Zhonghua wei zhong bing ji jiu yi xue最新文献

Stress ulceration is a common complication in critically ill patients, associated with increased mortality risk and prolonged intensive care unit (ICU) stay. In recent years, several large-scale clinical studies on risk factors, prevention, and treatment of stress ulcers have provided new evidence for guideline development. Moreover, the lack of standardized protocols for the prevention and treatment of stress ulcers in clinical practice underscores the urgent need for authoritative guidelines to address current inconsistencies in management strategies. Accordingly, the Chinese Society of Critical Care Medicine established a multidisciplinary expert panel to develop the Guidelines for the prevention and treatment of stress ulcers in critically ill patients (2026). Following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, the guideline formulation process involved proposing clinical questions, literature retrieval and screening, meta-analysis and evidence synthesis, initial formation of recommendation items, panel reviews, three rounds of remote meetings, four rounds of face-to-face meetings, manuscript revisions, and final approval by the Standing Committee of the Society. The guidelines were finalized in the form of 23 evidence-based recommendations. These guidelines cover key aspects of stress ulcer management, including risk factors, prevention, treatment, and adverse effects of acid-suppressive drugs. The aim is to provide evidence-based guidance for healthcare professionals and promote standardized clinical management of stress ulcers in adult patients.

Extracorporeal carbon dioxide removal (ECCO₂R) is a type of extracorporeal circulation technology. It generally refers to a technique that mimics the modality of veno-venous extracorporeal membrane oxygenation (VV-ECMO), aiming to eliminate carbon dioxide from the blood and correct hypercapnia with a relatively low blood flow. The removal efficacy of ECCO₂R depends on blood flow, gas flow rate, membrane lung surface area, and the partial pressure gradient of carbon dioxide (PCO₂) across the membrane. Currently, the surface area of gas exchangers used in clinical practice is generally less than 1 m². Therefore, ensuring the achievement of the target blood flow during ECCO₂R therapy is crucial to its effectiveness. However, the catheters currently available in clinical settings fail to deliver a blood flow of 400-500 mL/min, necessitating technical improvements. To address this clinical challenge, the medical staff of critical care medicine department of Zhongda Hospital, Southeast University designed a dedicated connecting tube for ECCO₂R therapy, which has been granted a National Utility Model Patent of China (ZL 2023 2 2120568.4). The main structure of this dedicated tube comprises three central venous catheters arranged in a Y shape: central venous catheter 1, central venous catheter 2, and central venous catheter 3. Catheters 1 and 2 are connected in parallel, and in series with catheter 3. The front-end connectors of catheters 1 and 2 are fitted with sterile protective caps, while the rear end of catheters 3 is equipped with a membrane lung connector for connection to the membrane lung. Separate side tubes are attached to the outer sides of catheter 1 and catheter 2 respectively, for connecting irrigation fluid, releasing pressure in the blood drainage segment, and shortening the pause time of extracorporeal circulation during ECCO₂R. Clamps are installed on the catheter 1, catheter 2, catheter 3, and the side tubes. The dedicated connecting tube for ECCO₂R features a simple in structure, easy to operate, and highly practical. The improved connecting tube can achieve a blood flow of 400-500 mL/min, which ensures the therapeutic effect of ECCO₂R and renders it suitable for clinical promotion.

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.