Journal of critical care最新文献_第9页

Postoperative oliguria after intermediate and high-risk surgeries in critical care, A cohort analysis 重症监护中高危手术后的术后少尿，一项队列分析。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-21 DOI: 10.1016/j.jcrc.2024.154976

Rodolpho Augusto de Moura Pedro , Guilherme Bittar Cunha , Igor Pietrobom , Bruna Carla Scharanch , Daniel Caraca Cubos , Rafael Alves Franco , Fernando Zampieri , Thiago Gomes Romano

Introduction

Oliguria is commonly used as a cutoff for acute kidney injury (AKI), however, a decrease in urine output is common during surgery and may represent an adaptative response in the perioperative setting rather than a reduction in glomerular filtration rate, leading to a possible overestimation of postoperative AKI incidence. Although this dilemma has been addressed in the intraoperative scenario, the incidence and impact of oliguria in the first postoperative day represents a gap in the current literature. Our main goal is to describe the incidence, risk factors and clinical outcomes related to postoperative oliguria.

Methods

This was a retrospective cohort conducted in four intensive care units (ICUs) across two private Brazilian hospitals, analyzing patients admitted after intermediate and high-risk surgeries between January 1, 2018 and December 31, 2022.

Results

1476 patients were included in the final analysis. Overall, 656 (44,5 %) were males, and the median age was 61,7 years. Oliguria was identified in 508 (34,4 %) patients within the first 24 h after surgery. Vasopressor requirement at admission, non-elective procedures, male sex and baseline serum creatinine were higher among oliguric patients. Among oliguric patients, age and basal serum creatine were higher among those who experienced AKI. Although only 12,4 % of oliguric patients developed AKI according to serum creatinine criterion, this incidence was significantly higher than in non-oliguric group (3,6 %), RR 3.42, IC 95 % 2.3–5.1 (p < 0.01). AKI recovery, RRT, ICU and hospital free days, and mortality were similar between the groups.

Conclusions

Postoperative oliguria is common after intermediate and high-risk surgical procedures and increases the risk of AKI. However, oliguria was largely unrelated with kidney disfunction measured by serum creatinine (87,6 %), raising doubts on whether diuresis overestimates AKI incidence in the postoperative setting.

导言：少尿通常被用作急性肾损伤（AKI）的临界值，但尿量减少在手术过程中很常见，可能是围手术期的一种适应性反应，而不是肾小球滤过率的降低，从而可能导致术后 AKI 发生率被高估。尽管这一难题已在术中得到解决，但术后第一天少尿的发生率和影响仍是目前文献中的空白。我们的主要目标是描述与术后少尿相关的发生率、风险因素和临床结果：这是一项回顾性队列研究，在巴西两家私立医院的四个重症监护病房（ICU）进行，分析了2018年1月1日至2022年12月31日期间中高危手术后入院的患者：最终分析共纳入了 1476 名患者。其中 656 人（44.5%）为男性，年龄中位数为 61.7 岁。508名患者（34.4%）在术后24小时内出现少尿症状。入院时需要使用血管加压药、非选择性手术、男性和基线血清肌酐在少尿患者中的比例较高。在少尿患者中，出现 AKI 的患者年龄和基础血清肌酸酐较高。虽然根据血清肌酐标准，只有 12.4% 的少尿患者发生了 AKI，但这一发生率明显高于非少尿患者组（3.6%），RR 为 3.42，IC 95 % 为 2.3-5.1（p 结论：少尿患者中，年龄和基础血清肌酐较低的患者发生 AKI 的比例较高：术后少尿在中高风险外科手术后很常见，会增加发生 AKI 的风险。然而，少尿在很大程度上与以血清肌酐测量的肾功能失调无关（87.6%），这让人怀疑利尿是否会高估术后 AKI 的发生率。

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引用次数: 0

Shock prediction with dipeptidyl peptidase-3 and renin (SPiDeR) in hypoxemic patients with COVID-19 使用二肽基肽酶-3 和肾素（SPiDeR）对 COVID-19 低氧血症患者进行休克预测。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-14 DOI: 10.1016/j.jcrc.2024.154950

Laurence W. Busse MD, MBA, FCCM , J. Pedro Teixeira MD , Christopher L. Schaich PhD , Caitlin C. ten Lohuis ACNP-BC , Nathan D. Nielsen MD, MSc , Jeffrey M. Sturek MD, PhD , Lisa H. Merck MD, MPH , Wesley H. Self MD, MPH , Michael A. Puskarich MD, MSCR , Akram Khan MBBS , Matthew W. Semler MD, MSc , Ari Moskowitz MD, MPH , David N. Hager MD, PhD , Abhijit Duggal MD, MPH, MSc , Todd W. Rice MD, MSc , Adit A. Ginde MD, MPH , Brian R. Tiffany MD, PhD , Nicole M. Iovine MD , Peter Chen MD , Basmah Safdar MD, MSc , Sean P. Collins MD, MSc

Background

Plasma dipeptidyl peptidase-3 (DPP3) and renin levels are associated with organ dysfunction and mortality. However, whether these biomarkers are associated with the subsequent onset of shock in at-risk patients is unknown.

Methods

Using plasma samples collected from participants enrolled in the fourth Accelerating COVID-19 Therapeutic Interventions and Vaccines Host Tissue platform trial, we measured DPP3 and renin in 184 subjects hospitalized with acute hypoxemia from COVID-19 without baseline vasopressor requirement. We calculated the odds ratio of development of shock (defined as the initiation of vasopressor therapy) by Day 28 based on Day 0 DPP3 and renin levels.

Results

Subjects with DPP3 above the median had a significantly higher incidence of vasopressor initiation within 28 days (28.4 % vs. 16.7 %, p = 0.031) and higher 28-day mortality (25.0 % vs. 6.7 %, p < 0.001). After adjusting for covariables, DPP3 above the median was associated with shorter time to vasopressor initiation, greater 28-day mortality, fewer vasopressor-free days, and greater odds of a hypotensive event over 7 days. Significant associations were not observed for renin.

Conclusions

In patients hospitalized with COVID-19 and hypoxemia without baseline hypotension, higher baseline plasma levels of DPP3 but not renin were associated with increased risk of subsequent shock and death.

背景：血浆二肽基肽酶-3（DPP3）和肾素水平与器官功能障碍和死亡率有关。然而，这些生物标志物是否与高危患者随后发生休克有关尚不清楚：我们使用从参加第四次加速 COVID-19 治疗干预和疫苗宿主组织平台试验的参与者处收集的血浆样本，测量了 184 名因 COVID-19 急性低氧血症住院且无基线血管加压需求的受试者的 DPP3 和肾素。我们根据第 0 天的 DPP3 和肾素水平计算了第 28 天发生休克（定义为开始使用血管加压疗法）的几率：结果：DPP3高于中位数的受试者在28天内启动血管加压疗法的发生率明显更高（28.4% vs. 16.7%，p = 0.031），28天死亡率也更高（25.0% vs. 6.7%，p 结论：DPP3高于中位数的受试者在28天内启动血管加压疗法的发生率明显更高（28.4% vs. 16.7%，p = 0.031），28天死亡率也更高（25.0% vs. 6.7%，p = 0.031）：在因 COVID-19 和低氧血症住院但无基线低血压的患者中，DPP3（而非肾素）的基线血浆水平越高，随后发生休克和死亡的风险就越高。

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引用次数: 0

Fever following extracorporeal membrane oxygenation decannulation: Infection, thrombosis or just physiology? 体外膜肺氧合拔管后发热：感染、血栓还是生理学原因？

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-11 DOI: 10.1016/j.jcrc.2024.154945

Benjamin Assouline , Gianlucca Belli , Karim Dorgham , Quentin Moyon , Alexandre Coppens , Marc Pineton de Chambrun , Juliette Chommeloux , David Levy , Ouriel Saura , Guillaume Hekimian , Matthieu Schmidt , Alain Combes , Charles-Edouard Luyt

Purpose

Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes.

Methods

Adult ECMO patients who were successfully weaned from ECMO were retrospectively included. Minimal and maximal core temperatures were collected daily for each patient from 48 h before decannulation up to 5 days after. Patients were grouped according to the cause of fever (infection, thrombosis, or no evident cause) and compared. Plasma cytokine profile was obtained, each day from decannulation to 5 days after for 20 patients.

Results

Between January 2021 and December 2022, 123 patients successfully weaned from ECMO were included. Post-decannulation fever occurred in 54 patients (44 %). It was associated with an infection in 39 patients (72 %) and with a thrombosis in 6 patients (11 %), and no cause was identified in the remaining 9 (17 %). Prolonged ECMO duration, extended ICU length-of-stay, diabetes and vascular comorbidities were significantly associated with a higher risk of infection. Finally, the pro-inflammatory cytokine profiles did not differ between febrile and afebrile patients.

Conclusion

Post-decannulation fever was common, and was mainly due to infections or thrombosis. Fever should therefore not be considered as a benign inflammatory reaction until proven otherwise.

目的：体外膜肺氧合（ECMO）拔管后经常出现发热。我们旨在评估拔管后发热的发生率，并描述其原因：方法：我们回顾性地纳入了成功从 ECMO 断流的成年 ECMO 患者。从拔管前 48 小时到拔管后 5 天，每天收集每位患者的最低和最高体温。根据发热原因（感染、血栓或无明显原因）将患者分组并进行比较。从拔管到拔管后 5 天，每天采集 20 名患者的血浆细胞因子谱：结果：2021 年 1 月至 2022 年 12 月期间，共有 123 名患者成功脱离 ECMO。有 54 名患者（44%）在拔管后出现发热。39 名患者（72%）发热与感染有关，6 名患者（11%）发热与血栓形成有关，其余 9 名患者（17%）发热原因不明。延长 ECMO 持续时间、延长重症监护室的住院时间、糖尿病和血管并发症与较高的感染风险明显相关。最后，发热患者与无发热患者的促炎细胞因子谱无差异：结论：解痉后发热很常见，主要是由于感染或血栓形成。因此，在未证实之前，发热不应被视为良性炎症反应。

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引用次数: 0

Clinical impact of hypermagnesemia in acute kidney injury patients undergoing continuous kidney replacement therapy: A propensity score analysis utilizing real-world data 高镁血症对接受持续肾脏替代治疗的急性肾损伤患者的临床影响：利用真实世界数据进行倾向评分分析。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-09 DOI: 10.1016/j.jcrc.2024.154947

Ming-Jen Chan , Jia-Jin Chen , Cheng-Chia Lee , Pei-Chun Fan , Yi-Jiun Su , Ya-Lien Cheng , Chao-Yu Chen , VinCent Wu , Yung-Chang Chen , Chih-Hsiang Chang

Purpose

While hypomagnesemia is known to be a risk factor for acute kidney injury (AKI), the impact of hypermagnesemia on prognosis in AKI patients undergoing continuous kidney replacement therapy (CKRT) remains unclear. This study investigates the relationship between hypermagnesemia and clinical outcomes in this patient population.

Methods

A retrospective analysis was conducted using data from a multicenter medical repository spanning from 2001 to 2019, involving patients who underwent CKRT. Patients were categorized into normomagnesemia (<2 mEq/L) and hypermagnesemia groups based (≥2 mEq/L) on their levels at CKRT initiation.

Results

Among the 2625 patients, 1194 (45.5 %) had elevated serum magnesium levels. The hypermagnesemia group exhibited a similar rate of non-recovery of renal function at 90-days compared to the normomagnesemia group (63.1 % vs. 62.8 %, odds ratio [OR] = 1.01, 95 % confidence interval [CI] 0.90–1.14). Furthermore, the high magnesium group demonstrated higher one-year all-cause mortality (hazard ratio [HR] 1.14, 95 % CI 1.07–1.21) and an elevated risk of one-year arrhythmia (HR 4.77, 95 % CI 1.59–14.29). There was no difference of incidence of seizure between hypermagnesemia and normomagnesemia group.

Conclusions

Our study suggests that hypermagnesemia in AKI patients undergoing CKRT is not associated with improved renal recovery but is linked to worse clinical outcomes, including all-cause mortality and arrhythmia. Close monitoring of serum magnesium levels is recommended in this population for optimizing clinical outcomes.

目的：众所周知，低镁血症是急性肾损伤（AKI）的一个危险因素，但高镁血症对接受持续肾脏替代治疗（CKRT）的AKI患者预后的影响仍不清楚。本研究探讨了高镁血症与此类患者临床预后之间的关系：方法：利用多中心医学资料库中 2001 年至 2019 年期间的数据进行了回顾性分析，涉及接受 CKRT 的患者。患者被分为正常镁血症（Results：在 2625 例患者中，有 1194 例（45.5%）血清镁水平升高。与正常镁血症组相比，高镁血症组在 90 天内肾功能未恢复的比例相似（63.1% 对 62.8%，几率比 [OR] = 1.01，95% 置信区间 [CI] 0.90-1.14）。此外，高镁血症组的一年全因死亡率更高（危险比 [HR] 1.14，95 % 置信区间 [CI] 1.07-1.21），一年心律失常的风险也更高（HR 4.77，95 % 置信区间 [CI] 1.59-14.29）。高镁血症组和正常镁血症组的癫痫发作率没有差异：我们的研究表明，在接受 CKRT 的 AKI 患者中，高镁血症与肾功能恢复的改善无关，但与更差的临床结果有关，包括全因死亡率和心律失常。建议密切监测这类人群的血清镁水平，以优化临床预后。

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引用次数: 0

Letter to the editor: “What every intensivist should know about: Trust in the icu” 致编辑的信："每一位重症监护医生都应了解：重症监护室中的信任"：重症监护室中的信任"。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-08 DOI: 10.1016/j.jcrc.2024.154949

Hannah M. Vincent BSN, RN , Jan Bakker

引用次数: 0

Decreased renal cortical perfusion post-EGDT is associated with MAKE-30 in sepsis EGDT 后肾皮质灌注减少与败血症 MAKE-30 有关

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-06 DOI: 10.1016/j.jcrc.2024.154943

Qiqi Li , Rong Li , Can Wang , Qian Zhang , Qian Zhang , Yan Huo , Yangong Chao , Xiaoting Wang , Zhenjie Hu , Lixia Liu , for the Chinese Critical UltraSound Study Group(CCUSG)

Objective

This study explores alterations in renal cortical perfusion post-Early Goal-Directed Therapy (EGDT) in sepsis patients, to investigate its association with major adverse kidney events within 30 days (MAKE-30) and identify hemodynamic factors associated with renal cortical perfusion.

Methods

Sepsis patients admitted to the ICU from Jan 2022 to Jul 2023 were prospectively enrolled. Contrast-enhanced ultrasound (CEUS) assessed renal cortical perfusion post-EGDT. Hemodynamic parameters and renal resistive index (RRI) were collected. Patients were categorized into MAKE-30 and non-MAKE-30 groups. The study examined the association between renal cortical perfusion and MAKE-30, explored the hemodynamic factors related to renal cortical perfusion.

Results

Of 94 sepsis patients, 46 (48.9 %) experienced MAKE-30. Distinctions in pulmonary (P = 0.012) and abdominal infection sites (P = 0.001) and significant SOFA (P < 0.001) and APACHE II scores (P = 0.003) differences were observed. No significant differences in baseline characteristics, vasopressor, or diuretic doses were noted (P > 0.05). Hemodynamic parameters in MAKE-30 and non-MAKE-30 patients showed no significant differences. RRI was higher in MAKE-30 patients (0.71 vs 0.66 P = 0.005). Renal microcirculation parameters, including AUC (p = 0.035), rBV (p = 0.021), and PI (p = 0.003), were lower in MAKE-30. Reduced cortical renal perfusion was associated with an increased risk of MAKE-30. Renal cortical perfusion RT was identified as an independent factor associated with this risk (HR 2.278, 95 % CI (1.152–4.507), P = 0.018). RRI correlated with renal cortical perfusion AUC (r = −0.220 p 0.033).

Conclusion

Despite normal systemic hemodynamics post-sepsis EGDT, MAKE-30 patients show reduced renal cortical perfusion. CEUS-derived RT is an independent factor associated with this change. RRI correlates with renal cortical perfusion.

目的本研究探讨脓毒症患者早期目标导向疗法（EGDT）后肾皮质灌注的改变，研究其与30天内主要不良肾脏事件（MAKE-30）的关联，并确定与肾皮质灌注相关的血流动力学因素。方法前瞻性纳入2022年1月至2023年7月入住重症监护室的脓毒症患者。对比增强超声（CEUS）评估了EGDT后的肾皮质灌注情况。收集了血液动力学参数和肾脏阻力指数（RRI）。患者被分为 MAKE-30 组和非 MAKE-30 组。研究考察了肾皮质灌注与 MAKE-30 之间的关联，并探讨了与肾皮质灌注相关的血流动力学因素。观察到肺部（P = 0.012）和腹部感染部位（P = 0.001）的差异，以及显著的 SOFA（P < 0.001）和 APACHE II 评分（P = 0.003）差异。基线特征、血管加压剂或利尿剂剂量无明显差异（P > 0.05）。MAKE-30 和非 MAKE-30 患者的血液动力学参数无明显差异。MAKE-30 患者的 RRI 较高（0.71 vs 0.66 P = 0.005）。MAKE-30 患者的肾微循环参数较低，包括 AUC（P = 0.035）、rBV（P = 0.021）和 PI（P = 0.003）。肾皮质灌注减少与 MAKE-30 风险增加有关。肾皮质灌注 RT 被确定为与这一风险相关的独立因素（HR 2.278，95 % CI (1.152-4.507)，P = 0.018）。RRI 与肾皮质灌注 AUC 相关（r = -0.220 P 0.033）。CEUS 导出的 RT 是与这一变化相关的独立因素。RRI 与肾皮质灌注相关。

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引用次数: 0

Optimizing fosfomycin dosing regimens in critically ill patients with and without continuous renal replacement therapy 在接受和未接受持续肾脏替代治疗的重症患者中优化磷霉素给药方案

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-11-06 DOI: 10.1016/j.jcrc.2024.154946

Taniya Charoensareerat , Phongphak Bunrit , Sasina Phanpoka , Thananya Netthanomsak , Dhakrit Rungkitwattanakul , Sutthiporn Pattharachayakul , Nattachai Srisawat , Weerachai Chaijamorn

Purpose

To define the optimal fosfomycin dosing regimens for drug-resistant gram-negative bacteria in critically ill patients and those receiving continuous renal replacement therapy (CRRT) via Monte Carlo simulations.

Materials and methods

A pharmacokinetic model for patients with and without CRRT was created to predict fosfomycin deposition in these patients. The pharmacodynamics (PD) targets were AUC/MIC ratio > 21.5, 28.2, and 98.8 for drug-resistant Klebsiella pneumoniae (KP), Pseudomonas aeruginosa (PA) and Escherichia coli (EC) infections, respectively. The optimal regimen was defined when the probability of target attainment (PTA) was >90 % of the virtual patients.

Results

The fosfomycin dosing regimens for KP infections with MIC 64 mg/L in critically ill patients and who received CRRT were 6 g every 8 h and 8 g every 12 h, respectively. For PA infections, the regimens of 6 g every 6 h and 7 g every 8 h achieved the target in critically ill patients and those undergoing CRRT. No regimen achieved the 90 % PTA against the EC infection with MIC >32 mg/L.

Conclusions

Dosing regimens for bacteria with high MICs as 64 mg/L in these patients were 18–24 g/day. Dose adjustments were required in those undergoing CRRT. Clinical validation is strongly needed.

目的通过蒙特卡洛模拟确定针对重症患者和接受持续肾脏替代疗法（CRRT）患者中耐药革兰氏阴性菌的最佳磷霉素给药方案。材料与方法为接受和未接受 CRRT 的患者创建药代动力学模型，以预测磷霉素在这些患者中的沉积情况。耐药肺炎克雷伯菌（KP）、铜绿假单胞菌（PA）和大肠埃希菌（EC）感染的药效学（PD）目标分别为 AUC/MIC比值> 21.5、28.2 和 98.8。结果对于 MIC 值为 64 mg/L 的重症患者和接受 CRRT 的 KP 感染，磷霉素给药方案分别为每 8 小时 6 克和每 12 小时 8 克。对于 PA 感染，在重症患者和接受 CRRT 治疗的患者中，每 6 小时给药 6 克和每 8 小时给药 7 克的方案均能达到目标。对于 MIC 为 32 mg/L 的 EC 感染，没有一种方案能达到 90% 的 PTA。接受 CRRT 治疗的患者需要调整剂量。临床验证非常必要。

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引用次数: 0

Long-term characteristics and outcomes of septic critically ill patients with and without COVID-19 患有和未患有 COVID-19 的脓毒症重症患者的长期特征和预后

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-31 DOI: 10.1016/j.jcrc.2024.154942

Felix Niebhagen , Lars Heubner , Anna Kirsch , Andreas Güldner , Hanns-Christoph Held , Ralph Schneider , Ulf Bodechtel , Jan Mehrholz , Thea Koch , Mario Menk , Peter Spieth

Background

In-hospital mortality of septic critically ill patients with COVID-19 is significantly higher than in those without COVID-19. The knowledge on long-term outcomes remains scarce. In this retrospective analysis, we compare clinical characteristics, long-term functional outcomes, and survival in septic critically ill patients with and without COVID-19.

Methods

Data of septic critically ill patients without COVID-19 were collected as part of the Comprehensive Sepsis Center Dresden-Kreischa registry from 2020 to 2023. The data of septic critically ill patients with COVID-19 were collected as part of the local ARDS/COVID-19 registry over the same period. Diagnosis of sepsis was based on the Sepsis-3 definition. Variables collected for analyses were obtained from electronic health records. Long-term follow-up was performed 6–12 months after sepsis diagnosis. Survival was depicted using Kaplan-Meier curves. Associations between long-term mortality and risk factors were modeled by Cox Regression.

Results

372 septic patients without COVID-19 and 301 with COVID-19 were enrolled. Septic patients with COVID-19 were significantly younger, had a significantly lower Charlson Comorbidity Index, and had a significantly higher SOFA score at ICU admission. Long-term follow-up showed a significantly higher mortality in septic patients with COVID-19 (73.4 % vs. 30.1 %; HR 3.4 (95 % CI 2.73–4.27; p < 0.05)). COVID-19 infection was associated with significant increased mortality (adjusted HR 3.27; 95 % CI 2.48–4.33; p < 0.05) and reduced health-related quality of life, measured by the EQ-5D-3 L Index, (0.56 (0.16–0.79) vs. 0.79 (0.69–0.99); p < 0.05).

Conclusions

In our cohort of septic critically ill patients, health-related quality of life and long-term survival were considerably reduced in patients with concomitant COVID-19. Furthermore, COVID-19 could be identified as an independent risk factor for higher long-term mortality in these patients.

背景患有 COVID-19 的脓毒症重症患者的院内死亡率明显高于未患 COVID-19 的患者。有关长期预后的知识仍然很少。在这项回顾性分析中，我们比较了有 COVID-19 和没有 COVID-19 的脓毒症重症患者的临床特征、长期功能预后和存活率。方法 2020 年至 2023 年期间，德累斯顿-克赖沙综合脓毒症中心（Comprehensive Sepsis Center Dresden-Kreischa registry）收集了没有 COVID-19 的脓毒症重症患者的数据。患有 COVID-19 的脓毒症重症患者的数据是在同一时期作为当地 ARDS/COVID-19 登记的一部分收集的。败血症诊断基于败血症-3定义。用于分析的变量来自电子健康记录。脓毒症确诊后 6-12 个月进行长期随访。生存率采用 Kaplan-Meier 曲线表示。结果372例脓毒症患者未携带COVID-19，301例患者携带COVID-19。患有COVID-19的脓毒症患者明显更年轻，Charlson综合指数明显更低，入ICU时的SOFA评分明显更高。长期随访显示，COVID-19 败血症患者的死亡率明显更高（73.4% 对 30.1%；HR 3.4 (95 % CI 2.73-4.27; p <0.05)）。COVID-19感染与死亡率显著增加（调整后 HR 3.27; 95 % CI 2.48-4.33; p <0.05）和健康相关生活质量下降（以 EQ-5D-3 L 指数衡量）（0.56 (0.16-0.79) vs. 0.79 (0.69-0.99); p <0.05）相关。此外，COVID-19 还是导致这些患者长期死亡率升高的一个独立风险因素。

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引用次数: 0

Letter to the editor: "Effectiveness of early high-flow nasal oxygen therapy after extubation of patients in the intensive care unit" 致编辑的信："重症监护室患者拔管后早期高流量鼻氧疗法的效果"

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-30 DOI: 10.1016/j.jcrc.2024.154940

Rashid Nadeem , Reham Helmy Amin Saad

引用次数: 0

Cumulative impact of hypotension during intermittent hemodialysis on kidney recovery in critically ill patients with AKI-D 间歇性血液透析期间低血压对 AKI-D 重症患者肾脏恢复的累积影响。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care

Pub Date : 2024-10-30 DOI: 10.1016/j.jcrc.2024.154944

Jae Ho Kim , Joonhee Yoon , Ji-Eun Kim , Seongho Jo , Yuri Lee , Ji Won Kim , Seun Deuk Hwang , Seoung Woo Lee , Joon Ho Song , Kipyo Kim

Background

Intermittent hemodialysis (IHD) is commonly implemented in patients with AKI-D, irrespective of the initial kidney replacement therapy (KRT) modality. However, concerns remain regarding the hemodynamic instability during IHD. This study aimed to assess the association between hypotensive episodes during IHD and kidney recovery in AKI-D patients.

Methods

We retrospectively enrolled AKI-D survivors who received IHD in the intensive care units of a tertiary care hospital in Korea from January 2018 to February 2024.

Results

A total of 1791 IHD sessions from 209 AKI-D survivors were analyzed. The patients underwent a median of 7 IHD sessions (interquartile range [IQR] 3–11), with an incidence of intradialytic hypotension (IDH) of 16.8 % per patient. Of these, 43.1 % were dialysis-dependent at hospital discharge. The number of IDH was a significant predictor of dialysis dependence (odds ratio [OR] 1.56; 95 % confidence interval [CI] 1.16–2.22). Patients experiencing ≥3 IDH episodes had a substantially higher risk of dialysis dependence compared to those without IDH (OR 9.41; 95 % CI 2.41–41.69). In per-session analysis, the target ultrafiltration rate was identified as an independent risk factor for IDH occurrence.

Conclusions

Our study revealed that IHD-related hypotension during hospitalization has a cumulative negative impact on kidney recovery in AKI-D survivors.

背景：间歇性血液透析（IHD）通常用于急性肾损伤（AKI-D）患者，与最初的肾脏替代治疗（KRT）方式无关。然而，间歇性血液透析期间的血流动力学不稳定性仍令人担忧。本研究旨在评估 IHD 期间低血压发作与 AKI-D 患者肾脏恢复之间的关系：我们回顾性地纳入了2018年1月至2024年2月期间在韩国一家三级医院重症监护室接受IHD治疗的AKI-D幸存者：我们分析了 209 名 AKI-D 幸存者的 1791 次 IHD 治疗。患者接受的 IHD 治疗次数中位数为 7 次（四分位数间距 [IQR] 3-11 次），每位患者的椎管内低血压 (IDH) 发生率为 16.8%。其中，43.1%的患者出院时依赖透析。IDH次数是透析依赖性的重要预测因素（几率比 [OR] 1.56；95 % 置信区间 [CI] 1.16-2.22）。与无 IDH 的患者相比，IDH ≥ 3 次的患者透析依赖的风险要高得多（OR 9.41; 95 % CI 2.41-41.69）。在按疗程分析中，目标超滤率被确定为发生 IDH 的独立风险因素：我们的研究表明，住院期间与 IHD 相关的低血压会对 AKI-D 幸存者的肾脏恢复产生累积性负面影响。

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引用次数: 0