Heart & Lung最新文献

Background

Frailty is prevalent among older patients in intensive care units (ICUs) and poses significant challenges to recovery. Despite its importance, there is limited research on effective nurse-led frailty management strategies in this context.

Objective

The purpose of this qualitative study was to explore nurses' perceptions of frailty management in cardiac ICUs through the lens of the Wuli-Shili-Renli (WSR) system approach.

Methods

Sixteen nurses from two tertiary hospitals in Shandong province, China, participated in semi-structured interviews. Participants were selected based on their involvement in frailty training, educational background, and cardiac ICU work experience. Thematic analysis was conducted to identify key themes and sub-themes.

Results

Analysis in three categories revealed the need for foundational support, including the need for appropriate screening tools, updated evidence-based practices, and institutional support. Closed-loop management involved frailty screening, personalized program implementation, information management, and follow-up assessment. Personnel training and coordination emphasized enhancing nurses' professionalism, multidisciplinary teamwork, and cooperation from patients and their caregivers.

Conclusion

The insights gained can inform evidence-based practices and improve the quality of care provided to frail patients in cardiac ICUs. There is a need for future research to empirically investigate these strategies.

Background

Some patients with psychotropic drug poisoning need intensive care unit (ICU) admission, but risk prediction models for prolonged ICU stays are lacking.

Objectives

Develop and evaluate a prediction model for prolonged ICU stays in patients with psychotropic drug poisoning.

Methods

The clinical data of patients with psychotropic drug poisoning were collected from the Medical Information Mart for Intensive Care (MIMIC)-Ⅳ 2.2 database. Patients were grouped by their ICU length of stay: non-prolonged (<2 days) and prolonged (≥2 days).

Variable selection methods included LASSO and logistic regression. The selected variables were used to construct the model, which was subsequently evaluated for discrimination, calibration, and clinical utility.

Results

The cohort included 413 patients with psychotropic drug poisoning, 49.4 % male, with a median age of 41 years. The variables stepwise selected for model construction through LASSO and logistic regression include sepsis, SAPS Ⅱ, heart rate, respiratory rate, and mechanical ventilation. The model showed good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.785 (95 % CI: 0.736–0.833) and was validated well with bootstrap internal validation (AUC: 0.792, 95 % CI: 0.745–0.839). Calibration curves indicated good fit (χ2 = 4.148, P = 0.844), aligning observed and predicted rates of prolonged ICU stays. Decision curve analysis (DCA) showed positive net benefits across a threshold probability range of 0.07–0.85.

Conclusions

The model developed in this study may help predict the risk of prolonged ICU stays for patients with psychotropic drug poisoning.

Background

Cardiovascular disease (CVD) is the leading cause of death worldwide, particularly affecting low- and middle-income countries. Food environments may be linked with the risk of CVD; however, current study findings regarding their relationship are inconsistent. A systematic review of their associations is needed to guide interventions to improve cardiovascular health.

Objective

This systematic review aimed to comprehensively assess the relationship between food environments and CVD outcomes, including incidence, hospitalization, mortality, and recurrence rates.

Method

According to PRISMA guidelines, a systematic search was conducted until 28th March 2024, using eight databases, including PubMed, Embase, Ovid, CINAHL, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data. The review quality was assessed according to the Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa Scale (NOS). The included studies were categorized based on their exposure factors into unhealthy, healthy, and comprehensive food environments, encompassing facilities that offer healthy and unhealthy foods. The findings were narratively synthesized according to this classification.

Result

A total of 23 studies, encompassing 13 cross-sectional studies and 10 cohort-longitudinal studies, were included in this review. Among the 20 studies on unhealthy food environments, 13 found a positive association with CVD outcomes. Of the seven studies on healthy food environments, 3 found a negative association with CVD outcomes. Additionally, 4 out of 8 studies on comprehensive food environments found a significant but inconsistent association with CVD outcomes.

Conclusion

This study suggested that unhealthy food environments are probably associated with CVD outcomes. At the same time, there is currently no conclusive evidence to indicate a relationship between healthy food environments or comprehensive food environments and CVD outcomes.

Background

Sex differences in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) susceptibility, illness severity, and hospital course are widely acknowledged. The effects of sex on outcomes experienced by patients with severe Coronavirus Disease 2019 (COVID-19) admitted to the intensive care unit (ICU) remains unknown.

Objectives

To determine the effects of sex on ICU mortality in patients with COVID-19

Methods

This retrospective analysis of an international multi-center prospective observational database included adults admitted to ICU for treatment of acute COVID-19 between 1st January 2020 and 30th June 2022. The primary outcome was ICU mortality. Multivariable Cox regression was used to ascertain the hazard of death (Hazard Ratio=HR) adjusted for pre-selected covariates. The secondary outcome was sex differences in complications of COVID-19 during hospital stay.

Results

Overall, 10,259 patients (3,314 females, 6,945 males) were included with a median age of 60 (interquartile range [IQR]=49–68) and 59 (IQR=49–67) years, respectively. Baseline characteristics were similar between sexes. More females were non-smokers (65% vs. 44 %, p < 0.01) and obese (39% vs. 30 %, p < 0.01), compared to males. Also, males received greater ICU intervention (mechanical ventilation, prone ventilation, vasopressors, and tracheostomy) than females. Males had a greater hazard of death (compared to females, HR=1.14; 95 % CI=1.02–1.26). Adjustment for complications during hospital stay did not alter the hazard of death (HR=1.16; 95 % CI=1.05–1.28). Males had a significantly elevated hazard of death among patients who received ECMO (HR=1.24; 95 % CI=1.01–1.53). Male sex was associated with cardiac arrest (adjusted OR [aOR]=1.37; 95 % CI=1.16–1.62) and PE (aOR=1.28; 95 % CI=1.06–1.55).

Conclusion

Among patients admitted to ICU for severe COVID-19, males experienced higher severity of illness and more frequent intervention than females. Ultimately, the hazard of death was moderately elevated in males compared to females despite greater PE and cardiac arrest.

Background

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide and constitutes a global health problem. The cardiometabolic index (CMI) is a new metric that combines abdominal obesity and lipid levels. Studies have shown that the prevalence of lipid metabolism disorders is greater among COPD patients and that the CMI can help reveal the potential role of lipid metabolism in disease progression by assessing the body's metabolic status; however, the association between the CMI and COPD is not known.

Objective

To explore the association between the CMI and the prevalence of COPD.

Methods

A cross-sectional study was conducted with 14,340 participants aged ≥ 20 years from the 2007–2018 NHANES databases. To assess the relationship between the CMI and the odds of COPD prevalence, we performed multivariate logistic regression analyses, subgroup analysis interaction tests, smoothed curve fitting, and threshold effect analyses.

Results

The study included a total of 14,340 participants, 48.49 % male and 51.51 % female, and the average age was 49.75 ± 17.49 years. According to the regression model adjusted for all confounding variables, participants in the highest quartile of the CMI had 22 % greater odds of having COPD than did those in the lowest quartile (OR = 1.22, 95 % CI: 1.03, 1.21, p = 0.010). A nonlinear association was found between the CMI and COPD, with an inflection point of 0.26. The OR (95 % CI) before the inflection point was 1.27 (1.12, 1.44), p = 0.0002. The interaction was statistically significant only in the sex analysis.

Conclusions

The level of the CMI and the odds of COPD prevalence were positively correlated in our study. These findings suggest that managing abdominal obesity and lipid levels may help prevent or mitigate COPD, emphasizing the potential value of the CMI as an indicator for early intervention and precision therapy.

Background

Observational studies have suggested a correlation between hyperuricemia and pulmonary arterial hypertension (PAH), yet the causal relationship remains uncertain. We aimed to establish this link using Mendelian Randomization (MR) methods.

Objectives

Based on publicly accessible data, our study employs MR to determine the causal relationship between uric acid (UA) and PAH.

Method

MR analysis was conducted among individuals of European descent. Genetic instruments linked to UA (p-value < 5 × 10^–8) were extracted from the Chronic Kidney Disease Genetic Consortium and genome-wide association study databases. PAH risk genetic associations were sourced separately. We employed four MR methods (MR-Egger, weighted median, inverse variance weighted, and weighted mode) with selected instrumental variables to assess the causal association between UA and PAH. MR-PRESSO was used to evaluate pleiotropy and outlier Single Nucleotide Polymorphisms (SNPs), while Cochran's Q test and funnel plot assessed SNP heterogeneity. Leave-one-out analysis examined SNP impacts on causal assessment.

Result

Two-sample MR analysis revealed a positive, causal relationship between UA levels and PAH.

Conclusion

Our MR analysis provides robust evidence of a causal link between serum UA and PAH, suggesting UA's potential as a biomarker and therapeutic target for PAH.

Background

Blood pressure variability (BPV) is a prognostic marker of cardiovascular disease (CVD). Sleep is recognized as a significant risk factor for CVD; however, little is known about the relationship between sleep characteristics and BPV.

Objective

In this systematic review, we aimed to (1) describe methods used to measure BPV and sleep and (2) describe the current evidence in the literature on the association between sleep and BPV.

Methods

A systematic search was conducted using the search terms “sleep” AND (“blood pressure variability” OR “ambulatory blood pressure monitor”) in CINAHL, PubMed, Web of Science, and PsycINFO databases.

Results

Twenty-two studies were included in this systematic review. Sleep was measured using various methods, including polysomnography, actigraphy, sleep diaries, and questionnaires, while BPV was measured over various time intervals using different monitoring devices such as a beat-to-beat blood pressure (BP) monitoring device, a 24-h ambulatory BP monitor, or an automatic upper arm BP monitor. The studies demonstrated mixed results on the associations between sleep parameters (sleep quality, architecture, and duration) and increased BPV.

Conclusions

Although the mechanisms that explain the relationship between sleep and BPV are still unclear, accumulating evidence suggests potential associations between increased BPV with poor sleep quality and longer sleep duration. Given the recent development of sleep and BP monitoring technologies, further research is warranted to assess sleep and BPV under free-living conditions. Such studies will advance our understanding of complex interactions between sleep and CVD risk.

Background

Heart failure is a major worldwide health concern and leading cause of mortality. RNAi interventions hold promise for patients resistant to conventional drugs due to their off-target effects and lack of specificity.

Objectives

To examine the safety and effectiveness of RNAi therapeutics in treating heart failure.

Methods

The PubMed, Embase, Scopus and Cochrane databases were searched using appropriate keyword from inception until December 31, 2023. A total of 14 studies fulfilling predefined selection criteria were included for qualitative synthesis.

Results

We found that in patients with cardiac amyloidosis, patisiran and revusiran showed considerable improvements in cardiac output and left ventricular wall thickness. In animal studies, Nox2-siRNA showed effectiveness in regaining heart function. Furthermore, cardiomyocyte count and left ventricular function were improved by DUSP5 siRNA + T3 therapy and meg3 inhibition after myocardial infarction (MI). RNAi showed minimal adverse effects like peripheral neuropathy, hepatotoxicity, urinary tract infection, vaginal infection, diarrhea, abdominal pain arrhythmias, conduction disorders, and cardiotoxicity (LV wall thinning, heart failure) and improved cardiac biomarkers.

Conclusion

RNAi therapeutics are novel treatment option for improving cardiac function because their high target specificity, ability to target genes that conventional drugs struggle to reach and potential for long-lasting effects. Further research on optimizing delivery methods, improving target specificity, evaluating long-term safety profiles and cost-effectiveness to fully realize their potential.

Background

Acute Respiratory Distress Syndrome (ARDS) necessitates personalized treatment strategies due to its heterogeneity, aiming to mitigate Ventilator-Induced Lung Injury (VILI). Advanced monitoring techniques, including imaging, driving pressure, transpulmonary pressure, and mechanical power, present potential avenues for tailored interventions.

Objective

To review some of the most important techniques for achieving greater personalization of mechanical ventilation in ARDS patients as evaluated in randomized clinical trials, by analyzing their effect on three clinically relevant aspects: mortality, ventilator-free days, and gas exchange.

Methods

Following PRISMA guidelines, we conducted a systematic review and meta-analysis of Randomized Clinical Trials (RCTs) involving adult ARDS patients undergoing personalized ventilation adjustments. Outcomes were mortality (primary end-point), ventilator-free days, and oxygenation improvement.

Results

Among 493 identified studies, 13 RCTs (n = 1255) met inclusion criteria. No personalized ventilation strategy demonstrated superior outcomes compared to traditional protocols. Meta-analysis revealed no significant reduction in mortality with image-guided (RR 0.88, 95 % CI 0.70–1.11), driving pressure-guided (RR 0.61, 95 % CI 0.29–1.30), or transpulmonary pressure-guided (RR 0.85, 95 % CI 0.58–1.24) strategies. Ventilator-free days and oxygenation outcomes showed no significant differences.

Conclusion

Our study does not support the superiority of personalized ventilation techniques over traditional protocols in ARDS patients. Further research is needed to standardize ventilation strategies and determine their impact on mechanical ventilation outcomes.