An updated HACOR score for predicting the failure of noninvasive ventilation: a multicenter prospective observational study.

BACKGROUND: Heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR) have been used to predict noninvasive ventilation (NIV) failure. However, the HACOR score fails to consider baseline data. Here, we aimed to update the HACOR score to take into account baseline data and test its predictive power for NIV failure primarily after 1-2 h of NIV. METHODS: A multicenter prospective observational study was performed in 18 hospitals in China and Turkey. Patients who received NIV because of hypoxemic respiratory failure were enrolled. In Chongqing, China, 1451 patients were enrolled in the training cohort. Outside of Chongqing, another 728 patients were enrolled in the external validation cohort. RESULTS: Before NIV, the presence of pneumonia, cardiogenic pulmonary edema, pulmonary ARDS, immunosuppression, or septic shock and the SOFA score were strongly associated with NIV failure. These six variables as baseline data were added to the original HACOR score. The AUCs for predicting NIV failure were 0.85 (95% CI 0.84-0.87) and 0.78 (0.75-0.81) tested with the updated HACOR score assessed after 1-2 h of NIV in the training and validation cohorts, respectively. A higher AUC was observed when it was tested with the updated HACOR score compared to the original HACOR score in the training cohort (0.85 vs. 0.80, 0.86 vs. 0.81, and 0.85 vs. 0.82 after 1-2, 12, and 24 h of NIV, respectively; all p values < 0.01). Similar results were found in the validation cohort (0.78 vs. 0.71, 0.79 vs. 0.74, and 0.81 vs. 0.76, respectively; all p values < 0.01). When 7, 10.5, and 14 points of the updated HACOR score were used as cutoff values, the probability of NIV failure was 25%, 50%, and 75%, respectively. Among patients with updated HACOR scores of ≤ 7, 7.5-10.5, 11-14, and > 14 after 1-2 h of NIV, the rate of NIV failure was 12.4%, 38.2%, 67.1%, and 83.7%, respectively. CONCLUSIONS: The updated HACOR score has high predictive power for NIV failure in patients with hypoxemic respiratory failure. It can be used to help in decision-making when NIV is used.

Sarcopenia is associated with short- and long-term mortality in patients with acute-on-chronic liver failure.

BACKGROUND: While sarcopenia is recognized as a predictor of mortality in cirrhosis, its influence on acute-on-chronic liver failure (ACLF) remains uncertain. Despite multiple studies examining the impact of sarcopenia on short-term mortality in patients with ACLF, the sample size of these studies was limited, and their outcomes were inconsistent. Therefore, this study aimed to explore the impact of sarcopenia on both short- and long-term mortality in patients with ACLF. METHODS: This retrospective cohort study included 414 patients with ACLF that were treated between January 2016 and September 2022. Sarcopenia was diagnosed based on the measurement of the skeletal muscle index at the third lumbar vertebra (L3-SMI). Subsequently, the patients were divided into sarcopenia and non-sarcopenia groups. We analysed the basic clinical data of the two groups. Multivariate Cox proportional analysis was used to analyse short-term (28 days) and long-term (1 year and overall) mortality rates. RESULTS: A total of 414 patients were included, with a mean age of 52.88 ± 13.41 years. Among them, 318 (76.8%) were male, and 239 (57.7%) had sarcopenia. A total of 280 (67.6%) patients died during the study period. Among them, 153 patients died within 28 days (37%) and 209 patients died within 1 year (50.5%). We found that the 28-day, 1-year and overall mortality rates in the sarcopenia group were significantly higher than those in the non-sarcopenia group (37% vs. 22.3%, P < 0.01; 50.5% vs. 34.9%, P < 0.01; and 67.6% vs. 53.1%, P < 0.01, respectively). Multivariate Cox regression analysis revealed that sarcopenia was significantly associated with increased mortality. The hazard ratios for sarcopenia were 2.05 (95% confidence interval [CI] 1.41-3.00, P < 0.01) for 28-day mortality, 1.81 (95% CI 1.29-2.54, P < 0.01) for 1-year mortality and 1.82 (95% CI 1.30-2.55, P < 0.01) for overall mortality. In addition, muscle density and international normalized ratio were associated with short- and long-term mortality. CONCLUSIONS: Sarcopenia is associated with both short- and long-term mortality in patients with ACLF. Therefore, regular monitoring for sarcopenia is important for these patients.

Employment intention and career planning of male nursing students in different levels of colleges and universities: A qualitative study.

AIM: To explore the employment intention and career planning of male nursing students at different levels of colleges and universities and provide references for formulating individualized training content. DESIGN: Phenomenological research method in qualitative research. METHODS: Using a phenomenological research method, 15 male nursing students from three levels of colleges and universities were interviewed in a one-to-half structure, and the data were analysed using NVivo12.0 software and the Colaizzi seven-step analysis method. RESULTS: Four themes and 10 sub-themes were extracted. The four themes included professional identity experience, nursing learning experience, career expectation and planning and educational needs. The 10 sub-themes included the negative effects of traditional impressions, the gradual establishment of professional identity, public health events promote professional identity, negative experiences in learning, positive growth from learning, varied career plans, career expectations and influencing factors, a reasonable schedule, diversity of content requirements and the positive effect of teaching teachers. CONCLUSIONS: Influenced by many factors, the employment intention and career planning of male nursing students at different higher education levels are varied. Schools and clinical practice units should strengthen the training of employment intention and career planning and make reasonable time adjustments to the training content. PUBLIC CONTRIBUTION: In total, 15 male interns accepted our interview request. We utilized their break time to conduct the interviews, resulting in significant contributions to the content of the article.

Potential application of ginseng in sepsis:: Applications of ginseng in sepsis.

Sepsis and septic shock affect millions of people worldwide each year with high clinical mortality rates. At present, basic research on sepsis has emerged in an endless stream, but there are few effective clinical translation results. Ginseng, a medicinal and edible representative of Araliaceae plants, contains a variety of biologically active compounds including ginsenosides, alkaloids, glycosides, polysaccharides, and polypeptides. Neuromodulation, anticancer activity, blood lipid regulation, and antithrombotic activity have been linked to ginseng treatment. At present, basic and clinical research have suggested various applications of ginseng in sepsis. In view of the different effects of various ginseng components on the pathogenesis of sepsis, and in order to further understand and develop the possible value of ginseng in sepsis, this manuscript reviews the application of various components of ginseng in the treatment of sepsis in recent years.

A case report and literature review of immune checkpoint inhibitor-associated pneumonia caused by penpulimab.

Objective: From the perspective of intensive care physicians, this paper reviews the diagnosis and treatment of CIP patients, analyzes and refines relevant literature on CIP. To summarize the characteristics of diagnosis and treatment of severe CIP provides the basis and reference for early identification, diagnosis and treatment. Methods: A case of severe CIP caused by piamprilizumab and ICI was reviewed and the literature was reviewed. Results: This was a patient with lung squamous cell carcinoma with lymphoma who had been treated with multiple chemoradiotherapy and immunotherapy with piamprizumab. The patient was admitted to the ICU with respiratory failure. The intensive care physician performs anti-infective, fluid management, hormonal anti-inflammatory, respiratory and nutritional support treatment, and relies on mNGS to exclude severe infection and CIP treatment, thus successfully saving the patient's life and improving discharge. Conclusions: The incidence of CIP is very low, and its diagnosis should be combined with clinical manifestations and previous drug use. mNGS can provide certain value in the exclusion of severe infections, so as to provide basis and reference for the early identification, diagnosis and treatment of severe CIP.

Melatonin: A window into the organ-protective effects of sepsis.

Sepsis is an uncontrolled host response to infection. In some cases, it progresses to multi-organ insufficiency, leading to septic shock and increased risk of mortality. Various organ support strategies are currently applied clinically, but they are still inadequate in terms of reducing mortality. Melatonin is a hormone that regulates sleep and wakefulness, and it is associated with a reduced risk of death in patients with sepsis. Evidence suggests that melatonin may help protect organ function from sepsis-related damage. Here, we review information related to the role of melatonin in protecting organ function during sepsis and explore its potential clinical applications, with the aim of providing an effective therapeutic strategy for treating sepsis-induced organ insufficiency.

Prediction of noninvasive ventilation failure using the ROX index in patients with de novo acute respiratory failure.

BACKGROUND: The ratio of SpO2/FiO2 to respiratory rate (ROX) index is commonly used to predict the failure of high-flow nasal cannula. However, its predictive power for noninvasive ventilation (NIV) failure is unclear. METHODS: This was a secondary analysis of a multicenter prospective observational study, intended to update risk scoring. Patients with de novo acute respiratory failure were enrolled, but hypercapnic patients were excluded. The ROX index was calculated before treatment and after 1-2, 12, and 24 h NIV. Differences in predictive power for NIV failure using the ROX index, PaO2/FiO2, and PaO2/FiO2/respiratory rate were tested. RESULTS: A total of 1286 patients with de novo acute respiratory failure were enrolled. Of these, 568 (44%) experienced NIV failure. Patients with NIV failure had a lower ROX index than those with NIV success. The rates of NIV failure were 92.3%, 70.5%, 55.3%, 41.1%, 35.1%, and 29.5% in patients with ROX index values calculated before NIV of ≤ 2, 2-4, 4-6, 6-8, 8-10, and > 10, respectively. Similar results were found when the ROX index was assessed after 1-2, 12, and 24 h NIV. The area under the receiver operating characteristics curve was 0.64 (95% CI 0.61-0.67) when the ROX index was used to predict NIV failure before NIV. It increased to 0.71 (95% CI 0.68-0.74), 0.74 (0.71-0.77), and 0.77 (0.74-0.80) after 1-2, 12, and 24 h NIV, respectively. The predictive power for NIV failure was similar for the ROX index and for the PaO2/FiO2. Likewise, no difference was found between the ROX index and the PaO2/FiO2/respiratory rate, except at the time point of 1-2 h NIV. CONCLUSIONS: The ROX index has moderate predictive power for NIV failure in patients with de novo acute respiratory failure.

Application of glucagon-like peptide-1 receptor antagonists in fibrotic diseases.

Fibrosis can occur in various organs, leading to structural destruction, dysfunction, and even organ failure. Hence, organ fibrosis is being actively researched worldwide. Glucagon-like peptide-1 (GLP-1), a naturally occurring hormone, binds to a G-protein-coupled receptor widely distributed in the pancreas, kidney, lung, heart, gastrointestinal tract, and other organs. Synthetic GLP-1 analogs can be used as GLP-1 receptor agonists (GLP-1RAs) for treating diabetes mellitus. In recent years, GLP-1RAs have also been found to exert anti-inflammatory, antioxidant, and cardiovascular protective effects. GLP-1RAs have also been shown to inhibit fibrosis of solid organs, such as the lung, heart, liver, and kidney. In this review, we discuss the advancements in research on the role of GLP-1RAs in the fibrosis of the heart, lung, liver, kidney, and other organs to obtain new clues for treating organ fibrosis.

Resveratrol: Potential Application in Sepsis.

Sepsis is a life-threatening organ dysfunction syndrome caused by host response disorders due to infection or infectious factors and is a common complication of patients with clinical trauma, burns, and infection. Resveratrol is a natural polyphenol compound that is a SIRT-1 activator with anti-inflammatory, antiviral, antibacterial, antifungal inhibitory abilities as well as cardiovascular and anti-tumor protective effects. In recent years, some scholars have applied resveratrol in animal models of sepsis and found that it has an organ protective effect and can improve the survival time and reduce the mortality of animals with sepsis. In this study, Medline (Pubmed), embase, and other databases were searched to retrieve literature published in 2021 using the keywords "resveratrol" and "sepsis," and then the potential of resveratrol for the treatment of sepsis was reviewed and prospected to provide some basis for future clinical research.

Optimization of Early Antimicrobial Strategies for Lung Transplant Recipients Based on Metagenomic Next-Generation Sequencing.

The management of perioperative antibiotic options after lung transplantation varies widely around the world, but there is a common trend to limit antibiotic use duration. Metagenomic next-generation sequencing (mNGS) has become a hot spot in clinical pathogen detection due to its precise, rapid, and wide detection spectrum of pathogens. Thus, we defined a new antibiotic regimen adjustment strategy in the very early stage (within 7 days) after lung transplantation mainly depending on mNGS reports combined with clinical conditions to reduce the use of antibiotics. To verify the clinical effect of the strategy, we carried out this research. Thirty patients who underwent lung transplantation were finally included, whose information including etiology, antibiotic adjustment, and the effect of our strategy was recorded. Lung transplant recipients in this study were prescribed with initial antibiotic regimen immediately after surgery; their antibiotic regimens were adjusted according to the strategy. According to our study, the entire effectiveness of the strategy was 90.0% (27/30). Besides, a total of 86 samples containing donor lung tissue, recipient lung tissue, and bronchoalveolar lavage fluid (BALF) were obtained in this study; they were all sent to mNGS test, while BALF was also sent to pathogen culture. Their results showed that the positive rate of BALF samples was higher (86.67%) than that of donor's lung tissue (20.0%) or recipient's lung tissue (13.33%) by mNGS test, indicating BALF samples are more valuable than other clinical samples from early postoperative period to guide the early adjustment of antibiotics after lung transplantation. It is effective for mNGS combined with traditional methods and clinical situations to optimize antibiotic regimens in lung transplantation recipients within 7 days after surgery.

Association between ARDS Etiology and Risk of Noninvasive Ventilation Failure.

Rationale: The etiology of acute respiratory distress syndrome (ARDS) may play an important role in the failure of noninvasive ventilation (NIV). Objectives: To explore the association between ARDS etiology and risk of NIV failure. Methods: A multicenter prospective observational study was performed in 17 intensive care units in China from September 2017 to December 2019. Patients with ARDS who used NIV as a first-line therapy were enrolled. The etiology of ARDS was recorded at study entry. Results: A total of 306 patients were enrolled. Of the patients, 146 were classified as having pulmonary ARDS (ARDSp) and 160 were classified as having extrapulmonary ARDS (ARDSexp). From initiation to 24 hours of NIV, the respiratory rate, heart rate, arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2), and arterial carbon dioxide pressure improved slower in patients with ARDSp than those with ARDSexp. Patients with ARDSp experienced more NIV failure (55% vs. 28%; P < 0.01) and higher 28-day mortality (47% vs. 14%; P < 0.01). The adjusted odds ratios of NIV failure and 28-day mortality were 5.47 (95% confidence interval [CI], 3.04-9.86) and 10.13 (95% CI, 5.01-20.46), respectively. In addition, we combined the presence of ARDSp, presence of septic shock, age, nonpulmonary sequential organ failure assessment score, respiratory rate at 1-2 hours of NIV, and PaO2/FiO2 at 1-2 h of NIV to develop a risk score of NIV failure. With the increase of the risk score, the rate of NIV failure increased. The area under the curve of the receiver operating characteristic was 0.84 (95% CI, 0.79-0.89) and 0.81 (0.69-0.92) in the training and validation cohorts, respectively. Using 5.5 as cutoff value to predict NIV failure, the sensitivity and specificity was good. Conclusions: Among patients with ARDS who used NIV as a first-line therapy, ARDSp was associated with slower improvement, more NIV failure, and higher 28-day mortality than ARDSexp. The risk score combined presence of ARDSp, presence of septic shock, age, nonpulmonary sequential organ failure assessment score, respiratory rate at 1-2 hours of NIV, and PaO2/FiO2 at 1-2 hours of NIV has high accuracy to predict NIV failure among ARDS population.

GLP-1 Receptor: A New Target for Sepsis.

Patients with sepsis often exhibit hyperglycemia, which increases mortality. glucagon-like peptide-1 receptor agonists (GLP-1RAs) not only regulate blood glucose homeostasis but also improve organ dysfunction, regulate immunity, and control inflammation and other functions in patients with sepsis. Here, we review the possible application of GLP-1RAs in sepsis, to provide a new perspective for the clinical diagnosis and treatment of patients with sepsis complicated with stress hyperglycemia.

Electrical Impedance Tomography Predicts Weaning Success in Adult Patients With Delayed Upper Abdominal Surgery: A Single-Center Retrospective Study.

Objective: To evaluate the predictive value of electrical impedance tomography (EIT) in patients with delayed ventilator withdrawal after upper abdominal surgery. Methods: We retrospectively analyzed data of patients who were ventilated >24 h after upper abdominal surgery between January 2018 and August 2019. The patients were divided into successful (group S) and failed (group F) weaning groups. EIT recordings were obtained at 0, 5, 15, and 30 min of spontaneous breathing trials (SBTs) with SBT at 0 min set as baseline. We assessed the change in delta end-expiratory lung impedance and tidal volume ratio (ΔEELI/VT) from baseline, the change in compliance change percentage variation (|Δ(CW-CL)|) from baseline, the standard deviation of regional ventilation delay index (RVDSD), and global inhomogeneity (GI) using generalized estimation equation analyses. Receiver operating characteristic curve analyses were performed to evaluate the predictive value of parameters indicating weaning success. Results: Among the 32 included patients, ventilation weaning was successful in 23 patients but failed in nine. Generalized estimation equation analysis showed that compared with group F, the ΔEELI/VT was lower, and the GI, RVDSD, and (|Δ(CW-CL)|) were higher in group S. For predicting withdrawal failure, the areas under the curve of the ΔEELI/VT, (|Δ(CW-CL)|), and the RVDSD were 0.819, 0.918, and 0.918, and 0.816, 0.884, and 0.918 at 15 and 30 min during the SBTs, respectively. Conclusion: The electrical impedance tomography may predict the success rate of ventilator weaning in patients with delayed ventilator withdrawal after upper abdominal surgery.

Hydrogen: Potential Applications in Solid Organ Transplantation.

Ischemia reperfusion injury (IRI) in organ transplantation has always been an important hotspot in organ protection. Hydrogen, as an antioxidant, has been shown to have anti-inflammatory, antioxidant, and antiapoptotic effects. In this paper, the protective effect of hydrogen against IRI in organ transplantation has been reviewed to provide clues for future clinical studies.

Clinical Symptoms and Outcomes of Severe Pneumonia Caused by Chlamydia psittaci in Southwest China.

Here, we aimed to retrospectively analyze the clinical characteristics of 27 patients with severe pneumonia caused by Chlamydia psittaci between January 2019 and April 2021 in southwest China. To this end, we collected data on the exposure history, clinical symptoms, laboratory examination, imaging characteristics, evolution, etiology, treatment, and outcomes to suggest a better diagnosis and prevention system. Our results showed that a metagenomic next-generation sequencing test could provide early diagnosis. All patients were sensitive to quinolones and tetracyclines, and the recovery rate was relatively high. Overall, all patients were in critical condition with moderate to severe acute respiratory distress syndrome and shock. In conclusion, early diagnosis of pneumonia caused by C. psittaci depends on effective molecular testing, and most patients recover after treatment.

Hydrogen: A Potential New Adjuvant Therapy for COVID-19 Patients.

Hydrogen has been shown to have antioxidant, anti-inflammatory, hormone-regulating, and apoptosis-resistance properties, among others. Based on a review of the research, the use of hydrogen might reduce the destructive cytokine storm and lung injury caused by SARS-CoV-2 during COVID-19 (Corona Virus Disease 2019) in the early stage, stimulating ropy sputum drainage, and ultimately reducing the incidence of severe disease. Molecular hydrogen treatment has the potential to become a new adjuvant therapy for COVID-19, but its efficacy and safety require large clinical trials and further confirmation.