as 0.196,0.242,0.190,0.335,0.284,0.223,respectively P＜0.05).
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Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.
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Objective To investigate the application of Critical Care Chest Ultrasonic Examination (CCUE)-plus (CCUE-plus) in the etiological diagnosis in patieuts with dyspnea and/or hemodynamic instability caused by abdominal abnormalities.Methods Patients who suffered from dyspnea and/or hemodynamic instability in the Department of Critical Care Medicine,Xiangya Hospital,Central South University from September 2013 to September 2016 were recruited in this study.A total of 255 consecutive patients completed CCUE within 2hrs of admission.If the diaphragm could not be seen in the routine phrenic points according to Bedside Lung Ultrasound Evaluation (BLUE) protocol,it would be found along midaxillary line and defined m-point.The 59 patients with altered diaphragmatic position (m-point was more than 2 cm higher than phrenic point) received sequential abdominal ultrasonography.The latter ultrasonographic findings were compared with CT results.Results There were 42 (71.19％) cases with positive findings of abdominal ultrasonography,including 18 cases of seroperitoneum,16 cases of intestinal obstruction and 8 cases combined.Compared with 56 patients who applied with CT exam,the abdominal ultrasonography revealed a sensitivity of 76.7％ and a specificity of 100.0％ to diagnose seroperitoneum (AUCRoc 0.917);whereas the sensitivity was 75.0％ and the specificity was 90.9％ (AUCRoc 0.778) to diagnose intestinal obstruction.Moreover,there were 44 (74.58％) patients with normal left ventricular systolic function;more than three quarters (46/59,77.97％) patients had pulmonary consolidation.Conclusion In patients with dyspnea and/or hemodynamic instability caused by abdominal abnormalities and altered diaphragmatic position in BLUE protocol,CCUE-plus protocol has a high positive predictive value of more than 90％ in abdominal abnormality.The findings of abdominal ultrasonography may change therapeutic target from cardio-pulmonary optimization to relief of intestinal obstruction or drainage of seroperitoneum.
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Objective To investigate the role of neuroglobin ( NGB) in oxygen-glucose deprivation and reoxygenation ( OGD/R ) induced mitochondrial depolarization and reactive oxygen species ( ROS ) production in a human neuroblastoma cell line (SH-SY5Y).Methods SH-SY5Y cells were transfected with lentivirus to establish a stable cell line of NGB knockdown ( KD).After treated with OGD/R, cells were collected at different time points to analyze NGB mRNA and protein levels.Furthermore, cells were stained with JC-1 and DCFH-DA to evaluate mitochondrial depolarization and ROS production by inverted fluorescence microscope.Also, to determine the neurotoxicity , we measured the lactate dehydrogenase ( LDH) level in the cell culture medium.Results After the treatment of OGD/R, the NGB mRNA and protein started to elevate and peak at 4 h and 8 h (2.04 ±0.35 fold,1.69 ±0.18 fold).Compared with the vector group , NGB KD group had much more mitochondrial depolarization [ JC-1 red/green ( 1.10 ±0.10 ) vs (1.46 ±0.11),P<0.05] and ROS production [DCFH-DA fluorescence (36.30 ±5.32) vs (16.26 ± 2.97),P<0.05].Furthermore, NGB KD groups had a higher level of LDH release [(63.42 ±6.14)%vs (49.65 ±5.09 )%, P <0.05 ].Conclusions NGB plays an important role in the homeostasis of mitochondria.Knockdown of NGB results in increased mitochondrial depolarization , ROS production and neurotoxicity under hypoxia circumstances.
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Objective To observe and evaluate the predictive value of electroencephalogram (EEG) abnormalities of the EEG monitoring of patients with brain dysfunction in the intensive care unit (ICU).Methods Total of 58 cases with brain dysfunction under EEG were collected from the ICU of the XiangYa Hospital,Central South University from January 2014 to December 2015.EEG was performed to monitor those patients and data was collected,analyzed and classified according to both Synek and Young EEG scales to evaluate its predictive value.The statistical analysis was performed with SPSS 23.0 software (MAC,USA) and statistical significant was considered as P ＜0.05.Numerical values were given as means ± SD and t-test was performed to compare data of different groups.Kaplan-Meier survival estimator was used to draw the survival curve,and the survival analysis was postulated by COX regression analysis.Results Data from 58 patients were collected and classified according to both Synek and Young EEG scales,positive waveforms as periodic discharge or delta-predominant background were found among 50 patients,electrographic seizures were found in 7 patients,patients with EEG abnormality possessed a high level of SI00β and showed statistical differences.The 28-day mortahty was independently associated with Acute Physiology and Chronic Health Evaluation (APACHE]] score) (OR:1.08;95％ CI [1.03 to 1.14])、Synek Grade ＞2 (OR:0.17;95％ CI [0.03 to 0.80])、electrographic seizures (OR:23.70;95％ CI [2.02 to 277.73]) and slow rhythm (OR:8.54;95％ CI [1.72 to 42.32]).Conclusions The 28-day mortality of patients under EEG with brain dysfunction was independently associated with Synek Grade ＞ 2,electrographic seizures and slow EEG rhythm.
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Objective To investigate the characteristics of lung ultrasound images in critical care postoperative patients using BLUE-plus protocol . Methods Two hundred and twenty-two patients who were performed lung ultrasound measurements according to the BLUE-plus protocol within 24 hours admitted to the Department of critical care were included in this study . Data was collected and retrospectively analyzed to compare the proportion of different lung ultrasound signs at different speculate regions ,and to compare the lung ultrasound characteristics of patients undergo different surgeries . Results Excluding A lines ,the most common abnormal lung ultrasound signs at the diaphragmatic points were B7 lines (13 .06％ ) ,and the most common abnormal lung ultrasound signs at the posterior blue points were C signs (28 .60％ ) . The rate of C signs was significantly higher in post spinal cord surgery patients than those in other groups ( P =0 .032) . The rate of B3 lines was significantly higher at bilateral PLAPS points in oxygenation index 100-200 group compared with that in oxygenation index>300 group ( P =0 .011) . The rate of C signs was significantly higher at the left posterior blue point in oxygenation index 200-300 group , and at bilateral posterior blue point in oxygenation index 100-200 and <100 groups compared with those in oxygenation index >300 group ( P =0 .011 , P <0 .001 and P =0 .002) . The rate of pleural effusion was significantly higher at the right posterior blue point in oxygenation index 200 -300 group ,and at bilateral posterior blue point in oxygenation index 100 -200 group compared with those in oxygenation index >300 group ( P = 0 .001 , P < 0 .001 ) . Conclusions Screen with the BLUE-plus protocol can help to find abnormal signs including B3 lines ,B7 lines ,C signs and pleural effusion ,therefore instructs individualized treatment for postoperative patients . Pulmonary edema ,lung consolidation and pleural effusion are three main reasons responsible for hypoxemia in postoperative patients . Intensivists should avoid fluid overload , strengthen airway management ,postural therapy and encourage early mobility in postoperative patients .
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Objective To investigate the diagnostic value of neuron-specific enolase(NSE),central nervous system specific protein (S100β),interleukin-6 (IL-6) in sepsis-associated encephalopathy (SAE).Methods Clinical data of patients admitted to ICU and diagnosed with sepsis were collected from January 2015 to June 2016 in Xiangya Hospital,Central South University.SAE was defined as cerebral dysfunction in the presence of sepsis that also fulfilled the exclusion criteria.The acute physiology and chronic health score (APACHE Ⅱ),sequential organ failure assessment (SOFA),NSE,S100β,IL-6,ICU stay time and 28-day mortality were compared between the two groups.NSE,S1003 and IL-6 were measured on the 1 st and 3rd day in ICU to determine the optimal cut-off value of SAE.Results Among 59 enrolled patients,36 were assigned to SAE group while 23 were non-SAE group.The SAE group had a significantly higher APACHE Ⅱ and SOFA scores,as well as the length of ICU stay (P ＜ 0.01).The levels of NSE,S1003 and IL-6 in the two groups both increased on the 1st day,and decreased on the 3rd day.The level of NSE on the 1st day [19.28 (13.00,30.52) μg/L vs 16.61 (7.58,22.01 μg/L)] and the 3rd day[16.03 (9.40,21.29) μg/L vs 11.39(8.49,15.00) μg/L,P=0.029],IL-6 on the 1st day[676.25(81.34,5 000.00) mg/L vs [209.10(42.27,648.20) mg/L,P =0.005] and the 3rd day [157.10 (72.85,687.63) mg/L vs 55.92 (31.62,177.00) mg/L,P =0.026] of SAE group was significantly higher than those of non-SAE group.However S100β between groups on the 1st day [0.33(0.15,0.54) μg/L vs 0.23(0.16,0.53) μg/L] and the 3rd day[0.19(0.10,0.29) μg/L vs 0.10(0.05,0.17) μg/L] was neither significant (P ＞0.05).The diagnostic values for SAE of NSE,S1003 and IL-6 were 14.36 μg/L,0.14 μg/L and 91.305 mg/L with sensitivity 61.1％,61.1％,72.2％ and specificity 73.9％,69.6％,69.6％,respectively.The diagnostic AUC of NSE and IL-6 combination was 0.774,95％ CI 0.651-0.896.Conclusion All sepsis patients have different degrees of brain injury.NSE combined with IL-6 on the 3rd day in ICU demonstrates the diagnostic significance of SAE.
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Objective To investigate the diagnostic value of neuron-specific enolase(NSE),central nervous system specific protein (S100β),interleukin-6 (IL-6) in sepsis-associated encephalopathy (SAE).Methods Clinical data of patients admitted to ICU and diagnosed with sepsis were collected from January 2015 to June 2016 in Xiangya Hospital,Central South University.SAE was defined as cerebral dysfunction in the presence of sepsis that also fulfilled the exclusion criteria.The acute physiology and chronic health score (APACHE Ⅱ),sequential organ failure assessment (SOFA),NSE,S100β,IL-6,ICU stay time and 28-day mortality were compared between the two groups.NSE,S1003 and IL-6 were measured on the 1 st and 3rd day in ICU to determine the optimal cut-off value of SAE.Results Among 59 enrolled patients,36 were assigned to SAE group while 23 were non-SAE group.The SAE group had a significantly higher APACHE Ⅱ and SOFA scores,as well as the length of ICU stay (P ＜ 0.01).The levels of NSE,S1003 and IL-6 in the two groups both increased on the 1st day,and decreased on the 3rd day.The level of NSE on the 1st day [19.28 (13.00,30.52) μg/L vs 16.61 (7.58,22.01 μg/L)] and the 3rd day[16.03 (9.40,21.29) μg/L vs 11.39(8.49,15.00) μg/L,P=0.029],IL-6 on the 1st day[676.25(81.34,5 000.00) mg/L vs [209.10(42.27,648.20) mg/L,P =0.005] and the 3rd day [157.10 (72.85,687.63) mg/L vs 55.92 (31.62,177.00) mg/L,P =0.026] of SAE group was significantly higher than those of non-SAE group.However S100β between groups on the 1st day [0.33(0.15,0.54) μg/L vs 0.23(0.16,0.53) μg/L] and the 3rd day[0.19(0.10,0.29) μg/L vs 0.10(0.05,0.17) μg/L] was neither significant (P ＞0.05).The diagnostic values for SAE of NSE,S1003 and IL-6 were 14.36 μg/L,0.14 μg/L and 91.305 mg/L with sensitivity 61.1％,61.1％,72.2％ and specificity 73.9％,69.6％,69.6％,respectively.The diagnostic AUC of NSE and IL-6 combination was 0.774,95％ CI 0.651-0.896.Conclusion All sepsis patients have different degrees of brain injury.NSE combined with IL-6 on the 3rd day in ICU demonstrates the diagnostic significance of SAE.
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Objective To evaluate the diagnostic and prognostic value of the serum procalcitonin ( PCT ) level in the non-acquired immune deficiency syndrome ( AIDS ) immunocompromised critically ill patients suspected to have infection. Methods A retrospective study was conducted in the non-AIDS immunocompromised patients who were admitted to Department of Critical Care Medicine of Xiangya Hospital, Central South University during January 2011 to December 2014. Demographic characteristics, underlying disease, acute physiology and chronic health evaluationⅡ( APACHEⅡ) score at admission, and clinical records including baseline and peak levels of temperature, white blood count ( WBC ), PCT, and survival rate within 28 days, infection focus, infectious agents ( bacterial, fungi or mixed infection ), and the severity of infection ( sepsis, severe sepsis, or septic shock ) were recorded. Receiver operating characteristic ( ROC ) curve was plotted, and the diagnostic and protective value of above parameters was evaluated. Results A total of 98 patients ( 43 male and 55 female ) were enrolled in the study with a median age of 44 ( 28, 52 ) years old and a median APACHEⅡscore of 17 ( 11, 20 );47 with malignant hematological tumor, 45 with autoimmune diseases, and 6 post solid organ transplantation. Among them 53 patients ( 54.1%) died within 28 days. Twenty-seven patients were diagnosed as systemic inflammatory response syndrome ( SIRS ) without infection. Among 71 patients with infection, 45 were diagnosed as bacterial infection, 10 with fungal infection, and 16 with mixed infection. Sepsis was diagnosed in 7 patients, severe sepsis in 32 patients , and septic shock in 32 patients .①There was no statistical significance in the baseline and peak levels of PCT and WBC, or baseline level of temperature between the groups of SIRS patients without infection and infected patients. The peak level of temperature was significantly higher in the patients with infection as compared with that of the SIRS without infection patients [℃:39.4 ( 38.9, 40.0 ) vs. 38.8 ( 37.8, 39.2 ), Z=-3.268, P=0.001 ]. It was showed by subgroup analysis that in patients with hematological malignant disease or autoimmune diseases, higher level of body temperature was found in infection group compared with non-infection SIRS group [℃:39.5 ( 39.0, 40.0 ) vs. 39.0 ( 38.4, 39.4 ), Z=-2.349, P=0.019;39.0 ( 38.4, 39.5 ) vs. 38.2 ( 37.0, 38.9 ), Z=-2.221, P=0.026 ].②The baseline level of PCT (μg/L ) were 0.54 ( 0.20, 4.19 ), 2.78 ( 0.50, 9.54 ), 1.00 ( 0.45, 6.89 ), and 0.22 ( 0.07, 1.86 ) in non-infection SIRS patients or the patients with bacterial, fungal, and mixed infection, respectively. The peak level of PCT (μg/L ) were 4.19 ( 1.95, 13.42 ), 12.37 ( 3.82, 45.89 ), 1.82 ( 0.49, 17.86 ), and 5.14 ( 2.66, 12.62 ), respectively, in each subgroup. When the comparison was conducted among the patients with different infectious agent, the baseline level of PCT in patients with bacterial infection was significantly higher than that in SIRS patients without infection ( P=0.026 ) and mixed infection patients ( P=0.001 ), and the peak level of PCT was significantly higher than that in the SIRS patients without infection ( P=0.009 ) and the patients with fungal infection ( P=0.016 ). ROC curve showed that the higher value was found in the baseline and peak levels of PCT for diagnosis of septic shock in all patients [ area under ROC curve ( AUC ) of baseline level = 0.681±0.054, P = 0.001; AUC of peak level = 0.690±0.054, P=0.002 ], and the same value was also found in the baseline and peak levels of PCT for diagnosis of bacterial infection in the patients with malignant hematological tumor ( AUC of baseline level=0.687±0.080, P=0.008;AUC of peak level=0.697±0.079, P=0.021 ).③The peak level of PCT (μg/L ) were 4.05 ( 0.53, 31.22 ), 5.78 ( 2.14, 16.68 ), and 11.64 ( 2.94, 58.14 ) in subgroup of patients with sepsis, severe sepsis and septic shock, respectively, and they showed no statistical significance among subgroups ( P>0.05 ). A high serum level of peak PCT strongly indicated the presence of septic shock ( AUC=0.646±0.060, P=0.019 ), especially in the subgroup of patients with systemic autoimmune disease ( AUC=0.689±0.081, P=0.035 ).④The peak level of PCT (μg/L ) in the APACHEⅡ>18 group ( 38 cases ) was significantly higher than that of APACHEⅡ≤18 group [ 60 cases, PCT (μg/L ):11.64 ( 3.36, 39.39 ) vs. 4.42 ( 1.32, 14.70 ), P=0.016 ];there was a certain correlation between the peak level of PCT and the severity of the disease.⑤The peak level of PCT in death group was significantly higher than that of the survival group [μg/L:9.07 ( 3.05, 33.09 ) vs. 4.19 ( 1.26, 14.61 ), P=0.043 ]. ROC curve showed that the peak level of PCT might be valuable in predicting the prognosis in immunocompromised patients ( AUC=0.619±0.057, P=0.043 ). Conclusions The serum level of PCT is found to be a reliable marker for the diagnosis of bacterial infection in immunocompromised critical patients, especially in those with hematologic malignancy. Additionally, PCT provides a useful tool for evaluating the severity of infection and the prognosis of critically ill patients.
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Objective To explore the ideal resuscitation pressure for uncontrolled hemorrhagic shock in different ages of rats.Methods Ninety-six rats were divided into 3 groups by ages (6 weeks,16 weeks and 12 months representing pre-adult,adult and elderly rats,respectively).Uncontrolled hemorrhagic-shock model was established in all rats.Then every group was divided into 4 groups by the different target pressures (untreated group,40 ～ 50 mmHg group,＞ 50 ～ 60 mmHg group,and ＞ 60 ～ 70 mmHg group).We recorded the survival time and 24 h survival rate of rats in each group and compared the blood gas analysis,blood lactate and hematocrit (Hct) level in each group at 90 min of establishing model.Results Different ages had different optimal recovery pressure.The optimal target resuscitation pressures for 6 weeks,16 weeks and 12 months rats were 40 ～50 mmHg,＞ 50 ～ 60 mmHg and ＞ 60 ～ 70 mmHg,respectively.Under the ideal pressure they had a better survival rate and lower blood lactate level (P ＜ 0.01 or P ＜ 0.05).Conclusious Hemorrhagic-shock rats at different ages have different ideal target resuscitation pressures during active hemorrhage.
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Objective To study the changes of S100βin serum and brain tissue of rats with sepsisassociated encephalopathy (SAE).Methods After placement of pole plates of electroencephalogram (EEG) on the brain cortex,thirty SD rats were randomly (random number) divided into three groups post hoc:sepsis group in which rats were made to be sepsis models by cecal ligation and puncture (n =18),normal group (n =6) and sham operation group (n =6).The sepsis-associated encephalopathy was diagnosed with electroencephalogram taken by RM6240 physiological signal recorder.Meanwhile,heart rate and blood pressure were recorded.Eight hours later,serum and brain tissue of sacrificed rats were taken for measuring S100β.The results ware analyzed with one-way ANOVA.Results Of 18 sepsis rats,3 were dead,8 without SAE and 7 with SAE.The levels of S100βin serum and brain tissue of rats with SAE group were significantly higher than those in normal group and sham operation proup (P ＜ 0.05).The Ratio of brain/serum S100βin rats with SAE group was higher than that in rats without SAE (1.74 vs 1.51,P ＜ 0.05).Conclusions Significantly high level of serum S100βwas a reliable bio-marker for diagnosis of SAE in rats.