Pub Date : 2025-01-01DOI: 10.1016/j.jointm.2024.04.001
David Furfaro , Xiaoyu Che , Wenhao Gou , Matthew J. Cummings , Nischay Mishra , Daniel Brodie , Thomas Briese , Oliver Fiehn , W. Ian Lipkin , Max R. O'Donnell
{"title":"Metabolomic profiling and prognostication in COVID-19 acute respiratory distress syndrome","authors":"David Furfaro , Xiaoyu Che , Wenhao Gou , Matthew J. Cummings , Nischay Mishra , Daniel Brodie , Thomas Briese , Oliver Fiehn , W. Ian Lipkin , Max R. O'Donnell","doi":"10.1016/j.jointm.2024.04.001","DOIUrl":"10.1016/j.jointm.2024.04.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 108-110"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141037971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jointm.2024.07.007
Jingjing Wang , Changxing Chen , Zhanqi Zhao , Puyu Deng , Chenchen Zhang , Yu Zhang , Hui Lv , Daonan Chen , Hui Xie , Ruilan Wang
<div><h3>Background</h3><div>Awake prone positioning (APP) can reportedly reduce the need for intubation and help improve prognosis of patients with acute hypoxemic respiratory failure (AHRF) infected with COVID-19. However, its physiological mechanism remains unclear. In this study, we evaluated the effect of APP on lung ventilation in patients with moderate-to-severe AHRF to better understand the effects on ventilation distribution and to prevent intubation in non-intubated patients.</div></div><div><h3>Methods</h3><div>The prospective study was performed in the Department of Critical Care Medicine at Shanghai General Hospital, China, from January 2021 to November 2022. The study included patients with AHRF (partial pressure of oxygen [PaO<sub>2</sub>]/inspired oxygen concentration [FiO<sub>2</sub>] <200 mmHg or oxygen saturation [SpO<sub>2</sub>]/FiO<sub>2</sub> <235) treated with high-flow nasal oxygen. Electrical impedance tomography (EIT) measurements including center of ventilation (COV), global inhomogeneity (GI) index, and regional ventilation delay (RVD) index were performed in the supine position (T<sub>0</sub>), 30 min after the start of APP (T<sub>1</sub>), and 30 min returning to supine position after the APP (T<sub>2</sub>). Clinical parameters like SpO<sub>2</sub>, respiratory rate (RR), FiO<sub>2</sub>, heart rate (HR), and ROX (the ratio of SpO<sub>2</sub> as measured by pulse oximetry/FiO<sub>2</sub> to RR) were also recorded simultaneously at T<sub>0</sub>, T<sub>1</sub>, and T<sub>2</sub>. To evaluate the effect of the time points on the variables, Mauchly's test was performed for sphericity and repeated measures analysis of variance was applied with Bonferroni's <em>post hoc</em> multiple comparisons.</div></div><div><h3>Results</h3><div>Ten patients were enrolled. The PaO<sub>2</sub>/FiO<sub>2</sub> ratio was (111.4±33.4) mmHg at the time of recruitment. ROX showed a significant increase after initiation of APP {median (interquartile range [IQR]): T<sub>0</sub>: 7.5 (6.0–10.1) <em>vs.</em> T<sub>1</sub>: 7.6 (6.4–9.3) <em>vs.</em> T<sub>2</sub>: 8.3 (7.2–11.0), <em>P</em>=0.043}. RR (<em>P</em>=0.409), HR (<em>P</em>=0.417), and SpO<sub>2</sub>/FiO<sub>2</sub> (<em>P</em>=0.262) did not change significantly during prone positioning (PP). The COV moved from the ventral area to the dorsal area (T<sub>0</sub>: 48.8%±6.2% <em>vs.</em> T<sub>1</sub>: 54.8%±6.8% <em>vs.</em> T<sub>2</sub>: 50.3%±6.1%, <em>P</em>=0.030) after APP. The GI decreased significantly after APP (T<sub>0</sub>: median=42.7 %, [IQR: 38.3%–47.5%] <em>vs.</em> T<sub>1</sub>: median=38.2%, [IQR: 34.6%–50.7%] <em>vs.</em> T<sub>2</sub>: median=37.4%, [IQR: 34.2%–41.4%], <em>P</em>=0.049). RVD (<em>P</em>=0.794) did not change after APP.</div></div><div><h3>Conclusions</h3><div>APP can improve ventilation distribution and homogeneity of lung ventilation as assessed by EIT in non-intubated patients with AHRF.</div><div><strong>Trail Registration</strong> C
背景：据报道，清醒俯卧位（APP）可以减少COVID-19感染的急性低氧性呼吸衰竭（AHRF）患者的插管需求，并有助于改善预后。然而，其生理机制尚不清楚。在本研究中，我们评估APP对中重度AHRF患者肺通气的影响，以更好地了解其对通气分布的影响，并预防非插管患者插管。方法：前瞻性研究于2021年1月至2022年11月在中国上海总医院重症医学科进行。研究纳入AHRF患者（氧分压[PaO2]/吸入氧浓度[FiO2] 2]/FiO2 0）， APP开始后30分钟（T1）， APP结束后30分钟恢复仰卧位（T2）。同时记录T0、T1、T2时SpO2、呼吸速率（RR）、FiO2、心率（HR）、ROX（脉搏血氧仪测得SpO2 /FiO2与RR之比）等临床参数。为了评估时间点对变量的影响，采用Mauchly检验进行球度检验，并采用Bonferroni事后多重比较进行重复测量方差分析。结果：10例患者入组。招募时PaO2/FiO2比值为（111.4±33.4）mmHg。APP启动后ROX显著升高{中位数（四分位数间距[IQR]）： T0: 7.5 (6.0-10.1) vs. T1: 7.6 (6.4-9.3) vs. T2: 8.3 (7.2-11.0)， P=0.043}。俯卧位（PP）时，RR （P=0.409）、HR （P=0.417）和SpO2/FiO2 （P=0.262）无显著变化。APP术后冠状病毒由腹侧区向背侧区转移（T0: 48.8%±6.2% vs T1: 54.8%±6.8% vs T2: 50.3%±6.1%，P=0.030）。APP术后GI明显下降（T0：中位数= 42.7%,[IQR: 38.3% ~ 47.5%] vs T1：中位数=38.2%,[IQR: 34.6% ~ 50.7%] vs T2：中位数=37.4%,[IQR: 34.2% ~ 41.4%]， P=0.049）。应用APP后RVD无显著变化（P=0.794）。结论：应用APP可改善非插管AHRF患者通气分布和肺通气均匀性。中国临床试验注册号：ChiCTR2000035895。
{"title":"Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology study","authors":"Jingjing Wang , Changxing Chen , Zhanqi Zhao , Puyu Deng , Chenchen Zhang , Yu Zhang , Hui Lv , Daonan Chen , Hui Xie , Ruilan Wang","doi":"10.1016/j.jointm.2024.07.007","DOIUrl":"10.1016/j.jointm.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Awake prone positioning (APP) can reportedly reduce the need for intubation and help improve prognosis of patients with acute hypoxemic respiratory failure (AHRF) infected with COVID-19. However, its physiological mechanism remains unclear. In this study, we evaluated the effect of APP on lung ventilation in patients with moderate-to-severe AHRF to better understand the effects on ventilation distribution and to prevent intubation in non-intubated patients.</div></div><div><h3>Methods</h3><div>The prospective study was performed in the Department of Critical Care Medicine at Shanghai General Hospital, China, from January 2021 to November 2022. The study included patients with AHRF (partial pressure of oxygen [PaO<sub>2</sub>]/inspired oxygen concentration [FiO<sub>2</sub>] <200 mmHg or oxygen saturation [SpO<sub>2</sub>]/FiO<sub>2</sub> <235) treated with high-flow nasal oxygen. Electrical impedance tomography (EIT) measurements including center of ventilation (COV), global inhomogeneity (GI) index, and regional ventilation delay (RVD) index were performed in the supine position (T<sub>0</sub>), 30 min after the start of APP (T<sub>1</sub>), and 30 min returning to supine position after the APP (T<sub>2</sub>). Clinical parameters like SpO<sub>2</sub>, respiratory rate (RR), FiO<sub>2</sub>, heart rate (HR), and ROX (the ratio of SpO<sub>2</sub> as measured by pulse oximetry/FiO<sub>2</sub> to RR) were also recorded simultaneously at T<sub>0</sub>, T<sub>1</sub>, and T<sub>2</sub>. To evaluate the effect of the time points on the variables, Mauchly's test was performed for sphericity and repeated measures analysis of variance was applied with Bonferroni's <em>post hoc</em> multiple comparisons.</div></div><div><h3>Results</h3><div>Ten patients were enrolled. The PaO<sub>2</sub>/FiO<sub>2</sub> ratio was (111.4±33.4) mmHg at the time of recruitment. ROX showed a significant increase after initiation of APP {median (interquartile range [IQR]): T<sub>0</sub>: 7.5 (6.0–10.1) <em>vs.</em> T<sub>1</sub>: 7.6 (6.4–9.3) <em>vs.</em> T<sub>2</sub>: 8.3 (7.2–11.0), <em>P</em>=0.043}. RR (<em>P</em>=0.409), HR (<em>P</em>=0.417), and SpO<sub>2</sub>/FiO<sub>2</sub> (<em>P</em>=0.262) did not change significantly during prone positioning (PP). The COV moved from the ventral area to the dorsal area (T<sub>0</sub>: 48.8%±6.2% <em>vs.</em> T<sub>1</sub>: 54.8%±6.8% <em>vs.</em> T<sub>2</sub>: 50.3%±6.1%, <em>P</em>=0.030) after APP. The GI decreased significantly after APP (T<sub>0</sub>: median=42.7 %, [IQR: 38.3%–47.5%] <em>vs.</em> T<sub>1</sub>: median=38.2%, [IQR: 34.6%–50.7%] <em>vs.</em> T<sub>2</sub>: median=37.4%, [IQR: 34.2%–41.4%], <em>P</em>=0.049). RVD (<em>P</em>=0.794) did not change after APP.</div></div><div><h3>Conclusions</h3><div>APP can improve ventilation distribution and homogeneity of lung ventilation as assessed by EIT in non-intubated patients with AHRF.</div><div><strong>Trail Registration</strong> C","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 43-50"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This review summarizes the current research advances and guideline updates in neurocritical care. For the therapy of ischemic stroke, the extended treatment time window for thrombectomy and the emergence of novel thrombolytic agents and strategies have brought greater hope for patient recovery. Minimally invasive hematoma evacuation and goal-directed bundled management have shown clinical benefits in treating cerebral hemorrhage. In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), early lumbar drainage can reduce the risk of infarction. Decompressive craniectomy for severe traumatic brain injury has also obtained high-quality evidence support. However, multimodal brain monitoring strategies for patients with traumatic brain injury need further optimization. For patients with cardiac arrest, extracorporeal cardiopulmonary resuscitation can reduce in-hospital mortality and improve long-term neurological prognosis. For neurocritical care patients, abundant high-quality studies have emerged in areas including multimodal neuromonitoring, hemodynamic management, airway management and respiratory therapy, and antiepileptic treatment. In 2023, the guidelines for aSAH have been updated for the first time in the past decade, aiming to provide evidence-based practice recommendations for clinical care. Chinese expert consensuses have also been formulated to guide analgesia and sedation for neurocritical care patients and developed a set of medical quality indicators on neurocritical care, which will enhance standardization and homogenization improvement in neurocritical care quality.
{"title":"Current advances in neurocritical care","authors":"Yuqing Chen , Shuya Wang , Shanshan Xu , Ningyuan Xu , Linlin Zhang , Jianxin Zhou","doi":"10.1016/j.jointm.2024.04.005","DOIUrl":"10.1016/j.jointm.2024.04.005","url":null,"abstract":"<div><div>This review summarizes the current research advances and guideline updates in neurocritical care. For the therapy of ischemic stroke, the extended treatment time window for thrombectomy and the emergence of novel thrombolytic agents and strategies have brought greater hope for patient recovery. Minimally invasive hematoma evacuation and goal-directed bundled management have shown clinical benefits in treating cerebral hemorrhage. In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), early lumbar drainage can reduce the risk of infarction. Decompressive craniectomy for severe traumatic brain injury has also obtained high-quality evidence support. However, multimodal brain monitoring strategies for patients with traumatic brain injury need further optimization. For patients with cardiac arrest, extracorporeal cardiopulmonary resuscitation can reduce in-hospital mortality and improve long-term neurological prognosis. For neurocritical care patients, abundant high-quality studies have emerged in areas including multimodal neuromonitoring, hemodynamic management, airway management and respiratory therapy, and antiepileptic treatment. In 2023, the guidelines for aSAH have been updated for the first time in the past decade, aiming to provide evidence-based practice recommendations for clinical care. Chinese expert consensuses have also been formulated to guide analgesia and sedation for neurocritical care patients and developed a set of medical quality indicators on neurocritical care, which will enhance standardization and homogenization improvement in neurocritical care quality.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 23-31"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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