世界危重病急救学杂志(英文版)最新文献

Post-reperfusion syndrome (PRS) in liver transplant recipients remains one of the most dreaded complications in liver transplant surgery. PRS can impact the short-term and long-term patient and graft outcomes. The definition of PRS has evolved over the years, from changes in arterial blood pressures and heart and/or decreases in the systemic vascular resistance and cardiac output to including the fibrinolysis and grading the severity of PRS. However, all that did not reflect on the management of PRS or its impact on the outcomes. In recent years, new scientific techniques and new technology have been in the pipeline to better understand, manage and maybe prevent PRS. These new methods and techniques are still in the infancy, and they have to be proven not in prevention and management of PRS but their effects in the patient and graft outcomes. In this article, we will review the long history of PRS, its definition, etiology, management and most importantly the new advances in science and technology to prevent and properly manage PRS.

Background: The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit (ICU) is an unanticipated event with possible life-threatening consequences. Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality. Two different types of unplanned ICU admissions include upgrades (patients admitted to the floor then moved to the ICU) and bounce backs (patients admitted to the ICU, discharged to the floor, and then readmitted to the ICU). Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.

Aim: To analyze the characteristics, management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.

Methods: This institutional review board approved, retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period (2017-2023). This included 134 upgrades and 69 bounce backs. Analyzed variables included: (1) Age; (2) Sex; (3) Comorbidities; (4) Mechanism of injury (MOI); (5) Injury severity score (ISS); (6) Glasgow Coma Scale (GCS); (7) Type of injury; (8) Transfusions; (9) Consultations; (10) Timing and reason for unplanned admission; (11) Intubations; (12) Surgical interventions; (13) ICU and hospital lengths of stay; and (14) Mortality.

Results: Unplanned ICU admissions comprised 4.2% of total ICU admissions. Main MOI was falls. Mean age was 70.7 years, ISS was 12.8 and GCS was 13.9. Main injuries were traumatic brain injury (37.4%) and thoracic injury (21.7%), and main reason for unplanned ICU admission was respiratory complication (39.4%). The 47.3% underwent a surgical procedure and 46.8% were intubated. Average timing for unplanned ICU admission was 2.9 days. Bounce backs occurred half as often as upgrades, however had higher rates of transfusions (63.8% vs 40.3%, P = 0.002), consultations (4.8 vs 3.0, P < 0.001), intubations (63.8% vs 38.1%%, P = 0.001), longer ICU lengths of stay (13.2 days vs 6.4 days, P < 0.001) and hospital lengths of stay (26.7 days vs 13.0 days, P < 0.001). Mortality was 25.6% among unplanned ICU admissions, 31.9% among geriatric unplanned ICU admissions and 11.9% among all trauma ICU patients.

Conclusion: Unplanned ICU admissions constituted 4.2% of total ICU admissions. Respiratory complications were the main cause of unplanned ICU admissions. Bounce backs occurred half as often as upgrades, but were associated with worse outcomes.

The intensive care unit (ICU) is a stressful environment for patients and their families as well as healthcare workers (HCWs). Distress, which is a negative emotional or physical response to a stressor is common in the ICU. Psychological first aid (PFA) is a form of mental health assistance provided in the immediate aftermath of disasters or other critical incidents to address acute distress and re-establish effective coping and functioning. The aim of this narrative review is to inform the development and utilization of PFA by HCWs in the ICU to reduce the burden of distress among patients, caregivers, and HCWs. This is the first such review to apply PFA to the ICU setting.

Background: Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality. The prevalence of at least moderate valvular heart disease is 2.5% across all age groups, but its prevalence increases with age. Mitral regurgitation and aortic stenosis are the most frequent types of valvular heart disease in the community and hospital context, respectively. Surgical valve replacement (or mitral valve repair) is the standard of care for treating heart valve disease. However, the replacement of a prosthetic heart valve can lead to complications, either in the peri-procedural phase or in the long-term follow-up period.

Case summary: We present a case of a 71-year-old female patient with a history of mitral valve replacement and warfarin anti-coagulation therapy. She was admitted to the intensive care unit due to spontaneously reperfused ischemic stroke of probable cardioembolic etiology. A dysfunctional mitral prosthesis was identified due to malfunction of one of the fixed discs. Furthermore, a possible microthrombotic lesion was suspected. Therefore, systemic thrombolysis was performed with subsequent normalization of mitral disc opening and closing.

Conclusion: This case underscores the critical importance of a multidisciplinary approach for timely decision-making in critically ill patients with prosthetic valve complications.

The advent of point-of-care testing (POCT) has revolutionized the approach to patient management, especially for pediatric care. POCT provides rapid, on-the-spot biochemical and microbiological evaluations, bypassing delays typically associated with central laboratory testing, enabling swift clinical decision-making. Additionally, POCT has proven to be a valuable prognostic tool for monitoring electrolyte, lactate, creatinine levels, often a marker of severe illness and poor outcomes. POCT enables its faster identification, allowing for prompt interventions. This capability is essential in managing conditions like sepsis, where timely treatment can significantly impact survival rates. However, the implementation of POCT is not without its challenges. Variability in sample handling, particularly with heparinized syringes, can affect the accuracy of certain measurements, such as potassium levels. The absence of comprehensive follow-up data and cost-effectiveness analyses in some studies indicate the need for continued research to optimize the use of POCT. In conclusion, POCT is a transformative tool in critical care, offering prompt and reliable assessments that significantly enhance patient management. As technology advances, the integration of POCT into emergency departments and intensive critical care units holds great promise for improving the quality of healthcare and patient survival rates.

Airway management plays a crucial role in providing adequate oxygenation and ventilation to patients during various medical procedures and emergencies. When patients have a limited mouth opening due to factors such as trauma, inflammation, or anatomical abnormalities airway management becomes challenging. A commonly utilized method to overcome this challenge is the use of video laryngoscopy (VL), which employs a specialized device equipped with a camera and a light source to allow a clear view of the larynx and vocal cords. VL overcomes the limitations of direct laryngoscopy in patients with limited mouth opening, enabling better visualization and successful intubation. Various types of VL blades are available. We devised a novel flangeless video laryngoscope for use in patients with a limited mouth opening and then tested it on a manikin.

Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up. These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families. Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity. For those with highly complex needs, care is often provided at major paediatric hospitals with expertise, specially trained personnel, and resources to support young people and their families for the first decades of life. At the end of adolescence, however, it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals. While there are some well-managed models to support this journey of transition, these are often specific to certain conditions and usually do not involve intensive care. Many patients may encounter considerable challenges during this period. Difficulties may include the loss of established therapeutic relationships, a perception of austerity and reduced amenity in facilities oriented to caring for adult patients, and care by clinicians with less experience with more common paediatric conditions. In addition, there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues. These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.

Gastrointestinal (GI) bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit (ICU). This literature review consolidates current insights on the epidemiology, etiology, management, and outcomes of GI bleeding in critically ill patients. GI bleeding remains a significant concern, especially among patients with underlying risk factors such as coagulopathy, mechanical ventilation, and renal failure. Managing GI bleeding in the ICU requires a multidisciplinary approach, including resuscitation, endoscopic intervention, pharmacologic therapy, and sometimes surgical procedures. Even with enhanced management strategies, GI bleeding in the ICU is associated with considerable morbidity and mortality, particularly when complicated by multi-organ failure. This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients, aiming to enhance survival rates and improve the quality of care within the ICU setting.

The systemic effects of gastrointestinal (GI) microbiota in health and during chronic diseases is increasingly recognised. Dietary strategies to modulate the GI microbiota during chronic diseases have demonstrated promise. While changes in dietary intake can rapidly change the GI microbiota, the impact of dietary changes during acute critical illness on the microbiota remain uncertain. Dietary fibre is metabolised by carbohydrate-active enzymes and, in health, can alter GI microbiota. The aim of this scoping review was to describe the effects of dietary fibre supplementation in health and disease states, specifically during critical illness. Randomised controlled trials and prospective cohort studies that include adults (> 18 years age) and reported changes to GI microbiota as one of the study outcomes using non-culture methods, were identified. Studies show dietary fibres have an impact on faecal microbiota in health and disease. The fibre, inulin, has a marked and specific effect on increasing the abundance of faecal Bifidobacteria. Short chain fatty acids produced by Bifidobacteria have been shown to be beneficial in other patient populations. Very few trials have evaluated the effect of dietary fibre on the GI microbiota during critical illness. More research is necessary to establish optimal fibre type, doses, duration of intervention in critical illness.