[Study of hospitalization risk indicators for intensive care unit patients evaluated by intelligent calculation method].

OBJECTIVE: To explore the characteristics of the changes in risk score for intensive care unit (ICU) patients during hospitalization by the intelligent calculation method, and to provide evidence for the risk prevention. METHODS: In this retrospective study, ICU patients of the Fifth Central Hospital in Tianjin from November 3, 2021 to March 28, 2022 were enrolled and divided into ≥ 14 days group, 10-13 days group, 7-9 days group, and 3-6 days group according to the ICU length of stay. Risk scores assessed by the intelligent calculation method of the ICU patients were collected, including nutritional risk screening 2002 (NRS 2002), Caprini score and Padua score. NRS 2002 score for all patients, Caprini score for surgical patients and Padua score for internal medicine patients were selected. Trends in change of each score were compared between patients admitted to ICU 1, 3, 7 (if necessary), 10 (if necessary), and 14 days (if necessary). RESULTS: A total of 138 patients were involved, including 79 males and 59 females, with an average age of (61.71±18.86) years and an average hospital stay of [6.00 (4.00, 9.25)] days. (1) in the group with ICU length of stay ≥ 14 days (21 cases): there was no significant change in the NRS 2002 scores of the patients within 10 days, but the NRS 2002 score was significantly decreased in 14 days as compared with 1 day [3.00 (2.50, 3.50) vs. 4.00 (3.00, 5.00), P < 0.05]; both Caprini and Padua score were increased with prolonged hospital stay and compared with 1 day, the scores at the other time points were significantly increased, especially at 14 days [Caprini score: 5.00 (3.25,7.00) vs. 2.50 (1.25, 5.50), Padua score: 6.00 (6.00, 7.00) vs. 3.00 (1.00, 3.00), both P < 0.05]. (2) in the group with ICU length of stay from 10-13 days (15 cases): with the prolonged hospital stay, there was no significant change in NRS 2002 score, but both Caprini and Padua score were increased at 3, 7, 10 days, especially at 10 days [Caprini score: 3.00 (2.00, 4.75) vs. 2.00 (0.25, 2.75), Padua score: 5.00 (3.50, 6.00) vs. 2.00 (0.50, 4.00), both P < 0.05]. (3) in the group with ICU length of stay from 7-9 days (23 cases): compared with 1 day, the NRS 2002 score at 3 days and7 days were decreased, but the Caprini and Padua score were increased, especially at 7 days [NRS 2002 score: 2.00 (1.00, 4.00) vs. 2.00 (2.00, 4.00), Caprini score: 3.00 (2.00, 5.50) vs. 2.00 (0.25, 3.00), Padua score: 5.00 (4.00, 6.00) vs. 2.00 (0,2.00),all P < 0.05]. (4) in the group with ICU length of stay from 3-6 days (79 cases): compared with 1 day, the NRS 2002 score at 3 days was decreased [NRS 2002 score: 2.00 (1.00, 3.00) vs. 2.00 (1.00, 3.00), P < 0.05], Caprini and Padua score were significantly increased [Caprini score: 3.00 (2.00, 4.00) vs. 2.00 (1.00, 3.00), Padua score: 5.00 (4.00, 5.00) vs. 2.00 (1.00, 3.00), both P < 0.05]. CONCLUSIONS: Based on dynamic assessment of intelligent calculation methods, the risk of thrombosis in ICU patients increased with hospital length of stay, and the nutritional risk was generally flat or reducing in different hospitalization periods.

[A clinical study on the determination of cuff pressure in artificial airway by minimum air leakage method].

OBJECTIVE: To compare the cuff pressure and leakage volume and the related complications of filling the tracheal tube cuff by minimum air leakage method and cuff pressure manometer method after endotracheal intubation, so as to provide theoretical basis for patients who was intubated to obtain appropriate cuff pressure. METHODS: A prospective randomized controlled study was conducted. 100 patients admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from December 2015 to June 2019 were enrolled. According to the random number table method, the patients were divided into the experimental group and control group, with 50 patients in each group. After successful endotracheal intubation, all patients were placed in a supine position with the head of the bed raised by 30 degree angle. The experimental group used the minimum air leakage method, and used the cuff pressure manometer to obtain the cuff pressure. In the control group, cuff pressure was maintained at 25-30 cmH2O (1 cmH2O = 0.098 kPa). Parameters such as cuff pressure and ventilator leakage volume at the beginning and 4 hours, 8 hours after the inflation were compared between the two groups, as well as the incidence of ventilation-associated pneumonia (VAP) and airway complications after extubation. RESULTS: Among the 100 cases, 53 were males and 47 were females. The age ranged from 23 to 87 years old, with an average of (68.53±8.46) years old. The intubation time ranged from 1 to 16 days. (1) At 4 hours and 8 hours after inflation, the cuff pressures of the two groups were lower than that of the first time of inflation, and the air leakage of the ventilator increased gradually with the extension of time. Compared with the control group, cuff pressures at each time point in the experimental group were significantly higher than those in the control group [mmHg (1 mmHg = 0.133 kPa): 33.72±9.14 vs. 25.68±5.26 at 0 hour, 30.54±7.81 vs. 24.35±4.93 at 4 hours, 26.57±5.64 vs. 22.42±4.14 at 8 hours, all P < 0.05], and ventilator leakage volumes were smaller than those in the control group (mL: 25.57±8.51 vs. 34.65±9.47 at 0 hour, 40.54±8.51 vs. 60.34±7.85 at 4 hours, both P < 0.05). (2) The incidence of VAP in the experimental group was significantly lower than that in the control group (4% vs. 10%, P < 0.05). There was no statistically significant difference in the incidence of other airway complications between the experimental group and control group (airway mucosal edema: 14% vs. 12%, ulcer: 8% vs. 6%, tracheal esophageal fistula: 0% vs. 0%, hoarseness: 4% vs. 6%, cough: 30% vs. 34%, sore throat: 28% vs. 32%, tracheal softening: 0% vs. 0%, cuff rupture: 10% vs. 8%, all P > 0.05). CONCLUSIONS: The optimal cuff pressure is very important for preventing VAP and reducing airway complications. The minimum air leakage method makes the clinical obtained endotracheal intubation cuff pressure more accurately, with less air leakage, safe and effective, and it is worthy of clinical promotion.

[Comparison of pulmonary circulation hemodynamics and respiratory mechanics induced by drowning with equal volume of freshwater and seawater in sheep: a randomized controlled study].

OBJECTIVE: To compare the effects of freshwater and seawater drowning on sheep's pulmonary circulation hemodynamics and respiratory mechanics. METHODS: According to the random number table method, healthy crossbred sheep were divided into freshwater drowning group (n = 12) and seawater drowning group (n = 12). 30 mL/kg of freshwater or seawater was infused respectively through trachea for approximately 5 minutes. Before the drowning, immediately after drowning, and 30, 60, 120 minutes after drowning, the systemic circulation hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), cardiac output (CO)] were monitored by pulse indicator continuous cardiac output (PiCCO); the respiratory parameters were obtained through the ventilator, including tidal volume (VT), lung compliance (Cdyn), oxygenation index (PaO2/FiO2), peak airway pressure (Ppeak)]; PiCCO and the right heart floating catheter (Swan-Ganz catheter) was used to measure pulmonary hemodynamic parameters [pulmonary systolic pressure (PAS), pulmonary diastolic pressure (PAD), pulmonary artery wedge pressure (PAWP), and extravascular lung water (EVLW)]. The animals were sacrificed at the end of the experiment, and the amount of residual water in the respiratory tract was measured; the pathological changes in the lung tissue were observed by hematoxylin-eosin (HE) staining. RESULTS: (1) Systemic circulation hemodynamics: compared with the values before drowning, HR, MAP, and CO at the time of immediately after drowning in both freshwater and seawater were significantly increased and peaked. In addition, all indicators in the freshwater drowning group were significantly higher than those in the seawater drowning group [HR (bpm): 170.75±1.87 vs. 168.67±2.27, MAP (mmHg, 1 mmHg = 0.133 kPa): 172.92±1.62 vs. 159.42±3.18, CO (L/min): 13.27±0.71 vs. 10.33±0.73, all P < 0.05]. (2) Respiratory parameters: compared with values before drowning, PaO2/FiO2, VT, and Cdyn decreased immediately in both freshwater and seawater drowning groups, Ppeak was significantly increased; in addition, the values in the seawater drowning group were decreased or increased more significantly than freshwater drowning group [PaO2/FiO2 (mmHg): 37.83±1.99 vs. 60.42±5.23, VT (mL): 86.25±7.66 vs. 278.75±9.67, Cdyn (mL/cmH2O): 8.86±0.33 vs. 23.02±0.69, Ppeak (cmH2O, 1 cmH2O = 0.098 kPa): 42.17±2.69 vs. 17.67±1.15, all P < 0.01]. In addition, PaO2/FiO2 in the freshwater drowning group was gradually increased over time, while the seawater group continued to decline. (3) Pulmonary circulation hemodynamic parameters: PAS, PAD, PAWP at the time of immediately after drowning in both freshwater and seawater groups were significantly higher than before drowning; in addition, the freshwater drowning group was significantly higher than the seawater drowning group [PAS (mmHg): 34.58±2.87 vs. 26.75±1.66, PAD (mmHg): 27.25±1.22 vs. 16.75±0.87, PAWP (mmHg): 27.83±1.85 vs. 11.75±1.82, all P < 0.01]. Thereafter, PAS and PAD in the freshwater drowning group gradually decreased, while the parameters in the seawater drown group continued to increase. PAWP gradually decreased after freshwater or seawater drowning, and recovered to pre-drowning levels 120 minutes after drowning and 30 minutes after drowning, respectively. EVLW continued to increase after freshwater drowning, reaching a peak at 30 minutes, and then decreased, until 120 minutes after drowning was still significantly higher than that before drowning (mL/kg: 10.73±1.27 vs. 7.67±0.69, P < 0.01); EVLW could not be measured. (4) Residual water in the respiratory tract: residual water in the freshwater drowning group was significantly less than that in the seawater drowning group (mL: 164.33±25.21 vs. 557.33±45.23, P < 0.01). (5) HE staining: partial alveolar atrophied in the freshwater drowning group, some alveolar spaces were broken, alveolar spaces and alveolar cavity showed a little powdery substance deposition; it was noted that alveolar expanded in the seawater drowning group, alveolar spaces were broken and bleeding and edema were obvious in the interstitial space. CONCLUSIONS: The effect of seawater drowning on the respiratory mechanics and pulmonary circulation of animals is more obvious than that of freshwater drowned animals, and the amount of residual water in the respiratory tract is also significantly more than that of freshwater drowned animals.

[Systemic pathologic physiology parameters changes in sheep drowning: a control study in freshwater and seawater].

OBJECTIVE: To compare the systemic pathologic physiology parameter changes in sheep drowning in freshwater and seawater. METHODS: The experimental animals were healthy crossbred sheep. According to the envelope method, 24 sheep were randomly divided into two groups, with 12 animals in each group. The animals in both groups were subjected to mechanical ventilation and analgesia and sedation, the drowning models were reproduced by injecting 10-25 mL/kg of seawater or freshwater into the endotracheal tube of animals. The changes in hemodynamics before drowning, immediately after drowning (immediately after water injection) and 30, 60, and 120 minutes after drowning in both groups were recorded. The urine color changes after drowning and occurrence time were recorded. The animals were sacrificed at 120 minutes after drowning, and heart, kidney, liver, spleen and intestine were harvested for pathological observation under light microscope using hematoxylin and eosin (HE) staining. RESULTS: (1) The changes in systemic hemodynamic: there was no significant difference in hemodynamics before drowning between the two groups. Compared with before drowning, heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), left ventricular maximum systolic force index (dPmax), and pulmonary wedge pressure (PAWP) immediately after drowning in both seawater and freshwater groups were significantly increased, which showed a decrease tendency with drowning time prolongation. Compared with drowning immediately, dPmax at 30 minutes after freshwater drowning was significantly decreased (mmHg/s: 919.83±14.51 vs. 2 628.42±59.75, P < 0.01), which was below the level before drowning till 120 minutes. CO at 30 minutes after freshwater drowning was retreated as compared with drowning immediately, but it was still higher than that before drowning (L/min: 8.25±0.66 vs. 5.75±0.73, P < 0.01). Global end-diastolic volume (GEDV) and PAWP at 120 minutes after freshwater drowning were decreased to the level before drowning [GEDV (mL): 642.92±7.29 vs. 638.25±7.00, PAWP (mmHg, 1 mmHg = 0.133 kPa): 5.83±1.19 vs. 5.42±1.08, both P > 0.05]. Compared with immediately after drowning, MAP, CO and PAWP at 30 minutes after seawater drowning were significantly lowered [MAP (mmHg): 90.50±3.58 vs. 159.42±3.18, CO (L/min): 2.37±0.45 vs. 10.33±0.73, PAWP (mmHg): 4.17±0.72 vs. 11.75±1.82, all P < 0.01], which were lower than those before drowning till 120 minutes. After drowning for 30 minutes, MAP, CO and PAWP in seawater group were significantly lower than those in freshwater group [MAP (mmHg): 90.50±3.58 vs. 117.42±1.78, CO (L/min): 2.37±0.45 vs. 8.25±0.66, PAWP (mmHg): 4.17±0.72 vs. 24.83±1.27], dPmax was significantly increased (mmHg/s: 1 251.42±62.50 vs. 919.83±14.51, all P < 0.01), and the tendency continued till 120 minutes. There was no significant difference in HR at all the time points between the two groups. (2) The changes in urine: after freshwater drowning, the animals had hemoglobinuria and lasted until the end of the experiment, and the time of hemoglobinuria occurrence was at 20-35 minutes after drowning with an average of (25.30±5.15) minutes. After seawater drowning, the change in urine was not found until the end of the experiment. (3) The variations of each organ tissue in pathology and hematology at 120 minutes after drowning: after freshwater drowning, the systemic tissue edema was found in organs such as heart, kidney, liver, spleen, and small intestine. After seawater drowning, there were different degrees of edema in the systemic organs, and some of them shrank. CONCLUSIONS: After freshwater drowning, the animals showed decreased dPmax, increased CO and blood volume, edema and hemolysis of the tissue cells. After seawater drowning, CO and blood volume decreased, and some tissue cells were in atrophy.

[The influence of joining central venous catheter and pressure transducer with T-junctions on central venous pressure].

OBJECTIVE: To investigate the influence of the number of T-junctions between central venous catheter and pressure transducer on measurement of central venous pressure ( CVP ) in patients. METHODS: A prospective controlled study was conducted. The patients with CVP monitoring in Department of Critical Care Medicine of the Fifth Center Hospital in Tianjin from February to October in 2014 were enrolled. The patients were divided into three groups according to the number of T-junction between central venous catheter and pressure transducer: without T-junction control group and 1, 2, 3 T-junctions groups. In each patient, corresponding CVP values with different number of T-junctions placed between the central venous catheter and pressure sensors were determined within a certain period, and a square-wave graphic was obtained and preserved on the monitor. The own frequency ( fn ) and the attenuation coefficient ( D ) of the system of pressure measurement were calculated after measurement of the shock wave following a square-wave to obtain the distance between two vibrations and the amplitude of the shock wave. The difference in CVP, fn and D were compared among the groups. RESULTS: A total of 20 cases were enrolled, and 150 groups of data were collected. (1) With the increase in the number of T-junction, CVP showed a tendency of gradual reduction. The CVP of the groups of control and 1, 2, 3 T-junctions was ( 7.00±1.60 ), ( 7.00±3.00 ), ( 5.00±2.00 ), and ( 4.00±1.00 ) mmHg ( 1 mmHg = 0.133 kPa ), respectively. The CVP of 3 T-junctions group was significantly lower than that of the control group ( F = 9.333, P = 0.015 ). (2) With an increase in the number of T-junction, fn showed a tendency of gradual increase. The fn of groups control and 1, 2, 3 T-junctions was ( 12.30±0.79 ), ( 16.00±0.91 ), ( 18.10±1.75 ), ( 20.90±2.69 ) Hz, respectively. The fn of 1, 2, 3 T-junctions group was significantly higher than that of the control group ( F1 = 45.962, F2 = 45.414, F3 = 46.830, all P = 0.000 ); the fn of groups 2 and 3 T-junctions was significantly higher than that of 1 T-junction group ( F1= 5.827, P1= 0.042; F2 = 15.038, P2 = 0.004 ), but there was no significant difference between the groups of 2 T-junctions and 3 T-junctions ( F = 3.800, P = 0.087 ). (3) With an increase of the number of T-junction, D also showed a tendency of gradual increase. The D of 1, 2, 3 T-junction group was 1.62±0.27, 1.60±0.22, 1.82±0.25, and 2.15±0.58, respectively. There were no differences among four groups. CONCLUSIONS: After the application of T-junctions between central venous catheter and pressure transducer, CVP values will be underestimated, the reason of which is considered to be the increase in length and thinner lumen of the T-junctions.

The effects of differential injection sites of cold saline on transpulmonary thermodilution parameter values.

AIM: To investigate the effects of differential sites for cold saline injection on transpulmonary thermodilution parameter values. METHODS: This was a prospective study. Twelve patients were recruited for the following examinations: control condition (injection site at proximal injection end of the Swan-Ganz catheter), proximal end condition (injection site at sheath of the Swan-Ganz catheter), and distal end condition (injection site at PA end of the Swan-Ganz catheter). Sixty measurements were performed for each condition. The cardiac index, global end diastolic volume index (GEDI), and extravascular lung water index for the three different injection sites were recorded from each patient. In addition, the mean transmission time (MTt), downslope time, and area under the curve obtained from PiCCO-VoLEF-Win software were compared among different groups. RESULTS: There were no differences in cardiac index and extravascular lung water index values among the three conditions (P>0.05). There were no differences in GEDI between the proximal end condition and control condition (P>0.05), while the GEDI was significantly lower for the distal end condition (493.33±254.65 mL/m(2)) than for the control condition (645.53±234.46 mL/m(2)) (P<0.05) and proximal end condition (717.96±321.63 mL/m(2)) (P<0.01). There were no differences in downslope time and area under the curve among the three conditions (P>0.05). There were no differences in MTt between the proximal end condition and control condition (P>0.05), while the MTt was significantly lower for distal end condition (40.22±16.37 seconds) than for the control condition (42.91±17.93 seconds) (P<0.05) and proximal end condition (47.16±16.64 seconds) (P<0.01). CONCLUSION: The differential sites for cold saline injection impacted transpulmonary thermodilution parameter values.

[Effect of unilateral lung recruitment maneuver on hemodynamics and dead space ratio in pigs with unilateral acute respiratory distress syndrome].

OBJECTIVE: To compare unilateral lung and traditional lung recruitment maneuver (RM) in animals with unilateral acute respiratory distress syndrome (ARDS) by implementing independent lung ventilation, and to explore the rational mechanical ventilation strategy for unilateral lung lesions. METHODS: Healthy hybrid pigs were used as experimental animals, and they were divided into two groups according to random number table method (sealed concealed envelope). There were 20 pigs in each group. According to different methods of lung RM, the conventional mechanical ventilation (i.e. implementing ventilation for both lung by using a ventilator) was performed as control group; the individual lung ventilation (that was, implementing ventilation for both lung individually by using two ventilators) as independent lung ventilation group. The model of left lung ARDS was reproduced, and the respective RM was implemented according to respective method of the two groups. The differences in hemodynamic parameters and dead space ratio (VD/VT) between two groups under the RM pressure of 20, 40, 60 cmH2O (1 cmH2O=0.098 kPa) were observed. RESULTS: (1) Hemodynamics parameters changes: with the increase in RM pressure, the heart rate (HR) in control group showed a tendency of gradual increase, and the level at 60 cmH2O was significantly higher than that at 20 cmH2O (192.65 ± 22.99 bpm vs. 178.20 ± 18.25 bpm, P<0.05). Mean arterial pressure (MAP) showed a tendency of gradual decrease, and that at 60 cmH2O was lower significantly than that at 20 cmH2O and 40 cmH2O (78.55±25.77 mmHg (1 mmHg=0.133 kPa) vs. 112.40 ± 10.84 mmHg, 106.15 ± 13.54 mmHg, both P<0.01). Cardiac output (CO) gradually lowered, and the differences at 20, 40, 60 cmH2O were logistically significant (11.14 ± 2.65 L/min, 9.56 ± 2.17 L/min, 6.01 ± 1.39 L/min, P<0.05 or P<0.01). With an increase in RM pressure, the difference in HR, MAP, CO in independent lung ventilation group were not significant, and the HR at 60 cmH2O was significantly lower than that of the control group (178.20 ± 18.26 bpm vs. 192.65 ± 22.99 bpm, P<0.05), and MAP and CO were significantly higher than those of the control group (MAP: 110.80 ± 11.60 mmHg vs. 78.55 ± 25.77 mmHg, CO: 9.68 ± 2.08 L/min vs. 6.01 ± 1.39 L/min, both P<0.01). (2) VD/VT changes: with an increase in RM pressure, the oxygenation index (PaO2/FiO2) in control group showed a tendency of gradual decrease, and the level at 60 cmH2O was significantly lower than that at 20 cmH2O and 40 cmH2O (126.40 ± 37.55 mmHg vs. 187.40 ± 21.66 mmHg, 175.20 ± 23.00 mmHg, both P<0.01). On the right side, VD/VT showed a tendency of gradual increase, and there was statistical significance in paired comparison among 20, 40, 60 cmH2O (0.52 ± 0.12, 0.60 ± 0.15, 0.72 ± 0.12, P<0.05 or P<0.01). There was no obvious change on the left side. Along with the increase in RM pressure, the PaO2/FiO2 of independent lung ventilation group showed a tendency of gradual increase, and that at 40 cmH2O and 60 cmH2O were significantly higher than that at 20 cmH2O (244.45 ± 53.93 mmHg, 270.05 ± 53.42 mmHg vs. 205.65 ± 31.33 mmHg, P<0.05 and P<0.01), and the level at 20, 40, 60 cmH2O was higher than that of the control group (205.65±31.33 vs. 187.40 ± 21.66, P<0.05; 244.45 ± 53.93 vs. 175.20 ± 23.00, P<0.01; 270.05 ± 53.42 vs. 126.40 ± 37.55, P<0.01). There were no changes in VD/VT on both sides, and VD/VT on the right side was significantly lower than that of the control group when the inflation pressure was 20, 40, 60 cmH2O (0.38 ± 0.14 vs. 0.52 ± 0.12, 0.43 ± 0.11 vs. 0.60 ± 0.15, 0.50 ± 0.13 vs. 0.72 ± 0.12, all P<0.01). CONCLUSIONS: For severe ARDS caused by single lung injury, implementation of independent lung RM on the basis of independent lung mechanical ventilation for individual lung was significantly superior to the traditional lung RM for the improvement of hemodynamic parameters and VD/VT.