Ultrasound evaluation of acute compartment syndrome: Based on healthy volunteers / 中华急诊医学杂志

Objective:To explore the application value of ultrasound in the early noninvasive monitoring of acute compartment syndrome model, and to provide reference for further clinical applications.Methods:This was a prospective self-controlled study. A model of healthy volunteers with acute compartment syndrome was established by cuff compression. The random method was used to determine the experimental side and the control side. The experimental side cuff was given 0, 20, 30, 40, 50, 60, 70, and 80 mmHg pressure in sequence, while the control side cuff was kept uncompressed at all times. Each pressure on the experimental side lasted for 5 min, during which the ultrasound was used to measure the blood flow waveform and vascular structure of the bilateral popliteal artery, popliteal vein and dorsal plantar artery. Statistical analysis was performed using repeated measures analysis of variance and multivariate analysis of variance.Results:The study included 25 healthy volunteers. There was no statistically significant difference in calf circumference and anterior tibial compartment thickness ( P = 0.314 and 0.678). During compression, the volunteers' heart rate and blood pressure were stable ( P = 0.235 and 0.358). On the experimental side, the maximum blood flow velocity of the popliteal artery during systole increased with the increase of pressure ( P<0.001), and the minimum blood flow velocity of the popliteal artery increased with the increase of pressure ( P<0.001). When pressurized by 30 mmHg, the maximum blood flow velocity of the popliteal artery on the experimental side was significantly higher than that on the control side [(73 ± 19) cm/s vs (59 ± 14) cm/s, P=0.023)]. When pressurized by 20 mmHg, the minimum blood flow velocity of the popliteal artery on the experimental side was significantly higher than that on the control side [(-28 ± 8) cm/s vs (-22 ± 6) cm/s, P=0.012)]. With the increase of pressure, the diastolic retrograde arterial flow ratio of the experimental side gradually increased ( P <0.001), and when the pressure was increased by 20 mmHg, the diastolic retrograde arterial flow ratio of the experimental side of the popliteal artery increased significantly [(0.42 ± 0.14) cm/s vs (0.30 ± 0.12) cm/s, P=0.009)]. The systolic prograde arterial flow ratio of the dorsal artery in the experimental side decreased with the increase of pressure ( P = 0.024). Conclusions:Increased limb compartment pressure can significantly change the arterial flow waveform of the proximal and distal arteries, and ultrasound can be used as an early monitoring tool for acute compartment syndrome.

A study on the monitor of gastric residual volume by ultrasound and its prediction on feeding intolerance during enteral nutrition in critically ill patients in intensive care unit / 中华急诊医学杂志

Objective:To explore the feasibility of bedside ultrasound in monitoring gastric residual volume and predicting feeding intolerance during enteral nutrition in critically ill patients in intensive care unit.Methods:The data of critically ill patients admitted to emergency intensive care unit of the Second Affiliated Hospital of Zhejiang University School of Medicine from April 2018 to September 2018 were retrospectively analyzed. The following patients were finally included in this study: (1) abdominal computed tomography during the stay of emergency intensive care unit was performed due to the requirement of disease evaluation and management; (2) bedside ultrasound was performed to measure the gastric antrum cross-sectional area at 30 min prior to or after abdominal computed tomography. The outline of stomach wall in the imaging of abdominal computed tomography was traced with the help of VOLUME-Work Flow medical imaging software to calculate the value of gastric residual volume. The relationship between gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions and gastric residual volume was evaluated by Pearson correlation analysis. The difference of gastric antrum cross-sectional area between those critically ill patients with or without feeding intolerance was compared by independent-sample t test. The predictive value of gastric antrum cross-sectional area under different body positions on feeding intolerance during enteral nutrition was analyzed by ROC curve. Results:Totally, forty-two patients were enrolled and analyzed in this study, in which the mean age was (53±13) y, mean body mass index was (21.5±2.8) kg/m 2 and mean acute physiology and chronic health evaluation was 17.0±6.9. The value of gastric residual volume was (314.5±126.6) mL, and the values of gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions were (7.11±4.13) cm 2, (4.22±2.66) cm 2, (8.36±4.58) cm 2, respectively. The correlation analysis indicated that gastric residual volume was positively associated with gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions ( r=0.543, 0.604 and 0.618, respectively; all P<0.001). During enteral nutrition, 15 patients experienced feeding intolerance while 27 patients hadn’t feeding intolerance, in which the gastric antrum cross-sectional areas under semi-sitting, horizontal and right-lateral positions were significantly increased in those patients with feeding intolerance than those patients without feeding intolerance [semi-sitting: (8.53±4.07) cm 2vs (4.60±2.76) cm 2; horizontal position: (5.15±2.75) cm 2vs (2.61±1.32) cm 2; right-lateral position: (10.32±4.06) cm 2vs (4.95±3.20) cm 2, all P<0.005] . ROC curve analysis showed that the area under ROC curves of gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions for predicting feeding intolerance during enteral nutrition were 0.815, 0.833 and 0.849, respectively; when its values≥3.917 cm 2, 3.395 cm 2 and 4.402 cm 2 were used as the cut-off points, the sensitivities were 92.0%, 69.6% and 92.3%, and the corresponding specificities were 69.2%, 92.3% and 71.4%, respectively. Conclusions:Bedside gastric ultrasound could accurately evaluate the status of gastric residual volume in critically ill patients, and effectively predict their occurrence of feeding intolerance during enteral nutrition.

Resuscitative effect of aortic balloon occlusion on traumatic cardiac arrest in swine / 中华创伤杂志

Objective@#To investigate the resuscitation effect of aortic balloon occlusion (ABO) on the traumatic cardiac arrest (TCA) in swine.@*Methods@#Twenty-seven male domestic swine weighing (32.7±3.8)kg were utilized. After 40% of estimated blood volume was removed within 20 minutes, the animals were subjected to 5 minutes of untreated ventricular fibrillation and then 5 minutes of cardiopulmonary resuscitation. Additionally, fluid resuscitation was initiated coincident with the beginning of cardiopulmonary resuscitation. The animals were randomly divided into model group (n=12) and ABO group (n=15). Once cardiopulmonary resuscitation was implemented, aortic balloon was concurrently inflated to stop the blood flow of descending thoracic aorta at the level of the diaphragm in the ABO group. In the model group, aortic balloon was placed in the same position without inflation. During cardiopulmonary resuscitation, the changes of coronary perfusion pressure (CPP), forehead's regional cerebral oxygen saturation (rSO2) and pressure of end-tidal CO2 (PETCO2) were continuously monitored, and the rate of return of spontaneous circulation (ROSC), duration of cardiopulmonary resuscitation, number of shocks and dose of epinephrine were recorded. At 5 minutes after successful resuscitation, the levels of arterial blood gas, lactate and jugular venous blood oxygen saturation (SjvO2) were measured.@*Results@#Compared with the model group, the values of CPP, rSO2 and PETCO2 during cardiopulmonary resuscitation were significantly increased in the ABO group [CPP: (33.5±5.6)mmHg vs. (23.1±5.2)mmHg at 1 minute, (35.3±6.0)mmHg vs. (26.8±7.4)mmHg at 2 minutes, (36.3±6.3)mmHg vs. (28.2±6.3)mmHg at 3 minutes, (40.1±7.1)mmHg vs. (30.5±6.2)mmHg at 4 minutes, (38.1±7.5)mmHg vs. (29.8±5.3)mmHg at 5 minutes; rSO2: (45.4±5.2)% vs. (39.2±5.1)% at 1 minute, (47.2±3.6)% vs. (42.0±6.4)% at 2 minutes, (47.7±3.0)% vs. (41.5±5.4)% at 3 minutes, (47.0±2.5)% vs. (42.1±5.9)% at 4 minutes, (47.1±2.0)% vs. (41.5±7.4)% at 5 minutes; PETCO2: (17.0±3.5)mmHg vs. (12.7±4.2)mmHg at 1 minute, (18.5±3.7)mmHg vs. (14.5±2.7)mmHg at 2 minutes, (20.7±5.3)mmHg vs. (15.5±3.2)mmHg at 3 minutes, (18.7±4.5)mmHg vs. (14.9±3.5)mmHg at 4 minutes, (18.2±3.2)mmHg vs. (14.5±4.2)mmHg at 5 minutes] (all P<0.05). The rate of ROSC was significantly higher in the ABO group than in the model group[100%(15/15) vs. 75%(9/12)] (P<0.05). Additionally, shorter duration of cardiopulmonary resuscitation, less number of shocks and lower doses of epinephrine were observed in the ABO group when compared with the model group[duration of cardiopulmonary resuscitation: 5(5, 5)minutes vs. 5(5, 12.5)minutes, number of shocks: 1(1, 1)times vs. 1(1, 4)times, dose of epinephrine: 0.62(0.62, 0.74)mg vs. 0.64(0.59, 2.59)mg] (all P<0.05). At 5 minutes after resuscitation, the level of arterial lactate was significantly decreased and the value of SjvO2 was significantly increased in the ABO group compared with the model group[Lactate: (9.6±0.8)mmol/L vs. (10.8±1.4)mmol/L; SjvO2: (50.0±8.6)% vs. (37.9±16.3)%] (both P<0.05).@*Conclusions@#In a swine model of TCA, ABO can increase cardiac and cerebral perfusion during cardiopulmonary resuscitation and improve the efficacy of cardiopulmonary resuscitation. It might provide a novel and effective method for the resuscitation of TCA in the clinical setting.

Resuscitative effect of aortic balloon occlusion on traumatic cardiac arrest in swine / 中华创伤杂志

Objective To investigate the resuscitation effect of aortic balloon occlusion (ABO) on the traumatic cardiac arrest (TCA) in swine.Methods Twenty-seven male domestic swine weighing (32.7 ± 3.8) kg were utilized.After 40％ of estimated blood volume was removed within 20 minutes,the animals were subjected to 5 minutes of untreated ventricular fibrillation and then 5 minutes of cardiopulmonary resuscitation.Additionally,fluid resuscitation was initiated coincident with the beginning of cardiopulmonary resuscitation.The animals were randomly divided into model group (n =12) and ABO group (n =15).Once cardiopulmonary resuscitation was implemented,aortic balloon was concurrently inflated to stop the blood flow of descending thoracic aorta at the level of the diaphragm in the ABO group.In the model group,aortic balloon was placed in the same position without inflation.During cardiopulmonary resuscitation,the changes of coronary perfusion pressure (CPP),forehead's regional cerebral oxygen saturation (rSO2) and pressure of end-tidal CO2 (PETCO2) were continuously monitored,and the rate of return of spontaneous circulation (ROSC),duration of cardiopulmonary resuscitation,number of shocks and dose of epinephrine were recorded.At 5 minutes after successful resuscitation,the levels of arterial blood gas,lactate and jugular venous blood oxygen saturation (SjvO2) were measured.Results Compared with the model group,the values of CPP,rSO2 and PETCO2 during cardiopulmonary resuscitation were significantly increased in the ABO group [CPP:(33.5 ± 5.6)mmHg vs.(23.1 ± 5.2)mmHg at 1 minute,(35.3 ± 6.0) mmHg vs.(26.8 ± 7.4) mmHg at 2 minutes,(36.3 ± 6.3) mmHg vs.(28.2 ± 6.3) mmHg at 3 minutes,(40.1 ± 7.1) mmHg vs.(30.5 ± 6.2) mmHg at 4 minutes,(38.1 ±7.5)mmHg vs.(29.8 ±5.3)mmHg at 5 minutes;rSO2:(45.4±5.2)％ vs.(39.2 ±5.1)％ at 1 minute,(47.2 ±3.6)％ vs.(42.0±6.4)％ at 2 minutes,(47.7 ±3.0)％ vs.(41.5 ±5.4)％ at 3 minutes,(47.0±2.5)％ vs.(42.1 ±5.9)％ at4 minutes,(47.1 ±2.0)％ vs.(41.5 ±7.4)％ at 5 minutes;PETCO2:(17.0 ± 3.5) mmHg vs.(12.7 ± 4.2) mmHg at 1 minute,(18.5 ± 3.7) mmHg vs.(14.5 ±2.7)mmHg at 2 minutes,(20.7 ±5.3)mmHg vs.(15.5 ±3.2)mmHg at 3 minutes,(18.7 ±4.5) mmHg vs.(14.9 ± 3.5) mmHg at 4 minutes,(18.2 ± 3.2) mmHg vs.(14.5 ± 4.2) mmHg at 5 minutes] (all P ＜0.05).The rate of ROSC was significantly higher in the ABO group than in the model group[100％ (15/15) vs.75％ (9/12)] (P ＜0.05).Additionally,shorter duration of cardiopulmonary resuscitation,less number of shocks and lower doses of epinephrine were observed in the ABO group when compared with the model group [duration of cardiopulmonary resuscitation:5 (5,5) minutes vs.5 (5,12.5) minutes,number of shocks:1 (1,1) times vs.1 (1,4) times,dose of epinephrine:0.62(0.62,0.74) mg vs.0.64 (0.59,2.59) mg] (all P ＜ 0.05).At 5 minutes after resuscitation,the level of arterial lactate was significantly decreased and the value of SjvO2 was significantly increased in the ABO group compared with the model group [Lactate:(9.6 ± 0.8) mmol/L vs.(10.8 ± 1.4) mmol/L;SjvO2:(50.0±8.6)％ vs.(37.9±16.3)％] (bothP＜0.05).Conclusions In a swine model of TCA,ABO can increase cardiac and cerebral perfusion during cardiopulmonary resuscitation and improve the efficacy of cardiopulmonary resuscitation.It might provide a novel and effective method for the resuscitation of TCA in the clinical setting.

The role of high-flow oxygen insufflation via nasal cannula in patients at high risk of re-intubation after weaning from mechanical ventilation assessed by lung ultrasound score / 中华急诊医学杂志

Objective To study the effect of high-flow oxygen insuffiation (HFOI) via nasal cannula in reduction in re-intubation rate,length of ICU stay and improvement of respiratory function in patients at high risk of re-intubation after weaning from mechanical ventilation assessed by lung ultrasound score (LUS).Methods Single center randomized(random number) clinical trial was carried out in one intensive care units in China from May 2016 to May 2017 including critically ill patients ready for planned extubation with high-risk factors for re-intubation assessed by LUS when the LUS ≥ 14 was considered to be high risk.The comparisons of the length of ICU stay,re-intubation rate in case of respiratory failure,respiratory rate pulse rate SaO2 PaO2/FiO2 of patients at 6 h,24 h and 48 hours after extubation were made between HFOI and conventional oxygen therapy (COT) group.Results During the study period,32 patients were enrolled in the study.Of them,15 were assigned in HFOI group and 17 in COT group.The length of ICU stay (8.0±2.4)days vs.(10.9±3.5) days and re-intubation rate (6.7％ vs.23.5％) were significantly different between two groups (P＜0.05).The respiratory rate pulse rate SaO2 and PaO2/FiO2 of patients at 6 h after ex-tubation in HFOI group were improved than those in COT group (P＜0.05);and the SaO2 and PaO2/FiO2 of patients 24 h and 48 h after ex-tubation in HFOI group had much more improvement than those in COT group (P＜0.05).Conclusion Among high-risk adults who assessed by lung ultrasound score,high-flow oxygen therapy could reduce re-intubation rate length of ICU stay and improve the respiratory function.High-flow oxygen therapy may offer advantages for these patients.

Comparative study on hypoglycemic effects of different traditional Chinese medicine treatments in rats with diabetes mellitus induced by alloxan / 中西医结合学报

Objective: To observe hypoglycemic effects of Yunu Decoction, Zuogui Pill and Shenqi Pill, three compound traditional Chinese herbal medicines, in treatment of diabetes mellitus induced by alloxan in rats, and to compare the therapeutic effects among the three recipes for nourishing yin, clearing away heat, and nourishing yin and warming yang. Methods: Diabetes mellitus was induced in rats with alloxan at a dose of 60 mg/kg via tail vain injection. The diabetic rats were randomly divided into four groups: alloxan model group, Yunu Decoction-treated group, Zuogui Pill-treated group and Shenqi Pill-treated group. Rats in the three recipe groups were administered intragastrically with water extraction of Yunu Decoction, Zuogui Pill, and Shenqi Pill accordingly for 10 days. Then the level of blood glucose was measured by glucose oxidase method and the glucose tolerance was determined. Results: Compared with the normal rats, blood glucose level in the alloxan model group was obviously increased (P<0.05). Glucose levels in the three recipe groups were obviously decreased as compared with the alloxan model group (P<0.05), and glucose level in the Yunu Decoction-treated group after treatment was significant lower than before treatment (P<0.05). The glucose tolerance test indicated that rats in the alloxan model and three recipe groups revealed impaired glucose tolerance as compared with the normal rats, and there were no significant differences between the alloxan model group and the three recipe groups. Conclusion: Yunu Decoction, Zuogui Pill and Shenqi Pill can effectively decrease the glucose level of the rats with diabetes mellitus induced by alloxan, and Yunu Decoction showed the best therapeutic effects. The glucose tolerance test shows that the three recipes cannot correct the abnormal metabolism of glucose.