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1.
J Surg Res ; 245: 610-618, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31522034

RESUMO

BACKGROUND: Herpes virus entry mediator (HVEM) is a coinhibitory molecule which can both stimulate and inhibit host immune responses. Altered expression of HVEM and its ligands is associated with increased nosocomial infections in septic patients. We hypothesize critically ill trauma patients will display increased lymphocyte HVEM expression and that such alteration is predictive of infectious events. MATERIALS AND METHODS: Trauma patients prospectively enrolled from the ICU were compared with healthy controls. Leukocytes were isolated from whole blood, stained for CD3 (lymphocytes) and HVEM, and evaluated by flow cytometry. Charts were reviewed for injuries sustained, APACHE II score, hospital course, and secondary infections. RESULTS: Trauma patients (n = 31) were older (46.7 ± 2.4 versus 36.8 ± 2.1 y; P = 0.03) than healthy controls (n = 10), but matched for male sex (74% versus 60%; P = 0.4). Trauma patients had higher presenting WBC (13.9 ± 1.3 versus 5.6 ± 0.5 × 106/mL; P = 0.002), lower percentage of CD3+ lymphocytes (7.5% ± 0.8 versus 22.5% ± 0.9; P < 0.001), but significantly greater expression of HVEM+/CD3+ lymphocytes (89.6% ± 1.46 versus 67.3% ± 1.7; P < 0.001). Among trauma patients, secondary infection during the hospitalization was associated with higher APACHE II scores (20.6 ± 1.6 versus 13.6 ± 1.4; P = 0.03) and markedly lower CD3+ lymphocyte HVEM expression (75% ± 2.6 versus 93% ± 0.7; P < 0.01). CONCLUSIONS: HVEM expression on CD3+ cells increases after trauma. Patients developing secondary infections have less circulating HVEM+CD3+. This implies HVEM signaling in lymphocytes plays a role in maintaining host defense to infection in after trauma. HVEM expression may represent a marker of infectious risk as well as a potential therapeutic target, modulating immune responses to trauma.


Assuntos
Tolerância Imunológica , Linfócitos/imunologia , Membro 14 de Receptores do Fator de Necrose Tumoral/metabolismo , Ferimentos e Lesões/imunologia , APACHE , Adulto , Biomarcadores/metabolismo , Complexo CD3/metabolismo , Estudos de Casos e Controles , Feminino , Voluntários Saudáveis , Humanos , /diagnóstico , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Membro 14 de Receptores do Fator de Necrose Tumoral/imunologia , Ferimentos e Lesões/sangue , Ferimentos e Lesões/complicações
2.
Med. intensiva (Madr., Ed. impr.) ; 43(9): 546-555, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185901

RESUMO

Objetivo: Conocer si la implantación de un protocolo para el manejo de la pancreatitis aguda (PA) en Medicina Intensiva (MI) redundó en la mejora de los resultados clínicos. Diseño: Serie de casos, observacional, retrospectivo, con un diseño antes-después. Periodo de estudio: 1/01/2001-31/12/2016, dividido en 2 periodos (preprotocolo 2001-2007; posprotocolo 2008-2016). Ámbito: Un servicio de MI con 48 camas y población de 700.000 habitantes. Participantes: Pacientes ingresados en MI con PA. No hubo criterios de exclusión. Intervenciones: Se aplicaron las recomendaciones propuestas en la 7.a Conferencia de Consenso (2007) de la SEMICYUC sobre la PA en el segundo periodo. Variables de interés principales: Edad, sexo, APACHE II, SOFA, periodo a estudio, días previos al ingreso en MI, tipo de nutrición, cirugía, profilaxis antibiótica, mortalidad hospitalaria, estancia en MI, estancia hospitalaria, clasificación basada en determinantes. Resultados: Doscientos ochenta y seis pacientes (94 preprotocolo, 192 posprotocolo), mortalidad hospitalaria de 66 casos (23,1%). La aplicación del protocolo supuso una disminución de la estancia hospitalaria previa al ingreso en MI, y de la profilaxis antibiótica, con un aumento del uso de nutrición enteral. Se evidenció un descenso de la mortalidad hospitalaria en el segundo periodo (35,1 vs. 17,18%, p=0,001), sin cambios significativos en la estancia en MI ni en la hospitalaria. En el análisis multivariante, la variable «periodo de tratamiento» mantuvo significación estadística respecto a la mortalidad hospitalaria (OR 0,34 en 2008-2016, IC 95% 0,15-0,74). Conclusiones: El establecimiento de un protocolo podría estar relacionado con un descenso de la mortalidad de los pacientes ingresados en MI por PA


Objective: To determine whether the implementation of a protocol for the management of patients with acute pancreatitis (AP) in an Intensive Care Unit (ICU) improves the clinical outcomes. Design: A retrospective, before-after observational case series study was carried out. Study period: 1 January 2001 to 31 December 2016, divided in 2 periods (pre-protocol 2001-2007, post-protocol 2008-2016). Scope: An ICU with 48 beds and a recruitment population of 700,000 inhabitants. Participants: AP patients admitted to the ICU, with no exclusion criteria. Interventions: The recommendations proposed in the 7th Consensus Conference of the SEMICYUC on AP (5 September 2007) were applied in the second period. Main variables of interest: Patient age, sex, APACHE II, SOFA, study period, pre-ICU hospital stay, nutrition, surgery, antibiotic prophylaxis, hospital mortality, ICU length of stay, hospital length of stay, determinant-based classification. Results: The study comprised 286 patients (94 in the pre-protocol period, 192 in the post-protocol period), with a global in-hospital mortality rate of 23.1% (n=66). Application of the protocol decreased the pre-ICU hospital stay and the use of antibiotic prophylaxis, and increased the use of enteral nutrition. Hospital mortality decreased in the second period (35.1 vs. 17.18%; P=.001), with no significant changes in ICU and hospital stays. In the multivariate logistic regression analysis, the variable period of treatment remained as a variable of statistical significance in terms of hospital mortality (OR 0.34 for the period 2008-2016, 95% CI 0.15-0.74). Conclusions: The implementation of a protocol could result in decreased mortality among AP patients admitted to the ICU


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Protocolos Clínicos , Pancreatite/complicações , Consenso , Evolução Clínica , Estudos Retrospectivos , APACHE , Escores de Disfunção Orgânica , Mortalidade Hospitalar , Análise Multivariada , Análise de Variância , Modelos Logísticos
3.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(10): 1137-1142, 2019 Oct 28.
Artigo em Chinês | MEDLINE | ID: mdl-31857507

RESUMO

OBJECTIVE: To determine expression levels of glial fibrillary acidic protein in patients of sepsis-associated encephalopathy (SAE) and its clinical significance.
 Methods: Patients, admitted to intensive care units and diagnosed as sepsis, were recruited to our study from October 2016 to August 2018 in the Third Xiangya Hospital, Central South University. SAE is defined as a brain dysfunction secondary to sepsis and without evidence of a primary central nervous system infection or encephalopathy due to other reasons. The SAE group and non-SAE group were classed by Confusion Assessment Method for the ICU (CAM-ICU) score. We measured the levels of serum GFAP, S100ß and neuron-specific enolase (NSE) within 24 hours after diagnosis of sepsis, and compared the patients' general clinical data, ICU stay time, 28-day and 180-day mortality.
 Results: Among 152 enrolled patients, 58 and 94 were assigned to the SAE group and the non-SAE group, respectively. There were a significantly higher Sequential Organ Failure Assessment (SOFA) scores, 28-day mortality rate, as well as 180-day mortality rate in the SAE group (all P<0.001). The levels of GFAP, NSE and S100ß in the SAE group were significantly higher than those in the non-SAE group (all P<0.001). The diagnostic values of GFAP was 0.67 µg/L, with sensitivity at 75.9% and specificity at 77.7%. Area under the receiver operating characteristic curve (AUROC) of GFAP, NSE and S100ß were 0.803, 0.795 and 0.750, respectively. Pearson analysis showed that serum GFAP level was positively correlated with Acute Physiology and Chronic Health Evaluation II (APACHE II) score, but it was negatively correlated with Glasgow Coma Scale (GCS) score, 28-day survival rate and 180-day survival rate.
 Conclusion: The level of serum GFAP is significantly increased in SAE, which shows certain correlation with incidence, severity and prognosis of the disease.


Assuntos
Proteína Glial Fibrilar Ácida/sangue , Encefalopatia Associada a Sepse , Sepse , APACHE , Humanos , Unidades de Terapia Intensiva , Escores de Disfunção Orgânica , Prognóstico , Curva ROC , Encefalopatia Associada a Sepse/diagnóstico
4.
Medicine (Baltimore) ; 98(44): e17704, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689800

RESUMO

For early diagnosis and treatment of invasive candidiasis (IC), the well-known risk factors may not apply in the intensive care unit (ICU). This retrospective study identified the risk factors predicting IC and candidemia in cancer patients under intensive care after gastrointestinal surgery.Enrolled were 229 cancer patients admitted to our oncology surgical ICU after gastrointestinal surgery between January 1, 2010 and October 31, 2014.The most common types of solid gastrointestinal cancers were gastric (49.8%), colon (20.1%), and esophageal (18.3%). The percentage of patients with corrected Candida colonization index (CCI) ≥0.4 was 31.9%. IC was confirmed in 19 patients (8.3%), and the ICU mortality was 15.8%. Candida albicans accounted for 52.6% of the total number of pathogenic Candida isolates. Among patients with CCI ≥0.4, the cancers with the highest prevalence were cardiac (45%) and gastric (36%), with ICU mortalities of 20% and 4.9%, respectively. For the diagnosis of candidemia, (1-3)-ß-D-glucan (BDG) ≥80 pg/mL showed a sensitivity and specificity of 25% and 82.7%, respectively, positive and negative predictive values 6.7% and 95.7%, and area under the receiver operating characteristic curve 0.512. CCI ≥0.4 was the only significant predictor of IC, and number of organ failures was the only predictor of candidemia (P = .000 and .026).CCI ≥0.4 was the only significant risk factor predicting IC, with greater prediction of intra-abdominal candidiasis but failure to predict candidemia. Blood culture and BDG detection are recommended to supplement diagnosis. Patients may have multifocal and high-grade Candida colonization after cardiac surgery, and; therefore, are at high risk of IC, which should be taken seriously.


Assuntos
Candidemia/epidemiologia , Candidíase Invasiva/epidemiologia , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Gastrointestinais/cirurgia , APACHE , Fatores Etários , Idoso , Candida/crescimento & desenvolvimento , Estado Terminal , Feminino , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Técnicas Microbiológicas , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia
5.
Medicine (Baltimore) ; 98(48): e18025, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770216

RESUMO

INTRODUCTION: Sepsis is a physiological, pathological, and biochemical syndrome caused by infection. Acupuncture may be useful for sepsis. This systematic review aims to assess the efficacy and safety of acupuncture as a complementary therapy for sepsis. METHODS AND ANALYSIS: We will search PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Wan Fang Database, Chinese Biomedicine (CBM) database, VIP database, and TCM Literature Analysis and Retrieval Database from inception to October 31, 2019 to identify any eligible study. We include all randomized controlled trials (RCTs) without any limitation of blinding or publication language, exclude cohort studies and case reports. Two reviewers will independently select studies, extract and manage data. The primary outcomes include the mortality at 28 days, acute physiology, and chronic health evaluation II scores. The secondary outcomes include the tumor necrosis factor α (TNF-α) counts, interleukin 6 (IL-6) counts, interleukin 10 (IL-10) counts, procalcitonin (PCT), lactic acid, the level of T cell subsets (CD3+, CD4+, CD8+, CD4+/CD8+), monocytes of human leukocyte antigen DR (HLA-DR), C-reactive protein (CRP), the numeration of leukocyte, intra-abdominal pressure, and adverse events or reactions. Statistical analyses will be performed using the Review Manager V.5.3 and R packages Metafor. We will use the Cochrane risk of bias tool for randomized trials to assess the risk of bias of included studies. ETHICS AND DISSEMINATION: This study will not involve personal information. Ethical approval will not be required. We will publish the results in a peer-reviewed journal. PROSPERO TRIAL REGISTRATION NUMBER: CRD42019141491.


Assuntos
Terapia por Acupuntura/métodos , Sepse/terapia , APACHE , Proteína C-Reativa/análise , Antígenos HLA-DR/sangue , Humanos , Interleucina-10/sangue , Interleucina-6/sangue , Ácido Láctico/sangue , Contagem de Leucócitos , Metanálise como Assunto , Pró-Calcitonina/sangue , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Sepse/sangue , Sepse/mortalidade , Revisão Sistemática como Assunto , Subpopulações de Linfócitos T/metabolismo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue
6.
Arq Gastroenterol ; 56(3): 280-285, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633726

RESUMO

BACKGROUND: Acute pancreatitis is a common disorder in medical practice. In recent times, management has changed drastically with majority of decisions like intravenous antibiotics, negative suction with Ryle's tube and surgical interventions like necrosectomy etc based on severity of the disease. There are different scores in use to assess severity of disease but the relative efficacy has remained a debatable subject. OBJECTIVE: The present study was thus done to investigate the predictive accuracy of different scoring systems in acute pancreatitis. METHODS: Fifty patients of acute pancreatitis admitted in medicine ward of Pt. B.D. Sharma PGIMS, Rohtak, India, were taken for study after fulfilling eligibility criteria. These patients were investigated at admission and followed up prospectively. The severity of pancreatitis was classified for each of these patients as per Revised Atlanta System of Classification. Commonly used scoring systems pertaining to acute pancreatitis, viz, BISAP, Ranson, APACHE II and modified computed tomography severity index (CTSI) were calculated. Subsequently these scores were then correlated with severity, presence of organ failure, occurrence of local complications and final outcome of the patients. RESULTS: Out of 50 patients, etiology was chronic alcohol intake in all but one with idiopathic pancreatitis. The mean age of the study population was 42.06±13.27 years. 32% of these patients had pancreatic necrosis, 40% had peripancreatic collections. 56% of them had mild acute pancreatitis, 24% had moderately severe acute pancreatitis, while 20% had severe acute pancreatitis. APACHE II had the highest accuracy in predicting severity, organ failure and fatal outcomes. As far as these parameters were concerned, the negative predictive values of BISAP score were also considerable. Modified CTSI score was accurate in predicting local complications but had limited accuracy in other predictions. CONCLUSION: APACHE II emerged as most reliable scoring system followed by BISAP and Ranson in management of the patients with acute pancreatitis. But in constraints of time and resources, even BISAP score with its significant negative predictive values served as a valuable tool for assessing and managing these patients.


Assuntos
Hepatite Alcoólica/classificação , Hepatite Alcoólica/complicações , APACHE , Doença Aguda , Adulto , Feminino , Hepatite Alcoólica/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Índice de Gravidade de Doença
7.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(9): 1087-1090, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31657330

RESUMO

OBJECTIVE: To investigate the implementation and application effect of 1-hour bundle in the treatment of patients with sepsis. METHODS: A convenient sampling method was conducted. 102 patients with sepsis admitted to central intensive care unit (ICU) of Henan Provincial People's Hospital from January 2018 to February 2019 were enrolled. Thirty-five patients with 3-hour and 6-hour bundle from January to September in 2018 were served as the control group, and 67 patients who received 1-hour bundle from October 2018 to February 2019 were served as the observation group. The patients in the control group was treated with 3-hour and 6-hour bundle according to 2012 international guidelines for the diagnosis and treatment of severe sepsis and septic shock; and those in the observation group were treated and nursed according to the 1-hour bundle published by Surviving Sepsis Campaign (SSC) update 2018, and the sepsis cluster treatment medical team was established. The team members were trained in relevant knowledge and discussed the possible obstacles within the team and propose feasible measures. The implementation of the 1-hour bundle in the observation group was recorded. The general data of the patients in both groups including gender, age, acute physiology and chronic health evaluation II (APACHE II), etc. were collected, and the outcome indicators (duration of mechanical ventilation, length of ICU stay, 28-day mortality) were observed. RESULTS: In the observation group, 37 of 67 patients receiving 1-hour bundle met the target, with the overall achievement rate of 55.2% (37/67). Of the 37 eligible patients, 5 patients receiving 1-hour bundle met the target before the training of 1-hour bundle, accounting for only 33.3% (5/15) of the 15 patients who received 1-hour bundle during the same period. With the extension of training time, the achievement rate of sepsis 1-hour bundle was gradually increased [the achievement rate at 1 week and 4 weeks of training was 40.0% (4/10) and 52.4% (11/21), respectively], and increased to 81.0% (17/21) at the end of 12 weeks training. Thirty-seven patients who received 1-hour bundle and met the criteria were enrolled and compared with the control group. There was no significant difference in gender, age, or APACHE II score between the two groups. Compared with the control group, the duration of mechanical ventilation and length of ICU stay of the observation group were significantly shortened (days: 6.15±0.49 vs. 7.24±0.53, days: 8.21±1.49 vs. 9.51±1.92), and the 28-day mortality was decreased significantly [10.8% (4/37) vs. 31.4% (11/35)], with statistically significant differences (all P < 0.05). CONCLUSIONS: Through teamwork, discussion and improvement, the achievement rate of sepsis 1-hour bundle can be significantly improved. The use of sepsis 1-hour bundle can effectively decrease the duration of mechanical ventilation and length of ICU stay, and reduce the 28-day mortality.


Assuntos
Sepse/terapia , APACHE , Humanos , Unidades de Terapia Intensiva , Prognóstico , Choque Séptico
8.
Medicine (Baltimore) ; 98(40): e17392, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577746

RESUMO

This study aims to construct a neural network to predict weaning difficulty among planned extubation patients in intensive care units.This observational cohort study was conducted in eight adult ICUs in a medical center about adult patients experiencing planned extubation.The data of 3602 patients with planned extubation in ICUs of Chi-Mei Medical Center (from Dec. 2009 through Dec. 2011) was used to train and test an artificial neural network (ANN) model. The input features contain 47 clinical risk factors and the outputs are classified into three categories: simple, difficult, and prolonged weaning. A deep ANN model with four hidden layers of 30 neurons each was developed. The accuracy is 0.769 and the area under receiver operating characteristic curve for simple weaning, prolonged weaning, and difficult weaning are 0.910, 0.849, and 0.942 respectively.The results revealed that the ANN model achieved a good performance in prediction the weaning difficulty in planned extubation patients. Such a model will be helpful for predicting ICU patients' successful planned extubation.


Assuntos
Extubação/métodos , Desmame do Respirador/métodos , APACHE , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
9.
Med. clín (Ed. impr.) ; 153(7): 270-275, oct. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-185335

RESUMO

Background and objective: To describe the characteristics and the evolution of patients with solid tumours admitted to the ICU and to identify factors associated with hospital mortality and to evaluate three illness severity scores. Material and methods: Descriptive study including 132 patients with solid tumour admitted to the ICU (2010-2016). Demographics and cancer-related data, organ failures, life-supporting therapies and severity scores: APACHE II, SOFA and ICU Cancer Mortality Model (ICMM) were collected. Results: There were 58 patients admitted for medical reasons and 74 for scheduled surgery. The ICU and hospital mortality rate were 12.9% and 19.7%, respectively. The medical reason for admission, the number of organ failures, and the need of life-supporting therapies were significantly associated with a higher mortality (p<0.05). In the logistic regression analysis, the three severity scores: SOFA (OR 1.18, 95% IC 1.14-1.48), APACHE II (OR 1.11, 95% CI 1.09-1.27), and ICMM (OR 1.03, 95% CI 1.02-1.07) were independently associated with a higher mortality (p<0.05). To evaluate the discrimination, the area under the receiver operating characteristics curves (AUROC) were calculated: APACHE II (0.795, 95% CI 0.69-0.9), SOFA (0.77, 95% CI 0.69-0.864) and ICMM (0.794, 95% CI 0.697-0.891). The comparison of AUC ROC after DeLong's test showed no difference between them. Conclusion: Hospital mortality was associated with the type and severity of acute illness. The three severity scores were useful to assess outcome and accurate in the discrimination, but we did not find a significant difference between them


Introducción y objetivo: Describir las características generales y la evolución de los pacientes con tumores sólidos ingresados en una unidad de cuidados intensivos (UCI), identificar los factores asociados a la mortalidad y evaluar el valor pronóstico de 3 escalas de gravedad. Material y métodos: Estudio descriptivo de 132 pacientes con diagnóstico de tumour sólido admitidos en la UCI (2010-2016). Se analizaron los datos demográficos relacionados con el tumour, la disfunción orgánica y las terapias de soporte vital, así como las escalas de gravedad APACHE II, SOFA e ICMM. Resultados: Ingresaron 58 pacientes por causa médica y 74 tras cirugía programada. La tasa de mortalidad en la UCI y hospitalaria fue del 12,9% y 19,7%, respectivamente. La causa médica de ingreso, el número de fallos orgánicos y la necesidad de terapias de soporte vital se asociaron significativamente con mayor mortalidad (p<0,05). En el análisis por regresión logística las 3 escalas evaluadas: SOFA (OR: 1,18; IC 95%: 1,14-1,48), APACHE II (OR: 1,11; IC 95%: 1,09-1,27) e ICMM (OR: 1,03; IC 95%: 1,02-1,07) se asociaron de forma independiente con una mayor mortalidad (p<0,05). Para evaluar la discriminación, se calcularon las AUROC: APACHE II (0,795; CI 95%: 0,69-0,9), SOFA (0,77; CI 95%: 0,69-0,864) e ICMM (0,794; CI 95%: 0,697-0,891). La comparación de las mismas por el test DeLong no mostró diferencias entre los sistemas de puntuación. Conclusiones: La mortalidad hospitalaria se asoció con el tipo y la gravedad de la enfermedad aguda. Las e escalas de gravedad evaluadas fueron igualmente útiles para evaluar el pronóstico, sin mostrar diferencias entre ellas


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Índice de Gravidade de Doença , Neoplasias/diagnóstico , Unidades de Terapia Intensiva , Prognóstico , Gravidade do Paciente , Mortalidade Hospitalar , Estudos Retrospectivos , APACHE , Escores de Disfunção Orgânica
10.
J Clin Neurosci ; 69: 245-249, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31542299

RESUMO

BACKGROUND/OBJECTIVE: Stroke is the second leading cause of death globally that predisposed to sepsis. Therefore, this study was aimed to assess the risk factors and epidemiologic features of sepsis in ischemic stroke patients admitted to ICUs. METHODS: Throughout this prospective study, we investigated all severe ischemic stroke patients admitted to ICUs of Namazi and Ali-Ashghar Hospitals in Shiraz. After ICU admission and diagnosing stroke by a neurologist according to NIHSS (National Institute of Health Stroke Scale) criteria, sepsis work-up was performed in all patients suspected to have sepsis. Then the incidence of sepsis and its risk factors in ICU admitted stroke patients were determined. RESULTS: A total of 149 patients were screened in this study. The mean age of the participants was 65.37 ±â€¯15.40 years old and 57.4% of them were male. Hypertension was the most common coexistent disease (74.6%) in stroke patients. Seventy-six patients (62.3%) were diagnosed with sepsis and pneumonia was the most common infection leading to sepsis in stroke patients. Our data showed significant differences between two groups in terms of APACHE-IV score (P < 0.001), NIHSS and APS (P < 0.001) before ICU admission (P < 0.001) and NIHSS at admission (P < 0.001); however, age (P = 0.07) and sex (P = 0.17) were not significantly different between the groups. Logistic regression analysis displayed that severe stroke (NIHSS = 21-42, OR = 49.09) and severe loss of consciousness (GCS < 8, OR = 27.95) at admission were the most essential predictive factors for sepsis after ischemic stroke. CONCLUSIONS: This study showed that ICU patients with severe ischemic stroke were more susceptible to sepsis during the hospital course.


Assuntos
Sepse/epidemiologia , Sepse/etiologia , Acidente Vascular Cerebral/complicações , APACHE , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 938-941, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537215

RESUMO

OBJECTIVE: To investigate the assessment values of procalcitonin (PCT), lactic acid (LAC), sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation II (APACHE II) score in patients with sepsis. METHODS: 140 patients with suspicious bacterial infection admitted to emergency department of Beijing Chaoyang Hospital of the Capital Medical University from August 2017 to June 2018 were enrolled. They were divided into three groups according to diagnostic criteria of Sepsis-3: non-sepsis group (n = 58), sepsis group (n = 66) and septic shock group (n = 16). The PCT, LAC, SOFA score, APACHE II score, 28-day prognosis, and positive detection rate of PCT and LAC were compared among three groups. Independent predictors of 28-day mortality were analyzed by Logistic regression; predictive values of PCT, LAC, SOFA score and APACHE II score for 28-day mortality in sepsis patients were analyzed by receiver operating characteristic (ROC) curve. RESULTS: PCT, LAC, SOFA score, APACHE II score at admission, and 28-day mortality in sepsis group and septic shock group were significantly higher than those in non-sepsis group, and PCT, LAC, APACHE II score, and 28-day mortality in sepsis shock group were further higher than those in sepsis group [PCT (µg/L): 38.1±12.6 vs. 4.6±2.3, LAC (mmol/L): 3.3±2.1 vs. 2.4±2.1, APACHE II score: 14.9±2.4 vs. 9.5±4.3, 28-day mortality: 75.0% vs. 24.2%, all P < 0.05]. The positive detection rate of PCT and LAC in sepsis group and septic shock group were higher than those in non-sepsis group (positive detection rate of PCT: 56.1%, 81.3% vs. 32.8%; positive detection rate of LAC: 42.4%, 62.5% vs. 13.7%; all P < 0.01). Logistic regression analysis showed that PCT, LAC, SOFA score and APACHE II score were independent predictors of 28-day mortality [PCT: odds ratio (OR) = 0.933, 95% confidence interval (95%CI) = 0.878-0.991; LAC: OR = 0.539, 95%CI = 0.347-0.838; SOFA score: OR = 0.291, 95%CI = 0.514-0.741; APACHE II score: OR = 0.808, 95%CI = 0.669-0.976; all P < 0.05]. ROC curve analysis showed that the area under ROC curve (AUC) of PCT, LAC, SOFA score and APACHE II score predicting 28-day mortality was 0.76, 0.86, 0.81 and 0.87, respectively. The assessment values of APACHE II score and LAC were higher than PCT in predicting 28-day mortality (Z1 = 2.56, Z2 = 2.45, both P < 0.01), and the performance of SOFA score was similar to PCT. CONCLUSIONS: PCT, LAC, SOFA score and APACHE II score were reliable indexes to evaluate disease severity for patients diagnosed with infection. The assessment values of APACHE II score and LAC in 28-day mortality were superior to SOFA score and PCT.


Assuntos
Ácido Láctico/metabolismo , Pró-Calcitonina/metabolismo , Sepse/metabolismo , APACHE , Humanos , Escores de Disfunção Orgânica , Prognóstico , Curva ROC
12.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 967-971, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537221

RESUMO

OBJECTIVE: To explore the effect of post-pyloric feeding by spiral nasoenteric tubes on ventilator-associated pneumonia (VAP) in neurocritical care patients. METHODS: A retrospective study was performed to analyze the clinical data of 175 neurocritical care adult patients with mechanical ventilation (MV) more than 48 hours, who were enrolled in three randomized controlled trials (RCT) conducted by Guangdong Provincial People's Hospital for post-pyloric tube placement between April 2012 to March 2019. The following patient clinical data were collected when patients were enrolled: gender, age, neurologic diagnosis, comorbidities, medication, endotracheal reintubation, bronchoscope treatment, the distal site of nasoenteric tubes, and acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, Glasgow coma scale (GCS) score, and acute gastrointestinal injury (AGI) grade assessed. Patients were divided into VAP group and non-VAP group according to the occurrence of VAP, and the differences of each index between the two groups were compared. Then the influencing factors of P < 0.1 were included in multivariate Logistic regression analysis to identify the potential risk factors affecting the incidence of VAP. Furthermore, patients were divided into gastric feeding group and post-pyloric feeding group according to the distal site of nasoenteric tubes, and subgroup analysis was performed to evaluate the variety of VAP in patients with different tube sites and status. RESULTS: (1) Forty-two patients occurred VAP in 175 MV patients, and the incidence of VAP was 24.0%. (2) Univariate analysis showed the P value of post-pyloric feeding, APACHE II score, GCS score and bronchoscope treatment were less than 0.1, and post-pyloric feeding and GCS score in VAP group were significantly lower than those in non-VAP group [post-pyloric feeding: 19.0% (8/42) vs. 36.8% (49/133), GCS: 5 (3, 7) vs. 6 (4, 9), both P < 0.05]. Multivariate Logistic regression analysis indicated that post-pyloric feeding was independent protective factor [odds ratio (OR) = 0.360, 95% confidence internal (95%CI) = 0.151-0.857, P = 0.021] and bronchoscope treatment was the independent risk factor (OR = 2.210, 95%CI = 1.051-4.647, P = 0.036) for VAP. (3) The incidence of VAP was 28.8% (34/118), 0% (0/4), 8.3% (1/12), 26.7% (4/15), 22.2% (2/9) and 5.9% (1/17) respectively when tube tip in stomach, D1, D2, D3, D4 and jejunum confirmed by abdominal radiography. Post-pyloric feeding in each proportion seemed to present lower VAP rate compared with gastric feeding, however, no significant difference was found (all P > 0.05). (4) The incidence of VAP in post-pyloric feeding group was significantly lower than that in gastric feeding group [14.0% (8/57) vs. 28.8% (34/118), OR = 0.403, 95%CI = 0.173-0.941, P = 0.032]. Lower VAP rate appeared on patients with SOFA < 12 (OR = 0.392, 95%CI = 0.154-0.995, P = 0.044) and AGI grade ≥ II (OR = 0.086, 95%CI = 0.011-0.705, P = 0.006) fed by post-pyloric route according to the result of subgroup analysis stratified by age, gender, APACHE II score, SOFA score and AGI grade. CONCLUSIONS: Post-pyloric feeding would decrease the incidence of VAP in neurocritical care patients on MV.


Assuntos
Pneumonia Associada à Ventilação Mecânica , APACHE , Adulto , Humanos , Unidades de Terapia Intensiva , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
13.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 998-1003, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537227

RESUMO

OBJECTIVE: To investigate the value of renal resistive index (RRI) in early predictor and discriminator of severe acute pancreatitis (SAP)-related acute kidney injury (AKI). METHODS: A retrospective observational study was conducted. SAP patients complicated with AKI (within 1 week of onset) and admitted to intensive care unit (ICU) of Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2016 to June 2019 were enrolled. The RRI within 24 hours admission was measured. Clinical data such as acute physiology and chronic health evaluation II (APACHE II), heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), intra-abdominal pressure (IAP), arterial blood lactate (Lac), oxygenation index (PaO2/FiO2), base excess (BE), serum creatinine (SCr), urine output, norepinephrine (NE) and RRI were collected. Within 24 hours and 7 days after ICU admission, patients were grouped according to AKI classification criteria of Kidney Disease: Improving Global Outcomes (KDIGO), and the differences of relevant parameters were statistically analyzed. Influence factors of AKI grading were screened by Logistic regression analysis. Pearson correlation analysis was used to analyze the correlation between RRI and other parameters. The predictive value of RRI for AKI classification was analyzed by receiver operating characteristic (ROC) curve. RESULTS: A total 57 patients were included, with an average age of (54.6±13.5) years old, and APACHE II score of 21.8±5.6. Within 24 hours, the number of patients suffered from stage 1-3 AKI were 19 (33.3%), 18 (31.6%) and 20 (35.1%), respectively. On day 7, the number of patients suffered from stage 0-3 AKI were 21 (36.9%), 8 (14.0%), 9 (15.8%) and 19 (33.3%), respectively. The higher APACHE II score, CVP, IAP, Lac, NE dosage and RRI were found in the group with higher AKI grades, especially in the group with stage 3 AKI on day 7. RRI of patients with stage 3 AKI was significantly higher than that of patients with stage 1 and 2 AKI within 24 hours (0.74±0.04 vs. 0.65±0.05, 0.68±0.05, both P < 0.05). Similarly, RRI of patients with stage 2 and 3 AKI were significantly higher than that of patients with stage 0 and 1 AKI on day 7 (0.70±0.04, 0.74±0.04 vs. 0.65±0.05, 0.66±0.05, all P < 0.05). Multivariate Logistic regression analysis showed that RRI was an independent factor of AKI classification [odds ratio (OR) = 3.15, 95% confidence interval (95%CI) = 1.09-9.04, P < 0.05], and IAP and CVP also had significant impacts on AKI grading [OR value was 2.11 (95%CI = 1.16-4.22), 3.78 (95%CI = 1.21-12.90), both P < 0.05]. ROC curve analysis showed that the area under curve (AUC) of RRI for predicting AKI ≥2 stage was 0.87 (P < 0.05); the cut-off > 0.71, sensitivity was 71% and specificity was 83%. The correlation analysis showed that RRI was positively correlated to a certain extent with IAP and lactic acid (r1 = 0.49, r2 = 0.39, both P < 0.05). CONCLUSIONS: High RRI on ICU admission was a significant predictor for development of severe AKI during the first week, and RRI can help predict the tendency of AKI in SAP.


Assuntos
Lesão Renal Aguda , Pancreatite , APACHE , Adulto , Idoso , China , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
14.
Medicine (Baltimore) ; 98(33): e16744, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415369

RESUMO

MicroRNAs (miRNAs) play an important role in the pathogenesis of sepsis, but the association of miRNAs single nucleotide polymorphisms (SNPs) and sepsis risk is not clear. We analyzed plasma levels of miR-187, miR-21, and miR-145 in 180 patients with sepsis and 180 healthy controls were analyzed, and the SNPs: rs12605436, rs13137, and rs353291 were detected by sequencing. Plasma levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6 were measured in all subjects by enzyme-linked immunosorbent assay (ELISA). The results showed that the levels of TNF-α and IL-6 in the plasma of patients with sepsis were significantly higher than those in patients of the control group (P < .0001). Plasma levels of miR-187 in patients with sepsis were significantly lower than those in the control group, while those of miR-21 and miR-145 were significantly higher than those in the control group (P < .0001). Plasma levels of miR-187 in sepsis patients were inversely correlated with those of TNF-α and IL-6 (r = -0.2841, -0.2163), and plasma levels of miR-21 and miR-145 were positively correlated with those of TNF-α and IL-6 (r = 0.615, 0.3057, 0.4465, 0.2734). The T allele of the miR-187 SNP rs12605436 was found to be a risk factor for sepsis (OR = 1.403, 95% CI = 1.205-1.612, P < .001). The T allele of the miR-21 SNP rs13137 and the T allele of the miR-145 SNP rs353291 (OR = 0.685, 95% CI = 0.566-0.820, P < .001) were found to be a protective factor for sepsis (OR = 0.755, 95% CI = 0.632-0.896, P < .001). From our results, we can see that the plasma levels of miRNAs containing the SNPs rs12605436, rs13137, and rs353291 are associated with the occurrence of sepsis.


Assuntos
Predisposição Genética para Doença , MicroRNAs/genética , Polimorfismo de Nucleotídeo Único , Sepse/genética , APACHE , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , China , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Sepse/sangue , Fator de Necrose Tumoral alfa/sangue
15.
Medicine (Baltimore) ; 98(33): e16871, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415425

RESUMO

Predicting long-term outcomes after sepsis is important when caring for patients with this condition. The purpose of the present study was to develop models predicting long-term mortality of patients with sepsis, including septic shock.Retrospective data from 446 patients with sepsis (60.8% men; median age, 71 years) treated at a single university-affiliated tertiary care hospital over 3 years were reviewed. Binary logistic regression was used to identify factors predicting mortality at 180 and 365 days after arrival at the emergency department. Long-term prognosis scores for the 180- and 365-day models were calculated by assigning points to variables according to their ß coefficients.The 180- and 365-day mortality rates were 40.6% and 47.8%, respectively. Multivariate analysis identified the following factors for inclusion in the 180- and 365-day models: age ≥65 years, body mass index ≤18.5 kg/m, hemato-oncologic diseases as comorbidities, and ventilator care. Patients with scores of 0 to ≥3 had 180-day survival rates of 83.8%, 70.8%, 42.3%, and 25.0%, respectively, and 365-day survival rates of 72.1%, 64.6%, 36.2%, and 15.9%, respectively (all differences P < .001; log-rank test). The areas under the receiver operating characteristic curves of the 180- and 365-day models were 0.713 (95% confidence interval [CI] 0.668-0.756, P < .001) and 0.697 (95% CI 0.650-0.740, P < .001), respectively.These long-term prognosis models based on baseline patient characteristics and treatments are useful for predicting the 6- and 12-month mortality rates of patients with sepsis.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Choque Séptico/mortalidade , Análise de Sobrevida , APACHE , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comorbidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Respiração Artificial/efeitos adversos , Adulto Jovem
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(7): 827-831, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31441404

RESUMO

OBJECTIVE: To evaluate the predictive value of neutrophil to lymphocyte ratio (NLR) on 28-day mortality of patients with severe pneumonia. METHODS: The clinical data of 214 severe pneumonia patients admitted to the department of emergency medicine of the First Affiliated Hospital of Xi'an Jiao Tong University from January 2015 to December 2018 were retrospectively analyzed. The clinical parameters, such as gender, age, underlying diseases, and blood routine, procalcitonin (PCT), liver and kidney function, blood lactic acid (Lac), arterial partial pressure of oxygen (PaO2) at admission or within 24 hours after admission were reviewed. NLR, oxygenation index (PaO2/FiO2) and acute physiology and chronic health evaluation II (APACHE II) were calculated, and the change tendency of each index within 3 days after admission were observed. The patients were divided into survival group and death group according to 28-day outcomes. Multivariate Logistic regression analysis was used to screen the high risk factors of 28-day mortality in patients with severe pneumonia. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of NLR for 28-day mortality risk in patients with severe pneumonia. RESULTS: 214 patients were enrolled in the analysis, 132 survived in 28 days and 82 died. Compared with survival group, the white blood cell (WBC), neutrophil (NEU), NLR, PCT, Lac and APACHE II scores were significantly increased, and lymphocyte (LYM) was significantly decreased in the death group. There was no significant difference in gender, age, basic diseases, platelet count (PLT), liver and kidney function parameters, or PaO2/FiO2 between the two groups. The NLR, PCT, Lac and APACHE II score in the death group were increased gradually within 3 days after admission, PaO2/FiO2 was decreased gradually, which showed significant differences as compared with survival group at 3 days after admission [NLR: 27.15±7.61 vs. 14.66±4.83, PCT (µg/L): 13.52±3.22 vs. 6.41±4.22, Lac (mmol/L): 6.78±1.70 vs. 2.74±1.15, APACHE II score: 37.76±5.30 vs. 22.11±4.94, PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 114.12±20.16 vs. 186.49±13.95, all P < 0.05]. Multiple Logistic regression analysis showed that NLR [odds ratio (OR) = 1.163, 95% confidence interval (95%CI) = 1.007-1.343, P = 0.040], PCT (OR = 1.210, 95%CI = 1.098-1.333, P = 0.001), Lac (OR = 1.263, 95%CI = 1.011-1.579, P = 0.040) and APACHE II score (OR = 1.103, 95%CI = 1.032-1.179, P = 0.004) were the independent risk factors of 28-day mortality in the patients with severe pneumonia. ROC curve analysis showed that compared with the traditional indicators including PCT, Lac, and APACHE II score, NLR showed a good predictive value for 28-day mortality in the patients with severe pneumonia [area under ROC curve (AUC): 0.791 vs. 0.707, 0.690, 0.720]. When the optimal cut-off value of NLR was 14.92, the sensitivity was 71.95% and the specificity was 73.48%, meanwhile, the positive likelihood ratio was 2.713 and the negative likelihood ratio was 0.382. CONCLUSIONS: The increased NLR at admission is a high risk factor of 28-day mortality in patients with severe pneumonia, which is useful for predicting prognosis of patients with severe pneumonia.


Assuntos
Neutrófilos , Pneumonia/mortalidade , APACHE , Humanos , Linfócitos , Pneumonia/metabolismo , Prognóstico , Curva ROC , Estudos Retrospectivos
17.
Med Sci Monit ; 25: 5969-5976, 2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31400275

RESUMO

BACKGROUND This study aimed to assess the prevalence, clinical characteristics, and risk factors for sinistral portal hypertension in patients with moderate or severe acute pancreatitis. MATERIAL AND METHODS A retrospective study included 825 patients with moderate or severe acute pancreatitis. Clinical and demographic data, the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Ranson scores for severity of acute pancreatitis, and the computed tomography (CT) severity index (CTSI) were evaluated. The formation of collateral vessels, bleeding, splenomegaly, hypersplenism during hospitalization or follow-up, and early anticoagulation and the occurrence of sinistral portal hypertension were evaluated. RESULTS Of the 825 patients with moderate or severe acute pancreatitis, 103 patients (12.5%) developed sinistral portal hypertension. The median time to diagnosis was 8 months, and the median patient age was 39 years. The most common causes of pancreatitis were biliary (46.3%), hypertriglyceridemia (31.5%), alcohol (14.9%), and others (7.3%). Independent risk factors for sinistral portal hypertension were male gender (OR, 4.666; 95% CI, 2.54-8.572; P<0.001), recurrent acute pancreatitis (OR, 9.556; 95% CI, 5.218-17.5; P<0.001), hypertriglyceridemia (OR, 2.056; 95% CI, 1.184-3.57; P=0.001), glucose >10 mmol/L (OR, 6.965; 95% CI, 4.027-12.045; P<0.001), smoking (OR, 6.32; 95% CI, 3.544-11.269; P<0.001), and infection of walled-off necrosis (OR=1.637; 95% CI, 1.061-2.524; P=0.015). Anticoagulation during hospitalization was not significantly associated with sinistral portal hypertension. CONCLUSIONS Hypertriglyceridemia, hyperglycemia, infection of walled-off necrosis, recurrent acute pancreatitis, and smoking were risk factors for sinistral portal hypertension, and early anticoagulation did not prevent the occurrence.


Assuntos
Hipertensão Portal/complicações , Hipertensão Portal/etiologia , Pancreatite/complicações , APACHE , Doença Aguda , Adulto , Feminino , Humanos , Hipertensão Portal/metabolismo , Hipertrigliceridemia/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
18.
Z Rheumatol ; 78(10): 925-931, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31468166

RESUMO

Patients with rheumatic diseases have an increased risk for admission to an intensive care unit (ICU) compared with individuals without these diseases. Besides cardiovascular events, infection complications are frequently the reason for ICU treatment. For autoimmune systemic diseases, such as systemic lupus erythematosus (SLE) and granulomatosis with polyangiitis (GPA), it is not uncommon for the disease to be first diagnosed during intensive medical care. In addition, flares of these diseases can necessitate ICU admission of the patients. The mortality of patients with rheumatic diseases on the ICU is increased compared with control collectives, especially in patients suffering from life-threatening infections. Treatment with corticosteroids is associated with an increased risk for ICU admission as well as a poorer survival rate. In contrast, patients treated with conventional and biologic disease-modifying anti-rheumatic drugs (DMARD) are less likely to need ICU treatment, compared with rheumatism patients without these medications. Among the established scoring systems applied to estimate the prognosis of ICU patients, the APACHE II score is the best investigated system in patients suffering from rheumatic diseases. This score probably reflects the condition of these patients better than other scoring systems.


Assuntos
Unidades de Terapia Intensiva , Doenças Reumáticas , APACHE , Cuidados Críticos , Humanos , Prognóstico , Estudos Retrospectivos , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/terapia
19.
Medicine (Baltimore) ; 98(35): e16939, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464931

RESUMO

The tracheostomy timing for patients with prolonged mechanical ventilation (PMV) was usually delayed in our country. Both physician decision time and tracheostomy delay time (time from physician's suggestion of tracheostomy to procedure day) affect tracheostomy timing. The effect of tracheostomy delay time on outcome has not yet been evaluated before.Patients older than 18 years who underwent tracheostomy for PMV were retrospectively collected. The outcomes between different timing of tracheostomy (early: ≤14 days; late: >14 days of intubation) were compared. We also analyzed the effect of physician decision time, tracheostomy delay time, and procedure type on clinical outcomes.A total of 134 patients were included. There were 57 subjects in the early tracheostomy group and 77 in the late group. The early group had significantly shorter mechanical ventilation duration, shorter intensive care unit stays, and shorter hospital stays than late group. There was no difference in weaning rate, ventilator-associated pneumonia, and in-hospital mortality. The physician decision time (8.1 ±â€Š3.4 vs 18.2 ±â€Š8.1 days, P < .001) and tracheostomy delay time (2.1 ±â€Š1.9 vs 6.1 ±â€Š6.8 days, P < .001) were shorter in the early group than in the late group. The tracheostomy delay time [odds ratio (OR) = 0.908, 95% confidence interval (CI) = 0.832-0.991, P = .031) and procedure type (percutaneous dilatation, OR = 2.489, 95% CI = 1.057-5.864, P = .037) affected successful weaning. Platelet count of >150 × 10/µL (OR = 0.217, 95% CI = 0.051-0.933, P = .043) and procedure type (percutaneous dilatation, OR = 0.252, 95% CI = 0.069-0.912, P = .036) were associated with in-hospital mortality.Shorter tracheostomy delay time is associated with higher weaning success. Percutaneous dilatation tracheostomy is associated with both higher weaning success and lower in-hospital mortality.


Assuntos
Respiração Artificial/estatística & dados numéricos , Traqueostomia/métodos , Desmame do Respirador/estatística & dados numéricos , APACHE , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Mortalidade Hospitalar/tendências , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Estudos Retrospectivos , Taiwan/epidemiologia , Fatores de Tempo
20.
Medicine (Baltimore) ; 98(35): e16944, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464933

RESUMO

INTRODUCTION: Head and neck cancer patients are at a high risk to suffer from malnourishment, a risk that increases in postoperative condition and with the use of enteral nutrition (EN). Until now patients who are suffering from indigestion in the intensive care unit (ICU) received treatment in the form of prokinetic drugs, drugs that can lead to serious side effects and only can partially improve digestion functions. Acupuncture was used successfully in several clinical trials to improve postoperative indigestion in cancer patients without any reported adverse events. The study aims are to investigate acupuncture effect in combination with prokinetic drugs in the treatment of indigestion in postoperative oral and hypopharyngeal cancer patients in the ICU. METHODS: Single-center, double-blind randomized control trial will compare between 2 equal groups. A total of 28 patients that will meet the inclusion criteria: age 30 to 80, postplastic surgery for oral cancer or hypopharyngeal cancer, developed feeding intolerance 2 times in the first postoperative day, Apache score <20, and needed EN. Patients will be randomly divided (1:1) into treatment group or control group for 3 treatments in 3 days along with routine ICU treatment. The main outcome measurement will be the number of days a patient needs to reach his total energy expenditure. EXPECTED OUTCOME: The results will shed light on the effectiveness and safety of acupuncture in a double-blind design treating postoperative ICU cancer patients. In addition, the study presents a revolutionary double-blind design that if, will prove as successful might influence the way double-blind acupuncture studies are performed today. OTHER INFORMATION: The study will be conducted in the surgical ICU department, of China medical university hospital, Taichung 404, Taiwan. The study is conducted on stable ICU patients and is anticipated to have minimum risk for adverse events. Patients enrollment and data collection will start from May 15, 2019. The study expected completion time: June 2021.


Assuntos
Terapia por Acupuntura/métodos , Cuidados Críticos/métodos , Dispepsia/terapia , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Bucais/cirurgia , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Dispepsia/etiologia , Nutrição Enteral/métodos , Feminino , Humanos , Neoplasias Hipofaríngeas/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/complicações , Cuidados Pós-Operatórios , Projetos de Pesquisa , Taiwan
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