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Objective:To investigate the epidemiological data of maternal sepsis in intensive care unit (ICU), analyze the common causes, outcomes of maternal sepsis, and the risk factors of multi-drug resistant (MDR) bacteria.Methods:A retrospective cohort study. Maternal sepsis cases admitted to ICUs of Peking University Third Hospital, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, and Beijing Friendship Hospital Affiliated to Capital Medical University from January 2008 to September 2022 were enrolled. The following data were recorded: demographic characteristics, sequential organ failure assessment (SOFA) during infection, infection time, infection sites, invasive intervention measures before infection, microbial culture results, blood routine test during infection, body temperature, and clinical outcomes caused by infection. According to the time of sepsis occurrence, the patients were divided into pre-ICU sepsis group and ICU sepsis group, and the causes of sepsis in the two groups were analyzed. According to whether MDR occurred, the patients were divided into MDR group and non-MDR group, and clinical outcomes were analyzed. Multivariate Logistic regression was used to analyze the risk factors of MDR bacteria infection in obstetrics with sepsis.Results:160 patients were enrolled, among which 104 cases of sepsis happened before ICU and 56 cases of sepsis happened during ICU, 53 cases were with MDR bacteria and 107 cases were without MDR bacteria. The median age of the patients was 30.5 (28.0, 34.0) years old, the median temperature was 38.8 (38.2, 39.5) ℃, and the median white blood cell count (WBC) was 17.2 (13.2, 21.3)×10 9/L, the median SOFA score was 5.0 (3.0, 8.0), and 130 cases (81.2%) were referred from other hospitals. The main infection sites were uterine cavity in 64 cases (40.0%), lung in 48 cases (30.0%), abdominal and pelvic cavity in 30 cases (18.8%), urinary system in 27 cases (16.9%). Sepsis led to hysterectomy in 6 cases (3.8%), stillbirth in 8 cases (5.0%), and neonatal death in 2 cases (1.3%). The main surgical intervention measures were cesarean section (44 cases, accounting for 27.5%), followed by exploratory laparotomy (19 cases, 11.9%). The median length of ICU stay was 5.0 (3.0, 10.0) days, and the median hospital length was 14.0 (10.0, 20.8) days. Intrauterine infection was the primary cause of sepsis happened during ICU, accounting for 50.0% (28/56), of which postpartum hemorrhage accounted for 85.7% (24/28). The proportion of diabetes [28.3% (15/53) vs. 14.0% (15/107)], intrauterine operation [41.5% (22/53) vs. 23.4% (25/107)], intrauterine infection [50.9% (27/53) vs. 34.6% (37/107)] and bacteremia [18.9% (10/53) vs. 2.8% (3/107)] in the MDR group were significantly higher than those in the non-MDR group (all P < 0.05). Multivariate Logistic regression analysis showed that diabetes [odds ratio ( OR) = 2.348, 95% confidence interval (95% CI) was 1.006-5.480, P = 0.048] and intrauterine operation ( OR = 2.541, 95% CI was 1.137-5.678, P = 0.023) were independent risk factors for MDR bacterial infection in obstetrics with sepsis. Conclusions:Intrauterine infection is the common cause of maternal sepsis in ICU, and postpartum hemorrhage is the common cause of secondary intrauterine infection in ICU. MDR bacteria can lead to serious clinical outcomes. Diabetes and intrauterine operation are independent risk factors for MDR bacteria' infection.
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Objective:To research whether clinical outcomes of patients with sepsis can be improved by higher enteral nutritional support.Methods:A retrospective cohort method was applied. 145 patients with sepsis who were hospitalized in intensive care unit (ICU) of Peking University Third Hospital from September, 2015 to August, 2021 and met inclusion criteria as well as exclusion criteria were selected, including 79 males and 66 females, the median age was 68 (61, 73). Researchers evaluated whether there was correlation between improved modified nutrition risk in critically ill score (mNUTRIC), daily energy intake and protein supplement of patients and their clinical outcomes through Poisson log-linear regression analysis and Cox regression analysis.Results:The median of mNUTRIC score of 145 hospitalized patients was 6 (3, 10), wherein 70.3% of patients (102 cases) were in high-score group (≥ 5 scores) and 29.7% of patients (43 cases) were in low-score group (< 5 scores); the average of daily protein intake in ICU was about 0.62 (0.43, 0.79) g·kg -1·d -1, and the average of daily energy intake was about 64.4 (48.1, 86.2) kJ·kg -1·d -1. As shown by Cox regression analysis, increase of mNUTRIC score, sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) were correlated to growth of in-hospital mortality [hazard ratio ( HR) = 1.12, 95% confidence interval (95% CI) was 1.08-1.16, P = 0.006; HR = 1.04, 95% CI was 1.01-1.08, P = 0.030; HR = 1.08, 95% CI was 1.03-1.13, P = 0.023]. Higher average daily intake of protein and energy as well as lower mNUTRIC, SOFA, and APACHE Ⅱ scores were also significantly correlated to lower 30-day mortality ( HR = 0.45, 95% CI was 0.25-0.65, P < 0.001; HR = 0.77, 95% CI was 0.61-0.93, P < 0.001; HR = 1.10, 95% CI was 1.07-1.13, P < 0.001; HR = 1.07, 95% CI was 1.02-1.13, P = 0.041; HR = 1.15, 95% CI was 1.05-1.23, P = 0.014); however, there was no significant correlation between gender as well as number of complications and in-hospital mortality. Within 30 days of attack of sepsis, the average daily intake of protein and energy were not correlated to days of non-ventilator ( HR = 0.66, 95% CI was 0.59-0.74, P = 0.066; HR = 0.78, 95% CI was 0.63-0.93, P = 0.073). Increase of patients' average daily intake of protein and energy were significantly correlated to a lower in-hospital mortality ( HR = 0.41, 95% CI was 0.32-0.50, P < 0.001; HR = 0.87, 95% CI was 0.84-0.92, P < 0.001), shorter ICU stay ( HR = 0.46, 95% CI was 0.39-0.53, P < 0.001; HR = 0.82, 95% CI was 0.78-0.86, P < 0.001), and hospital stay ( HR = 0.51, 95% CI was 0.44-0.58, P < 0.001; HR = 0.77, 95% CI was 0.68-0.88, P < 0.001). According to correlation analysis, among patients with mNUTRIC score ≥ 5, increasing daily intake of protein and energy can reduce in-hospital mortality ( HR = 0.44, 95% CI was 0.32-0.58, P < 0.001; HR = 0.73, 95% CI was 0.69-0.77, P < 0.001), and 30-day mortality ( HR = 0.51, 95% CI was 0.37-0.65, P < 0.001; HR = 0.90, 95% CI was 0.85-0.96, P < 0.001); the receiver operator characteristic curve (ROC curve) further confirmed that higher protein intake had good predictive value for inpatient mortality area under the curve (AUC) = 0.96 and 30-day mortality (AUC = 0.94); higher emergy intake had good predictive value for inpatient mortality (AUC = 0.87) and 30-day mortality (AUC = 0.83). By contrast, among patients with mNUTRIC score < 5, it is only discovered that increasing daily intake of protein and energy can reduce 30-day mortality of patients ( HR = 0.76, 95% CI was 0.69-0.83, P < 0.001). Conclusions:The increase of average daily intake of protein and energy for patients with sepsis is significantly correlated to reduction of in-hospital mortality and 30-day mortality, shorter ICU stay, and hospital stay. The correlation is more significant in patients with high mNUTRIC score, and higher intake of protein and energy can bring down in-hospital mortality and 30-day mortality. As for patients with low mNUTRIC score, nutritional support cannot improve prognosis of the patients significantly.
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Sepsis is an organ dysfunction caused by dysregulation of the body's response to infection, with high morbidity and mortality. The pathogenesis of sepsis is still unclear, and there are no specific treatment drugs. As a cell energy supply unit, the dynamic changes of mitochondria are closely related to various diseases. Studies have shown that structure and function of mitochondria are changed in different organs during sepsis. The energy shortage, oxidative stress change, imbalance of fusion and fission, autophagy reduce, biological functions of mitochondria play important roles in sepsis progress, which can provide a research target for the treatment of sepsis.
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Humans , Mitochondria/pathology , Sepsis/drug therapy , Oxidative Stress , AutophagyABSTRACT
Objective:To analyze the risk factors of hyperthermia after removal of drainage tubes in patients after neurosurgery.Methods:The clinical data of 146 patients after neurosurgery with indwelling drainage tubes admitted to the department of critical care medicine of Pecking University Third Hospital from January 2019 to July 2021 were analyzed retrospectively. The patients were divided into hyperthermia group (body temperature≥39 ℃) and non-hyperthermia group (body temperature < 39 ℃) according to whether their body temperatures within 24 hours after removal of drainage tubes. General clinical data and outcomes of the two groups were collected, and different tendentious scores were matched with the hyperthermia group and non-hyperthermia group based on Glasgow coma score (GCS), respectively. After such matching, the clinical baseline characteristics [age, gender, admission diagnosis, major complications, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) at admission, GCS], number of days of drainage tubes retention, location of drainage tubes, microbial culture results before removal of drainage tubes, white blood cell (WBC) and neutrophil ratio (NEU%) before and after removal of drainage tubes as well as clinical outcomes of the cohort patients were analyzed. The primarily outcome was in-hospital mortality, and then the length of intensive care unit (ICU) stay.Results:A total of 146 patients after neurosurgery were included, 28 of which developed hyperthermia after removal of drainage tubes. The GCS scores at admission in the hyperthermia group were significantly lower than that in the non-hyperthermia group, while the proportion of hypertension and diabetes in the hyperthermia group was significantly higher than that in the non-hyperthermia group. Based on GCS scores, the two groups, each of which included 28 patients, were matched with tendentious scores, and there was no significant difference in gender, age, GCS scores and the proportion of hypertension and diabetes between the two groups. The main disease for patients upon admission was cerebral hemorrhage (53.6%, 30/56). The proportion of indwelling ventricular drainage tube retention in the hyperthermia group was significantly higher than that in the non-hyperthermia group [32.1% (9/28) vs. 7.1% (2/28), P < 0.05], but there was no significant difference in the location of other drainage tubes between the two groups. The proportion of lumbar puncture in the hyperthermia group was also significantly higher than that in the non-hyperthermia group [25.0% (7/28) vs. 0 (0/28), P < 0.05]. Compared with the non-hyperthermia group, WBC [×10 9/L: 13.0 (9.5, 15.2) vs. 11.5 (8.8, 13.3)] of 1 day before removal of drainage tubes, NEU% [0.892 (0.826, 0.922) vs. 0.843 (0.809, 0.909)] after removal of drainage tubes and positive rate of drainage-fluid culture or drainage-tube-tip culture [7.1% (2/28) vs. 0% (0/28)] in the hyperthermia group increased, but there were not significant differences. There was no significant difference in the proportion of pulmonary, urinary system and blood flow infection before removal of drainage tubes in the two groups. In terms of primary outcomes, compared with the non-hyperthermia group, the length of ICU stay [days: 17.0 (8.0, 32.3) vs. 8.5 (1.0, 16.8), P < 0.05] in the hyperthermia group was significantly prolonged, and the in-hospital mortality [35.7% (10/28) vs. 10.7% (3/28), P < 0.05] in the hyperthermia group was obviously increased. The positive rate of carbapenem-resistant bacteria culture [32.1% (9/28) vs. 3.6% (1/28), P < 0.05] in the hyperthermia group during hospitalization was significantly higher than that in the non-hyperthermia group. Conclusions:Hyperthermia after removal of drainage tubes for patients after neurosurgery can significantly prolong the length of ICU stay and increase the in-hospital mortality, which may be related to the secondary infection caused by indwelling intracranial drainage tubes and the intracranial spread of bacteria caused by removal of drainage tubes, as well as the intracranial multidrug-resistant bacterial infection caused by the drainage tubes.
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Anorexia nervosa is a mental disorder characterized by an intense fear of gaining weight, a distortion of body image, longstanding dietary restriction and low body weight, which has an impact on the cognition, behavior and emotion of patients to varying degrees. Recently, thanks to the advances of microbiota-gut-brain axis research, the role of gut microbiota in the mechanisms of anorexia nervosa has been elucidated. The application of probiotics has been proved to alleviate anxiety, depression and improve appetite, which is expected to be an important measure for the treatment of anorexia nervosa in the future.
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Objective:To compare the clinical characteristics of critically ill pregnant women admitted to the intensive care unit (ICU) with different admission methods, in order to make more effective and rational use of ICU resources.Methods:A retrospective study was conducted. The clinical data of critically ill pregnant women admitted to ICU of Peking University Third Hospital from January 2006 to July 2019 were analyzed. According to the admission mode to ICU, the pregnant women were divided into emergency admission group (transferred to ICU on the same day or the next day due to critical illness) and planned admission group (transferred to ICU 2 days after admitting in obstetric ward). The clinical characteristics of ICU critical pregnant women, such as the incidence, causes of admission, severity of the disease, main treatment measures, mortality, and medical expenses were collected, and a comparative analysis between the two groups was performed.Results:During the nearly 14 years, a total of 576 critical pregnant women in ICU were enrolled, accounting for 0.8% (576/71 790) of the total number of obstetric inpatients and 4.6% (576/12 412) of the total number of ICU inpatients. Seven maternal deaths accounted for 1.2% of all critically pregnant women transferred to ICU, and the overall mortality of pregnant women was 10/100 thousand. Of the 576 critically pregnant women, there were 327 patients (56.8%) in the emergency admission group and 249 patients (43.2%) in the planned admission group. Compared with the planned admission group, the proportion of elective cesarean section in the emergency admission group was significantly lower (17.7% vs. 94.0%, P < 0.01), and the proportion of emergency cesarean section was significantly higher (65.1% vs. 2.4%, P < 0.01), the acute physiology and chronic health evaluation (APACHE Ⅱ, APACHE Ⅲ) scores, simplified acute physiology score Ⅱ (SAPS Ⅱ) and Marshall score were significantly higher [APACHE Ⅱ score: 6.0 (4.0, 9.8) vs. 4.0 (3.0, 7.0), APACHE Ⅲ score: 14.0 (11.0, 20.3) vs. 12.0 (9.0, 16.0), SAPS Ⅱ score: 8 (0, 12) vs. 3 (0, 8), Marshall score: 2 (1, 4) vs. 1 (1, 3), all P < 0.01]. The length of ICU stay in the emergency admission group was significantly longer than that in the planned admission group [days: 2 (1, 5) vs. 2 (1, 3), P < 0.01], and the total length of hospital stay was significantly shorter [days: 9 (7, 13) vs. 13 (10, 18), P < 0.01]. Both in the emergency admission group and the planned admission group, obstetric factors were the main reason for admission, 60.9% (199/327) and 70.3% (175/249), respectively. The proportion of postpartum hemorrhage was the highest [35.2% (115/327) and 57.0% (142/249)], followed by preeclampsia/eclampsia [7.0% (23/327) and 7.6% (19/249)]. Only 7 of the 19 critically pregnant women with puerperal infection were planned admission. All 21 patients with acute fatty liver of pregnancy (AFLP) during pregnancy were emergency admission. Among the emergency and planned admission patients, 73 patients (22.3%) and 42 patients (16.9%) required mechanical ventilation (duration of mechanical ventilation > 24 hours), 99 patients (30.3%) and 35 patients (14.1%) needed vasoactive agents, 67 patients (20.5%) and 20 patients (8.0%) received hemodynamic monitoring, and 123 patients (37.6%) and 154 patients (61.8%) were given anticoagulation therapy, respectively. In terms of severity score of critical pregnant women, there were significant differences in APACHE Ⅱ, APACHE Ⅲ, SAPS Ⅱ and Marshall scores of pregnant women with different diseases. Among them, the APACHE Ⅲ, SAPS Ⅱ and Marshall scores of AFLP were the highest [21.0 (15.0, 32.5), 12.0 (6.0, 16.5) and 6.0 (3.5, 8.0), respectively]. The APACHE Ⅱ and APACHE Ⅲ scores of postpartum hemorrhage were the lowest [4.0 (3.0, 7.0), 12.0 (10.0, 16.0)]. The SAPS Ⅱ score of pneumonia was the lowest [2.0 (0, 14.0)]. The Marshall score for puerperal infection was the lowest [1.0 (0, 3.0)]. In terms of the total medical expenses, the cost in the emergency admission group was significantly lower than that in the planned admission group [10 thousand Yuan: 3.1 (2.0, 4.7) vs. 4.1 (2.9, 5.8), P < 0.05]. Conclusions:Compared with the critically ill pregnant women who planned to be admitted to ICU, the patients emergency admitted to ICU were more complicated and urgent, and the severity of the condition was scored higher. At present, the severity scoring system commonly used in ICU can only partly evaluate the severity of critically ill pregnant women, therefore, it is necessary to design the specific severity scoring system for critically ill pregnant women to effectively and rationally use the precious ICU resources.
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Objective:To investigate the perfection and improvement of the execution of integrative medicine therapy in severe tetanus therapy, to successfully control tetanus severe spasms, autonomic dysfunction and prevent lethal side-effect of prolong and high-dosage sedative-muscle-relaxant therapy, resulted in significant reduction of mortality of tetanus.Methods:Symptoms, treatments and outcome of tetanus patients admitted to Peking University Third Hospital from 1965 to 2020 were reviewed. Patients were classified with Ablett classification. The cases of Ablett grade Ⅲ and Ⅳ were severe tetanus. The patients were divided into two groups according to whether they were treated together with traditional Chinese medicine (TCM) simultaneously during the standard tetanus treatment; the patients in the TCM group were divided into the tetanus TCM medication group and the non tetanus TCM medication group according to the medicine provided whether was in accord with the conventional tetanus TCM prescriptions. The mortality of each group was calculated. In addition, one survived and one deceased case with severe convulsion, autonomic nerve dysfunction (Ablett grade Ⅳ) were selected, combined with the treatment methods and curative effects, the types, use methods and outcomes of Chinese and Western medicine were analyzed.Results:The 46 tetanus cases were treated with Western medicine. Twenty-two of them, TCM were applied. Fifteen of the 22 cases took the TCM prescription which was accord with the conventional tetanus prescription. The mortality of the 46 cases was 21.7% (10/46). The number of non-TCM group was 24 cases, with mortality of 20.8% (5/24); 1 case was Ablett Ⅱ, 1 was Ablett Ⅲ and 3 were Ablett Ⅳ. The number of the TCM group was 22 cases, with mortality of 22.7% (5/22), 2 cases were Ablett Ⅲ, 3 were Ablett Ⅳ. The TCM prescription of these 5 deceased cases was not directed towards tetanus. The tetanus TCM medication group was 15 cases, with no mortality. Case analyses: case 1 was intubated because of severe spasms. Autonomic dysfunction occurred on the 8th day after admission. Esmolol with increasing the dosage of the sedatives and muscle relaxant, was not effective. Tetanus TCM was applied after 2 days of autonomic dysfunction happened. Autonomic dysfunction was then under controlled on the 2nd day post-TCM. She was recovery and discharged after 4 weeks. Case 2, also was intubated because of severe spasms. Autonomic dysfunction happened on the 3rd day after admission, and failed to be controlled by large-dose sedatives, muscle relaxant, and Esmolol. After 8 days of persistent autonomic dysfunction, tetanus TCM was applied and autonomic dysfunction was under controlled on the 2nd day post-TCM administration. Large dosage of muscle-relaxant was applied continuously. After 5 days' administration of TCM, the TCM was withdrew. One day after the withdrawal of TCM, respiratory and cardiac arrest happened because of the diffused bronchiole obstruction with pulmonary secretions loading.Conclusion:Based on the precise and real-time diagnosis of the state of the disease, integrative medicine therapy with an overall analysis tetanus TCM prescription, is the key of declining tetanus mortality.
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Objective:To observe the effect of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) on the prognosis of patients with coronavirus disease 2019 (COVID-19) accompanied with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology when authors worked as medical team members for treating COVID-19. COVID-19 patients with pulse oxygen saturation/fraction of inspiration oxygen (SpO 2/FiO 2, S/F) ratio < 235, managed by medical teams [using S/F ratio instead of oxygenation index (PaO 2/FiO 2) to diagnose ARDS] from February to April 2020 were included. The patients were divided into NIPPV group and HFNC group according to their oxygen therapy modes. Clinical data of patients were collected, including general characteristics, respiratory rate (RR), fraction of FiO 2, SpO 2, heart rate (HR), mean arterial pressure (MAP), S/F ratio in the first 72 hours, lymphocyte count (LYM), percentage of lymphocyte (LYM%) and white blood cell count (WBC) at admission and discharge or death, the duration of dyspnea before NIPPV and HFNC, and the length from onset to admission. The differences of intubation rate, all-cause mortality, S/F ratio and RR were analyzed, and single factor analysis and generalized estimation equation (GEE) were used to analyze the risk factors affecting S/F ratio. Results:Among the 41 patients, the proportion of males was high (68.3%, 28 cases), the median age was 68 (58-74) years old, 28 cases had complications (68.3%), and 34 cases had multiple organ dysfunction syndrome (MODS, 82.9%). Compared with HFNC group, the proportion of complications in NIPPV group was higher [87.5% (21/24) vs. 41.2% (7/17), P < 0.05], and the value of LYM% was lower [5.3% (3.4%-7.8%) vs. 10.0% (3.9%-19.7%), P < 0.05], the need of blood purification was also significantly lower [0% (0/24) vs. 29.4% (5/17), P < 0.05]. The S/F ratio of NIPPV group gradually increased after 2 hours treatment and RR gradually decreased with over time, S/F ratio decreased and RR increased in HFNC group compared with baseline, but there was no significant difference in S/F ratio between the two groups at each time point. RR in NIPPV group was significantly higher than that in HFNC group after 2 hours treatment [time/min: 30 (27-33) vs. 24 (21-27), P < 0.05]. There was no significant difference in rate need intubation and hospital mortality between NIPPV group and HFNC group [66.7% (16/24) vs. 70.6% (12/17), 58.3% (14/24) vs. 52.9% (9/17), both P > 0.05]. Analysis of the factors affecting the S/Fratio in the course of oxygen therapy showed that the oxygen therapy mode and the course of illness at admission were the factors affecting the S/F ratio of patients [ β values were -15.827, 1.202, 95% confidence interval (95% CI) were -29.102 to -2.552 and 0.247-2.156, P values were 0.019 and 0.014, respectively]. Conclusion:Compared with HFNC, NIPPV doesn't significantly reduce the intubation rate and mortality of patients with COVID-19 accompanied with ARDS, but it significantly increases the S/F ratio of those patients.
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Objective To explore the issues related to the standardized training of resident doctors at the primary hospital and provide basis for the standardization of doctors' training. Methods Questionnaires were used to investigate the resident titles, ages, and education background in the Huanxian People's Hospital. The self-assessment of the competency of resident doctors and professional contents necessary for their improvement were analyzed to identify the medical topics should be recommended to improve their clinical knowledge and techniques. Results Forty-six of 52 registered residents in the Huanxian People's Hospital participated in the survey with a participation rate of 88.5%. In this hospital, mainly the title of physicians was resident, accounting for 43.3% (52/120), the ages were chiefly in the range of 31 - 35 years, and their education levels were college degree 42.3% (22/52) and bachelor degree 48.1% (25/52). 76.1% (35/46) of the residents found they had difficulties in working and not competent enough on the present post, and 71.7% (33/46) of residents considered that they were in urgent need to strengthen their trainings of clinical thinking and clinical skills. Conclusions Strengthening the residents' self academic qualifications, improving the hospital teaching system, enhancing the teaching management, and focusing on clinical thinking and clinical skills training are the main issues in the current standardized training in primary hospitals. By accelerating the standardized training of residents, they may have the chance to transform to be the middle-level physicians and improve the unreasonable structure of doctor title distribution that will play the key role in the development of primary hospitals.
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Objective To evaluate the effectiveness of group teaching of Third Hospital of Peking University (Beijing Medical Third Hospital) for a hospital located in remote area. Methods From 2016 to 2017, 19 medical staff from Peking University Third Hospital gave their support to Huanxian People's Hospital and provided respectively the theoretical support, guidance of clinical skills, medical consultation, free paid clinic, outpatient service, and teaching rounds, etc. A questionnaire survey was carried out to realize the subjective evaluation of the 155 clinical front-line staff who had participated in the class regarding the effect of group teaching and the most welcome teaching mode and contents; the objective data on the monthly outpatient visits, number of patients admitted into the hospital, the number of surgical patients, etc were calculated and compared between the pre-support (2014 to 2015) and post-support (2016 to 2017) period to evaluate the effect of counterpart support. Results One hundred and fourteen of the 155 medical staff in their respective departments were trained by the experts, and the percentage of medical staff believed that the counterpart support helped clinical work very much accounting for [58.8% (67/114)] being significantly higher than those who considered of no help [9.6% (11/114)], a little help [16.7% (19/114)] and some help [14.9% (17/114), χ2= 94.082, P = 0.000]; after support, the number of monthly outpatient visits compared to that of pre-support period (case times:43 816.5±3 406.9 vs. 37 319.5±4 302.1) and the number of monthly patients hospitalized compared to that of pre-support period (case times: 2 978.3±235.1 vs. 2 250.9±218.1) were significantly higher than those before the support (all P < 0.05), no statistical significant difference in monthly surgery volume (case times: 449.8±107.3 vs. 459.0±85.4, P > 0.05) between the above 2 periods was seen. The survey showed that the mostly demanding teaching method was theoretical teaching [65.8% (102/155)], followed by teaching rounds [50.3% (78/155)] and outpatient teaching the least [18.1% (28/155)]. That the ratios of various teaching contents with their sequence from high to low the medical personnel required were as follows: to learn new technologies [76.8% (119/155)], medical frontier knowledge [68.4% (106/155)], and standard diagnosis and treatment manipulations [67.7% (105/155)], cultivation of clinical thinking [66.5% (103/155)] and passing on surgical skills [56.1% (87/155)]. There were statistical significant differences between each teaching method and teaching content (all P < 0.05). Conclusions Teaching to cultivate qualified health personnel is the key to the development of hospitals located in remote areas, according to their needs, combining local conditions and the establishment of long-term cooperation mechanisms, we can comprehensively improve the professional quality of medical personnel and the overall strength of hospitals located in remote areas.
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Objective To assess the nutritional status of severe malnutrition patients with anorexia nervosa by multi-frequency bioelectrical impedance technique, and to provide the basis for nutritional support therapy. Methods A prospective study was conducted. Twenty-six severe malnutrition patients with anorexia nervosa, body mass index (BMI)≤16 kg/m2admitted to intensive care unit (ICU) of Peking University Third Hospital and general three ward of Peking University Sixth Hospital from June 1st to September 30th, 2017 were enrolled. The extracellular water (ECW), intracellular water (ICW), ECW/ICW ratio, adipose tissue mass (ATM), lean tissue mass (LTM), total body water/body weight (TBW/WT), ATM/WT, and LTM/WT were measured by multi-frequency bioelectrical impedance meter. Thirty-eighty healthy volunteers with normal nutritional status (23.0 kg/m2> BMI > 18.5 kg/m2) matched by gender and height were enrolled as healthy control group. The predictive value of main body composition for nutritional status were analyzed by receiver operating characteristic (ROC) curve. Results All the patients were female. There was no significant difference in height between two groups, but WT and BMI in the severe malnutrition group were significantly higher than those in the healthy control group [WT (kg): 38.1±4.9 vs. 54.2±3.3, BMI (kg/m2): 13.6±2.5 vs. 21.2±1.1, both 1 < 0.01]. Compared with the healthy control group, the ECW, ICW, ATM, LTM, ATM/WT and LTM/WT were significantly decreased in the severe malnutrition group [ECW (L): 9.02±0.42 vs. 10.19±0.77, ICW (L):12.6±0.9 vs.19.1±1.3, ATM (kg): 9.3±1.1 vs. 16.6±1.9, LTM (kg): 16.5±1.5 vs. 26.1±1.7, ATM/WT: 0.26±0.02 vs. 0.30±0.02, LTM/WT: 0.22±0.02 vs. 0.26±0.01, all 1 < 0.01], the ECW/ICW and TBW/WT were significantly increased in the severe malnutrition group (ECW/ICW: 0.72±0.06 vs. 0.54±0.06, TBW/WT: 0.58±0.02 vs. 0.52±0.02, both 1 < 0.01). It was shown by ROC curve analysis that the area under ROC curve (AUC) of TBW/WT、ATM/WT、LTM/WT for evaluating severe malnutrition were 0.999, 0.919, 0.954 respectively; when the cut-off of TBW/WT,ATM/WT, LTM/WT were 0.58, 0.28, 0.24 respectively, the sensitivity were 100%, 85%, 80% respectively, and the specificity were 95%, 80%, 91% respectively. Conclusion Main body composition of severe malnutrition patients with anorexia nervosa changed significantly. Bioelectrical impedance technology can be an effective assessment tool for the nutritional status of such patients.
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Objective To investigate the relevant factors of early stage hyponatremia in patients with complete cervical spinal cord injury (CSCI). Methods A retrospective study was conducted in consecutive 49 individuals with complete CSCI from January 2010 to December 2015.The diagnostic criteria for hyponatremia was two consecutive tests (interval <24 h) of serum sodium <135 mmol/L.Twenty-six patients with hyponatremia were classified as hyponatremia group , and the other 23 patients without hyponatremia were classified as control group .Ten factors were included in the univariate analysis: age, gender, the highest level of CSCI , the degree of CSCI , the blood albumin when transferred to ICU , the serum sodium when transferred to ICU , the use of glucocorticoid , the incidence of neurogenic shock , the average daily urine output , and the average daily liquid balance .The variables with significance (P<0.05) in the univariate analysis then entered stepwise logistic regression analysis .The optimal critical point of the continuous variables with statistical significance in the univariate analysis was determined by drawing the receiver operator characteristic curve . Results There were differences in two variables between the two groups ( P<0.05 ) .The incidence of neurogenic shock before the occurrence of hyponatremia was 57.7% ( 15/26 ) in the patients with hyponatremia and 26.1% ( 6/23 ) in the patients without hyponatremia(χ2 =6.516,P=0.011).The average daily urine output was (2225 ±389) ml in the patients with hyponatremia and (1936 ±289) ml in the patients without hyponatremia (t=2.924,P=0.005).The stepwise logistic regression analysis indicated that these two factors may be the independent relevant factors (OR =13.708 and 0.996, P =0.004 and 0.002, respectively).The receiver operator characteristic curve demonstrated the average daily urine output more than 2331 ml was the optimal critical point . Conclusion The neurogenic shock and the average daily urine volume more than 2331 ml are the independent relevant factors of early stage hyponatremia in patients with complete CSCI .
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Objective To study the optimal timing of tracheotomy in patients with acute cervical spinal cord injury who need ventilation for a long time . Methods A retrospective research on seventy-nine patients with acute cervical spinal cord injury who underwent tracheostomy in our hospital from January 2011 to December 2015 was conducted .The 79 patients were divided into two groups.The patients with a duration from intubation to tracheostomy less than or equal to 10 days were enrolled in group A , and the duration more than 10 days, group B.The duration of ventilation , the length of ICU stay , and the incidence rate of lung infection were compared between the two groups . Results The duration of ventilation in the group A (192 ±58) h was less than that in the group B (348 ±53) h (t=-12.490, P=0.000).The length of ICU stay in the group A (9.8 ±2.7) d was less than that in the group B (15.9 ±2.2) d (t=-11.058, P=0.000).The incidence of pneumonia in the group A (16.2%, 6/37) was lower than that in the group B (38.1%, 16/42,χ2 =4.686, P=0.030).Mechanical ventilation was successfully withdrawn in 34 and 38 cases of group A and B, without significant difference (χ2 =0.000, P=1.000). Conclusion Early tracheostomy in patients with acute cervical spinal cord injury who need ventilation for a long time could shorten the duration of ventilation and the length of ICU stay , and decrease the incidence of pneumonia .
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Antibiotics are the cornerstone to cure infectious diseases, however, it also destroys the intestinal inherent microflora, and may cause serious gastrointestinal dysfunction, such as abdominal distension, diarrhea, mucosal barrier damage etc. In severe conditions, it may induce intestinal sepsis. With the development of the human microbiology group program and the popularity of microbial sequencing technology, people can comprehend the effects of antibiotics on intestinal flora deeply, meanwhile the traditional biomedical model (the basis of bacterial disease) is questioned. It presents the effects and mechanisms of antibiotics on intestinal microflora and intestinal mucosal barrier function in detail and demonstrates the feasibility by the treatment of probiotics and fecal transplantation to construct "health-promoting microbes" to adjust gastrointestinal function, in addition, it can promote the rational use of antibiotics.
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Objective To investigate the value of employing pulse indicator continuous cardiac output (PiCCO) for cardiac function monitoring in patients with severe septic shock.Methods A prospective observation was conducted.Thirty-six septic shock patients in Department of Critical Care Medicine of Peking University Third Hospital admitted from August 2011 to December 2013 were enrolled.According to the degree of severity,the patients were divided into PiCCO monitor group and routine monitor group.The PiCCO monitor provided a continuous assessment of fluid resuscitation,vasopressors and inotropes infusion in the patients with severe septic shock.The following cardiac function parameters were assessed in severe septic shock patients on the 1st and 3rd day after intensive care unit (ICU)admission:cardiac index (CI),global ejection fraction (GEF),rate of left ventricular pressure increase (dp/dt max),echocardiography,and blood troponin T (TNT) and B-type natriuretic peptide (BNP).The central venous pressure (CVP),mean arterial pressure (MAP) and the time reaching their standard values,and the norepinephrine dosage and 3-day fluid balance in severe septic shock patients were compared between milrinone and non-milrinone usage groups.The severity degree and outcome were compared between PiCCO monitor group and routine monitor group.Results There were 15 patients in PiCCO monitor group and 21 in routine monitor group among 36 septic shock patients.① In 15 patients with PiCCO monitoring,the patients with decreased CI,GEF,and dp/dt max accounted for 40.0％,93.3％,and 33.3％ at 1 day after ICU admission,and accounted for 60.0％,93.3％,and 60.0％ at 3 days after ICU admission,and it showed that CI,GEF,and dp/dt max was not improved at 3 days after ICU admission.Echocardiography showed that 35.7％ patients had lower left ventricular ejection fraction (LVEF) at 1 day after ICU admission,71.4％ and 71.4％ of patients,respectively,had lower early diastolic mitral flow velocity/early diastolic myocardial velocity (E/Em) and early diastolic mitral flow velocity/end diastolic mitral flow velocity (E/A).Three days after ICU admission,80％ of patients with low LVEF value turned to normal,and diastolic dysfunction was ameliorated in 50％ patients.At 1 day after ICU admission,higher TNT was found in 92.9％ of patients,higher BNP in 100％ of patients,and 3 days after ICU admission,71.4％ and 78.6％ patients showed a decrease in TNT and BNP,respectively.② In PiCCO monitor group,there were no significant differences in initial CVP,MAP and their time reaching standard values,norepinephrine dosage between milrinone group (n =8) and non-milrinone group (n =7).However,3-day intake of liquid in milrinone group was significantly higher than that in non-milrinone group (mL:8 324±3 962 vs.4 372±2 081,t =-2.362,P =0.034).③ Compared with routine monitor group,there was a significant elevation in acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,duration of mechanical ventilation,length of ICU stay and 28-day hospital mortality in PiCCO monitor group [APACHE Ⅱ score:20.67 ± 6.15 vs.14.71 ±4.67,t =-3.304,P =0.002; SOFA score:9.53±3.00 vs.7.52± 1.97,t =-2.433,P =0.020; duration of mechanical ventilation (hours):132 (54-310) vs.63 (14-284),Z =-2.295,P =0.022; length of ICU stay (days):7 (4-15) vs.5 (1-14),Z =-2.360,P =0.018; 28-day hospital mortality:26.7％ vs.0,P =0.023].Conclusion With the use of the PiCCO hemodynamic monitoring in patients with severe septic shock,more comprehensive values of blood volume,systemic vascular resistance and cardiac function can be obtained for guiding fluid resuscitation and selection of vasopressor and inotropic drugs.
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ObjectiveTo investigate the impacts of sepsis-induced cardiac dysfunction on hemodynamics, organ function and prognosis in the patients with septic shock.Methods A prospective cohort study was conducted in 44 patients suffering from septic shock with the duration< 24 hours admitted to the Department of Critical Care Medicine of Peking University Third Hospital during June 2013 to June 2014. The patients were divided into two groups according to the left ventricular ejection fraction (LVEF) as recorded in echocardiogram at time of admission to the intensive care unit (ICU) as sepsis-induced myocardial dysfunction group (LVEF< 0.50,n= 11) and normal cardiac function group (LVEF≥0.50,n= 33). The cardiac function evaluation and hemodynamics monitoring were performed with echocardiogram and pulse-induced contour cardiac output (PiCCO) on 1, 3, 7 days after the ICU admission. The plasma levels of the biomarkers of myocardial damage, troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured, and the parameters representing organ function and the 28-day prognosis were collected as well.Results On the ICU admission, central venous pressure (CVP) and left ventricular end-diastolic diameter (LVEDD) were obviously lower in normal cardiac function group than those of myocardial dysfunction group [CVP (mmHg, 1 mmHg = 0.133 kPa): 10±4 vs. 14±6,P< 0.05; LVEDD (mm): 45.0±5.3 vs. 51.8±7.1,P< 0.01], and there was no significant difference in other hemodynamic parameters between two groups. On the 3rd day, all the cardiac function and hemodynamic parameters showed no significant differences between the two groups. On the 7th day, the cardiac index (CI) and pulmonary vascular permeability index (PVPI) of normal cardiac function group were significantly higher than those of myocardial dysfunction group [CI (mL·s-1·m-2): 63.3±13.3 vs. 48.3±10.0,P< 0.05;PVPI: 1.5 (1.4, 1.9) vs. 1.1 (0.7, 1.1),P< 0.01], and no significant difference was found in the other parameters. The plasma levels of TnT and NT-proBNP were found to have no difference at three time points between two groups. There was no difference in the number or the extent of organ dysfunction, including lung, kidney, liver and coagulation system, between the groups at the time of ICU admission. There was no obvious difference in the 28-day survival rate between the myocardial dysfunction group and normal cardiac function group [81.8% (9/11) vs. 72.7% (24/33),χ2= 0.398, P= 0.528].Conclusions Sepsis-induced myocardial dysfunction is a reversible organ dysfunction. It can directly induce decreased left ventricular systolic function and enlargement of ventricle in patients with septic shock without reducing cardiac output or impairing the functions of other organs, or elevating the mortality rate.
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Objective To monitor intra-abdominal pressure (IAP) in critically ill patients.Methods A prospective cohort study was conducted.IAP was measured through the bladder technique.Patients were screened for intra-abdominal hypertension (IAH,IAP ≥ 12 mmHg,1 mmHg=0.133 kPa) upon ICU admission.The patients with IAH/abdominal compartment syndrome (ACS) were given appropriate treatment and management for IAH and/or ACS.Mean arterial pressure (MAP),IAP,abdominal perfusion pressure (APP),filtration gradient (FG) and serum creatinine (Cr) were determined in patients with or without IAH,as well as in survivors and non-survivors.Results The entire protocol of IAP measurement was completed in 88 patients.Number of IAH and ACS patients was 25 (28.4％) and 2 (2.3％),respectively.The number of survivors was 80 (90.9％),with 8 (9.1％) non-survivors.Compared with non-IAH patients,IAP and SCr were increased in IAH patients [IAP (mmHg):14.16 ± 2.43 vs.8.13 ± 2.28,t=10.984,P=0.000; SCr (μmol/L):126.72 ± 83.02 vs.73.41 ± 37.59,t=3.087,P=0.005],with a lower FG (mmHg:59.32 ± 17.08 vs.70.24 ± 15.03,t=-2.956,P=0.004).There were no significant differences in MAP and APP between IAH group and non-IAH group [MAP (mmHg):79.18 ± 12.33 vs.88.71 ± 17.34,t=-1.368,P=0.190; APP (mmHg):73.40 ± 16.11 vs.78.37 ± 14.32,t=-1.415,P=0.161].Compared with survivors,non-survivors showed significantly lower APP and FG [APP (mmHg):60.88 ± 14.58 vs.78.56 ± 14.06,t=3.382,P=0.001 ; FG (mmHg):50.38 ± 16.18 vs.68.81 ± 15.44,t=3.208,P=0.002],and higher SCr (μmol/L:129.12 ±83.62 vs.84.36 ± 55.15,t=-2.082,P=0.040).There was no significant difference in IAP and MAP between survivors and non-survivors [MAP (mmHg):71.00 ± 25.46 vs.84.38 ± 13.53,t =1.224,P=0.238 ; IAP (mmHg):10.62 ±5.34 vs.9.76 ± 3.40,t=-0.647,P=0.519].Conclusions Earlier IAP measurements in critically ill patients are essential for the detection of IAH/ACS and renal injury.With appropriate management of IAH/ACS,significant decrease in morbidity and mortality of patients has been achieved.
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<p><b>BACKGROUND</b>Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for subsequent invasive MRSA infection, particularly in patients admitted for critical care. The purpose of this study was to investigate the risk factors affecting nasal colonization of MRSA in patients admitted to intensive care units (ICU).</p><p><b>METHODS</b>Between August 1, 2011 and June 30, 2012, we screened for MRSA nasal colonization in 350 patients by Real-time PCR within 24 hours of admission by means of swab samples taken from the anterior nares. According to the results of PCR, the patients were divided into 2 groups: the positive group with nasal MRSA colonization and the negative group without nasal MRSA colonization. The 31 (8.86%) patients were MRSA positive. The risk factors evaluated included thirteen variables, which were analyzed by t test for continuous variables and χ(2) test for discrete variables. The variables with significance (P < 0.05) were analyzed with stepwise Logistic regression.</p><p><b>RESULTS</b>There were differences (P < 0.05) in four variables between two groups. The duration of stay in hospital prior to ICU admission in the positive group was (35.7 ± 16.1) days, vs. (4.5 ± 3.1) days in the negative group. The average blood albumin level was (28.4 ± 2.9) g/L in the positive group, vs. (30.5 ± 4.3) g/L in the negative group. Of 31 patients in the positive group, seven had been treated with antibiotics longer than seven days vs. 34 of 319 patients in the negative group. In the positive group, four of 31 patients received treatment with more than two classes of antibiotics prior to admission in ICU, contrasted to 13 of 319 patients in the negative group. Furthermore, stepwise Logistic regression analysis for these four variables indicates that the duration of stay in hospital prior to ICU admission may be an independent risk factor.</p><p><b>CONCLUSIONS</b>MRSA colonization in ICU admission may be related to many factors. The duration of stay in hospital prior to ICU admission is an independent risk factor.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Anti-Bacterial Agents , Therapeutic Uses , Intensive Care Units , Methicillin-Resistant Staphylococcus aureus , Virulence , Nasal Cavity , Microbiology , Polymerase Chain Reaction , Risk Factors , Staphylococcal Infections , Drug TherapyABSTRACT
ObjectiveTo determine the effects of perioperative hemodynamic goal directed therapy (GDT) on postoperative infection rates. MethodsWe conducted a systematic review and Meta-analysis.MEDLINE,the Cochrane Library,EMBASE,CNKI and other sources were searched until March 2011.All randomized controlled trials (RCTs) on adult major surgical patients managed with perioperative GDT or according to routine haemodynamic practice were included.Primary outcome measure was specific for type of infection. Two authors independently extracted data and assessed study quality using standardized instruments; Consensus was reached by conference.The Cochrance Collaboration's software RevMan 5.0 was used for data analysis. ResultsSixteen studies were included in the final analysis,providing a sample of 3309 patients. Perioperative GDT significantly reduced surgical site infections (SSI)(OR =0.60; 95％CI0.46-0.74; P ＜0.0001),pneumonia (OR =0.69; 95％CI 0.53 -0.90;P =0.007),and urinary tract infections (UTIs) (OR =0.44; 95％ CI 0.22 -0.88; P =0.02),and there was no heterogeneity between studies (P ＞ 0.1,I2 ＜ 50％ ).A significant decrease in total infection episodes was observed (OR=0.37; 95％CI0.22-0.61; P＜0.00001). ConclusionsA flow-directed hemodynamic therapy protects the high-risk surgical patients against postoperative hospital-acquired infections.
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OBJECTIVE To study the isolation status and antimicrobial resistance of nonfermenting Gram-negative bacilli collected from intensive care unit(ICU) of our hospital so as to instruct the rational clinical application of antibiotics.METHODS The antimicrobial resistance of nonfermenting Gram-negative bacilli isolates collected from patients in ICU from Jan 2003 to Dec 2007 was analyzed.Antimicrobial susceptibility of clinical isolates were tested by Kirby-Bauer method.RESULTS Total 384 nonfermenting Gram-negative bacilli isolates were collected in 5 years.The most common species were Acinetobacter baumannii(219),Pseudomonas aeruginosa(117) and Stenotrophomonas maltophilla(36).The antimicrobial resistance rate of nonfermenting Gram-negative bacterial to most antibiotics were much higher.The antimicrobial resistance rate of Acinetobacter spp to imipenem,cefoperazone/sulbactam and piperacillin/tazobactam was 3.7%,28.3% and 42.9%.But the resistance rate of Acinetobacter spp to imipenem was increased in recent 2 years(58.0%).The antimicrobial resistance rate of P.aeruginosa to cefoperazone/sulbactam was the lowest.That of imipenem-resistant P.aeruginosa to cefoperazone/sulbactam was 34.0%.S.maltophilla was relatively susceptible to ceftazidime,cefoperazone/sulbactam and piperacillin/tazobactam.CONCLUSIONS Nonfermenters Gram-negative bacilli are the important pathogens in ICU.Surveillance of their prevalence and drug resistance may provide evidences for rational antibiotic choices.