ABSTRACT
Objective:To seek the biomarkers of diagnostic value for an early postoperative onset of intensive care unit acquired weakness(ICUAW)in liver transplant(LT)recipients.Methods:Between September 2017 and August 2019, A total of 62 consecutive allogeneic orthotopic LT liver transplantation recipients at The First People's Hospital of Kunming between September 2017 and August 2019 are prospectively reviewedenrolled in this study. Upon After entering ICU, blood samples are assayed taken for adenosine 5'-monophosphate-activated protein kinase alpha(AMPK-α)、and glucose transporter type 4(GLUT-4)test. Clinical and bBiochemical specimens are collected. When transplant recipients are during awake and cooperative hours. Their muscle strength is recordedexamined. The score table of Medical Research Council(MRC)is utilized sed as the diagnostic standard of ICUAW. And ICUAW is diagnosed with < 48 points. Based on this, 62 subjects are divided into two groups of ICUAW group(17 cases)and non-ICUAW group (45 cases). The age, sex, mechanical ventilation time, ICU hospitalization time, partial blood oxygen pressure, systolic blood pressure, central venous pressure(CRP), blood glucose, total bilirubin, alanine aminotransferase(ALT), aspartate aminotransferase(AST), γ- Glutamyl transpeptidase(γ- GGT), blood urea nitrogen, blood creatinine and levels of AMPK-α and GLUT-4 are compared between patients in ICUAW group and non-ICUAW two groups. and levels of AMPK-α and GLUT-4 were compared between patients in ICUAW group and non-ICUAW two groups. The powers of AMPK-α And and GLUT-4 in predicting ICUAW was were evaluated by receiver operating characteristic curve(ROC)and area under the curve(AUC). Differences with P<0.05 is deemed as significant. Results:ICUAW is diagnosed in 17/62(27.42%)LT recipients. ICUAW patients had longer mechanical ventilation time(27 vs. 10h, P<0.05)and extended ICU hospitalization time(4 vs. 3d, P<0.05). No significant inter-group difference existed in AMPK-α(1.01±2.43 vs. 1.74±4.24 units/ml, 95% CI: -2.92~1.45, P>0.05). And the expression of GLUT-4 declined in ICUAW patients(137.86±127.87 vs. 419.15±267.68 ng/L, 95% CI: -417.13~-145.45, P<0.05). GLUT-4 ROC curve hint at some negative predictive value for the occurrence of ICUAW. ROC curve area was 0.88 and SE 0.05( P<0.05, 95% CI: 0.78~0.98). Conclusions:ICUAW patients have longer mechanical ventilation time and extended ICU hospitalization time. Monitoring GLUT-4 offers some predictive value for ICUAW in LT recipients. Elevated GLUT-4 is associated with a low probability of ICUAW.
ABSTRACT
Objective To compare the efficiencies of enteral nutrition with nasogastric tube with that of enteral nutrition with endoscopic gastrostomy tube in ICU long-term bedridden patients. Methods A total of 6 patients who were admitted in our ICU between January 2008 and September 2009 were enrolled in this study. The expected completion of daily calorie supply, completion of total volume of nutrient fluid feeding, nutrient fluid backstreaming condition, and incidence rate of tube obstruction were compared between those supported with nasogastric tube and endoscopic gastrostomy tube. Results The completion of daily calorie supply and completion of total volume of nutrient fluid feeding were significantly superior in patients who were supported with endoscopic gastrostomy tube than those with nasogastric tube (P = 0. 002 and P = 0. 008, respectively). In addition, nutrient fluid backstreaming condition and incidence rate of tube obstruction were significantly lower than with nasogastric tube (P= 0. 011 and P = 0. 021, respectively). Conclusion Enteral nutrition with endoscopic gastrostomy tube is more efficient in reaching the nutrition support target than with nasogastric tube.