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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 通过气管造口吸入高流量氧气对长期机械通气患者呼吸模式和膈肌功能的影响：随机生理交叉研究
Journal of intensive medicine
Pub Date : 2024-04-01 DOI: 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

背景与传统的供氧设备相比，通过鼻插管进行高流量供氧治疗（HFOT）具有明显的临床优势。关于通过气管插管进行高流量供氧治疗是否也有这种效果的数据有限。因此，我们旨在研究通过气管插管进行高流量氧治疗对长期机械通气的气管插管患者的膈肌功能和呼吸参数的短期影响。方法 2020 年 12 月至 2021 年 4 月期间，我们在重症监护室对气管插管和长期机械通气患者进行了一项随机、交叉、生理学研究。患者接受了 30 分钟的自主呼吸试验（SBT），并通过气管插管T型片或通过气管插管高频吸氧（HFOT）吸氧，然后通过气管插管T型片呼吸15分钟，再以随机交叉的方式使用另一种方式吸氧30分钟。在每个疗程开始和结束时，通过赖特肺活量计测量血气、呼吸频率（f）和潮气量（VT），并进行膈肌超声波检查，包括膈肌偏移和膈肌增厚分数，这表示吸气肌肉的努力程度。患者被随机分配到使用 T-piece（10 次）或 HFOT（9 次）开始 SBT。使用 HFOT 时，SBT 期间 VT 和分钟通气量（VE）显著增加（从 [465±119] mL 到 [549±134] mL，P <0.001，从 [12.4±4.3] L/min 到 [13.1±4.2]L/min，P<0.05），但在带T-piece的SBT过程中没有明显变化（分别从[495±132] mL到[461±123] mL和从[12.8±4.4] mL到[12.0±4.4] mL）；HFOT期间f/VT下降（从[64±31] 次/（min∙L）到[49±24] 次/（min∙L），P <0.001），但在带T-piece的SBT期间（从[59±28]次/（min∙L）到[64±33]次/（min∙L））没有明显变化；在HFOT期间动脉血氧分压升高（从[99±39]mmHg到[132±48]mmHg，P <0.001），但在带T-piece的SBT期间动脉血氧分压降低（从[124±50]mmHg到[83±22]mmHg，P <0.01）。此外，HFOT 时，膈肌偏移增加（从[12.9±3.3] mm 增加到[15.7±4.4] mm，P <0.001），但在使用 T 片的 SBT 时，膈肌偏移没有显著变化（从[13.4±3.3] mm 增加到[13.6±3.3] mm）。结论在长期机械通气的患者中，通过气管造口进行高频通气与使用T-piece相比，可改善通气、呼吸模式和氧合，而不会增加吸气肌肉的努力。
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引用次数: 0
Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China 中国成人重症监护病房患者营养评估和监测临床实践指南
Journal of intensive medicine
Pub Date : 2024-04-01 DOI: 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.

中国重症医学会（CSCCM）制定了中国成人重症监护病房（ICU）患者营养评估和监测的临床实践指南。该指南重点关注营养评估和代谢监测，以实现重症患者最佳的个性化营养治疗。该指南由重症医学专家和循证医学方法学专家共同制定，在对2000年至2023年7月期间发表的相关试验或研究进行系统全面的回顾和总结后制定而成。通过重症医学、肠外和肠内营养以及外科专家组的讨论和审查，共形成了 18 项建议，并达成了共识。这些建议以目前可用的证据为基础，涉及多个关键领域，包括筛查和评估、肠内喂养不耐受的评估和评价、营养治疗期间的代谢和营养测量与监测，以及与营养供给相关的器官功能评价。每个问题都根据人群、干预、比较和结果（PICO）原则进行了分析。此外，还对未达成共识但可能具有潜在临床和研究价值的四个问题进行了解释。计划在 3-5 年内采用国际指南更新方法更新本营养评估和监测指南。
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引用次数: 0
Optimal strategy for treatment of sepsis based on the host inflammatory reaction and immune response 基于宿主炎症反应和免疫反应的败血症最佳治疗策略
Journal of intensive medicine
Pub Date : 2024-04-01 DOI: 10.1016/j.jointm.2023.10.002
Hui Zhang, Ning Dong, Yongming Yao
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引用次数: 0
Protein-S-100-beta is increased in patients with decompensated cirrhosis admitted to ICU 入住重症监护病房的失代偿期肝硬化患者的蛋白-S-100-beta 增高
Journal of intensive medicine
Pub Date : 2024-04-01 DOI: 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

背景肝性脑病（HE）在肝病患者中发病率很高。肝性脑病的病理生理学核心是高氨血症和全身炎症的协同作用。然而，一些数据表明血脑屏障（BBB）的功能发生了改变。在临床实践和床旁评估血脑屏障功能具有挑战性。蛋白-S-100β（PS100-Beta）可作为高血压患者血脑屏障通透性的外周标志物。本研究旨在评估前瞻性队列中入住重症监护室（ICU）的肝硬化失代偿期患者血浆 PS100-Beta 水平。排除了既往有神经功能损害或强化或复苏措施受限的患者。这些患者与门诊肝硬化和非肝硬化患者组成的对照组进行了比较。重症监护室出院后，对患者进行至少 3 个月的随访，以观察是否出现明显的肝损伤。收集了不良后果（肝移植或死亡）。在使用逻辑回归进行的多变量分析中，评估了 PS100-Beta 结合其他因素预测显性 HE 的能力。使用似然比来确定影响并计算几率比（OR）。采用 Kaplan-Meier 法进行存活率分析，采用 Log-rank 检验比较组间存活率。与门诊患者相比，ICU 失代偿期肝硬化患者血浆 PS100-Beta 水平升高（[0.15±0.01] mg/L vs. [0.08±0] mg/L，P <0.001）。有明显高血压的 ICU 患者的 PS100-Beta 水平（[0.19±0.03] mg/L）高于无明显高血压的 ICU 患者（[0.13±0.01] mg/L）（P=0.003）。在门诊患者中，F 0-3 与 F 4 纤维化患者的 PS100-Beta 水平没有差异（P=0.670）。PS100-Beta 值与 Child-Pugh 评分（P<0.001）、终末期肝病模型（MELD）评分（P=0.004）、C 反应蛋白（P<0.001）、氨血症（P<0.001）、慢性肝衰竭联盟（CLIF-C）器官衰竭（P <0.001）和CLIF-C急性-慢性（P=0.038）评分，但与ICU患者的白细胞（P=0.053）、降钙素原（PCT）（P=0.107）或淋巴细胞-中性粒细胞比率（P=0.522）无关。在包括年龄、氨血症、PS100-Beta、PCT、MELD、是否存在经颈静脉门静脉分流术和钠水平在内的多变量模型中，确诊显性 HE 的诊断率为 0.765。结论肝硬化失代偿期 ICU 患者的血清 PS100-Beta 水平升高，显示明显 HE 的患者更高，且 PS100-Beta 水平与预后相关。这表明这些患者的 BBB 通透性增加。
{"title":"Protein-S-100-beta is increased in patients with decompensated cirrhosis admitted to ICU","authors":"Nicolas Weiss ,&nbsp;Simona Tripon ,&nbsp;Maxime Mallet ,&nbsp;Françoise Imbert-Bismut ,&nbsp;Mehdi Sakka ,&nbsp;Dominique Bonnefont-Rousselot ,&nbsp;Philippe Sultanik ,&nbsp;Sarah Mouri ,&nbsp;Marika Rudler ,&nbsp;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> &lt;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 &lt;</em>0.001), Model for End-Stage Liver Disease (MELD) score (<em>P=</em>0.004), C-reactive protein (<em>P &lt;</em>0.001), ammonemia (<em>P &lt;</em>0.001), and chronic liver failure consortium (CLIF-C) organ failure (<em>P &lt;</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}
引用次数: 0
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 呼气末正压对急性脑损伤患者颅内压、脑灌注压和脑氧饱和度的影响：是敌是友？范围综述
Journal of intensive medicine
Pub Date : 2024-04-01 DOI: 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。
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引用次数: 0
TRPV1: The key bridge in neuroimmune interactions TRPV1：神经免疫相互作用的关键桥梁
Journal of intensive medicine
Pub Date : 2024-04-01 DOI: 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.

神经系统和免疫系统在对抗感染和炎症以及维持免疫平衡方面至关重要。免疫系统和神经系统既相互独立，又紧密结合、相互协调。许多分子和受体在这两个系统之间的交流中发挥着关键作用。瞬时受体电位香草素亚族成员 1（TRPV1）是一种非选择性阳离子通道，最近被证明在神经免疫轴中广泛表达，并与神经性疼痛、自身免疫性疾病和免疫细胞功能有关。TRPV1 是神经免疫相互作用的关键桥梁，使两个系统之间的交流顺畅、便捷。在此，我们讨论了免疫系统和神经系统之间的协调性交叉对话，以及 TRPV1 的功能作用和运作方式。我们认为，TRPV1 为神经系统和免疫系统之间的协作关系提供了新的见解，为治疗神经源性炎症和免疫介导疾病的先进治疗方法提供了令人兴奋的机会。
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引用次数: 0
Austrian syndrome: Resurgence of an old and deadly triad 奥地利综合症:古老而致命的黑社会死灰复燃
Journal of intensive medicine
Pub Date : 2024-04-01 DOI: 10.1016/j.jointm.2023.06.006
Kristian Rivera, Dolors Viles, Marta Zielonka, Carlos Izurieta, Tania Ramírez Martínez, Diego Menéndez
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引用次数: 0
Severe asthma exacerbation: Changes in patient characteristics, management, and outcomes from 1997 to 2016 in 40 ICUs in the greater Paris area 严重哮喘加重：1997年至2016年大巴黎地区40所重症监护病房的患者特征、管理和治疗效果的变化
Journal of intensive medicine
Pub Date : 2024-04-01 DOI: 10.1016/j.jointm.2023.08.008
Romy Younan , Jean Loup Augy , Bertrand Hermann , Bertrand Guidet , Philippe Aegerter , Emmanuel Guerot , Ana Novara , Caroline Hauw-Berlemont , Amer Hamdan , Clotilde Bailleul , Francesca Santi , Jean-Luc Diehl , Nicolas Peron , Nadia Aissaoui

Background

Despite advances in asthma treatments, severe asthma exacerbation (SAE) remains a life-threatening condition in adults, and there is a lack of data derived from adult patients admitted to intensive care units (ICUs) for SAE. The current study investigated changes in adult patient characteristics, management, and outcomes of SAE over a 20-year period in 40 ICUs in the greater Paris area.

Methods

In this retrospective observational study, admissions to 40 ICUs in the greater Paris area for SAE from January 1, 1997, to December 31, 2016 were analyzed. The primary outcome was the proportion of ICU admissions for SAE during 5-year periods. Secondary outcomes were ICU and hospital mortality, and the use of mechanical ventilation and catecholamine. Multivariate analysis was performed to assess factors associated with ICU mortality.

Results

A total of 7049 admissions for SAE were recorded. For each 5-year period, the proportion decreased over time, with SAE accounting for 2.84% of total ICU admissions (n=2841) between 1997 and 2001, 1.76% (n=1717) between 2002 and 2006, 1.05% (n=965) between 2007 and 2011, and 1.05% (n=1526) between 2012 and 2016. The median age was 46 years (interquartile range [IQR]: 32–59 years), 55.41% were female, the median Simplified Acute Physiology Score II was 20 (IQR: 13–28), and 19.76% had mechanical ventilation. The use of mechanical ventilation remained infrequent throughout the 20-year period, whereas the use of catecholamine decreased. ICU and hospital mortality rates decreased. Factors associated with ICU mortality were renal replacement therapy, catecholamine, cardiac arrest, pneumothorax, acute respiratory distress syndrome, sepsis, and invasive mechanical ventilation (IMV). Non-survivors were older, had more severe symptoms, and were more likely to have received IMV.

Conclusion

ICU admission for SAE remains uncommon, and the proportion of cases decreased over time. Despite a slight increase in symptom severity during a 20-year period, ICU and hospital mortality decreased. Patients requiring IMV had a higher mortality rate.

背景尽管哮喘治疗方法不断进步，但严重哮喘加重（SAE）仍然是威胁成人生命的一种疾病，而且缺乏因严重哮喘加重而入住重症监护病房（ICU）的成人患者的相关数据。本研究调查了大巴黎地区 40 家重症监护病房在 20 年间因 SAE 入院的成人患者特征、管理和治疗效果的变化。主要结果是5年期间因SAE入住ICU的比例。次要结果是重症监护室和医院死亡率，以及机械通气和儿茶酚胺的使用情况。为评估与重症监护室死亡率相关的因素，进行了多变量分析。1997年至2001年间，SAE占ICU住院总人数的2.84%（n=2841）；2002年至2006年间，SAE占ICU住院总人数的1.76%（n=1717）；2007年至2011年间，SAE占ICU住院总人数的1.05%（n=965）；2012年至2016年间，SAE占ICU住院总人数的1.05%（n=1526）。中位年龄为 46 岁（四分位间距 [IQR]：32-59 岁），55.41% 为女性，中位简化急性生理学评分 II 为 20（IQR：13-28），19.76% 使用机械通气。在这 20 年间，使用机械通气的情况仍然不多，而使用儿茶酚胺的情况则有所减少。重症监护室和医院死亡率均有所下降。与重症监护病房死亡率相关的因素包括肾脏替代治疗、儿茶酚胺、心脏骤停、气胸、急性呼吸窘迫综合征、败血症和有创机械通气（IMV）。非幸存者年龄更大、症状更严重、更有可能接受了有创机械通气。尽管在 20 年间症状的严重程度略有增加，但重症监护病房和医院的死亡率却有所下降。需要接受 IMV 治疗的患者死亡率较高。
{"title":"Severe asthma exacerbation: Changes in patient characteristics, management, and outcomes from 1997 to 2016 in 40 ICUs in the greater Paris area","authors":"Romy Younan ,&nbsp;Jean Loup Augy ,&nbsp;Bertrand Hermann ,&nbsp;Bertrand Guidet ,&nbsp;Philippe Aegerter ,&nbsp;Emmanuel Guerot ,&nbsp;Ana Novara ,&nbsp;Caroline Hauw-Berlemont ,&nbsp;Amer Hamdan ,&nbsp;Clotilde Bailleul ,&nbsp;Francesca Santi ,&nbsp;Jean-Luc Diehl ,&nbsp;Nicolas Peron ,&nbsp;Nadia Aissaoui","doi":"10.1016/j.jointm.2023.08.008","DOIUrl":"10.1016/j.jointm.2023.08.008","url":null,"abstract":"<div><h3>Background</h3><p>Despite advances in asthma treatments, severe asthma exacerbation (SAE) remains a life-threatening condition in adults, and there is a lack of data derived from adult patients admitted to intensive care units (ICUs) for SAE. The current study investigated changes in adult patient characteristics, management, and outcomes of SAE over a 20-year period in 40 ICUs in the greater Paris area.</p></div><div><h3>Methods</h3><p>In this retrospective observational study, admissions to 40 ICUs in the greater Paris area for SAE from January 1, 1997, to December 31, 2016 were analyzed. The primary outcome was the proportion of ICU admissions for SAE during 5-year periods. Secondary outcomes were ICU and hospital mortality, and the use of mechanical ventilation and catecholamine. Multivariate analysis was performed to assess factors associated with ICU mortality.</p></div><div><h3>Results</h3><p>A total of 7049 admissions for SAE were recorded. For each 5-year period, the proportion decreased over time, with SAE accounting for 2.84% of total ICU admissions (<em>n</em>=2841) between 1997 and 2001, 1.76% (<em>n</em>=1717) between 2002 and 2006, 1.05% (<em>n</em>=965) between 2007 and 2011, and 1.05% (<em>n</em>=1526) between 2012 and 2016. The median age was 46 years (interquartile range [IQR]: 32–59 years), 55.41% were female, the median Simplified Acute Physiology Score II was 20 (IQR: 13–28), and 19.76% had mechanical ventilation. The use of mechanical ventilation remained infrequent throughout the 20-year period, whereas the use of catecholamine decreased. ICU and hospital mortality rates decreased. Factors associated with ICU mortality were renal replacement therapy, catecholamine, cardiac arrest, pneumothorax, acute respiratory distress syndrome, sepsis, and invasive mechanical ventilation (IMV). Non-survivors were older, had more severe symptoms, and were more likely to have received IMV.</p></div><div><h3>Conclusion</h3><p>ICU admission for SAE remains uncommon, and the proportion of cases decreased over time. Despite a slight increase in symptom severity during a 20-year period, ICU and hospital mortality decreased. Patients requiring IMV had a higher mortality rate.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"4 2","pages":"Pages 209-215"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667100X23000786/pdfft?md5=e0ff932d3368a9ded6771ca7c84932a5&pid=1-s2.0-S2667100X23000786-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135762523","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}
引用次数: 0
Glucocorticoid therapy for acute respiratory distress syndrome: Current concepts 糖皮质激素治疗急性呼吸窘迫综合征：当前概念
Journal of intensive medicine
Pub Date : 2024-04-01 DOI: 10.1016/j.jointm.2024.02.002

Acute respiratory distress syndrome (ARDS), a fatal critical disease, is induced by various insults. ARDS represents a major global public health burden, and the management of ARDS continues to challenge healthcare systems globally, especially during the pandemic of the coronavirus disease 2019 (COVID-19). There remains no confirmed specific pharmacotherapy for ARDS, despite advances in understanding its pathophysiology. Debate continues about the potential role of glucocorticoids (GCs) as a promising ARDS clinical therapy. Questions regarding GC agent, dose, and duration in patients with ARDS need to be answered, because of substantial variations in GC administration regimens across studies. ARDS heterogeneity likely affects the therapeutic actions of exogenous GCs. This review includes progress in determining the GC mechanisms of action and clinical applications in ARDS, especially during the COVID-19 pandemic.

急性呼吸窘迫综合征（ARDS）是一种致命的危重疾病，由各种损伤诱发。ARDS 是全球公共卫生的主要负担，ARDS 的管理继续对全球医疗保健系统构成挑战，尤其是在 2019 年冠状病毒病（COVID-19）大流行期间。尽管人们对 ARDS 的病理生理学有了更深入的了解，但目前仍未确定针对 ARDS 的特效药物疗法。关于糖皮质激素（GCs）作为一种有前景的 ARDS 临床疗法的潜在作用的争论仍在继续。有关 ARDS 患者使用糖皮质激素的药物、剂量和持续时间等问题亟待解决，因为不同研究的糖皮质激素给药方案存在很大差异。ARDS 的异质性可能会影响外源性 GCs 的治疗作用。本综述包括确定 GC 作用机制的进展以及在 ARDS 中的临床应用，尤其是在 COVID-19 大流行期间。
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引用次数: 0
Latest developments in early diagnosis and specific treatment of severe influenza infection 重症流感感染的早期诊断和特异性治疗的最新进展
Journal of intensive medicine
Pub Date : 2024-04-01 DOI: 10.1016/j.jointm.2023.09.006
Francisco Valenzuela-Sánchez , Blanca Valenzuela-Méndez , Juan Francisco Rodríguez-Gutiérrez , Ángel Estella

Influenza pandemics are unpredictable recurrent events with global health, economic, and social consequences. The objective of this review is to provide an update on the latest developments in early diagnosis and specific treatment of the disease and its complications, particularly with regard to respiratory organ failure. Despite advances in treatment, the rate of mortality in the intensive care unit remains approximately 30%. Therefore, early identification of potentially severe viral pneumonia is extremely important to optimize treatment in these patients. The pathogenesis of influenza virus infection depends on viral virulence and host response. Thus, in some patients, it is associated with an excessive systemic response mediated by an authentic cytokine storm. This process leads to severe primary pneumonia and acute respiratory distress syndrome. Initial prognostication in the emergency department based on comorbidities, vital signs, and biomarkers (e.g., procalcitonin, ferritin, human leukocyte antigen-DR, mid-regional proadrenomedullin, and lactate) is important. Identification of these biomarkers on admission may facilitate clinical decision-making to determine early admission to the hospital or the intensive care unit. These decisions are reached considering pathophysiological circumstances that are associated with a poor prognosis (e.g., bacterial co-infection, hyperinflammation, immune paralysis, severe endothelial damage, organ dysfunction, and septic shock). Moreover, early implementation is important to increase treatment efficacy. Based on a limited level of evidence, all current guidelines recommend using oseltamivir in this setting. The possibility of drug resistance should also be considered. Alternative options include other antiviral drugs and combination therapies with monoclonal antibodies. Importantly, it is not recommended to use corticosteroids in the initial treatment of these patients. Furthermore, the implementation of supportive measures for respiratory failure is essential. Current recommendations are limited, heterogeneous, and not regularly updated. Early intubation and mechanical ventilation is the basic treatment for patients with severe respiratory failure. Prone ventilation should be promptly performed in patients with acute respiratory distress syndrome, while early tracheostomy should be considered in case of planned prolonged mechanical ventilation. Clinical trials on antiviral treatment and respiratory support measures specifically for these patients, as well as specific recommendations for different at-risk populations, are necessary to improve outcomes.

流感大流行是不可预测的经常性事件，会对全球健康、经济和社会造成影响。本综述旨在介绍该疾病及其并发症（尤其是呼吸器官衰竭）的早期诊断和具体治疗方面的最新进展。尽管在治疗方面取得了进步，但重症监护病房的死亡率仍约为 30%。因此，早期识别潜在的重症病毒性肺炎对优化这些患者的治疗极为重要。流感病毒感染的发病机制取决于病毒的毒性和宿主的反应。因此，有些患者会在真正的细胞因子风暴介导下出现过度的全身反应。这一过程会导致严重的原发性肺炎和急性呼吸窘迫综合征。在急诊科根据合并症、生命体征和生物标志物（如降钙素原、铁蛋白、人类白细胞抗原-DR、中区域前肾上腺髓质素和乳酸盐）来初步判断预后非常重要。入院时对这些生物标志物的鉴定有助于临床决策，以决定是否尽早入院或入住重症监护病房。做出这些决定时要考虑到与预后不良相关的病理生理情况（如细菌合并感染、炎症亢进、免疫麻痹、严重内皮损伤、器官功能障碍和脓毒性休克）。此外，尽早实施治疗对提高疗效也很重要。基于有限的证据，目前所有的指南都建议在这种情况下使用奥司他韦。此外，还应考虑耐药性的可能性。其他选择包括其他抗病毒药物和单克隆抗体联合疗法。重要的是，在对这些患者进行初始治疗时，不建议使用皮质类固醇。此外，对呼吸衰竭采取支持性措施也至关重要。目前的建议很有限，而且各不相同，也没有定期更新。早期插管和机械通气是治疗严重呼吸衰竭患者的基本方法。急性呼吸窘迫综合征患者应立即进行俯卧位通气，而在计划延长机械通气时间的情况下，应考虑尽早进行气管切开术。为改善治疗效果，有必要专门针对这些患者进行抗病毒治疗和呼吸支持措施的临床试验，并针对不同的高危人群提出具体建议。
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