World journal of emergency medicine最新文献

Background: Sepsis-associated encephalopathy (SAE) is a diffuse dysfunction of the nervous system resulting from sepsis originating outside the central nervous system. Elderly individuals (≥65 years of age) constitute a particularly vulnerable population comprised by a high burden of underlying diseases and complications, which frequently leads to underdiagnosis or misdiagnosis. These patients are at increased risk of long-term or permanent central nervous system impairment, making rapid and accurate diagnosis and treatment especially critical. The review is expected to promote improvements in the diagnosis and treatment of SAE in elderly patients, ultimately achieving more standardized and efficient SAE management.

Methods: We performed a literature search in four databases-PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang-from inception to April 2025 using bilinguals (Chinese and English).

Results: The diagnostic criteria for SAE in elderly individuals include the following: (1) sepsis; (2) new-onset neurological dysfunction; and (3) exclusion of other causes of neurological dysfunction. Physicians should develop tailored empiric anti-infective plans for elderly SAE patients, considering comorbidities, organ function, infection site, local bacterial spectrum, and resistance. The treatment protocol can be adjusted once the pathogen is identified. Stabilizing hemodynamics and ensuring cerebral perfusion are two fluid resuscitation strategies used in elderly SAE patients. An individualized approach to fluid resuscitation using restrictive fluid volumes should be employed. Supportive treatment for elderly SAE patients focuses on improving tissue perfusion/oxygenation, controlling blood glucose levels, and correcting internal imbalances. Early rehabilitation, nutritional support, cognitive training, and family-based emotional support are important components of comprehensive care.

Conclusion: The diagnosis and management of SAE in elderly patients support early recognition and timely intervention.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive technique used to control non-compressible torso hemorrhage. However, the optimal degree of partial occlusion that offers maximum therapeutic benefit remains unclear. This study aimed to identify the optimal partial inflation volume for REBOA.

Methods: In a swine model of hemorrhagic shock, nine healthy female pigs were randomly assigned to three groups based on balloon inflation volume: 30% (R30), 60% (R60), and 100% (R100) of the volume required to eliminate the contralateral femoral arterial waveform. Hemodynamic variables, fluid and vasopressor requirements, and biochemical markers were evaluated during balloon occlusion and resuscitation following 40% blood volume-controlled hemorrhage.

Results: The R30 group showed higher mean arterial pressure during resuscitation and required less fluid and norepinephrine than those of the R100 group. The mean heart rate significantly differed over time among the groups, with more gradual changes in the R30 group. Markers of ischemia-reperfusion injury (lactate, pH, blood urea nitrogen, and creatinine) similarly exhibited significant temporal differences. Post hoc analysis revealed significant pH differences between the groups. The plasma lactate and creatinine levels were significantly lower in the R30 group than those in the other two groups.

Conclusion: In this swine hemorrhagic shock model, partial REBOA with 30% balloon inflation maintained hemodynamic stability while reducing metabolic derangement compared with higher ballon volumes of 60% and 100% inflation. A strategy involving partial inflation targeting approximately 30%, followed by monitoring the blood pressure trend while using a vasoconstrictor, if necessary, may have potential clinical utility.

Background: Pulse indicated continuous cardiac output (PiCCO) has largely replaced Swan-Ganz catheterization in shock patients. However, whether PiCCO monitoring can improve outcomes of shock patients, such as mortality, length of hospital stay, duration of mechanical ventilation, or laboratory parameters, remains unknown.

Methods: This retrospective cohort study included patients with shock in the intensive care unit (ICU) from January 2013 to January 2020. Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not. Demographic characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, quick Sequential Organ Failure Assessment (qSOFA) scores, 14-day mortality, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 0, 1, 3 and 7 days after onset of shock, duration of mechanical ventilation, length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching (PSM).

Results: Real-world analysis of 1,583 ICU patients suffering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups (36.2% vs. 32.6%, P=0.343). Duration of mechanical ventilation, hospital stay, and hospitalization costs were also similar between the two groups (P>0.05). No differences in changes of NT-proBNP levels on days 0, 1, 3, and 7 as compared to baseline were noted between the two groups (P>0.05).

Conclusions: The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation, length of hospital stay, or reduce hospitalization costs, nor will it bring survival benefits to ICU patients suffering shock.

Background: The nonspecific clinical presentation of adrenal insufficiency (AI) frequently leads to misdiagnosis, often as psychiatric or gastrointestinal disorders. AI is classified anatomically as primary AI (PAI), secondary AI (SAI), or tertiary AI (TAI). Without timely recognition, progression to adrenal crisis (AC) can result in life-threatening outcomes. This study aimed to systematically analyze the clinical features, etiologies, and outcomes of AI in Lhasa's emergency population to improve diagnostic accuracy and optimize clinical management.

Methods: A retrospective analysis of emergency department admissions from January 2020 to August 2024 at People's Hospital of Xizang Autonomous Region was conducted. AI diagnoses were identified via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes from electronic health records (EHR). Patients were grouped into incipient AC (IAC) or AC cohorts based on hemodynamic status. Demographic profiles, etiologies, clinical presentations, and laboratory results were analyzed.

Results: Forty-three AI patients were identified. The population-standardized admission rate for AI increased from 9 to 16 per million person-years, with PAI cases doubling during this period. Adrenal tuberculosis (58.1%) and adrenal hematoma (18.6%) were the leading etiologies. Compared to the IAC group, the AC group demonstrated lower systolic blood pressure (SBP) (P=0.001) and diastolic blood pressure (DBP) (P<0.001); higher neutrophil count (P=0.048), eosinophil count (P=0.044), CRP (P=0.004), blood urea nitrogen (BUN) (P=0.007); lower sodium (P<0.001) and glucose levels (P=0.001). The hospital stay was longer in the AC group (20 d vs. 14 d; P<0.001).

Conclusion: AI incidence is rising in high-altitude regions, with adrenal tuberculosis remaining the most common cause. AC is associated with increased inflammatory responses, hemodynamic instability, and metabolic disturbances. Targeted interventions are required to improve outcomes.