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In this Issue of CCR 在本期的CCR中
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2022-12-05 DOI: 10.51893/2022.4.ITI
Rinaldo Bellomo (Editor-in-Chief)
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引用次数: 0
Mortality associated with acute respiratory distress syndrome, 2009-2019: a systematic review and meta-analysis 2009-2019年与急性呼吸窘迫综合征相关的死亡率:系统回顾和荟萃分析
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2022-12-05 DOI: 10.51893/2022.4.OA4
Divyajot Sadana , Simrat Kaur , Kesavan Sankaramangalam , Ishan Saini , Kinjal Banerjee , Matthew Siuba , Valentina Amaral , Shruti Gadre , Heather Torbic , Sudhir Krishnan , Abhijit Duggal

Background: Acute respiratory distress syndrome (ARDS) occurs commonly in intensive care units. The reported mortality rates in studies evaluating ARDS are highly variable.

Objective: To investigate mortality rates due to ARDS from before the 2009 H1N1 influenza pandemic began until the start of coronavirus disease 2019 (COVID-19) pandemic.

Design: We performed a systematic search and then ran a proportional meta-analysis for mortality. We ran our analysis in three ways: for randomised controlled trials only, for observational studies only, and for randomised controlled trials and observational studies combined.

Data sources: MEDLINE and Embase, using a highly sensitive criterion and limiting the search to studies published from January 2009 to December 2019.

Review methods: Two of us independently screened titles and abstracts to first identify studies and then complete full text reviews of selected studies. We assessed risk of bias using the Cochrane RoB-2 (a risk-of-bias tool for randomised trials) and the Cochrane ROBINS-1 (a risk-of-bias tool for non-randomised studies of interventions).

Results: We screened 5844 citations, of which 102 fully met our inclusion criteria. These included 34 randomised controlled trials and 68 observational studies, with a total of 24 158 patients. The weighted pooled mortality rate for all 102 studies published from 2009 to 2019 was 39.4% (95% CI, 37.0–41.8%). Mortality was higher in observational studies compared with randomised controlled trials (41.8% [95% CI, 38.9–44.8%] v 34.5% [95% CI, 30.6–38.5%]; P = 0.005).

Conclusions: Over the past decade, mortality rates due to ARDS were high. There is a clear distinction between mortality in observational studies and in randomised controlled trials. Future studies need to report mortality for different ARDS phenotypes and closely adhere to evidence-based medicine.

PROSPERO registration: CRD42020149712 (April 2020).

背景:急性呼吸窘迫综合征(ARDS)常见于重症监护病房。在评估ARDS的研究中报告的死亡率变化很大。目的:调查2009年H1N1流感大流行开始前至2019年冠状病毒病(COVID-19)大流行开始期间ARDS的死亡率。设计:我们进行了系统搜索,然后对死亡率进行了比例荟萃分析。我们以三种方式进行了分析:仅针对随机对照试验,仅针对观察性研究,以及随机对照试验和观察性研究相结合。数据来源:MEDLINE和Embase,使用高度敏感的标准,并将搜索限制在2009年1月至2019年12月发表的研究。综述方法:我们两人独立筛选标题和摘要,首先确定研究,然后完成选定研究的全文综述。我们使用Cochrane rob2(随机试验的偏倚风险工具)和Cochrane ROBINS-1(非随机干预研究的偏倚风险工具)评估偏倚风险。结果:我们筛选了5844篇引文,其中102篇完全符合我们的纳入标准。其中包括34项随机对照试验和68项观察性研究,共有24158名患者。2009年至2019年发表的所有102项研究的加权合并死亡率为39.4% (95% CI, 37.0-41.8%)。观察性研究的死亡率高于随机对照试验(41.8% [95% CI, 38.9-44.8%] vs 34.5% [95% CI, 30.6-38.5%];P = 0.005)。结论:在过去的十年中,ARDS的死亡率很高。观察性研究和随机对照试验的死亡率有明显区别。未来的研究需要报告不同ARDS表型的死亡率,并密切遵循循证医学。普洛斯彼罗注册:CRD42020149712(2020年4月)。
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引用次数: 0
Erratum 1 勘误表1
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2022-12-05 DOI: 10.51893/2022.2.le
Andrew Casamento, Thomas Niccol
Casamento A and Niccol T. Efficacy and safety of ketamine in mechanically ventilated intensive care unit patients: a scoping review (erratum). Crit Care Resusc 2022; 24 (2): 195-195; https://doi.org/10.51893/2022.2.L The authors wish to correct an error in the recently published erratum letter. In the introductory paragraph, “……. a further two randomised controlled trials comparing fentanyl with placebo in mechanically ventilated Intensive Care Unit (ICU) patients have come to our attention.” should read: “……. a further two randomised controlled trials comparing ketamine with placebo in mechanically ventilated Intensive Care Unit (ICU) patients have come to our attention.”
氯胺酮在机械通气重症监护病房患者中的疗效和安全性:一项范围回顾(勘误)。危重监护复苏2022;24 (2): 195-195;https://doi.org/10.51893/2022.2.L作者希望更正最近出版的勘误表中的一个错误。在引言部分,“....... .另外两项比较芬太尼和安慰剂在机械通气重症监护病房(ICU)患者中的随机对照试验引起了我们的注意。应该读作:“.......另外两项比较氯胺酮和安慰剂在机械通气重症监护病房(ICU)患者中的随机对照试验引起了我们的注意。”
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引用次数: 0
A four-step model to aid teaching, clinical assessment and communication of circulatory disorders among junior clinicians 辅助初级临床医生循环系统疾病教学、临床评估和沟通的四步模式
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2022-12-05 DOI: 10.51893/2022.4.POV
Daryl Jones , Paula Carty , Dharshi Karalapillai
Conditions associated with circulatory disturbance are common causes of admission to the intensive care unit (ICU)1 as well as clinical deterioration after admission has occurred. Accordingly, it is important for ICU clinicians to have a thorough knowledge of the causes of circulatory failure and an approach to assessing them. Circulatory conditions are also a common cause of clinical deterioration in hospital ward.
与循环障碍相关的情况是入住重症监护病房(ICU)的常见原因1,也是入院后临床恶化的常见原因。因此,ICU临床医生对循环衰竭的原因有一个全面的了解和评估方法是很重要的。循环系统疾病也是医院病房临床恶化的常见原因。
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引用次数: 0
Incidence and risk factors for medical adhesive-related skin injury in catheters of critically ill patients: A prospective cohort study 危重病人导管中医用粘胶相关皮肤损伤的发生率和危险因素:一项前瞻性队列研究
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2022-10-05 DOI: 10.1101/2022.10.03.22280567
O. P. Frota, J. N. Pinho, M. A. Ferreira-Júnior, Elaine Cristina Fernandes Baez Sarti, Fabiana M. Paula, D. N. Ferreira
Aim: To investigate the incidence and risk factors for medical adhesive-related skin injury (MARSI) in catheters of critically ill patients. Methods: A prospective cohort study was conducted in adult intensive care units of two Brazilian university hospitals. A total of 150 patients (439 catheters) were included. Skin exposed to the catheter fixation adhesives (central venous, nasogastric, nasoenteral and indwelling urinary) was examined daily by four trained researchers. The patients sociodemographic and clinical data were collected from their electronic medical records. The association between independent variables and MARSI was investigated by bivariate statistics, followed by multiple logistic regression. Results: The MARSI incidence was 42% (8.64 MARSIs per 100 patients/day). Advanced age, prolonged hospital stay, dry skin, repetitive adhesive removal, low Braden Scale score and hypoalbuminemia were associated with MARSI (p < .05). According to multivariate logistic regression, dry skin increased the chance of MARSI by 5.21 times (odds ratio [OR] 5.21; 95% confidence interval [95% CI] 2.43-11.11), while the Braden Scale score was a protective factor, showing 31% less chance of MARSI for each added score (OR 0.69; 95% CI 0.57-0.85). A higher incidence of MARSI was observed in nasoenteral catheters and in those fixed with adhesive using natural rubber. The MARSI types were predominantly mechanical (70.3%): skin stripping (41.3%), skin tear (26.1%) and tension injury or blister (2.9%). Conclusions: MARSI is a common event in adult intensive care units and most risk factors are modifiable. Preventive actions are potentially capable of reducing incidence, optimizing financial resources and improving clinical results.
目的:探讨危重患者导管内医用粘胶性皮肤损伤(MARSI)的发生率及危险因素。方法:在巴西两所大学医院的成人重症监护病房进行前瞻性队列研究。共纳入150例患者(439根导管)。每天由四名训练有素的研究人员检查暴露于导管固定粘合剂(中心静脉,鼻胃,鼻肠和留置尿)的皮肤。从电子病历中收集患者的社会人口学和临床资料。采用双变量统计和多元逻辑回归分析自变量与MARSI之间的关系。结果:MARSI发生率为42%(每100例患者/天8.64例MARSI)。高龄、住院时间延长、皮肤干燥、反复去除粘接剂、布雷登量表评分低和低白蛋白血症与MARSI相关(p < 0.05)。根据多因素logistic回归,皮肤干燥使MARSI的几率增加5.21倍(优势比[OR] 5.21;95%可信区间[95% CI] 2.43-11.11),而布雷登量表评分是一个保护因素,每增加一分,MARSI的可能性降低31% (OR 0.69;95% ci 0.57-0.85)。在鼻肠导管和用天然橡胶粘接剂固定的导管中观察到较高的MARSI发生率。MARSI类型主要为机械性(70.3%):皮肤剥离(41.3%)、皮肤撕裂(26.1%)和张力损伤或水疱(2.9%)。结论:MARSI是成人重症监护病房的常见事件,大多数危险因素是可以改变的。预防行动有可能降低发病率、优化财政资源和改善临床结果。
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引用次数: 1
Improving capacity to conduct observational studies in Australian and New Zealand ICUs 提高澳大利亚和新西兰icu开展观察性研究的能力
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2022-09-05 DOI: 10.51893/2022.3.L
Daryl Jones , Glenn Eastwood , Carol Hodgson
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引用次数: 0
Pain assessment and analgesic management in patients admitted to intensive care: an Australian and New Zealand point prevalence study 重症监护患者的疼痛评估和镇痛管理:一项澳大利亚和新西兰的点患病率研究
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2022-09-05 DOI: 10.51893/2022.3.OA1
Benjamin L. Moran , David A. Scott , Elizabeth Holliday , Serena Knowles , Manoj Saxena , Ian Seppelt , Naomi Hammond , John A. Myburgh , For the George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Pain in Survivors of Intensive Care Units (PAIN-ICU) Study Investigators

Objective: To describe pain assessment and analgesic management practices in patients in intensive care units (ICUs) in Australia and New Zealand.

Design, setting and participants: Prospective, observational, multicentre, single-day point prevalence study conducted in Australian and New Zealand ICUs. Observational data were recorded for all adult patients admitted to an ICU without a neurological, neurosurgical or postoperative cardiac diagnosis. Demographic characteristics and data on pain assessment and analgesic management for a 24-hour period were collected.

Main outcome measures: Types of pain assessment tools used and frequency of their use, use of opioid analgesia, use of adjuvant analgesia, and differences in pain assessment and analgesic management between postoperative and non-operative patients.

Results: From the 499 patients enrolled from 45 ICUs, pain assessment was performed at least every 4 hours in 56% of patients (277/499), most commonly with a numerical rating scale. Overall, 286 patients (57%) received an opioid on the study day. Of the 181 mechanically ventilated patients, 135 (75%) received an intravenous opioid, with the predominant opioid infusion being fentanyl. The median dose of opioid infusion for ventilated patients was 140 mg oral morphine equivalents. Of the 318 non-ventilated patients, 41 (13%) received patient-controlled analgesia and 76 (24%) received an oral opioid, with the predominant opioid being oxycodone. Paracetamol was administered to 63 ventilated patients (35%) and 164 non-ventilated patients (52%), while 2% of all patients (11/499) received a non-steroidal anti-inflammatory drug. Ketamine infusion and regional analgesia were used in 15 patients (3%) and 17 patients (3%), respectively. Antineuropathic agents (predominantly gabapentinoids) were used in 53 patients (11%).

Conclusions: Although a majority of ICU patients were frequently assessed for pain with a validated pain assessment tool, cumulative daily doses of opioids were high, and the use of multimodal adjuvant analgesia was low. Our data on current pain assessment and analgesic management practices may inform further research in this area.

目的:描述澳大利亚和新西兰重症监护病房(icu)患者的疼痛评估和镇痛管理实践。设计、环境和参与者:在澳大利亚和新西兰icu中进行的前瞻性、观察性、多中心、单天点患病率研究。观察性数据记录了所有没有神经、神经外科或术后心脏诊断的ICU成年患者。收集24小时内的人口学特征和疼痛评估和镇痛管理数据。主要结局指标:使用的疼痛评估工具的类型和使用频率,阿片类镇痛的使用,辅助镇痛的使用,以及术后和非手术患者在疼痛评估和镇痛管理方面的差异。结果:从45个icu纳入的499例患者中,56%的患者(277/499)至少每4小时进行一次疼痛评估,最常见的是数字评分量表。总体而言,286名患者(57%)在研究当天接受了阿片类药物治疗。在181例机械通气患者中,135例(75%)接受静脉注射阿片类药物,主要输注阿片类药物为芬太尼。阿片类药物输注的中位剂量为140 mg口服吗啡当量。318例非通气患者中,41例(13%)接受患者自控镇痛,76例(24%)接受口服阿片类药物,主要阿片类药物为羟考酮。63例通气患者(35%)和164例非通气患者(52%)使用扑热息痛,2%的患者(11/499)使用非甾体类抗炎药。氯胺酮输注和局部镇痛分别为15例(3%)和17例(3%)。53例(11%)患者使用抗神经病变药物(主要是加巴喷丁类药物)。结论:尽管大多数ICU患者经常使用经过验证的疼痛评估工具进行疼痛评估,但阿片类药物的日累积剂量较高,而多模式辅助镇痛的使用较低。我们关于当前疼痛评估和镇痛管理实践的数据可以为该领域的进一步研究提供信息。
{"title":"Pain assessment and analgesic management in patients admitted to intensive care: an Australian and New Zealand point prevalence study","authors":"Benjamin L. Moran ,&nbsp;David A. Scott ,&nbsp;Elizabeth Holliday ,&nbsp;Serena Knowles ,&nbsp;Manoj Saxena ,&nbsp;Ian Seppelt ,&nbsp;Naomi Hammond ,&nbsp;John A. Myburgh ,&nbsp;For the George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Pain in Survivors of Intensive Care Units (PAIN-ICU) Study Investigators","doi":"10.51893/2022.3.OA1","DOIUrl":"10.51893/2022.3.OA1","url":null,"abstract":"<div><p><strong>Objective:</strong> To describe pain assessment and analgesic management practices in patients in intensive care units (ICUs) in Australia and New Zealand.</p><p><strong>Design, setting and participants:</strong> Prospective, observational, multicentre, single-day point prevalence study conducted in Australian and New Zealand ICUs. Observational data were recorded for all adult patients admitted to an ICU without a neurological, neurosurgical or postoperative cardiac diagnosis. Demographic characteristics and data on pain assessment and analgesic management for a 24-hour period were collected.</p><p><strong>Main outcome measures:</strong> Types of pain assessment tools used and frequency of their use, use of opioid analgesia, use of adjuvant analgesia, and differences in pain assessment and analgesic management between postoperative and non-operative patients.</p><p><strong>Results:</strong> From the 499 patients enrolled from 45 ICUs, pain assessment was performed at least every 4 hours in 56% of patients (277/499), most commonly with a numerical rating scale. Overall, 286 patients (57%) received an opioid on the study day. Of the 181 mechanically ventilated patients, 135 (75%) received an intravenous opioid, with the predominant opioid infusion being fentanyl. The median dose of opioid infusion for ventilated patients was 140 mg oral morphine equivalents. Of the 318 non-ventilated patients, 41 (13%) received patient-controlled analgesia and 76 (24%) received an oral opioid, with the predominant opioid being oxycodone. Paracetamol was administered to 63 ventilated patients (35%) and 164 non-ventilated patients (52%), while 2% of all patients (11/499) received a non-steroidal anti-inflammatory drug. Ketamine infusion and regional analgesia were used in 15 patients (3%) and 17 patients (3%), respectively. Antineuropathic agents (predominantly gabapentinoids) were used in 53 patients (11%).</p><p><strong>Conclusions:</strong> Although a majority of ICU patients were frequently assessed for pain with a validated pain assessment tool, cumulative daily doses of opioids were high, and the use of multimodal adjuvant analgesia was low. Our data on current pain assessment and analgesic management practices may inform further research in this area.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000509/pdfft?md5=864a70ce1d359a096f829edce90c2071&pid=1-s2.0-S1441277223000509-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42979209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Prevalence, features and workplace factors associated with burnout among intensivists in Australia and New Zealand 澳大利亚和新西兰重症监护人员职业倦怠的患病率、特征和工作场所因素
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2022-09-05 DOI: 10.51893/2022.3.OA8
Shona Mair , Liz Crowe , Mark Nicholls , Siva Senthuran , Kristen Gibbons , Daryl Jones

Objectives: To investigate the prevalence and features of self-reported burnout among intensivists working in Australia and New Zealand, and evaluate potentially modifiable workplace stressors associated with increased risk of self-reported burnout.

Methods: We performed an electronic survey among registered intensivists in Australia and New Zealand. Burnout and professional quality of life were measured using the Professional Quality of Life Scale version 5 (ProQOL-5). Socio-organisational factors were defined a priori and assessed using a five-point Likert scale. Thematic analysis was conducted on an open-ended question on workplace stressors.

Results: 261 of 921 estimated intensivists responded (response rate, 28.3%). Overall, few participants (0.8%) demonstrated high scores (> 75th centile) for burnout, and 70.9% of participants scored in the average range for burnout. Of note, 98.1% of participants scored in the average to high range for compassion satisfaction. No association was found between sex, age, or years of practice with the level of burnout or compassion satisfaction. Seven themes emerged regarding intensivists' most stressful aspects of work: interpersonal interactions and workplace relationships (25.5%), workload and its impact (24.9%), resources and capacity (22.6%), health systems leadership and bureaucracy (16.1%), end-of-life issues and moral distress (8.4%), clinical management (4.9%), and job security and future uncertainty (1.3%).

Conclusion: Fewer Australian and New Zealand intensivists experienced burnout than previously reported. Many self-reported work stressors do not relate to clinical work and are due to interpersonal interactions with other colleges and hospital administrators. Such factors are potentially modifiable and could be the focus of future interventions.

目的:调查在澳大利亚和新西兰工作的重症护理人员自我报告的倦怠的患病率和特征,并评估与自我报告的倦怠风险增加相关的潜在可改变的工作场所压力因素。方法:我们对澳大利亚和新西兰的注册重症医师进行了电子调查。职业倦怠和职业生活质量采用职业生活质量量表第5版(ProQOL-5)进行测量。社会组织因素的定义是先验的,并使用五点李克特量表进行评估。对一个关于工作场所压力源的开放式问题进行了专题分析。结果:921名预估强化医师中有261人有反应(有效率28.3%)。总体而言,少数参与者(0.8%)表现出高分(>75百分位),70.9%的参与者在倦怠的平均范围内得分。值得注意的是,98.1%的参与者在同情满意度方面得分在中高区间。没有发现性别、年龄或从业年限与倦怠程度或同情心满意度之间存在关联。关于重症医生工作中压力最大的方面,出现了七个主题:人际交往和工作场所关系(25.5%)、工作量及其影响(24.9%)、资源和能力(22.6%)、卫生系统领导和官僚作风(16.1%)、临终问题和道德困扰(8.4%)、临床管理(4.9%)、工作保障和未来不确定性(1.3%)。结论:澳大利亚和新西兰的重症监护人员经历过的倦怠比以前报道的要少。许多自我报告的工作压力源与临床工作无关,而是由于与其他学院和医院管理人员的人际交往。这些因素可能是可以改变的,可能是未来干预的重点。
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引用次数: 0
The relationship between commencement of continuous renal replacement therapy and urine output, fluid balance, mean arterial pressure and vasopressor dose 持续肾替代治疗开始与尿量、体液平衡、平均动脉压和血管加压剂剂量的关系
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2022-09-05 DOI: 10.51893/2022.3.OA5
Benjamin Sansom , Gina Tonkin-Hill , Stefanie Kalfas , Seunga Park , Jeffrey Presneill , Rinaldo Bellomo

Background and objectives: The effect of initiating continuous renal replacement therapy (CRRT) on urine output, fluid balance and mean arterial pressure (MAP) in adult intensive care unit (ICU) patients is unclear. We aimed to evaluate the impact of CRRT on urine output, MAP, vasopressor requirements and fluid balance, and to identify factors affecting urine output during CRRT.

Design: Retrospective cohort study using data from existing databases and CRRT machines.

Setting: Medical and surgical ICUs at a single university-associated centre.

Participants: Patients undergoing CRRT between 2015 and 2018.

Main outcome measures: Hourly urine output, fluid balance, MAP and vasopressor dose 24 hours before and after CRRT commencement. Missing values were estimated via Kaplan smoothing univariate time-series imputation. Mixed linear modelling was performed with noradrenaline equivalent dose and urine output as outcomes.

Results: In 215 patients, CRRT initiation was associated with a reduction in urine output. Multivariate analysis confirmed an immediate urine output decrease (–0.092 mL/kg/h; 95% confidence interval [CI], –0.150 to –0.034 mL/kg/h) and subsequent progressive urine output decline (effect estimate, –0.01 mL/kg/h; 95% CI, –0.02 to –0.01 mL/kg/h). Age and greater vasopressor dose were associated with lower post-CRRT urine output. Higher MAP and lower rates of net ultrafiltration were associated with higher post-CRRT urine output. With MAP unchanged, vasopressor dose increased in the 24 hours before CRRT, then plateaued and declined in the 24 hours thereafter (effect estimate, –0.004 μg/kg/ min per hour; 95% CI, –0.005 to –0.004 μg/kg/min per hour). Fluid balance remained positive but declined towards neutrality following CRRT implementation.

Conclusions: CRRT was associated with decreased urine output despite a gradual decline in vasopressor and a positive fluid balance. The mechanisms behind the reduction in urine output associated with commencement of CRRT requires further investigation.

背景与目的:目前尚不清楚开始持续肾替代治疗(CRRT)对成人重症监护病房(ICU)患者尿量、体液平衡和平均动脉压(MAP)的影响。我们旨在评估CRRT对尿量、MAP、血管加压素需求和体液平衡的影响,并确定CRRT期间影响尿量的因素。设计:回顾性队列研究,使用来自现有数据库和CRRT机器的数据。环境:一个大学附属中心的内科和外科icu。参与者:2015年至2018年间接受CRRT的患者。主要观察指标:CRRT开始前后24小时每小时尿量、体液平衡、MAP和血管加压剂剂量。通过Kaplan平滑单变量时间序列imputation估计缺失值。以去甲肾上腺素当量剂量和尿量为结果进行混合线性建模。结果:在215例患者中,CRRT开始与尿量减少相关。多因素分析证实尿量立即下降(-0.092 mL/kg/h;95%置信区间[CI], -0.150至-0.034 mL/kg/h)和随后的进行性尿量下降(效应估计,-0.01 mL/kg/h;95% CI, -0.02 ~ -0.01 mL/kg/h)。年龄和较大的血管加压剂剂量与crrt后较低的尿量相关。较高的MAP和较低的净超滤率与crrt后较高的尿量相关。在MAP不变的情况下,血管加压剂剂量在CRRT前24小时升高,然后在CRRT后24小时趋于稳定并下降(效应估计为-0.004 μg/kg/ min / h;95% CI, -0.005 ~ -0.004 μg/kg/min / h)。液体平衡仍然为正,但在CRRT实施后下降到中性。结论:尽管血管加压素逐渐下降,体液平衡呈阳性,CRRT仍与尿量减少有关。与CRRT开始相关的尿量减少背后的机制需要进一步研究。
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引用次数: 0
Virological and clinical features of acute respiratory failure associated with COVID-19 in pregnancy: a case-control study 妊娠期与COVID-19相关的急性呼吸衰竭的病毒学和临床特征:一项病例对照研究
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2022-09-05 DOI: 10.51893/2022.3.OA3
Jean-Christophe Richard , Emilie Frobert , Grégory Destras , Hodane Yonis , Mehdi Mezidi , Francois Dhelft , Sophie Trouillet-Assant , Paul Bastard , Adrian Gervais , William Danjou , Frederic Aubrun , Fanny Roumieu , Jean-Marc Labaune , Laurence Josset , Antonin Bal , Bruno Simon , Jean-Laurent Casanova , Bruno Lina , Jean-Charles Picaud , Corinne Dupont , Laurent Bitker

Objective: Pregnancy is a risk factor for acute respiratory failure (ARF) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We hypothesised that SARS-CoV-2 viral load in the respiratory tract might be higher in pregnant intensive care unit (ICU) patients with ARF than in non-pregnant ICU patients with ARF as a consequence of immunological adaptation during pregnancy.

Design: Single-centre, retrospective observational case–control study.

Setting: Adult level 3 ICU in a French university hospital.

Participants: Eligible participants were adults with ARF associated with coronavirus disease 2019 (COVID-19) pneumonia.

Main outcome measure: The primary endpoint of the study was viral load in pregnant and non-pregnant patients.

Results: 251 patients were included in the study, including 17 pregnant patients. Median gestational age at ICU admission amounted to 28 + 3/7 weeks (interquartile range [IQR], 26 + 1/7 to 31 + 5/7 weeks). Twelve patients (71%) had an emergency caesarean delivery due to maternal respiratory failure. Pregnancy was independently associated with higher viral load (-4.6 ± 1.9 cycle threshold; P < 0.05). No clustering or over-represented mutations were noted regarding SARS-CoV-2 sequences of pregnant women. Emergency caesarean delivery was independently associated with a modest but significant improvement in arterial oxygenation, amounting to 32 ± 12 mmHg in patients needing invasive mechanical ventilation. ICU mortality was significantly lower in pregnant patients (0 v 35%; P < 0.05). Age, Simplified Acute Physiology Score (SAPS) II score, and acute respiratory distress syndrome were independent risk factors for ICU mortality, while pregnancy status and virological variables were not.

Conclusions: Viral load was substantially higher in pregnant ICU patients with COVID-19 and ARF compared with non-pregnant ICU patients with COVID-19 and ARF. Pregnancy was not independently associated with ICU mortality after adjustment for age and disease severity.

目的:妊娠是严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)感染后急性呼吸衰竭(ARF)的危险因素。我们假设妊娠重症监护病房(ICU) ARF患者的呼吸道SARS-CoV-2病毒载量可能高于非妊娠重症监护病房ARF患者,这可能是妊娠期间免疫适应的结果。设计:单中心、回顾性观察性病例对照研究。环境:法国大学医院成人三级ICU。参与者:符合条件的参与者是与2019冠状病毒病(COVID-19)肺炎相关的成人ARF。主要结局指标:研究的主要终点是怀孕和非怀孕患者的病毒载量。结果:251例患者纳入研究,其中孕妇17例。ICU入院时的中位胎龄为28 + 3/7周(四分位数范围[IQR], 26 + 1/7至31 + 5/7周)。12例(71%)患者因产妇呼吸衰竭而紧急剖腹产。妊娠与较高的病毒载量独立相关(-4.6±1.9周期阈值;P & lt;0.05)。在孕妇的SARS-CoV-2序列中未发现聚类或过度代表突变。紧急剖宫产与动脉氧合的适度但显著的改善独立相关,在需要有创机械通气的患者中达到32±12 mmHg。妊娠患者ICU死亡率显著降低(0 vs 35%;P & lt;0.05)。年龄、简化急性生理评分(SAPS) II评分和急性呼吸窘迫综合征是ICU死亡率的独立危险因素,而妊娠状态和病毒学变量不是。结论:妊娠ICU合并COVID-19和ARF患者的病毒载量明显高于非妊娠ICU合并COVID-19和ARF患者。在调整年龄和疾病严重程度后,妊娠与ICU死亡率没有独立关联。
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Critical Care and Resuscitation
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