Zhonghua wei zhong bing ji jiu yi xue最新文献

Extracorporeal membrane oxygenation (ECMO), as a critical life support technology, has played a significant role in treating patients with refractory respiratory and circulatory failure. In recent years, with the advancements in medical technology, the scope of application of ECMO has been expanding, especially in the fields of acute respiratory distress syndrome, cardiogenic shock and other important roles. However, its high costs, complex operation, and associated risks of complications remain challenges in clinical practice. At present, an increasing number of studies have focused on developing and validating ECMO prognostic models. Developing precise prognostic prediction models is crucial for optimizing treatment decisions and improving patient survival rates. This article categorizes existing prognostic models for adult ECMO patients based on methodological classification, patient population, and theoretical framework. It highlights the limitations of current models in terms of sample size, multi-center validation, static data analysis, and model applicability. Moreover, it proposes future directions for model development, such as multi-center prospective studies, integration of machine learning and deep learning technologies, and increased focus on long-term outcomes, offering insights for researchers to improve model construction and explore new research directions.

Prehospital emergency care is the primary stage in the treatment of critically ill patients, where efficient and accurate monitoring methods are crucial for patient survival and prognosis. End-tidal carbon dioxide (EtCO₂) monitoring is a real-time, non-invasive method that can sensitively capture the status of respiratory, circulatory, and metabolic functions, particularly in the urgent and complex pre-hospital environment, a immediate detection and non-invasive method, can sensitively capture the respiratory, circulatory, and metabolic status of patients. It provides valuable guidance for rapid decision-making and precise interventions. This is particularly valuable in the complex and urgent prehospital environment, providing critical data for rapid decision-making and precise intervention. This paper systematically reviews the advancements in the application of EtCO₂ monitoring across various fields, including sepsis identification, trauma assessment, cardiac arrest, respiratory critical care, endotracheal intubation confirmation, and management of metabolic diseases, aiming to explore its application value and prospects in pre-hospital emergency care.

In-hospital cardiac arrest (IHCA) is a critical medical issue threatening the survival and prognosis of hospitalized patients, characterized by high incidence, high mortality and poor prognosis. Early warning and intervention for IHCA are urgently needed. The early warning score (EWS) is developed as a point-of-care warning tool for early identification and intervention of hospitalized patients with deteriorating condition. In recent years, EWS has become one of the important methods for early warning of IHCA, especially EWS based on machine learning (ML) has shown great potential. This review mainly focuses on the traditional EWS and ML-based EWS, discusses the research status of EWS worldwide, and focuses on the research progress of EWS in early warning of IHCA.

Objective: To observe the clinical efficacy of vitamin B1 in patients with ICU-acquired weakness (ICU-AW).

Methods: A retrospective analysis was conducted to select ICU-AW patients treated with vitamin B1 in the intensive care unit (ICU) of Shanghai East Hospital, Tongji University from July 2022 to December 2023. Propensity score matching was used to match the control group and observation group at a 1 : 1 ratio, considering differences in patient age, gender, and acute physiology and chronic health evaluation II (APACHE II). The control group received conventional treatment, while the observation group received vitamin B1 in addition to conventional treatment. Comparisons were made between the two groups in terms of basic information, APACHE II scores, Medical Research Council muscle strength score (MRC), interleukin-6 (IL-6), C-reactive protein (CRP), and serum creatinine (SCr) levels before and after treatment, mechanical ventilation time, and length of ICU stay were collected and compared between the two groups.

Results: A total of 30 patients with ICU-AW were included, both 15 in each group. There were no significant differences in gender, age and APACHE II score between the two groups. There were no significant differences in APACHE II score, MRC score, IL-6, CRP, SCr levels, and the duration of ventilator-assisted ventilation and ICU stay between the two groups of patients before treatment. Both groups showed improvements in APACHE II scores and MRC scores after treatment, with the observation group showing significantly greater improvement compared to the control group (APACHE II score: 10.80±1.47 vs. 12.20±1.52, MRC score: 50.40±7.10 vs. 42.00±8.78, both P < 0.05). After treatment, both groups showed significant reductions in IL-6, CRP, and SCr levels, but there were no significant differences between the observation group and control group. The observation group had significantly shorter durations of mechanical ventilation (days: 7.67±1.54 vs. 9.67±2.44, P < 0.05) and ICU stay (days: 13.33±1.72 vs. 15.13±2.56, P < 0.05) compared to the control group.

Conclusions: The use of vitamin B1 during the treatment of ICU-AW significantly improves muscle strength and reduces the duration of mechanical ventilation and ICU stay.

The ultimate goal of cardiac arrest-cardiopulmonary resuscitation (CA-CPR) is to reduce brain damage and promote neurological recovery. Although the return of spontaneous circulation (ROSC) has improved, the proportion of patients who survive to discharge is very low, so how to evaluate the recovery of brain function after resuscitation is particularly important in clinical work. From a clinical perspective, although early prognostic indicators are not perfect, identifying high-risk features may help clinicians determine the severity of brain injury caused by a patient's potential course of disease. This review, based on recent literature, selects several commonly used clinical brain function evaluation indicators to provide theoretical and practical support for assessing brain function recovery in patients after CPR.

Objective: To investigate the current status and influencing factors of feeding intolerance (FI) during enteral nutrition (EN) in intensive care unit (ICU) patients.

Methods: A retrospective case-control study was conducted, including patients from two ICU wards of a tertiary hospital in Guizhou Province from July 2019 to December 2022. Clinical data were collected using a self-designed data collection form, including general information [age, gender, acute physiology and chronic health evaluation II (APACHE II)], clinical treatment (mechanical ventilation, mild hypothermia therapy), medication use (vasoactive drugs, glucocorticoids, analgesics, sedatives), EN implementation (types of EN fluids, EN methods, tube feeding rate), EN tolerance, and blood glucose status. Patients were divided into EN tolerance and EN intolerance groups based on the FI criteria. Differences in the above-mentioned indicators between the two groups were compared, and statistically significant indicators were included in a binary multivariate Logistic regression analysis to explore the independent influencing factors of FI during EN in ICU patients.

Results: A total of 683 ICU patients were included, with 57.10% (390/683) incidence of FI during EN. The most common FI symptom was diarrhea (41.58%), followed by gastric retention, reflux, abdominal distension, nausea, abdominal pain, vomiting, and aspiration, with blood in stool being the least common (3.37%). Compared to the EN tolerance group, the EN intolerance group had significantly higher proportions of patients aged ≥60 years, undergoing mechanical ventilation, receiving analgesic and sedative medications, having hyperglycemia, using short-peptide EN fluids, receiving continuous EN, and having a feeding rate > 40 mL/h (all P < 0.05). The binary multivariate Logistic regression analysis revealed that age ≥60 years [odds ratio (OR) = 1.738, 95% confidence interval (95%CI) was 1.241-2.436, P = 0.001], continuous EN (OR = 0.534, 95%CI was 0.377-0.756, P < 0.001), use of analgesic medications (OR = 1.701, 95%CI was 1.139-2.539, P = 0.009), hyperglycemic state (OR = 2.794, 95%CI was 1.999-3.907, P < 0.001), and tube feeding rate > 40 mL/h (OR = 1.018, 95%CI was 1.009-1.027, P < 0.001) were independent risk factors for FI during EN in ICU patients.

Conclusions: The incidence of FI during EN in ICU patients is relatively high and influenced by age, EN methods, analgesic medications, hyperglycemic state, and tube feeding rate. Therefore, healthcare professionals need to accurately identify the risk factors for FI and actively implement effective intervention measures to reduce the incidence of FI and improve patient outcomes.

Objective: To systematically evaluate the impact of aspirin on the pulmonary inflammatory response in animal models of acute lung injury/acute respiratory distress syndrome (ALI/ARDS).

Methods: Experimental research on aspirin therapy or prevention of ALI/ARDS in animal models were searched in PubMed, Web of Science, Cochrane library, Embase, China biology medicine, CNKI, Wanfang, VIP. The search time limit was from the establishment of the database to July 17, 2023. The control group established the ALI/ARDS model without any pharmacological intervention. The intervention group was given aspirin or aspirin-derived compounds or polymeric-aspirin (Poly-A) at different time points before and after the preparation of the model, of which there was no restriction on the dosage form, dosage, mode of administration, or number of doses. The primary outcome indicators included bronchoalveolar lavage fluid (BALF) or lung tissue myeloperoxidase (MPO) activity, interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α) and the counts of neutrophils in BALF. Two researchers screened the literature and extracted information based on inclusion and exclusion criteria. Literature quality was assessed by the bias risk assessment tool SYRCLE. RevMan 5.3 software was used for data synthesis and statistical analysis.

Results: A total of 17 papers were eventually included, involving a total of 449 animal models, all of which were murine. One paper was at high risk of bias and the rest 16 papers were at moderate risk of bias. Meta-analysis showed that compared with the control group, the neutrophil count in BALF [standardized mean difference (SMD) = -5.06, 95% confidence interval (95%CI) was -7.00 to -3.12, P < 0.000 01], the myeloperoxidase (MPO) activity in BALF or lung tissue (SMD = -3.45, 95%CI was -4.43 to -2.47, P < 0.000 01), the TNF-α level in BALF or lung tissue (SMD = -2.78, 95%CI was -3.58 to -1.98, P < 0.000 01), and the IL-1β level in BALF or lung tissue (SMD = -3.12, 95%CI was -4.56 to -1.69, P < 0.000 1) were significantly decreased in the ALI/ARDS model of the intervention group.

Conclusions: Aspirin reduces the level of lung inflammation in animal models of ALI/ARDS. However, there are problems of poor quality and significant heterogeneity of the included studies, which still need our further validation.