Pub Date : 2024-04-10DOI: 10.1016/j.jointm.2024.02.004
Background
This study aimed to identify plasma lipoproteins and small metabolites associated with high risk of malnutrition during intensive care unit (ICU) stay in patients with severe injuries.
Methods
This observational prospective exploratory study was conducted at two level-1 trauma centers in the Netherlands. Adult patients (aged ≥18 years) who were admitted to the ICU for more than 48 h between July 2018 and April 2022 owing to severe injuries (polytrauma, as defined by Injury Severity Scores of ≥16) caused by blunt trauma were eligible for inclusion. Partial least squares discriminant analysis was used to analyze the relationship of 112 lipoprotein-related components and 23 small metabolites with the risk of malnutrition (modified Nutrition Risk in Critically Ill score). Malnutrition was diagnosed based on Subjective Global Assessment scores. The relationship of lipoprotein properties and small metabolite concentrations with malnutrition (during ICU admission) was evaluated using mixed effects logistic regression.
Results
Overall, 51 patients were included. Lower (very) low-density lipoprotein ([V]LDL) (free) cholesterol and phospholipid levels, low particle number, and higher levels of LDL triglycerides were associated with a higher risk of malnutrition (variable importance in projection [VIP] value >1.5). Low levels of most (V)LDL and intermediate-density lipoprotein subfractions and high levels of high-density lipoprotein Apo-A1 were associated with the diagnosis of malnutrition (VIP value >1.5). Increased levels of dimethyl sulfone, trimethylamine N-oxide, creatinine, N, N-dimethylglycine, and pyruvic acid and decreased levels of creatine, methionine, and acetoacetic acid were also indicative of malnutrition (VIP value >1.5). Overall, 14 lipoproteins and 1 small metabolite were significantly associated with a high risk of malnutrition during ICU admission (P <0.05); however, the association did not persist after correcting the false discovery rate (P=0.35 for all).
Conclusion
Increased triglyceride in several lipoprotein subfractions and decreased levels of other lipoprotein subfraction lipids and several small metabolites (involved in the homocysteine cycle, ketone body formation, and muscle metabolism) may be indicative of malnutrition risk. Following validation in larger cohorts, these indicators may guide institution of preventive nutritional measures in patients admitted to the ICU with severe injuries.
{"title":"Relevance of plasma lipoproteins and small metabolites in assessment of nutritional status among patients with severe injuries","authors":"","doi":"10.1016/j.jointm.2024.02.004","DOIUrl":"10.1016/j.jointm.2024.02.004","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to identify plasma lipoproteins and small metabolites associated with high risk of malnutrition during intensive care unit (ICU) stay in patients with severe injuries.</p></div><div><h3>Methods</h3><p>This observational prospective exploratory study was conducted at two level-1 trauma centers in the Netherlands. Adult patients (aged ≥18 years) who were admitted to the ICU for more than 48 h between July 2018 and April 2022 owing to severe injuries (polytrauma, as defined by Injury Severity Scores of ≥16) caused by blunt trauma were eligible for inclusion. Partial least squares discriminant analysis was used to analyze the relationship of 112 lipoprotein-related components and 23 small metabolites with the risk of malnutrition (modified Nutrition Risk in Critically Ill score). Malnutrition was diagnosed based on Subjective Global Assessment scores. The relationship of lipoprotein properties and small metabolite concentrations with malnutrition (during ICU admission) was evaluated using mixed effects logistic regression.</p></div><div><h3>Results</h3><p>Overall, 51 patients were included. Lower (very) low-density lipoprotein ([V]LDL) (free) cholesterol and phospholipid levels, low particle number, and higher levels of LDL triglycerides were associated with a higher risk of malnutrition (variable importance in projection [VIP] value >1.5). Low levels of most (V)LDL and intermediate-density lipoprotein subfractions and high levels of high-density lipoprotein Apo-A1 were associated with the diagnosis of malnutrition (VIP value >1.5). Increased levels of dimethyl sulfone, trimethylamine N-oxide, creatinine, N, N-dimethylglycine, and pyruvic acid and decreased levels of creatine, methionine, and acetoacetic acid were also indicative of malnutrition (VIP value >1.5). Overall, 14 lipoproteins and 1 small metabolite were significantly associated with a high risk of malnutrition during ICU admission (<em>P</em> <0.05); however, the association did not persist after correcting the false discovery rate (<em>P</em>=0.35 for all).</p></div><div><h3>Conclusion</h3><p>Increased triglyceride in several lipoprotein subfractions and decreased levels of other lipoprotein subfraction lipids and several small metabolites (involved in the homocysteine cycle, ketone body formation, and muscle metabolism) may be indicative of malnutrition risk. Following validation in larger cohorts, these indicators may guide institution of preventive nutritional measures in patients admitted to the ICU with severe injuries.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 496-507"},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000380/pdfft?md5=b352dc663650351f572332b8c2564c95&pid=1-s2.0-S2667100X24000380-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140759253","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}
Sepsis is a life-threatening organ dysfunction, and septic cardiomyopathy (SCM) may complicate the course of the disease. Infection with multidrug-resistant (MDR) pathogens has been linked with worse outcomes. This study aims to evaluate SCM in patients with infections caused by different antimicrobial-resistant phenotypes.
Method
This retrospective study included patients with sepsis/septic shock, hospitalized, and intubated in the intensive care unit of the University Hospital of Larissa between January 2022 and September 2023 with echocardiographic data during the first two days after infection onset. The patients were divided into two groups: non-MDR-SCM group and MDR-SCM group. The cardiac function was compared between the two groups.
Result
A total of 62 patients were included in the study. Forty-four patients comprised the MDR-SCM and 18 the non-MDR-SCM group. Twenty-six patients (41.9%) presented with left ventricular (LV) systolic dysfunction, and ≤35% right ventricular fractional area change (RVFAC) was present in 56.4%. LV systolic function was more severely impaired in the non-MDR-SCM group (left ventricular ejection fraction, 35.8% ±4.9% vs. 45.6%±2.4%, P=0.049; LV outflow tract velocity time integral, [10.1±1.4] cm vs. [15.3±0.74] cm, P=0.001; LV-Strain, –9.02%±0.9% vs. –14.02%±0.7%, P=0.001). The MDR-SCM group presented with more severe right ventricular (RV) dilatation (right ventricular end-diastolic area/left ventricular end-diastolic area, 0.81±0.03 vs. 0.7±0.05, P=0.042) and worse RV systolic function (RVFAC, 32.3%±1.9% vs. 39.6%±2.7%, P=0.035; tricuspid annular plane systolic excursion, [15.9±0.9] mm vs. [18.1±0.9] mm, P=0.165; systolic tissue Doppler velocity measured at the lateral tricuspid annulus, [9.9±0.5] cm/s vs. [13.1±0.8] cm/s, P=0.002; RV-strain, –11.1%±0.7% vs. –15.1%±0.9%, P=0.002).
Conclusion
SCM related to MDR infection presents with RV systolic dysfunction predominance, while non-MDR-SCM is mainly depicted with LV systolic dysfunction impairment.
背景败血症是一种危及生命的器官功能障碍，而败血症性心肌病（SCM）可能会使病程复杂化。耐多药（MDR）病原体感染与更差的预后有关。这项回顾性研究纳入了 2022 年 1 月至 2023 年 9 月期间在拉里萨大学医院重症监护室住院并插管的脓毒症/脓毒性休克患者，他们在感染发生后的头两天都接受了超声心动图检查。患者被分为两组：非 MDR-SCM 组和 MDR-SCM 组。研究共纳入 62 名患者。研究共纳入 62 例患者，其中 44 例为 MDR-SCM 组，18 例为非 MDR-SCM 组。26名患者（41.9%）出现左心室收缩功能障碍，56.4%的患者右心室折返面积（RVFAC）变化≤35%。非 MDR-SCM 组的左心室收缩功能受损更严重（左心室射血分数，35.8%±4.9% vs. 45.6%±2.4%，P=0.049；左心室流出道速度时间积分，[10.1±1.4] cm vs. [15.3±0.74] cm，P=0.001；左心室应变，-9.02%±0.9% vs. -14.02%±0.7%，P=0.001）。MDR-SCM 组的右心室（RV）扩张更为严重（右心室舒张末期面积/左心室舒张末期面积，0.81±0.03 vs. 0.7±0.05，P=0.042）。05，P=0.042）和更差的 RV 收缩功能（RVFAC，32.3%±1.9% vs. 39.6%±2.7%，P=0.035；三尖瓣环平面收缩期偏移，[15.9±0.9] mm vs. [18.1±0.9] mm，P=0.结论与 MDR 感染相关的 SCM 主要表现为 RV 收缩功能障碍，而非 MDR-SCM 主要表现为 LV 收缩功能障碍。
{"title":"Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance","authors":"Vasiliki Tsolaki , Kyriaki Parisi , George E. Zakynthinos , Efrosini Gerovasileiou , Nikitas Karavidas , Vassileios Vazgiourakis , Epaminondas Zakynthinos , Demosthenes Makris","doi":"10.1016/j.jointm.2023.11.009","DOIUrl":"10.1016/j.jointm.2023.11.009","url":null,"abstract":"<div><h3>Background</h3><p>Sepsis is a life-threatening organ dysfunction, and septic cardiomyopathy (SCM) may complicate the course of the disease. Infection with multidrug-resistant (MDR) pathogens has been linked with worse outcomes. This study aims to evaluate SCM in patients with infections caused by different antimicrobial-resistant phenotypes.</p></div><div><h3>Method</h3><p>This retrospective study included patients with sepsis/septic shock, hospitalized, and intubated in the intensive care unit of the University Hospital of Larissa between January 2022 and September 2023 with echocardiographic data during the first two days after infection onset. The patients were divided into two groups: non-MDR-SCM group and MDR-SCM group. The cardiac function was compared between the two groups.</p></div><div><h3>Result</h3><p>A total of 62 patients were included in the study. Forty-four patients comprised the MDR-SCM and 18 the non-MDR-SCM group. Twenty-six patients (41.9%) presented with left ventricular (LV) systolic dysfunction, and ≤35% right ventricular fractional area change (RVFAC) was present in 56.4%. LV systolic function was more severely impaired in the non-MDR-SCM group (left ventricular ejection fraction, 35.8% ±4.9% <em>vs</em>. 45.6%±2.4%, <em>P</em>=0.049; LV outflow tract velocity time integral, [10.1±1.4] cm <em>vs</em>. [15.3±0.74] cm, <em>P</em>=0.001; LV-Strain, –9.02%±0.9% <em>vs</em>. –14.02%±0.7%, <em>P</em>=0.001). The MDR-SCM group presented with more severe right ventricular (RV) dilatation (right ventricular end-diastolic area/left ventricular end-diastolic area, 0.81±0.03 <em>vs.</em> 0.7±0.05, <em>P</em>=0.042) and worse RV systolic function (RVFAC, 32.3%±1.9% <em>vs</em>. 39.6%±2.7%, <em>P</em>=0.035; tricuspid annular plane systolic excursion, [15.9±0.9] mm <em>vs</em>. [18.1±0.9] mm, <em>P</em>=0.165; systolic tissue Doppler velocity measured at the lateral tricuspid annulus, [9.9±0.5] cm/s <em>vs</em>. [13.1±0.8] cm/s, <em>P</em>=0.002; RV-strain, –11.1%±0.7% <em>vs</em>. –15.1%±0.9%, <em>P</em>=0.002).</p></div><div><h3>Conclusion</h3><p>SCM related to MDR infection presents with RV systolic dysfunction predominance, while non-MDR-SCM is mainly depicted with LV systolic dysfunction impairment.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 3","pages":"Pages 355-361"},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000100/pdfft?md5=7cd85d81d6c78960d1e103c5c4495df7&pid=1-s2.0-S2667100X24000100-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764610","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}
To evaluate the effect of recombinant human thrombopoietin (rhTPO) on clinical prognosis by exploring changes in endothelial cell injury markers and inflammatory factors in patients with sepsis after treatment with rhTPO.
Methods
This retrospective observational study involved patients with sepsis (diagnosed according to Sepsis 3.0) admitted to Shanghai General Hospital intensive care unit from January 1, 2019 to December 31, 2022. Patients were divided into two groups (control and rhTPO) according to whether they received rhTPO. Baseline information, clinical data, prognosis, and survival status of the patients, as well as inflammatory factors and immune function indicators were collected. The main monitoring indicators were endothelial cell-specific molecule (ESM-1), human heparin-binding protein (HBP), and CD31; secondary monitoring indicators were interleukin (IL)-6, tumor necrosis factor (TNF)-α, extravascular lung water index, platelet, antithrombin III, fibrinogen, and international normalized ratio. We used intraperitoneal injection of lipopolysaccharide (LPS) to establish a mouse model of sepsis. Mice were randomly divided into four groups: normal saline, LPS, LPS + rhTPO, and LPS + rhTPO + LY294002. Plasma indicators in mice were measured by enzyme-linked immunosorbent assay.
Results
A total of 84 patients were included in the study. After 7 days of treatment, ESM-1 decreased more significantly in the rhTPO group than in the control group compared with day 1 (median=38.6 [interquartile range, IQR: 7.2 to 67.8] pg/mL vs. median=23.0 [IQR: −15.7 to 51.5] pg/mL, P=0.008). HBP and CD31 also decreased significantly in the rhTPO group compared with the control group (median=59.6 [IQR: −1.9 to 91.9] pg/mL vs. median=2.4 [IQR: −23.2 to 43.2] pg/mL; median=2.4 [IQR: 0.4 to 3.5] pg/mL vs. median=−0.6 [IQR: −2.2 to 0.8] pg/mL, P <0.001). Inflammatory markers IL-6 and TNF-α decreased more significantly in the rhTPO group than in the control group compared with day 1 (median=46.0 [IQR: 15.8 to 99.1] pg/mL vs. median=31.2 [IQR: 19.7 to 171.0] pg/mL, P <0.001; median=17.2 [IQR: 6.4 to 23.2] pg/mL vs. median=0.0 [IQR: 0.0 to 13.8] pg/mL, P=0.010). LPS + rhTPO-treated mice showed significantly lower vascular von Willebrand factor (P=0.003), vascular endothelial growth factor (P=0.002), IL-6 (P <0.001), and TNF-α (P <0.001) than mice in the LPS group. Endothelial cell damage factors vascular von Willebrand factor (P=0.012), vascular endothelial growth factor (P=0.001), IL-6 (P <0.001), and TNF-α (P=0.001) were significantly elevated by inhibiting the PI3K/Akt pathway.
Conclusion
rhTPO alleviates endothelial injury and inflammatory indices in sepsis, and may regulate septic endothelial cell
背景通过探讨脓毒症患者接受rhTPO治疗后血管内皮细胞损伤标志物和炎症因子的变化，评估重组人血小板生成素（rhTPO）对临床预后的影响。方法这项回顾性观察研究涉及2019年1月1日至2022年12月31日期间上海总医院重症监护室收治的脓毒症患者（根据脓毒症3.0标准诊断）。根据患者是否接受rhTPO治疗，将其分为两组（对照组和rhTPO组）。收集患者的基线信息、临床数据、预后和生存状况，以及炎症因子和免疫功能指标。主要监测指标为内皮细胞特异性分子（ESM-1）、人肝素结合蛋白（HBP）和CD31；次要监测指标为白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α、血管外肺水指数、血小板、抗凝血酶Ⅲ、纤维蛋白原和国际标准化比值。我们采用腹腔注射脂多糖（LPS）的方法建立了败血症小鼠模型。小鼠被随机分为四组：正常生理盐水组、LPS 组、LPS + rhTPO 组和 LPS + rhTPO + LY294002 组。小鼠血浆指标通过酶联免疫吸附试验测定。治疗 7 天后，与第 1 天相比，rhTPO 组的 ESM-1 降幅比对照组更明显（中位数=38.6 [四分位距：7.2 至 67.8] pg/mL vs. 中位数=23.0 [四分位距：-15.7 至 51.5] pg/mL，P=0.008）。与对照组相比，rhTPO 组的 HBP 和 CD31 也显著下降（中位数=59.6 [IQR: -1.9 to 91.9] pg/mL vs. 中位数=2.4 [IQR: -23.2 to 43.2] pg/mL；中位数=2.4 [IQR: 0.4 to 3.5] pg/mL vs. 中位数=-0.6 [IQR: -2.2 to 0.8] pg/mL，P <0.001）。与第 1 天相比，rhTPO 组炎症指标 IL-6 和 TNF-α 的下降幅度比对照组更大（中位数=46.0 [IQR: 15.中位数=31.2 [IQR: 19.7 to 171.0] pg/mL, P <0.001；中位数=17.2 [IQR: 6.4 to 23.2] pg/mL vs. 中位数=0.0 [IQR: 0.0 to 13.8] pg/mL, P=0.010）。经 LPS + rhTPO 处理的小鼠的血管冯-威廉因子（P=0.003）、血管内皮生长因子（P=0.002）、IL-6（P <0.001）和 TNF-α （P <0.001）均明显低于 LPS 组小鼠。内皮细胞损伤因子血管冯-威廉因子（P=0.012）、血管内皮生长因子（P=0.001）、IL-6（P <0.001）和TNF-α（P=0.001）在抑制PI3K/Akt通路后显著升高。
{"title":"Recombinant human thrombopoietin in alleviating endothelial cell injury in sepsis","authors":"Yun Xie, Hui Lv, Daonan Chen, Peijie Huang, Shaohong Wu, Hongchao Shi, Qi Zhao, Ruilan Wang","doi":"10.1016/j.jointm.2023.12.006","DOIUrl":"10.1016/j.jointm.2023.12.006","url":null,"abstract":"<div><h3>Background</h3><p>To evaluate the effect of recombinant human thrombopoietin (rhTPO) on clinical prognosis by exploring changes in endothelial cell injury markers and inflammatory factors in patients with sepsis after treatment with rhTPO.</p></div><div><h3>Methods</h3><p>This retrospective observational study involved patients with sepsis (diagnosed according to Sepsis 3.0) admitted to Shanghai General Hospital intensive care unit from January 1, 2019 to December 31, 2022. Patients were divided into two groups (control and rhTPO) according to whether they received rhTPO. Baseline information, clinical data, prognosis, and survival status of the patients, as well as inflammatory factors and immune function indicators were collected. The main monitoring indicators were endothelial cell-specific molecule (ESM-1), human heparin-binding protein (HBP), and CD31; secondary monitoring indicators were interleukin (IL)-6, tumor necrosis factor (TNF)-α, extravascular lung water index, platelet, antithrombin III, fibrinogen, and international normalized ratio. We used intraperitoneal injection of lipopolysaccharide (LPS) to establish a mouse model of sepsis. Mice were randomly divided into four groups: normal saline, LPS, LPS + rhTPO, and LPS + rhTPO + LY294002. Plasma indicators in mice were measured by enzyme-linked immunosorbent assay.</p></div><div><h3>Results</h3><p>A total of 84 patients were included in the study. After 7 days of treatment, ESM-1 decreased more significantly in the rhTPO group than in the control group compared with day 1 (median=38.6 [interquartile range, IQR: 7.2 to 67.8] pg/mL <em>vs.</em> median=23.0 [IQR: −15.7 to 51.5] pg/mL, <em>P</em>=0.008). HBP and CD31 also decreased significantly in the rhTPO group compared with the control group (median=59.6 [IQR: −1.9 to 91.9] pg/mL <em>vs.</em> median=2.4 [IQR: −23.2 to 43.2] pg/mL; median=2.4 [IQR: 0.4 to 3.5] pg/mL <em>vs.</em> median=−0.6 [IQR: −2.2 to 0.8] pg/mL, <em>P</em> <0.001). Inflammatory markers IL-6 and TNF-α decreased more significantly in the rhTPO group than in the control group compared with day 1 (median=46.0 [IQR: 15.8 to 99.1] pg/mL <em>vs.</em> median=31.2 [IQR: 19.7 to 171.0] pg/mL, <em>P</em> <0.001; median=17.2 [IQR: 6.4 to 23.2] pg/mL <em>vs.</em> median=0.0 [IQR: 0.0 to 13.8] pg/mL, <em>P</em>=0.010). LPS + rhTPO-treated mice showed significantly lower vascular von Willebrand factor (<em>P</em>=0.003), vascular endothelial growth factor (<em>P</em>=0.002), IL-6 (<em>P</em> <0.001), and TNF-α (<em>P</em> <0.001) than mice in the LPS group. Endothelial cell damage factors vascular von Willebrand factor (<em>P</em>=0.012), vascular endothelial growth factor (<em>P</em>=0.001), IL-6 (<em>P</em> <0.001), and TNF-α (<em>P</em>=0.001) were significantly elevated by inhibiting the PI3K/Akt pathway.</p></div><div><h3>Conclusion</h3><p>rhTPO alleviates endothelial injury and inflammatory indices in sepsis, and may regulate septic endothelial cell","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 3","pages":"Pages 384-392"},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000082/pdfft?md5=0d5c0ad6b53ef35c58b4152fa3f88aae&pid=1-s2.0-S2667100X24000082-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760516","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 : 2024-04-04DOI: 10.1016/j.jointm.2024.01.007
Background
To evaluate the effectiveness and safety of the Shenfu injection (SFI) combined with standard bundle treatment in septic patients with hypoperfusion.
Method
This study was a multi-center, randomized, open-label, controlled trial conducted in four teaching hospitals in China. The septic patients with hypoperfusion and traditional Chinese medicine (TCM) syndrome with Yang-Qi deficiency were enrolled from January 2019, through September 2020. Eligible patients were randomly allocated in a 1:1 ratio to either receive 60 mL of SFI infusion per day plus standard treatment (SFI group) or standard bundle treatment alone (control group). The primary outcome was 28-day all-cause mortality. Secondary outcomes were 90-day all-cause mortality time to weaning from mechanical ventilation, time to weaning from vasopressors, time to discharge from the ICU and hospital, and laboratory results after randomization.
Results
A total of 188 patients completed the trail. This study revealed that the results of the SFI group and the control groups were not statistically significant in 28-day all-cause mortality (10.6% vs. 20.2%, respectively; P=0.106). The infusion of SFI was associated with a significant reduction in the duration of vasopressor use (median=4.0 days, interquartile range [IQR]: 2.0 days–6.0 days vs. median=5.0 days, IQR: 3.0 days–8.0 days, respectively; P=0.043). Patients in the SFI group had statistically greater reductions in plasma lactate levels compared with those in the control group at the first 12 h (median=1.1 mmol/L, IQR: 0.3–2.0 mmol/L vs. median=0.0 mmol/L, IQR: −0.2 to 0.8 mmol/L, respectively; P <0.001) and 24 h (median=1.4 mmol/L, IQR: 0.3–2.2 mmol/L vs. median=0.4 mmol/L, IQR: −0.4 to 1.6 mmol/L, respectively; P=0.001).
Conclusion
SFI plus standard therapy did not significantly decrease 28-day all-cause mortality for septic patients with hypoperfusion and TCM syndrome with Yang-Qi deficiency.
Trial registration Chinese Clinical Trial Registry Identifier: ChiCTR1800020435
{"title":"Effectiveness and safety of Shenfu injection in septic patients with hypoperfusion: A multi-center, open-label, randomized, controlled trial","authors":"","doi":"10.1016/j.jointm.2024.01.007","DOIUrl":"10.1016/j.jointm.2024.01.007","url":null,"abstract":"<div><h3>Background</h3><p>To evaluate the effectiveness and safety of the Shenfu injection (SFI) combined with standard bundle treatment in septic patients with hypoperfusion.</p></div><div><h3>Method</h3><p>This study was a multi-center, randomized, open-label, controlled trial conducted in four teaching hospitals in China. The septic patients with hypoperfusion and traditional Chinese medicine (TCM) syndrome with Yang-Qi deficiency were enrolled from January 2019, through September 2020. Eligible patients were randomly allocated in a 1:1 ratio to either receive 60 mL of SFI infusion per day plus standard treatment (SFI group) or standard bundle treatment alone (control group). The primary outcome was 28-day all-cause mortality. Secondary outcomes were 90-day all-cause mortality time to weaning from mechanical ventilation, time to weaning from vasopressors, time to discharge from the ICU and hospital, and laboratory results after randomization.</p></div><div><h3>Results</h3><p>A total of 188 patients completed the trail. This study revealed that the results of the SFI group and the control groups were not statistically significant in 28-day all-cause mortality (10.6% <em>vs.</em> 20.2%, respectively; <em>P</em>=0.106). The infusion of SFI was associated with a significant reduction in the duration of vasopressor use (median=4.0 days, interquartile range [IQR]: 2.0 days–6.0 days <em>vs</em>. median=5.0 days, IQR: 3.0 days–8.0 days, respectively; <em>P</em>=0.043). Patients in the SFI group had statistically greater reductions in plasma lactate levels compared with those in the control group at the first 12 h (median=1.1 mmol/L, IQR: 0.3–2.0 mmol/L <em>vs</em>. median=0.0 mmol/L, IQR: −0.2 to 0.8 mmol/L, respectively; <em>P</em> <0.001) and 24 h (median=1.4 mmol/L, IQR: 0.3–2.2 mmol/L <em>vs</em>. median=0.4 mmol/L, IQR: −0.4 to 1.6 mmol/L, respectively; <em>P</em>=0.001).</p></div><div><h3>Conclusion</h3><p>SFI plus standard therapy did not significantly decrease 28-day all-cause mortality for septic patients with hypoperfusion and TCM syndrome with Yang-Qi deficiency.</p><p><strong>Trial registration</strong> Chinese Clinical Trial Registry Identifier: ChiCTR1800020435</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 484-490"},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X24000185/pdfft?md5=ca8ff5897cde33b86419141d8972bb71&pid=1-s2.0-S2667100X24000185-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140785510","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 : 2024-04-01DOI: 10.1016/j.jointm.2023.11.008
Elena Lytra , Stelios Kokkoris , Ioannis Poularas , Dimitrios Filippiadis , Demosthenes Cokkinos , Dimitrios Exarhos , Spyros Zakynthinos , Christina Routsi
Background
Compared to conventional oxygen devices, high-flow oxygen treatment (HFOT) through the nasal cannulae has demonstrated clinical benefits. Limited data exist on whether such effects are also present in HFOT through tracheostomy. Hence, we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation.
Methods
A randomized, crossover, physiological study was conducted in our ICU between December 2020 and April 2021, in patients with tracheostomy and prolonged mechanical ventilation. The patients underwent a 30-min spontaneous breathing trial (SBT) and received oxygen either via T-piece or by HFOT through tracheostomy, followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner. At the start and end of each session, blood gasses, breathing frequency (f), and tidal volume (VT) via a Wright's spirometer were measured, along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction, which expressed the inspiratory muscle effort.
Results
Eleven patients were enrolled in whom 19 sessions were uneventfully completed; eight patients were studied twice on two different days with alternate sessions; and three patients were studied once. Patients were randomly assigned to start the SBT with a T-piece (n=10 sessions) or with HFOT (n=9 sessions). With HFOT, VT and minute ventilation (VE) significantly increased during SBT (from [465±119] mL to [549±134] mL, P <0.001 and from [12.4±4.3] L/min to [13.1±4.2] L/min, P <0.05, respectively), but they did not change significantly during SBT with T-piece (from [495±132] mL to [461±123] mL and from [12.8±4.4] mL to [12.0±4.4] mL, respectively); f/VT decreased during HFOT (from [64±31] breaths/(min∙L) to [49±24] breaths/(min∙L), P <0.001), but it did not change significantly during SBT with T-piece (from [59±28] breaths/(min∙L) to [64±33] breaths/(min∙L)); partial pressure of arterial oxygen increased during HFOT (from [99±39] mmHg to [132±48] mmHg, P <0.001), but it decreased during SBT with T-piece (from [124±50] mmHg to [83±22] mmHg, P <0.01). In addition, with HFOT, diaphragmatic excursion increased (from [12.9±3.3] mm to [15.7±4.4] mm, P <0.001), but it did not change significantly during SBT with T-piece (from [13.4±3.3] mm to [13.6±3.3] mm). The diaphragmatic thickening fraction did not change during SBT either with T-piece or with HFOT.
Conclusion
In patients with prolonged mechanical ventilation, HFOT through tracheostomy compared with T-piece improves ventilation, pattern of breathing, and oxygenation without increasing the i
{"title":"The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation: A randomized, physiological, crossover study","authors":"Elena Lytra , Stelios Kokkoris , Ioannis Poularas , Dimitrios Filippiadis , Demosthenes Cokkinos , Dimitrios Exarhos , Spyros Zakynthinos , Christina Routsi","doi":"10.1016/j.jointm.2023.11.008","DOIUrl":"10.1016/j.jointm.2023.11.008","url":null,"abstract":"<div><h3>Background</h3><p>Compared to conventional oxygen devices, high-flow oxygen treatment (HFOT) through the nasal cannulae has demonstrated clinical benefits. Limited data exist on whether such effects are also present in HFOT through tracheostomy. Hence, we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation.</p></div><div><h3>Methods</h3><p>A randomized, crossover, physiological study was conducted in our ICU between December 2020 and April 2021, in patients with tracheostomy and prolonged mechanical ventilation. The patients underwent a 30-min spontaneous breathing trial (SBT) and received oxygen either via T-piece or by HFOT through tracheostomy, followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner. At the start and end of each session, blood gasses, breathing frequency (f), and tidal volume (V<sub>T</sub>) via a Wright's spirometer were measured, along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction, which expressed the inspiratory muscle effort.</p></div><div><h3>Results</h3><p>Eleven patients were enrolled in whom 19 sessions were uneventfully completed; eight patients were studied twice on two different days with alternate sessions; and three patients were studied once. Patients were randomly assigned to start the SBT with a T-piece (<em>n</em>=10 sessions) or with HFOT (<em>n</em>=9 sessions). With HFOT, V<sub>T</sub> and minute ventilation (V<sub>E</sub>) significantly increased during SBT (from [465±119] mL to [549±134] mL, <em>P</em> <0.001 and from [12.4±4.3] L/min to [13.1±4.2] L/min, <em>P</em> <0.05, respectively), but they did not change significantly during SBT with T-piece (from [495±132] mL to [461±123] mL and from [12.8±4.4] mL to [12.0±4.4] mL, respectively); f/V<sub>T</sub> decreased during HFOT (from [64±31] breaths/(min∙L) to [49±24] breaths/(min∙L), <em>P</em> <0.001), but it did not change significantly during SBT with T-piece (from [59±28] breaths/(min∙L) to [64±33] breaths/(min∙L)); partial pressure of arterial oxygen increased during HFOT (from [99±39] mmHg to [132±48] mmHg, <em>P</em> <0.001), but it decreased during SBT with T-piece (from [124±50] mmHg to [83±22] mmHg, <em>P</em> <0.01). In addition, with HFOT, diaphragmatic excursion increased (from [12.9±3.3] mm to [15.7±4.4] mm, <em>P</em> <0.001), but it did not change significantly during SBT with T-piece (from [13.4±3.3] mm to [13.6±3.3] mm). The diaphragmatic thickening fraction did not change during SBT either with T-piece or with HFOT.</p></div><div><h3>Conclusion</h3><p>In patients with prolonged mechanical ventilation, HFOT through tracheostomy compared with T-piece improves ventilation, pattern of breathing, and oxygenation without increasing the i","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 202-208"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000956/pdfft?md5=41cb94554c920133228b5df3638f7f08&pid=1-s2.0-S2667100X23000956-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139395706","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 : 2024-04-01DOI: 10.1016/j.jointm.2023.12.002
Xiangdong Guan , Dechang Chen , Yuan Xu (Chinese Society of Critical Care Medicine)
The Chinese Society of Critical Care Medicine (CSCCM) has developed clinical practice guidelines for nutrition assessment and monitoring for patients in adult intensive care units (ICUs) in China. This guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill patients. This guideline was developed by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough review of the system and a summary of relevant trials or studies published from 2000 to July 2023. A total of 18 recommendations were formed and consensus was reached through discussions and reviews by expert groups in critical care medicine, parenteral and enteral nutrition, and surgery. The recommendations are based on currently available evidence and cover several key fields, including screening and assessment, evaluation and assessment of enteral feeding intolerance, metabolic and nutritional measurement and monitoring during nutrition therapy, and organ function evaluation related to nutrition supply. Each question was analyzed according to the Population, Intervention, Comparison, and Outcome (PICO) principle. In addition, interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value. The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3–5 years.
{"title":"Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China","authors":"Xiangdong Guan , Dechang Chen , Yuan Xu (Chinese Society of Critical Care Medicine)","doi":"10.1016/j.jointm.2023.12.002","DOIUrl":"10.1016/j.jointm.2023.12.002","url":null,"abstract":"<div><p>The Chinese Society of Critical Care Medicine (CSCCM) has developed clinical practice guidelines for nutrition assessment and monitoring for patients in adult intensive care units (ICUs) in China. This guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill patients. This guideline was developed by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough review of the system and a summary of relevant trials or studies published from 2000 to July 2023. A total of 18 recommendations were formed and consensus was reached through discussions and reviews by expert groups in critical care medicine, parenteral and enteral nutrition, and surgery. The recommendations are based on currently available evidence and cover several key fields, including screening and assessment, evaluation and assessment of enteral feeding intolerance, metabolic and nutritional measurement and monitoring during nutrition therapy, and organ function evaluation related to nutrition supply. Each question was analyzed according to the Population, Intervention, Comparison, and Outcome (PICO) principle. In addition, interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value. The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3–5 years.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 137-159"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23001081/pdfft?md5=c543e5107fc60c2b9c473644c4af05b1&pid=1-s2.0-S2667100X23001081-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139886357","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 : 2024-04-01DOI: 10.1016/j.jointm.2023.10.002
Hui Zhang, Ning Dong, Yongming Yao
{"title":"Optimal strategy for treatment of sepsis based on the host inflammatory reaction and immune response","authors":"Hui Zhang, Ning Dong, Yongming Yao","doi":"10.1016/j.jointm.2023.10.002","DOIUrl":"10.1016/j.jointm.2023.10.002","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 175-180"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000828/pdfft?md5=51a4ca6d4802a577a702eb2db1948d7a&pid=1-s2.0-S2667100X23000828-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139305694","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 : 2024-04-01DOI: 10.1016/j.jointm.2023.08.006
Nicolas Weiss , Simona Tripon , Maxime Mallet , Françoise Imbert-Bismut , Mehdi Sakka , Dominique Bonnefont-Rousselot , Philippe Sultanik , Sarah Mouri , Marika Rudler , Dominique Thabut
Background
Hepatic encephalopathy (HE) is highly prevalent in patients with liver diseases. The pathophysiology of HE is centered on the synergic role of hyperammonemia and systemic inflammation. However, some data suggest altered functioning of the blood–brain barrier (BBB). Assessing BBB function is challenging in clinical practice and at the bedside. Protein-S-100 Beta (PS100-Beta) could be a useful peripheral marker of BBB permeability in HE. This study aimed to assess plasmatic PS100-Beta levels in a prospective cohort of patients admitted to the intensive care unit (ICU) with decompensated cirrhosis with and without overt HE.
Methods
We retrospectively evaluated a prospective cohort of cirrhotic patients admitted to the ICU from October 2013 to September 2015 that had an available plasmatic PS100-Beta measurement. Patients with previous neurological impairment or limitation of intensive or resuscitative measures were excluded. Overt HE was defined as West-Haven grades 2 to 4. The patients were compared to a control cohort of outpatient clinic cirrhotic and non-cirrhotic patients explored for isolated elevation of liver enzymes. After ICU discharge, the patients were followed for at least 3 months for the occurrence of overt HE. Adverse outcomes (liver transplantation or death) were collected. The ability of PS100-Beta – in combination with other factors – to predict overt HE was evaluated in a multivariate analysis using logistic regression. Likelihood ratios were used to determine the effects and calculate odds ratios (OR). Survival analysis was performed by using the Kaplan–Meier method and survival between groups was compared using a Log-rank test.
Results
A total of 194 ICU patients and 207 outpatients were included in the study. Increased levels of plasmatic PS100-Beta were detected in the ICU decompensated cirrhotic patients compared with the outpatients ([0.15±0.01] mg/L vs. [0.08±0] mg/L, P <0.001). ICU patients with overt HE had higher levels of PS100-Beta ([0.19±0.03] mg/L) compared with the ICU patients without overt HE ([0.13±0.01] mg/L) (P=0.003). PS100-Beta levels did not differ in outpatients with F 0–3 compared to F 4 fibrosis (P=0.670). PS100-Beta values were correlated with Child-Pugh score (P <0.001), Model for End-Stage Liver Disease (MELD) score (P=0.004), C-reactive protein (P <0.001), ammonemia (P <0.001), and chronic liver failure consortium (CLIF-C) organ failure (P <0.001) and CLIF-C acute-on-chronic (P=0.038) scores, but not with leukocytes (P=0.053), procalcitonin (PCT) (P=0.107), or the lymphocyte-to-neutrophil ratio in ICU patients (P=0.522). In a multivariate model including age, ammonemia, PS100-Beta, PCT, MELD, presence of transjugular portosystemic shunt, and sodium level, the diagnostic performance was 0.765 for
{"title":"Protein-S-100-beta is increased in patients with decompensated cirrhosis admitted to ICU","authors":"Nicolas Weiss , Simona Tripon , Maxime Mallet , Françoise Imbert-Bismut , Mehdi Sakka , Dominique Bonnefont-Rousselot , Philippe Sultanik , Sarah Mouri , Marika Rudler , Dominique Thabut","doi":"10.1016/j.jointm.2023.08.006","DOIUrl":"10.1016/j.jointm.2023.08.006","url":null,"abstract":"<div><h3>Background</h3><p>Hepatic encephalopathy (HE) is highly prevalent in patients with liver diseases. The pathophysiology of HE is centered on the synergic role of hyperammonemia and systemic inflammation. However, some data suggest altered functioning of the blood–brain barrier (BBB). Assessing BBB function is challenging in clinical practice and at the bedside. Protein-S-100 Beta (PS100-Beta) could be a useful peripheral marker of BBB permeability in HE. This study aimed to assess plasmatic PS100-Beta levels in a prospective cohort of patients admitted to the intensive care unit (ICU) with decompensated cirrhosis with and without overt HE.</p></div><div><h3>Methods</h3><p>We retrospectively evaluated a prospective cohort of cirrhotic patients admitted to the ICU from October 2013 to September 2015 that had an available plasmatic PS100-Beta measurement. Patients with previous neurological impairment or limitation of intensive or resuscitative measures were excluded. Overt HE was defined as West-Haven grades 2 to 4. The patients were compared to a control cohort of outpatient clinic cirrhotic and non-cirrhotic patients explored for isolated elevation of liver enzymes. After ICU discharge, the patients were followed for at least 3 months for the occurrence of overt HE. Adverse outcomes (liver transplantation or death) were collected. The ability of PS100-Beta – in combination with other factors – to predict overt HE was evaluated in a multivariate analysis using logistic regression. Likelihood ratios were used to determine the effects and calculate odds ratios (OR). Survival analysis was performed by using the Kaplan–Meier method and survival between groups was compared using a Log-rank test.</p></div><div><h3>Results</h3><p>A total of 194 ICU patients and 207 outpatients were included in the study. Increased levels of plasmatic PS100-Beta were detected in the ICU decompensated cirrhotic patients compared with the outpatients ([0.15±0.01] mg/L <em>vs.</em> [0.08±0] mg/L, <em>P</em> <0.001). ICU patients with overt HE had higher levels of PS100-Beta ([0.19±0.03] mg/L) compared with the ICU patients without overt HE ([0.13±0.01] mg/L) (<em>P</em>=0.003). PS100-Beta levels did not differ in outpatients with F 0–3 compared to F 4 fibrosis (<em>P=</em>0.670). PS100-Beta values were correlated with Child-Pugh score (<em>P <</em>0.001), Model for End-Stage Liver Disease (MELD) score (<em>P=</em>0.004), C-reactive protein (<em>P <</em>0.001), ammonemia (<em>P <</em>0.001), and chronic liver failure consortium (CLIF-C) organ failure (<em>P <</em>0.001) and CLIF-C acute-on-chronic (<em>P=</em>0.038) scores, but not with leukocytes (<em>P=</em>0.053), procalcitonin (PCT) (<em>P=</em>0.107), or the lymphocyte-to-neutrophil ratio in ICU patients (<em>P=</em>0.522). In a multivariate model including age, ammonemia, PS100-Beta, PCT, MELD, presence of transjugular portosystemic shunt, and sodium level, the diagnostic performance was 0.765 for","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 222-230"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000634/pdfft?md5=cdb44b7374f175c2aa8fdd3039629378&pid=1-s2.0-S2667100X23000634-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135849656","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 : 2024-04-01DOI: 10.1016/j.jointm.2023.08.001
Greta Zunino , Denise Battaglini , Daniel Agustin Godoy
Background
Patients with acute brain injury (ABI) are a peculiar population because ABI does not only affect the brain but also other organs such as the lungs, as theorized in brain–lung crosstalk models. ABI patients often require mechanical ventilation (MV) to avoid the complications of impaired respiratory function that can follow ABI; MV should be settled with meticulousness owing to its effects on the intracranial compartment, especially regarding positive end-expiratory pressure (PEEP). This scoping review aimed to (1) describe the physiological basis and mechanisms related to the effects of PEEP in ABI; (2) examine how clinical research is conducted on this topic; (3) identify methods for setting PEEP in ABI; and (4) investigate the impact of the application of PEEP in ABI on the outcome.
Methods
The five-stage paradigm devised by Peters et al. and expanded by Arksey and O'Malley, Levac et al., and the Joanna Briggs Institute was used for methodology. We also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension criteria. Inclusion criteria: we compiled all scientific data from peer-reviewed journals and studies that discussed the application of PEEP and its impact on intracranial pressure, cerebral perfusion pressure, and brain oxygenation in adult patients with ABI. Exclusion criteria: studies that only examined a pediatric patient group (those under the age of 18), experiments conducted solely on animals; studies without intracranial pressure and/or cerebral perfusion pressure determinations, and studies with incomplete information. Two authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online database. Data were presented in narrative and tubular form.
Results
The initial search yielded 330 references on the application of PEEP in ABI, of which 36 met our inclusion criteria. PEEP has recognized beneficial effects on gas exchange, but it produces hemodynamic changes that should be predicted to avoid undesired consequences on cerebral blood flow and intracranial pressure. Moreover, the elastic properties of the lungs influence the transmission of the forces applied by MV over the brain so they should be taken into consideration. Currently, there are no specific tools that can predict the effect of PEEP on the brain, but there is an established need for a comprehensive monitoring approach for these patients, acknowledging the etiology of ABI and the measurable variables to personalize MV.
Conclusion
PEEP can be safely used in patients with ABI to improve gas exchange keeping in mind its potentially harmful effects, which can be predicted with adequate monitoring supported by bedside non-invasive neuromonitoring tools.
背景急性脑损伤（ABI）患者是一个特殊人群，因为正如脑肺串扰模型所推测的那样，ABI 不仅会影响大脑，还会影响肺等其他器官。ABI 患者通常需要机械通气（MV），以避免 ABI 后出现呼吸功能受损的并发症；由于机械通气对颅内腔的影响，尤其是对呼气末正压（PEEP）的影响，因此应谨慎处理机械通气。本范围综述旨在：(1) 描述 ABI 中 PEEP 影响的生理学基础和相关机制；(2) 探讨如何开展相关临床研究；(3) 确定 ABI 中设置 PEEP 的方法；(4) 调查 ABI 中应用 PEEP 对结果的影响。方法采用 Peters 等人设计的五阶段范式，并由 Arksey 和 O'Malley、Levac 等人以及 Joanna Briggs 研究所扩展。我们还遵循了系统综述和荟萃分析首选报告项目（PRISMA）扩展标准。纳入标准：我们从同行评审期刊和研究中收集了所有科学数据，这些数据讨论了 PEEP 的应用及其对 ABI 成年患者的颅内压、脑灌注压和脑氧饱和度的影响。排除标准：仅研究儿科患者群体（18 岁以下）的研究、仅在动物身上进行的实验、未测定颅内压和（或）脑灌注压的研究以及信息不完整的研究。两位作者使用PubMed索引在线数据库对截至2023年7月发表的论文进行了检索和筛选。数据以叙述和管状的形式呈现。结果初步检索获得了 330 篇关于在 ABI 中应用 PEEP 的参考文献，其中 36 篇符合我们的纳入标准。PEEP 对气体交换的有利影响已得到公认，但它所产生的血液动力学变化应进行预测，以避免对脑血流和颅内压造成不良后果。此外，肺部的弹性特性也会影响 MV 在脑部的作用力传递，因此也应考虑在内。结论 PEEP 可以安全地用于 ABI 患者，以改善气体交换，同时注意其潜在的有害影响，这些影响可以通过床旁无创神经监测工具支持的充分监测进行预测。
{"title":"Effects of positive end-expiratory pressure on intracranial pressure, cerebral perfusion pressure, and brain oxygenation in acute brain injury: Friend or foe? A scoping review","authors":"Greta Zunino , Denise Battaglini , Daniel Agustin Godoy","doi":"10.1016/j.jointm.2023.08.001","DOIUrl":"10.1016/j.jointm.2023.08.001","url":null,"abstract":"<div><h3>Background</h3><p>Patients with acute brain injury (ABI) are a peculiar population because ABI does not only affect the brain but also other organs such as the lungs, as theorized in brain–lung crosstalk models. ABI patients often require mechanical ventilation (MV) to avoid the complications of impaired respiratory function that can follow ABI; MV should be settled with meticulousness owing to its effects on the intracranial compartment, especially regarding positive end-expiratory pressure (PEEP). This scoping review aimed to (1) describe the physiological basis and mechanisms related to the effects of PEEP in ABI; (2) examine how clinical research is conducted on this topic; (3) identify methods for setting PEEP in ABI; and (4) investigate the impact of the application of PEEP in ABI on the outcome.</p></div><div><h3>Methods</h3><p>The five-stage paradigm devised by Peters et al. and expanded by Arksey and O'Malley, Levac et al., and the Joanna Briggs Institute was used for methodology. We also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension criteria. Inclusion criteria: we compiled all scientific data from peer-reviewed journals and studies that discussed the application of PEEP and its impact on intracranial pressure, cerebral perfusion pressure, and brain oxygenation in adult patients with ABI. Exclusion criteria: studies that only examined a pediatric patient group (those under the age of 18), experiments conducted solely on animals; studies without intracranial pressure and/or cerebral perfusion pressure determinations, and studies with incomplete information. Two authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online database. Data were presented in narrative and tubular form.</p></div><div><h3>Results</h3><p>The initial search yielded 330 references on the application of PEEP in ABI, of which 36 met our inclusion criteria. PEEP has recognized beneficial effects on gas exchange, but it produces hemodynamic changes that should be predicted to avoid undesired consequences on cerebral blood flow and intracranial pressure. Moreover, the elastic properties of the lungs influence the transmission of the forces applied by MV over the brain so they should be taken into consideration. Currently, there are no specific tools that can predict the effect of PEEP on the brain, but there is an established need for a comprehensive monitoring approach for these patients, acknowledging the etiology of ABI and the measurable variables to personalize MV.</p></div><div><h3>Conclusion</h3><p>PEEP can be safely used in patients with ABI to improve gas exchange keeping in mind its potentially harmful effects, which can be predicted with adequate monitoring supported by bedside non-invasive neuromonitoring tools.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 247-260"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000580/pdfft?md5=a8e9718c9ec5036255b41e37c2c706e3&pid=1-s2.0-S2667100X23000580-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135706326","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 : 2024-04-01DOI: 10.1016/j.jointm.2024.01.008
The nervous and immune systems are crucial in fighting infections and inflammation and in maintaining immune homeostasis. The immune and nervous systems are independent, yet tightly integrated and coordinated organizations. Numerous molecules and receptors play key roles in enabling communication between the two systems. Transient receptor potential vanilloid subfamily member 1 (TRPV1) is a non-selective cation channel, recently shown to be widely expressed in the neuroimmune axis and implicated in neuropathic pain, autoimmune disorders, and immune cell function. TRPV1 is a key bridge in neuroimmune interactions, allowing for smooth and convenient communication between the two systems. Here, we discuss the coordinated cross-talking between the immune and nervous systems and the functional role and the functioning manner of the TRPV1 involved. We suggest that TRPV1 provides new insights into the collaborative relationship between the nervous and immune systems, highlighting exciting opportunities for advanced therapeutic approaches to treating neurogenic inflammation and immune-mediated diseases.
{"title":"TRPV1: The key bridge in neuroimmune interactions","authors":"","doi":"10.1016/j.jointm.2024.01.008","DOIUrl":"10.1016/j.jointm.2024.01.008","url":null,"abstract":"<div><p>The nervous and immune systems are crucial in fighting infections and inflammation and in maintaining immune homeostasis. The immune and nervous systems are independent, yet tightly integrated and coordinated organizations. Numerous molecules and receptors play key roles in enabling communication between the two systems. Transient receptor potential vanilloid subfamily member 1 (TRPV1) is a non-selective cation channel, recently shown to be widely expressed in the neuroimmune axis and implicated in neuropathic pain, autoimmune disorders, and immune cell function. TRPV1 is a key bridge in neuroimmune interactions, allowing for smooth and convenient communication between the two systems. Here, we discuss the coordinated cross-talking between the immune and nervous systems and the functional role and the functioning manner of the TRPV1 involved. We suggest that TRPV1 provides new insights into the collaborative relationship between the nervous and immune systems, highlighting exciting opportunities for advanced therapeutic approaches to treating neurogenic inflammation and immune-mediated diseases.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 4","pages":"Pages 442-452"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X2400032X/pdfft?md5=c89ebda7d6bd06da8655c68eccce2495&pid=1-s2.0-S2667100X2400032X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778434","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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