Objective To investigate the postoperative treatment of pleuropneumonectomy for tuberculosis destroyed lung in ICU, in order to improve the therapeutical efficacy for these patients. Methods Clinical data of 52 patients who suffered from tuberculosis destroyed lung and underwent pleuropneumonectomy from June 2008 to June 2010 were analyzed retrospectively. All of subjects received routine treatment in ICU after the operation. Meanwhile，appropriate targeting treatments were applied including diagnosis and treatment of postoperative bleeding; application of fiberbronchoscope to aspirate the sputum after the operation,sequential non-invasive ventilation after the invasive ventilation for acute respiratory failure after operation ,etc.Results A total of 52 patients received the pleuropneumonectomy operation. Bleeding occurred in 11 cases after operation and stopped after the integrated therapy. 8 patients suffered from acute respiratory failure and attenuated after sequential ventilation. No patients died for postoperative bleeding or acute respiratory failure. Conclusions Patients who suffered from tuberculosis destroyed lung and received pleuropneumonectomy with postoperative bleeding and acute respiratory failure have a good prognosis after appropriate postoperative treatment in ICU.
侵袭性真菌感染(IFI)不仅可发生在恶性血液病、恶性肿瘤、器官移植和AIDS等经典免疫功能缺陷患者中，近年来ICU的重症患者由于严重的基础疾病、外科手术指征和范围的扩大、各种导管的体内介入与留置，以及广谱抗生素和糖皮质激素的广泛应用等，IFI发病率也迅速增加。据统计，IFI占医院获得性感染的8％-15％。IFI病情进展快速、凶险，已13益成为导致ICU危重病患者死亡的重要原因之一。引起ICU IFI的病原体包括念珠菌、曲霉、隐球菌、镰刀霉、接合菌、肺孢子菌等，其中以念珠菌和曲霉最多见，占90％ 以上。由于ICU危重症患者多数属非经典IFI高危人群，临床表现缺乏特异性，临床诊治极为困难。本文就ICU内侵袭性念珠菌感染(Ic)和侵袭性曲霉感染(IA)的流行病学、诊断和治疗进展进行阐述，以期对临床有所裨益。
ObjectiveTo explore the applicability of early goal-directed sedation (EGDS) in intensive care unit (ICU) patients with mechanical ventilation.MethodsAn prospective double blind study was conducted. ICU patients with mechanical ventilation in the First Affiliated Hospital of Jinzhou Medical University were recruited as research objects by chester sampling from September 2015 to September 2017, and divided into an experimental group and a control group by stratified randomization. Two groups were sedated on the basis of adequate analgesia. The experimental group adopted the EGDS strategy that dexmedetomidin was the first choice to be infused at the rate of 1 μg·kg–1·h–1. And the patients were given Richmond agitation-sedation score (RASS) on the interval of 4 hours: used additionally propofol and midazolam if RASS>2, or reduced right metomomidin at the speed of 0.2 μg·kg–1·h–1 per 30 min if RASS<–3, and stopped sedation until RASS of –2 to 0. The control group adopted routine sedation strategy that propofol was the first choice to be infused and combined with dexmedetomidine and midazolam until RASS score in –2 to –3. The doses of sedative drugs, mechanical ventilation time, ICU-stayed time, total hospitalization time and the incidence of adverse events such as delirium, accidental extubation, and ICU death were compared between two groups.ResultsSixty-sis cases were selected in the experimental group and 71 in the control group. The baseline data such as gender, age, acute physiology chronic health evaluation Ⅱ (APACHEⅡ), or basic diseases in two groups had no significant differences. Compared with the control group, the per capita total doses of dexmedetomidine, propofol and midazolam in the experimental group were significantly less [right metopromicine (μg): 154.45±27.86 vs. 378.85±39.76; propofol (mg): 4 490.03±479.88 vs. 7 349.76±814.31; midazolam (mg): 255.38±46.24 vs. 562.79±97.26; all P<0.01], mechanical ventilation time, ICU-stayed time, total hospitalization time were significantly lower [mechanical ventilation time (d): 7.7±3.3vs. 11.7±3.6; ICU-stayed time (d): 10.2±3.9 vs. 19.2±4.1, total hospitalization time (d): 29.9±4.6 vs. 50.4±9.1; all P<0.01]. The Kaplan-Meier survival curves showed that the incidence of delirium in the experimental group was significantly lower than that in the control group (log-rankχ2=5.481, P<0.05). The accidental extubation rate and accidental fatality rate in two groups had no significant differences (log-rankχ2=0.078, 0.999, P>0.05).ConclusionEGDS can not only reduce the dose of sedative drugs, shorten the mechanical ventilation time, the ICU-stayed time and the total hospitalization time, but also reduce the incidence of delirium, so it has a positive impact in ICU patients with mechanical ventilation.
Objective To investigate the species distribution and antibiotic resistance among the bloodstream infections in intensive care unit ( ICU) . Methods A retrospective analysis was performed to review the microbiological and susceptibility test data of all bloodstream infections in ICU from January 2004 to September 2009. The patterns of antibiotic resistance among the top five bacteria were compared. Results 89 cases of bloodstream infection were detected with 112 strains, including 55 Gram-positive ( G+ ) bacteria( 49. 1% ) , 55 Gram-negative ( G- ) bacteria ( 49. 1% ) , and 2 fungi ( 1. 8% ) . The main pathogens causing bloodstream infection were Burkholderia spp. ( 33, 29. 5% ) , S. epidermidis( 31, 27. 7% ) , Klebsiella pneumoniae ( 7, 6. 3% ) , S. aureus ( 7, 6. 3% ) , S. hominis ( 6, 5. 4% ) , Acinetobacter baumannii ( 6,5. 4% ) , Pseudomonas aeruginosa( 5, 4. 5% ) and S. haemolyticus( 5, 4. 5%) , suggesting that Burkholderia spp. was predominant pathogenic G- bacteria, and coagulase-negative staphylococcus was predominant G+ bacteria. The antibiotic resistance tests demonstrated that isolated G- bacillus was highly sensitive to carbopenem, while vancomycin-resistant G+ cocci were not found. Conclusions Within the latest 5 years,the prevalence of G+ bacteria infection is almost equivalent to G- bacteria in blood stream infection.Coagulase-negative staphylococcus is the mainly G+ bacteria and Burkholderia spp. is predominant in G- bacteria. Carbopenemand glycopeptides still remain to be the first choice.
ObjectiveTo investigate the application value of noninvasive ventilation (NIV) performed in patients with unplanned extubation (UE) in intensive care unit (ICU).MethodsThis was a retrospective analysis. The clinical data, application of NIV, reintubation rate and prognosis of UE patients in the ICU of this hospital from January 2014 to December 2018 were reviewed, and the patients were assigned to the control group or the NIV group according to the application of NIV after UE. The data between the two groups were compared and the application effects of NIV in UE patients were evaluated.ResultsA total of 66 UE patients were enrolled in this study, including 44 males and 22 females and with an average age of (64.2±16.1) years. Out of them, 41 patients (62.1%) used nasal catheter or mask for oxygenation as the control group, 25 patients (37.9%) used NIV as the NIV group. The Acute Physiology andChronic Health EvaluationⅡ score of the control group and the NIV group were (18.6±7.7) vs. (14.8±6.3), P=0.043. The causes of respiratory failure in the control group and the NIV group were as follows: pneumonia 16 patients (39.0%) vs. 7 patients (28.0%), postoperative respiratory failure 7 patients (17.1%) vs. 8 patients (32.0%), chronic obstructive pulmonary disease 8 patients (19.5%) vs. 6 patients (24.0%), others 5 patients (12.2%) vs. 4 patients (16.0%), heart failure 3 patients (7.3%) vs. 0 patients (0%), nervous system diseases 2 (4.9%) vs. 0 patients (0%), which showed no significant difference between the two groups. Mechanical ventilation time before UE were (12.5±19.8) vs (12.7±15.2) d (P=0.966), PaO2 of the control group and the NIV group before UE was (114.9±37.4) vs. (114.4±46.3)mm Hg (P=0.964), and oxygenation index was (267.1±82.0) vs. (257.4±80.0)mm Hg (P=0.614). Reintubation rate was 65.9% in the control group and 24.0% in the NIV group (P=0.001). The duration of mechanical ventilation was (23.9±26.0) vs. (21.8±26.0)d (P=0.754), the length of stay in ICU was (34.4±36.6) vs. (28.5±25.8)d (P=0.48). The total mortality rate in this study was 19.7%. The mortality rate in the control group and NIV group were 22.0% and 16.0% (P=0.555).ConclusionPatients with UE in ICU may consider using NIV to avoid reintubation.
ObjectiveTo identify the incidence of postintubation hypotension (PIH) in critically ill patients and evaluate the responsive risk factors and prognosis. MethodsThe data of intubation patients with normal blood pressure before intubation were collected and analyzed in Intensive Care Unit (ICU) in the latest two years and divided into two groups. One contained PIH patients and the other one contained patients with no change in blood pressure after intubation. The primary outcome measure was 28-day mortality and secondary outcome measure was length of stay (LOS) in ICU and hospital. ResultsThere were 25(31.65%) PIH patients in included 79 patients. The patients in PIH group had significantly higher 28-day mortality (40.00% vs 14.81%, P=0.01) and there were no difference in LOS in ICU and hospital. Risk factors were age (OR:1.1, 95% CI:1.00-1.12), chronic respiratory diseases (OR:3.0, 95% CI:1.13-8.07) and complication with over two chronic diseases (OR:3.6, 95% CI:1.18-11.03). ConclusionPIH is more common in old patients complicated with chronic diseases and results in higher 28-day mortality.
Objective To investigate the characteristics of ventilator associated pneumonia (VAP)caused by Stenotrophomonas maltophilia(Sm)in ICU。Methods The clinical data of 39 patients with VAP caused by Sm，from Jan 2001 to Dec 2006，were retrospectively investigated．Results In 15 kinds of antibiotics sensitivity test，all cases showed 100％ resistance to 12 kinds of antibiotics except sulfamethoxazole／trimethoprim。ticarcillin／clavulanic acid and ciprofloxacin with sensitivity rate of 46．2％ ， 30．8％ and 12．8％ ．respectively．92．30％ of Sm VAP were CO—infected with other microorganisms and 79．5％ of VAP were late-onset．The use of broad-spectrum antibiotics．especially carbapenem．and prolonged mechanical ventilation more than 7 days were risk factors for Sm VAP．Morbidity of Sm VAP was 87．2％ ．Conclusions Sm VAP has an important role in ICU infections with high morbidity and CO-infection rate．It should be alerted to the possibility of Sm VAP in the case of when prolonged ventilation (gt;7 days)or carbapenem is used．
Objective To investigate the role and mechanisms of trimetazidine (TMZ) in intensive care unit-acquired weakness (ICU-AW). Methods Seventy wild-type male C57BL/6 mice were selected and the ICU-AW mouse model was constructed by intraperitoneal injection of different concentrations of lipopolysaccharide (LPS). The body weights, grip strengths, and 96-hour survival rates of each group were observed, and the optimal concentration of LPS and time of sampling were screened out, the mRNA and protein expression of the gastrocnemius muscle atrophic proteins Atrogin-1 and muscle-specific RING finger protein 1 (MuRF1) were further detected to verify the success of modelling, and LPS (12 mg/kg) was used as the subsequent modelling concentration according to the preliminary results. After successful modelling, another 70 mice were randomly divided into normal control group (Normal group), LPS solvent (Vehicle) group, LPS group, LPS+TMZ solvent group, LPS+TMZ group, LPS+TMZ+AC-YVAD-CMK (AC) solvent group, and LPS+TMZ+AC group, with 10 mice in each group. The Normal group did not have any intervention; the Vehicle group was injected intraperitoneally with an equal volume of saline with LPS; the remaining groups were injected intraperitoneally with LPS (12 mg/kg); after the completion of the LPS injection, the LPS+TMZ group, the LPS+TMZ+AC solvent group, and the LPS+TMZ+AC group were given TMZ (5 mg/kg) by gastric gavage once a day for 4 days. The LPS+TMZ solvent group was given TMZ equivalent saline gavage once a day for 4 days. The LPS+TMZ+AC group was injected intraperitoneally with the cysteinyl aspartate specific proteinase 1 (Caspase-1) inhibitor AC-YVAD-CMK (AC, 6.5 mg/kg) 1 h before LPS injection, and the LPS+TMZ+AC solvent group was injected with an equal amount of AC solvent phosphate buffer. At the end of TMZ treatment, body weight, grip strength, 96-hour survival rate, mRNA and protein expression of MuRF1, Atrogin-1, Caspase-1, and gasdermin D (GSDMD) in gastrocnemius muscle, as well as serum IL-1β and IL-18 concentrations in mice were detected in each group, and the gastrocnemius muscle was stained with HE to observe histopathological changes. Results Compared with the Normal group, mice in the LPS (12 mg/kg) and LPS (14 mg/kg) groups showed significant decreases in body weight and grasping strength and the weakening was most obvious at 3 - 5 d (P<0.05), but the survival rate of the LPS (12 mg/kg) group was higher than that of the LPS (14 mg/kg) group (P<0.05), the HE staining of gastrocnemius muscle showed that the mice in the LPS (12 mg/kg) group was significantly atrophied compared with that of the Normal group, and the gene and protein expression of MuRF1 and Atrogin-1 were significantly elevated (P<0.05), and the mice injected with LPS (12 mg/kg) for 4 days (96 h) were finally selected as the conditions for subsequent experimental modelling and sampling.The mRNA and protein expression of Caspase-1 and GSDMD in skeletal muscle was significantly higher in the LPS group compared with the Normal and Vehicle groups (P<0.01), and the concentrations of serum IL-1β and IL-18 were significantly higher(P<0.01). Mice in the TMZ group showed significant improvement in body weight, grip strength, survival rate, and degree of muscle atrophy compared with the LPS and TMZ solvent groups (P<0.05); gene and protein levels of MuRF1, Atrogin-1, Caspase-1, and GSDMD in the gastrocnemius muscle were significantly reduced (P<0.05); and levels of serum IL-1β and IL-18 were significantly reduced (P<0.05) ); the mice in the LPS+TMZ+AC group had significantly improved body weight, grip strength, survival rate, and muscle atrophy compared with the LPS+TMZ group and the LPS+TMZ+AC solvent group (P<0.05), and the gene and protein contents of MuRF1, Atrogin-1, Caspase-1, and GSDMD in the gastrocnemius muscle were reduced (P<0.05), and the serum IL-1β and IL -18 concentrations were reduced (P<0.05). Conclusion TMZ is able to exert a skeletal muscle protective effect by inhibiting Caspase-1/GSDMD-mediated pyroptosis, which is an important reference for the prevention and treatment of ICU-AW.
Objective To evaluate systematically the effectiveness and safety of procalcitonin ( PCT) -guided therapy in comparison with standard therapy in patients with suspected or confirmed severe bacterial infections in intensive care unit ( ICU) . Methods Five randomized controlled trials ( 927 patients) were included for statistical analysis by the cochrane collaboration′s RevMan5. 0 software. Results PCT-guided therapy was associated with a significant reduction in duration of antibiotic therapy [ MD =- 2. 01, 95% CI ( - 2. 37, - 1. 64) , P lt;0. 00001] , but the mortality [ OR =1. 11, 95% CI ( 0. 83, 1. 49) ,P =0. 47] and length of ICU stay[ MD = 0. 49, 95% CI( - 1. 44, 2. 42) , P = 0. 62] were not significantly different. Conclusions An algorithmbased on serial PCT measurements would allow a more judicious use of antibiotics than currently traditional treatment of patients with severe infections in ICU. It can reduce the use of antibiotics and appears to be safe.