Pub Date : 2025-12-01DOI: 10.3760/cma.j.cn121430-20250702-00369
Yanni Chen, Xing An, Xigang Ma
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.
{"title":"[Prognostic differences between patients with endogenous and exogenous acute respiratory distress syndrome and the dynamic predictive value of cumulative fluid balance].","authors":"Yanni Chen, Xing An, Xigang Ma","doi":"10.3760/cma.j.cn121430-20250702-00369","DOIUrl":"10.3760/cma.j.cn121430-20250702-00369","url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"37 12","pages":"1115-1119"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.3760/cma.j.cn121430-20250730-00411
Enping Zhang, Yu Tian, Bo Yang, Tao Chen
<p><strong>Objective: </strong>To investigate the mechanism by which agmatine alleviates sepsis-induced intestinal injury through the inhibition of intestinal pyroptosis.</p><p><strong>Methods: </strong>1) Bioinformatic analysis: Dataset GSE13904 was selected from the gene expression omnibus (GEO) database, gene ontology (GO), Kyoto encyclopedia of genes and genomes database (KEGG), and protein-protein interaction (PPI) analyses were performed to analyze transcriptomic changes in the blood of sepsis patients. 2) Animal experiments: Ten C57BL/6J mice were randomly divided into a sham group (laparotomy only without ligation) and a sepsis-induced intestinal injury model group [cecal ligation and puncture (CLP)], with 5 mice in each group. Mice were euthanized 48 hours after successful modeling, and ileal tissues were harvested. The expression of immunoglobulin superfamily containing leucine rich repeat (ISLR) in the intestinal tissues of mice was detected by quantitative polymerase chain reaction (qPCR) and Western blotting. 3) Cell experiments: ICE-6 cells were divided into the following groups: control group (cultured in complete medium), lipopolysaccharide (LPS) group (cultured in complete medium containing 10 mg/L lipopolysaccharide, LPS), LPS+agmatine group (treated with 120 μmol/L agmatine on the basis of the LPS group), and an LPS+agmatine+siRNA-ISLR group [transfected with small interfering RNA (siRNA)-ISLR on the basis of the LPS + agmatine group]. Furthermore, cells transfected with siRNA negative control (siRNA-NC) were used to verify the silencing effect of siRNA-ISLR on the ISLR gene. ICE-6 cells were divided into a control group, an LPS group, an LPS+agmatine group, and an LPS+agmatine+Aconine group [treated with 0.25 mmol/L Aconine, a nuclear factor-κB (NF-κB) signaling activator, on the basis of the LPS + agmatine group]. The expression levels of ISLR, NOD-like receptor protein 3 (NLRP3), interleukin-1β (IL-1β), and caspase-1 in cells from each group were detected by qPCR and Western blotting. The levels of IL-6, IL-1β, and tumor necrosis factor-α (TNF-α) in the cell supernatants were measured by enzyme-linked immunosorbent assay (ELISA).</p><p><strong>Results: </strong>1) Bioinformatic analysis: GO, KEGG, and PPI analyses of dataset GSE13904 revealed abnormal expression of multiple molecules in sepsis patients, among which ISLR expression was significantly decreased. 2) Animal experiments: The expression levels of ISLR in the intestinal tissue of mice in the sepsis-induced intestinal injury model group were significantly lower than those in the sham group [ISLR mRNA (2<sup>-ΔΔCt</sup>): 0.52±0.12 vs. 1.02±0.21; ISLR/GAPDH: 0.55±0.01 vs. 1.00±0.01, both P < 0.05], which was consistent with the trend observed in the bioinformatic analysis; therefore, ISLR was selected as the target molecule for functional and mechanistic investigation. 3) Cell experiments: Compared with the control and siRNA-NC groups, ISLR expression was downregulate
{"title":"[Agmatine alleviates sepsis-induced intestinal injury by modulating the nuclear factor-ΚB signaling pathway through immunoglobulin superfamily containing leucine rich repeat to suppress intestinal pyroptosis].","authors":"Enping Zhang, Yu Tian, Bo Yang, Tao Chen","doi":"10.3760/cma.j.cn121430-20250730-00411","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20250730-00411","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the mechanism by which agmatine alleviates sepsis-induced intestinal injury through the inhibition of intestinal pyroptosis.</p><p><strong>Methods: </strong>1) Bioinformatic analysis: Dataset GSE13904 was selected from the gene expression omnibus (GEO) database, gene ontology (GO), Kyoto encyclopedia of genes and genomes database (KEGG), and protein-protein interaction (PPI) analyses were performed to analyze transcriptomic changes in the blood of sepsis patients. 2) Animal experiments: Ten C57BL/6J mice were randomly divided into a sham group (laparotomy only without ligation) and a sepsis-induced intestinal injury model group [cecal ligation and puncture (CLP)], with 5 mice in each group. Mice were euthanized 48 hours after successful modeling, and ileal tissues were harvested. The expression of immunoglobulin superfamily containing leucine rich repeat (ISLR) in the intestinal tissues of mice was detected by quantitative polymerase chain reaction (qPCR) and Western blotting. 3) Cell experiments: ICE-6 cells were divided into the following groups: control group (cultured in complete medium), lipopolysaccharide (LPS) group (cultured in complete medium containing 10 mg/L lipopolysaccharide, LPS), LPS+agmatine group (treated with 120 μmol/L agmatine on the basis of the LPS group), and an LPS+agmatine+siRNA-ISLR group [transfected with small interfering RNA (siRNA)-ISLR on the basis of the LPS + agmatine group]. Furthermore, cells transfected with siRNA negative control (siRNA-NC) were used to verify the silencing effect of siRNA-ISLR on the ISLR gene. ICE-6 cells were divided into a control group, an LPS group, an LPS+agmatine group, and an LPS+agmatine+Aconine group [treated with 0.25 mmol/L Aconine, a nuclear factor-κB (NF-κB) signaling activator, on the basis of the LPS + agmatine group]. The expression levels of ISLR, NOD-like receptor protein 3 (NLRP3), interleukin-1β (IL-1β), and caspase-1 in cells from each group were detected by qPCR and Western blotting. The levels of IL-6, IL-1β, and tumor necrosis factor-α (TNF-α) in the cell supernatants were measured by enzyme-linked immunosorbent assay (ELISA).</p><p><strong>Results: </strong>1) Bioinformatic analysis: GO, KEGG, and PPI analyses of dataset GSE13904 revealed abnormal expression of multiple molecules in sepsis patients, among which ISLR expression was significantly decreased. 2) Animal experiments: The expression levels of ISLR in the intestinal tissue of mice in the sepsis-induced intestinal injury model group were significantly lower than those in the sham group [ISLR mRNA (2<sup>-ΔΔCt</sup>): 0.52±0.12 vs. 1.02±0.21; ISLR/GAPDH: 0.55±0.01 vs. 1.00±0.01, both P < 0.05], which was consistent with the trend observed in the bioinformatic analysis; therefore, ISLR was selected as the target molecule for functional and mechanistic investigation. 3) Cell experiments: Compared with the control and siRNA-NC groups, ISLR expression was downregulate","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"37 12","pages":"1100-1108"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.3760/cma.j.cn121430-20250707-00644
Dan Li, Xueyan Wu, Zhenkang Peng, Ying Du, Xianqing Shi, Penglin Ma, Guohui Yang
<p><strong>Objective: </strong>To investigate phenotypic classification based on plasma lactate trajectories and its association with 28-day mortality in patients with septic cardiomyopathy (SCM).</p><p><strong>Methods: </strong>A multicenter retrospective cohort study was conducted. Patients with SCM admitted to the intensive care units (ICUs) of three tertiary hospitals (Affiliated Hospital of Guizhou Medical University, Guizhou Provincial People's Hospital, and GuiQian International Hospital) from October 2019 to December 2024 were enrolled. Baseline characteristics, intervention strategies, and clinical outcomes were collected, including the first blood lactate level upon ICU admission and daily lactate values within 7 days after SCM diagnosis. The primary outcome was 28-day mortality, and secondary outcomes included 28-day vasoactive drug-free days, duration of mechanical ventilation, and ICU length of stay. Latent class growth model (LCGM) was used to identify lactate trajectory-based phenotypes. Differences in the above indicators among phenotypes were compared, and univariate and multivariate Cox regression analyses were performed to identify independent risk factors for 28-day mortality in SCM patients.</p><p><strong>Results: </strong>A total of 216 SCM patients were included, among whom 41 died and 175 survived within 28 days. LCGM identified four lactate trajectory phenotypes: phenotype 1 (persistent low level, n = 142), phenotype 2 (moderate level with rapid decline, n = 32), phenotype 3 (moderate level with slow increase, n = 20), and phenotype 4 (high level with slow decline, n = 22). The 28-day mortality rates of patients in phenotypes 1-4 showed a significant increasing trend (9.2%, 21.9%, 30.0%, and 68.2%, respectively, P < 0.05). Phenotype 1, which exhibited the lowest mortality and lowest acute physiology and chronic health evaluation (APACHE), was designated as the baseline group. Univariate Cox regression analysis showed that phenotypes 3 and 4 were associated with 28-day mortality in SCM patients (both P < 0.05). Multivariate Cox regression analysis revealed that phenotype 3 [hazard ratio (HR) = 2.831, 95% confidence interval (95%CI) was 1.243-6.447] and phenotype 4 (HR = 2.389, 95%CI was 1.223-4.663) were independent risk factors for 28-day mortality (both P < 0.05). Kaplan-Meier survival curves showed that the survival probability gradually flattened after 3 weeks of hospitalization. Using phenotype 1 as the baseline, patients with phenotypes 3 and 4 had a higher risk of death, and the risk in phenotype 4 was significantly higher than that in phenotype 3 (P < 0.05). Accordingly, the four patient groups were stratified into high-risk (high level with slow decline), intermediate-risk (moderate level with slow increase), and low-risk (moderate level with rapid decline and persistent low level) categories.</p><p><strong>Conclusions: </strong>Four phenotypes of SCM were successfully identified based on lactate trajectories, whi
{"title":"[Lactate trajectory-based phenotypes and their association with 28-day mortality in septic cardiomyopathy: a multicenter retrospective cohort study].","authors":"Dan Li, Xueyan Wu, Zhenkang Peng, Ying Du, Xianqing Shi, Penglin Ma, Guohui Yang","doi":"10.3760/cma.j.cn121430-20250707-00644","DOIUrl":"10.3760/cma.j.cn121430-20250707-00644","url":null,"abstract":"<p><strong>Objective: </strong>To investigate phenotypic classification based on plasma lactate trajectories and its association with 28-day mortality in patients with septic cardiomyopathy (SCM).</p><p><strong>Methods: </strong>A multicenter retrospective cohort study was conducted. Patients with SCM admitted to the intensive care units (ICUs) of three tertiary hospitals (Affiliated Hospital of Guizhou Medical University, Guizhou Provincial People's Hospital, and GuiQian International Hospital) from October 2019 to December 2024 were enrolled. Baseline characteristics, intervention strategies, and clinical outcomes were collected, including the first blood lactate level upon ICU admission and daily lactate values within 7 days after SCM diagnosis. The primary outcome was 28-day mortality, and secondary outcomes included 28-day vasoactive drug-free days, duration of mechanical ventilation, and ICU length of stay. Latent class growth model (LCGM) was used to identify lactate trajectory-based phenotypes. Differences in the above indicators among phenotypes were compared, and univariate and multivariate Cox regression analyses were performed to identify independent risk factors for 28-day mortality in SCM patients.</p><p><strong>Results: </strong>A total of 216 SCM patients were included, among whom 41 died and 175 survived within 28 days. LCGM identified four lactate trajectory phenotypes: phenotype 1 (persistent low level, n = 142), phenotype 2 (moderate level with rapid decline, n = 32), phenotype 3 (moderate level with slow increase, n = 20), and phenotype 4 (high level with slow decline, n = 22). The 28-day mortality rates of patients in phenotypes 1-4 showed a significant increasing trend (9.2%, 21.9%, 30.0%, and 68.2%, respectively, P < 0.05). Phenotype 1, which exhibited the lowest mortality and lowest acute physiology and chronic health evaluation (APACHE), was designated as the baseline group. Univariate Cox regression analysis showed that phenotypes 3 and 4 were associated with 28-day mortality in SCM patients (both P < 0.05). Multivariate Cox regression analysis revealed that phenotype 3 [hazard ratio (HR) = 2.831, 95% confidence interval (95%CI) was 1.243-6.447] and phenotype 4 (HR = 2.389, 95%CI was 1.223-4.663) were independent risk factors for 28-day mortality (both P < 0.05). Kaplan-Meier survival curves showed that the survival probability gradually flattened after 3 weeks of hospitalization. Using phenotype 1 as the baseline, patients with phenotypes 3 and 4 had a higher risk of death, and the risk in phenotype 4 was significantly higher than that in phenotype 3 (P < 0.05). Accordingly, the four patient groups were stratified into high-risk (high level with slow decline), intermediate-risk (moderate level with slow increase), and low-risk (moderate level with rapid decline and persistent low level) categories.</p><p><strong>Conclusions: </strong>Four phenotypes of SCM were successfully identified based on lactate trajectories, whi","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"37 12","pages":"1085-1091"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"[Predictive value of combined detection of pro-opiomelanocortin and α-melanocyte stimulating hormone for progression to persistent inflammation, immunosuppression, and catabolism syndrome in critical patients].","authors":"Jiawen Chen, Xiancheng Chen, Haoran Li, Jiali Liu, Minhua Cheng, Jianfeng Duan, Zhanghua Zhu, Wenkui Yu","doi":"10.3760/cma.j.cn121430-20240911-00446","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240911-00446","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"37 12","pages":"1156-1159"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Objective: </strong>To observe changes in blood gas analysis and lung ventilation using electrical impedance tomography (EIT) in elderly patients with mild to moderate acute respiratory distress syndrome (ARDS) undergoing awake prone position ventilation (APPV), and to evaluate the rate of tracheal intubation.</p><p><strong>Methods: </strong>A randomized controlled study was conducted, involving 58 elderly patients with mild to moderate ARDS admitted to the respiratory intensive care unit (RICU) of Henan Provincial People's Hospital from August 2022 to April 2023. Patients were randomly divided into a control group (n = 27) and an experimental group (n = 31) using a random number table. The control group received conventional treatments, including sputum suction, anti-infection therapy, and non-invasive ventilation. The experimental group received additional prone position therapy. The gender, age, heart rate (HR), respiratory rate (RR), pH value, arterial partial pressure of carbon dioxide (PaCO<sub>2</sub>), oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>), acute physiology and chronic health evaluation II (APACHE II), and regional ventilation values (ROIs 1-4) at baseline and on days 1, 3, 5, and 7 were collected and compared between the two groups. The 7-day tracheal intubation rate was also recorded and analyzed.</p><p><strong>Results: </strong>There were no statistically significant differences in gender, age, HR, RR, pH value, PaCO<sub>2</sub>, PaO<sub>2</sub>/FiO<sub>2</sub>, and APACHE II scores between the two groups of patients at the time of enrollment. After intervention, both groups showed varying degrees of improvement in RR and the PaO<sub>2</sub>/FiO<sub>2</sub>, with the rate of improvement slowing after day 5, and the experimental group demonstrated more significant improvements in the PaO<sub>2</sub>/FiO<sub>2</sub> (P < 0.05 for group, time, and group-time interaction). In terms of lung ventilation ROIs, the ROI 1 and ROI 2 values in both groups gradually decreased over time, while the ROI 3 and ROI 4 values increased. The magnitude of change in the experimental group was greater than in the control group, which showed limited improvement during the same period. significant time effects were found for ROI 1-4 values over time in both groups (time effect: F = 25.364, 21.475, 39.895, 41.579, all P < 0.05). and significant group effects were observed for ROI 2 and ROI 3 values (group effect: F = 4.481 and 11.409, both P < 0.05). On day 1, the experimental group showed significant improvements in ROI 1-3 values compared to the control group (F = 10.536, 25.637, 28.451, all P < 0.05). By day 3, significant differences were observed in ROI 1-4 values between the two groups (F = 6.356, 25.734, 23.678, 19.254, all P < 0.05). On day 5, gas distribution in lung tissues became more uniform in the experimental group, with statistically significant differences in ROI 1-4 values (F = 8.342 and 18.345, both P < 0.05). By day 7
{"title":"[Application of electrical impedance tomography technology in the study of awake prone position ventilation in elderly acute respiratory distress syndrome patient].","authors":"Shenghao Gao, Haibo Wang, Ting Zhang, Xiaoju Zhang, Tengteng Zhang, Taibo Huang, Zhenyu Li, Xuanxuan Li, Dongping Wang, Shaoshuai Cui, Jianjian Cheng","doi":"10.3760/cma.j.cn121430-20250324-00290","DOIUrl":"10.3760/cma.j.cn121430-20250324-00290","url":null,"abstract":"<p><strong>Objective: </strong>To observe changes in blood gas analysis and lung ventilation using electrical impedance tomography (EIT) in elderly patients with mild to moderate acute respiratory distress syndrome (ARDS) undergoing awake prone position ventilation (APPV), and to evaluate the rate of tracheal intubation.</p><p><strong>Methods: </strong>A randomized controlled study was conducted, involving 58 elderly patients with mild to moderate ARDS admitted to the respiratory intensive care unit (RICU) of Henan Provincial People's Hospital from August 2022 to April 2023. Patients were randomly divided into a control group (n = 27) and an experimental group (n = 31) using a random number table. The control group received conventional treatments, including sputum suction, anti-infection therapy, and non-invasive ventilation. The experimental group received additional prone position therapy. The gender, age, heart rate (HR), respiratory rate (RR), pH value, arterial partial pressure of carbon dioxide (PaCO<sub>2</sub>), oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>), acute physiology and chronic health evaluation II (APACHE II), and regional ventilation values (ROIs 1-4) at baseline and on days 1, 3, 5, and 7 were collected and compared between the two groups. The 7-day tracheal intubation rate was also recorded and analyzed.</p><p><strong>Results: </strong>There were no statistically significant differences in gender, age, HR, RR, pH value, PaCO<sub>2</sub>, PaO<sub>2</sub>/FiO<sub>2</sub>, and APACHE II scores between the two groups of patients at the time of enrollment. After intervention, both groups showed varying degrees of improvement in RR and the PaO<sub>2</sub>/FiO<sub>2</sub>, with the rate of improvement slowing after day 5, and the experimental group demonstrated more significant improvements in the PaO<sub>2</sub>/FiO<sub>2</sub> (P < 0.05 for group, time, and group-time interaction). In terms of lung ventilation ROIs, the ROI 1 and ROI 2 values in both groups gradually decreased over time, while the ROI 3 and ROI 4 values increased. The magnitude of change in the experimental group was greater than in the control group, which showed limited improvement during the same period. significant time effects were found for ROI 1-4 values over time in both groups (time effect: F = 25.364, 21.475, 39.895, 41.579, all P < 0.05). and significant group effects were observed for ROI 2 and ROI 3 values (group effect: F = 4.481 and 11.409, both P < 0.05). On day 1, the experimental group showed significant improvements in ROI 1-3 values compared to the control group (F = 10.536, 25.637, 28.451, all P < 0.05). By day 3, significant differences were observed in ROI 1-4 values between the two groups (F = 6.356, 25.734, 23.678, 19.254, all P < 0.05). On day 5, gas distribution in lung tissues became more uniform in the experimental group, with statistically significant differences in ROI 1-4 values (F = 8.342 and 18.345, both P < 0.05). By day 7","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"37 12","pages":"1109-1114"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Objective: </strong>To analyze the effect of serum magnesium on 90-day all-cause mortality in heart failure patients admitted to the intensive care unit (ICU).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from the Medical Information Mart for Intensive Care- III (MIMIC- III) database. Heart failure patients admitted to the ICU of Beth Israel Deaconess Medical Center between 2001 and 2012 were selected. Demographic characteristics, comorbidities, initial vital signs, and laboratory data were extracted. The outcome measure was 90-day all-cause mortality after ICU admission. Patients were divided into non-renal failure and renal failure groups based on the presence of renal failure. Univariate Logistic regression was used to analyze the relationship between potential confounding factors and the 90-day all-cause mortality. Multivariate Logistic regression was used to analyze the independent effect of serum magnesium on the 90-day all-cause mortality. A threshold effect analysis identified an inflection point for blood urea nitrogen (BUN) at 530 mg/L, and an interaction analysis examined the effect of BUN on the relationship between serum magnesium and the 90-day all-cause mortality.</p><p><strong>Results: </strong>A total of 1 162 ICU patients with heart failure were included, among which 695 were in the non-renal failure group and 467 in the renal failure group; 317 patients died (27.3%). Univariate analysis showed that serum magnesium was significantly associated with mortality in the renal failure group [odds ratio (OR) = 1.994, 95% confidence interval (95%CI) was 1.223-3.252, P < 0.05], but not in the non-renal failure group (OR = 1.098, 95%CI was 0.700-1.722, P > 0.05). Multivariate analysis showed that after adjusting for all selected confounding factors, serum magnesium was not significantly associated with mortality in the renal failure group (OR = 1.053, 95%CI was 0.519-2.132, P > 0.05), while in the non-renal failure group, serum magnesium showed a protective effect (OR = 0.460, 95%CI was 0.239-0.885, P < 0.05). The interaction analysis between BUN and serum magnesium showed that after adjusting for all selected confounding factors, there was an interaction between BUN and serum magnesium in the non-renal failure group (interaction P values were < 0.05), with a significant association between serum magnesium and mortality in the high BUN subgroup (OR = 0.082, 95%CI was 0.016-0.406, P < 0.05), but no significant association in the low BUN subgroup (OR = 0.946, 95%CI was 0.466-1.918, P > 0.05); there was no interaction between BUN and serum magnesium in the renal failure group (interaction P values were > 0.05), and there was no significant association between serum magnesium and mortality in both the high BUN subgroup and the low BUN subgroup (all P > 0.05).</p><p><strong>Conclusions: </strong>Renal function and BUN levels significantly modify the relationship between serum magnesium and 90
{"title":"[Effect of serum magnesium on mortality in intensive care unit patients with heart failure: a retrospective analysis based on the MIMIC-III database].","authors":"Junqing Ma, Shanhong Zhang, Yanquan Hou, Xiaowei Miao, Hongrui Zhang, Zujun Song","doi":"10.3760/cma.j.cn121430-20250122-00053","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20250122-00053","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the effect of serum magnesium on 90-day all-cause mortality in heart failure patients admitted to the intensive care unit (ICU).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from the Medical Information Mart for Intensive Care- III (MIMIC- III) database. Heart failure patients admitted to the ICU of Beth Israel Deaconess Medical Center between 2001 and 2012 were selected. Demographic characteristics, comorbidities, initial vital signs, and laboratory data were extracted. The outcome measure was 90-day all-cause mortality after ICU admission. Patients were divided into non-renal failure and renal failure groups based on the presence of renal failure. Univariate Logistic regression was used to analyze the relationship between potential confounding factors and the 90-day all-cause mortality. Multivariate Logistic regression was used to analyze the independent effect of serum magnesium on the 90-day all-cause mortality. A threshold effect analysis identified an inflection point for blood urea nitrogen (BUN) at 530 mg/L, and an interaction analysis examined the effect of BUN on the relationship between serum magnesium and the 90-day all-cause mortality.</p><p><strong>Results: </strong>A total of 1 162 ICU patients with heart failure were included, among which 695 were in the non-renal failure group and 467 in the renal failure group; 317 patients died (27.3%). Univariate analysis showed that serum magnesium was significantly associated with mortality in the renal failure group [odds ratio (OR) = 1.994, 95% confidence interval (95%CI) was 1.223-3.252, P < 0.05], but not in the non-renal failure group (OR = 1.098, 95%CI was 0.700-1.722, P > 0.05). Multivariate analysis showed that after adjusting for all selected confounding factors, serum magnesium was not significantly associated with mortality in the renal failure group (OR = 1.053, 95%CI was 0.519-2.132, P > 0.05), while in the non-renal failure group, serum magnesium showed a protective effect (OR = 0.460, 95%CI was 0.239-0.885, P < 0.05). The interaction analysis between BUN and serum magnesium showed that after adjusting for all selected confounding factors, there was an interaction between BUN and serum magnesium in the non-renal failure group (interaction P values were < 0.05), with a significant association between serum magnesium and mortality in the high BUN subgroup (OR = 0.082, 95%CI was 0.016-0.406, P < 0.05), but no significant association in the low BUN subgroup (OR = 0.946, 95%CI was 0.466-1.918, P > 0.05); there was no interaction between BUN and serum magnesium in the renal failure group (interaction P values were > 0.05), and there was no significant association between serum magnesium and mortality in both the high BUN subgroup and the low BUN subgroup (all P > 0.05).</p><p><strong>Conclusions: </strong>Renal function and BUN levels significantly modify the relationship between serum magnesium and 90","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"37 12","pages":"1125-1132"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.3760/cma.j.cn121430-20250731-00414
Jie Jing, Xiaowei Chang, Hongbo Luo, Mingxi Zhao, Baoxiang Cai, Zunzhu Li
Objective: To summarize the best available evidence regarding diaphragmatic function training in mechanically ventilated patients and to establish a foundation for clinical practice.
Methods: Systematic searches were conducted in databases and official websites including UpToDate, the National Guideline Clearinghouse (NGC), the Registered Nurses' Association of Ontario (RNAO), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, PubMed, Web of Science, CNKI, Wanfang Data, VIP, and Yimaitong. The search period covered from the inception of each database to December 31, 2024. The types of evidence included guideline, clinical decision, expert consensus, systematic review, Meta-analysis, and randomized controlled trial (RCT). Two researchers conducted the literature search, study selection, quality assessment and evidence extraction and synthesis independently.
Results: A total of 16 articles were included, consisting of 1 guideline, 1 clinical decision, 2 expert consensuses, 4 systematic reviews, 3 Meta-analyses, and 5 RCTs. Nineteen pieces of evidence were ultimately categorized into 7 dimensions, including implementation team, intervention timing, training assessment, training methods, management of ICU-acquired weakness (ICU-AW), monitoring and safety, and outcome evaluation.
Conclusions: This summary of best evidence for diaphragmatic function training in mechanically ventilated patients is scientifically rigorous and comprehensive, offering a valuable reference for guiding clinical practice.
目的：总结机械通气患者膈肌功能训练的最佳证据，为临床实践奠定基础。方法：系统检索UpToDate、国家指南信息中心（NGC）、安大略省注册护士协会（RNAO）、护理与相关健康文献累积索引（CINAHL）、Cochrane图书馆、PubMed、Web of Science、中国知网（CNKI）、万方数据、VIP、医美通等数据库和官方网站。检索期从每个数据库建立到2024年12月31日。证据类型包括指南、临床决策、专家共识、系统评价、meta分析和随机对照试验（RCT）。两位研究者独立进行文献检索、研究选择、质量评估和证据提取与合成。结果：共纳入16篇文献，包括1篇指南、1篇临床决策、2篇专家共识、4篇系统综述、3篇meta分析和5篇随机对照试验。19条证据最终被划分为实施团队、干预时机、培训评估、培训方法、icu获得性弱点（ICU-AW）管理、监测与安全性、结局评价等7个维度。结论：本文总结的机械通气患者膈功能训练最佳证据科学严谨、全面，可为指导临床实践提供有价值的参考。
{"title":"[Summary of the best evidence for diaphragmatic function training in mechanically ventilated patients].","authors":"Jie Jing, Xiaowei Chang, Hongbo Luo, Mingxi Zhao, Baoxiang Cai, Zunzhu Li","doi":"10.3760/cma.j.cn121430-20250731-00414","DOIUrl":"10.3760/cma.j.cn121430-20250731-00414","url":null,"abstract":"<p><strong>Objective: </strong>To summarize the best available evidence regarding diaphragmatic function training in mechanically ventilated patients and to establish a foundation for clinical practice.</p><p><strong>Methods: </strong>Systematic searches were conducted in databases and official websites including UpToDate, the National Guideline Clearinghouse (NGC), the Registered Nurses' Association of Ontario (RNAO), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, PubMed, Web of Science, CNKI, Wanfang Data, VIP, and Yimaitong. The search period covered from the inception of each database to December 31, 2024. The types of evidence included guideline, clinical decision, expert consensus, systematic review, Meta-analysis, and randomized controlled trial (RCT). Two researchers conducted the literature search, study selection, quality assessment and evidence extraction and synthesis independently.</p><p><strong>Results: </strong>A total of 16 articles were included, consisting of 1 guideline, 1 clinical decision, 2 expert consensuses, 4 systematic reviews, 3 Meta-analyses, and 5 RCTs. Nineteen pieces of evidence were ultimately categorized into 7 dimensions, including implementation team, intervention timing, training assessment, training methods, management of ICU-acquired weakness (ICU-AW), monitoring and safety, and outcome evaluation.</p><p><strong>Conclusions: </strong>This summary of best evidence for diaphragmatic function training in mechanically ventilated patients is scientifically rigorous and comprehensive, offering a valuable reference for guiding clinical practice.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"37 12","pages":"1120-1124"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.3760/cma.j.cn121430-20250108-00025
Hualian Wu, Benjin Wang, Tao Chen, Junxi Chen, Hongyan Chen, Miao Chen, Mingtao Quan
<p><strong>Objective: </strong>To investigate the effects of an early off-bed activity protocol on respiratory mechanics in intensive care unit (ICU) patients receiving invasive mechanical ventilation via endotracheal intubation.</p><p><strong>Methods: </strong>A prospective randomized controlled trial was conducted. Adult patients admitted to the ICU of the Affiliated Hospital of Zunyi Medical University between January 2024 and October 2024, who were receiving invasive mechanical ventilation and undergoing early mobilization, were enrolled. Patients were randomly assigned to a control group or an experimental group using a random number table. The control group received conventional progressive early mobilization. The experimental group received early mobilization using a patient transfer device to move patients off the bed, followed by a series of activities. The two groups only differed in the intervention protocol; all other routine treatments and care were consistent. The gender, age, main diagnosis upon admission to the ICU, and acute physiology and chronic health evaluation(APACHE) of the two groups of patients were compared. Minute ventilation (MV), inspiratory tidal volume (MVi), expiratory tidal volume (MVe), respiratory rate of the ventilator (RR), airway resistance (Raw), dynamic lung compliance (Cdyn), work of breathing (WOB), mean airway pressure (Pm), peak inspiratory pressure (PIP), plateau pressure (Pplat), driving pressure (ΔP), and positive end expiratory pressure (PEEP) were compared between the two groups before the intervention and at 5, 10, 15, and 30 minutes after the intervention. The duration of invasive mechanical ventilation, ICU length of stay, and the 48-hour reintubation rate were also compared.</p><p><strong>Results: </strong>A total of 170 patients receiving invasive mechanical ventilation were initially enrolled; 11 dropped out during the study, resulting in 78 patients in the control group and 81 in the experimental group for final analysis. There were no significant differences in baseline characteristics, including gender, age, primary ICU diagnosis, APACHE score, or pre-intervention respiratory mechanics parameters between the two groups. Over the intervention time course, MV, MVi, MVe, RR, Raw, and Cdyn showed an increasing trend, while Raw and WOB showed a decreasing trend in both groups, with these changes being more pronounced in the experimental group. There were significant time, intervention, and interaction effects (all P < 0.01). However, there were no significant differences in Pm, PIP, Pplat, ΔP, or PEEP between the two groups at any post-intervention time point. The duration of invasive mechanical ventilation and ICU length of stay were significantly shorter in the experimental group compared to the control group [invasive mechanical ventilation time (hours): 84.21±32.08 vs. 121.94±59.24; ICU length of stay (days): 5.21±1.77 vs. 7.06±2.75; both P < 0.05]. But the 48-hour reintubation rate was not
目的：探讨早期下床活动方案对重症监护病房（ICU）气管插管有创机械通气患者呼吸力学的影响。方法：采用前瞻性随机对照试验。选择2024年1月至2024年10月在遵义医科大学附属医院重症监护室接受有创机械通气并进行早期活动的成年患者。采用随机数字表法将患者随机分为对照组和实验组。对照组接受常规渐进式早期活动。实验组接受早期动员，使用患者转移装置将患者移离床，随后进行一系列活动。两组只在干预方案上有所不同；所有其他常规治疗和护理均一致。比较两组患者的性别、年龄、入住ICU时的主要诊断、急性生理和慢性健康评估（APACHE）。比较干预前及干预后5、10、15、30分钟两组患者的分钟通气量（MV）、吸气潮气量（MVi）、呼气潮气量（MVe）、呼吸机呼吸频率（RR）、气道阻力（Raw）、肺动态顺应性（Cdyn）、呼吸功（WOB）、平均气道压力（Pm）、吸气峰值压力（PIP）、平台压力（Pplat）、驱动压力（ΔP）、呼气末正压（PEEP）。比较两组患者有创机械通气时间、ICU住院时间和48h再插管率。结果：最初共有170例接受有创机械通气的患者入组；11人在研究过程中退出，最终分析结果为对照组78人，实验组81人。两组患者的基线特征无显著差异，包括性别、年龄、初级ICU诊断、APACHE评分或干预前呼吸力学参数。在干预时间过程中，两组患者的MV、MVi、MVe、RR、Raw、Cdyn均呈上升趋势，而Raw、WOB均呈下降趋势，且实验组变化更为明显。时间效应、干预效应、交互效应均显著（P < 0.01）。然而，两组在任何干预后时间点Pm、PIP、Pplat、ΔP或PEEP均无显著差异。实验组有创机械通气时间和ICU住院时间均明显短于对照组[有创机械通气时间(h): 84.21±32.08∶121.94±59.24；ICU住院天数（天）：5.21±1.77 vs. 7.06±2.75；P < 0.05]。两组患者48小时再插管率无显著差异。结论：常规渐进式早期活动和早期下床活动对ICU机械通气患者呼吸力学参数均有影响，但早期下床活动影响更大。早下床活动不会增加气道压力或引起气道损伤。提前下床活动较好地缩短了有创机械通气时间和ICU住院时间，证明是安全可行的。
{"title":"[Effects of early off-bed activity on respiratory mechanics in intensive care unit patients undergoing mechanical ventilation].","authors":"Hualian Wu, Benjin Wang, Tao Chen, Junxi Chen, Hongyan Chen, Miao Chen, Mingtao Quan","doi":"10.3760/cma.j.cn121430-20250108-00025","DOIUrl":"10.3760/cma.j.cn121430-20250108-00025","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of an early off-bed activity protocol on respiratory mechanics in intensive care unit (ICU) patients receiving invasive mechanical ventilation via endotracheal intubation.</p><p><strong>Methods: </strong>A prospective randomized controlled trial was conducted. Adult patients admitted to the ICU of the Affiliated Hospital of Zunyi Medical University between January 2024 and October 2024, who were receiving invasive mechanical ventilation and undergoing early mobilization, were enrolled. Patients were randomly assigned to a control group or an experimental group using a random number table. The control group received conventional progressive early mobilization. The experimental group received early mobilization using a patient transfer device to move patients off the bed, followed by a series of activities. The two groups only differed in the intervention protocol; all other routine treatments and care were consistent. The gender, age, main diagnosis upon admission to the ICU, and acute physiology and chronic health evaluation(APACHE) of the two groups of patients were compared. Minute ventilation (MV), inspiratory tidal volume (MVi), expiratory tidal volume (MVe), respiratory rate of the ventilator (RR), airway resistance (Raw), dynamic lung compliance (Cdyn), work of breathing (WOB), mean airway pressure (Pm), peak inspiratory pressure (PIP), plateau pressure (Pplat), driving pressure (ΔP), and positive end expiratory pressure (PEEP) were compared between the two groups before the intervention and at 5, 10, 15, and 30 minutes after the intervention. The duration of invasive mechanical ventilation, ICU length of stay, and the 48-hour reintubation rate were also compared.</p><p><strong>Results: </strong>A total of 170 patients receiving invasive mechanical ventilation were initially enrolled; 11 dropped out during the study, resulting in 78 patients in the control group and 81 in the experimental group for final analysis. There were no significant differences in baseline characteristics, including gender, age, primary ICU diagnosis, APACHE score, or pre-intervention respiratory mechanics parameters between the two groups. Over the intervention time course, MV, MVi, MVe, RR, Raw, and Cdyn showed an increasing trend, while Raw and WOB showed a decreasing trend in both groups, with these changes being more pronounced in the experimental group. There were significant time, intervention, and interaction effects (all P < 0.01). However, there were no significant differences in Pm, PIP, Pplat, ΔP, or PEEP between the two groups at any post-intervention time point. The duration of invasive mechanical ventilation and ICU length of stay were significantly shorter in the experimental group compared to the control group [invasive mechanical ventilation time (hours): 84.21±32.08 vs. 121.94±59.24; ICU length of stay (days): 5.21±1.77 vs. 7.06±2.75; both P < 0.05]. But the 48-hour reintubation rate was not","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"37 12","pages":"1133-1138"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Objective: </strong>To investigate the clinical effectiveness of an early mobilization protocol based on the ICU mobility scale (IMS) movement model in intensive care unit (ICU) patients with difficult weaning from mechanical ventilation.</p><p><strong>Methods: </strong>A quasi-experimental study design was adopted. Patients with difficult weaning admitted to the department of critical care medicine, the First Affiliated Hospital of Wannan Medical College, from February 2022 to February 2023 were assigned to the control group, while those admitted from March 2023 to March 2024 were allocated to the experimental group, all meeting predefined inclusion and exclusion criteria. The control group received conventional early rehabilitation activities, whereas the experimental group received an IMS model-based early mobilization protocol in addition to standard care. General demographic data, Medical Research Council (MRC), Barthel index score, and generalized anxiety disorder-7 (GAD-7) score at the time of enrollment and discharge, diaphragmatic ultrasound parameters (including diaphragm thickness, diaphragm thickening fraction, and diaphragm excursion) at the time of enrollment and 24 hours after extubation, and outcomes-related indicators of each group of patients were collected and compared.</p><p><strong>Results: </strong>A total of 52 patients with difficult weaning were enrolled, including 25 in the control group and 27 in the experimental group. No significant differences were observed between the two groups in terms of gender, age, or other baseline characteristics, indicating comparability. There were no statistically significant differences in MRC scores or Barthel index scores between the groups at enrollment. However, at ICU discharge, the experimental group showed significantly higher MRC scores (44.41±2.61 vs. 35.32±2.75) and Barthel index scores [45 (35, 45) vs. 40 (35, 45), both P < 0.05]. Regarding diaphragmatic ultrasound parameters, no significant differences were found between groups at baseline in diaphragm thickness, diaphragm thickening fraction, or diaphragm excursion. At discharge, the experimental group exhibited a significantly higher diaphragm thickening fraction 24 hours after extubation (%: 26.53 ± 3.74 vs. 24.31±3.71, P < 0.05) and greater diaphragm excursion (cm: 1.80±0.40 vs. 1.52±0.57, P < 0.05). In terms of anxiety status, there was no significant difference in GAD-7 scores between groups at enrollment; however, at discharge, the experimental group had a significantly lower GAD-7 score [12.0 (8.5, 17.0) vs. 16.0 (15.0, 17.0), P < 0.05]. For clinical outcomes, the experimental group had significantly shorter durations of mechanical ventilation (MV) [hours: 144.00 (116.00, 304.00) vs. 396.00 (240.50, 606.50)] and ICU length of stay [days: 12.00 (8.00, 24.00) vs. 24.00 (18.00, 41.50)], both P < 0.05. No significant differences were observed between the two groups in total hospital stay, 48-hour reintubation ra
目的：探讨基于ICU活动量表（IMS）运动模型的早期活动方案在重症监护病房（ICU）机械通气困难脱机患者中的临床效果。方法：采用准实验研究设计。将2022年2月至2023年2月皖南医学院第一附属医院重症医学科收治的脱机困难患者作为对照组，将2023年3月至2024年3月收治的患者作为实验组，所有患者均符合预先设定的纳入和排除标准。对照组接受常规的早期康复活动，而实验组在标准护理的基础上接受基于IMS模型的早期活动方案。收集各组患者入组和出院时的一般人口学资料、医学研究理事会（MRC）、Barthel指数评分、广泛性焦虑障碍-7 （GAD-7）评分、入组时和拔管后24小时的膈超声参数（包括膈膜厚度、膈膜增厚分数、膈膜偏移）及结局相关指标进行比较。结果：共纳入52例困难脱机患者，其中对照组25例，实验组27例。两组之间在性别、年龄或其他基线特征方面未观察到显著差异，表明可比性。入组时MRC评分和Barthel指数评分在组间无统计学差异。但在ICU出院时，实验组MRC评分（44.41±2.61）比35.32±2.75)和Barthel指数评分(45（35,45）比40（35,45）均显著高于对照组（P < 0.05）。关于膈超声参数，两组在基线时膈膜厚度、膈膜增厚分数或膈膜偏移均无显著差异。出院时，实验组拔管后24 h膈膜增厚分数显著高于对照组（%:26.53±3.74 vs. 24.31±3.71,P < 0.05），膈膜偏移显著高于对照组（cm: 1.80±0.40 vs. 1.52±0.57,P < 0.05）。在焦虑状态方面，入组时各组间GAD-7评分差异无统计学意义；但在出院时，实验组的GAD-7评分明显低于对照组[12.0（8.5,17.0）比16.0 (15.0,17.0),P < 0.05]。临床结果方面，实验组机械通气时间（MV）[小时：144.00（116.00,304.00）比396.00(240.50,606.50)]和ICU住院时间[天数：12.00（8.00,24.00）比24.00(18.00,41.50)]均显著缩短，P < 0.05。两组在总住院时间、48小时再插管率、48小时ICU再入院率或总住院费用方面无显著差异。在实施动员方案期间，总体安全概况是有利的。结论：基于IMS模型的ICU脱机困难患者早期活动方案可有效增强运动能力，改善膈肌功能，提高自理能力，缓解焦虑，缩短MV时间和ICU住院时间。
{"title":"[Construction and empirical study of an early exercise protocol based on the ICU mobility scale model for difficult-to-wean intensive care unit patients].","authors":"Ruixiang Sun, Haijiao Jiang, Xiaogan Jiang, Weihua Lu, Guangliang Mei, Ke Fang, Jintian Yu, Zhiqing Zhou","doi":"10.3760/cma.j.cn121430-20241021-00503","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20241021-00503","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical effectiveness of an early mobilization protocol based on the ICU mobility scale (IMS) movement model in intensive care unit (ICU) patients with difficult weaning from mechanical ventilation.</p><p><strong>Methods: </strong>A quasi-experimental study design was adopted. Patients with difficult weaning admitted to the department of critical care medicine, the First Affiliated Hospital of Wannan Medical College, from February 2022 to February 2023 were assigned to the control group, while those admitted from March 2023 to March 2024 were allocated to the experimental group, all meeting predefined inclusion and exclusion criteria. The control group received conventional early rehabilitation activities, whereas the experimental group received an IMS model-based early mobilization protocol in addition to standard care. General demographic data, Medical Research Council (MRC), Barthel index score, and generalized anxiety disorder-7 (GAD-7) score at the time of enrollment and discharge, diaphragmatic ultrasound parameters (including diaphragm thickness, diaphragm thickening fraction, and diaphragm excursion) at the time of enrollment and 24 hours after extubation, and outcomes-related indicators of each group of patients were collected and compared.</p><p><strong>Results: </strong>A total of 52 patients with difficult weaning were enrolled, including 25 in the control group and 27 in the experimental group. No significant differences were observed between the two groups in terms of gender, age, or other baseline characteristics, indicating comparability. There were no statistically significant differences in MRC scores or Barthel index scores between the groups at enrollment. However, at ICU discharge, the experimental group showed significantly higher MRC scores (44.41±2.61 vs. 35.32±2.75) and Barthel index scores [45 (35, 45) vs. 40 (35, 45), both P < 0.05]. Regarding diaphragmatic ultrasound parameters, no significant differences were found between groups at baseline in diaphragm thickness, diaphragm thickening fraction, or diaphragm excursion. At discharge, the experimental group exhibited a significantly higher diaphragm thickening fraction 24 hours after extubation (%: 26.53 ± 3.74 vs. 24.31±3.71, P < 0.05) and greater diaphragm excursion (cm: 1.80±0.40 vs. 1.52±0.57, P < 0.05). In terms of anxiety status, there was no significant difference in GAD-7 scores between groups at enrollment; however, at discharge, the experimental group had a significantly lower GAD-7 score [12.0 (8.5, 17.0) vs. 16.0 (15.0, 17.0), P < 0.05]. For clinical outcomes, the experimental group had significantly shorter durations of mechanical ventilation (MV) [hours: 144.00 (116.00, 304.00) vs. 396.00 (240.50, 606.50)] and ICU length of stay [days: 12.00 (8.00, 24.00) vs. 24.00 (18.00, 41.50)], both P < 0.05. No significant differences were observed between the two groups in total hospital stay, 48-hour reintubation ra","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"37 12","pages":"1139-1146"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.3760/cma.j.cn121430-20241018-00497
Wenjie Ge, Shoujun Zhu, Tingting Guo, Xinyi Zhu
Objective: To search, evaluate, and summarize the best available evidence regarding enteral and parenteral nutrition support for adult patients with sepsis, in order to provide an evidence-based foundation for the nutritional management of these patients.
Methods: A systematic search was conducted in the following databases and resources for clinical guidelines, clinical decisions, evidence summaries, expert consensus statements, systematic reviews, randomized controlled trials (RCTs), and quasi-experimental studies related to enteral and parenteral nutrition in adult septic patients: the Cochrane Library, UpToDate, the JBI Evidence-Based Healthcare Center Database, BMJ Best Practice, official websites of professional societies including the American College of Critical Care Medicine, the American Society for Parenteral and Enteral Nutrition (ASPEN), the European Society of Intensive Care Medicine, the European Society for Parenteral and Enteral Nutrition (ESPEN), the Chinese Society of Critical Care Medicine, and the Chinese Society for Parenteral and Enteral Nutrition, ScienceDirect, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Chinese Medical Journal Full-text Database, Chinese Biomedical Literature Service System, Wanfang Data, China National Knowledge Infrastructure, the VIP Chinese Science and Technology Core Journal Database, Guidelines International Network, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, and Registered Nurses' Association of Ontario, and Medlive Guide. The search timeframe was from January 1, 2014, to June 30, 2024. Two researchers with evidence-based research backgrounds independently conducted the literature quality appraisal. Evidence was extracted and summarized from the included literature, incorporating expert opinion.
Results: After rigorous screening, 25 high-quality publications were included, comprising 5 clinical guidelines, 1 clinical decision, 2 evidence summaries, 5 expert consensus statements, 5 systematic reviews, 6 RCTs, and 1 quasi-experimental study. Focusing on key aspects of nutritional management (encompassing 7 major themes: nutritional screening and assessment, mode of nutritional support, timing of initiating nutritional support, energy and protein requirements, nutritional components, monitoring tolerance to nutritional support therapy, and complication prevention and management), 33 core recommendations were ultimately formulated and refined.
Conclusions: This study provides evidence-based recommendations for the enteral and parenteral nutrition management in adult patients with sepsis, aiming to enhance the effectiveness of nutritional support and improve patient clinical outcomes.
{"title":"[Evidence summary on enteral and parenteral nutrition for adult patients with sepsis].","authors":"Wenjie Ge, Shoujun Zhu, Tingting Guo, Xinyi Zhu","doi":"10.3760/cma.j.cn121430-20241018-00497","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20241018-00497","url":null,"abstract":"<p><strong>Objective: </strong>To search, evaluate, and summarize the best available evidence regarding enteral and parenteral nutrition support for adult patients with sepsis, in order to provide an evidence-based foundation for the nutritional management of these patients.</p><p><strong>Methods: </strong>A systematic search was conducted in the following databases and resources for clinical guidelines, clinical decisions, evidence summaries, expert consensus statements, systematic reviews, randomized controlled trials (RCTs), and quasi-experimental studies related to enteral and parenteral nutrition in adult septic patients: the Cochrane Library, UpToDate, the JBI Evidence-Based Healthcare Center Database, BMJ Best Practice, official websites of professional societies including the American College of Critical Care Medicine, the American Society for Parenteral and Enteral Nutrition (ASPEN), the European Society of Intensive Care Medicine, the European Society for Parenteral and Enteral Nutrition (ESPEN), the Chinese Society of Critical Care Medicine, and the Chinese Society for Parenteral and Enteral Nutrition, ScienceDirect, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Chinese Medical Journal Full-text Database, Chinese Biomedical Literature Service System, Wanfang Data, China National Knowledge Infrastructure, the VIP Chinese Science and Technology Core Journal Database, Guidelines International Network, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, and Registered Nurses' Association of Ontario, and Medlive Guide. The search timeframe was from January 1, 2014, to June 30, 2024. Two researchers with evidence-based research backgrounds independently conducted the literature quality appraisal. Evidence was extracted and summarized from the included literature, incorporating expert opinion.</p><p><strong>Results: </strong>After rigorous screening, 25 high-quality publications were included, comprising 5 clinical guidelines, 1 clinical decision, 2 evidence summaries, 5 expert consensus statements, 5 systematic reviews, 6 RCTs, and 1 quasi-experimental study. Focusing on key aspects of nutritional management (encompassing 7 major themes: nutritional screening and assessment, mode of nutritional support, timing of initiating nutritional support, energy and protein requirements, nutritional components, monitoring tolerance to nutritional support therapy, and complication prevention and management), 33 core recommendations were ultimately formulated and refined.</p><p><strong>Conclusions: </strong>This study provides evidence-based recommendations for the enteral and parenteral nutrition management in adult patients with sepsis, aiming to enhance the effectiveness of nutritional support and improve patient clinical outcomes.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"37 12","pages":"1147-1155"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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