Effect of early off-bed mobility on diaphragm function in intensive care unit patients undergoing mechanical ventilation / 中华危重病急救医学

Objective:To explore the improvement of diaphragm function after early off-bed mobility intervention in intensive care unit (ICU) patients undergoing mechanical ventilation.Methods:A randomized controlled trial was conducted. A total of 147 adult patients undergoing mechanical ventilation admitted to ICU of Affiliated Hospital of Zunyi Medical University from October 2019 to March 2022 were enrolled. The patients were divided into control group and observation group by convenient sampling. Except for the different intervention programs of early mobility, other treatment and nursing of the patients in the two groups were carried out according to ICU routine. Progressive early activities were performed in the control group, while early off-bed mobility was performed in the observation group. The changes of diaphragm thickness at the end of inspiratory (DTei), diaphragm thickness at the end of expiratory (DTee) and diaphragm thickening fraction (DTF) before and 24, 48, 72 and 96 hours of intervention, and the duration of mechanical ventilation, length of ICU stay and 24-hour re-intubation rate after intervention were compared between the two groups.Results:Among the 147 patients, there were 4 cases of detachment in the control group and 5 cases of detachment in the observation group. Finally, 138 patients were enrolled, 69 cases in the control group and 69 cases in the observation group. There was no significant difference in gender, age, diagnosis of ICU, sedatives, muscle strength, ventilator model, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and DTei, DTee, DTF before intervention between the two groups. The DTei, DTee and DTF in both groups were increased gradually with the extension of intervention time, especially in the observation group [DTei (cm) at 24, 48, 72 and 96 hours of intervention in the observation group were 0.247±0.014, 0.275±0.016, 0.300±0.013 and 0.329±0.013, while in the control group were 0.242±0.015, 0.258±0.013, 0.269±0.014, and 0.290±0.017, effect of time: F = 993.825, P = 0.000, effect of intervention: F = 82.304, P = 0.000, interaction effect between intervention and time: F = 84.457, P = 0.000; DTee (cm) of the observation group were 0.213±0.014, 0.227±0.013, 0.243±0.016, 0.264±0.010, while in the control group were 0.213±0.016, 0.218±0.013, 0.224±0.013, 0.234±0.014, effect of time: F = 385.552, P = 0.000, effect of intervention: F = 28.161, P = 0.000, interaction effect between intervention and time: F = 45.012, P = 0.000; DTF of the observation group were (15.98±4.23)%, (21.35±4.67)%, (24.09±4.44)% and (25.24±3.74)%, while in the control group were (14.17±4.66)%, (18.11±3.92)%, (20.22±4.19)% and (20.98±4.12)%, effect of time: F = 161.552, P = 0.000, effect of intervention: F = 49.224, P = 0.000, interaction effect between intervention and time: F = -4.507, P = 0.000]. The duration of mechanical ventilation and length of ICU stay in the observation group were significantly shorter than those in the control group [duration of mechanical ventilation (hours): 112.68±12.25 vs. 135.32±22.10, length of ICU stay (days): 7.84±1.78 vs. 10.23±2.43, both P < 0.01]. However, there was no significant difference in 24-hour re-intubation rate between the observation group and the control group (0% vs. 2.90%, P > 0.05). Conclusions:Both early off-bed mobility and progressive early activities can prevent diaphragm weakness in ICU patients undergoing mechanical ventilation, and the effect of early off-bed mobility is better. Early off-bed mobility can significantly shorten the duration of mechanical ventilation and length of ICU stay, and it is safe and feasible.

Effect of early off-bed mobility on delirium in mechanical ventilated patients in intensive care unit: a prospective randomized controlled study / 中华危重病急救医学

Objective:To investigate the feasibility of early off-bed mobility in patients with mechanical ventilation and its effect on delirium and the duration of delirium in the intensive care unit (ICU).Methods:Adult patients who were admitted to ICU of the Affiliated Hospital of Zunyi Medical University from January 1st to December 31st 2020 for invasive mechanical ventilation and no early activity contraindication were selected. The patients were randomly divided into two groups. The experimental group conducted early off-bed mobility, such as using the shift machine off-bed sitting and walking aids to assist standing and walking, and the off-bed mobility is based on patient tolerance. The control group was given early bed activities, including conducting the joint range activity, limb movement, bed sitting, upper limb elastic belt movement, and lower limb cycling, once a day. Each joint moved 15-20 times, a total of 30 minutes. Both groups were treated with anti-infection, mechanical ventilation, analgesia and sedation, and nutrition therapy. After intervention, confusion assessment method for the ICU (CAM-ICU) was used to assess the onset and duration of delirium, physical restraint rate and duration of physical restraint, mechanical ventilation time, and the length of ICU stay.Results:After excluding patients who died or gave up treatment during the intervention period, 266 patients were included, with 133 patients in the experimental group and 133 patients in the control group. There were no significant differences in gender, age, diagnosis, degree of illness, sedative drugs between the two groups. The incidence of the delirium in intervention group was significantly lower than that in control group [26.3% (35/133) vs. 42.1% (56/133), χ 2 = 7.366, P = 0.007], the duration of delirium was shorter than that in control group (hours: 11.26±4.11 vs. 17.00±3.29, t = -4.157, P = 0.000), the rate of physical restraint was lower than that in control group [19.5% (26/133) vs. 45.1% (60/133), χ 2 = 19.864, P = 0.000], the duration of physical restraint was shorter than that in control group (hours: 9.71±4.07 vs. 13.55±7.40, t = -5.234, P = 0.000), the mechanical ventilation time and the length of ICU stay were shorter than those in control group [mechanical ventilation time (hours) : 106.23±42.25 vs. 133.10±41.88, t = -3.363, P = 0.001; length of ICU stay (days) : 8.35±6.21 vs. 13.25±9.98, t =-4.190, P = 0.000]. Conclusions:Early off-bed mobility can reduce physical restraint rate and the incidence of delirium, and thus can accelerate rehabilitation in critically ill patients. Early off-bed mobility is safe and effective for patients with mechanical ventilation in ICU.

Effect of progressive early bed exercise on blood flow in lower limb of patients on mechanical ventilation in intensive care unit / 中华危重病急救医学

Objective To investigate the effect of progressive early bed physical activity on blood flow in lower limb of patients on mechanical ventilation in intensive care unit (ICU). Methods Adult patients with mechanical ventilation ≥ 72 hours admitted to ICU of the Affiliated Hospital of Zunyi Medical University from February 22nd to November 30th, 2016 were enrolled. The patients were randomly divided into experimental group and control group by random number table method. Patients in the two groups were given the same basic treatment, including antibiotics, analgesia and sedation, mechanical ventilation, nutritional support, and routine ICU activities such as maintaining functional position of limbs and raising of bed head. On the basis of those, the experimental group was given early bed physical activity with gradual enhancement of grades Ⅰ-Ⅲ according to the nerve, circulation and respiration situations, such as passive/active exercise of the bicycle, straight leg lifting exercise, etc. The exercise intensity was evaluated with target heart rate, and the exercise was performed for 15-30 minutes at a time, twice a day. The control group was given intermittent pneumatic compression (IPC), 30 minutes in each time, twice a day. Mean blood flow and blood volume were measured before and immediately, 5, 10 and 15 minutes after intervention on the 3rd day. Heart rate and blood pressure were measured at 5 minutes before intervention, during 5 minutes, and 5, 10, 15, 30 minutes after intervention on the 3rd day. Results 214 adult patients were selected, after excluding the patients who died during the intervention or gave up treatment, 160 patients were included in the data analysis, with 81 in the experimental group and 79 in the control group. The mean blood flow velocity and blood volume were increased in both groups, and the mean blood flow velocity and blood flow volume in the experimental group were significantly increased and lasted longer than those in the control group [mean blood flow velocity (mm/s) of the experimental group were 11.92±1.06, 18.19±0.17, 17.24±0.14, 15.48±0.12, 12.68±0.16, and that of the control group were 12.01±1.41, 15.65±0.18, 12.91±0.14, 12.13±0.12, 11.59±0.16, respectively, the time effect was F = 1 043.101, P = 0.000, the intervention effect was F = 151.001, P = 0.000, and the interaction effect between intervention and time was F = 224.830, P = 0.001; the blood volume (mL/min) of the experimental group were 3.39±0.96, 5.59±0.11, 5.16±0.12, 4.19±0.10. 3.35±0.09, and that of the control group were 3.28±0.82, 4.04±0.11, 3.40±0.12, 3.02±0.10, 3.00±0.10, respectively, the time effect was F = 680.405, P = 0.000, the intervention effect was F = 125.359, P = 0.000, and the interaction effect between intervention and time was F = 79.631, P = 0.012]. The heart rate and blood pressure of the two groups of patients in the course of intervention were increased first, then decreased and then slowly recovered to the change trend before intervention, but the index of the experimental group fluctuated greatly [heart rate (bpm) of the experimental group were 97.64±1.50, 113.91±1.36, 105.96±1.34, 98.52±1.48, 97.84±1.46, 97.54±1.48, and that of the control group were 97.03±1.57, 105.39±1.38, 96.76±1.35, 96.54±1.50, 97.22±1.48, 96.53±1.49, respectively, the time effect was F = 235.030, P = 0.000, the intervention effect was F = 39.473, P = 0.000, and the interaction effect between intervention and time was F = 3.494, P = 0.063; the systolic blood pressure (mmHg, 1 mmHg = 0.133 kPa) of the experimental group were 118.57±1.06, 133.05±1.01, 120.44±1.10, 117.78±1.07, 117.65±1.01, 118.14±1.00, and that of the control group were 118.10±1.08, 126.68±1.02, 118.23±1.11, 117.48±1.08, 118.04±1.03, 118.90±1.10, respectively, the time effect was F = 336.604, P = 0.000, the intervention effect was F = 26.350, P = 0.000, and the interaction effect between intervention and time was F = 0.948, P = 0.332; the diastolic blood pressure (mmHg) of the experimental group were 68.07±0.72, 72.79±0.73, 70.68±0.74, 69.30±0.72, 68.73±0.74, 67.80±0.73, and that of the control group were 68.51±0.73, 72.03±0.74, 70.05±0.75, 69.10±0.73, 68.41±0.75, 67.85±0.74, respectively, the time effect was F = 286.390, P = 0.000, the intervention effect was F = 4.812, P = 0.000, and the interactive effect between intervention and time was F = 0.055, P = 0.815]. Conclusions The effects of progressive early bed physical activity on the mean blood flow velocity and blood volume of lower limbs in ICU patients with mechanical ventilation are better than those of IPC. Although the fluctuation of heart rate and blood pressure is large, it does not cause any harm to the patients.

Risk factors of venous thomboembolism in ICU:a Meta-analysis / 重庆医学

Objective To systematically analyze the risk factors of venous thromboembolism (VTE) occurrenced in intensive care unit(ICU).Methods The literatures on risk factors for ICU-acquired VTE were retrieved from PubMed,Cochrane Library,Embase,ScienceDirect,CNKI,WanFang,VIP and CBM Databases.Then the data was extraction and quality assessment was performed.The RevMan 5.3 software was used for conducting the Meta-analysis.Results Fifteen articles were included,involving 939 VTE cases.The meta analysis results of different factors were the renal insufficiency(OR =14.60),deep v ein thrombosin(DVT)/pulmonary embolism (PE) history(OR=8.23),rencent surgery history(OR =6.75),age＞ 60 years old(OR =4.84),shock(OR =4.36),malignant tumors (OR=2.76),central venous catheter(OR=2.54),heart function grade＞3(OR=2.27),mechanical ventilation(OR=1.57),D-dimer(WMD=423.99),APACHE Ⅱ score(WMD=4.25).Conclusion The risk factors of developing VTE in ICU are renal insufficiency,DVT/PE history,recent surgery history,age≥60 years old,shock,malignant tumors,central venous catheter,heart function grade＞3,mechanical ventilation,D-dimer and high APACHE Ⅱ score.

The effectiveness of intensive insulin therapy for preventing intensive care unit acquired weakness：a Meta-analysis / 重庆医学

Objective To assess the effect of the intensive insulin therapy for preventing the intensive care unit acquired weakness systematically ,in order to provide reference for making the intervention strategy .Methods We searched the database CBM ,CNKI ,WanFang Data ,VIP ,PubMed ,Cochrane Library ,EMBASE and ISI from the day of establishment to Dec 2014 to find the relevant studies with computer and by hand .Two researchers selected the studies ,evaluated the quality of the articles and ex‐tracted data according to the rigorous criterion ,then we performed the Meta‐analysis on the data with the software RevMan5 .3 .Re‐sults Three articles were enrolled ,2 788 patients in the intensive care unit were recruited ,including 1 380 patients were from the experimental group and 1 408 patients came from the controlled group .The result of the Meta‐analysis showed that compared to the conventional insulin therapy ,intensive insulin therapy reduced the incidence of intensive care unit weakness(RR= 0 .61 ,95% CI:0 .42-0 .89 ,P=0 .01) ,but there was no statistical significance of it on the the intensive care unit mortality(RR=0 .74 ,95% CI:0 .47-1 .17 ,P=0 .20) ,the hospital mortality(RR=0 .81 ,95% CI:0 .58 -1 .13 ,P= 0 .22) ,the duration of intensive care unit stay (MD=0 ,95% CI:-0 .37-0 .37 ,P=1 .00) and the duration of mechanical ventilation(MD= -1 .48 ,95% CI:-3 .43-0 .47 ,P=0 .14) . Conclusion Intensive insulin therapy can reduce the incidence of intensive care unit acquired weakness ,but the effect of it on the intensive care unit mortality ,hospital mortality ,duration of intensive stay and duration of mechanical ventilation needs further research to verify .

Adaptability of oleaginous microalgae Chlorococcum alkaliphilus MC-1 cultivated with flue gas / 生物工程学报

In order to lower the cost of lipid production of microalgae and reduce greenhouse gas emissions, microalgae Chlorococcum alkaliphilus MC-1 with the characteristics of rapid pH drift and high pH adaptability, was cultivated with bubbling of flue gas. The experiment was first performed in the photobioreactor (15 L) in three groups (control group, CO2 group and flue gas group), then, in the open raceway pond (24 m2). The adaptability of microalgae MC-1 to the cultivation with flue gas was studied. The results showed that the maximum biomass concentration, growth rate, total lipid content and CO2 fixation rate were (1.02+/-0.07) g/L, (0.12+/-0.02) g/(L.d), (37.84+/-0.58)% and (0.20+/-0.02) g/(L.d) in the photobioreactor treated with flue gas, 36%, 33.33%, 15.34% and 33.33% higher than those of the CO2 group, respectively. In the open raceway pond with aeration of flue gas, the maximum biomass concentration, growth rate, total lipid content and CO2 fixation rate were 147.40 g/m2, 14.73 g/(m2.d), 35.72% and 24.01 g/(m2.d), respectively, which were similar to the cultivation with pure CO2. The toxic heavy metal contents (Pb, As, Cd and Cr) in the biomass of MC-1 treated with flue gas were all below the legal limits. Additionally, the absorptive effect of CO2, NO and SO2 were determined. In the photobioreactor and open raceway pond, the average absorption ratios of these gases were all higher than previous studies. Therefore, our study showed that MC-1 can adapt to the cultivation with flue gas, and it is feasible to enlarge the outdoor cultivation of MC-1 for lipid production coupling with emissions reduction of flue gas.

CT-guided percutaneous acetic acid injection combined with transcatheter arterial chemoembolization in the treatment of primary hepatocellular carcinoma / 介入放射学杂志

Objective To study the curative effect of CT-guided percutaneous acetic acid injection(PAI)combined with transcatheter arterial chemoembolization(TACE)in the treatment of primary heaptocellular carconima.Methods 52 cases with primary heaptocellular carconima were divided into two groups.26 cases were treated with TACE and PAI,combined group comparing with other 26 cases treated with TACE group.Results Decrease of AFP,shrinkage of tumor mass and survival rate of 1-2 years of the combined group and TACE group were 78.3% vs 50.0%,65.4%(17/26) vs 38.5%(10/26)and 73.1%(19/26),52.6%(10/19) vs 57.7%(15/26),33.3%(5/15),respectively;with statistical significance(P