ABSTRACT
Objective:To explore the threshold and diagnostic value of Chinese version of the Chelsea Physical Function Assessment Tool (CPAx-Chi) for ICU acquired weakness(ICU-AW).Methods:To learn the details and precautions of the CPAx-Chi scale, and then two researchers used the CPAx-Chi scale and MRC-Score scale to independently evaluate 200 patients who come from a comprehensive ICU in a top first-class hospital in Gansu Province simultaneously. The best cut-off point and value of the CPAx-Chi scale in the diagnosis of ICU-AW were determined by calculating the Receiver Operating Characteristic (ROC) curve, the Youden index(YI) and the consistency test that are all based on the MRC-Score≤48.Results:The ROC Area Under Curve(AUC) of the CPAx-Chi scale diagnosis ICU-AW which based on the MRC-Score≤48 were as follows: ROC AUC of group A was 0.899 (95% CI 0.862-1.025); ROC AUC of group B was 0.874 (95% CI 0.824-0.925). When the best cut-off point of CPAx-Chi scale for diagnosis ICU-AW was 31.5, the maximum YI=0.643, the sensitivity was 87%, and the specificity was 77% in group A; and the maximum YI= 0.62, the sensitivity was 75%, and the specificity was 87% in group B. Meanwhile, when the best cut-off point of CPAx-Chi scale for diagnosis ICU-AW was 30.5, the maximum YI=0.62, the sensitivity was 79%, and the specificity was 83% in group B. Taking the CPAx -Chi≤31 as the best cut-off point, the score differences in ICU-AW group and the non-ICU-AW group were not detected, A group ( F value was 4.53, P=0.035) or B group ( F value was 6.51, P=0.011). The consistency of CPAx -Chi≤31 and MRC-Score≤48 in the diagnosis of ICU-AW was high, and the Kappa=0.845 ( P=0.02) in the group A; the Kappa=0.839( P=0.04) in the group B, and the group differences were detected. Conclusions:CPAx-Chi≤31 is the best cut-off point for diagnosing ICU-AW, and has good sensitivity and specificity. CPAx-Chi scale can be popularized and applied in the critical care medicine in China.
ABSTRACT
Objective:To evaluate the effect of lower limb neuromuscular electrical stimulation (NMES) on mechanical ventilation patients in intensive care unit (ICU).Methods:Databases including the Cochrane Library, PubMed, Web of Science, Embase, SinoMed, CNKI, VIP and Wanfang database were searched from inception to May 2021. Randomized controlled trails (RCT) about the influence of NMES of lower limbs in patients with mechanical ventilation in ICU were collected. Routine rehabilitation measures were implemented in the control group, while the combination of routine rehabilitation and NMES on the lower limbs was implemented in the observation group. The literature screening, data extracting, and bias risk assessment of included studies were conducted independently by two reviewers. RevMan 5.3 software was used to perform Meta-analysis. Funnel plot was used to test publication bias.Results:A total of 8 RCT were eventually enrolled. The literature quality evaluation results showed that 1 study was grade A and 7 studies were grade B, suggesting that the quality of the included literature was relatively high. The Meta-analysis results showed that NMES in the lower extremities could effectively shorten the duration of mechanical ventilation in ICU patients [standardized mean difference ( SMD) = -0.51, 95% confidence interval (95% CI) was -0.72 to -0.31, P < 0.000 01], increase the maximum inspiratory pressure [MIP; mean difference ( MD) = 14.19, 95% CI was 9.30 to 19.09, P < 0.000 01], and improve the functional status of critically ill patients [functional status score for ICU (FSS-ICU); MD = 10.44, 95% CI was 3.12 to 17.77, P = 0.005] with statistically significances. However, there were no significant advantages in increasing the Medical Research Council (MRC) score ( MD = 2.13, 95% CI was -1.38 to 5.63, P = 0.23), reducing ICU mortality [relative risk ( RR) = 0.80, 95% CI was 0.51 to 1.24, P = 0.31], shortening length of ICU stay ( MD = -0.54, 95% CI was -3.67 to 2.59, P = 0.74), and the combined effect was not statistically significant. Funnel plot based on the duration of mechanical ventilation showed that the distribution of included articles was basically symmetrical, and no publication bias was detected. Conclusions:NMES of the lower limbs can not only shorten the ventilation duration effectively, but also improve the MIP and functional status of mechanically ventilated patients in ICU. However, it has no significant effect on the MRC score, ICU mortality and length of ICU stay of patients with mechanical ventilation. In the future, high-quality, large sample size and multi-center RCT are needed to verify the effects of NMES.
ABSTRACT
Objective:To investigate the cognitive impairment after intensive care unit (ICU) discharge and provide theoretical basis for prevention and intervention.Methods:Studies about cognitive impairment after ICU discharge were retrieved in PubMed, Embase, Cochrane Library, Web of Science, Wanfang data, CNKI and SinoMed from their foundation to December 2019. The literature screening and data extraction were performed by two researchers independently, and the quality of different types of researches was evaluated using Cochrane Handbook 5.1.0, Newcastle-Ottawa scale (NOS) and agency for healthcare research and quality criteria (AHRQ). The Meta-analysis was performed by Stata 13.0 software. Sensitivity analysis was used to determine the reliability of the combined effect values. Funnel plot and Egger test were used to analyze publication bias. The non-parametric clipping was used to evaluate the impact of publication bias on the results.Results:A total of 35 studies were enrolled, including 27 prospective cohort studies, 4 retrospective cohort studies, 2 randomized controlled trial (RCT) studies, 1 case-control study, and 1 cross-sectional study. Three literatures were published in Chinese and 32 were in English, which covered 13 countries, and a total of 102 504 ICU survivors were followed up successfully. Literature quality evaluation results showed that the NOS scores of 31 cohort studies were between 6 and 9, of which the case-control study scored 9. The quality grade of 2 RCT studies were both B. According to the AHRQ criteria, 1 cross-sectional study's design was scientifically rigorous and of high quality. Thirty-five studies reported that the overall incidence of cognitive impairment after ICU discharge ranged from 2.47% to 66.07%. For the multiple follow-ups studies, the first survey data was selected for Meta-analysis, and the results showed that the pooled incidence was 38.44% [95% confidence interval (95% CI) was 29.32-47.55]. Each study was removed for sensitivity analysis and the pooled results did not change much, which indicated that the results were reliable. The sub-group analysis was performed on different evaluation methods for cognitive impairment after ICU discharge, different types of ICU patients, and different follow-up time. The results showed that the pooled incidence of studies using neuropsychological test to evaluate cognitive impairment after ICU discharge was 31.42% (95% CI was 21.82-41.02), the pooled incidence of studies using questionnaires or scales was 38.75% (95% CI was 29.54-47.96), and the difference between the two groups was statistically significant ( P < 0.01). The pooled incidence of cognitive impairment after ICU discharge in general ICU patients was 43.42% (95% CI was 30.88-55.95), acute respiratory distress syndrome (ARDS) patients' pooled incidence was 34.40% (95% CI was 23.02-45.79), and the pooled incidence of elderly ICU patients was 12.93% (95% CI was 8.48-17.37), the difference among the three groups was statistically significant ( P < 0.01). The incidences of cognitive impairment < 1 year, 1 to 4 years, ≥ 5 years after ICU discharge were 43.30% (95% CI was 29.47-57.13), 34.21% (95% CI was 26.70-41.72), and 20.22% (95% CI was 4.89-35.55), respectively, and the differences among the three groups were statistically significant ( P < 0.01). The funnel plot showed that the distribution of all studies was asymmetric, and the Egger test result also suggested that there might be publication bias ( P < 0.05). The non-parametric clipping was used to estimate the impact of publication bias on the results, and the result showed that the difference in the incidence of cognitive impairment after ICU discharge before and after non-parametric clipping was large, suggesting that publication bias might influence the stability of the research results. Conclusions:The incidence of cognitive impairment after ICU discharge is relatively high and persistent for a long time, but diagnostic criteria of cognitive impairment and follow-up time are quite different. It is necessary to develop consistent evaluation criteria and rigorous designed research in the further.
ABSTRACT
Objective:To evaluate the effect of preventing and treatment of pharmaceuticals on intensive care unit-acquired weakness (ICU-AW) by systematic review.Methods:The randomized controlled trials (RCTs) concerning pharmaceutical prevention and treatment about ICU-AW in SinoMed, CNKI, Wanfang data, PubMed, Cochrane Library, Web of Science, EMbase, and other sources were searched from their foundation to May 30th, 2019. The patients in the intervention group were treated with drugs to prevent or treat ICU-AW; and those in control group were treated with other rehabilitation methods. Data searching, extracting and quality evaluation were assessed by two reviewers independently. Stata 12.0 software was then used for Meta-analysis. Only descriptive analysis was conducted when only one study was enrolled.Results:A total of 11 RCTs were enrolled with 1 865 patients in the intervention group and 1 894 in the control group. The results of quality evaluation showed that 4 studies were A-level and 7 studies were B-level, indicating that the overall quality of the enrolled literature was high. Meta-analysis showed that intensive insulin therapy could prevent ICU-AW [relative risk ( RR) = 0.761, 95% confidence interval (95% CI) was 0.662-0.876, P = 0.000], but reduced phenylalanine loss (nmol·100 mL -1·min -1: -3±3 vs. -11±3, P < 0.05) and glutamine intake (nmol·100 mL -1·min -1: -97±22 vs. -51±13, P < 0.05). There was no significant difference in the prevention and treatment of ICU-AW between other drugs (including growth hormone, glutamine, dexmedetomidine, neostigmine, oxandrolone, and intravenous immunoglobulin) and control group. Conclusions:Intensive insulin therapy can prevent ICU-AW, but the risk of hypoglycemia will increase. Other drugs including growth hormone, glutamine, dexmedetomidine, neostigmine, oxandrolone, and intravenous immunoglobulin have no obvious advantages in the prevention and treatment of ICU-AW, so no drug has been recommended to prevent and treat ICU-AW.
ABSTRACT
Objective:To systematically evaluate the clinical efficacy of oral ginger capsule or ginger powder in chemotherapy-induced nausea and vomiting in cancer patients.Methods:Computers searched Chinese Journal Full-text Database (CNKI), China Biomedical Literature Database (CBM), Wanfang Database, PubMed, EMbase, Web of Science, and Cochrane Library about oral chemotherapy in patients with cancer ginger correlation clinical curative effect of nausea and vomiting randomized controlled trial, supplemented by other search methods, the time range was built until July 2019. Quality evaluation and data extraction were performed independently by two investigators, and Meta analysis was performed by RevMan5.3 software.Results:A total of 12 articles and 13 studies were included, with a total of 1 105 patients. Meta-analysis showed that oral ginger capsule or ginger powder reduced the incidence of acute vomiting (risk ratio value was 0.76, 95% confidence interval was 0.59-0.98, P<0.05) and the severity of vomiting (mean difference value was-0.79, 95% confidence interval was-1.36--0.23, P<0.01), including the severity of acute vomiting (mean difference value was-1.39, 95% confidence interval was-2.72--0.06, P<0.05) and the severity of delayed vomiting (mean difference value was-0.46, 95% confidence interval was-0.82--0.10, P<0.05). However, there was no significant difference between the two groups in the incidence and severity of acute and delayed nausea ( P>0.05). Conclusions:This study demonstrates that oral ginger capsule or ginger powder is a complementary treatment for chemotherapy-induced nausea and vomiting in cancer patients, and more high-quality studies are needed to validate its clinical efficacy in the future.
ABSTRACT
Objective:To systematically evaluate the clinical efficacy of oral ginger capsule or ginger powder in chemotherapy-induced nausea and vomiting in cancer patients.Methods:Computers searched Chinese Journal Full-text Database (CNKI), China Biomedical Literature Database (CBM), Wanfang Database, PubMed, EMbase, Web of Science, and Cochrane Library about oral chemotherapy in patients with cancer ginger correlation clinical curative effect of nausea and vomiting randomized controlled trial, supplemented by other search methods, the time range was built until July 2019. Quality evaluation and data extraction were performed independently by two investigators, and Meta analysis was performed by RevMan5.3 software.Results:A total of 12 articles and 13 studies were included, with a total of 1 105 patients. Meta-analysis showed that oral ginger capsule or ginger powder reduced the incidence of acute vomiting (risk ratio value was 0.76, 95% confidence interval was 0.59-0.98, P<0.05) and the severity of vomiting (mean difference value was-0.79, 95% confidence interval was-1.36--0.23, P<0.01), including the severity of acute vomiting (mean difference value was-1.39, 95% confidence interval was-2.72--0.06, P<0.05) and the severity of delayed vomiting (mean difference value was-0.46, 95% confidence interval was-0.82--0.10, P<0.05). However, there was no significant difference between the two groups in the incidence and severity of acute and delayed nausea ( P>0.05). Conclusions:This study demonstrates that oral ginger capsule or ginger powder is a complementary treatment for chemotherapy-induced nausea and vomiting in cancer patients, and more high-quality studies are needed to validate its clinical efficacy in the future.
ABSTRACT
Objective To determine the safety criteria for early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in intensive care unit (ICU) by systematic review.Methods Randomized controlled trails (RCTs) and cohort studies about early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in ICU were retrieved in CBM,CNKI,Wanfang Data,PubMed,Cochrane Library and Web of Science from their foundation to March 2018,and other sources as supplement was also retrieved.The intervention program of RCT study was ICU routine nursing in control group,early activity in observation group,and early activity in cohort study without control group.Early activities included active and passive activities on the bed,sitting upright,bed-chair transfer,standing and walking.Literature screening and data extraction were performed independently by two researchers.Variables or parameters.related to cardiovascular,respiratory,nervous,orthopedic and other systems were collected for safety criteria.Variables or parameters used in at least three literatures were collected for each system.Cochrane 5.1.0 was used to evaluate the quality of RCT study,and Newcastle-Ottawa scale (NOS) was used to evaluate the quality of cohort study.Results A total of 24 articles about early activity of patients undergoing mechanical ventilation in ICU were enrolled,involving 4647 patients,including 11 RCT studies involving 1 031 patients,509 in control group and 522 in observation group;13 cohort studies including 3616 patients.It was shown by systematic review that safety criteria for early activity in patients undergoing mechanical ventilation in ICU involved five systems,20 variables or parameters.The cardiovascular system included 8 variables or parameters,such as 40 bpm ＜ heart rate (HR) ＜ 130 bpm (n =4),hemodynamic stability (n =5),no myocardial infarction (n =3),no arrhythmia (n =4),no vascular active drugs (n =4),90 mmHg ＜ systolic blood pressure (SBP) ＜ 200 mmHg (1 mmHg =0.133 kPa,n =4),65 mmHg ≤ mean arterial pressure (MAP) ≤ 110 mmHg (n =3),no history of cardiopulmonary resuscitation (CPR,n =5).The respiratory system included 4 variables or parameters,involving 5 times/min ＜ respiratory rate (RR) ＜ 40 times/min (n =5),fraction of inspired oxygen (FiO2) ≤ 0.60 and positive end-expiratory pressure (PEEP) ≤ 10 cmH2O (1 cmH2O =0.098 kPa,n =4),FiO2 ＜ 0.60 or PEEP ＜ 10 cmH2O (n =3),pulse blood oxygenation (SpO2) ＞ 0.88 (n =5).The nervous system included 4 variables,including no neuromuscular disease (n =7),no increase in intracranial pressure (n =7),no coma (n =4),understand and do the right thing (n =4).The orthopedic system included 2 variables,including no fracture (n =3),no unstable fracture (n =8).Other factors included 2 variables,including no open abdomen wound (n =4),and no palliative care (n =3).Conclusions This study identified safety criteria for early goal-directed rehabilition exercise in patients undergoing mechanical ventilation in ICU included five systems of cardiovascular,respiratory,neurological,orthopedic,and other systems,in which cardiovascular and respiratory systems were the most frequently cited variables or parameters.The consistency of each system security criteria or variables reported by different literatures was high,but the parameters need to be further verified by high-quality study.
ABSTRACT
Objective To explore effective and objective diagnostic tools for evaluating intensive care unit acquired weakness (ICUAW). Methods The studies about evaluation and diagnosis of adult ICUAW in PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP and Wanfang databases from the date of their foundation to July 1st in 2018 were retrieved by computer. The literatures in Chinese and English were searched. Two investigators independently screened literature and evaluated the literature quality ratings, and extracted the research design, sample size, research object, evaluation item, reliability, validity, clinical application and other indicators, and then systematically analyzed the reliability and validity of ICUAW diagnostic tools, and evaluated diagnostic tools' advantages, disadvantages and application status. Results There were 19 literatures including 14 assessment scales and ultrasound diagnosis. The 14 assessment scales were medical research council score (MRC-Score), Barthel index (BI), 6-minute walk test (6MWT), clinical outcome variables scale (COVS), the Chelsea critical care physical assessment tool (CPAx), functional independence measure (FIM), functional status score for the intensive care unit (FSS-ICU), the ICU mobility scale (IMS), rivermead mobility index (RMI), the Perme ICU score (PERME), the physical function ICU test (PFIT), the physical function ICU test score (PFIT-s), the surgical ICU optimal mobility score (SOMS), and the Manchester mobility score (MMS). Nine scales (60%) were tested reliability and the rang of inter-rater reliability was 0.600-0.996, and the test reliability was 0.970, and the range of internal consistency reliability was 0.680-0.992. Validity of 6 scales (40%) were evaluated, and the range of structure validity was 0.57-0.94, the range of content validity was 0.830-0.988, the range of concurrent validity was 0.730-0.823. It was shown that the reliability of ICUAW assessment scale was relatively good at present, but the degree of accurate assessment of ICUAW was relatively low. The evaluation content of ICUAW can be divided into three categories: in the first, they measured the muscles strength of body just like MRC-Score; in the second, they evaluated the physical function and mobility, such as COVS, CPAx, FIM, FSS-ICU, IMS, PERME, PFIT, RMI, SOMS and MMS; in the third, they evaluated daily activity and physiology parameter just as 6MWT, BI and ultrasound. Different scales were correlated with the length of ICU stay (ICU-LOS), the hospital discharge, and the mortality. For example: COVS, CPAx, FSS-ICU, PFIT, PFIT-s and SOMS could predict the ICU-LOS and hospital discharge, RMI and SOMS can predict patient mortality. However, there was no evidence to testify the consistency between them. Now, the specialist consensus about the observation nodes of threshold and electrophysiological records were the complex action potential (CMAP) range < 0.43-0.65 mV and the sensory nerve action potential (SNAP) range < 17.6 μV. Conclusions There are many diagnostic tools in ICUAW, and the reliability of each scale is relatively good. In future studies, we should collect the advantages of each scale, explore the specific indicators to evaluate ICUAW and improve the accuracy and validity of diagnostic ICUAW.
ABSTRACT
Objective To investigate the pre-emptive analgesia effects of hydromorphone on stress reaction in patients undergoing gynecological laparoscopic surgery.Methods Forty ASA Ⅰ or Ⅱ patients [age:45-58 years,body mass index:18-24 kg· (m2)-1] undergoing gynecological laparoscopic surgery were randomly divided into 2 groups (n =20 for each group):treatment group and control group.Hydromorphone (1 mg) was intravenously injected before anesthesia in treatment group.In the two groups,after routine induction and incubation,remifentanil (0.2 μg· min-1 · kg-1) and propofol (0.1 mg· min-1· kg-1) were injected with micro perfusion pump,cisatracurium was injected intermittently.Injection of remifentanil and propofol was stopped when skin suture started.The concentrations of epinephrine(E) and norepinephrine(NE) were obtained before induction (t1),pneumoperitoneum (t2),1 h after pneumoperitoneum (t3) and extubation (t4),respectively.The heart rate,blood pressure and the time of operation to extubation of the patients were recorded.Results There were no significant changes in extubation time after operation among the groups.Heart rate and systolic blood pressure were significantly lower in the treatment group than in the control group (P ＜ 0.05).Plasma E and NE levels at t1 were significantly lower than those at t2,t3 and t4.Plasma E and NE were significantly lower in treatment group than that of control group at t2,t3 and t4 (P ＜ 0.05).Conclusion Pre-emptive analgesia of hydromorphone can significantly decrease the release of epinephrine and norepinephrine during and after laparoscopic surgery,restrain the increase of heart rate and systolic blood pressure during extubation,without influence of revival time.