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Objective:To investigate the relationship between albumin (ALB) level immediately after major abdominal surgery and postoperative acute kidney injury (AKI) in critically ill patients.Methods:A retrospective cohort study was conducted. Patients who accepted the major abdominal surgery admitted to the department of intensive care unit (ICU) of the Peking University First Hospital from June 2017 to July 2018 were enrolled. Clinical data including the postoperative ALB level and renal function were collected. Patients were divided into postoperative AKI group and postoperative non-AKI group according to the AKI diagnosis and staging criteria of Kidney Disease: Improving Global Outcomes (KIDGO). The risk factors of perioperative AKI occurrence were analyzed, and multivariate Logistic regression analysis was performed. The receiver operator characteristic curve (ROC curve) was plotted for the ALB level to predict the occurrence of AKI and to determine the ALB cut-off value. The Kaplan-Meier survival curve of postoperative survival of patients was drawn.Results:A total of 363 critically ill patients underwent major abdominal surgery, and 105 patients (28.9%) suffered from AKI. Compared with the non-AKI group, the patients in the AKI group were older ( t = -2.794, P = 0.005), preoperative proportions of diabetes and chronic kidney disease were higher ( χ21 = 4.613, χ22 = 5.427, both P < 0.05), the proportion of American Society of Anesthesiologists (ASA) grades and Ⅴ was higher ( χ2 = 19.444, P < 0.001), baseline serum creatinine (SCr) and preoperative brain natriuretic peptide (BNP) levels were higher ( U1 = 2.859, U2 = 2.283, both P < 0.05), preoperative ALB level was lower ( t = 3.226, P = 0.001), the proportion of preoperative use of contrast media was higher ( χ2 = 7.431, P = 0.006), the proportions of emergency surgery and using vasopressor during surgery were higher ( χ21 = 4.211, χ22 = 4.947, both P < 0.05), non-renal SOFA score and acute physiology and chronic health evaluation (APACHE) within 24 hours after ICU admission were higher ( U = 2.233, t = 3.130, both P < 0.05), and the proportion of postoperative immediate ALB less than 32 g/L was higher ( χ2 = 7.601, P = 0.006). ROC curve analysis showed that the cut-off value of immediate postoperative ALB for predicting postoperative AKI was 32 g/L, with the sensitivity was 86.7%, and the specificity was 28.3%. Multivariate Logistic regression analysis showed that ASA grade, use of contrast before surgery, baseline SCr and postoperative immediate serum ALB level below 32 g/L were independent risk factors for AKI [odds ratio ( OR) and 95% confidence interval (95% CI) were 2.248 (1.458-3.468), 2.544 (1.332-4.857), 1.018 (1.008-1.027) and 2.685 (1.383-5.212), respectively, all P < 0.01]. Compared with the non-AKI group, the proportion of patients with AKI undergoing mechanical ventilation in ICU was higher ( χ2 = 13.635, P < 0.001), mechanical ventilation duration, length of ICU stay, postoperative hospital stay were longer ( U1 = 2.530, U2 = 5.032, U3 = 3.200, all P < 0.05), more postoperative complications except AKI ( U = 4.799, P < 0.001), and in-hospital mortality and total hospitalization cost were higher ( χ2 = 11.681, U = 3.537, both P < 0.001). Compared with the group with postoperative immediate serum ALB ≥ 32 g/L, the proportion of mechanical ventilation in ICU of the ALB < 32 g/L group was higher ( χ2 = 33.365, P < 0.001), the length of ICU stay and postoperative hospital stay were longer ( U1 = 3.246, U2 = 4.563, both P < 0.001), more postoperative complications except AKI ( U = 3.328, P = 0.001), total hospitalization cost was higher ( U = 4.127, P < 0.001). Conclusion:For critically ill patients underwent major abdominal surgery, the postoperative immediate serum ALB level below 32 g/L significantly increased the risk of AKI, which was related to the poor prognosis of the patients.
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Objective:To identify the risk factors for myocardial injury after non-cardiac surgery.Methods:The medical records of adult patients admitted to the intensive care unit of Peking University First Hospital after non-cardiac surgery from June 2017 to June 2018 were retrospectively collected.Myocardial injury was defined as serum cardiac troponin I concentration>0.06 μg/L within 3 days after operation, and the patients were divided into myocardial injury group and non-myocardial injury group.The perioperative data of patients were obtained through searching the electronic medical record system.The variables of which P values were less than 0.05 would enter the logistic regression analysis to stratify the risk factors for myocardial injury after non-cardiac surgery. Results:A total of 752 patients were included in the study, and the incidence of myocardial injury occurred after non-cardiac surgery was 15.7%.Emergency operation and highest lactic acid concentration during operation were the independent risk factors for myocardial injury after non-cardiac surgery.Conclusion:Emergency operation and highest lactic acid concentration during operation are the independent risk factors for myocardial injury after non-cardiac surgery.
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The high incidence of coronavirus disease 2019 (COVID-19) and high mortality of critical patients have posed a great challenge to global public health resources. Currently there are no specific antiviral drugs and vaccines available for COVID-19, which has drawn the attention to the usefulness of convalescent plasma (CP) again, so the application of CP in the adult patients with COVID-19 is reviewed. The main contents include the possible mechanism of CP, the evidence of CP in the treatment of COVID-19 patients, the safety of clinical application of CP and the main factors affecting the clinical effect of CP, which may provide some basis for clinicians to choose CP for the treatment of adult patients with COVID-19.
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The latest advance of sedation for critically ill adult patients in intensive care unit (ICU) was reviewed in order to provide certain clinical information for the ICU physicians about sedation. Guidelines, clinical research, Meta-analysis, and reviews in recent years were collected using electronic data base. Discussions included: ① the definition of light sedation, and its effects on clinical outcome, stress, sleep and delirium; ② light sedation strategies included: the target population, the target sedation strategy and daily sedation interruption, clinical assessment and monitoring of sedation, selection of sedative drugs, light sedation extenuation; ③ light sedation strategies and pain, agitation, delirium control bundles; ④ the problems and prospects of light sedation. Light sedation is the main principle of currently ICU sedation strategy in critically ill adult patients. Goal-directed light sedation should be considered as a routine therapy in most clinical situation, and its goal should be achieved as early as possible in the early stage of sedation. Routine use of benzodiazepines should be avoided, especially in patients with or at a risk of delirium. Prevention and treatment of agitation with a combination of non-pharmacologic or pharmacologic methods; ICU specification rules for pain, agitation and delirium prevention and treatment should be made. Light sedation is the main ICU sedation strategy in adult patients now, but must be individualized for each patient.
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Objective The purpose of our study is to analyze the effects of different ways of anesthesia on the prognosis of these patients.Methods Our study was a retrospective study,enrolling elderly patients (≥65 years)undergoing pheochromocytoma resection surgery from Jan 2004 to Feb 201 5 in our hospital.We recorded perioperative data including demography,primary disease,com-bined disease,preoperative management,anesthesiology,surgery,and prognosis.Then we divided the patients into two groups,general anesthesia (group G)and general anesthesia combined with epi-dural anesthesia (group GE),to make further statistical analysis.Results There were 33 patients en-rolled,totally undergoing 35 cases of surgery accounting for 13.4% of pheochromocytoma resection surgery in the same period in our hospital.The maintenance of analgesia during surgery by using remifentanyl (18.2% vs 79.2%,P = 0.001 )and sufentanyl (45.5% vs 79.2%,P = 0.046 )were significantly lower in group of general anesthesia combined with epidural anesthesia.However hemo-dynamic parameters didn’t show statistical difference between groups.There were no patients dead during perioperative period.In group GE,the duration of mechanical ventilation (P =0.039),post-operative hospital stay (P =0.013)and total hospital stay (P =0.01 5)were much shorter than those in group G.Multivariable Cox model analysis showed that general anesthesia combined with epidural anesthesia was an independent protective factor for shorter postoperative hospital stay (RR=0.245, 95% CI 0.106-0.564,P =0.001),and combination of vasopressors during operation were the inde-pendent predictors of longer postoperative hospital stay (RR= 4.184,95% CI 1.146-1 5.281,P =0.030).Conclusion During pheochromocytoma resection surgery in elderly patients,general anesthe-sia combined with epidural anesthesia had lower rate of using intravenous analgesic drugs,shorter du-ration of mechanical ventilation,postoperative hospital stay and total hospital stay.
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Objective To investigate the invasive aspergillosis (IA) status in a surgical intensive care unit (SICU).Methods The clinical data including general state,operation,pathogenic microorganisms,infection position,clinical situation,treatment and prognosis of patients with IA admitted to the SICU of Peking University First Hospital from January 2004 to December 2013 were retrospectively analyzed.Results 8 220 patients admitted to the SICU of Peking University First Hospital from January 2004 to December 2013 were enrolled.Of 8 220 patients,there were 29 cases experienced IA,with an incidence of 0.35％,and the incidence of hospital onset of IA infection was 0.27％ (22/8 220).The incidence of hospital onset of IA infection was accounted for 6.98％ (22/315) of the incidence of hospital onset of infection in SICU in the same period.Compared with 2004-2008,in 2009-2013,the incidence of hospital onset of infection was significantly decreased [3.19％ (137/4 293) vs.4.53％ (178/3 927),x2=10.020,P=0.002],while the incidence of IA [0.56％ (24/4 293) vs.0.13％ (5/3 927),x2=10.874,P=0.001],the incidence of hospital onset of IA infection [0.40％ (17/4 293) vs.0.13％ (5/3 927),x2=5.556,P=0.019],and the percentage of incidence of hospital onset of IA infection according to the incidence of hospital onset of infection were increased by 5 years [12.40％ (17/137) vs.2.81％ (5/178),x2=10.982,P=0.001].Of 29 patients with IA,25 cases had occurred after operation,and the majority of them were from the Department of General Surgery (13 cases),and followed by post-renal transplantation (6 cases) and post-thoracic surgery (3 cases).In the total submission of 155 specimens from 29 patients with IA,there were 17 strains isolated aspergillosis,among which included 2 strains of Aspergillus fumigatus,and 15 other un-subgrouped strains.The most common infection site was lower respiratory tract (23 cases,79.31％).Sixteen patients were found with positive galactomannan (GM) test.In all the risk factors contributing to IA,the ratio of the long-term usage of broad-spectrum antibiotics over 4 days was the highest [36.25％ (29/80)],which followed by the long-term use of hormone [18.75％ (15/80)],complicated with acute kidney injury [18.75％ (15/80)],liver injury [13.75％ (11/80)],the long-term use of immunosuppressive orally [7.50％ (6/18)],and complicated with neutropenia [5.00％ (4/80)].In 29 patients with IA,there were 28 patients received anti-fungal treatment except for 1 patient without treatment,and those were single use of itraconazole in 1 case,single use of echinocandins in 3 cases,single use of liposomal amphotericin B in 5 cases,8 cases with voriconazole,single use of liposomal amphotericin B or echinocandins then replaced by voriconazole in 8 cases,and 3 cases of echinocandins therapy combined with voriconazole.Seventeen of 29 patients died,with a mortality rate of 58.62％.Conclusions IA is an uncommon but increasing postoperative complication of patients in SICU in recent 5 years.The most common sites of IA were lower respiratory tract.The mortality of IA is very high.So clinicians should pay more attention to the careful monitor for IA.
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OBJECTIVE To evaluate the clinical efficacy and safety of extending the administration time of meropenem in the treatment of moderate and severe bacterial infections in surgical intensive care uint(SICU) patients.METHODS Fifty patients with moderate and severe bacterial infections admitted to SICU were randomized to two groups: meropenem 30 min infusion group(n=25) and meropenem 3 h infusion group(n=25),the clinical efficacy and side-effects were observed between two groups.RESULTS Twenty-five patients were enrolled in meropenem 30 min infusion group with an effective rate of 48%,bacterial clearance rate of 26.9%.On the other hand,twenty-five patients were enrolled in meropenem 3 h infusion group with an effective rate of 60%,bacterial clearance rate of 43.5%.There were no significant differences between two groups(P=0.375,P=0.224,separately).CONCLUSIONS There are no significant differences between two groups on effective rate and bacterial clearance rate.
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OBJECTIVE To investigate the occurrence of nosocomial infection and the correlated risk factors of death in patients admitted to the Surgical Intensive Care Unit(SICU) of Peking University First Hospital.METHODS The clinical data of the occurrence,sites,and pathogenic microorganisms of nosocomial infection in patients(admitted) to the SICU from Jan 2002 to Jan 2005 were analyzed retrospectively,and the correlated risk factors of death in patients with nosocomial infection were screened by Logistic regression analysis.RESULTS Nosocomial infection occurred in 4.2% patients admitted to the SICU.The mortality of patients with nosocomial infection was(48.9%.) The most frequent sites of infection were lower respiratory tract(88.9%),hematological system((48.9%),) and urinary tract(26.7%).The most prevalent pathogens of infection were Gram-negative(bacteria)((64.1%),) including Pseudomonas aeruginosa,Stenotrophomonas maltophilia,Acinetobacter calcoaceticus-(baumannii) complex and Klebsiella oxytoca.Gram-positive bacteria accounted for 24.8%,including MRSA,MRSE,and Enterococcus faecium.Fungi accounted for 11.1%,of which Candida albicans was the most frequent one.(Multidrug) resistance was an important character of the pathogens of nosocimal infection of SICU.(Aggregate)(analysis) of the correlated risk factors of death showed there were three indenpedent risk factors,including mental disturbance,hypotension,and acute renal failure(P=0.015,0.028,and 0.003,respectively).CONCLUSIONS Careful monitoring should be made for infections of lower respiratory tract,hematological system and urinary tract for patients in the SICU.The species diversity and multidrug resistance of pathogens of nosocomial infection in the SICU make it difficult to initiate the early empirical antibiotic therapy.Empirical selection of antibiotics should be made according to the local data of species and susceptibility patterns of pathogens of nosocomial infection.Mental disturbance,hypotension and acute renal failure are three independent risk factors of death for patients with(nosocomia)l infection in SICU.
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Objective To investigate the effects of isoflurane (Iso) on the water-maze performances in scopolamine (Sco) treated rats.Methods Fifty-five male SD rats weighing 150-200 g were randomly divided into 8 groups :group I control (Con)/1 d ( n = 6); group II Iso/1 d ( n = 7);group III Sco/1 d ( n = 9);group IV Iso + Sco/1 d ( n = 9) ; group V Con/7 d ( n = 6); group VI Iso/7 d ( n = 6); group VII Sco/7 d ( n = 6) and group VIII Iso + Sco/7 d ( n = 6) . In Iso and Iso + Sco groups the animals inhaled 1.5% isoflurane 2 h per day for four consecutive days. The Morris water-maze (MWM) test was performed for 3 consecutive days starting from the first day (group I -IV ) or the 7th day (group V -VII) after the 4 day isoflurane inhalation. Scopolamine 0.8 mg.kg-1 was given ip 20 min before the beginning of the MWM test in Sco and Iso + Sco groups. Results In group I - IV , (1) the latency period and swimming distance were significantly longer in Sco and Iso + Sco group than those in Con and Iso group ( P