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Objective:To explore the application rules and effects of "Four Elements, One Peptide, and Two Transplantations" in the bundle treatment of the patients with coronavirus disease 2019 (COVID-19), so as to provide a scientific evidence for effective treatment and prevention of severe type.Methods:A retrospective comparative study method was used to analyze the clinical data of COVID-19 patients admitted to Wuxi Fifth People's Hospital from January 2020 to March 2022, including demographic information, underlying diseases, clinical classification, length of hospital stay, treatment cost, clinical symptoms, laboratory tests and other key indicators, and evaluate the application rules and effect of "Four Elements, One Peptide, and Two Transplantations" in the bundle treatment of the patients with COVID-19.Results:The L-type new coronavirus strain was predominant in 2020, the Delta variant in 2021, and the Omicron variant in 2022. The proportion of mild cases was highest in 2022, with the highest proportion of > 65 years old patients developing severe and critical. Among the 150 patients, the proportion of interferon use (100.0%) was the highest in the bundle treatment regimen of "Four Elements, One Peptide, and Two Transplantation". The combined use of vitamin C, interferon and thymopeptide was highest in 2022. More than 75.0% of the age > 65 years old group had underlying diseases, which was also the age group with the highest proportion of "Four Elements, One Peptide, and Two transplantations". Compared with mild cases, the age, length of hospital stay, and hospitalization cost of patients with COVID-19 increased significantly with severity. Mild, ordinary, severe, and critically ill patients all had low lymphocyte counts, with 40.0% of severe patients having the lowest lymphocyte counts within 3 days of admission. The lymphocyte count of critically ill patients was reduced or continuously reduced after admission, and the use of the "Four Elements, One Peptide, and Two transplantations" method to regulate immunity can effectively save the lives of critically ill patients. Of all cases of COVID-19 infection, 51.3% were asymptomatic, followed by respiratory symptoms (48.7%) and lung lesions (38.0%). Patients with renal dysfunction received this bundle therapy was highest, followed abnormal coagulation and abnormal liver function. This bundle therapy promoted a significant increase in CD4 + T lymphocytes and B lymphocytes in various cases. After treatment, as the virus turns negative, the proportion of M1 type macrophages increased, and the proportion of regulatory T cell (Treg cells) that suppress immunity and the infection related C-C chemokine receptor type (CCR10 +) Treg cells decreased. Mild adult cases showed a great change and declined rapidly. Conclusions:Advanced age with underlying diseases is a risk factor for severe disease of COVID-19, the "Four Elements, One Peptide, and Two transplantations" bundle fine treatment of COVID-19 can improve the proportion of lymphocyte composition and organ function, which can control the occurrence and development of severe diseases. In addition to the proportion of CD4 + T cells, the changes of the M1 macrophage, total Treg cell, and CCR10 + Treg cell proportions can be used to determine disease changes of adult patients.
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Objective To design bundle treatment plan in the early stage for severe human infection by avian influenza H7N9, and explore its clinical efficacy and application value. Methods Fifteen patients with severe human infection by avian influenza H7N9 in Guizhou Province from December 29th, 2016 to June 7th, 2017 were enrolled. Patients admitted from March 6th, 2017 to June 7th, 2017 served as a prospective observation period (bundle treatment group), and those from December 29th, 2016 to March 5th, 2017 were selected as a historical control period (conventional treatment group). Conventional treatment group was given conventional treatment such as isolation, anti-virus, symptomatic treatment, and traditional Chinese medicine and so on. Bundle treatment group was given bundle treatment on the basis of conventional treatment, including isolation, anti-virus, respiratory support, restrictive fluid management, immunotherapy, inhibition of inflammation, antibiotic therapy, nutritional support, prevention of hospital acquired infection (HAP), individual sedation, continuous blood purification (CBP) for acute kidney injury (AKI) and severe acute respiratory distress syndrome (ARDS) patients, and intensive care. A cluster of bundle treatment team was set up to ensure that all measures carried out smoothly. The gender, age, onset to diagnosis time, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, oxygenation index (PaO2/FiO2) at admission, the length of intensive care unit (ICU) stay, total hospitalization time and prognosis of the two groups were observed. Correlation analysis between bundle therapy and prognosis was analyzed by Spearman correlation analysis. Receiver operating characteristic (ROC) curve was drawn, and the clinical value of bundle treatment was analyzed. Results There was no significant difference in gender, age, onset to diagnosis time, APACHEⅡscore, PaO2/FiO2, the length of ICU stay, or total hospitalization time between bundle treatment group (n = 9) and conventional treatment group (n = 6), but the death patients in the bundle treatment group was significantly fewer than those in conventional treatment group (cases:2 vs. 5, χ2= 3.225, P = 0.041). Correlation analysis showed that there was a significant correlation between the mortality and whether received bundle treatment or not in patients who infected by avian influenza H7N9 (r = -0.875, P = 0.018). ROC curve analysis showed that the area under the ROC curve (AUC) of non-bundle treatment for predicting the death in patients with severe human infection by avian influenza H7N9 was 0.938, 95% confidence interval (95%CI) was 0.795-1.000, the sensitivity was 88.88%, and the specificity was 98.62%. Conclusions Early bundle therapy has a significant effect on severe human infection by avian influenza H7N9, which can improve the prognosis and reduce the mortality of patients. It is worthy for clinical application.
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ObjectiveTo determine the effect of multi-criteria decision analysis (MCDA) on the effect of bundle treatment for severe pneumonia.Methods A prospective historical control observation was conducted. Seventy-five patients with severe pneumonia having received MCDA (from January 2013 to August 2014) were assigned as intervention group. MCDA group was set up by the medical staff. Bundled treatment plan was composed of the MCDA evaluation results, anti-infection, phlegm and other conventional treatment measures which was adjust on time until the patient was transferred out of the respiratory intensive care unit (RICU) or died. Seventy patients with severe pneumonia before receiving MCDA (from August 2010 to December 2012) were set as historical control group. Comparison of general condition before treatment and the incidence of hospital infection, average hospitalization cost, duration of RICU stay and mortality between these two groups were performed.Results There were no statistically significant differences in gender, age, past history, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score at admission between two groups. Compared with control group, the incidence of hospital infection [1.33% (1/75) vs. 11.43% (8/70),χ2 = 4.723,P = 0.030], mean hospitalization cost in RICU (10 thousand Yuan: 3.44±0.79 vs. 3.76±0.91,t = 2.265, P = 0.025), length of RICU stay (days: 15.01±4.22 vs. 16.92±4.79,t = 2.552,P = 0.012) and mortality in RICU [8.0% (6/75) vs. 21.4% (15/70),χ2 = 5.272,P = 0.032] in intervention group was significantly decreased. Conclusions Application of MCDA in the bundle treatment of severe pneumonia could elevate the scientificalness of decision, and reduce the medical cost. Additionally, MCDA is worth to be generalized because the implementation of guidelines can improve the clinical outcome and prognosis of the patients.
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Objective To investigate the therapeutic effect of bundle treatments for critically ill patients with pulmonary tuberculosis and respiratory failure (RF).Methods A prospective study was conducted, including 56 patients with pulmonary tuberculosis and RF necessary for invasive mechanical ventilation admitted into Department of Critical Care Medicine of the Fourth People's Hospital of Nanning City from January 2013 to December 2014 as the observation group to be treated by bundle treatments. A series of treatments and cares were given to the critically ill patients, such as invasive mechanical ventilation, application of antibiotics by experience within the first hour, supportive treatment targeted to hemodynamics in early stage, correction of brain dysfunction, effective therapy for tuberculosis, establishment of enteral nutrition in early stage and prevention of ventilator-associated pneumonia (VAP), etc. All the above treatments were completed one by one in 6 hours to 12 hours. Meanwhile, 42 patients who hospitalized from January 2011 to December 2012 and treated with conventional targeted therapy were designed as the control group. The changes of vital signs, blood routine test, respiration, liver, kidney, etc organ functions, the improvement of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, expected mortality and sequential organ failure assessment (SOFA) score, the incidence of VAP, cure and improvement rate, mortality, duration of invasive mechanical ventilation, the length of stay in intensive care unit (ICU) were compared between the two groups after treatments.Results There were no statistically significant differences in the comparisons between the two groups before and after treatments in temperature, white blood cell count (WBC), blood glucose, total bilirubin (TBil), alanine transaminase (ALT), albumin (Alb) and cholesterol level (allP > 0.05), except the platelet (PLT) count in observation group was higher than that in control group before treatments. After treatments for 72 hours, in the two groups, the heart rate (HR), respiration rate (RR), APACHE Ⅱ score and expected mortality were lower than those before treatments, while the arterial partial pressure of oxygen (PaO2) and oxygenation index were higher than those before treatments. There were no statistically significant differences in pH value, PLT, arterial partial pressure of carbon dioxide (PaCO2) and SOFA score before and after treatments in the control group (allP > 0.05). In the observation group, after treatments, the pH value was increased compared with that before treatments, while PLT, PaCO2 and SOFA score were decreased compared with those before treatments (allP 0.05).Conclusion The bundle treatments can effectively reduce the incidence of VAP and elevate the improvement and cure rate in patients with pulmonary tuberculosis complicated with RF.
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Objective To evaluate the impact of sepsis bundle treatment on morbidity of sepsis or septic shock in burned patients. Methods A retrospective clinical study was conducted on burned patients with severe sepsis or sepsis shock in burn intensive care unit. 95 patients were divided into control group(43 patients) and study group (52 patients)according to their treatment. The relationship between sepsis bundle index and sepsis, septic shock and 28-day mortality respectively were analyzed with logistic regression analysis. The compliance of sepsis bundles,and 28-day mortality were noted. Results The 28-day mortility rate,the mobidity of sepsis and septic shock in study group was lower than that of control group (P ＜ 0. 05). It could be found that 6-hour EGDT and 24-hour EGDT was the independent protective factor of sepsis and septic shock through logistic regression analysis ,and blood gas analysis, EGDT and vasoactive drug were correlated with 28-day mortality(P ＜0. 05). Compliance with sepsis bundles of 6-hour EGDT and 24-hour EGDT in study group was only 51.9%, and 63.2% respectively. Conclusion Sepsis bundle was able to improve survival rate in severe burn patients. Compliance with sepsis bundles in burn medical staff needed a buring improve.
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OBJECTIVE To reduce the occurrence of ventilator associated lower respiratory infection(VALRI) with the simple effective method.METHODS All studied patients who received mechanical ventilation(MV) in ICU were divided into the study group(antibacterial-processed endotracheal tube group) and the control group.Bacterial culture of samples from endotracheal tube inwall and lower respiratory tract were obtained periodically.The clinical data such as the duration of MV,the time of occurrence of VALRI,and the case fatality rate were recorded and analyzed.RESULTS In patients with MV