Pub Date : 2019-10-01DOI: 10.4103/jtccm.jtccm_7_20
P. Honore, A. Mugisha, L. Kugener, S. Redant, R. Attou, A. Gallerani, D. Bels
{"title":"No Association between Earlier Antibiotic Administration and Reduction in In-Hospital Mortality in Patients with Severe Sepsis: We Are Not Sure","authors":"P. Honore, A. Mugisha, L. Kugener, S. Redant, R. Attou, A. Gallerani, D. Bels","doi":"10.4103/jtccm.jtccm_7_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_7_20","url":null,"abstract":"","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"18 1","pages":"137 - 138"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89289208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.4103/jtccm.jtccm_15_19
I. Eliaz
Tissue fibrosis is initially an adaptive response to organ injury, but eventually, parenchymal scarring and subsequent cellular dysfunction and organ failure ensue. Few therapies currently exist for fibrosis, especially those that target fibrogenesis. Galectin-3 (Gal-3) is a member of the lectin family of proteins, is produced predominantly by macrophages, and has essential functions in inflammation and angiogenesis. Gal-3 is activated in fibrotic models and abnormally elevated in fibrotic patients. Gal-3 inhibitors help to ameliorate or prevent fibrosis. For this review, we searched for original articles and reviews published between Jul 1, 2014, and Nov 1, 2019, using the following search terms (or combination of words) in PubMed: “galectin 3”, “fibrosis”, “heart”, “cardiac”, “liver”, “hepatic”, “lung”, “pulmonary”, “kidney”, and “renal”.
{"title":"Galectin-3 and Fibrosis: Research in the Last 5 Years","authors":"I. Eliaz","doi":"10.4103/jtccm.jtccm_15_19","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_15_19","url":null,"abstract":"Tissue fibrosis is initially an adaptive response to organ injury, but eventually, parenchymal scarring and subsequent cellular dysfunction and organ failure ensue. Few therapies currently exist for fibrosis, especially those that target fibrogenesis. Galectin-3 (Gal-3) is a member of the lectin family of proteins, is produced predominantly by macrophages, and has essential functions in inflammation and angiogenesis. Gal-3 is activated in fibrotic models and abnormally elevated in fibrotic patients. Gal-3 inhibitors help to ameliorate or prevent fibrosis. For this review, we searched for original articles and reviews published between Jul 1, 2014, and Nov 1, 2019, using the following search terms (or combination of words) in PubMed: “galectin 3”, “fibrosis”, “heart”, “cardiac”, “liver”, “hepatic”, “lung”, “pulmonary”, “kidney”, and “renal”.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"1 1","pages":"117 - 126"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85137581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.4103/jtccm.jtccm_2_20
G. Satyarthee, G. Pinilla-Monsalve, Luis Moscote-Salazar's
{"title":"Severe Hypersensitivity Syndrome to Lamotrigine","authors":"G. Satyarthee, G. Pinilla-Monsalve, Luis Moscote-Salazar's","doi":"10.4103/jtccm.jtccm_2_20","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_2_20","url":null,"abstract":"","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"811 1","pages":"135 - 136"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78900691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.4103/jtccm.jtccm_11_18
L. Forni, Z. Peng, K. Kashani, C. Ronco, J. Kellum
Biomarkers play important roles in clinical practices including diagnosis and treatment selection. With regard to acute kidney injury (AKI), the use of biomarkers to guide clinical trials is very promising. The committee of the 19th Acute Dialysis Quality Initiative (ADQI) conference met in April 2017 and discussed the integration of biomarkers within clinical trials of acute kidney injury. Consensus had been reached for the significant benefits of integration of biomarkers in clinical trials as well as some potential limitations. Authors concluded the potential role of biomarkers from risk stratification to identification of AKI as well as to monitor therapeutic effects. The group also concluded that biomarkers included within clinical trails could provide both sensitivity and specificity to facilitate trial design. Then the group discussed the role of biomarkers within the PICO (Patient, Intervention, Comparator, Outcome) framework, including the use of biomarkers in patient selection, intervention guidance, comparator and end-point decision. Finally, the committee concluded both the benefits and potential drawbacks of implementing biomarkers in clinical trials of acute kidney injury.
{"title":"Biomarkers and the Potential Role in Clinical Trials of Acute Kidney Injury: Consensus Report of Acute Dialysis Quality Initiative XIX","authors":"L. Forni, Z. Peng, K. Kashani, C. Ronco, J. Kellum","doi":"10.4103/jtccm.jtccm_11_18","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_11_18","url":null,"abstract":"Biomarkers play important roles in clinical practices including diagnosis and treatment selection. With regard to acute kidney injury (AKI), the use of biomarkers to guide clinical trials is very promising. The committee of the 19th Acute Dialysis Quality Initiative (ADQI) conference met in April 2017 and discussed the integration of biomarkers within clinical trials of acute kidney injury. Consensus had been reached for the significant benefits of integration of biomarkers in clinical trials as well as some potential limitations. Authors concluded the potential role of biomarkers from risk stratification to identification of AKI as well as to monitor therapeutic effects. The group also concluded that biomarkers included within clinical trails could provide both sensitivity and specificity to facilitate trial design. Then the group discussed the role of biomarkers within the PICO (Patient, Intervention, Comparator, Outcome) framework, including the use of biomarkers in patient selection, intervention guidance, comparator and end-point decision. Finally, the committee concluded both the benefits and potential drawbacks of implementing biomarkers in clinical trials of acute kidney injury.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"PP 1","pages":"113 - 116"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84537342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.4103/jtccm.jtccm_12_19
Yini Sun, M. Ford, C. Coopersmith
The mucosal immune system plays a central role in the pathophysiology of health and disease. As the home to the largest population of lymphocytes in the body, the mucosal immune system closely communicates within other elements of the intestine, with constant cross talk with the gut microbiome and epithelial layer. Further, the gut's immune system plays a central role in communicating with remote organs. The mucosal immune system is critical in preventing autoimmunity, while simultaneously retaining the capacity to respond vigorously to mucosal invaders. This results in a state where the mucosal immune system not only can help restore homeostasis in critical illness but can also worsen inflammation and organ injury in sepsis. The purpose of this minireview is to provide an overview of mucosal immunity in health and in sepsis, with a focus on intraepithelial lymphocytes. Understanding the role of the mucosal immune system in both controlling and propagating sepsis is vital for future efforts designed to target it for therapeutic gain in the intensive care unit.
{"title":"Gut Immunity – Homeostasis and Dysregulation in Sepsis","authors":"Yini Sun, M. Ford, C. Coopersmith","doi":"10.4103/jtccm.jtccm_12_19","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_12_19","url":null,"abstract":"The mucosal immune system plays a central role in the pathophysiology of health and disease. As the home to the largest population of lymphocytes in the body, the mucosal immune system closely communicates within other elements of the intestine, with constant cross talk with the gut microbiome and epithelial layer. Further, the gut's immune system plays a central role in communicating with remote organs. The mucosal immune system is critical in preventing autoimmunity, while simultaneously retaining the capacity to respond vigorously to mucosal invaders. This results in a state where the mucosal immune system not only can help restore homeostasis in critical illness but can also worsen inflammation and organ injury in sepsis. The purpose of this minireview is to provide an overview of mucosal immunity in health and in sepsis, with a focus on intraepithelial lymphocytes. Understanding the role of the mucosal immune system in both controlling and propagating sepsis is vital for future efforts designed to target it for therapeutic gain in the intensive care unit.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"9 1","pages":"89 - 95"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78919995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.4103/jtccm.jtccm_2_19
M. Abdulla
Dettol a mixture of 4.8% chloroxylenol, 9% pine oil, and 12% isopropyl alcohol, is a popular household disinfectant. Serious complications of Dettol poisoning include aspiration, pneumonia, adult respiratory distress syndrome, shock, acute coronary syndrome, and cardiopulmonary arrest. We report a patient with Dettol poisoning who developed tracheal ulceration complicated by diffuse subcutaneous emphysema bilateral pneumothorax and pneumomediastinum. To the best of our knowledge, tracheal ulceration following Dettol poisoning was not reported previously.
{"title":"Tracheal Ulceration in Dettol Poisoning","authors":"M. Abdulla","doi":"10.4103/jtccm.jtccm_2_19","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_2_19","url":null,"abstract":"Dettol a mixture of 4.8% chloroxylenol, 9% pine oil, and 12% isopropyl alcohol, is a popular household disinfectant. Serious complications of Dettol poisoning include aspiration, pneumonia, adult respiratory distress syndrome, shock, acute coronary syndrome, and cardiopulmonary arrest. We report a patient with Dettol poisoning who developed tracheal ulceration complicated by diffuse subcutaneous emphysema bilateral pneumothorax and pneumomediastinum. To the best of our knowledge, tracheal ulceration following Dettol poisoning was not reported previously.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"323 1","pages":"109 - 110"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80307405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.4103/jtccm.jtccm_6_19
Xue-zhong Xing, Hai-jun Wang, S. Qu, Chu-lin Huang, Hao Zhang, Hao Wang
Objective: The objective of the study is to investigate the effect of critical care transition programs (TPs) on the short-term outcomes in critically ill cancer patients. Methods: Data of critically ill cancer patients admitted to the intensive care unit (ICU) at National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between September 2017 and August 2018 were retrospectively reviewed and analyzed. Patients were grouped as TP group or non-TP (nTP) group according to whether patients received post-ICU follow-up. Results: In unmatched groups, compared with nTP group, patients in TP group were more severe with higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, higher Simplified Acute Physiology Score 3 score, and higher Sequential Organ Failure Assessment score and decreased ICU mortality (0 vs. 3.1%, P = 0.001) and in-hospital mortality (0 vs. 3.2%, P = 0.001). After matching, there were no significant differences in readmission rate, in-hospital mortality, readmission/in-hospital mortality, ICU length of stay (LOS), and hospital LOS between TP and nTP groups (all P > 0.05). Subgroup analysis demonstrated that in severe group (APACHE II >15), compared with nTP group, patients in TP group had increased readmission rate (8.3% vs. 62.5%, P < 0.001) and increased duration of hospital LOS (13.92 ± 10.54 vs. 26.38 ± 15.46 days; P = 0.003). There is a trend that ICU mortality (23.6% vs. 0, P = 0.121) and hospital mortality (25.8% vs. 0, P = 0.108) were decreased in TP group than in nTP group. In less severe group (APACHE II ≤ 15), there were no significant differences in readmission rate (4.5% vs. 3.8%, P = 0.655), ICU LOS (3.00 ± 4.40 vs. 2.92 ± 3.23 days; P = 0.790), ICU mortality (1.0% vs. 0, P = 0.117), and hospital mortality (1.0% vs. 0, P = 0.117). Conclusions: Critical care TPs may decrease ICU mortality and hospital mortality in critically ill cancer patients with APACHE II >15. It has no role in less severe critically ill cancer patients with APACHE II ≤15.
目的:本研究旨在探讨重症监护过渡方案(TPs)对危重癌症患者短期预后的影响。方法:回顾性分析2017年9月至2018年8月在中国医学科学院、北京协和医学院国家癌症中心/国家癌症临床研究中心/肿瘤医院重症监护病房(ICU)收治的危重癌症患者资料。根据患者是否接受icu后随访分为TP组和非TP (nTP)组。结果:在未匹配组中，与nTP组相比，TP组患者更严重，急性生理和慢性健康评估(APACHE) II评分更高，简化急性生理评分3评分更高，序事性器官衰竭评估评分更高，ICU死亡率(0比3.1%，P = 0.001)和住院死亡率(0比3.2%，P = 0.001)降低。配对后，TP组与nTP组在再入院率、院内死亡率、再入院/院内死亡率、ICU住院时间(LOS)、院内LOS方面差异无统计学意义(P < 0.05)。亚组分析显示，与nTP组相比，TP组患者再入院率增加(8.3% vs. 62.5%， P < 0.001)，住院时间延长(13.92±10.54 vs. 26.38±15.46 d);P = 0.003)。TP组ICU病死率(23.6% vs. 0, P = 0.121)和住院病死率(25.8% vs. 0, P = 0.108)均低于nTP组。轻重症组(APACHEⅱ≤15)再入院率(4.5% vs 3.8%， P = 0.655)、ICU住院时间(3.00±4.40 vs 2.92±3.23)d;P = 0.790)、ICU死亡率(1.0%比0,P = 0.117)和医院死亡率(1.0%比0,P = 0.117)。结论:重症监护TPs可降低APACHEⅱ型危重癌症患者的ICU死亡率和住院死亡率[j][15]。对APACHEⅱ≤15的轻危重癌症患者无作用。
{"title":"The Effect of Critical Care Transition Programs on the Short-Term Outcomes of Critically Ill Cancer Patients: A Propensity Score Matching Study","authors":"Xue-zhong Xing, Hai-jun Wang, S. Qu, Chu-lin Huang, Hao Zhang, Hao Wang","doi":"10.4103/jtccm.jtccm_6_19","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_6_19","url":null,"abstract":"Objective: The objective of the study is to investigate the effect of critical care transition programs (TPs) on the short-term outcomes in critically ill cancer patients. Methods: Data of critically ill cancer patients admitted to the intensive care unit (ICU) at National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between September 2017 and August 2018 were retrospectively reviewed and analyzed. Patients were grouped as TP group or non-TP (nTP) group according to whether patients received post-ICU follow-up. Results: In unmatched groups, compared with nTP group, patients in TP group were more severe with higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, higher Simplified Acute Physiology Score 3 score, and higher Sequential Organ Failure Assessment score and decreased ICU mortality (0 vs. 3.1%, P = 0.001) and in-hospital mortality (0 vs. 3.2%, P = 0.001). After matching, there were no significant differences in readmission rate, in-hospital mortality, readmission/in-hospital mortality, ICU length of stay (LOS), and hospital LOS between TP and nTP groups (all P > 0.05). Subgroup analysis demonstrated that in severe group (APACHE II >15), compared with nTP group, patients in TP group had increased readmission rate (8.3% vs. 62.5%, P < 0.001) and increased duration of hospital LOS (13.92 ± 10.54 vs. 26.38 ± 15.46 days; P = 0.003). There is a trend that ICU mortality (23.6% vs. 0, P = 0.121) and hospital mortality (25.8% vs. 0, P = 0.108) were decreased in TP group than in nTP group. In less severe group (APACHE II ≤ 15), there were no significant differences in readmission rate (4.5% vs. 3.8%, P = 0.655), ICU LOS (3.00 ± 4.40 vs. 2.92 ± 3.23 days; P = 0.790), ICU mortality (1.0% vs. 0, P = 0.117), and hospital mortality (1.0% vs. 0, P = 0.117). Conclusions: Critical care TPs may decrease ICU mortality and hospital mortality in critically ill cancer patients with APACHE II >15. It has no role in less severe critically ill cancer patients with APACHE II ≤15.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"19 1","pages":"96 - 99"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87056638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.4103/jtccm.jtccm_9_19
Hong Bo, Andrew J I Harrison, Yan Kang, X. Liao
Fluid overload is one of the main complications associated with intravenous fluid therapy. Weight-based fluid accumulation is often calculated for fluid balance status in most researches. Fluid overload was defined as more than a 10% increase in body weight relative to baseline. There are many evidences that fluid overload is associated with an increased risk of acute kidney injury (AKI) and mortality. This review focuses on the pathophysiological link between fluid overload and AKI. Disruption of endothelial glycocalyx induced by fluid overload plays an important role in AKI. In addition, the compositions of the fluids (some colloids and chloride-rich fluids) may also contribute to kidney injury. On the other side, fluid overload is more obvious and the outcome in patients with AKI or with more critical illness. Therefore, the relationship between fluid overload and AKI should be fully understood and carefully managed.
{"title":"Fluid Overload and Acute Kidney Injury, Chicken or Eggs?","authors":"Hong Bo, Andrew J I Harrison, Yan Kang, X. Liao","doi":"10.4103/jtccm.jtccm_9_19","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_9_19","url":null,"abstract":"Fluid overload is one of the main complications associated with intravenous fluid therapy. Weight-based fluid accumulation is often calculated for fluid balance status in most researches. Fluid overload was defined as more than a 10% increase in body weight relative to baseline. There are many evidences that fluid overload is associated with an increased risk of acute kidney injury (AKI) and mortality. This review focuses on the pathophysiological link between fluid overload and AKI. Disruption of endothelial glycocalyx induced by fluid overload plays an important role in AKI. In addition, the compositions of the fluids (some colloids and chloride-rich fluids) may also contribute to kidney injury. On the other side, fluid overload is more obvious and the outcome in patients with AKI or with more critical illness. Therefore, the relationship between fluid overload and AKI should be fully understood and carefully managed.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"66 1","pages":"81 - 88"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90931702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.4103/jtccm.jtccm_13_18
E. García-Ballestas, Juan Carreazo, H. Padilla-Zambrano, A. Agrawal, J. Charry, L. Moscote-Salazar
Cerebrovascular disease (CVD) has been studied for many years, representing a cause of high morbidity and mortality; it has a great impact at a social, economic, and psychological level in the young adult population. There are different etiological factors that we do not find in the adult population, for that it is important to know how to differentiate them. There is no definitive etiological factor in this population given that the epidemiologic profile fluctuates considerably throughout regions and provinces, even if the same country is considered to make comparisons. CVD in young adults is caused by many etiological factors, predominantly the rare ones, such as cardioembolic, small vessel disease, due to thrombophilias, and undetermined cause. Despite being the main cause, the undetermined etiology is overestimated because it deserves for a detailed investigation in search of one of the rare causes, also, because of the lack of more complex studies in centers worldwide. No atherosclerotic large vessels diseases, such as cervicocephalic artery dissection, moyamoya disease, systemic vasculitis, and other rare syndromes should be considered to make an accurate diagnosis approach.
{"title":"Etiopathogenic Factors of Cerebrovascular Disease in Young Adults: A Review of the Literature","authors":"E. García-Ballestas, Juan Carreazo, H. Padilla-Zambrano, A. Agrawal, J. Charry, L. Moscote-Salazar","doi":"10.4103/jtccm.jtccm_13_18","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_13_18","url":null,"abstract":"Cerebrovascular disease (CVD) has been studied for many years, representing a cause of high morbidity and mortality; it has a great impact at a social, economic, and psychological level in the young adult population. There are different etiological factors that we do not find in the adult population, for that it is important to know how to differentiate them. There is no definitive etiological factor in this population given that the epidemiologic profile fluctuates considerably throughout regions and provinces, even if the same country is considered to make comparisons. CVD in young adults is caused by many etiological factors, predominantly the rare ones, such as cardioembolic, small vessel disease, due to thrombophilias, and undetermined cause. Despite being the main cause, the undetermined etiology is overestimated because it deserves for a detailed investigation in search of one of the rare causes, also, because of the lack of more complex studies in centers worldwide. No atherosclerotic large vessels diseases, such as cervicocephalic artery dissection, moyamoya disease, systemic vasculitis, and other rare syndromes should be considered to make an accurate diagnosis approach.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"101 1","pages":"76 - 80"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85872035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Objective: This study aims to evaluate the predictive value of the diaphragmatic excursion for weaning from mechanical ventilation in postoperative patients with rheumatic heart disease complicated with cachexia. Methods: Eighty-four postoperative patients with rheumatic heart disease complicated with cachexia who need mechanical ventilation >72 h were enrolled for this prospective study. All patients were evaluated during the weaning process from June 2015 to March 2018. Patients received SBT for 1 h, and we performed ultrasound for the right hemidiaphragm and tested the diaphragmatic excursion. Patients who passed the SBT and no need for reintubation or non-invasive positive pressure ventilation (NIPPV) within 48 h were classified as Group A and others were classified as Group B. Results: We found that the diaphragmatic excursion of Group B (0.76 ± 0.23 cm) was significantly smaller than that of Group A (1.19 ± 0.62 cm), and the oxygen partial pressure of Group B (70.1 ± 9.2 mmHg) was significantly lower than that of Group A (98.6 ± 7.8 mmHg). Conclusion: The assessment of diaphragmatic excursion using ultrasound may be helpful to predict the outcome of weaning for postoperative patients with rheumatic heart disease complicated with cachexia.
{"title":"Diaphragmatic Dysfunction as a Predictor of Weaning Outcomes from Mechanical Ventilation in Postoperative Patients with Rheumatic Heart Disease Complicated with Cachexia","authors":"Lingai Pan, Fuxun Yang, Xiaoxiu Luo, Xiao-qin Zhang","doi":"10.4103/jtccm.jtccm_8_19","DOIUrl":"https://doi.org/10.4103/jtccm.jtccm_8_19","url":null,"abstract":"Background and Objective: This study aims to evaluate the predictive value of the diaphragmatic excursion for weaning from mechanical ventilation in postoperative patients with rheumatic heart disease complicated with cachexia. Methods: Eighty-four postoperative patients with rheumatic heart disease complicated with cachexia who need mechanical ventilation >72 h were enrolled for this prospective study. All patients were evaluated during the weaning process from June 2015 to March 2018. Patients received SBT for 1 h, and we performed ultrasound for the right hemidiaphragm and tested the diaphragmatic excursion. Patients who passed the SBT and no need for reintubation or non-invasive positive pressure ventilation (NIPPV) within 48 h were classified as Group A and others were classified as Group B. Results: We found that the diaphragmatic excursion of Group B (0.76 ± 0.23 cm) was significantly smaller than that of Group A (1.19 ± 0.62 cm), and the oxygen partial pressure of Group B (70.1 ± 9.2 mmHg) was significantly lower than that of Group A (98.6 ± 7.8 mmHg). Conclusion: The assessment of diaphragmatic excursion using ultrasound may be helpful to predict the outcome of weaning for postoperative patients with rheumatic heart disease complicated with cachexia.","PeriodicalId":93326,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"3 1","pages":"100 - 102"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74142771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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