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Objective:To evaluate the prognostic value of transthoracic lung ultrasound comet-tail and extravascular lung water index (EVLWI) in septic patients.Methods:A prospective cohort study was conducted. Sixty septic patients admitted to department of intensive care unit (ICU) of Sichuan Provincial People's Hospital from November 2016 to October 2019 were enrolled. The EVLWI and pulmonary vascular permeability index (PVPI) were determined by pulse-indicated continuous cardiac output (PiCCO) system at 0, 24, 48 and 72 hours. At the same time, the numbers of comet tail signs in both lungs (parasternal, midclavicular, axillary to midaxillary) were collected by chest ultrasound. Moreover, arterial blood gas analysis, such as pH value, central venous-to-arterial carbon dioxide difference (Pcv-aCO 2), central venous oxygen saturation (ScvO 2), blood lactic acid (Lac), PaO 2/FiO 2 were measured. Pearson correlation analysis was performed between the number of comet-tail sign and EVLWI. Multivariate Logistic regression model was used to analyze the relationship between the number of comet-tail sign, EVLWI and prognosis. Receiver operator characteristic curve (ROC curve) was drawn to predict the prognosis. Results:There were 43 males and 17 females in 60 septic patients. The average age was (64.3±15.5) years old (range: 31-83 years old). There were 35 cases with pulmonary infection, 10 cases with abdominal infection, 6 cases with urinary tract infection, 3 cases with skin and soft tissue infection, 3 cases with intestinal infection, 1 case with meningitis, 1 case with cellulitis and 1 case with multiple injury. Acute respiratory distress syndrome (ARDS) occurred with 8 patients; 40 patients (66.7%) survived and 20 patients (33.3%) died on day 28. Pearson correlation analysis showed that the number of comet-tail sign was positively correlated with EVLWI ( r = 0.944, P < 0.001). There was significant difference in the number of comet-tail signs among sepsis patients with different primary infection sites ( H = 17.714, P < 0.001). The number of comet-tail signs in sepsis patients with pulmonary infection [19 (13, 27)] was significantly higher than that with other infections. The number of comet-tail sign in patients with ARDS was significantly higher than that in patients without ARDS [27 (19, 30) vs. 15 (9, 24), H = 25.387, P < 0.001]. Multivariate Logistic regression analysis showed that EVLWI, the number of comet-tail signs and PVPI were independent risk factors for death in septic patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 10.772 (1.161-99.851), 2.360 (1.070-5.202), 2.042 (1.152-3.622), all P < 0.05]. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value of Logistic regression model based on comet-tail sign and EVLWI were 90.0%, 90.0%, 90.0%, 81.8%, 94.7%, respectively, and area under curve (AUC) were 0.926±0.018, 95% CI was 0.912-0.975, P < 0.001. Conclusions:The transthoracic lung ultrasound comet-tail in septic patients is significantly correlated with EVLWI monitored by PiCCO. The transthoracic lung ultrasound comet-tail combined with EVLWI can better improve the sensitivity, specificity and accuracy of 28-day prognosis in septic patients.
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Objective To explore the value of speckle tracking imaging ( STI) in the evaluation of left ventricular longitudinal movement function in patients with sepsis. Methods From April 2015 to November 2016,sixty?eight patients (sepsis group) who were admitted into ICU of Sichuan Provincial People's Hospital and other 68 healthy subjects ( control group) were selevted in the study. The total longitudinal strain values of 3 long axes and the longitudinal strain of each segment of the left ventricle were measured by STI technique. Results The overall strain values of the septic group and the control group on the left ventricular long axis were (-17. 34±4. 34) and (-18. 43±2. 90),respectively. The difference between the two groups was statistically significant ( P=0. 04 ) , and the overall strain of the sepsis group was relatively low. The apical segment of posterior ventricular septal,the middle section of anterior septal and lateral wall of the two groups had showed no statistically significant difference ( P<0. 05) ,the differences in the other longitudinal strain values of each segment in left ventricular of the two groups were statistically significant( P<0. 05) . The longitudinal strain values of the posterior ventricular septal were (-14. 11 ± 3. 21 ) and (-18. 23 ± 2. 34 ) , ( P=0. 018 ); the longitudinal strain of the middle segment of ventricular septal were (-20. 38±2. 78) and (-17. 30±3. 42),(P=0. 024);the longitudinal strain of the basal segment of the anterior ventricular septal were (-16. 98±3. 51) and (-17. 32 ± 2. 35 ) , ( P=0. 012 ); the anterior interventricular septal apical longitudinal strain value were (-13. 11±5. 21) and (-22. 43 ± 1. 64) ( P=0. 044); the longitudinal strain values of the front wall were (-16. 22±5. 93) and (-19. 72 ± 4. 81) ( P=0. 030); the longitudinal strain values of the lower wall were (-18. 54±4. 97) and (-20. 01±3. 26),(P=0. 002); the longitudinal strain of the posterior wall is (-17. 82 ±2. 31) and (-19. 57±3. 11) (P=0. 021). Conclusion The STI technique can find out the myocardial injury in the early stage of sepsis,which offers a reliable way for evaluation of sepsis patients.
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Objective:To investigate the effect of bedside ultrasound in measuring the gastric residual volume in postoperative patients with rheumatic heart disease complicated with cachexia with enteral nutrition support.Method:From June 2015 to May 2017,60 patients with rheumatic heart disease complicated with cachexia who admitted in ICU were randomly divided into two groups,group A (routine enteral nutrition plan plus ultrasound monitoring GRV)and group B (routine enteral nutrition plan plus withdraw every 4h to monitor the GRV),to guide the implementation of enteral nutrition.Results:There was significant difference in Hb,TP and ALB levels between the two groups (P ＜0.05).The nutritional status of group A was better than that of group B.The incidence of gastric retention and pulmonary infection in group A was significant lower than group B (P ＜0.05).The length of target feeding time and ICU stay had a statistically difference in group A and group B [(3.02 ± 0.78) d vs (4.89 ± 0.69) d,t=2.278,P=0.019] and [(10.41 ± 1.98) d vs (11.39 ± 1.75) d,t=2.384,P=0.015].Conclusion:The application of bedside ultrasound to monitor the gastric residual volume can be an accurate method to guide enteral nutrition in postoperative patients with rheumatic heart disease complicated with cachexia,which can improve the nutrition status,shorten the length of target feeding time and ICU stay and reduce enteral nutrition-related complications.
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<p><b>OBJECTIVE</b>To investigate the changes of plasma gelsolin level in patients with critical illness and its application in prognostic evaluation.</p><p><b>METHODS</b>Ninety six critically ill patients admitted in ICU of Sichuan Provincial People's Hospital from February 2012 to December 2013 were enrolled in the prospective cohort study. Plasma gelsolin levels were detected with enzyme linked immunosorbent assay (ELISA) at admission (d1), d2, d4 and d8 after admission, and also detected in blood samples of 186 healthy subjects as controls. Logistic regression model was used to analyze the relationship between the level of plasma gelsolin and prognosis of patients.</p><p><b>RESULTS</b>The average levels of plasma gelsolin were significantly lower in critically ill patients than those in control subjects (F=1986.37, P<0.01). There was significant difference in overall level of gelsolin between survival patients and fatal patients (F=16.691, P<0.01). APACHE Ⅱ score was associated with survival outcomes (r=0.489, P=0.009); the APACHE Ⅱ score was significantly higher in fatal patients than that in survival patients (29.5±7.7 vs 22.1±5.7, t=5.375, P<0.01). There was a negative correlation between plasma gelsolin levels and fatal outcomes (r=-0.512, P<0.01). Logistic regression analysis showed that the overall plasma gelsolin levels and the last measured level was a prognostic factor for critically ill patients (P<0.05).</p><p><b>CONCLUSION</b>Plasma gelsolin levels are correlated with the severity of critically ill patients, and plasma gelsolin can be used as indicator of prognosis.</p>