The Chinese Society of Critical Care Medicine (CSCCM) has developed the clinical practice guidelines of nutrition assessment and monitoring for patients in adult intensive care unit (ICU) of China. This guideline focuses on nutrition assessment and metabolic monitoring to achieve the optimal and individualized nutrition therapy for critical ill patients. This guideline was made by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough system review and summary of relevant trials or studies published from 2000 to July 2023. A total of 18 recommendations were formed and consensus was reached through discussions and review by expert groups in critical care medicine, parenteral and enteral nutrition, and surgery. The recommendations are based on the currently available evidence and cover several key fields, including nutrition risk screening and assessment, evaluation and assessment of enteral feeding intolerance, metabolic and nutritional measurement and monitoring during nutrition therapy, and organ function evaluation related to nutrition supply. Each question was analyzed according to the PICO principle. In addition, interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value. The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3 to 5 years.
Objective:To investigate the psychological status and its related factors of maternal women in the intensive care unit (ICU).Methods:A total of 101 maternal women in the ICU were included in the study. The Hospital Anxiety and Depression Scale was used to screen the anxiety and/or depression of include patients. The factors that associated with anxiety and depression were analyzed.Results:The anxiety rate was 50.5% (51/101) and depressive rate was 49.5% (50/101) in these patients. Univariate analysis showed that education (χ2=8.755, P＜0.05; χ2=12.695, P＜0.01), pregnancy outcome (χ2=6.179, P＜0.05), VAS score (Z=2.091, P＜0.05) and APACHE Ⅱ score (Z=2.663, P＜0.01) other than age, marriage, health insurance payment status, number of deliveries, the experience of miscarriage, receive mechanical ventilation and sedative drug (P＞0.05) were associated with anxiety and depression. Multivariable logistic regression analysis showed that high VAS score (OR=1.185, P＜0.05), high APACHE Ⅱ score (OR=1.095, P＜0.05) and adverse pregnancy outcome (OR=4.067, P＜0.01) were risk factors of the development of anxiety and depression, while high education was a protective factor for the development of anxiety and depression (OR=0.253, P＜0.01; OR=0.183, P＜0.01; OR=0.148, P＜0.001).Conclusion:There is a high incidence of maternal anxiety and depression in the ICU in maternal patients. The pregnancy outcome, severity of illness, pain severity and education level are associated with anxiety and depression.
Objective:To evaluate the effect of high density lipoprotein (HDL) level on the occurrence of sepsis-related acute respiratory distress syndrome (ARDS).Methods:A total of 222 patients with sepsis admitted to the Intensive Care Department of the Space Center Hospital were divided into ARDS group (102 cases) and non-ARDS group (120 cases) according to the occurrence of ARDS. Clinical data of all patients were collected. Unifactor and multifactor logistic regression were used to analyze the risk factors of ARDS in patients with sepsis. Receiver operating characteristic curves (ROC) was used to analyze the predictive efficacy of HDL for sepsis related ARDS patients.Results:(1) 102 cases of sepsis developed ARDS, the incidence rate was 45.95%. (2) The levels of HDL, albumin (ALB) in peripheral blood of ARDS patients were significantly lower than those of non-ARDS patients, but acute physiological and chronic health score (APACHE Ⅱ), the levels of procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) were significantly higher than those of non ARDS patients, all the differences were statistically significant (P＜0.05). Multifactor logistic regression analysis showed that high APACHE Ⅱ score, high level of CRP and low level of HDL were risk factors for ARDS in sepsis patients. (3) The area under curve (AUC) of ROC of HDL for predicting ARDS patients with sepsis was 0.722, and 0.81 mmol/L was used as the critical point for predicting ARDS. The sensitivity was 76.67%, and the specificity was 65.69%.Conclusion:Low level of HDL is an independent risk factor of sepsis complicated with ARDS. HDL level has certain predictive value in the occurrence and prognosis of ARDS induced by sepsis.
Objective:To evaluate the value of plasma heparin binding protein (HBP) in the early diagnosis of sepsis, and to explore the application value of HBP for the severity and prognosis assessment of sepsis.Methods:A prospective observational study was conducted in Department of Critical Care Medicine of Northern Jiangsu People's Hospital. One hundred and ninety-eight patients with confirmed infections from June 2019 to June 2021 were enrolled in this study. According to the illness severity of sepsis, patients were assigned as non-sepsis (n=48), sepsis (n=52) and septic shock (n=98). Forty patients in the same period without infection were selected as control group. The differences in HBP, procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and lactate (Lac) levels were compared and analyzed. The prognostic values on sepsis diagnosis and 28-day mortality were evaluated through drawing receiver operating characteristic (ROC) curve. Logistic regression analysis was used to clarify the factors affecting the prognosis of sepsis.Results:The plasma level of HBP was obviously elevated in septic shock group than patients in other three groups (P＜0.05), while patients in sepsis group had higher HBP than patients in non-sepsis group (P＜0.05). Take an optimal cutoff value of 35.8 ng/ml, the area under the curve (AUC) for HBP to distinguish sepsis from from non-sepsis was 0.922. The levels of HBP and Lac were also significantly elevated in non-survivors compared to survival group (P＜0.05). Ho sever, no significant differences of PCT, CRP and WBC levels were found between the two groups. Plasma HBP＞97.6 ng/ml was associated with elevated mortality, AUC of HBP predicting 28-day mortality of sepsis patients was 0.750, with a sensitivity of 65.5% and a specificity of 77.7%. The plasma HBP levels in death group were higher than those in survival group at 0 h, 24 h, 48 h and 72 h after admission (P＜0.05). Meanwhile, in death group, the plasma HBP level showed no statistical differences in each time point compared with that in the previous time point (P＞0.05).Conclusion:HBP can be a better and more specific early predictor of sepsis compared with PCT, CRP, WBC and Lactate. Meanwhile, the level and tendency of HBP has valuable to evaluate the severity of sepsis and mortality.
Analgesia and sedation are crucial for critically ill patients. In recent years, a comprehensive strategy featuring prioritized analgesia, light sedation, delirium screening and prevention, early mobility and sleep improvement has been formed. However, a concise and easy-to-operate flow chart still needs to be improved. We have developed a protocolized process for pain and agitation management for critically ill patients to provide a hands-on tool in clinical practice.
Objective:To analyze the current status of Carbapenem-resistant Enterobacteriaceae (CRE) colonization and infection in ICU of Qinghai University Affiliated Hospital, and to evaluate the impact of CRE colonization on CRE infection.Methods:A prospective study was performed. Patients who were admitted to the ICU of Qinghai University Affiliated Hospital and met the inclusion and exclusion criteria from December 2020 to December 2021 were actively screened for CRE with anal swabs. The results of active CRE screening and CRE infection were collected.Results:A total of 296 patients were included in this study, and 18 patients were positive for CRE colonization, with a colonization rate of 6.08% (18/296). During the study period, a total of 6 patients developed CRE infection, with a rate of 2.03% (6/296). Four patients with CRE infection had a positive results of CRE colonization, with a colonization rate of 66.67% (4/6). By contrast, the colonization rate in non-CRE infected patients was 4.83% (14/290). CRE colonization had a consistent relationship with CRE infection (Kappa=0.312, P=0.000). Four of 6 patients with CRE infection died, with mortality rate of 66.67% (4/6). The CRE colonization strains were mainly Escherichia coli with mainly NDM type. Klebsiella pneumoniae was the main strain of CRE infection with a mainly NDM type.Conclusion:CRE colonized patients have a higher risk of CRE infection. Active anal swab screening for high-risk patient is helpful to detect CRE colonized strains early, which is beneficial to the prevention and control of CRE infection.
In recent years, with the advancement of medical, extracorporeal life support technology has become an important strategy for critically ill patients, such as continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), etc. Effective anticoagulation and less bleeding complications are the main contradictions that need to be solved urgently during extracorporeal life support. Currently, unfractionated heparin remains the most commonly used for anticoagulation. However, hemorrhage associated with systemic heparinization remains a major complication and is directly related to patient outcomes. Various improved anticoagulation techniques have been used to reduce the risk of bleeding. Nafamostat Mesylate (NM) is a synthetic ultra-short-acting serine protease inhibitor, which can play an anticoagulant role by inactivating thrombin and inhibiting the activation of coagulation factors. Evidences show that NM can reduce the incidence of bleeding without increasing the incidence of thromboembolism. We aim to summarize the anticoagulation application of NM in CRRT and ECMO in critically ill patients on the basis of existing literature reports, in order to provide reference for the anticoagulation management during treatment.
Objective:To investigate the incidence of sepsis in post-craniotomy stroke patients and its impact on prognosis of patients.Methods:This was a single-center prospective cohort study. All of the adult post-craniotomy stroke patients admitted into the intensive care unit (ICU) ward of Beijing Tiantan Hospital during study period (from January 1, 2017 to December 31, 2018) and with an ICU length of stay (LOS) longer than 24 hours were eligible. Patients with sepsis before craniotomy were excluded. Demographic and baseline clinical characteristics (age, gender, underlying disease, etc.), information about main diagnosis and surgery were collected. All patients were screened daily for presence of infection and sepsis. For patients with infection and/or sepsis, the infection sites and pathogens were recorded. All patients were followed up until discharge (alive or dead). The ICU LOS, hospital LOS, hospitalization costs, and Glasgow outcome scale (GOS) at discharge were recorded.Results:During study period, a total of 226 patients were included, among whom 115 (50.9%) were male and 111 (49.1%) were female. The mean age was (51.6±13.6) years. Patients with hemorrhagic stroke accounted for 87.2% (n=197), and patients with ischemic stroke accounted for 12.8% (n=29). Of all patients, 122 developed infection and 76 developed sepsis. The incidence of sepsis was 33.6% (95% CI: 27.4%-39.8%). Compared with non-septic patients, septic patients had longer median ICU LOS [13 (8, 22) d vs 4 (2, 7) d, Z=7.994, P＜0.001], longer hospital LOS [27 (17, 38) d vs 17 (10, 25) d, Z=5.579, P＜0.001], and higher hospitalization costs [140 406 (100 406, 217 111) yuan vs 87 034 (60 102, 119 352) yuan, Z=6.297, P＜0.001]. Logistic regression analysis showed that sepsis was not associated with death in stroke patients after craniotomy, but sepsis was an independent risk factor for poor prognosis (GOS≤3 points) (OR=2.205, 95% CI: 1.034-4.703, P=0.041).Conclusions:Patients have a higher risk of complicated sepsis during hospitalization after stroke craniotomy. Sepsis is not a risk factor for death during hospitalization, but can serve as an independent risk factor for poor prognosis.
Objective:To investigate the application of pulse-indicated continuous cardiac output (PiCCO) guided fluid resuscitation in septic shock patients with cardiac insufficiency.Methods:One hundred and fifty four septic shock patients with cardiac insufficiency in Department of Intensive Care Unit of Dongtai People's Hospital from June 2019 to December 2022 were randomly divided into research group (79 cases) and control group (75 cases). PiCCO guided fluid resuscitation in research group was compared the River's early goal-directed therapy (EGDT) guided fluid resuscitation in the control group. The total resuscitated fluid, lactic acid and lactate clearance at each time point, duration of mechanical ventilation, morality in ICU and mortality at 28 day were recorded and compared between two groups.Results:After resuscitation: (1) In terms of the total amount of resuscitation fluid, (2602±1086) ml in research group and (3296±919) ml in control group, there was significant difference between 2 groups (P＜0.05); (2) In terms of central venous pressure (CVP), there was no significant difference (P＞0.05) at initial time point, but much lower after 24 h in research group with significant difference (P＜0.05); (3) In terms of lactated and lactate clearance, lactate level at 6 hour was (4.44±1.67) mmol/L in research group and (5.03±1.74) mmol/L in control group, all 2 groups had decreased lactate levels compared with the initial levels, and lactate level at 6 and 24 hour were lower in research group, with significant differences (P＜0.05); Lactate clearance rate was significantly higher in research group than that in the control group at each time point, with significant differences (P＜0.05); (4) The mean arterial pressure (MAP) at different time points was increased compared with the initial MAP, but there was no statistically significant difference (P＞0.05). N terminal pro -brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) at 6 hour were lower in research group than those in the control group with significant differences (P＜0.05). In terms of dose of vasoactive drugs, dose of norepinephrine was significantly reduced in research group, with significant differences(P＜0.05). In terms of prognosis, duration of mechanical ventilation was significantly lower in research group, with significant differences (P＜0.05), but there was no significant difference in motalities (P＞0.05).Conclusion:PiCCO has important clinical value in guiding fluid resuscitation in septic shock patients with cardiac insufficiency, by reducing total amount of resuscitation fluid, decreasing lung water and cardiac preload, but still improving tissue perfusion.
Hypoxic-ischemic encephalopathy is a common sequela after cardiac arrest, and the prognosis of such patients with a markedly reduced quality of survival is often unsatisfactory. We present a case study of neurologic music therapy（NMT）for a maternal women with hypoxic-ischemic encephalopathy, to provide experience for the rehabilitation of critically maternal women with similar diseases. A critical care plan was formulated following a comprehensive assessment of the patient's condition, and NMT was gradually administered. After 46 days in the hospital, the patient was safely discharged with a good prognosis due to attentive nursing and NMT.
Objective:To evaluate the value of electric sequential organ failure assessment (eSOFA), quick sequential organ failure assessment (qSOFA) and system inflammatory reaction syndrome (SIRS) scoring system in predicting the prognosis of patients with sepsis in the non-ICU environment.Methods:Patients with sepsis in 10 non-ICU wards of Peking Union Medical College Hospital from October 2016 to March 2017 were prospectively analyzed. The clinical outcome of survival status 28 days after admission was taken as the prognostic index. The eSOFA, qSOFA and SIRS scores of the patients were calculated and the ROC curve was used to evaluate the prognostic value of eSOFA, qSOFA and SIRS scores.Results:A total of 193 patients met the Sepsis-3 diagnosis criteria. The AUROC of eSOFA, qSOFA and SIRS scores for predicting the prognosis of sepsis patients were 0.766 (95%CI: 0.700-0.824), 0.798 (95%CI: 0.700-0.896) and 0.589 (95%CI: 0.475-0.703) respectively. Among them, qSOFA had the best predictive performance, and both of qSOFA and eSOFA were better than SIRS.Conclusion:In non-ICU wards, qSOFA performed best in predicting prognosis of sepsis patients, eSOFA is the next and SIRS is the worst.
Objective:To construct and compare the nomogram prediction model of perioperative acute kidney injury (AKI) in Stanford type A and type B acute aortic dissection (AAD) patients.Methods:The data of patients diagnosed with AAD in our hospital from January 2019 to December 2021 were collected. The independent risk factors of TAAAD-AKI and TBAAD-AKI were screened by LASSO regression and multi-factor logistic regression, respectively, and the nomogram prediction model was constructed. Through the internal verification of bootstrapping, the advantages and disadvantages of the model were evaluated from three aspects: accuracy, calibration, and clinical benefit.Results:Data from 464 patients with AAD were collected. The incidence of TAAAD-AKI was 83.5% (147/176), whereas TBAAD-AKI was 41.0% (118/288). First serum creatinine (SCr) on admission, D-dimer value on admission, cardiopulmonary bypass time, mechanical ventilation time, and perioperative use of pressor medications were the independent risk variables for the creation of the TAAAD-AKI nomogram. The variables screened by TBAAD-AKI were first SCr on admission, poor renal perfusion on admission, days of ICU retention, and perioperative use of loop diuretics. The area under the curve (AUC) of receiver operating characteristic curves (ROC) of TAAAD-AKI model was 0.899, which implied a high level of accuracy. The AUC value of the TBAAD-AKI model was 0.825, indicating moderate accuracy. The two nomogram models had good calibration, according to the model's calibration curve and the Hosmer-Lemeshow test. The decision-making curve also found that the model had good clinical benefits.Conclusion:The predictors of TAAAD-AKI and TBAAD-AKI are distinct except for the first SCr on admission. While the majority of the TBAAD-AKI are preoperative, the significant TAAAD-AKI variables are primarily focused during and after the procedure. Constructing and verifying two feasible nomograms is crucial for clinical early warning of AKI.
Objective:To explore the effect of integrating ideological and political and humanistic education in critical care medicine teaching.Methods:The teaching team has integrated ideological, political and humanistic education into theoretical teaching through the aspects of establishing the education objectives of the course, strengthening the construction of teachers, exploring humanistic and ideological elements, adopting various teaching methods, creating humanistic and ideological and political material database, and optimizing evaluation mechanism. In order to clarify the effect of the reformation, a questionnaire survey was conducted among standardized training physicians and students majoring in anesthesia of grade 2017 and 2018.Results:The results of the questionnaire survey showed that 86.0% (92/107) of the students were satisfied with the teaching effect of humanistic and ideological and political education, 89.7% (96/107) of the students were satisfied with the teaching model of humanistic and ideological and political education in classroom, 89.7% (96/107) of the students thought that ideological, political and humanities teaching was very helpful to understand the knowledge of this subject, and 91.6% (98/107) of the students were satisfied with the achievement of educational objectives of the course.Conclusion:The reformation and practice of integrating ideological, political and humanitic education into teaching of critical care medicine in our hospital has achieved the expected educational goal, and has been widely accepted by students and highly praised by experts.
Sepsis is defined as life-threatening organ dysfunction caused by adysregulated host response to infection, considered as a major global public health problem. Though relevant studies focused on Chinese sepsis epidemiology were not comprehensive, those studies still suggested that compared with high-income countries (HICs), the incidence and mortality of sepsis in China were relatively high, the long-term outcomes were poor and the burden of sepsis was heavy. This review of the current domestic sepsis epidemiology-related studies provides research directions for the adjustment of medical and health resources and future research.
Objective:To investigate the regulatory effect of angiotensin converting enzyme 2 (ACE2) on inflammatory injury of human pulmonary microvascular endothelial cells (HPMECs).Methods:The primary cultured HPMECs were treated with lipopolysaccharide (LPS) as an injury model. LPS dose dependent response and ACE2 agonist/antagonist intervention experiments were carried out: (1) Dose dependent response experiment: HPMECs were treated with LPS at different concentrations of 50, 100, 500, and 1000 ng/ml for 24 h. Cell counting kit-8 (CCK-8) method was used to detect the cell viability. Lactate dehydrogenase (LDH) activity was tested to reflect the degree of cell injury and ACE2 expression was tested by Western blot. (2) HPMECs were pre-incubated with the ACE2 agonist DIZE (or ACE2 inhibitor MLN-4760), followd by adding LPS, culture for another 24 hours. Meanwhile a blank control group (normal endothelial cell medium) and LPS, agonist (or inhibitor) were used. Interleukin 1β (IL-1β) and IL-6 levels in the cell culture supernatant were determined by enzyme-linked immunosorbent assay. The expression of ACE2 and MasR were testes by Western Blot.Results:After 24 h of LPS stimulation, the cell viability of HPMECs decreased compared with that of CTRL group, and the cell viability decreased significantly with the increase of LPS concentration (P＜0.001). The ACE2 expression increased, and reach the highest level in 100 ng/ml group (2.24±0.57). Compared with LPS group, LDH relative release activity, IL-1β and IL-6 release were significantly decreased ( all P＜0.01) while MasR protein expression was significantly increased (P＜0.01) in LPS+DIZE group. Compared with LPS group, the relative release activity of LDH and IL-1β and IL-6 level were increased while ACE2 and MasR expression decreased significantly in LPS+MLN-4760 group (P＜0.0001).Conclusion:LPS-induced HPMECs cell injury model up-regulates ACE2 expression. Activating ACE2 function can enhance the expression of MasR and reduce the release of inflammatory factors, thereby alleviating the cell injury induced by LPS.
The preservation of spontaneous breathing has different meanings for patients with different severity of acute respiratory distress syndrome (ARDS). Respiratory effort monitoring is the key to the implementation of safe and reliable spontaneous breathing. We discussed the advantages and disadvantages of spontaneous respiration and reviewed the monitoring methods of spontaneous breathing efforts guided by ventilatory response indicators, airway pressure changes, intra-thoracic pressure changes, and diaphragm function in this manuscript. It is recommended for clinicians to monitor the respiratory effort that guided the intervention to avoid aggravating lung injury in ARDS management.
