World journal of emergency medicine最新文献

BACKGROUND: Severe acute pancreatitis (SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit (ICU) patients remains inadequately researched. This study aims to determine the prevalence of delirium in critically ill patients diagnosed with SAP, and to identify risk factors associated with delirium in this patient population. METHODS: This was a retrospective, multicenter study, which enrolled adult patients diagnosed with SAP who admitted intensive care unit (ICU) for at least 24 h. Patient assessment was conducted using the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU). The cumulative incidence of delirium was determined. Demographic, clinical data, and length of ICU stay were compared between patients with and without delirium. A logistic regression model was employed to identify potential risk factors for delirium. RESULTS: A total of 1,814 patients were included from seven hospitals in Anhui province, China. Delirium was observed in 25.2% of patients. Logistic regression analysis identified APACHE II scores (odds ratio [OR]=3.37, 95% confidence interval [CI]: 1.09-10.43, P=0.04), physical restraint (OR=11.11, 95%CI: 4.35-28.39, P<0.05), invasive mechanical ventilation (IMV) (OR=2.44, 95%CI: 1.41-4.25, P=0.002), and ICU length of stay ≥ 7 days (OR=3.14, 95%CI: 2.27-4.36, P<0.05) as independent risk factors of delirium. CONCLUSION: The present study revealed a substantial incidence of delirium in critically ill patients with SAP, associated with factors including APACHE II score, IMV, physical restraint, and prolonged ICU stays.

BACKGROUND: Previous studies have reported that early computed tomography (CT) findings significantly contribute to the outcomes of cardiac arrest (CA) patients. This study aims to evaluate the association between chest CT features and prognosis in CA patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). METHODS: A retrospective observational study was conducted on adult CA patients treated with ECPR in a tertiary hospital between March 2015 and June 2023. All the patients underwent a whole-body CT scan within 1 h of ECPR. Data regarding demographic and clinical characteristics were collected from electronic medical records. The presence of gravity-dependent distribution and CT scores based on chest CT scans were determined for each patient. The primary outcome was 28-day survival. Receiver operating characteristic (ROC) curves were used to evaluate the ability of chest CT features (gravity-dependent distribution and CT scores) to predict poor outcomes. The cut-off value of the CT score was determined. Kaplan-Meier curves were used to compare 28-day survival between the low- and high-CT score groups, which were classified using the estimated cut-off value. RESULTS: Among the 100 patients included, 74 were non-survivors. The non-survivor patients showed a higher presence of gravity-dependent distribution and higher CT scores than survivors (P<0.05). Patients with gravity-dependent distribution had significantly higher CT scores than those with non-gravity-dependent distribution (P<0.05). The combination of CT score and gravity-dependent distribution predicted poor outcomes better than considering the features individually, demonstrating moderate performance (AUC: 0.693, 95% CI: 0.568-0.801). According to the survival analysis, the risk of death increased as the CT score rose, with an estimated cut-off value of ≥ 11 (P=0.016). CONCLUSION: Chest CT features were associated with poor outcomes in CA patients following ECPR.

BACKGROUND: The mechanisms underlying hypothermic liver injury necessitate investigation for the development of effective diagnostic and therapeutic approaches. We aim to establish a model of hypothermic liver injury to explore the hepatic alterations, thereby facilitating the prevention and treatment of the liver injury associated with hypothermia. METHODS: The mice were placed in a -20 °C environment, to establish a hypothermic injury model. The liver function, metabolites, and proteins expression were measured by thromboelastography, histopathology, metabolomics and western blotting, respectively. Furthermore, apoptosis and pathway changes in the liver cells conducted with target metabolites were examined and verified. RESULTS: According to the prolonged righting reflex recovery time and death occurrence, the mice with the anal temperature (AT) dropping to 20 °C or 15 °C were used to establish a model of hypothermia. The model mice showed changes in alanine aminotransferase (ALT), aspartate transaminase (AST), and coagulation indicators. HE staining results indicated that liver tissue in the AT 20°C mice had large hemorrhagic patches, while the AT 15°C mice displayed significant congestion, along with extensive infiltration of inflammatory cells around the central vein. Metabolomic and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of target metabolites revealed a significant increase in 3-hydroxybutyric acid and changes in the cyclic adenosine monophosphate (cAMP) signaling pathway in the liver tissue of hypothermic mice. The hypothermic mice showed decreases in levels of cAMP, protein kinase A C-α (PKA C-α), and phosphorylated BCL-2/BCL-XL-associated death promoter (p-Bad) and an increase in BCL-2/BCL-XL-associated death promoter (Bad) level in the liver. These protein changes and apoptosis were intensified by 3-hydroxybutyric acid in liver cells. CONCLUSION: Hypothermia may induce apoptosis in the liver cell which may be related to the changes of the cAMP-PKA pathway proteins expression. These findings provide a basis for the treatment of hypothermic injury.

BACKGROUND: Patients suffering from hemorrhagic shock (HS) complicated by severe trauma are at high risk of developing acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The underlying pathophysiology is complex, and the lack of targeted therapeutic strategies remains a major clinical challenge. METHODS: In this narrative review, a literature search was conducted in the PubMed to identify articles published from 2006 to August 2025 concerning trauma, HS, traumatic HS (THS), biomarkers related to ALI, ARDS and HS, as well as their treatment. Through its multifactorial pathogenesis, we discuss the diagnostic and prognostic values of biomarkers, their potential role in treatment, and therapeutic advancements and perspectives. RESULTS: ALI and ARDS are serious complications in severe trauma patients with HS. Hypoperfusion, hypoxia, endothelial cell activation, inflammation, ischemia/reperfusion injury and the intestinal response, as well as chest trauma and transfusion-related events are potential causes of lung injury. The pulmonary epithelial biomarkers soluble receptor for advanced glycation end products (sRAGE) and surfactant protein-D provide indicators for evaluating the severity of lung contusion and injury, whereas Clara cell protein 16 may have clinical value for trauma patients with ALI complicated by pneumonia. Elevated endothelial biomarkers angiopoietin-2 and syndecan-1 are correlated with injury severity, transfusion, coagulopathy, the onset of ARDS, and patient outcomes. The role of biomarkers in therapeutic benefit is reviewed. CONCLUSIONS: Preventive and therapeutic strategies for THS-induced ALI/ARDS rely on the implementation of multi-target, multi-mechanism interventions that address the complex pathophysiology. Targeted phenotypic therapy guided by biomarkers would be of interest for future research aimed at improving clinical outcomes.