Early high-volume hemofiltration treatment in severe sepsis / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the effect of early application of high-volume hemofiltration treatment (HVHF) on the levels of lactic acid, pro-inflammatory cytokines and C-reactive protein (CRP) in plasma, as well as APACHE II score in patients suffering from severe sepsis.</p><p><b>METHODS</b>Thirty patients meeting the diagnosis of severe sepsis were enrolled in the trial within 24 hours of insults. The level of lactic acid, interleukin-6 (IL-6) and CRP in plasma were measured before HVHF and at 24, 48 or 72 h following HVHF treatment.</p><p><b>RESULT</b>The plasma levels of lactic acid and IL-6 decreased significantly at 24 h, 48 h, 72 h after HVHF (P <0.05), while, IL-10 did not differ significantly following HVHF (P>0.05), when compared with that before HVHF.</p><p><b>CONCLUSION</b>The early application of HVHF could clear the plasma lactic acid and pro-inflammatory cytokines, and improve the tissue oxygenation in severe sepsis.</p>

Survey of attitudes and behaviors of healthcare professionals on delirium in ICU / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To assess the medical community's awareness and practice regarding delirium in the intensive care unit (ICU).</p><p><b>METHODS</b>One hundred and ten predesigned questionnaires were distributed to ICU practitioners in the affiliated hospitals of Zhejiang University.</p><p><b>RESULTS</b>A total of 105 valid questionnaires were collected. Totally, 55.3% of the clinicians considered that delirium was common in the ICU. Delirium was believed to be a significant or serious problem by 70.5% of respondents, and under-diagnosis was acknowledged by 56.2% of the respondents. The incidence of ICU delirium is even more under-estimated by the pediatric doctors compared with their counterparts in adult ICU (P less than 0.05). Primary disease of the brain (agreed by 82.1% of the respondents) was believed to be the most common risk factor for delirium. None of the ICU professionals screened delirium or used a specific tool for delirium assessment routinely. The vast majority (92.4%) of respondents had little knowledge on the diagnosis and the standard treatment of delirium.</p><p><b>CONCLUSIONS</b>Although delirium is considered as a serious problem by a majority of the surveyed ICU professionals, it is still under-recognized in routine critical care practice. Data from this survey show a disconnection between the perceived significance of delirium and the current practices of monitoring and treatment in ICU in China.</p>

Epidemiological study of severe sepsis in a newborn intensive care unit / 中华外科杂志

<p><b>OBJECTIVES</b>To determine the incidence and outcome of severe sepsis in Newborn Intensive Care Unit (NICU) and to characterize their demographics and infection pattern.</p><p><b>METHODS</b>Characteristics of 243 newborns admitted to NICU from June 1st, 2006 to May 31st, 2007 were retrospectively analyzed.</p><p><b>RESULTS</b>Analysis of data derived from 243 newborns admitted to NICU over an 1-year period with 48 (19.8%) cases diagnosed as severe sepsis, and 70.8% of them were males. The median age of severe sepsis patients was 2 (1-6 ) days. In 56.3% of the patients bacteria were isolated, and E. coli was the predominant microbe. PRISM score and mortality rate were higher in those with severe sepsis, while their Apgar score was lower than other cases. The overall hospital mortality of severe sepsis was 45.8%. Risk factors for hospital mortality included higher PRISM score, severe organ dysfunction, circulatory system dysfunction, and hematological or central nervous system dysfunction.</p><p><b>CONCLUSIONS</b>This study shows that severe sepsis is a common, frequently fatal morbid condition in critical ill newborns in NICU, showing similar disease pattern with other investigations. Further multiple-center investigations are helpful to prevent, control and salvage critically ill children suffering from severe sepsis.</p>

Comparison of three different organ failure assessment score systems in predicting outcome of severe sepsis / 中华外科杂志

<p><b>OBJECTIVE</b>To compare multiple organ dysfunction score (MODS), the sequential organ failure assessment (SOFA) and the logistic organ dysfunction score (LODS) in predicting hospital mortality in severe sepsis.</p><p><b>METHODS</b>Four hundred and three patients admitted to the ICU from December 2004 to November 2007 with a diagnosis of severe sepsis were enrolled in this study. Their MODS, SOFA, LODS and Acute Physiology and Chronic Health Evaluation (APACHE) II at admission and the highest score during hospitalization were respectively recorded and collected in regard to mortality. The discrimination of three multiple organ dysfunction score systems were assessed by the areas under the receiver operating characteristic curves (AUC).</p><p><b>RESULTS</b>The AUC of admission scores was 0.811 for LODS, 0.787 for SOFA, 0.725 for MODS, and 0.770 for APACHE II in predicting hospital mortality. All maximum scores had better power of discrimination than the admission scores (P < 0.01). The power of discrimination of LODS and SOFA were better than the MODS, either the admission or the highest, respectively (P < 0.01). However, no significant difference was observed between the LODS and the SOFA regarding mortality prediction (P > 0.05). The AUC value for the APACHE II score was much lower compared to LODS (P < 0.01). However, there was no difference in AUC value among APACHE II, SOFA and MODS (P > 0.05).</p><p><b>CONCLUSION</b>LODS, SOFA and MODS show a good discrimination power, while maximum LODS is of the highest discrimination power to predict the outcome of patient with severe sepsis.</p>