Research Progress on Capillary Leak Syndrome Associated with Hematopoietic Stem Cell Transplantation--Review / 中国实验血液学杂志

Capillary leak syndrome (CLS) is a clinical syndrome characterized by impairment of vascular endothelial barrier function, increased vascular permeability, and reversible systemic edema. It is one of the early fatal complications after hematopoietic stem cell transplantation. So far, the exact pathogenesis of CLS has not been elucidated, and the diagnostic criteria and treatment methods have not been unified. At present, it is believed that the fundamental cause of CLS is hypercytokinemia, and the core factor is high permeability of vascular endothelial cells. According to the clinical manifestations, the natural course of CLS can be divided into prodrome, leakage and recovery stages. As far as treatment is concerned, symptomatic and supportive treatment is dominant according to different characteristics of each stage. In this review, the pathogenesis, clinical manifestations, diagnosis and treatment of hematopoietic stem cell transplant-associated CLS were briefly summarized.

Analysis of risk factors of extrapulmonary organ dysfunction in children with severe refractory mycoplasma pneumoniae pneumonia / 中华急诊医学杂志

Objective:To analyze the clinical features of severe refractory mycoplasma pneumoniae pneumonia (SRMPP) in children, and explore its risk factors complicated with extrapulmonary organ dysfunction.Methods:The clinical data of children with SRMPP who were admitted to the Department of Critical Care Medicine of Shanghai Children's Hospital from July 2017 to June 2019 were retrospectively summarized. The patients were divided into two groups according to the occurrence of extrapulmonary organ dysfunction: the extrapulmonary organ dysfunction group and the respiratory dysfunction group. The differences of clinical features and laboratory indexes between the two groups were compared, and the risk factors of extrapulmonary organ dysfunction were screened out by logistic regression analysis.Results:A total of 107 cases with SRMPP were admitted to the Pediatric Intensive Care Unit during the past two years, and there were 44 cases (41.1%) complicated with pleural effusion, 17 cases (15.9%) with plastic bronchitis, 104 cases (97.2%) with positive results for macrolide resistance genes (2063, 2064), with an in-hospital mortality rate of 2.8% (3/107). Among 107 children with SRMPP, there were 51 cases (47.7%) with extrapulmonary organ dysfunction, 43 cases (40.2%) with cardiovascular dysfunction, 13 cases (12.1%) with coagulation dysfunction, 11 cases (10.3%) with gastrointestinal dysfunction, 4 cases (3.7%) with renal dysfunction, 4 cases (3.7%) with brain dysfunction, 3 cases (2.8%) with liver dysfunction, and 16 cases (15.0%) with multiple organ dysfunction. Compared with the respiratory dysfunction group, the incidence of capillary leak syndrome was higher (52.9% vs. 17.9%, P < 0.001), the capillary leak index was increased [11.71 (4.63, 27.07) vs. 5.78 (2.07, 15.71), P =0.019], serum albumin was decreased [(32.2 ± 5.6)g/L vs. (34.7 ± 6.7)g/L, P=0. 041], and prothrombin time was prolonged significantly [12.7 (11.7, 13.8)s vs. 12.0 (11.4, 13.0)s, P=0. 009]. Logistic regression analysis showed that capillary leak syndrome ( OR=0. 278, 95% CI 0.102-0.759, P=0. 013) and prolonged prothrombin time ( OR=1. 443, 95% CI 1.018-2.046, P=0. 039) were independent risk factors for SRMPP complicated with extrapulmonary organ dysfunction. Conclusions:Approximately 50% of children with SRMPP have dysfunction of extrapulmonary organs, such as circulation, coagulation and gastrointestinal disorders. Capillary leak syndrome and prolonged prothrombin time are independent risk factors for SRMPP complicated with extrapulmonary organ dysfunction.

Progress on pathogenesis of capillary leak syndrome / 中国小儿急救医学

Capillary leak syndrome is a disease characterized by high permeability of vascular endo-thelium leading to anasarca,hypotension,hypoalbuminemia and hemoconcentration,It can cause multiple or-gan failure and high mortality in acute stage. Vascular endothelial hyperpermeability is the core of pathogene-sis of capillary leak syndrome. This article reviewed the latest research progress on the pathogenesis of capil-lary leak syndrome from the aspects of serological mechanism,histological changes and genetic factors.

Practice of neonatal capillary leakage syndrome / 中华实用儿科临床杂志

Capillary leak syndrome( CLS)is a group of clinical syndromes which caused by various causes of capillary endothelial damage,increased vascular permeability,resulting in a large amount of plasma protein infiltration into the interstitial space. It is one of the common critical cases in Neonatal Intensive Care Unit. As the complicated pathogenesis,blurred clinical stage and often neglected due to other complications,clinical treatment of CLS is difficult. Currently,there is no uniform diagnostic criteria,and the diagnosis is mainly based on clinical manifestation and labora-tory examination. The treatment of it is empiric but no specific treatment. Primary disease treatment and fluid manage-ment are the critical parts of the treatment of CLS. Now,the etiology,pathogenesis,clinical diagnosis and treatment of the disease were explained combined with the domestic and foreign literature and clinical diagnosis and treatment prac-tices,which aims to improve clinicians′understanding of the disease and the level of clinical diagnosis and treatment.

Practice of neonatal capillary leakage syndrome / 中华实用儿科临床杂志

Capillary leak syndrome(CLS)is a group of clinical syndromes which caused by various causes of capillary endothelial damage, increased vascular permeability, resulting in a large amount of plasma protein infiltration into the interstitial space.It is one of the common critical cases in Neonatal Intensive Care Unit.As the complicated pathogenesis, blurred clinical stage and often neglected due to other complications, clinical treatment of CLS is difficult.Currently, there is no uniform diagnostic criteria, and the diagnosis is mainly based on clinical manifestation and laboratory examination.The treatment of it is empiric but no specific treatment.Primary disease treatment and fluid management are the critical parts of the treatment of CLS.Now, the etiology, pathogenesis, clinical diagnosis and treatment of the disease were explained combined with the domestic and foreign literature and clinical diagnosis and treatment practices, which aims to improve clinicians′ understanding of the disease and the level of clinical diagnosis and treatment.

Value of angiopoietin-Ⅱin assessment of the early stage of acute pancreatitis based on the new Atlanta classification criteria / 中国医师进修杂志

investigate the serum angiopoietin-Ⅱ (AngⅡ) levels in acute pancreatitis (AP) patients and the relationship between AngⅡlevels and the disease severity of AP based on the new Atlanta classification criteria. Methods Seventy-seven patients with AP who were treated in the Affiliated Baiyun Hospital of Guizhou Medical University were included in this prospective study. According to the revised Atlanta classification, the modified Mashall scoring system was used to divided patients into AP with the persistent organ failure(POF) group and without POF group, and the CECT was used to divided patients into AP with pancreatic necrosis(PN) group and without PN group. The levels of AP 72 h after admission of two groups were compared with t test, and Spearman analysis was used to analyze the correlation between common severity indicators and Ang Ⅱ. The receiver operating characteristic (ROC) was performed to analyze the area under curve(AUC), sensitivity and specificity of Ang Ⅱ in predicting POF and PN. Results According to the modified Mashall scoring system, there were 18 patients (23.38%) in POF group and 59 patients (76.62%) in without POF group. According to CECT, 22 patients (28.57%)were in PN group and 55 patients(71.43%) in without PN group. The AngⅡof the POF and PN groups was significantly higher than those without POF and PN groups (P＝0.001, 0.011) on day 1 on admission. The cut-off value was 126.44 μg/L, and the AUC, sensitivity and specificity for predicting POF were 0.739, 83.3% and 68.4%, which was significantly better than that of traditional predictive indicators, such as C-reaction protein (CRP), procalcitonin (PCT), blood urea nitrogen (BUN), bedside index for severity in AP (BISAP) score and Ranson score. When the cut-off value was 130.90 μg/L, the AUC, sensitivity and specificity for predicting PN were 0.703, 77.3% and 73.6%, respectively, which was significantly better than that of all traditional single indicator. The predicted value was less than PCT and CRP 2 or 3 day after admission. In addition, the Ang Ⅱlevel 1 day after admission was closely related to the Ranson score, BISAP score, and PCT level which was commonly used indicators of AP severity. Conclusions Under the new Atlanta classification criteria, Ang Ⅱ is superior to the traditional predictive indicators commonly used for predicting POF, and is a better single biochemical indicator for predicting PN in clinic.

Clinical analysis of secondary hemophagocytic lymphohistiocytosis complicated with capillary leak syndrome / 中华血液学杂志

Objective: To investigate the clinical characteristics of secondary hemophagocytic lymphohistiocytosis (sHLH) complicated with capillary leak syndrome (CLS) . Methods: The clinical and laboratory data of 87 sHLH patients, who were treated in our hospital between January 2015 and December 2017, were retrospectively analyzed. Depending on whether they were complicated with CLS, 21 sHLH patients were classified as the CLS-sHLH group, while 66 were classified as the non-CLS-sHLH group. The differences of clinical manifestations, laboratory tests, treatment and prognosis between the two groups were compared. Results: There was no significant difference in the etiology of sHLH between the CLS-sHLH group and the non-CLS-sHLH group (P>0.05) . The neutrophil, fibrinogen and albumin levels in the CLS-sHLH group were lower than those in the non-CLS-sHLH group, while the triacylglycerol levels were higher than those in the non-CLS-sHLH group (P<0.05) . Varying degrees of edema, weight gain, hypotension, hypoproteinemia, oliguria and multiple serous effusions were observed in the CLS-sHLH group. Among them, there were 15 patients that CLS get improved, and the medial time of improvement was 7 (5-14) days. The other 6 patients did not get remission, while they died within 6-30 days. The median overall survival of the CLS-sHLH group was lower than that of the non-CLS-sHLH group (75 days vs not reached, P=0.031) . Conclusions: There may be no correlation between the cause of sHLH and the occurrence of CLS. Severity of neutropenia, fibrinogen and albumin levels, and triglyceride levels may be accompanied for sHLH patients complicated with CLS. Patients with sHLH who complicated with CLS have a poor prognosis. Active treatment of HLH and its primary disease, reasonable fluid replacement and oxygen supply are crucial, which can effectively control disease progression.

Neonatal capillary leak syndrome: analysis of 68 cases / 中华围产医学杂志

Objective@#To analyze clinical features, treatment, prognosis and risk factors for death of capillary leak syndrome (CLS) in neonates.@*Methods@#This retrospective study involved 68 neonates with CLS treated in the Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University from January 2013 to December 2017. Clinical data, including features, causes, treatment and outcomes of those CLS cases were analyzed. Chi-square test and multivariate logistic regression analysis were performed.@*Results@#Among the 68 cases consisting of 49 males and 19 females, 86.7% (59/68) were born at ≥ 35 gestational weeks. Fifty-three neonates (77.9%) developed symptoms within three days after admission. Forty-two cases (61.8%) had respiratory distress syndrome and 35 (51.5%) had septicemia. The mortality rate was 23.5% (16/68). Among the survivors, 38.5% (20/52) showed abnormal cranial MRI. Univariate analysis with Chi-square test showed that neonatal death due to CLS was associated with the lactic acid level >10 mmol/L, oliguria lasting for 12 h or anuria for 8 h, no negative fluid balance occured within seven days, adrenaline infusion >0.6 μg/(kg·min) and administration of 3% sodium chloride. Multivariate logistic regression analysis showed that lactic acid level, oliguria/anuria duration and the time achieve negative fluid balance were independent risk factors for neonatal death of CLS.@*Conclusions@#Neonatal CLS is a condition with high fatality rate and poor prognosis. Respiratory distress syndrome and septicemia are the common causes. The prognosis of CLS might be improved by treatment with 3% sodium chloride. Lactic acid level, oliguria/anuria duration and the time achieve negative fluid balance are independent risk factors for neonatal death due to CLS.

Value of angiopoietin-Ⅱ in assessment of the early stage of acute pancreatitis based on the new Atlanta classification criteria / 中国医师进修杂志

Objective@#To investigate the serum angiopoietin-Ⅱ (Ang Ⅱ) levels in acute pancreatitis (AP) patients and the relationship between AngⅡ levels and the disease severity of AP based on the new Atlanta classification criteria.@*Methods@#Seventy-seven patients with AP who were treated in the Affiliated Baiyun Hospital of Guizhou Medical University were included in this prospective study. According to the revised Atlanta classification, the modified Mashall scoring system was used to divided patients into AP with the persistent organ failure(POF) group and without POF group, and the CECT was used to divided patients into AP with pancreatic necrosis(PN) group and without PN group. The levels of AP 72 h after admission of two groups were compared with t test, and Spearman analysis was used to analyze the correlation between common severity indicators and Ang Ⅱ. The receiver operating characteristic (ROC) was performed to analyze the area under curve(AUC), sensitivity and specificity of Ang Ⅱ in predicting POF and PN.@*Results@#According to the modified Mashall scoring system, there were 18 patients (23.38%) in POF group and 59 patients (76.62%) in without POF group. According to CECT, 22 patients (28.57%)were in PN group and 55 patients(71.43%) in without PN group. The Ang Ⅱ of the POF and PN groups was significantly higher than those without POF and PN groups (P=0.001, 0.011) on day 1 on admission. The cut-off value was 126.44 μg/L, and the AUC, sensitivity and specificity for predicting POF were 0.739, 83.3% and 68.4%, which was significantly better than that of traditional predictive indicators, such as C-reaction protein (CRP), procalcitonin (PCT), blood urea nitrogen (BUN), bedside index for severity in AP (BISAP) score and Ranson score. When the cut-off value was 130.90 μg/L, the AUC, sensitivity and specificity for predicting PN were 0.703, 77.3% and 73.6%, respectively, which was significantly better than that of all traditional single indicator. The predicted value was less than PCT and CRP 2 or 3 day after admission. In addition, the Ang Ⅱlevel 1 day after admission was closely related to the Ranson score, BISAP score, and PCT level which was commonly used indicators of AP severity.@*Conclusions@#Under the new Atlanta classification criteria, Ang Ⅱ is superior to the traditional predictive indicators commonly used for predicting POF, and is a better single biochemical indicator for predicting PN in clinic.

Clinical analysis of secondary hemophagocytic lymphohistiocytosis complicated with capillary leak syndrome / 中华血液学杂志

Objective@#To investigate the clinical characteristics of secondary hemophagocytic lymphohistiocytosis (sHLH) complicated with capillary leak syndrome (CLS) .@*Methods@#The clinical and laboratory data of 87 sHLH patients, who were treated in our hospital between January 2015 and December 2017, were retrospectively analyzed. Depending on whether they were complicated with CLS, 21 sHLH patients were classified as the CLS-sHLH group, while 66 were classified as the non-CLS-sHLH group. The differences of clinical manifestations, laboratory tests, treatment and prognosis between the two groups were compared.@*Results@#There was no significant difference in the etiology of sHLH between the CLS-sHLH group and the non-CLS-sHLH group (P>0.05) . The neutrophil, fibrinogen and albumin levels in the CLS-sHLH group were lower than those in the non-CLS-sHLH group, while the triacylglycerol levels were higher than those in the non-CLS-sHLH group (P<0.05) . Varying degrees of edema, weight gain, hypotension, hypoproteinemia, oliguria and multiple serous effusions were observed in the CLS-sHLH group. Among them, there were 15 patients that CLS get improved, and the medial time of improvement was 7 (5-14) days. The other 6 patients did not get remission, while they died within 6-30 days. The median overall survival of the CLS-sHLH group was lower than that of the non-CLS-sHLH group (75 days vs not reached, P=0.031) .@*Conclusions@#There may be no correlation between the cause of sHLH and the occurrence of CLS. Severity of neutropenia, fibrinogen and albumin levels, and triglyceride levels may be accompanied for sHLH patients complicated with CLS. Patients with sHLH who complicated with CLS have a poor prognosis. Active treatment of HLH and its primary disease, reasonable fluid replacement and oxygen supply are crucial, which can effectively control disease progression.

A clinical research of Xuebijing for treatment of blood capillary leak syndrome / 中国中西医结合急救杂志

Objective To explore the safety and therapeutic effect of Xuebijing injection for treatment of patients with capillary leak syndrome (CLS).Methods Seventy-seven patients with clinical diagnosis of CLS admitted to Intensive Care Unit (ICU) of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine (TCM) from November 2015 to October 2016 were enrolled, they were divided into a control group (35 cases) and a Xuebijing group (42 cases) according to random number table method. The conventional treatment was given and at the same time the primary disease was actively treated in the control group; while in the Xuebijing group, on the basic treatment of the control group, additionally, Xuebijing injection 100 mL+ 0.9% normal saline (100 mL) was intravenously dripped, twice a day, 5 days constituting one therapeutic course. Before and after treatment for 5 days, the white blood cell count (WBC), neutrophils percentage (N), alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), serum creatinine (SCr), procalcitonin (PCT), pH value, partial pressure of blood oxygen (PaO2), blood lactic acid value (Lac), activated partial thromboplastin time (APTT), prothrombin time (PT), blood platelet count (PLT) in the patients of the two groups were compared; and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was recorded; the length of stay in ICU, mechanical ventilation time, and 28-day survival rate were statistically calculated in two groups.Results After treatment, the levels of WBC, N, PCT, ALT, AST, BUN, SCr, Lac, APACHE Ⅱ score in Xuebijing group were lower than those in the control group [WBC(×109/L): 9.85±0.61 vs. 13.87±2.58, N: 0.75±0.08 vs. 0.90±0.10, PCT (μg/L): 1.13±0.71 vs. 4.99±1.38, ALT (U/L): 79.56±30.85 vs. 84.21±27.32, AST (U/L): 91.98±38.10 vs. 110.28±35.79, BUN (mmol/L): 7.35±0.82 vs. 8.57±1.43, SCr (μmol/L): 111.67±43.96 vs. 132.51±55.10, Lac (mmol/L): 1.88±1.01 vs. 3.31±1.46, APACHE Ⅱ score: 11.34±3.59 vs. 17.65±4.77]; the PaO2, PLT, 28-day survival rate in Xuebijing group were higher than those in the control group [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 75.47±21.10 vs. 54.22±15.23, PLT (×109/L): 211.54±58.25 vs. 153.27±49.69, 28-day survival rate: 85.71% (36/42) vs. 71.43% (25/35), allP < 0.05]; the PT, APTT, ICU hospitalization time and mechanical ventilation time in Xuebijing group were shorter than those in the control group [PT (s): 13.62±2.11 vs. 18.45±4.26, APTT (s): 31.33±4.27 vs. 36.85±5.56, length of stay in ICU (days): 12.4±3.7 vs. 20.5±4.1, mechanical ventilation time (days): 10.5±4.9 vs. 18.7±5.5, allP < 0.05].Conclusion The application of Xuebijing injection for treatment of patients with CLS can relieve their disease situation, reduce inflammatory indicators, improve the blood coagulation function and hypoxemia, shorten the ICU hospitalization time and mechanical ventilation time, elevate the 28-day survival rate, and has no harmful effects on liver and kidney functions.

Clinical analysis of 34 cases with sepsis and systemic capillary leak syndrome / 中华外科杂志

Objective@#To study the clinical characteristics of sepsis with systemic capillary leak syndrome(SCLS) and to evaluate the therapeutic effect and clinical significance of fluid therapy adjusted timely in these patients.@*Methods@#The clinical data of 34 patients with sepsis and SCLS in the Department of Hepatobiliary Surgery ICU of General Hospital of People′s Liberation Army General Hospital from July 2014 to January 2016 were retrospectively analyzed.There were 21 males and 13 females, aged from 21 to 74 years, with an average age of 56.3 years.Primary disease as follows: 18 cases with severe acute pancreatitis, 7 postoperative cases of subtotal hepatectomy, 5 postoperative cases of pancreatoduodenectomy, 4 postoperative cases of cholelithiasis.These patients were divided into survival group and death group according to their 28-day survival status.The clinical data including C-reactive protein(CRP), platelets (PLT), brain natriuretic peptide (BNP), the level of arterial blood lactic acid(LAC), oxygenation index(PaO2/FiO2, OI), net fluid balance(NFB) and norepinephrine dosage(NE) were collected and compared between two groups at three different intervals(day 1-3, day 4-6, day 7-9). The measurement data and numeration data were statistically analyzed with t test and χ2 test respectively to explore the inherent characteristics of the disease evolution and its clinical significance.@*Results@#The survival group (n=23)and the death group(n=11)had no significant difference in the characteristics of basic clinical characters.The condition of the survival group and the death group were both in progress in 1-3 days period manifested as increased CRP(t=-0.473, P=0.640) and BNP levels(t=0.140, P=0.895), decreased PLT counts(t=-0.505, P=0.620) in the inflammatory response, decreased LAC(t=-1.008, P=0.320) and OI level (t=-2.379, P=0.020)in tissue perfusion index, and positive fluid balance(NFB: t=0.910, P=0.370), required NE(t=-0.853, P=0.400) to maintain effective perfusion pressure with systemic edema in both groups.There was no significant difference of all these clinical parameters between the two groups.The patients′ condition of the survival group reached a plateau phase, whereas all relative indicators of the death group implied significant aggravation and deterioration of systemic infection(CRP: t=-3.438, P=0.000; PLT: t=1.649, P=0.110; BNP: t=-10.612, P=0.000), tissue perfusion (LAC: t=-11.305, P=0.000; OI: t=2.743, P=0.010)and tissue edema NFB(t=-4.257, P=0.000) and NE(t=-7.956, P=0.000) in 4-6 days period.In the last 7-9 days period the patients′ condition of the survival group took a turn for improvement, yet the condition of the death group continued to deteriorate, refractory septic shock developed and multiple organ dysfunction syndrome followed afterwards inevitably(CRP: t=-10.036, P=0.000; PLT: t=6.061, P=0.000; BNP: t=-10.119, P=0.000; LAC: t=-24.466, P=0.000; OI: t=13.443, P=0.010; NFB: t=-8.345, P=0.000; NE: t=-7.121, P=0.000).@*Conclusions@#The condition of patient with sepsis and SCLS would be improved markedly at the critical turning point around 7-9 days period since the effective systemic treatment began.If the infection does not be significantly constrolled and SCLS still remains in a sustained extravasation period in 7-9 days, the prognosis of these patients may be worse and the mortality may be higher than that of the patients mentioned before.

Clinical study of Xuebijing Injection in treatment of capillary leak syndrome / 国际检验医学杂志

Objective To study the clinical application effect of Xuebijing Injection in the treatment of capillary leak syndrome.Methods One hundred patients with capillary leak syndrome in our hospital from January 2013 to April 2016 were selected and randomly divided into the control group and observation group according to the ID number of admission.The two groups were given the Western medicine routine therapy of capillary leak syndrome.The observation group was simultaneously given Xuebijing Injection.The APACHE II score,Mashall score and hemodynamics were compared between the two groups.The disease condition change was dynamically observed.Results The APACHE II score and Mashall score before and after treatment in the observation group were significantly suprior to those in the control group(P<0.05);the peripheral blood circulating endothelial cells (CEC) number at admission in the two groups were higher than the normal level,the CEC content after taking the treatment was gradually decreased (P<0.05),but the CEC content decrease in the observation group was less than that of the control group (P<0.01);were observed before and after the treatment group APACHE II and Mashall score was significantly better than the control group (P<0.05);but the CEC content in the observation group was significnatly superior to the control group(P<0.01);the expressions of vascular endothelial growth factor (VEGF),TNF alpha and interleukin-6 (IL-6) in the observation group were better than those in the control group (P<0.05).Conclusion Using Xuebijing Injection in treating capillary leak syndrome can effectively protect the vascular endothelial cells,improves the living quality of patients and can be popularized and applied in clinical treatment.

Advances in pathophysiology of fluid resuscitation of septic shock in children / 中华实用儿科临床杂志

Fluid resuscitation is one of the most important advances in the treatment of septic shock in recent 20 years. Although saving many children's lives,this technique has been challenged by some studies. This article re-viewed systematically hemodynamics characteristic,myocardial depression and capillary leak syndrome in septic shock in children.

Value of extravascular lung water Index in assessment of prognosis of elderly patients with combined septic shock and pulmonary capillary leakage / 中华老年医学杂志

Objective To investigate the value of extravascular lung water index(EVLWI) in assessment of prognosis of elderly patients with combined septic shock and pulmonary capillary leakage.Methods Totally 34 elderly patients with septic shock and pulmonary capillary leakage in our hospital from Jan.2011 to Dec.2012 were selected.Cardiac index (CI),global end diastolic volume index (GEDI),systemic vascular resistance index (SVRI),pulmonary vascular permeability index (PVPI) and EVLWI were detected by pulse-indicator continuous cardiac output (PiCCO) technology for 3 days.Based on the actual body weight (ABW) and predicted body weight (PBW),the actual extravascular lung water index and predicted extravascular lung water index were calculated.Peak airway pressure (Ppeak),plateau pressure (Pplat),mean airway pressure (Pm),tidal volume (VT),positive end expiratory pressure (PEEP),oxygen concentration (FiO2) and static lung compliance (Cst) were monitored,the arterial partial pressure of oxygen (PaO2) was detected by blood gas analysis,and the PaO2/FiO2 (P/F) and oxygenation index (OI) were calculated.Chest X-ray,lung injury score (LIS) were conducted.The correlations of EVLWI to actual body weight (EVLWIa) and predicted body weight(EVLWIp) with P/F,Cst and LIS were analyzed.The predictive value of EVLWIa and EVLWIp in the prognosis in elderly patients with septic shock and pulmonary capillary leakage was assessed.Results At day 1,non-survivors had higher levels of SOFA score and lactate level than survivors (both P＜0.05).However,these variables including SOFA score,LIS,PVPI,lactate level,fluid balance,norepinephrine level,EVLWIa and EVLWIp were higher and PaO2/FiO2 was lower in non-survivors than in the survivors at day 3 (all P＜0.05).EVLWIa and EVLWIp were positively correlated with LIS (r=0.461 and 0.588,both P＜0.05) and negatively correlated with PaO2/FiO2 (P/F) (r=-0.307 and-0.436,both P＜0.05).EVLWIa and EVLWIp had negatively correlations with Cst,but r=-0.141 and-0.154,both P＞0.05.Multiple logistic regression analysis showed that SOFA,EVLWa and EVLWp were independent predictive risk factors for mortality in elderly patients with septic shock and pulmonary capillary leakage.The areas under the receiver operating characteristic curve (ROC) of SOFA,EVLWIa and EVLWIp for predicting the prognosis were 0.769,0.832 and 0.855 respectively.With 11.96ml/kg as the cutoff point of EVLWIp,the sensitivity and specificity of EVLWIp predicting the survival of patients was 94.4％ and 61.5％ respectively.Conclusions Extravascular lung water can predict the prognosis and reflect the severity of lung injury in elderly patients with septic shock and puhnonary capillary leakage.Compared with EVLWIa,the EVLWIp has a better correlation with lung injury and a higher predictive value for survival.

The protective effects of hydrocortisone on glycocalyx in the intestinal capillary endothelium after trauma-hemorrhagic shock / 中华急诊医学杂志

Objective To study the protective effects of hydrocortisone on glycocalyx in the vascular endothelium after trauma-hemorrhagic shock (T/HS) because the role of glycocalyx in maintaining the permeability of vascular endothelium intact,and in turn to identify the hydrocortisone protecting intestinal microcirculation.Methods Studies were carried out,in vivo,on a model of rats with induced T/HS.Intestinal perfusion and changes in endothelial glycocalyx and the associated molecular mechanism were assessed by using laser-Doppler velocimetry and electron microscopy,and the measurements of heparan sulfate,syndacan-1,and TNF-α in the superior mesenteric vein (SMV) with ELISA and Western-blot,and the expression of NF-κB in the vascular endothelium.Protective effects of hydrocortisone on the intestinal microcirculation after T/HS were evaluated.Results Degradation of the glycocalyx in intestinal vascular endothelium occurred 1-3 hours after T/HS in rats (P ＜0.05).By 3 hours later,significant reduction in intestinal perfusion was observed (P ＜ 0.05).The level of TNF-α in the SMV and the expression of NF-κB in the vascular endothelium increased.With the use of hydrocortisone,intestinal perfusion was improved,and the degradation of glycocalyx was attenuated.Conclusions The degradation of glycocalyx is associated with the malfunction of intestinal microcirculation after T/HS.The NF-κB/TNF-α system in vascular endothelium participates in this process of glycocalyx degradation.Hydrocortisone may be a good agent to interrupt the course of glycocalx degradation.

Application of PICCO technique in fluid management of the traumatic patients with capillary leak syndrome / 实用医学杂志

Objective To investigate the significance of pulse indicating the continuous cardiac output (PICCO) technique in patients with post-trauma capillary leak syndrome (PTCLS). Methods Twenty traumatic patients with PTCLS received PICCO monitor from 2011 to 2014 were enrolled in this study. analyzed, The patients, with twelve males and eight females, aged from twenty three to fifty. And twenty patients in the control group, with ten males and ten females, aged from twenty one to fifty two. Twenty six patients were injuried by traffic, ten patients were injuried by crash and four patients were injuried by sword. No significant differences were found in age、gender、weight、scores of ISS、Murray and APACHEⅡof all patients. All patients were survived. The balance of fluids, Lactate, Central venous oxygen saturation (ScvO2) and the mean artery pressure (MAP) were compared at 0, 24, 48 and 72 h after entering into the ICU. The duration of ICU stay and ventilation were also compared. Results (1)No significant differences in MAP、Lac and ScvO2 were observed in two groups. (2)No significant differences in the balance of fluids when patients entered into ICU, but significant differences were found at 24, 48 and 72 h post-entering into ICU (P < 0.05). (3)Significant differences in the duration of ICU stay and ventilation between the two groups were observed (P < 0.05). Conclusion PICCO technique can provid a quantitative target for PTCLS patients, with decreasing fluid infusion, and reducing the duration of ICU stay and ventilation.

The impact of Interleukin-1β on the structure of human umbilical vein endothelial cells and aquaporin-1 expression / 中华肝胆外科杂志

Objective To explore the role of IL-1β in capillary leak syndrome by observing the alterations of AQP-1 expression,apoptosis,and ultrastructural of vascular endothelial cells under the action of IL-1β.Methods Umbilical vein endothelial cells (UVEC) in vitro were randomly allocated into 3 groups:time,concentration,and control.In the time group,UVECs were treated with culture medium containing 20 μg/L IL-1β for3 h(T1),8 h(T2),12 h(T3) and 24 h(T4).In the concentration group,UVECs were treated with culture medium containing 0.2 μg/L(C1),2 μg/L(C2) and 20 μg/L(C3) IL-1β for 24 h.In the control group,UVECs were treated with culture medium without IL-1β for 24 h.The changes of AQP-1 mRNA and protein expression were detected by real-time PCR and Western blot.Apoptosis was detected by flow cytometry,and cell ultrastructural changes were observed by electron microscopy.Results AQP-1 mRNA and protein expression of T1-T4 in the time group and C1-C3 in the concentration group were lower than those of the control group (P ＜ 0.05).The apoptotic rate was increased,and mitochondrial swelling,vacuolar degeneration,karyolysis and necrosis were observed under electron microscopy.These were more pronounced with time or concentration increases.Conclusions IL-1β can cause a decrease of AQP-1 mRNA and protein expression,increase in apoptotic rate and increase in damage to the cells'ultrastructure.This is an important reason for damage to the vascular endothelial barrier and may be associated with capillary leak syndrome.

Systemic capillary leak syndrome (Clarkson's disease) during elective pylorus-preserving pancreaticoduodenectomy: case report

Systemic capillary leak syndrome (SCLS), also called Clarkson's disease is rare and life-threatening disorder of unknown etiology, which is a characteristic triad of hypovolemic shock, hemoconcentration, and hypoalbuminemia. Unexplained capillary leakage from the intravascular to the interstitial space, which has been estimated up to 70% of the intravascular volume, is the proposed mechanism. Because the pathogenesis is unknown, it is diagnosed clinically after exclusion of other diseases that cause systemic capillary leak and no efficacious pharmacological treatment has been clearly established. The mortality rate ranges from 30% to 76%. In Korea, four cases of SCLS (5 cases in adult and 1 case in child) were reported by 2012. We describe a case of severe SCLS that suddenly occurred and rapidly progressed during pylorus preserving pancreaticoduodenectomy and review the literature.

Systemic capillary leak syndrome under general anesthesia: a case report / 대한마취과학회지

Systemic capillary leak syndrome (SCLS) is very rare and lethal disease and only 150 cases have been reported after the first publication of its report in 1960 by Clarkson. SCLS is characterized by hemoconcentation and hypoalbuminemia caused by reversible plasma extravasation. Its mechanism is unknown, but transient dysfunction of the endothelium is the most suspected cause and trigger of this event may cause immunologic disarrangement. After recovery of endothelial function, fluid injected during the shock period is redistributed and can cause severe pulmonary edema. SCLS should be considered in patients with acute and severe hypotension with hemoconcentration and hypoalbuminemia without obvious cardiac dysfunction. Especially we should take into account the possibility of SCLS if fluid replacement does not work or the shock state is aggravated despite aggressive fluid resuscitation and vasopressor administration. SCLS itself is a very rare disease; furthermore, SCLS that develops during well-controlled surgery is even more rare. So we report this case with review of the literature.