ABSTRACT
Objective To investigate the prevalence of feeding intolerance (FI),and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients.Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014,and all clinical,laboratory,and survival data were prospectively collected.The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms,feeding details and organ dysfunction within the first week of ICU stay.The intra-abdominal pressures (IAP) was measured using AbViser device.Results Of 550 patients enrolled,418 were assessed in GI symptoms and feeding details within 7 days of ICU stay.The mean age and SOFA score were (65.1 ± 18.3) years and (8.96 ±4.10),respectively.Of them,355 patients (84.9％) were under mechanical ventilation support,and 37 (8.85％) received renal replacement therapy.The mean length of time for enteral feeding was (30.8 ±26.2) h,and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2％ and 25.4％,respectively.Compared to those with FI within 7 days of ICU stay,the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3％ vs.5.7％,P =0.003) and higher rate of withdrawal of vasoactive medication (45.5％ vs.20.0％,P =0.037),as well as lower mortality rate of 28-day (24.4％ vs.38.7％,P =0.004) and 60-day (29.6％ vs.44.3％,P =0.005).In multivariate Cox regression model with adjustment for age,sex,participant center,serum creatinine and lactate,AGI grade on the first day of ICU stay,and comorbidities,the FI within 7 days of ICU stay (x2 ≥ 7.24,P ＜ 0.01) remained to be independent predictors for 60-day mortality.After further adjusted for SOFA score,the FI within 7 days of ICU stay (HR =1.71,95％ CI:1.18-2.49;P =0.006) and AGI grade on the first day of ICU stay (HR =1.33,95 ％ CI:1.07-1.65;P =0.009) could provide independent prognostic values of 60-day mortality.Conclusions There is high rate of FI occurred within 7 days of ICU stay,and is significantly associated with worse outcome.In addition,this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality.
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Objective To observe the pulmonary inflammation and oxidative stress in rats with cecal ligation and puncture sepsis. Methods The male rats in 8 weeks were randomly divided into control group, sham operation group and model group,The ALI model of sepsis was prepared by cecal ligation and puncture (CLP). In order to achieve the effect of experimental observation, the rats were killed after the operation 12 h, and the lung tissue HE staining analysis was performed, and the levels of MPO and MDA were observed. Results The degree of lung injury and the levels of MPO and MDA in the model group were significantly higher than those in the control group and the sham operation group (P < 0.01).Conclusion Rats with cecal ligation and puncture sepsis model can well simulate sepsis inflammatory response and oxidative stress.
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Objective To evaluate the therapeutic effects of bi-level positive airway pressure on acute left heart failure. Methods Thirty patients with acute left heart failure received combined conventional therapy and bilevel positive airway pressure, and were compared with 30 patients with acute left heart failure receiving traditional treatment as controls. The changes in the power of hydrogen, partial pressure of oxygen in artery, pulse oxygen saturation,partial pressure of carbondioxide in artery,buffuer excess,blood pressure,heart rate,and breathing frequency,and clinical symptom were compared between the two groups. Results Compared with control group,the blood pressure,heart rate, breathing frequency decreased significantly( P＜0. 05 ) ;pulse oxygen saturation increased significantly (P＜0. 05 ) ; the power of hydrogen, partial pressure of oxygen in artery, partial pressure of carbondioxide in artery, and buffuer excess were improved more significantly ( P＜0. 05 ) ; the marked response rate and the total effective rate increased significantly(P＜0. 05). Conclusion The combined conventional therapy and bi-level positive airway pressure has a good efficacy in the patients with acute left heart failure.
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The latency change detection of EPs is of special interest in many clinical applications such as diagnosis of the injury and pathological changes in the nervous system. This paper reviews the adaptive latency change detection approaches under stable noise conditions, based on the fractional lower order statistics. It also evaluates and compares the performances of the presented algorithms.