The prognostic role of the albumin-corrected anion gap (ACAG) in cirrhotic patients with invasive fungal infection (IFI) remains unclear. This retrospective cohort study aimed to investigate the association between ACAG and 28-/90-day mortality in this high-risk population. A retrospective cohort study was conducted at Beijing Ditan Hospital, including patients with cirrhosis complicated by IFI who were admitted between January 2009 and December 2021. ACAG was calculated using initial anion gap and albumin measurements within 24 h of admission. Patients were stratified into high and normal ACAG groups by an ACAG cutoff of 20 mmol/L. The primary outcomes were 28-day and 90-day all-cause mortality. Cox proportional hazards regression models and Kaplan-Meier survival analysis were employed to assess the association between ACAG levels and mortality outcomes. Subgroup analyses were performed to explore the consistency of the association. The prognostic value of ACAG was assessed by receiver operating characteristic (ROC) curve analysis. A total of 313 cirrhotic patients with IFI were enrolled. Patients with high ACAG (≥ 20 mmol/L) had significantly higher 28-day (36.44

Background:Sepsis accounts for a significant proportion of global deaths and has limited treatment options. Cancer patients are at a higher risk of sepsis and experience worse outcomes, highlighting the complex interplay between sepsis and cancer on immune cell function and clinical prognosis. Methods:Between July and December 2023, we prospectively enrolled 30 sepsis patients and 10 healthy controls, categorizing the patients into sepsis with non-cancer and sepsis with cancer based on established clinical diagnostics. Multi-color flow cytometry was used to monitor changes in the expression of surface molecules of monocyte and neutrophil subsets, phagocytic activity and cytokine-producing capacity. Results:Compared with sepsis with non-cancer, the sepsis with cancer group demonstrated elevated 28-day mortality rates, increased CD177+ activated band neutrophil and HLA-DRlowCCR2low classical monocyte, and attenuated phagocytic activity of immature neutrophil and monocyte. Further, HLA-DRlowCCR2low classical monocytes and CD177+ myelocytes may serve as immunological predictors of adverse outcomes in sepsis. The HLA-DRlowCCR2low classical monocyte and CD177+ myelocytes exhibit significant correlations with internal environment and coagulation markers. Conclusion:In septic patients, particularly those patients with cancer, attenuated phagocytic activity of immature neutrophil (myelocytes, metamyelocytes, band neutrophils) and monocyte, and HLA-DRlowCCR2low classical monocyte and CD177+ myelocytes may serve as immunological predictors of poor prognosis.

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) pose significant threats to patient outcomes, frequently resulting in multiple organ dysfunction syndrome (MODS) and elevated mortality rates. This study investigates MODS outcomes among ALF and ACLF patients in China, identifying key factors that influence mortality and prognosis. A retrospective cohort analysis was conducted at a specialized tertiary hospital in Beijing, covering the period from June 2009 to May 2022, which included 585 patients:195 with ALF and 390 with ACLF. Among these, 61

Abstract Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) pose significant threats to patient prognosis, often leading to multiple organ dysfunction syndrome (MODS), which is characterized by simultaneous dysfunction of two or more organ systems and significantly heightens the risk of mortality. Standard strategies for managing organ complications in critical illness may not always be suitable for patients with liver failure (LF).This study aims to investigate the outcomes of MODS in patients with ALF and ACLF in China, while also identifying factors influencing mortality and prognosis. We conducted a retrospective cohort study at a specialized tertiary hospital for liver diseases in Beijing, China, spanning from June 1, 2009, to May 31, 2022.Risk factors were assessed through univariate and multivariate analyses using logistic regression. Cumulative 90-day mortality rates between the ACLF and ALF groups were compared using Cox Analysis. 195 patients with ALF and 318 patients with ACLF were included in this study. The primary outcome of interest was 90-day mortality. This study enrolled a total of 513 patients. Of these, 119 patients (61%) with ALF and 140 patients (44%) with ACLF experienced MODS. Patients with ALF exhibited a higher number of organ failures compared to those with ACLF (2 vs. 1, P = 0.006). Additionally, patients with ALF demonstrated higher median admission critical illness scores.Multivariate logistic analysis indicated that GIB (OR = 3.112, 95% CI 1.4–6.916, P = 0.005), MELD-Na scores (OR = 1.079, 95% CI 1.033–1.127, P = 0.001), Age (OR = 1.056, 95% CI 1.025–1.088, P < 0.001), NLR (OR = 1.073, 95% CI 1.014–1.132, P = 0.014), ICU admission (OR = 4.319, 95% CI 1.347–13.851, P = 0.014), and Clif-SOFA (OR = 1.147, 95% CI 1.022–1.287, P = 0.02) were independent influential factors in predicting 90-day mortality, with an AUCROC of 0.881. Multivariate logistic analysis revealed that SOFA score (OR = 1.255, 95% CI 1.166–1.351, P = 0.001), GCS scores (OR = 0.674, 95% CI 0.606–0.881, P = 0.001), Age (OR = 1.048, 95% CI 1.022–1.076, P < 0.001), and ICU admission (OR = 0.258, 95% CI 0.075–0.885, P = 0.031) were independent influential factors in predicting 90-day mortality, with an AUCROC of 0.872.Cox analysis for cumulative 90-day mortality indicated that patients with ALF had higher mortality rates compared to those with ACLF (33.8% vs. 27%, P = 0.026) and compared to patients with cirrhosis ACLF and non-cirrhosis ACLF (33.8% vs. 31% vs. 25.9%, P = 0.018).Patients with ALF exhibited a higher incidence of MODS and consequently had a poorer 90-day prognosis.

Background: Respiratory failure in acquired immunodeficiency syndrome (AIDS) patients was the leading cause of intensive care unit (ICU) admission in our center. We aimed to describe the pulmonary infections and outcomes for respiratory failure in AIDS patients.Methods: A retrospective study was conducted on AIDS adult patients with respiratory failure who were admitted to the ICU in Beijing Ditan hospital, China, from January 2012 to December 2021. We investigated pulmonary infections complicated by respiratory failure in AIDS patients. The primary outcome was ICU mortality, and a comparison between survivors and nonsurvivors was performed. Multiple logistic regression analysis was used to identify predictors of ICU mortality. The Kaplan-Meier curve and Log rank test were used for survival analysis.Results: A total of 231 AIDS patients were admitted to ICU with respiratory failure over a 10-year period with a male predominance (95.7%). Pneumocystis jirovecii pneumonia was the main etiology of pulmonary infections (80.1%). The ICU mortality was 32.9%. In multivariate analysis, ICU mortality was independently associated with invasive mechanical ventilation (IMV) [odds ratio (OR), 27.910; 95% confidence interval (CI, 8.392-92.818; p = 0.000) and the time before ICU admission (OR, 0.959; 95% CI, 0.920-0.999; p = 0.046). In the survival analysis, patients with IMV and later admission to ICU had a higher probability of mortality.Conclusion: Pneumocystis jirovecii pneumonia was the primary etiology for respiratory failure in AIDS patients admitted to the ICU. Respiratory failure remains a severe illness with high mortality, and ICU mortality was negatively associated with IMV and later admission to ICU.

Background: Acute respiratory failure (ARF) remains the most common diagnosis for intensive care unit (ICU) admission in acquired immunodeficiency syndrome (AIDS) patients. Methods: We conducted a single-center, prospective, open-labeled, randomized controlled trial at the ICU, Beijing Ditan Hospital, China. AIDS patients with ARF were enrolled and randomly assigned in a 1:1 ratio to receive either high-flow nasal cannula (HFNC) oxygen therapy or non-invasive ventilation (NIV) immediately after randomization. The primary outcome was the need for endotracheal intubation on day 28. Results: 120 AIDS patients were enrolled and 56 patients in the HFNC group and 57 patients in the NIV group after secondary exclusion. Pneumocystis pneumonia (PCP) was the main etiology for ARF (94.7%). The intubation rates on day 28 were similar to HFNC and NIV (28.6% vs. 35.1%, p = 0.457). Kaplan–Meier curves showed no statistical difference in cumulative intubation rates between the two groups (log-rank test 0.401, p = 0.527). The number of airway care interventions in the HFNC group was fewer than in the NIV group (6 (5–7) vs. 8 (6–9), p < 0.001). The rate of intolerance in the HFNC group was lower than in the NIV group (1.8% vs. 14.0%, p = 0.032). The VAS scores of device discomfort in the HFNC group were lower than that in the NIV group at 2 h (4 (4–5) vs. 5 (4–7), p = 0.042) and at 24 h (4 (3–4) vs. 4 (3–6), p = 0.036). The respiratory rate in the HFNC group was lower than that in the NIV group at 24 h (25 ± 4/min vs. 27 ± 5/min, p = 0.041). Conclusions: Among AIDS patients with ARF, there was no statistical significance of the intubation rate between HFNC and NIV. HFNC had better tolerance and device comfort, fewer airway care interventions, and a lower respiratory rate than NIV. Clinical Trial Number: Chictr.org (ChiCTR1900022241).

BACKGROUND The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients’ hemodynamics. After successful operation, patients typically recover the ability to engage in general physical activity. As a better ventilatory strategy, extracorporeal membrane oxygenation (ECMO) provides gas exchange via an extracorporeal circuit, and is increasingly being used to improve respiratory and circulatory function. After the modified Fontan operation, circulation is different from that of patients who are not subjected to the procedure. This paper describe a successful case using ECMO in curing influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago. The special cardiac structure and circulatory characteristics are explored in this case. CASE SUMMARY We report a successful case using ECMO in curing influenza A infection in a 23-year-old man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago. The man was admitted to the intensive care unit with severe acute respiratory distress syndrome as a result of influenza A infection. He was initially treated by veno-venous (VV) ECMO, which was switched to veno-venous-arterial ECMO (VVA ECMO) 5 d later. As circulation and respiratory function gradually improved, the VVA ECMO equipment was removed on May 1, 2018. The patient was successfully withdrawn from artificial ventilation on May 28, 2018 and then discharged from hospital on May 30, 2018. CONCLUSION After the modified Fontan operation, circulation is different compared with that of patients who are not subjected to the procedure. There are certainly many differences between them when they receive the treatment of ECMO. Due to the special cardiac structure and circulatory characteristics, an individualized liquid management strategy is necessary and it might be better for them to choose an active circulation support earlier.

目的:探讨Smartpatch长时程动态心电图对冠心病合并心肌缺血的诊断价值.方法:选取2020年5月～2021年5月来本院进行治疗的冠心病患者212例作为研究对象,两组患者均进行Smartpatch长时程动态心电图以及常规心电图检测,对检测结果进行分析,比较两种方法诊断心肌缺血的准确度、敏感度以及特异度.结果:常规心电图与Smartpatch长时程动态心电图诊断心肌缺血患者的检出率分别为64.62％(137/212)以及92.92％(197/212),Smartpatch长时程动态心电图的检出率明显高于常规心电图(P<0.05);比较常规心电图以及Smartpatch长时程动态心电图对冠心病合并心肌缺血的诊断的准确率、灵敏度以及特异度,结果表明常规心电图对患者诊断的准确率、灵敏度以及特异度分别为53.30％、76.19％以及15.38％明显低于Smartpatch长时程动态心电图的96.32％、86.29％以及86.67％,Smartpatch长时程动态心电图对冠心病合并心肌缺血诊断的准确率、灵敏度以及特异度明显高于常规心电图,差异具有统计学意义(P<0.05).结论:Smartpatch长时程动态心电图诊断冠心病合并心肌缺血的准确度、灵敏度以及特异度更高.

目的:人感染猕猴α疱疹病毒1型是罕见的人畜共患病，2021年4月，在中国北京一位实验动物饲养员出现发热、皮疹、行走无力等症状，后被诊断为人感染猕猴α疱疹病毒1型，病毒性脑脊髓炎，为我国首例人感染猕猴α疱疹病毒1型病患。这名患者在入院前出现心脏呼吸骤停，诊断为缺血缺氧性脑病并出现坏死性病毒性脑脊髓炎，住院期间脑功能损害逐渐加重，临床判定脑死亡，在患者入院39 d，病程第51 d，家属撤除治疗。

Background: The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients’ hemodynamics. After successful operation, patients typically recover the ability to engage in general physical activity. The mortality of patients diagnosed with acute respiratory distress syndrome (ARDS) ranges from 17.3 to 41.4% among critically ill patients with H1N1 infection. As a better ventilatory strategy, extracorporeal membrane oxygenation (ECMO) provides gas exchange via an extracorporeal circuit, and is increasingly being used to improve respiratory and circulatory function. As is known to all, after the modified Fontan operation, circulation was different compared with patients who were not subjected to the procedure. But very few articles describe the special circulation about the case who was post-operative of the modified Fontan operation especially when it received the treatment of E-CMO. This study aims to describe a successful case using E-CMO in curing the influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation thirteen years ago. We want to explore the special cardiac structure and circulatory characteristics in this case. Methods: To report a successful case using extracorporeal membrane oxygenation in curing the influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation thirteen years ago. In this article, we describe a 23-year-old man, with a history of modified Fontan operation for the Tausing-Bing syndrome, admitted to ICU with severe acute respiratory distress syndrome as a result of influenza A infection. The man was initially treated by V-V ECMO, five days later was switched to V-V-A E-CMO. Results: As circulation and respiratory function gradually improved, the VV-A ECMO equipment was removed on May 1, 2018.The patient was successfully withdrawn from artificial ventilation on May 28, 2018, then discharged from hospital on May 30, 2018. Conclusion: After the modified Fontan operation, circulation was different compared with patients who were not subjected to the procedure. There were certainly many differences between the two sides when they received the treatment of E-CMO. As the special cardiac structure and circulatory characteristics, an individualized liquid management strategy was necessary and it might be better for them to choose an active cycle support earlier.

Objective:To evaluate the application value of serum amyloid A (SAA) and C-reactive protein (CRP) in the monitoring the status of coronavirus disease 2019 (COVID-19).Methods:The clinical data of COVID-19 patients admitted to the Department of Intensive Medicine and Infection Center of Beijing Ditan Hospital affiliated to Capital Medical University from January 20 to June 29, 2020 were retrospective analyzed, including 147 cases in mild group and 75 cases in severe group. The differences between SAA and CRP at each time point between the two groups and the prediction value for severe COVID-19 were analyzed.Results:The average ages of the severe and mild cases were 57.2±16.8 and 35.9±17.4 years old, respectively and the difference was statistically significant ( P<0.05). The proportions of male cases in severe and mild groups were 62.7% and 48.3%, respectively and the difference was statistically significant ( P<0.05). For underlying diseases, the proportion of patient with diabetes in severe and mild groups were 25.3% and 2.7%, respectively and the difference was statistically significant ( P<0.05); the proportion of patient with hypertension in severe and mild groups were 37.3% and 17.0%, respectively and the difference was statistically significant ( P<0.05). The average hospitalization time in severe and mild groups were 31.5±10.2 days and 24.5±13.8 days, respectively and the difference was statistically significant ( P<0.05). The levels of CRP and SAA at the 0, 3, 7 and 14 days after admission in severe were higher than those in mild group. In ROC analyses of the prediction values, the area under curve (AUC) of CPR at the 0, 3, 7 and 14 days after admission for severe COVID-19 were 0.923, 0.918, 0.945 and 0.776 respectively, while AUCs of SAA at the above time points were 0.807, 0.795, 0.864 and 0.762, respectively. CRP level above 27.85mg/dL at 0 day and 45.25mg/dL at 3 days after admission can predict the occurrence of severe illness in patients. SAA level above 66.0mg/dL at 0 day and 267.35 mg/dL at 3 days after hospitalization can predict the occurrence of severe illness in patients. Conclusions:Regular testing of SAA and CRP would be helpful for the judgment of disease severity and the prediction of disease development and can be applied in clinical practice.

Abstract Background Acute kidney injury (AKI) is a common complication among human immunodeficiency virus (HIV)-infected patients resulting in increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in Intensive Care Unit (ICU) and explore the influence factors correlated with CRRT and their prognosis. Methods We performed a retrospective case-control study in the ICU of the Beijing Ditan Hospital Capital Medical University. From June 1, 2005 to May 31, 2017, 225 cases were enrolled in this clinical study. Results 122 (54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1, 2 and 3 were 38 (31.1%), 21(17.2%) and 63(51.7%), respectively. 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By univariate logistics analysis, it showed that higher likelihood of diagnosis for respiratory failure (OR = 7.333,95% CI 1.467–36.664, p = 0.015), higher likelihood of diagnosis for septic shock (OR = 1.005,95% CI 1.001–1.01, p = 0.018), and higher likelihood to use vasoactive agents (OR = 10.667,95% CI 1.743–65.271, p = 0.001), longer mechanical ventilation duration (OR = 1.011,95% CI 1.002–1.019, p = 0.011), higher likelihood for diagnosis for PCP (OR = 7.50,95% CI 1.288–43.687, p = 0.025), higher SOFA score at ICU admission (OR = 1.183,95% CI 1.012–1.383, p = 0.035), longer duration of CRRT (OR = 1.014,95% CI 1.001–1.028, p = 0.034) contributed to a higher mortality at ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p = 0.595). Conclusions There is a high incidence of AKI in HIV-infected patients admitted in our ICU. Patients with severe AKI were more prone to be admitted for CRRT and have a consequent poor prognosis.

Abstract Background: AKI is a common complication among human immunodeficiency virus (HIV)--infecting patients and resulting in increased morbidity and mortality. CRRT is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in ICU and explore the influence factors correlated with CRRT and prognosis.Methods: We performed a retrospective case-control study, in ICU of Beijing Ditan Hospital Capital Medical University, which is a top three hospital majoring in infectious diseases. From June 1,2005 to May 31,2017, 225 cases were enrolled in this research eventually.Results: 122(54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1/2/3 were respectively 38(31.1%)/23(18.9%)/61(50%). 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By multivariate logistics analysis, it showed that the use of vasoactive agents (OR=174.31,95% CI 1.743-65.271, p=0.018), diagnosis of PCP(OR=27.136,95% CI 1.855-397.066, p=0.016) and longer duration of CRRT (OR=1.034,95% CI 1.004-1.065, p=0.028) were independent risk factors for predicting patients’ death of CRRT in ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p =0.309).Conclusions: The incidence of AKI was 54.2% in HIV-infected patients admitted to the ICU, and about 26.2% AKI patients received CRRT during the stay of ICU.56.25%CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. The use of vasoactive agents, diagnosis of PCP were independent risk factors for predicting patients’ death of CRRT in ICU. The cumulative survival of AKI 3 patients between CRRT and non-CRRT groups shows no significant differences.

目的 评价Swansea诊断标准与国内诊断标准对于妊娠急性脂肪肝(acute fatty liver of pregnancy,AFLP)患者诊断的一致性.方法 回顾性分析首都医科大学附属北京地坛医院2008年1月至2018年1月收治的出院诊断为AFLP患者的资料,使用Swansea诊断标准进行评分.对同期收治的非AFLP妊娠期肝病(包括HELLP综合征、妊娠合并脂肪肝、妊娠期肝内胆汁淤积症、妊娠合并其他肝功能衰竭)患者进行Swansea诊断标准评分,并使用国内诊断标准进行判定.对Swansea诊断标准与国内诊断标准进行Kappa一致性检验,计算Swansea诊断标准的受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积.结果 出院诊断为AFLP的患者74例,HELLP综合征14例,妊娠合并脂肪肝87例,妊娠期肝内胆汁淤积症220例,妊娠合并其他肝功能衰竭9例.因74例患者中仅4例进行了肝组织活检,故以Swansea评分≥5分作为判定标准.出院诊断为AFLP的患者中,按照Swansea标准诊断AFLP 68例,非AFLP妊娠期肝病6例.非AFLP妊娠期肝病患者共计330例,按照Swansea标准诊断AFLP 13例,非AFLP妊娠期肝病317例.Swansea诊断与国内诊断标准一致性的Kappa值为0.848,ROC曲线下面积为0.940(95％CI:0.902～0.978).结论 Swansea诊断标准与国内诊断标准诊断AFLP的一致性较好,可在临床中推广应用.

噬血细胞综合征是由免疫功能紊乱引起的一种致命性的临床综合征.主要表现为发热、全血细胞减少及脾大,可在骨髓或其他组织发现噬血细胞现象,其诊断主要依据临床表现及实验室的相关检查结果.本文报道1例以肝功能损害为首发表现的妊娠合并噬血细胞综合征患者,经糖皮质激素联合免疫球蛋白治疗后病情好转.

To describe the epidemiology, outcomes, and risk factors of acute kidney injury (AKI) among human immunodeficiency virus (HIV)-infected patients admitted to the intensive care unit (ICU).We reviewed all the HIV-infected admissions to the ICU at Beijing Ditan hospital in the time span from June 2005 to May 2017 and collected demographic, clinical, and laboratory data for our sample. AKI was diagnosed and classified according to the Kidney Disease Improving Global Outcomes (KIDIGO) criteria. We analyzed the incidence of AKI and its associated mortality. The potential risk factors for severe AKI were also investigated in this study. A total of 225 HIV-infected patients were included in the final analysis. The incidences of no-AKI, AKI stage 1, AKI stage 2, and AKI stage 3, were 46.2% (104), 19.1% (43), 8.4% (19), and 26.2% (59), respectively. By logistic regression analysis, severe AKI (stages 2-3) was an important predicator for 60-day mortality with an odds ratio of 4.234. By multivariate analysis, a high acute physiology and chronic health evaluation, version II (APACHE-II) score (p=0.024), low albumin (p<0.031) at the first 24-h admission ICU, shock (p=0.013), and bloodstream infection (p=0.006) during hospitalization were all found to be significant risk factors for severe AKI. AKI is common in HIV-infected patients admitted to the ICU, and the mortality of patients with AKI stages 2-3 is significantly higher compared with those without such conditions. A high APACHE-II score and a lower albumin level at the first 24-h admission to ICU are significant predictors of severe AKI in this specific population. Shock and bloodstream infection during hospitalization can also lead to severe AKI.

Mannitol and hypertonic saline are used to ameliorate brain edema and intracranial hypertension during and after craniotomy. We hypothesized that the agreement of measured and calculated serum osmolality during the infusion of hypertonic saline would be better than mannitol. The objective was to determine the accuracy of serum osmolality estimation by different formulas during the administration of hyperosmolar agent.

Objective To evaluate the effect of dexmedetomidine on stress hormone and hemodynamic in the delayed extubation patients after craniotomy.Methods Forty patients after intracranial surgery with delayed extubation were randomly divided to two treatment study groups, labeled“Dex group” or“Saline group”.Dexmedetomidine group patients received a continuous infusion of 0.6μg· kg-1· h-1(10 mg/L).Placebo group patients received a maintenance infusion of 0.9% sodium chloride for injection at a volume and rate equal to that of dexmedetomidine.Plasma levels of epinephrine, norepinephrine, dopamine, cortisol, HR, SBP and DBP were detected at before infusion(T1), 2 hours(T2), 4 hours(T3) and 8 hours(T4) after infusion, end of infusion(T5).Results Plasma levels of norepinephrine, dopamine, cortisol of dexmedetomidine group were lower than those of saline group(P<0.05).HR, SBP and DBP of dexmedetomidine group were significantly lower than those of saline group(P<0.01).Conclusion As new sedative and analgesic drugs, use of dexmedetomidine(0.6μg· kg-1 · h-1 ) infusion was able to reduce plasma levels of norepinephrine, dopamine and cortisol, reduce the stress response, maintain hemodynamic stability.

BACKGROUND:We conducted a randomized trial to evaluate the efficacy and safety of dexmedetomidine for prophylactic analgesia and sedation in patients with delayed extubation after craniotomy.METHODS:From June 2012 to July 2014, 150 patients with delayed extubation after craniotomy were randomized 1:1 and were assigned to the dexmedetomidine group that received a continuous infusion of 0.6 μg/kg/h (10 μg/mL) or the control group that received a maintenance infusion of 0.9% sodium chloride for injection. The mean percentage of time under optimal sedation (SAS3-4), the percentage of patients who required rescue with propofol/fentanyl, and the total dose of propofol/fentanyl required throughout the course of drug infusion, as well as VAS, HR, MAP, and SpO2 were recorded.RESULTS:The percentage of time under optimal sedation was significantly higher in the dexmedetomidine group than in the control group (98.4%±6.7% vs. 93.0%±16.2%, P=0.008). The VAS was significantly lower in the dexmedetomidine group than in the control group (1.0 vs. 4.0, P=0.000). The HR and mean BP were significantly lower in the dexmedetomidine group than in the control group at all 3 time points (before endotracheal suctioning, immediately after extubation, and 30 min after extubation). No significant difference in SpO2 was observed between the 2 groups. For hemodynamic adverse events, patients in the dexmedetomidine group were more likely to develop bradycardia (5.3% vs. 0%, P=0.043) but had a lower likelihood of tachycardia (2.7% vs. 18.7%, P=0.002).CONCLUSIONS:Dexmedetomidine may be an effective prophylactic agent to induce sedation and analgesia in patients with delayed extubation after craniotomy. The use of dexmedetomidine (0.6 μg/kg/h) infusion does not produce respiratory depression, but may increase the incidence of bradycardia.

INTRODUCTION:Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients presenting acute cardiac and/or pulmonary dysfunctions, who are at high risk of developing acute kidney injury and fluid overload. Continuous renal replacement therapy (CRRT) is commonly used in intensive care units (ICU) to provide renal replacement and fluid management. We conducted a review to assess the feasibility, efficacy and safety of the combination of ECMO and CRRT and to illustrate the indications and methodology of providing renal replacement therapy during the ECMO procedure. METHOD:We searched for all published reports of a randomized controlled trial (RCT), quasi-RCT, or other comparative study design, conducted in patients undergoing ECMO plus CRRT. Two reviewers independently selected potential studies and extracted data. We used the modified Jadad scale and the Newcastle-Ottawa for quality assessment of RCTs and non-RCTs, respectively. Statistical analyses were performed using RevMan 5.2. RESULTS:We identified 19 studies meeting the eligibility criteria (seven cohort, six case control, one historically controlled trial and five studies of technical aspects). There are three major methods for performing CRRT during ECMO: 'independent CRRT access', 'introduction of a hemofiltration filter into the ECMO circuit (in-line hemofilter)' and 'introduction of a CRRT device into the ECMO circuit'. We conducted a review with limited data synthesis rather than a formal meta-analysis because there could be greater heterogeneity in a systematic review of non-randomized studies than that of randomized trials. For ECMO survivors receiving CRRT, overall fluid balance was less than that in non-CRRT survivors. There was a higher mortality and a longer ECMO duration when CRRT was added, which may reflect a relatively higher severity of illness in patients who received ECMO plus CRRT. CONCLUSIONS:The combination of ECMO and CRRT in a variety of methods appears to be a safe and effective technique that improves fluid balance and electrolyte disturbances. Prospective studies would be beneficial in determining the potential of this technique to improve the outcome in critically ill patients.