Critical Care and Resuscitation最新文献_第3页

Efficacy and safety of guanfacine in hospitalized patients with delirium: A scoping review 胍法辛治疗谵妄住院患者的疗效和安全性：一项范围综述。

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2024-12-01 DOI: 10.1016/j.ccrj.2024.08.009

Nuttapol Pattamin MD , Atthaphong Phongphithakchai MD , Sofia Spano MD , Akinori Maeda MD , Anis Chaba MD , Yukiko Hikasa MD , Rinaldo Bellomo MD, PhD, FRACP, FCICM

Objective

To assess current evidence regarding guanfacine use in hospitalized patients with delirium.

Introduction

Delirium is a common and important complication of critical illness. Central alpha-2 agonists are often used for symptomatic management. Guanfacine is an enteral central alpha-2 agonist approved for the treatment of attention deficit hyperactivity disorders. However, its use for delirium treatment has not been systematically assessed.

Inclusion criteria

All studies of guanfacine to treat patients with delirium during hospitalization. We excluded reviews, letters, commentaries, correspondence, conference abstracts, expert opinions or editorials.

Methods

We performed a systematic search of the literature using: MEDLINE (Ovid), Embase (Ovid), CENTRAL and SCOPUS (Elsevier) from inception until 29 February, 2024. Two independent reviewers assessed the identified citations and abstracts. Data on study and patient characteristics, as well as efficacy and safety outcomes, were extracted. Efficacy was defined by guanfacine's ability to relieve delirium and improve clinical outcomes, including intensive care unit (ICU) length of stay (LOS), hospital LOS, and mortality. Safety was assessed for hemodynamic stability or other reported side effects.

Results

We screened 908 articles and included two case reports, one case series, two retrospective descriptive cohorts, and one retrospective analytic cohort. Guanfacine therapy was associated with delirium attenuation and a reduction in the use of sedative agents. Median dosage was 1.5 mg daily, with a median time to delirium improvement of 3 days. However, guanfacine therapy was not associated with decreased ICU or hospital LOS. The most frequently reported adverse events were mild hypotension and bradycardia.

Conclusion

There is limited data on the efficacy of guanfacine for the treatment of delirium. However, given its pharmacologic properties and its available safety data, controlled investigations may be justified.

目的：评价目前关于住院谵妄患者使用胍法辛的证据。谵妄是危重症常见而重要的并发症。中枢α -2激动剂常用于症状治疗。胍法辛是一种经批准用于治疗注意缺陷多动障碍的肠内中枢α -2激动剂。然而，其在谵妄治疗中的应用尚未得到系统评估。纳入标准：所有使用胍法辛治疗住院期间谵妄患者的研究。我们排除了综述、信件、评论、通信、会议摘要、专家意见或社论。方法：采用MEDLINE （Ovid）、Embase （Ovid）、CENTRAL和SCOPUS（爱思唯尔）系统检索自成立至2024年2月29日的文献。两名独立审稿人评估了确定的引文和摘要。提取了有关研究和患者特征以及疗效和安全性结果的数据。疗效的定义是胍法辛缓解谵妄和改善临床结果的能力，包括重症监护病房（ICU）住院时间（LOS）、医院LOS和死亡率。安全性评估为血流动力学稳定性或其他报告的副作用。结果：我们筛选了908篇文章，包括2篇病例报告、1个病例系列、2个回顾性描述性队列和1个回顾性分析队列。胍法辛治疗与谵妄衰减和镇静药使用减少有关。中位剂量为每日1.5 mg，到谵妄改善的中位时间为3天。然而，胍法辛治疗与ICU或医院LOS的降低无关。最常见的不良事件是轻度低血压和心动过缓。结论：胍法辛治疗谵妄的疗效资料有限。然而，考虑到其药理学特性和现有的安全性数据，对照研究可能是合理的。

{"title":"Efficacy and safety of guanfacine in hospitalized patients with delirium: A scoping review","authors":"Nuttapol Pattamin MD , Atthaphong Phongphithakchai MD , Sofia Spano MD , Akinori Maeda MD , Anis Chaba MD , Yukiko Hikasa MD , Rinaldo Bellomo MD, PhD, FRACP, FCICM","doi":"10.1016/j.ccrj.2024.08.009","DOIUrl":"10.1016/j.ccrj.2024.08.009","url":null,"abstract":"<div><h3>Objective</h3><div>To assess current evidence regarding guanfacine use in hospitalized patients with delirium.</div></div><div><h3>Introduction</h3><div>Delirium is a common and important complication of critical illness. Central alpha-2 agonists are often used for symptomatic management. Guanfacine is an enteral central alpha-2 agonist approved for the treatment of attention deficit hyperactivity disorders. However, its use for delirium treatment has not been systematically assessed.</div></div><div><h3>Inclusion criteria</h3><div>All studies of guanfacine to treat patients with delirium during hospitalization. We excluded reviews, letters, commentaries, correspondence, conference abstracts, expert opinions or editorials.</div></div><div><h3>Methods</h3><div>We performed a systematic search of the literature using: MEDLINE (Ovid), Embase (Ovid), CENTRAL and SCOPUS (Elsevier) from inception until 29 February, 2024. Two independent reviewers assessed the identified citations and abstracts. Data on study and patient characteristics, as well as efficacy and safety outcomes, were extracted. Efficacy was defined by guanfacine's ability to relieve delirium and improve clinical outcomes, including intensive care unit (ICU) length of stay (LOS), hospital LOS, and mortality. Safety was assessed for hemodynamic stability or other reported side effects.</div></div><div><h3>Results</h3><div>We screened 908 articles and included two case reports, one case series, two retrospective descriptive cohorts, and one retrospective analytic cohort. Guanfacine therapy was associated with delirium attenuation and a reduction in the use of sedative agents. Median dosage was 1.5 mg daily, with a median time to delirium improvement of 3 days. However, guanfacine therapy was not associated with decreased ICU or hospital LOS. The most frequently reported adverse events were mild hypotension and bradycardia.</div></div><div><h3>Conclusion</h3><div>There is limited data on the efficacy of guanfacine for the treatment of delirium. However, given its pharmacologic properties and its available safety data, controlled investigations may be justified.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 286-294"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957527","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: 0

Severe intensive care unit–acquired hypernatraemia: Prevalence, risk factors, trajectory, management, and outcome 重症监护病房获得性高钠血症：患病率、危险因素、发展轨迹、管理和结果。

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2024-12-01 DOI: 10.1016/j.ccrj.2024.09.004

Anis Chaba MD , Atthaphong Phongphithakchai MD , Oscar Pope MD , Sam Rajapaksha MD , Pratibha Ranjan MD , Akinori Maeda MD, PhD , Sofia Spano MD , Yukiko Hikasa MD , Glenn Eastwood RN, PhD , Nuttapol Pattamin MD , Nuanprae Kitisin MD , Ahmad Nasser MD , Kyle C. White MD, PhD , Rinaldo Bellomo MD, PhD , Severe Hypernatremia Assessment, Resolution, and Eradication (SHARE) Investigators

Background

Severe intensive care unit–acquired hypernatraemia (ICU-AH) is a serious complication of critical illness. However, there is no detailed information on how this condition develops.

Objectives

The objective of this study was to study the prevalence, risk factors, trajectory, management, and outcome of severe ICU-AH (≥155 mmol·L⁻¹).

Methods

A retrospective study was conducted in a 40-bed ICU in a university-affiliated hospital. Assessment of sodium levels, factors associated with severe ICU-AH, urinary electrolyte measurements, water therapy, fluid balance, correction rate, and delirium was made.

Results

We screened 11,642 ICU admissions and identified 109 patients with severe ICU-AH. The median age was 57 years, 63% were male, and the median Acute Physiology and Chronic Health Evaluation III score was 64 (52; 80). On the day of ICU admission, 64% of patients were ventilated; 71% received vasopressors, and 22% had acute kidney injury. The median peak sodium level was 158 (156; 161) mmolL⁻¹ at a median of 4 (1; 11) days after ICU admission. Only eight patients (7%) had urine sodium measurement (median concentration: 17 mmol·L⁻¹). On the day of peak hypernatraemia, 80% of patients were unable to drink due to invasive ventilation; 34% were on diuretics; 25% had fever, and 50% did not receive hypotonic fluids. When available, the median electrolyte-free water clearance was −1.1 L (−1.7; −0.5), representing half of the urine output. After peak hypernatraemia, the correction rate was −2.8 mmol·L⁻¹ per day (95% confidence interval: [-2.9 to −2.6]) during the first 3 d.

Conclusions

Severe hypernatraemia occurred in the setting of inability to drink, near-absent measurement of urinary free water losses, diuretic therapy, fever, renal impairment, and near-absent or limited or delayed water administration. Correction was slow.

背景：重症监护病房获得性高钠血症（ICU-AH）是危重症的严重并发症。然而，没有关于这种情况如何发展的详细信息。目的：本研究的目的是研究重症ICU-AH（≥155 mmol·L-1）的患病率、危险因素、发展轨迹、管理和结局。方法：对某大学附属医院40张床位的ICU进行回顾性研究。评估钠水平、重症ICU-AH相关因素、尿电解质测量、水治疗、体液平衡、矫正率和谵妄。结果：我们筛选了11,642例ICU入院患者，确定了109例重症ICU- ah患者。中位年龄为57岁，63%为男性，急性生理和慢性健康评估III评分中位为64分(52分；80)。入院当天，64%的患者进行了通气；71%接受血管加压药物治疗，22%发生急性肾损伤。钠含量峰值中位数为158 (156；161) mmol -1，中位数为4 (1；入住ICU后11天。只有8例（7%）患者检测了尿钠（中位浓度：17 mmol·L-1）。高钠血症高峰当日，80%患者因有创通气无法饮水；34%的患者服用利尿剂；25%有发热，50%未接受低渗液。当可用时，无电解质水间隙的中位数为-1.1 L (-1.7；-0.5)，占尿量的一半。在高峰高钠血症后，前3 d的纠正率为-2.8 mmol·L-1 /天（95%可信区间：[-2.9至-2.6]）。结论：严重高钠血症发生在不能喝水、几乎没有尿游离水损失测量、利尿剂治疗、发烧、肾功能损害以及几乎没有或有限或延迟给水的情况下。修正是缓慢的。

{"title":"Severe intensive care unit–acquired hypernatraemia: Prevalence, risk factors, trajectory, management, and outcome","authors":"Anis Chaba MD , Atthaphong Phongphithakchai MD , Oscar Pope MD , Sam Rajapaksha MD , Pratibha Ranjan MD , Akinori Maeda MD, PhD , Sofia Spano MD , Yukiko Hikasa MD , Glenn Eastwood RN, PhD , Nuttapol Pattamin MD , Nuanprae Kitisin MD , Ahmad Nasser MD , Kyle C. White MD, PhD , Rinaldo Bellomo MD, PhD , Severe Hypernatremia Assessment, Resolution, and Eradication (SHARE) Investigators","doi":"10.1016/j.ccrj.2024.09.004","DOIUrl":"10.1016/j.ccrj.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Severe intensive care unit–acquired hypernatraemia (ICU-AH) is a serious complication of critical illness. However, there is no detailed information on how this condition develops.</div></div><div><h3>Objectives</h3><div>The objective of this study was to study the prevalence, risk factors, trajectory, management, and outcome of severe ICU-AH (≥155 mmol·L<sup>−1</sup>).</div></div><div><h3>Methods</h3><div>A retrospective study was conducted in a 40-bed ICU in a university-affiliated hospital. Assessment of sodium levels, factors associated with severe ICU-AH, urinary electrolyte measurements, water therapy, fluid balance, correction rate, and delirium was made.</div></div><div><h3>Results</h3><div>We screened 11,642 ICU admissions and identified 109 patients with severe ICU-AH. The median age was 57 years, 63% were male, and the median Acute Physiology and Chronic Health Evaluation III score was 64 (52; 80). On the day of ICU admission, 64% of patients were ventilated; 71% received vasopressors, and 22% had acute kidney injury. The median peak sodium level was 158 (156; 161) mmolL<sup>−1</sup> at a median of 4 (1; 11) days after ICU admission. Only eight patients (7%) had urine sodium measurement (median concentration: 17 mmol·L<sup>−1</sup>). On the day of peak hypernatraemia, 80% of patients were unable to drink due to invasive ventilation; 34% were on diuretics; 25% had fever, and 50% did not receive hypotonic fluids. When available, the median electrolyte-free water clearance was −1.1 L (−1.7; −0.5), representing half of the urine output. After peak hypernatraemia, the correction rate was −2.8 mmol·L<sup>−1</sup> per day (95% confidence interval: [-2.9 to −2.6]) during the first 3 d.</div></div><div><h3>Conclusions</h3><div>Severe hypernatraemia occurred in the setting of inability to drink, near-absent measurement of urinary free water losses, diuretic therapy, fever, renal impairment, and near-absent or limited or delayed water administration. Correction was slow.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 4","pages":"Pages 311-318"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957646","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: 0

Natural language processing in the intensive care unit: A scoping review 重症监护室的自然语言处理：范围综述

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.06.008

Julia K. Pilowsky RN, PhD , Jae-Won Choi MBiomedE, BE (Comp), BE-Health (HI) (ProfHons) , Aldo Saavedra PhD , Maysaa Daher BPsych, MAppStats , Nhi Nguyen MBBS, FCICM , Linda Williams RN, MHealthManagement , Sarah L. Jones RN, Grad Dip Ed (Nursing), Grad Cert (ICU)

Objectives

Natural language processing (NLP) is a branch of artificial intelligence focused on enabling computers to interpret and analyse text-based data. The intensive care specialty is known to generate large volumes of data, including free-text, however, NLP applications are not commonly used either in critical care clinical research or quality improvement projects. This review aims to provide an overview of how NLP has been used in the intensive care specialty and promote an understanding of NLP's potential future clinical applications.

Design

Scoping review.

Data sources

A systematic search was developed with an information specialist and deployed on the PubMed electronic journal database. Results were restricted to the last 10 years to ensure currency.

Review methods

Screening and data extraction were undertaken by two independent reviewers, with any disagreements resolved by a third. Given the heterogeneity of the eligible articles, a narrative synthesis was conducted.

Results

Eighty-seven eligible articles were included in the review. The most common type (n = 24) were studies that used NLP-derived features to predict clinical outcomes, most commonly mortality (n = 16). Next were articles that used NLP to identify a specific concept (n = 23), including sepsis, family visitation and mental health disorders. Most studies only described the development and internal validation of their algorithm (n = 79), and only one reported the implementation of an algorithm in a clinical setting.

Conclusions

Natural language processing has been used for a variety of purposes in the ICU context. Increasing awareness of these techniques amongst clinicians may lead to more clinically relevant algorithms being developed and implemented.

目标自然语言处理（NLP）是人工智能的一个分支，主要是让计算机能够解释和分析基于文本的数据。众所周知，重症监护专业会产生包括自由文本在内的大量数据，但在重症监护临床研究或质量改进项目中，NLP 应用并不常用。本综述旨在概述 NLP 在重症监护专业中的应用情况，并促进对 NLP 未来潜在临床应用的了解。为确保时效性，搜索结果仅限于过去 10 年内。综述方法由两名独立的综述员进行筛选和数据提取，如有任何分歧，则由第三名综述员解决。鉴于符合条件的文章存在异质性，因此进行了叙述性综合。最常见的类型（n = 24）是使用 NLP 衍生特征预测临床结果的研究，最常见的是预测死亡率（n = 16）。其次是使用 NLP 识别特定概念的文章（23 篇），包括败血症、探亲和精神疾病。大多数研究只描述了算法的开发和内部验证（n = 79），只有一项研究报告了算法在临床环境中的实施情况。提高临床医生对这些技术的认识可能会开发和实施更多与临床相关的算法。

{"title":"Natural language processing in the intensive care unit: A scoping review","authors":"Julia K. Pilowsky RN, PhD , Jae-Won Choi MBiomedE, BE (Comp), BE-Health (HI) (ProfHons) , Aldo Saavedra PhD , Maysaa Daher BPsych, MAppStats , Nhi Nguyen MBBS, FCICM , Linda Williams RN, MHealthManagement , Sarah L. Jones RN, Grad Dip Ed (Nursing), Grad Cert (ICU)","doi":"10.1016/j.ccrj.2024.06.008","DOIUrl":"10.1016/j.ccrj.2024.06.008","url":null,"abstract":"<div><h3>Objectives</h3><p>Natural language processing (NLP) is a branch of artificial intelligence focused on enabling computers to interpret and analyse text-based data. The intensive care specialty is known to generate large volumes of data, including free-text, however, NLP applications are not commonly used either in critical care clinical research or quality improvement projects. This review aims to provide an overview of how NLP has been used in the intensive care specialty and promote an understanding of NLP's potential future clinical applications.</p></div><div><h3>Design</h3><p>Scoping review.</p></div><div><h3>Data sources</h3><p>A systematic search was developed with an information specialist and deployed on the PubMed electronic journal database. Results were restricted to the last 10 years to ensure currency.</p></div><div><h3>Review methods</h3><p>Screening and data extraction were undertaken by two independent reviewers, with any disagreements resolved by a third. Given the heterogeneity of the eligible articles, a narrative synthesis was conducted.</p></div><div><h3>Results</h3><p>Eighty-seven eligible articles were included in the review. The most common type (n = 24) were studies that used NLP-derived features to predict clinical outcomes, most commonly mortality (n = 16). Next were articles that used NLP to identify a specific concept (n = 23), including sepsis, family visitation and mental health disorders. Most studies only described the development and internal validation of their algorithm (n = 79), and only one reported the implementation of an algorithm in a clinical setting.</p></div><div><h3>Conclusions</h3><p>Natural language processing has been used for a variety of purposes in the ICU context. Increasing awareness of these techniques amongst clinicians may lead to more clinically relevant algorithms being developed and implemented.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 210-216"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000243/pdfft?md5=baca71f4ef8b264efa157f45c9f3f932&pid=1-s2.0-S1441277224000243-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230444","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: 0

Response to: “More than one pathway: ECMO training and credentialing” 回应："不止一条途径：ECMO 培训和资格认证"

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.07.001

Stuart C. Duffin BMedSci, MBBS, FCICM, DESA, EDIC, Judith H. Askew BAppSci, MBBS, FCICM, Timothy J. Southwood MBBS, MSc, FCICM, Paul Forrest MBCHB, FANZCA, Brian Plunkett MBChB, FRACS, Richard J. Totaro MBBS, FRACP, FCICM

引用次数: 0

Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ): An observational study 澳大利亚和新西兰严重急性呼吸窘迫综合征的管理（SAGE-ANZ）：观察研究

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.05.001

Rachael L. Parke RN, PhD , Shay P. McGuinness MBChB , Alana Cavadino PhD , Keri-Anne Cowdrey RN, MN , Samantha Bates RN, MN , Shailesh Bihari MBBS, PhD , Amanda Corley RN, PhD , Eileen Gilder RN, PhD , Carol Hodgson PhD , Edward Litton MBChB, PhD , Colin McArthur MBChB , Alistair Nichol MBBCh, PhD , Jane Parker RN, MPH , Anne Turner RN, MPH , Steve Webb MBBS, PhD , Frank MP. Van Haren MD, PhD , SAGE-ANZ Study Investigators and the Australia and New Zealand Intensive Care Society Clinical Trials Group

Objective

Acute respiratory distress syndrome (ARDS) is associated with significant mortality, morbidity, and cost. We aimed to describe characteristics and management of adult patients admitted to intensive care units (ICUs) in Australia and New Zealand with moderate-severe ARDS, to better understand contemporary practice.

Design

Bi-national, prospective, observational, multi-centre study.

Setting

19 ICUs in Australia and New Zealand.

Participants

Mechanically ventilated patients with moderate-severe ARDS.

Main outcome measures

Baseline demographic characteristics, ventilation characteristics, use of adjunctive support therapy and all-cause mortality to day 28. Data were summarised using descriptive statistics.

Results

200 participants were enrolled, mean (±SD) age 55.5 (±15.9) years, 40% (n = 80) female. Around half (51.5%) had no baseline comorbidities and 45 (31%) tested positive for COVID-19. On day 1, mean SOFA score was 9 ± 3; median (IQR) PaO₂/FiO₂ ratio 119 (89, 142), median (IQR) FiO₂ 70% (50%, 99%) and mean (±SD) positive end expiratory pressure (PEEP) 11 (±3) cmH₂O. On day one, 10.5% (n = 21) received lung protective ventilation (LPV) (tidal volume ≤6.5 mL/kg predicted body weight and plateau pressure or peak pressure ≤30 cm H₂O). Adjunctive therapies were received by 86% (n = 172) of patients at some stage from enrolment to day 28. Systemic steroids were most used (n = 127) followed by neuromuscular blockers (n = 122) and prone positioning (n = 27). Median ventilator-free days (IQR) to day 28 was 5 (0, 20). In-hospital mortality, censored at day 28, was 30.5% (n = 61).

Conclusions

In Australia and New Zealand, compliance with evidence-based practices including LPV and prone positioning was low in this cohort. Therapies with proven benefit in the treatment of patients with moderate-severe ARDS, such as lung protective ventilation and prone positioning, were not routinely employed.

目的急性呼吸窘迫综合征（ARDS）与严重的死亡率、发病率和成本相关。我们旨在描述澳大利亚和新西兰重症监护病房（ICU）收治的中重度ARDS成人患者的特征和管理情况，以便更好地了解当代的实践。结果200名参与者，平均（±SD）年龄为55.5（±15.9）岁，40%（n = 80）为女性。约半数（51.5%）患者无基线合并症，45人（31%）COVID-19检测呈阳性。第一天，平均 SOFA 评分为 9 ± 3；PaO2/FiO2 比率中位数（IQR）为 119（89，142），FiO2 中位数（IQR）为 70%（50%，99%），呼气末正压（PEEP）平均值（±SD）为 11（±3）cmH2O。第一天，10.5%（n = 21）的患者接受了肺保护性通气（LPV）（潮气量≤6.5 mL/kg预测体重，高原压或峰值压≤30 cm H2O）。86%的患者（n = 172）在入组至第 28 天的某个阶段接受了辅助治疗。使用最多的是全身类固醇（127 人），其次是神经肌肉阻滞剂（122 人）和俯卧位（27 人）。截至第28天的无呼吸机天数中位数（IQR）为5天（0，20）。结论在澳大利亚和新西兰，包括 LPV 和俯卧位在内的循证疗法在该队列中的依从性很低。在澳大利亚和新西兰，包括 LPV 和俯卧位在内的循证实践的依从性较低。在中度重度 ARDS 患者的治疗中，肺保护性通气和俯卧位等已证实有效的疗法并未得到常规采用。

{"title":"Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ): An observational study","authors":"Rachael L. Parke RN, PhD , Shay P. McGuinness MBChB , Alana Cavadino PhD , Keri-Anne Cowdrey RN, MN , Samantha Bates RN, MN , Shailesh Bihari MBBS, PhD , Amanda Corley RN, PhD , Eileen Gilder RN, PhD , Carol Hodgson PhD , Edward Litton MBChB, PhD , Colin McArthur MBChB , Alistair Nichol MBBCh, PhD , Jane Parker RN, MPH , Anne Turner RN, MPH , Steve Webb MBBS, PhD , Frank MP. Van Haren MD, PhD , SAGE-ANZ Study Investigators and the Australia and New Zealand Intensive Care Society Clinical Trials Group","doi":"10.1016/j.ccrj.2024.05.001","DOIUrl":"10.1016/j.ccrj.2024.05.001","url":null,"abstract":"<div><h3>Objective</h3><p>Acute respiratory distress syndrome (ARDS) is associated with significant mortality, morbidity, and cost. We aimed to describe characteristics and management of adult patients admitted to intensive care units (ICUs) in Australia and New Zealand with moderate-severe ARDS, to better understand contemporary practice.</p></div><div><h3>Design</h3><p>Bi-national, prospective, observational, multi-centre study.</p></div><div><h3>Setting</h3><p>19 ICUs in Australia and New Zealand.</p></div><div><h3>Participants</h3><p>Mechanically ventilated patients with moderate-severe ARDS.</p></div><div><h3>Main outcome measures</h3><p>Baseline demographic characteristics, ventilation characteristics, use of adjunctive support therapy and all-cause mortality to day 28. Data were summarised using descriptive statistics.</p></div><div><h3>Results</h3><p>200 participants were enrolled, mean (±SD) age 55.5 (±15.9) years, 40% (n = 80) female. Around half (51.5%) had no baseline comorbidities and 45 (31%) tested positive for COVID-19. On day 1, mean SOFA score was 9 ± 3; median (IQR) PaO<sub>2</sub>/FiO<sub>2</sub> ratio 119 (89, 142), median (IQR) FiO<sub>2</sub> 70% (50%, 99%) and mean (±SD) positive end expiratory pressure (PEEP) 11 (±3) cmH<sub>2</sub>O. On day one, 10.5% (n = 21) received lung protective ventilation (LPV) (tidal volume ≤6.5 mL/kg predicted body weight and plateau pressure or peak pressure ≤30 cm H<sub>2</sub>O). Adjunctive therapies were received by 86% (n = 172) of patients at some stage from enrolment to day 28. Systemic steroids were most used (n = 127) followed by neuromuscular blockers (n = 122) and prone positioning (n = 27). Median ventilator-free days (IQR) to day 28 was 5 (0, 20). In-hospital mortality, censored at day 28, was 30.5% (n = 61).</p></div><div><h3>Conclusions</h3><p>In Australia and New Zealand, compliance with evidence-based practices including LPV and prone positioning was low in this cohort. Therapies with proven benefit in the treatment of patients with moderate-severe ARDS, such as lung protective ventilation and prone positioning, were not routinely employed.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 161-168"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000139/pdfft?md5=d534b9440be94c4ac8edd575b084a64d&pid=1-s2.0-S1441277224000139-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230330","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: 0

Brain tissue oxygen monitoring in moderate-to-severe traumatic brain injury: Physiological determinants, clinical interventions and current randomised controlled trial evidence 中重度创伤性脑损伤的脑组织氧监测：生理决定因素、临床干预措施和当前随机对照试验证据

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.05.003

Toby Jeffcote FCICM, PhD , Kuan-Ying Lu MBiomedEng , Philip Lewis PhD , Dashiell Gantner FCICM, PhD , Camila R. Battistuzzo PhD , Andrew A. Udy FCICM, PhD

Modern intensive care for moderate-to-severe traumatic brain injury (msTBI) focuses on managing intracranial pressure (ICP) and cerebral perfusion pressure (CPP). This approach lacks robust clinical evidence and often overlooks the impact of hypoxic injuries. Emerging monitoring modalities, particularly those capable of measuring brain tissue oxygen, represent a promising avenue for advanced neuromonitoring. Among these, brain tissue oxygen tension (PbtO₂) shows the most promising results. However, there is still a lack of consensus regarding the interpretation of PbtO₂ in clinical practice. This review aims to provide an overview of the pathophysiological rationales, monitoring technology, physiological determinants, and recent clinical trial evidence for PbtO₂ monitoring in the management of msTBI.

中重度创伤性脑损伤（msTBI）的现代重症监护主要集中在颅内压（ICP）和脑灌注压（CPP）的管理上。这种方法缺乏可靠的临床证据，而且经常忽视缺氧性损伤的影响。新出现的监测模式，尤其是那些能够测量脑组织氧的监测模式，为先进的神经监测带来了希望。其中，脑组织氧张力（PbtO2）显示出最有希望的结果。然而，临床实践中对 PbtO2 的解释仍缺乏共识。本综述旨在概述病理生理学原理、监测技术、生理决定因素，以及在毫秒创伤性脑损伤治疗中进行 PbtO2 监测的最新临床试验证据。

{"title":"Brain tissue oxygen monitoring in moderate-to-severe traumatic brain injury: Physiological determinants, clinical interventions and current randomised controlled trial evidence","authors":"Toby Jeffcote FCICM, PhD , Kuan-Ying Lu MBiomedEng , Philip Lewis PhD , Dashiell Gantner FCICM, PhD , Camila R. Battistuzzo PhD , Andrew A. Udy FCICM, PhD","doi":"10.1016/j.ccrj.2024.05.003","DOIUrl":"10.1016/j.ccrj.2024.05.003","url":null,"abstract":"<div><p>Modern intensive care for moderate-to-severe traumatic brain injury (msTBI) focuses on managing intracranial pressure (ICP) and cerebral perfusion pressure (CPP). This approach lacks robust clinical evidence and often overlooks the impact of hypoxic injuries. Emerging monitoring modalities, particularly those capable of measuring brain tissue oxygen, represent a promising avenue for advanced neuromonitoring. Among these, brain tissue oxygen tension (PbtO<sub>2</sub>) shows the most promising results. However, there is still a lack of consensus regarding the interpretation of PbtO<sub>2</sub> in clinical practice. This review aims to provide an overview of the pathophysiological rationales, monitoring technology, physiological determinants, and recent clinical trial evidence for PbtO<sub>2</sub> monitoring in the management of msTBI.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 204-209"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000152/pdfft?md5=e58a24cff9d40d7de6e006570777fc6b&pid=1-s2.0-S1441277224000152-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230443","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: 0

ARDS, guidelines and ANZ practice: The persistent disconnect ARDS、指南和澳新实践：长期脱节

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.08.005

Ary Serpa Neto MD, MSc, PhD

引用次数: 0

A retrospective registry-based study into the proportion of patients admitted to intensive care who have anaphylaxis as a principal diagnosis and their outcomes in Australia and New Zealand 基于登记簿的回顾性研究：澳大利亚和新西兰重症监护病房收治的主要诊断为过敏性休克的患者比例及其治疗结果

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.06.002

Zheng Jie Lim (Zee) MBBS (Hons), MMed Periop , Dharshi Karalapillai MBBS, PhD, FANZCA, FCICM, PGDipUS , Helen Kolawole BMedSc, MBBS, MClinEd, FANZCA , Chris Fiddes MBBS, FANZCA , David Pilcher MBBS, MRCP, FRACP, FCICM , Ashwin Subramaniam MBBS, MMed, GChPOM, FRACP, FCICM, PhD

Objective

To describe the proportion of patients admitted to intensive care who have anaphylaxis as a principal diagnosis and their subsequent outcomes in Australia and New Zealand.

Design

Retrospective observational study of ICU admissions for severe anaphylaxis.

Setting

ICU admissions recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2012 and 2022.

Participants

Adults 16 years or older with severe anaphylaxis admitted to the ICU.

Interventions

None.

Main outcome measures

Proportion of patients admitted to ICU who have anaphylaxis as a principal diagnosis, mortality rate, ICU and hospital length of stay.

Results

7189 of the 7270 ICU admissions for severe anaphylaxis recorded between 2012 and 2022, were included in the analysis. This represented a proportion from 0.25% in 2012 to 0.43% in 2022. ICU and hospital mortality were 0.4% and 0.8%, respectively. The proportion of ICUs reporting at least one severe anaphylaxis each year increased from 61.7% in 2012 to 83.0% in 2022. Most of the patients were discharged home (92.6%, n = 6660). Increasing age (OR = 1.055; 95%CI: 1.008–1.105) and SOFA scores (OR = 1.616; 95%CI: 1.265–2.065), an immunosuppressive chronic condition (OR = 16.572; 95%CI: 3.006–91.349) and an increasing respiratory rate above 16 breaths/min (OR = 1.116; 95%CI: 1.057–1.178) predicted in-hospital mortality in patients with anaphylaxis, while higher GCS decreased in-hospital mortality (OR = 0.827; 95%CI: 0.705–0.969).

Conclusions

The overall proportion of patients admitted to ICU who have anaphylaxis as a principal diagnosis has increased. In-hospital mortality remains low despite the need for vital organ support. Further studies should investigate these identified factors that may predict in-hospital mortality among these patients.

Trial registration

Not applicable.

目的描述澳大利亚和新西兰重症监护病房收治的主要诊断为过敏性休克的患者比例及其随后的预后.设计对重症监护病房收治的严重过敏性休克患者进行回顾性观察研究.设置2012年至2022年期间澳大利亚和新西兰重症监护协会成人患者数据库中记录的重症监护病房收治患者.干预措施无.主要结果测量重症监护病房收治的主要诊断为过敏性休克的患者比例.干预措施无。主要结果测量以过敏性休克为主要诊断的ICU入院患者比例、死亡率、ICU和住院时间。结果在2012年至2022年期间记录的7270例ICU严重过敏性休克入院患者中，有7189例被纳入分析。这一比例从2012年的0.25%上升到2022年的0.43%。重症监护病房和医院的死亡率分别为 0.4% 和 0.8%。每年至少报告一次严重过敏性休克的重症监护室比例从2012年的61.7%增至2022年的83.0%。大多数患者出院回家（92.6%，n = 6660）。年龄增加（OR = 1.055；95%CI：1.008-1.105）、SOFA 评分增加（OR = 1.616；95%CI：1.265-2.065）、免疫抑制性慢性疾病（OR = 16.572；95%CI：3.006-91.349）和呼吸频率超过 16 次/分（OR = 1.116；95%CI：1.057-1.178）预示着住院患者的过敏性休克发生率增加。结论ICU收治的以过敏性休克为主要诊断的患者总比例有所增加。尽管需要重要器官支持，但院内死亡率仍然很低。进一步的研究应调查这些已确定的可能预测这些患者院内死亡率的因素。

{"title":"A retrospective registry-based study into the proportion of patients admitted to intensive care who have anaphylaxis as a principal diagnosis and their outcomes in Australia and New Zealand","authors":"Zheng Jie Lim (Zee) MBBS (Hons), MMed Periop , Dharshi Karalapillai MBBS, PhD, FANZCA, FCICM, PGDipUS , Helen Kolawole BMedSc, MBBS, MClinEd, FANZCA , Chris Fiddes MBBS, FANZCA , David Pilcher MBBS, MRCP, FRACP, FCICM , Ashwin Subramaniam MBBS, MMed, GChPOM, FRACP, FCICM, PhD","doi":"10.1016/j.ccrj.2024.06.002","DOIUrl":"10.1016/j.ccrj.2024.06.002","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the proportion of patients admitted to intensive care who have anaphylaxis as a principal diagnosis and their subsequent outcomes in Australia and New Zealand.</p></div><div><h3>Design</h3><p>Retrospective observational study of ICU admissions for severe anaphylaxis.</p></div><div><h3>Setting</h3><p>ICU admissions recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2012 and 2022.</p></div><div><h3>Participants</h3><p>Adults 16 years or older with severe anaphylaxis admitted to the ICU.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main outcome measures</h3><p>Proportion of patients admitted to ICU who have anaphylaxis as a principal diagnosis, mortality rate, ICU and hospital length of stay.</p></div><div><h3>Results</h3><p>7189 of the 7270 ICU admissions for severe anaphylaxis recorded between 2012 and 2022, were included in the analysis. This represented a proportion from 0.25% in 2012 to 0.43% in 2022. ICU and hospital mortality were 0.4% and 0.8%, respectively. The proportion of ICUs reporting at least one severe anaphylaxis each year increased from 61.7% in 2012 to 83.0% in 2022. Most of the patients were discharged home (92.6%, n = 6660). Increasing age (OR = 1.055; 95%CI: 1.008–1.105) and SOFA scores (OR = 1.616; 95%CI: 1.265–2.065), an immunosuppressive chronic condition (OR = 16.572; 95%CI: 3.006–91.349) and an increasing respiratory rate above 16 breaths/min (OR = 1.116; 95%CI: 1.057–1.178) predicted in-hospital mortality in patients with anaphylaxis, while higher GCS decreased in-hospital mortality (OR = 0.827; 95%CI: 0.705–0.969).</p></div><div><h3>Conclusions</h3><p>The overall proportion of patients admitted to ICU who have anaphylaxis as a principal diagnosis has increased. In-hospital mortality remains low despite the need for vital organ support. Further studies should investigate these identified factors that may predict in-hospital mortality among these patients.</p></div><div><h3>Trial registration</h3><p>Not applicable.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 185-191"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000176/pdfft?md5=f3d17dbf6c2d76f42f55e0c44acee7cb&pid=1-s2.0-S1441277224000176-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230347","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: 0

More than one pathway: ECMO training and credentialing 不止一条途径：ECMO 培训和资格认证

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.06.004

Michael Kouch M.D, Nitin Puri M.D, Emily Damuth M.D, Christopher Noel M.D, Jason Bartock M.D, Adam Green M.D

引用次数: 0

Point-of-care creatinine vs. central laboratory creatinine in the critically ill 重症患者的床旁肌酐与中心实验室肌酐对比

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation

Pub Date : 2024-09-01 DOI: 10.1016/j.ccrj.2024.07.002

Kyle C. White FCICM, MPH , James McCullough FCICM, MMed , Kiran Shekar FCICM, PhD , Siva Senthuran FCICM, MBBS , Kevin B. Laupland FCICM, PhD , Goce Dimeski BSc Med Lab, PhD , Ary Serpa-Neto FCICM, PhD , Rinaldo Bellomo MD, PhD , Queensland Critical Care Research Network (QCRCN)

Objective

Frequent measurement of creatinine by point-of-care testing (POCT) may facilitate the earlier detection of acute kidney injury (AKI) in critically ill patients. However, no robust data exist to confirm its equivalence to central laboratory testing. We aimed to conduct a multicenter study to compare POCT with central laboratory creatinine (CrC) measurement.

Design

Retrospective observational study, using hospital electronic medical records. Obtained paired point-of-care creatinine (CrP) from arterial blood gas machines and CrC.

Setting

Four intensive care units in Queensland, Australia.

Participants

Critically ill patients, where greater than 50% of POCT contained creatinine.

Main outcome measures

Mean difference, bias, and limits of agreement between two methods, and biochemical confounders.

Results

We studied 79,767 paired measurements in 19,118 patients, with a median Acute Physiology and Chronic Health Evaluation 3 score of 51. The mean CrC was 115.5 μmol/L (standard deviation: 100.2) compared to a CrP mean of 115 μmol/L (standard deviation: 100.7) (Pearson coefficient of 0.99). The mean difference between CrP and CrC was 0.49 μmol/L with 95% limits of agreement of −27 μmol/L and +28 μmol/L. Several biochemical variables were independently associated with the difference between tests (e.g., pH, potassium, lactate, glucose, and bilirubin), but their impact was small.

Conclusion

In critically ill patients, measurement of creatinine by POCT yields clinically equivalent values to those obtained by central laboratory measurement and can be easily used for more frequent monitoring of kidney function in such patients. These findings open the door to the use of POCT for the earlier detection of acute kidney injury in critically ill patients.

目的通过床旁检测（POCT）频繁测量肌酐有助于更早地发现重症患者的急性肾损伤（AKI）。然而，目前还没有可靠的数据证实其与中心实验室检测具有等效性。我们旨在开展一项多中心研究，对 POCT 和中心实验室肌酐 (CrC) 测量进行比较。结果我们对 19118 名患者的 79767 次配对测量进行了研究，患者的急性生理学和慢性健康评估 3 中位数为 51 分。CrC 平均值为 115.5 μmol/L（标准偏差：100.2），而 CrP 平均值为 115 μmol/L（标准偏差：100.7）（皮尔逊系数为 0.99）。CrP 和 CrC 的平均值相差 0.49 μmol/L，95% 的一致性范围为 -27 μmol/L 和 +28μmol/L。一些生化变量（如 pH 值、钾、乳酸、葡萄糖和胆红素）与检测之间的差异有独立关联，但影响较小。这些发现为使用 POCT 更早发现危重病人的急性肾损伤打开了大门。

{"title":"Point-of-care creatinine vs. central laboratory creatinine in the critically ill","authors":"Kyle C. White FCICM, MPH , James McCullough FCICM, MMed , Kiran Shekar FCICM, PhD , Siva Senthuran FCICM, MBBS , Kevin B. Laupland FCICM, PhD , Goce Dimeski BSc Med Lab, PhD , Ary Serpa-Neto FCICM, PhD , Rinaldo Bellomo MD, PhD , Queensland Critical Care Research Network (QCRCN)","doi":"10.1016/j.ccrj.2024.07.002","DOIUrl":"10.1016/j.ccrj.2024.07.002","url":null,"abstract":"<div><h3>Objective</h3><p>Frequent measurement of creatinine by point-of-care testing (POCT) may facilitate the earlier detection of acute kidney injury (AKI) in critically ill patients. However, no robust data exist to confirm its equivalence to central laboratory testing. We aimed to conduct a multicenter study to compare POCT with central laboratory creatinine (CrC) measurement.</p></div><div><h3>Design</h3><p>Retrospective observational study, using hospital electronic medical records. Obtained paired point-of-care creatinine (CrP) from arterial blood gas machines and CrC.</p></div><div><h3>Setting</h3><p>Four intensive care units in Queensland, Australia.</p></div><div><h3>Participants</h3><p>Critically ill patients, where greater than 50% of POCT contained creatinine.</p></div><div><h3>Main outcome measures</h3><p>Mean difference, bias, and limits of agreement between two methods, and biochemical confounders.</p></div><div><h3>Results</h3><p>We studied 79,767 paired measurements in 19,118 patients, with a median Acute Physiology and Chronic Health Evaluation 3 score of 51. The mean CrC was 115.5 μmol/L (standard deviation: 100.2) compared to a CrP mean of 115 μmol/L (standard deviation: 100.7) (Pearson coefficient of 0.99). The mean difference between CrP and CrC was 0.49 μmol/L with 95% limits of agreement of −27 μmol/L and +28 μmol/L. Several biochemical variables were independently associated with the difference between tests (e.g., pH, potassium, lactate, glucose, and bilirubin), but their impact was small.</p></div><div><h3>Conclusion</h3><p>In critically ill patients, measurement of creatinine by POCT yields clinically equivalent values to those obtained by central laboratory measurement and can be easily used for more frequent monitoring of kidney function in such patients. These findings open the door to the use of POCT for the earlier detection of acute kidney injury in critically ill patients.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 198-203"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000279/pdfft?md5=fe53682e5d2e5687b85d3ba807712d31&pid=1-s2.0-S1441277224000279-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230446","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: 0