Sepsis is a life-threatening condition characterized by organ dysfunction. Intestinal injury resulting from sepsis can worsen its progression, potentially culminating in severe infections and death. Due to its extreme severity and the significant threat to patients’ lives, sepsis has garnered considerable attention from the medical community. Therefore, a comprehensive bibliometric analysis of the collaboration and impact among countries, institutions, authors, subject areas, journals, keywords, and citations in the field of septic intestinal injury is essential. The bibliometric analysis included 1051 documents published between 2004 and 2024. The overall trend in the number of articles published showed an upward trajectory. China and the United States are the most influential countries in this field. Coopersmith, Craig M. and Deitch, EA have demonstrated their significant influence and pivotal roles in the field through their extensive publication records and the wide citation of their research. From 2004 to 2024, “MODS”, “epithelium”, “biomarker”, and “gut microbiome” are long-standing hot topics in this field, while “intestinal microbiota”, “intestinal barrier dysfunction”, and “bacteremia” may be important directions for future research. In summary, this study provides valuable and informative insights to relevant scholars that will contribute to the development of the field.
This study aims to identify risk factors for postoperative complications in patients with acute Stanford A type aortic dissection and construct a predictive model for postoperative mortality risk. The ultimate goal is to more accurately assess patient prognosis and optimize treatment strategies. A retrospective analysis was conducted on the medical records of 182 patients who underwent acute Stanford A type aortic dissection surgery at the Department of Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, from January 2020 to June 2023. Patients were categorized into survival and death groups based on their 30-day postoperative survival status. Logistic regression analysis was performed on biochemical indicators with statistical significance. The R language's RStudio tool was used to construct the model, dividing the dataset into training and validation sets in a 7:3 ratio to assess the model's effectiveness. External validation of the model was carried out using data from 131 patients who met the inclusion criteria and were treated at our hospital from July 2023 to July 2024. (1) This study enrolled 182 patients with Stanford type A aortic dissection, with a 30-day survival rate of 52.75
Management of severe complications after lung transplantation is critical to improving patient outcomes and graft survival. These complications include primary graft dysfunction (PGD), infections, chronic lung allograft dysfunction (CLAD), and rejection. PGD, occurring within the first 72 h post-transplant, can lead to high morbidity and mortality and requires prompt interventions such as ventilatory support and Extracorporeal Membrane Oxygenation(ECMO). Infections remain a leading cause of complications, with immunosuppressive therapy heightening susceptibility to bacterial, viral, and fungal pathogens. CLAD, the primary cause of long-term graft failure, manifests as bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS) and necessitates vigilant monitoring and potentially retransplantation. Effective management strategies include optimizing immunosuppression, monitoring for early signs of infection or rejection, and using advanced therapies like ECMO or bronchoscopic interventions. Atrial arrhythmias, such as atrial fibrillation, are common after lung transplantation and may increase thromboembolic risk. Heart failure may also result from acute rejection, elevated pulmonary pressures, or ventricular dysfunction. Both complications require careful management to optimize outcomes. Future directions emphasize personalized approaches to immunosuppression and novel therapies targeting CLAD progression to improve survival and quality of life in lung transplant recipients.
This document specifies the definitions, diagnostic criteria, and treatment requirements for sepsis. It aims to provide a standardized approach for the diagnosis and treatment of sepsis in medical institutions at all levels. The content is based on the latest research and clinical practices, with the goal of improving the management and outcomes of sepsis patients.
As a core regulatory node in human pathophysiological processes, temperature imbalance has become increasingly prominent in clinical significance. In the diagnosis and treatment of critically ill patients, temperature management has evolved into a core strategy integrating multidimensional pathophysiological pathways. The Target Temperature Management (TTM) system established by the International Society of Critical Care Medicine marks a shift from empirical intervention to precision treatment, demonstrating efficacy in conditions such as myocardial protection and sepsis. However, it also presents challenges, including conflicts between immunosuppression and inflammation control, as well as effects on coagulation function. With the integration of precision medicine concepts, optimizing temperature management strategies now faces new challenges, such as constructing intelligent decision-making systems.
Personalized treatment and prognosis improvement of sepsis remain one of the most challenging issues in critical care medicine. Whole blood cell-derived inflammatory markers have the potential to reflect the body’s inflammatory status, immune function, and changes in disease condition. This article discusses the significant importance of whole blood cell-derived inflammatory markers in the assessment and monitoring of sepsis patients’ conditions, calling for more attention to be paid to these markers. This attention will provide a solid basis for achieving early and precise diagnosis as well as personalized treatment stratification.
Contrast-enhanced diagnostic testing is often withheld in critically ill patients with acute kidney injury (AKI) due to safety concerns associated with iodinated contrast media. The impact of iodinated intravenous contrast agents on the rate of renal recovery is unknown when administered to patients who present to the intensive care unit with severe acute kidney injury. A retrospective cohort study of cases admitted to the intensive care unit with severe acute kidney injury who received a contrast-enhanced CT (CECT), propensity-matched to controls who received an unenhanced CT (UECT). Primary endpoints were the incidence of subjects with progressive AKI that met criteria for contrast-induced nephropathy, the incidence of renal replacement therapy (RRT) initiation, and the rate of renal function recovery over the first 120 h of hospitalization. The incidence of progressive acute kidney injury was similar between patients who received a CECT and those who received a UECT in both unmatched and propensity-matched patients with eGFR less than 30 mL/min/1.73 m2 at the time of imaging. There was no increased utilization of RRT after 24 h in those who received a CECT than those who received a UECT. Renal recovery rate was similar between cases and controls, and unaffected by the provision of iodinated contrast. The use of low-osmolar intravenous iodinated contrast does not impede the recovery of eGFR in critically ill patients with severe acute kidney injury.
Acute respiratory distress syndrome (ARDS) is a highly lethal non-cardiogenic pulmonary edema. In recent years, with the rapid development of critical care medicine technology and the global pandemic of coronavirus infectious disease-2019 (COVID-19), the medical community has gained new insights into the diagnosis and treatment of ARDS. Lung-protective mechanical ventilation remains its primary and widely accepted treatment approach. However, there is still a lack of systematic summary of non-mechanical ventilation treatment strategies for ARDS. Therefore, the special committee of critical care medicine of the Chinese Research Hospital Association organized domestic experts in related disciplines, followed the guidelines of the GRADE international framework, systematically reviewed, analyzed, and discussed relevant domestic and international research, ultimately producing this guideline.
Abstract Background This review and meta-analysis assessed strategies for improving Healthcare Workers HCWs’ adherence to Infection Control Measures ICMs while working in an ICU since the setting provides a potentially high risk for HAIs. Methods Of these, 103 studies were identified to meet the inclusion criteria and, therefore, were included, which reported intervention studies conducted in ICUs with the purpose of promoting HCWs’ adherence to ICMs. Results The results indicate that the most effective strategies are multimodal-education linked to feedback, simulations, and other applications that achieve a 23.6% improvement in compliance, with consistent effectiveness across settings. Educational interventions alone achieved an average improvement of 16.13% and showed large variability, depending on the context. Conclusion Multimodal strategies surpass educational strategies in improving adherence to ICMs. Health facilities should adopt comprehensive, multimodal strategies to improve patient safety and reduce HAIs, and future efforts should refine these approaches for broader applications.
Innate lymphoid cells (ILCs) are a class of lymphocytes that do not express specific antigen recognition receptors, which play a significant role in various diseases due to their unique immunomodulatory functions. Among these, type 2 innate lymphoid cells (ILC2s) form a distinct subpopulation and are recognized as key mediators in anti-infective and allergic responses. Cardiovascular diseases are a leading cause of intensive care unit admissions. Cardiovascular diseases, including myocardial infarction and heart failure, have a complex pathogenesis involving inflammation, tissue injury, and repair. Recent studies suggest that ILC2s are crucial in cardiovascular diseases by regulating inflammation, promoting tissue repair, and facilitating cardiac remodeling through the secretion of anti-inflammatory cytokines like IL-4, IL-5, and IL-13, etc. However, ILC2s have a complex role in cardiovascular health, potentially contributing to adverse cardiac remodeling and heart failure in certain contexts. Thus, the precise mechanisms by which ILC2s influence cardiovascular disease processes remain incompletely understood. This review summarizes recent advances in understanding ILC2 mechanisms in cardiovascular diseases and explores their potential as therapeutic targets, aiming to identify new treatment strategies.
AbstractSepsis remains the bread and butter of critical care medicine, but despite detailed knowledge of the pathophysiology, prospective clinical trials continue to yield disappointing results and the mortality for sepsis remains unacceptably high. Current definitions and inclusion criteria from current clinical care standards make studies very unlikely to be “positive” despite the likelihood that the studied therapies may indeed be clinically efficacious. The Society of Critical Care medicine has acknowledged these limitations and has proposed a focus on individualized management of sepsis research. Therapeutic plasma exchange (TPE) has an extensive body of literature to support its role in sepsis, but the current standards of care do not often include TPE in the management algorithm. These findings highlight current flaws in research and bedside care, while offering the opportunity to apply the recommendations of the Surviving Sepsis Campaign and improved patient care- both now and in the future.
Activation of NLPR3 inflammasome promotes the maturation and secretion of IL-1β and IL-18, leading to a series of inflammatory reactions, while inhibition of NLRP3 inflammasome alleviates the severity of Severe Acute Pancreatitis (SAP). An inducible enzyme responsible for heme decomposition, heme oxygenase-1 (HO-1), has anti-inflammatory, antioxidant, and anti-proliferative effects. HO-1 activity profoundly affects the host ability to forbear infection by reducing tissue damage or affecting resistance and increasing the capacity to pathogen load. We postulated that hemin, a strong HO-1 inducer, could decrease NLRP3 inflammasome activation, which would alleviate the severity of SAP and acute lung injury caused by pancreatitis. By administering intraperitoneal injections of caerulein (Cae) and lipopolysaccharide (LPS), the SAP rat model was created. Then, the SAP rats were pretreated with Hemin or zinc protoporphyrin IX (Znpp, a HO-1 inhibitor) to stimulate or inhibit the HO-1 enzyme respectively, and the effects and mechanisms were investigated. The pancreas and lung tissue of the SAP rats suffered considerable pathological damage after Cae and LPS injection, with significant increases of amylase, lipase, IL-1β and IL-18 levels in the serum. Hemin pretreatment decreased IL-1β and IL-18 release in the serum and prevented pancreatic and pulmonary damage. Hemin dramatically reduced oxidative stress, downregulated the expression of NLRP3, ASC, and Caspase-1, and elevated HO-1 expression. On the contrary, there were no discernible changes between the SAP control and Znpp treated groups. These results showed that hemin prevented Cae and LPS-induced lung and pancreatic injury through suppression of the inflammatory response. The impact of hemin on the activity of the NLRP3 inflammasome was depending critically on HO-1 activity. The protective role and mechanism HO-1 against the acute and severe inflammatory responses may provide a novel and effective therapeutic approach for SAP treatment.
Abstract Breakthrough infection of rabies is rarely reported. And it is difficult to make a definite diagnosis of rabies for patients with atypical clinical manifestations. Here we report a rabies breakthrough infection who presented atypical clinical manifestations. The diagnosis of rabies was confirmed by the detection of rabies virus in cerebrospinal fluid by metagenomics next-generation sequencing (mNGS).
Abstract Background Post intensive care syndrome (PICS) is a new emerging condition affecting more than 80% of the population discharged from Intensive care unit (ICU). It affects the individual with a myriad of symptoms degrading the individual’s quality of life (QoL). Most critical method to prevent this is early diagnosis through a reliable measure taking into account the multidimensional nature of PICS. Thus, this study aims to find out is there a need of a comprehensive assessment scale for PICS covering all the domains. Methods Data was searched on databases incorporating PubMed, Cochrane Library, Google Scholar and EBSCO, Psyc INFO, Web of Science, Scopus, Science Direct, Medline, CINAHL. 18,756 articles were retrieved. It was narrowed down to 20 articles which were finally reviewed. The review summarizing all the reasons why a comprehensive outcome measure is needed for PICS including all the aspects of the syndrome. Furthermore, the review delineates the potential advantages that a novel assessment tool could provide, enriching our comprehension and handling of the intricate ramifications of PICS. Results The review highlights several key findings that underscore the necessity of a thorough outcome measure for assessing PICS: (i) the multifaceted nature of symptoms; (ii) challenges related to underdiagnosis and misdiagnosis; (iii) inconsistencies in assessment measures; (iv) insufficient attention to social aspects; (v) confounding factors related to comorbidities; (vi) the diverse array of assessment measures presently employed. All this is currently contributing to a confusing assessment of PICS leading to increased population affected with multitude of symptoms experienced after ICU discharge. Conclusion The existing assessment instruments for PICS exhibit wide variability in complexity, difficult comparison and evidence integration, thereby complicating therapeutic decisions. The lack of a universally accepted measurement standard increases the challenge of diagnosing and preventing PICS. Additionally, some tools may inaccurately represent PICS characteristics, leading to inconsistent reporting. Thus, there is an urgent demand for a comprehensive, multidimensional tool to provide a valid diagnosis.
Abstract Background Patients with severe infection often require careful fluid management. Intravenous linezolid can increase the fluid volume, whereas oral linezolid can effectively limit the fluid volume. However, the differences in the treatment effect and incidence of thrombocytopenia between oral and intravenous linezolid in patients with severe infection remain unclear. Methods Patients who received linezolid in the intensive care unit of PLA General Hospital from December 2010 to December 2020 were divided into an oral group and intravenous group according to the route of administration, and we further established the PO group and PO-match group by propensity score matching. The anti-infection effect of linezolid and incidence of thrombocytopenia were compared between the two groups. Results In total, 177 patients were enrolled in the study (59 in PO group and 118 in PO-match group). The microbial clearance rate and clinical cure rate were similar between the two groups (70.0% vs. 79.3%, P = 0.293; 72.9% vs. 83.9%, P = 0.213). The 30-day mortality rate was slightly higher in the PO group than in the PO-match group, but the difference was not statistically significant (13.6% vs. 6.8%, P = 0.138). There was no difference in the incidence of thrombocytopenia between the two groups (62.7% vs. 65.3%, P = 0.739). Conclusions There were no significant differences in the treatment effect or incidence of thrombocytopenia between oral and intravenous administration of linezolid in patients with severe infection.
Abstract Background The association between septic shock, acute tubular necrosis, and central diabetes insipidus is infrequent: our recent clinical observation invited us to deepen its pathophysiological features. Methods We reported an unusual case report of a young, healthy man with a septic shock, severe dehydration with a hematocrit of 70.6% caused by gastrointestinal infection and refractory renal failure, and persistent polyuria. Results The patient presented severe dehydration, hypovolemic shock with a hematocrit of 70.6%, and acute renal failure. The subsequent laboratory exams demonstrated a gastrointestinal infection of Campylobacter Upsaliensis and Helicobacter pylori. The persistent renal failure and polyuria later 20 days made it mandatory for further investigations. A Magnetic brain Resonance excluded encephalic lesions but demonstrated a posterior pituitary lobe hypointense. Conclusions This cascade of pathological events seems originated from a septic shock: the consequent increase in hematocrit and blood viscosity, estimated double the normal, with severe hypotensive shock correlated, decelerated the microcirculatory blood flow, until a proper blood stasis in the venous system. These factors caused hypoxia and possible venous thromboses, electively affecting the pituitary hypothalamic nuclei and their axons in the post-hypophysis and its portal system.
Abstract Introduction Although heparin has been widely used in clinical practice, its effect on mortality in sepsis is still controversial. This study aimed to investigate the effectiveness of heparin in septic patients. Methods Adult septic patients were identified from the Medical Information Mart for Intensive Care (MIMIC)-IV 2.0 database, which contains patients admitted to intensive care units (ICUs) at the Beth Israel Deaconess Medical Centre from 2008 to 2019. Propensity score matching (PSM) was employed to adjust for the baseline differences in the probability to receive heparin or not. The marginal structural cox model (MSCM) was used to account for both baseline and time-dependent covariates. Group-based trajectory modelling (GBTM) was performed to identify activated partial thromboplastin time (APTT) trajectory groups, and patient outcomes were compared between the heparin- and non-heparin groups in each phenotype. Results A total of 9940 septic patients were enrolled in the study, including 1690 (17%) in the heparin group. By PSM, significant benefit in terms of mortality was observed among the heparin group (HR = 0.82; 95% CI 0.71–0.94; p = 0.004). Similar findings were replicated with the MSCM analysis (HR = 0.66; 95% CI 0.44–0.98; p = 0.038). In the GBTM analysis, three APTT trajectory groups were identified: “normal” (n = 8236; 82.8%); “medium high” (n = 1358; 13.7%); and “high” (n = 346; 13.5%). Heparin therapy was associated with a reduced mortality (HR, 0.59; 95% CI, 0.41–0.84; p = 0.003) in patients with the medium high APTT level [51.7 s (interquartile range, 40.1–64.3)]. Conclusions Heparin therapy was associated with improved outcome in septic patients, and it showed significant survival benefit in patients achieved the medium high APTT phenotype.
Machine learning (ML) can be promising for stratifying patients into homogeneous groups and assessing mortality based on score combination. Using ML, we compared mortality prediction performance for clustered and non-clustered models and tried to develop a simple decision algorithm to predict the patient’s cluster membership with classification and regression trees (CART). Retrospective study involving patients requiring ICU admission (1st January 2011–16th September 2022). Clusters were identified by combining Charlson Comorbidity Index (CCI) plus Simplified Acute Physiology Score II (SAPS II) or Sequential Organ Failure Assessment (SOFA). Intercluster and survival analyses were performed. We analyzed the relationship with mortality with multivariate logistic regressions and receiver operating characteristic curves (ROC) for models with and without clusters. Nested models were compared with Likelihood Ratio Tests (LRT). Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were compared for non-nested models. With the best model, we used CART to build a decision tree for patient’s membership. Our sample consisted of 2605 patients (mortality 59.7
Sepsis is a severe disease with a complex pathogenesis and is an important factor in the mortality of patients in intensive care units (ICUs). The administration of vitamin C and its combination treatment in sepsis was not supported by the results of multiple randomized controlled clinical trials. However, the efficacy of a higher vitamin C dose in treating patients with sepsis remains unclear. Therefore, the effectiveness of administering a larger dosage of vitamin C to patients with sepsis remains unclear. The Clinical Efficacy of Megadose Vitamin C in Sepsis (CEMVIS) trial is a multicenter, single-blind, randomized, placebo-controlled trial with 234 individuals with sepsis. The following adult patients will be enrolled: those with procalcitonin (PCT) ≥ 2 ng/mL and sepsis 3.0 diagnostic criteria. Patients will be randomly assigned to receive 12 g vitamin C or the same volume of 5 https://www.clinicaltrials.gov .
Intensive care unit (ICU) patients can be immobilised over long periods due to their conditions, and the subsequent management inclusive of mechanical ventilation, which is also associated with complications. Hence, early mobilization of intubated patients (EMIP) may be beneficial but there are various barriers including the lack of consensus guidelines. Based on a brief scoping literature review, this article notes of perhaps one consensus guidelines developed from a systematic review in 2014 followed by a meeting of experts from ICU but there are other guidelines, recommendations, and strategies. However, there still exists the challenge of consensus guidelines for early mobilization. Barriers and/or facilitators, evaluation of optimal intervention dosage, good communication, and use of necessary assistive equipment have also been identified. Some resource limited countries lack physiotherapists and equipment, and these services are therefore provided mostly by nurses and junior doctors, which calls for tailored guidelines. Prominent note in the guidelines is oximetry but not blood gas measurement and another note are the limitations caused by vasoactive agents. Perhaps, the cost and invasive nature of the blood gas analyses are concerns and this is significant for resource limited countries. However, this test and alternatives need considerations in the guidelines. There is agreement on safe early mobilisation of intubated patients (EMIP), but this requires developing to tailor for resource limited countries. The vasoactive agents affect blood gases, hence evidence-base blood gases and acid–base analyses are necessary to integrate in monitoring intubated patients in ICU. Given the four criteria (cardiovascular, neurological, respiratory, and ‘others’) and challenges in the existing guidelines, some laboratory tests are recommended as additional items to the ‘others’ criterion to improve on potential points of imprecision and risk of bias.
