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1.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 1033-1036, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537234

RESUMO

OBJECTIVE: To study the risk factors and the clinical characteristics of non-tuberculous mycobacterial (NTM) pulmonary diseases in patients with mechanical ventilation. METHODS: Retrospective survey was carried out in the patients with mechanical ventilation who combined with NTM pulmonary disease admitted to intensive care unit (ICU) of the First Affiliated Hospital of Guangzhou Medical University from May 2016 to May 2019. The general information, basic diseases, symptoms, signs, biochemical examinations, acid-fast stain test, mycobacterium culture and strain identification results, and chest CT data were collected to summarize the clinical characteristics of patients with mechanical ventilation combined with NTM pulmonary disease. RESULTS: There were 12 patients with mechanical ventilation combined with NTM pulmonary disease, 6 males and 6 females, 37-82 years old, with an average age of 65 years. In these 12 cases, patients with cancer (lung cancer were 4 cases, mediastinal tumor was 1 case) and after lung transplantation (use of anti-rejection drugs at the same time) were 5 and 2 respectively. Patients with at least 3 underlying diseases [included hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), bronchiectasis, chronic renal insufficiency] were 5. Clinical symptoms of the 12 cases were non-specific. The CT findings were not characteristic, including nodules, patchy infiltrations and fibrous streak. Pleural effusion was common among these subjects but nodular bronchiectatic patterns were absence. Routine laboratory indicators of bacterial infection were non-specific. But the number of lymphocytes of all cases decreased. Mycobacteria cultures were positive with the rapid growth of mycobacteria in these 12 cases. Mycobacterium avium (4 cases), Mycobacterium chelonae (4 cases), Mycobacterium chelonae-abscessus complex (2 cases) and Mycobacterium intracellulare (2 cases) were isolated. Anti-NTM therapy was given to the patients when the acid-fast staining test of their airway secretion was positive and the TB-DNA test was negative, including oral levofloxacin and clarithromycin. Finally, all patients were successfully weaned and discharged from ICU. CONCLUSIONS: The clinical symptoms of NTM patients with pulmonary disease are non-specific, and the imaging features of chest CT are varied. Patients with mechanical ventilation in ICU, who have the risk of immune dysfunction or underlying structural lung diseases, and who have difficult controlled lung infection, accompanied by pleural effusion and with decreased lymphocytes, should be aware that pneumonia may be caused by non-tuberculous mycobacteria.

2.
J Thorac Dis ; 10(7): 4424-4432, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30174891

RESUMO

Background: Weaning from mechanical ventilation (MV) is an important and universal issue in critically ill patients, with no consensus that predicts weaning success. Twitch tracheal airway pressure (TwPtr) may be a more objective indicator of diaphragm function. The present study evaluated TwPtr relative to negative inspiratory force (NIF) or Medical Research Council (MRC) score, for predicting success of weaning from MV. Methods: From December 2015 to March 2017, 62 patients were included who received invasive MV >48 hours and then underwent a test for spontaneous breathing. The NIF and MRC score were sequentially determined. The TwPtr measurement was performed via magnetic stimulation of the neck phrenic nerve. Results: Weaning success was achieved by 54 patients (87.1%), including 30, 12, and 12 patients who experienced simple, difficult, and prolonged weaning, respectively. The areas under receiver operating characteristic curves (AUCs) for NIF, MRC score, and TwPtr were 0.778, 0.560, and 0.792. When TwPtr was combined with NIF, the sensitivity and specificity of weaning success were 96.3% and 75.0%, and AUC was 0.807. In the weaning success group, after correction for age, the AUC of TwPtr was 0.878, which differentiated the simple weaning from non-simple group. Conclusions: TwPtr was superior to either NIF or MRC score for differentiating patients in the simple weaning group from those patients who experienced difficult, prolonged, or failed weaning. TwPtr combined with NIF may be used to predict weaning success better than the MRC score alone.

3.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 30(7): 671-676, 2018 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-30045796

RESUMO

OBJECTIVE: To investigate the cause of massive hemoptysis in critical patients, and to evaluate the effect of bronchial artery embolization (BAE) on critical patients with massive hemoptysis. METHODS: A retrospective controlled analysis was conducted. The clinical data of 35 patients with life-threatening massive hemoptysis admitted to intensive care unit (ICU) of the First Hospital Affiliated to Guangzhou Medical University from January 2009 to December 2017 were analyzed. The patients were divided into BAE and non-BAE group according to whether receiving BAE or not. BAE patients were subdivided into subgroups: hemoptysis after ventilation and hemoptysis before ventilation subgroups, as well as survival and non-survival subgroups. The etiology of all massive hemoptysis was analyzed. The gender, age, acute physiology and chronic health evaluation II (APACHE II) score, amount of hemoptysis, whether presence of pleural thickening in chest CT, the length of ICU stay, total length of hospital stay, the duration of mechanical ventilation (MV), clinical effective and prognostic indicators of patients were recorded. The correlation between variables was analyzed by Spearman correlation analysis. RESULTS: All 35 patients were enrolled in the finally analysis. The main cause of critical patients with massive hemoptysis was fungal infection [37.1% (13/35)], followed by pneumonia and abnormal coagulation [17.1% (6/35)], bronchiectasis [11.4% (4/35)], tumor [8.6% (3/35)], etc. In all 35 patients, 27 were treated with BAE and 8 were treated without BAE. There was no difference in gender, age, the length of ICU stay, total length of hospital stay, the duration of MV, amount of hemoptysis, APACHE II score, whether use antiplatelet agents or anticoagulants, or whether presence of pleural thickening in chest CT between the two groups. The rate of hemoptysis remission in BAE group was significantly higher than that of non-BAE group [92.6% (25/27) vs. 25.0% (2/8), P < 0.01], but there was no statistically significant difference in hospital survival as compared with that of non-BAE group [48.1% (13/27) vs. 25.0% (2/8), P > 0.05]. Subgroup analysis showed that 64.3% (9/14) of patients with hemoptysis after ventilation was caused by pulmonary fungal infection, which was significantly higher than those with hemoptysis before ventilation [15.4% (2/13), P = 0.018]. Compared with hemoptysis after ventilation group, the length of ICU stay and the duration of MV in hemoptysis before ventilation group were significantly shortened [the length of ICU stay (days): 12.0 (14.0) vs. 30.0 (81.8), the duration of MV (days): 10.0 (16.0) vs. 25.0 (68.3)], the patients using antiplatelet drugs or anticoagulant drugs was decreased significantly (case: 1 vs. 9, all P < 0.05). However, there was no statistically significant difference in gender, age, total length of hospital stay, amount of hemoptysis, APACHE II score, whether presence of pleural thickening in chest CT, the rate of hemoptysis remission, the incidence of secondary BAE or hospital survival rate between the two groups. Compared with the survival subgroup (n = 13), more patients in the non-survival subgroup (n = 14) were treated with antiplatelet or anticoagulants (P < 0.05); and Spearman correlation analysis showed that the survival of the patients with BAE was negatively correlated with the use of antiplatelet or anticoagulants (r = -0.432, P = 0.024). There was no significant difference in the gender, age, the length of ICU day, total length of hospitalization, duration of MV, estimated hemoptysis, APACHE II score, or the proportion of pleural thickening between the two groups. CONCLUSIONS: The study indicated that the etiology of massive hemoptysis in critical patients was complicated. Fungal infection was the main cause in patients with hemoptysis after ventilation. BAE was effective in the control of massive hemoptysis in ICU, but it was not ideal for patients with abnormal coagulation function or abnormal platelet count or platelet dysfunction from antiplatelet or anticoagulant drugs, the overall survival rate was still low.


Assuntos
Hemoptise , APACHE , Artérias Brônquicas , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 97(23): e10989, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29879056

RESUMO

RATIONALE: Many factors contribute to a complicated postoperative course following difficult weaning off a ventilator after lung transplantation. PATIENT CONCERNS: A female patient underwent a successful surgery but received a size-mismatched lung graft. The graft had been pruned before transplantation. She experienced delayed ventilator weaning 3 days after lung transplantation. DIAGNOSES: A postoperative X-ray revealed a normal mediastinal structure and diaphragm position. Diaphragmatic function was assessed by diaphragm electromyography (EMGdi) via esophageal and surface electrodes. EMGdi showed decreased left compound motor action potentials (CMAPs), prolonged left phrenic nerve conduction time (PNCT), failure to induce right CMAPs and PNCT under bilateral magnetic stimulation, and right phrenic nerve injury. INTERVENTIONS: She was treated with neural nutritional support and prescribed rehabilitation measures such as strengthening limb activities on the bed. OUTCOMES: The patient finally achieved satisfactory outcomes after an early diagnosis and medical interventions. LESSONS: Lung size mismatch before transplantation and phrenic nerve injury during surgery should be avoided wherever possible.


Assuntos
Diafragma/fisiologia , Eletromiografia/métodos , Transplante de Pulmão/efeitos adversos , Respiração Artificial/efeitos adversos , Transplantados , Desmame do Respirador/efeitos adversos , Adulto , Feminino , Humanos , Transplante de Pulmão/métodos , Terapia de Campo Magnético/métodos , Nervo Frênico/lesões , Nervo Frênico/fisiopatologia , Complicações Pós-Operatórias , Transplantes/anatomia & histologia , Transplantes/transplante , Resultado do Tratamento
5.
Clin Respir J ; 12(4): 1372-1380, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28749608

RESUMO

INTRODUCTION: Prone position ventilation (PPV) has been shown to improve oxygenation and decrease pulmonary vascular resistance and mortality in patients with severe acute respiratory distress syndrome (ARDS). Whether these benefits of PPV occur similarly in acute exacerbations of interstitial lung disease (ILD) is not clear. We retrospectively explored the use of PPV in acute exacerbation with ILD versus those with severe acute respiratory distress syndrome (severe ARDS). METHODS: Retrospective study of the application of PPV in 17 patients with acute exacerbations of ILD and in 19 patients with severe ARDS. Pre- and post-PPV hemodynamic parameters, respiratory mechanics, prognostic indicators, complications and mortality rates at 28, 60 and 90 days were compared. RESULTS: There was no difference in baseline characteristics between the two groups except for higher driving pressure and more diastolic dysfunction in ILD group than severe ARDS group Compared with pre-PPV, cardiac index and driving pressure remained unchanged post-PPV in both groups. PPV increased PaO2 /FiO2 [118.7 (92.0, 147.8) pre-PPV vs 132.0 (93.5, 172.0) post-PPV; P < 0.05] and central venous oxygenation in patients with ILD. In patients with severe ARDS, PPV significantly increased PaO2 /FiO2 [109.23 (89,135) pre- PPV vs 126.13 (100.93, 170) post-PPV; P < 0.05] and intrathorax blood volume index. However, mortality rates at 28, 60 and 90 days remained high in both groups (76.4%, 88.2% and 88.2% vs 36.8%, 57.9% and 57.9% in ILD and severe ARDS, respectively; P < 0.05). CONCLUSION: Our findings suggest that PPV may improve oxygenation and partially improve hemodynamic parameters during acute exacerbations of ILD.


Assuntos
Doenças Pulmonares Intersticiais/terapia , Decúbito Ventral , Respiração Artificial/métodos , Mecânica Respiratória/fisiologia , Doença Aguda , China/epidemiologia , Feminino , Seguimentos , Humanos , Doenças Pulmonares Intersticiais/mortalidade , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
6.
Am J Respir Cell Mol Biol ; 56(1): 11-19, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27508324

RESUMO

Lung epithelial-mesenchymal transition (EMT) plays an important role in ventilation-associated lung fibrosis, which may contribute to the poor outcome of patients with acute respiratory distress syndrome. Because microRNAs control and modulate normal physiological and pathophysiological processes, we investigated the role of microRNAs in the development of acute respiratory distress syndrome-associated EMT in response to mechanical stress. In the current study, primary human alveolar epithelial type II (AEII) cells were subjected to cyclic stretch that resulted in EMT profiles with decreased gene expression of cytokeratin-8, E-cadherin, and surfactant protein B, and increased expression of vimentin, α-smooth muscle actin, and N-cadherin. Microarray analysis revealed that the expression of microRNA-19b (miR-19b) was up-regulated in the AEII cells, and real-time polymerase chain reaction showed that the expression of miR-19b increased in both the AEII cells and the primary human small-airway epithelial cells. Overexpression of miR-19b in small-airway epithelial cells promoted the mechanical stretch-induced EMT phenotypes, whereas inhibition of miR-19b attenuated it. The inhibitory effect of miR-19b was attributed to enhanced signaling of phosphatidylinositol-3,4,5-trisphosphate 3-phosphatase (PTEN), leading to inactivation of the AKT pathway. Restoration of PTEN expression or inhibition of AKT phosphorylation suppressed the mechanical stretch-induced EMT phenotypes. We further demonstrated that the mechanical stretch-induced miR19 expression was regulated by the focal adhesion kinase-Rho pathway. In conclusion, we found that miR-19b plays a key role in the development of the EMT phenotype through down-regulation of PTEN in human lung epithelial cells in response to mechanical stretch. The miR-19b-PTEN signaling pathway may serve as a novel therapeutic target in the context of ventilator-associated lung fibrosis.


Assuntos
Transição Epitelial-Mesenquimal , MicroRNAs/metabolismo , PTEN Fosfo-Hidrolase/metabolismo , Estresse Mecânico , Sequência de Bases , Linhagem Celular , Células Epiteliais/metabolismo , Proteína-Tirosina Quinases de Adesão Focal/metabolismo , Genes Reporter , Humanos , Luciferases/metabolismo , MicroRNAs/genética , Fases de Leitura Aberta/genética , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais , Proteínas rho de Ligação ao GTP/metabolismo
7.
J Thorac Dis ; 8(10): E1207-E1212, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27867589

RESUMO

X-linked agammaglobulinemia (XLA) is caused by mutation in the gene coding for Bruton's tyrosine kinase (BTK), which impairs peripheral B cell maturation and hypogammaglobulinemia. In this report, we present a case of XLA in a 22-year-old adult male. Genetic testing revealed a novel mutation located at the conserved region (c.383T>C). The patient had a history of recurrent respiratory tract infection which eventually progressed to chronic type II respiratory failure. Several pathogenic bacteria were isolated on culture of respiratory secretions obtained on bronchoscopy. The patient improved on treatment with antibiotics.

8.
PLoS One ; 11(6): e0158061, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27336170

RESUMO

Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life support for acute respiratory distress syndrome (ARDS) patients. However, the outcomes of this procedure have not yet been characterized in severe ARDS patients. The aim of this study was to evaluate the outcomes of severe ARDS patients supported with ECMO and to identify potential predictors of mortality in these patients. A total of 38 severe ARDS patients (aged 51.39±13.27 years, 32 males) who were treated with ECMO in the specialized medical intensive care unit of Guangzhou Institute of Respiratory Diseases from July 2009 to December 2014 were retrospectively reviewed. The clinical data of the patients on the day before ECMO initiation, on the first day of ECMO treatment and on the day of ECMO removal were collected and analyzed. All patients were treated with veno-venous ECMO after a median mechanical ventilation duration of 6.4±7.6 days. Among the 20 patients (52.6%) who were successfully weaned from ECMO, 16 patients (42.1%) survived to hospital discharge. Of the identified pre-ECMO factors, advanced age, a long duration of ventilation before ECMO, a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, underlying lung disease, and pulmonary barotrauma prior to ECMO were associated with unsuccessful weaning from ECMO. Furthermore, multiple logistic regression analysis indicated that both barotrauma pre-ECMO and underlying lung disease were independent predictors of hospital mortality. In conclusion, for severe ARDS patients treated with ECMO, barotrauma prior to ECMO and underlying lung disease may be major predictors of ARDS prognosis based on multivariate analysis.


Assuntos
Oxigenação por Membrana Extracorpórea , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/terapia , Adulto , Idoso , Causas de Morte , China/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Prognóstico , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
9.
Artigo em Chinês | MEDLINE | ID: mdl-26805530

RESUMO

OBJECTIVE: To investigate the value of N-terminal pro-B type natriuretic peptide (NT-proBNP) in predicting the outcome of spontaneous breathing trial (SBT) in ventilated elderly renal dysfunction patients. METHODS: The clinical data of patients who received mechanical ventilation in the Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease from January 2011 to December 2014 were analyzed retrospectively. AU the patients conformed to the following criteria: age > 65 years, endogenous creatinine clearance rate (CCr) < 60 mL×min(-1)×1.73 m(-2), the duration of mechanical ventilation > 72 hours and undergone at least one SBT. The patients were assigned to a SBT success group and a SBT failure group according to the outcome of first SBT. The following factors were recorded: gender, age, the underlying disease [chronic obstructive pulmonary disease (COPD), heart failure (HF) and others], body mass index (BMI), serum pre-albumin (pre-ALB), and acute physiology and chronic health evaluation II (APACHE II) score, CCr and the concentration of the plasma NT-proBNP before SBT. Receiver operator characteristic curve (ROC) was plotted, and the predict value of NT-proBNP for the outcome of SBT in elder patients with kidney dysfunction was determined. RESULTS: A total of 58 patients with complete data were enrolled, with 41 cases in SBT success group, and 17 in SBT failure group. There were no significant differences in gender [male/female (cases): 26/15 vs. 13/4, χ (2) = 0.930, P = 0.335], age (years: 70.2±7.4 vs. 74.6±10.1, t = 0.833, P = 0.339), the stratification of underlying diseases [COPD/HF/COPD+HF/others (cases): 15/9/13/4 vs. 7/3/5/2, χ (2) = 0.242, P = 0.971], BMI (kg/m(2): 25.2±11.3 vs. 27.4±6.43, t = 1.038, P = 0.221), pre-ALB (mg/L: 201.0±13.2 vs. 189.0±7.6, t = 0.688, P = 0.519), and APACHE II score (12.2±3.2 vs. 13.5±6.3, t = 1.482, P = 0.147) and CCr (mL×min(-1)×1.73 m(-2): 51.3±7.7 vs. 54.2±6.4, t = 0.711, P = 0.487) before SBT between SBT success group and SBT failure group. The concentration of plasma NT-proBNP in SBT failure group was significantly higher than that of the SBT success group (µg/L: 4.162±1.128 vs. 2.284±1.399, t = 4.905, P = 0.000). The area under ROC curve for plasma NT-proBNP in predicting successful SBT among elder patients with kidney dysfunction was 0.878, with 95% confidence interval (95%CI) 0.786 - 0.970. The cut-off method was used, and it was identified that the concentration of NT-proBNP < 3.350 µg/L as a predictor for successful SBT, with sensitivity of 82.4%, specificity of 87.8%, positive prediction value of 88.1% and negative predictive value of 76.5%. CONCLUSIONS: The concentration of plasma NT-proBNP may increase in elderly kidney dysfunction patients undergoing ventilation, and NT-proBNP < 3.350 µg/L can serve as a good predictor for SBT success.


Assuntos
Nefropatias , Idoso , Feminino , Humanos , Masculino , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Prognóstico , Doença Pulmonar Obstrutiva Crônica , Curva ROC , Respiração , Respiração Artificial , Estudos Retrospectivos , Desmame do Respirador
10.
Arch Iran Med ; 18(8): 545-8, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26265524

RESUMO

Lipid storage myopathy is a metabolic disorder characterized by abnormal lipid accumulation in muscle fibers and progressive muscle weakness. Here, we report the case of a 17-year-old woman with progressive muscle weakness, refractory hyperlactatemia, and multiple organ insufficiency. Severe pneumonia was the initial diagnosis. After anti-infective treatment, fluid resuscitation, and mechanical ventilation, the patient's symptoms improved but hyperlactatemia and muscle weakness persisted. She was empirically treated with carnitine. Biochemical tests, electromyography, and muscle biopsy confirmed lipid storage myopathy. After 7 weeks of treatment, the patient resumed normal daily life. An empirical treatment with carnitine may be beneficial for patients before an accurate diagnosis of lipid storage myopathy is made.


Assuntos
Hiperlactatemia/etiologia , Erros Inatos do Metabolismo Lipídico/diagnóstico , Distrofias Musculares/diagnóstico , Adolescente , Bronquite/etiologia , Carnitina/uso terapêutico , Feminino , Humanos , Erros Inatos do Metabolismo Lipídico/tratamento farmacológico , Debilidade Muscular/etiologia , Distrofias Musculares/tratamento farmacológico , Pneumonia/etiologia
11.
PLoS One ; 10(8): e0136520, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26317621

RESUMO

BACKGROUND: Patients with H7N9 avian flu concurrent with severe acute respiratory distress syndrome (ARDS) usually have a poor clinical outcome. Prone position ventilation (PPV) has been shown to improve the prognosis of patients with severe ARDS. This study explored the effects of PPV on the respiratory and circulatory mechanics of H7N9-infected patients with severe ARDS. METHODS: Individuals admitted to four hospitals designated for H7N9 patients in Guangdong province were treated with PPV, and their clinical data were recorded before and after receiving PPV. RESULTS: Six of 20 critically ill patients in the ICU received PPV. After treatment with 35 PPV sessions, the oxygenation index (OI) values of the six patients when measured post-PPV and post-supine position ventilation (SPV) were significantly higher than those measured pre-PPV (P < 0.05).The six patients showed no significant differences in their values for respiratory rate (RR), peak inspiratory pressure (PIP), tidal volume (TV) or arterial partial pressure of carbon dioxide (PaCO2) when compared pre-PPV, post-PPV, and post-SPV. Additionally, there were no significant differences in the mean values for arterial pressure (MAP), cardiac index (CI), central venous pressure (CVP), heart rate (HR), lactic acid (LAC) levels or the doses of norepinephrine (NE) administered when compared pre-PPV, post-PPV, and post-SPV. CONCLUSION: PPV provided improved oxygenation that was sustained after returning to a supine position, and resulted in decreased carbon dioxide retention. PPV can thus serve as an alternative lung protective ventilation strategy for use in patients with H7N9 avian flu concurrent with severe ARDS.


Assuntos
Influenza Humana/terapia , Posicionamento do Paciente/métodos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Idoso , Feminino , Hemodinâmica , Humanos , Subtipo H7N9 do Vírus da Influenza A , Influenza Humana/complicações , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/efeitos adversos , Decúbito Ventral , Ventilação Pulmonar , Respiração , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/etiologia , Estudos Retrospectivos
12.
Chest ; 148(3): 759-766, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25950752

RESUMO

BACKGROUND: There has been a significant increase in the publication of clinical practice guidelines (CPGs) for respiratory diseases in China. However, little is known about the quality and potential impacts of these CPGs. Our objective was to critically evaluate the quality of Chinese CPGs for respiratory diseases that were published in peer-reviewed medical journals. METHODS: A systematic search of scientific literature published between 1979 and 2013 was undertaken to identify and select CPGs that were related to respiratory diseases. Four Chinese databases (the Chinese Biomedical Literature database [CBM], the China National Knowledge Infrastructure [CNKI], the VIP database, and the WANFANG database) were used. The quality of eligible guidelines was assessed independently by four reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. The overall agreement among reviewers was evaluated using an intraclass correlation coefficient. RESULTS: A total of 109 guidelines published in 27 medical journals from 1979 to 2013 were evaluated. The overall agreement among reviewers was considered good (intraclass correlation coefficient, 0.838; 95% CI, 0.812-0.862). The scores of the six AGREE domains were low: 57.3% for scope and purpose (range, 4.2%-80.5%), 23.8% for stakeholder involvement (range, 2.8%-54.2%), 7.7% for rigor of development (range, 0%-27.1%), 59.8% for clarity and presentation (range, 22.2%-80.6%), 10.9% for applicability (range, 0%-22.9%), and 0.6% for editorial independence (range, 0%-16.7%). Scores for all guidelines were below 60%, and only three guidelines (2.8%) were recommended for clinical practice with modifications. CONCLUSIONS: The quality of the guidelines was low, and stakeholder involvement, rigor of development, applicability, and editorial independence should be considered in the future development of CPGs for respiratory diseases in China.


Assuntos
Guias de Prática Clínica como Assunto/normas , Doenças Respiratórias/terapia , China , Humanos
13.
BMC Infect Dis ; 15: 179, 2015 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-25886493

RESUMO

BACKGROUND: Imipenem-resistant Acinetobacter baumannii (IRAB) is an important cause of hospital-acquired infection. We aimed to describe an outbreak of IRAB infection and to investigate its possible source in an intensive care unit. METHODS: An environmental investigation was undertaken. Antimicrobial susceptibility testing was performed by microdilution. These isolates were genotyped by use of repetitive extragenic palindromic polymerase chain reaction (rep-PCR; DiversiLab). The study included 11 patients infected with IRAB and 14 control patients free of IRAB. Case and control patients were compared for possible predisposing factors. A multifaceted intervention was implemented to control the outbreak. RESULTS: Thirty-nine IRABs were isolated from patients and the environmental surveillance culture in August, November, and December 2011. All isolates were resistant to imipenem. The IRAB strains belonged to seven clones (A-G) by the use of rep-PCR. There were four epidemic clones (D-G) in the outbreak, and Clone D was predominant. For the case-control study, patients with chronic obstructive pulmonary disease were susceptible to infection with IRAB. The hospital mortality of the case group was significantly higher than that of the control group. CONCLUSIONS: The outbreak strains were transmitted among infected patients and equipment by inappropriate use of gloves. A combination of aggressive infection control measures is essential for preventing recurrent nosocomial outbreaks of IRAB.


Assuntos
Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/isolamento & purificação , Antibacterianos/farmacologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças/prevenção & controle , Imipenem/farmacologia , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Infecções por Acinetobacter/mortalidade , Acinetobacter baumannii/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , China/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Farmacorresistência Bacteriana , Contaminação de Equipamentos , Feminino , Luvas Protetoras/microbiologia , Humanos , Controle de Infecções , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade
14.
Physiol Rep ; 3(2)2015 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-25677546

RESUMO

Alveolar epithelial type II (AEII) cells are a key structure and defender in the lung but also are the targets in many lung diseases, including acute respiratory distress syndrome, ventilator-induced lung injury, and pulmonary fibrosis. We sought to establish an optimized method for high yielding and long maintenance of characteristics of primary human AEII cells to facilitate the investigation of the mechanisms of lung diseases at the cellular and molecular levels. Adult human peripheral normal lung tissues of oncologic patients undergoing lung resection were collected. The AEII cells were isolated and identified by the expression of pro-surfactant protein (SP)C, epithelial sodium channel (αENaC) and cytokeratin (CK)-8, the lamellar bodies specific for AEII cells, and confirmed by the histology using electron microscopy. The phenotype of AEII cells was characterized by the expression of surfactant proteins (SP-A, SP-B, SP-C, SP-D), CK-8, KL-6, αENaC, and aquaporin (AQP)-3, which was maintained over 20 days. The biological activity of the primary human AEII cells producing SP-C, cytokines, and intercellular adhesion molecule-1 was vigorous in response to stimulation with tumor necrosis factor-α. We have modified previous methods and optimized a method for isolation of high purity and long maintenance of the human AEII cell phenotype in primary culture. This method provides an important tool for studies aiming at elucidating the molecular mechanisms of lung diseases exclusively in AEII cells.

15.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 27(10): 785-90, 2015 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-27132438

RESUMO

OBJECTIVE: To explore the effect of prone position ventilation (PPV) on respiratory mechanics and prognosis in patients with acute respiratory distress syndrome (ARDS) concurrent with interstitial lung disease (ILD). METHODS: The data of 36 severe ARDS patients admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University from February 2013 to January 2015, were retrospectively analyzed. They were then divided into two groups according to the presence of ILD or not. The changes in respiratory mechanics and oxygenation indexes were compared before and after PPV treatment in all the patients. Kaplan-Meier method was applied to draw the 60-day survival curves of both groups. RESULTS: There were 17 cases with ILD among these 36 severe ARDS patients. (1) No significant difference was found in baseline data between ILD group and non-ILD group. (2) Respiratory mechanics and oxygenation pre-PPV and post-PPV: compared with pre-PPV, oxygenation index (PaO2/FiO2, mmHg, 1 mmHg = 0.133 kPa) post-PPV was significantly increased in both groups [ILD group : 132.0 (93.5, 172.0) vs. 118.7 (92.0, 147.8); non-ILD group: 126.1 (100.9, 170.0) vs. 109.2 (89.0, 135.0), both P < 0.05]. Compared with pre-PPV, positive end-expiratory pressure (PEEP, cmH2O, 1 cmH2O = 0.098kPa) post-PPV was significantly higher in ILD group [10.0 (10.0, 12.0) vs. 10.0 (9.2, 12.0), P < 0.05], and respiratory rate (RR, times/min) was significantly lower in non-ILD group [24.5 (22.0, 27.0) vs. 25.5 (22.8, 28.0), P < 0.05]. The compliance of the respiratory system (Crs, mL/cmH2O) post-PPV in non-ILD group was significantly lower than that of the ILD group [19.7 (16.1, 28.6) vs. 23.0 (19.0, 29.7), P < 0.05]. (3) Respiratory mechanics and oxygenation pre-PPV and post-PPV in total: after all the PPV therapy, PaO2/FiO2 (mmHg) was significantly increased in non-ILD group [135.0 (86.0, 200.0) vs. 97.4 (69.2, 127.5), P < 0.05], PaO2/FiO2 after all the PPV therapy in non-ILD group was also higher than that in ILD group [135.0 (86.0, 200.0) vs. 78.7 (59.3, 114.9), P < 0.05]. No significant difference in Crs (mL/cmH2O) before PPV treatment was found between non-ILD and ILD groups [24.3 (15.9, 48.9) vs. 18.9 (12.7, 27.3), P > 0.05], and Crs was lower after PPV treatment in both groups, but without significant difference [non-ILD group: 22.7 (15.2, 27.1) vs. 24.3 (15.9, 48.9); ILD group: 16.2 (12.8, 25.6) vs. 18.9 (12.7, 27.3), both P > 0.05]. (4) The 60-day mortality in ILD group was significantly higher than that in non-ILD group [88.2% (15/17) vs. 57.9% (11/19), P = 0.047). It was shown by Kaplan-Meier curves that 60-day survival patients in ILD group was significantly lower than those in non-ILD group (χ2 = 5.658, P = 0.017). CONCLUSIONS: PPV can improve oxygenation in severe ARDS. Compared with non-ILD group, though the compliance of respiratory system in ILD group is increased during PPV, long-term effect is better in non-ILD group.


Assuntos
Doenças Pulmonares Intersticiais/terapia , Respiração com Pressão Positiva , Decúbito Ventral , Síndrome do Desconforto Respiratório do Adulto/terapia , Mecânica Respiratória , Gasometria , Humanos , Doenças Pulmonares Intersticiais/complicações , Prognóstico , Síndrome do Desconforto Respiratório do Adulto/complicações
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 26(12): 855-9, 2014 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-25476075

RESUMO

OBJECTIVE: To investigate the value of the application of fibrobronchoscopy in extubation for patients suffering from acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with low cough peak expiratory flow (CPEF). METHODS: A single-center prospective controlled study was conducted. The ventilated AECOPD patients who were cooperative at the time of extubation in Department of Critical Care Medicine of Guangzhou Institute of Respiratory Disease of Guangzhou Medical University from June 2009 to May 2014 were enrolled. All patients successfully passed the spontaneous breathing trial (SBT). Extubation was performed after determination of CPEF following energetic coughing. According to the CPEF, the patients were divided into CPEF ≥ 60 L/min group (high CPEF group) and CPEF<60 L/min group (low CPEF group). After extubation, fibrobronchoscopic drainage was given to the patients in high CPEF group when necessary. Fibrobronchoscopic drainage was given to the patients in low CPEF group at least once a day, and the frequency of such treatment could be increased according to the patient's condition. If the patients did not require re-intubation within 48 hours,extubation was recorded as successful. The gender, age, acute physiology and chronic health evaluationII (APACHEII) score before extubation, ventilation time, the time of intensive care unit (ICU) stay, the mortality in ICU, the rate of re-intubation, the ability to cough and the frequency of application of fibrobronchoscopy after extubation were recorded. RESULTS: A total of 102 patients with AECOPD were enrolled, 58 patients in high CPEF group and 44 in low CPEF group. Compared with high CPEF group, the mean age in low CPEF group was older (years: 74.3 ± 15.2 vs. 69.5 ± 11.4, t=2.164, P=0.041), the time of ICU stay was significantly longer (days: 20.1 ± 11.2 vs. 17.4±7.3, t=2.274, P=0.030), but there was no significant difference in gender [male/female (cases):35/9 vs. 45/13, χ² = 0.057, P=0.812], APACHEII score (11.9 ± 1.9 vs. 10.3 ± 4.2, t=1.290, P=0.200), mechanical ventilation time (days: 14.8 ± 10.8 vs. 13.3 ± 9.6, t=0.677, P=0.501) and the rate of re-intubation [18.18% (8/44) vs. 12.07% (7/58), χ² = 1.412, P=0.235] between low CPEF group and high CPEF group. The cough strength of patients in high CPEF group was almost always "strong" (52 cases), and in the low CPEF group, most of them was "moderate" (14 cases) or "weak" (26 cases). The frequency of application of fibrobronchoscopy in low CPEF group was higher than that in high CPEF group (times: 4.1 ± 1.8 vs. 1.3 ± 0.9, t=2.626, P=0.011). All patients underwent weaning successfully, and no death occurred. CONCLUSIONS: The application of fibrobronchoscopy in the extubated AECOPD patients with low CPEF can reduce the rate of re-intubation, avoid the prolonged ventilation, but cannot reduce the time of ICU stay.


Assuntos
Extubação , Broncoscopia/métodos , Tosse/fisiopatologia , Doença Pulmonar Obstrutiva Crônica , Idoso , Idoso de 80 Anos ou mais , Drenagem , Feminino , Humanos , Unidades de Terapia Intensiva , Intubação , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Estudos Prospectivos , Respiração Artificial , Desmame do Respirador
17.
J Thorac Dis ; 6(9): 1293-9, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25276372

RESUMO

OBJECTIVE: The study aimed to construct and manage an acute respiratory distress syndrome (ARDS)/sepsis registry that can be used for data warehousing and clinical research. METHODS: The workflow methodology and software solution of research electronic data capture (REDCap) was used to construct the ARDS/sepsis registry. Clinical data from ARDS and sepsis patients registered to the intensive care unit (ICU) of our hospital formed the registry. These data were converted to the electronic case report form (eCRF) format used in REDCap by trained medical staff. Data validation, quality control, and database management were conducted to ensure data integrity. RESULTS: The clinical data of 67 patients registered to the ICU between June 2013 and December 2013 were analyzed. Of the 67 patients, 45 (67.2%) were classified as sepsis, 14 (20.9%) as ARDS, and eight (11.9%) as sepsis-associated ARDS. The patients' information, comprising demographic characteristics, medical history, clinical interventions, daily assessment, clinical outcome, and follow-up data, was properly managed and safely stored in the ARDS/sepsis registry. Data efficiency was guaranteed by performing data collection and data entry twice weekly and every two weeks, respectively. CONCLUSIONS: The ARDS/sepsis database that we constructed and manage with REDCap in the ICU can provide a solid foundation for translational research on the clinical data of interest, and a model for development of other medical registries in the future.

18.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 26(9): 615-9, 2014 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-25230860

RESUMO

OBJECTIVE: To evaluate the effect of time elapsed on continuous pulse contour cardiac output (PCCO) measurement in septic shock patients. METHODS: Data during February 2011 to February 2013 from 25 septic shock patients equipped with a pulse indicator continuous cardiac output (PiCCO) device in Department of Critical Care Medicine of Guangzhou Medical University were retrospectively analyzed. PCCO was recorded immediately before transpulmonary thermodilution (COTPTD) calibration. After divided by ideal body surface area, cardiac index (CI) was calculated, and PCCI/CITPTD pairs were analyzed. Four subsets of CI pairs were defined according to intervals of time elapsed from the previous calibration [within the first hour (including 1 hour), between 1 and 8 hours (including 8 hours), between 8 and 16 hours (including 16 hours), and more than 16 hours]. Linear regression, the threshold value of concordance (as indicated by bias ± 2SD) and percentage error (2SD/the mean of CITPTD) were used to compare agreement between PCCI and CITPTD. RESULTS: A total of 162 data pairs from 25 patients were analyzed. For all data pairs, PCCI correlated significantly with CITPTD (r² = 0.494, P<0.001), the bias±2SD was -(0.06 ± 1.41) L × min⁻¹ × m⁻² and the percentage error was 37%. Among the four time-interval subsets, the percentage error was <30% only in subset between 1 and 8 hours, and the percentage error in other subsets was over 30%. Linear regression analysis between ΔPCCI and ΔCITPTD showed a r² of 0.217 (P<0.001) for the whole 162 data pairs. A r² of 0.327 (P<0.001) and a r² of 0.303 (P<0.001) were calculated for the subset of between 1 and 8 hours and between 8 and 16 hours respectively. CONCLUSIONS: Our study in septic shock patients suggests that the accuracy of PCCO will be decreased as the increase of the time interval for calibration. Transpulmonary thermodilution calibration should be performed again if hemodynamic changes or was inconsistent with the clinical presentation. It is suggested that re-calibration should be done within 8 hours.


Assuntos
Choque Séptico , Calibragem , Débito Cardíaco , Cuidados Críticos , Humanos , Estudos Retrospectivos , Termodiluição
19.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 25(8): 455-9, 2013 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-24021038

RESUMO

OBJECTIVE: To investigate the effect of mechanical stretch induced epithelial-mesenchymal transition in human lung epithelial cells BEAS-2B in vitro. METHODS: The human lung epithelial cells BEAS-2B were subjected to cyclic stretch by the FX-5000T system at 0.33 Hz of 10% or 20% elongation for 24, 48 and 72 hours respectively. The morphologic changes were observed by microscopy. The mRNA and protein expressions of E-cadherin, Cytokeratin-8 (CK-8), α-smooth muscle actin (α-SMA) and Vimentin were evaluated by immunofluorescence before and after mechanical stretch and fluorescent quantitation reverse transcription-polymerase chain reaction (qRT-PCR). RESULTS: (1) When stretch by 20% elongation for 48 hours, the morphological changes in BEAS-2B cells from cobblestone-like structure to elongated shape and obviously when stretch for up to 72 hours, while 10% elongation showed no significant morphological changes comparing to control. (2) Decreasing E-cadherin and CK-8 protein expression was associated with increased immunostaining for α-SMA protein at 72 hours after 20% mechanical stretch. (3) Expression of E-cadherin mRNA was decreased to 0.388±0.056 and 0.247±0.064 after 20% mechanical stretch for 48 hours and 72 hours compared with control without stretch (set 1, both P<0.05), expression of CK-8 mRNA was decreased to 0.436±0.060 at 72 hours after 20% mechanical stretch (P<0.01), α-SMA mRNA was increased to 1.437±0.267 (48 hours) and 1.261±0.247 (72 hours) after 20% mechanical stretch (both P<0.05), and Vimentin mRNA was increased to 1.679±0.172 (48 hours) after 20% mechanical stretch (P<0.05). Expression of E-cadherin mRNA was decreased to 0.387±0.081 at 72 hours after 10% mechanical stretch (P<0.05), Vimentin mRNA was increased to 1.688±0.179 at 48 hours after 10% mechanical stretch while other markers showed no significant changes comparing with control. CONCLUSIONS: Excessive mechanical stretch could induce epithelial-mesenchymal transition in lung epithelial cells BEAS-2B in vitro.


Assuntos
Células Epiteliais/citologia , Transição Epitelial-Mesenquimal , Pulmão/citologia , Estresse Mecânico , Actinas/metabolismo , Antígenos CD , Fenômenos Biomecânicos , Caderinas/metabolismo , Linhagem Celular , Humanos , Queratina-8/metabolismo
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 25(8): 484-8, 2013 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-24021045

RESUMO

OBJECTIVE: To observe the effects of cyclic stretch on expression of cytokines and adhesion molecules in human pulmonary artery endothelial cells (HPAECs), herein to provide a theoretical basis to ventilator-induced lung injury (VILI). METHODS: HPAECs were subjected to cyclic stretch by the Flexcell FX-5000T system at 0.5 Hz of 10% or 20% elongation for 3, 6, 12, 24 hours respectively. The mRNA and protein expression of interleukin (IL-6, IL-8), monocyte chemotactic protein-1 (MCP-1) and intercellular adhesion molecule-1 (ICAM-1) was determined by fluorescent quantitation reverse transcription-polymerase chain reaction (qRT-PCR), enzyme linked immunosorbent assay (ELISA) or Western blotting. RESULTS: Increasing the stretch force, the mRNA and protein expression of IL-8, MCP-1, ICAM-1 were up regulated with increasing stretch time. Compared with the control (set 1), after 20% cyclic stretch for 24 hours, IL-8 mRNA expression was up regulated to 1.58±0.10, MCP-1 mRNA expression was up regulated to 2.85±0.52, and ICAM-1 mRNA expression was up regulated to 1.90±0.14 (all P<0.05). Compared with control group, after 20% cyclic stretch for 24 hours, the protein expression of IL-8 and MCP-1 in HPAEC was significantly increased (IL-8: 3401.08±439.60 ng/L vs. 1422.60±66.98 ng/L, MCP-1: 1117.64±237.54 ng/L vs. 307.88±80.84 ng/L, both P<0.05), ICAM-1 protein expression was up regulated to 2.15±0.40 (P<0.05), while the expression of IL-6 mRNA and protein had no statistic difference compared with control group. CONCLUSIONS: Cyclic stretch enhanced the expression of IL-8, MCP-1 and ICAM-1 in an intensity-dependent fashion, so it may be involved in the pathogenesis of lung injury induced by mechanical ventilation.


Assuntos
Células Endoteliais/metabolismo , Molécula 1 de Adesão Intercelular/metabolismo , Respiração Artificial/efeitos adversos , Estresse Mecânico , Fenômenos Biomecânicos , Células Cultivadas , Quimiocina CCL2/metabolismo , Endotélio Vascular/citologia , Endotélio Vascular/metabolismo , Humanos , Interleucina-8/metabolismo , Artéria Pulmonar/citologia , Artéria Pulmonar/metabolismo
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