Zhonghua wei zhong bing ji jiu yi xue最新文献

Cardiopulmonary resuscitation (CPR) is a critical life-saving intervention for patients who have suffered cardiac arrest (CA), which helps the organism of CA patients to rapidly restore respiratory and circulatory functions. However, the survival rate of patients after CPR is extremely low. Globally, sudden cardiac arrest causes over 3 million deaths annually, and the survival rate after CPR is less than 8%. Hypoxic ischemic brain injury (HIBI) is the primary cause of death in 68% of these cases. Hyperbaric oxygen therapy (HBOT) enhances the dissolution of oxygen in plasma, increases the arterial blood oxygen partial pressure in the body, and improves tissue hypoxia. It is widely used in conditions of cerebral ischemia and hypoxia (such as stroke, CA, etc), but its role in HIBI following CPR has not been fully studied. Therefore, this article systematically reviews the multi-target mechanisms of HBOT in the treatment of HIBI, including the inhibition of cell apoptosis and necrosis, improvement of oxidative stress, reduction of neuroinflammation, and enhancement of blood-brain barrier permeability and collateral circulation. It also discusses emerging treatment strategies such as HBOT combined with gut microbiome modulation and active abdominal compression-decompression CPR (AACD-CPR), exploring their potential as new therapeutic targets for HIBI post-CPR, with the aim of identifying more promising clinical translation paths to improve neurological functional prognosis and quality of life after CPR.

Sedation and analgesia strategies are integral components of treatment for critically ill patients. They help to reduce discomfort and anxiety, minimize adverse medical events, enable safe and effective interventions, and ultimately improve patient outcomes. In recent years, with advancing research, the concepts and strategies guiding clinical sedation and analgesia have progressively evolved. Significant shifts have occurred, moving from continuous deep sedation to a model prioritizing analgesia and light sedation, and further to recommendations favoring the use of propofol and dexmedetomidine over benzodiazepines. This series of transitions demonstrates progress in clinical practice. This article will review research on sedation protocols for different patient populations, focusing on the evolution of sedation strategies, comparisons of clinical effects among different sedative agents, the relationships between sedation, delirium, and sleep, and the early comfort using analgesia, minimal sedatives and maximal humane care (eCASH) concept. The aim is to provide a scientific basis for the individualized sedation strategies in clinical practice.

To improve the oxygenation dysfunction in critically ill patients undergoing mechanical ventilation, prone position ventilation has been increasingly adopted. However, it may cause patient discomfort, pressure injuries, facial edema, hemodynamic disturbances, and airway-related complications. To address these issues, the medical staff in the department of critical care medicine at Harrison International Peace Hospital Affiliated to Hebei Medical University, designed an adjustable facial support cushion for prone position ventilation, which has obtained a national utility model patent of China (patent number: ZL 2022 2 3295294.4). This device consists of an extendable support frame, a placement platform, a support platform, a forehead support cushion, bilateral cheek support cushions, a jaw and neck support cushion, an adjustment assembly, and a hook assembly. Patients who received prone position mechanical ventilation in the department of critical care medicine at Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2022 to June 2024 were selected. They were divided into odd-numbered and even-numbered groups according to the order of prone positioning: the odd-numbered group served as the control group and the even-numbered group as the observation group, with 50 cases in each group. The control group used a soft pillow to support the face, while the observation group used a self-made adjustable facial support cushion. General characteristics, incidence of facial pressure injuries, and endotracheal tube displacement were compared between the two groups. Results showed that there were no statistically significant differences in gender, age, or primary diseases between the two groups, making them comparable. The incidence of facial pressure injuries in the observation group was significantly lower than that in the control group [18% (9/50) vs. 68% (34/50), P < 0.05]. Due to the support holes for the endotracheal tube and the hook assembly beneath the support platform of the cushion, the ventilator tubing was prevented from pulling the endotracheal tube by gravity, and thus the incidence of endotracheal tube displacement was significantly lower in the observation group [44% (22/50) vs. 96% (48/50), P < 0.05]. The use of the self-made adjustable facial support cushion can significantly reduce the occurrence of adverse events such as pressure injuries in patients undergoing prone position mechanical ventilation and is worthy of clinical promotion and application.

Objective: To investigate the differences in prognosis and to analyze the predictive value of cumulative fluid balance at different time points for 28-day mortality in patients with endogenous versus exogenous acute respiratory distress syndrome (ARDS).

Methods: In this retrospective observational study, patients diagnosed with ARDS according to the Berlin definition (2012) and admitted to the department of critical care medicine of the General Hospital of Ningxia Medical University between August 2020 and February 2025 were enrolled. Patient demographics, laboratory parameters, blood gas analyses, tidal volume, positive end expiratory pressure (PEEP), norepinephrine dosage, and disease severity scores were collected. The 28-day ventilator-free days, ICU length of stay, and 28-day survival status were recorded. The cumulative fluid balance was calculated at 3, 5, and 7 days after ICU admission. Based on etiology, patients were categorized into endogenous and exogenous ARDS groups. The Kaplan-Meier method was used to compare 28-day survival rates, and receiver operator characteristic curves (ROC curves) were plotted to assess the predictive value of cumulative fluid balance at 3, 5, and 7 days for 28-day mortality in both groups.

Results: A total of 218 ARDS patients were included, comprising 100 with endogenous ARDS and 118 with exogenous ARDS. Significant differences were observed between the two groups in age, heart rate, activated partial thromboplastin time (APTT), total bilirubin (TBil), C-reactive protein (CRP), procalcitonin (PCT), pH, PEEP, lactate, bicarbonate, and norepinephrine dosage (all P < 0.05). The ICU length of stay was significantly longer in the endogenous ARDS group than in the exogenous ARDS group [days: 11.50 (6.00, 18.00) vs. 8.00 (4.00, 17.25), P < 0.05]. No significant differences were found in 28-day ventilator-free days or 28-day mortality between the two groups. The Kaplan-Meier analysis showed no significant difference in the 28-day survival rate [41.0% (41/100) vs. 54.2% (64/118), P > 0.05]. ROC curve analysis indicated that the cumulative fluid balance at 3, 5, and 7 days had a higher predictive value for 28-day mortality in the exogenous ARDS group compared to the endogenous ARDS group. The most significant predictive performance was observed for the 7-day cumulative fluid balance in the exogenous ARDS group [area under the curve (AUC) = 0.754]. At a cut-off value of 9.42 mL/kg, the sensitivity was 75.93% and the specificity was 71.87%.

Conclusions: Patients with endogenous ARDS had a significantly longer ICU stay than those with exogenous ARDS. The cumulative fluid balance at 3, 5, and 7 days after ICU admission demonstrated a higher predictive value for 28-day mortality in patients with exogenous ARDS.

Objective: To investigate the predictive value of combined detection of pro-opiomelanocortin (POMC) and α-melanocyte stimulating hormone (α-MSH) for progression to persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) in critical patients.

Methods: A retrospective cohort study was conducted, including critical patients admitted to the intensive care unit (ICU) of Nanjing Drum Tower Hospital between March 2020 and July 2021. Baseline data were collected, encompassing gender, age, infection source, smoking history, alcohol consumption history, and underlying diseases. On the first day of ICU admission, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II(APACHE II), serum POMC and α-MSH levels were recorded, along with the incidence of PIICS during ICU stay. Spearman correlation analysis was used to evaluate the correlation between POMC and α-MSH levels and disease severity. Receiver operator characteristic curve (ROC curve) was constructed to evaluate the predictive accuracy of POMC and α-MSH for PIICS progression.

Results: A total of 63 critical patients were included, among whom 47 (75%) developed PIICS and 16 (25%) did not. Compared with the non-PIICS group, the PIICS group showed significantly higher APACHE II and SOFA scores, while no statistical differences were observed in other baseline characteristics. The POMC level on the first day of ICU admission was significantly higher in the PIICS group than in the non-PIICS group, while the α-MSH level showed the opposite trend [POMC (ng/L): 2 149.02 (1 939.54, 2 761.06) vs. 1 884.73 (1 651.83, 2 234.99), α-MSH (ng/L): 1 526.95 (982.84, 2 092.94) vs. 2 182.76 (1 500.57, 3 401.51), both P < 0.05]. Spearman correlation analysis demonstrated that the serum POMC level at admission to the ICU was positively correlated with the SOFA score and the occurrence of PIICS (with r values of 0.275 and 0.279, respectively, both P < 0.05). In contrast, the α-MSH level was negatively correlated with the APACHE II score, SOFA score, and the occurrence of PIICS (with r values of -0.291, -0.339, and -0.287, respectively, all P < 0.05). ROC curve analysis demonstrated that both POMC and α-MSH had certain predictive value for the progression of critical patients to PIICS. The predictive value was the greatest when POMC and α-MSH were detected in combination, area under the curve (AUC) was 0.743, with the sensitivity and specificity for predicting PIICS being 87.2% and 50.0%, respectively.

Conclusions: The combined detection of POMC and α-MSH on the first day of ICU admission showed certain predictive value for the progression of critical patients to PIICS.