International clinical research of critical care medicine in 2021 / 中华危重病急救医学

The progress of critical care medicine in 2021 is still encouraging. The new international guideline for management of sepsis and septic shock came out after 4 years. Besides, a couple of preferable clinical evidences were released including restrictive blood transfusion strategy for patients with acute myocardial infarction, prevention of peripheral venous catheter infection, heparin inhalation and driving pressure setting in patients with acute respiratory distress syndrome (ARDS), lower oxygenation target for acute hypoxemic respiratory failure, low level positive end-expiratory pressure in non-ARDS patients with respiratory failure, light sedation or non-sedation strategy, biological phenotypes, as well machine learning in sepsis and ARDS. However, we also encounter negative results such as balanced solution during fluid resuscitation, hypothermia therapy after out-of-hospital cardiac arrest or traumatic brain injury, adrenomedullin-specific antibody adrecizumab therapy and coupled plasma filtration-adsorption (CPFA) therapy for patients with septic shock, extracorporeal carbon dioxide removal (ECCO 2R) implementation in acute hypoxic respiratory failure, continuous infusion of hypertonic saline in patients with traumatic brain injury. Collectively, in the future, individualized diagnosis and management based on the principle of "wise choice" will become the daily practice scene for all intensivists.

Hemodynamic features and advances in research of goal-directed analgesia for patients with burn shock / 中华烧伤杂志

The hemodynamic state of patients with burn shock is extremely unstable. Goal-directed analgesia based on hemodynamic characteristics of different treatment phases is a key point in the treatment of burn shock. This can play active roles in reducing the stress response, decreasing the oxygen consumption, and protecting the organ function. This article reviews the hemodynamic characteristics of burn shock and its need for analgesia in different treatment phases, hoping to provide reference for appropriate analgesia.

Progress of pain assessment and analgesia strategy for mechanical ventilation patients / 中华危重病急救医学

Standardized pain assessment is a precondition of appropriate analgesia for mechanical ventilation patients. However, routine pain assessment rates remain very low in intensive care unit (ICU). Behavioral pain scale (BPS) and critical-care pain observation tool (CPOT) can be used to assess pain in mechanical ventilation patients who are unable to report pain by themselves. No matter what strategy we taken, analgesia-first sedation should be used in priority. Meanwhile, patient-centered and goal-directed sedation strategy should be adopted based on the individual condition.If condition permits, patients should be maintained in light states of sedation as long as possible, because this is associated with improved clinical outcomes. Humanistic care, multidisciplinary cooperation and comprehensive training are also important components of a perfect analgesia strategy.

The impact of goal directed analgesia on mechanical ventilated patients′s outcomes in intensive care unit:a clinical observational study / 中华内科杂志

To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit. A total of 126 patients who needed mechanical ventilation were recruited. With a method of before and after paired comparison, they were divided into two group:( 1 ) analgesia with empirical administration or control group; ( 2 ) goal directed analgesia based on critical-care pain observation tool (CPOT). Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from ( 368. 47 ± 27. 41 ) mg to ( 151. 27 ± 29. 31 ) mg (P<0. 05), whereas the consumption of dexmedetomidine significantly increased from ( 623. 62 ± 20. 91) μg to (812. 34 ± 22. 57) μg(P<0. 05). The median score of Richmond agitation-sedation scale increased from -3 to -1. The incidence of delirium significantly reduced from 23. 81% to 17. 46%( P<0. 05). The mean ventilator duration was significantly shortened from (168. 49 ± 11. 41) h to (142. 38 ± 13. 24) h(P<0. 05). ICU length of stay was significantly shortened from (23. 64 ± 9. 26) d to (19. 63 ± 8. 46) d ( P < 0. 05 ) . Due to the mild sedation, patients receiving goal directed analgesia report less delirium, less ventilation time and shorter ICU length of stay, suggesting that the general outcome is improved.

Clinical analysis of laparoscopic splenectomy in 31 cases / 重庆医学

Objective To study the surgical techniques and clinical experience of the total laparoscopic splenectomy .Methods Retrospective analysis 31 cases were performed laparoscopic splenectomy from January 2003 to April 2015 .Among them ,there were 12 cases with liver cirrhosis and hypersplenism ,5 cases with spleen hemangiomatosis ,3 cases with splenic lymphoma ,3 cases with splenic cyst ,2 cases with obsolete rupture of spleen hematoma ,6 cases with idiopathic thrombocytopenia .During surgery ,Li‐gaSure was used to deal with stomach ligament splenic artery .Using silk or endoscopic linear cutters to process splenic pedicle indi‐vidually .Results All operations were performed successfully without conversion to open surgery .13 patients were cutting off splenic pedicle by ligating of splenic portal blood vessel and 18 patients were using endoscopic linear cutters .The operation time was 80-240 min ,mean (130 ± 35)min ,the blood loss was 60-500 mL ,mean (150 ± 80)mL ,hospital stay was 8 .3 days .There was no mortality and pancreatic leakage complications .Conclusion On the basis of open surgery ,evaluating carefully before operation ,se‐lecting appropriate cases ,using different laparoscopic instruments ,handling splenic pedicle individually ,can make the laparoscopic splenectomy be a more safe and useful operation modality .

A correlation of pulse pressure and prognosis of refractory septic shock patients / 中华内科杂志

Objective To explore the correlation of pulse pressure(PP) and outcome in refractory septic shock patients.Methods A total of 68 patients with refractory septic shock consecutively admitted in our ICU from January 2012 to December 2012 were retrospectively studied.Hemodynamic data and arterial lactate concentration were collected at the time of admission and 24 hours after admission.The outcome of Day 28 post-diagnosis was also recorded.Results (1) Compared with the survivors,heart rate(HR) at 24hours after admission was higher in non-survivors,while 24 h lactate clearance rate (rLac) was lower in them (P ＜ 0.05).Other hemodynamic parameters showed no difference between the non-survivors and the survivors at 24 hours after admission,including central venous pressure (CVP),mean arterial pressure (MAP),systolic blood pressure(SBP),diastolic blood pressure(DBP),PP,pulse pressure/heart rate (PP/HR),pulse pressure/mean arterial pressure(PP/MAP),pulse pressure/systolic pressure(PP/SBP),pulse pressure/diastolic pressure (PP/DBP),the value of SBP above MAP (SMP) and the value of DBP below MAP(MDP).(2)The mortality rate was higher in the patients with HR≥100 b/min than those with HR ＜ 100 b/min,but without statistical significance (56.25％ vs 36.11％,P =0.096).Compared with the survivors,no matter with HR≥100 b/min or HR ＜ 100 b/min,lactate(Lac) at the 24 hours after admission was higher in all the non-survivors (P ＜ 0.05),while with lower rLac (P ＜ 0.05).In those with HR ≥100 b/min,the following hemodynamic parameters were higher in the non-survivors than in the survivors,including PP,PP/HR,PP/MAP,PP/SBP,PP/DBP,SMP and MDP (all P values ＜ 0.05),while no statistical difference was observed in those with HR ＜ 100 b/min.(3)The mortality rate showed no statistical difference in those with MAP≥85 mmHg(1 mmHg =0.133 kPa) and with MAP ＜ 85 mmHg(42.42％ vs 48.57％,P =0.611).No matter MAP≥85 mmHg or MAP ＜ 85 mmHg,compared with the survivors,all the non-survivors had higher Lac at the 24 hours after admission (P ＜ 0.05),while with lower rLac (P ＜ 0.05).In those with MAP≥85 mmHg,HR was higher in the non-survivors than the survivors (P ＜ 0.05).In those with MAP ＜ 85 mmHg,compared with the survivors,the non-survivors had higher PP,PP/MAP,PP/SBP,PP/DBP,SMP and MDP (P ＜0.05),while with lower DBP (P ＜0.05).Conclusion PP is correlated with the outcome in refractory septic shock patients.When the HR and MAP differ,PP has different effect on the outcome and contributes more to the tissue perfusion and outcome in those with higher HR and lower MAP.

Study of optimal discharge pressure of compressor in CO2 refrigerating trans-critical cycle / 药物分析学报

In this paper, a carbon dioxide trans-critical refrigerating system which is different from a conventional subcritical refrigerating cycle was studied. The trans-critical carbon dioxide refrigerating systems are based on the Gustav Lorntzen cycle. Emphasis was focused on how to determine the optimal discharge pressure of compressor in CO2 trans-critical cycle. The factors related with the optimal discharge pressure were analyzed. A formula was developed based on cycle simulation, which could be used to predict the optimal discharge pressure of a basic CO2 trans-critical cycle. After further studies on CO2 trans-critical cycles with a regenerator or expander, two more formulas were also developed. These formulas could provide an access to improve the COP of CO2 trans-critical cycle.