RESUMO
Objective To investigate the predictive value of bedside echocardiographic assessment of the inferior vena cava variability ( ΔIVC ) in the weaning of patients with mechanical ventilation before spontaneous breathing test ( SBT ) . Methods Eighty-two mechanical ventilation patients admitted to the department of critical care medicine in our hospital from June to December 2017 and ready to wean from the mechanical ventilation were successively included . SBT was performed by T-tube mode after screening and the success of weaning is defined that the spontaneous breathing time exceeds 48 h after extubated . According to the outcomes of weaning ,the patients were divided into the weaning success group( 61 cases) and the weaning failure group(21 cases) ,the successful rate of weaning was 76 .1％ . The basic clinical characteristics of the patients ,including age ,sex ,acute physiology and chronic health score II ,heart rate , respiratory rate ,mean arterial pressure ,central venous pressure ( CVP) and the level of lactic acid were recorded ,and the inferior vena cava variability ( ΔIVC ) were measured before SBT with bedside echocardiography . The ΔIVC differences between the patients in the weaning success group and the weaning failure group were compared ,and the predicted value of ΔIVC for the weaning results was evaluated by ROC curve ,expressed as the area under the curve ( AUC) . Results The CVP of the weaning failure group was higherthanthatintheweaningsuccessgroup[(10.0±3.2)mmHgvs(7.2±2.8)mmHg(1mmHg =0 .133 kPa) , P =0 .01] . There was no significant difference in other basic clinical characteristics( all P >0 .05) . The ΔIVC of the weaning success group was significantly higher than that of the weaning failure group[(67.1±25.8)％ vs(33.8±23.2)％ ,P =0.001].TheAUCofthe ΔIVC predicted the weaning result before SBT was 0 .76 . The sensitivity of ΔIVC>50％ predicting successful weaning was 81 .8％ and the specificity was 79 .2％ . Conclusions Echocardiographic assessment of the inferior vena cava variability in patients with mechanical ventilation before SBT can predict the weaning outcome and guide fluid management clinically .
RESUMO
Objective To systematically evaluate the effect of different administration methods of hydrocortisone on blood glucose in patients with septic shock. Methods The Cochrane Library, PubMed, Web of Science, Embase, CNKI, CBM, Wanfang, and VIP databases were searched from foundation to December 31st, 2017 for the randomized controlled trials (RCTs) about hydrocortisone on blood glucose of different drug-deliver ways in patients with septic shock. In addition, the citation retrievals were performed by the literature references. Then the quality evaluation and data extraction was conducted by two researchers independently according to the Cochrane systematic review methods. RevMan 5.3 software was utilized to perform meta-analysis on the influences of the two different administration methods of the continuously pumping hydrocortisone group (experimental group) vs. the intermittently dripping hydrocortisone group (control group) on the mean blood glucose (MBG), largest amplitude of glycemic excursion (LAGE), glucose variability (GV), hyperglycemia time window in patients with septic shock. Results 1 203 relevant articles were preliminarily searched. Then the duplications were removed, reviews, and non-RCTs and articles evidently not accordant with the inclusion criteria were excluded by titles and abstracts. Eventually a total of 5 well-designed RCTs (404 cases) were incorporated, including 201 cases in the experimental group and 203 cases in the control group. The results of meta-analysis showed that compared with the control group, MBG was significantly decreased in the experimental group [mean difference (MD) = -0.99, 95% confidence interval (95%CI) = -1.53 to -0.45, P < 0.05], LAGE was decreased (MD = -5.66, 95%CI =-6.92 to -4.41, P < 0.05), GV was reduced (MD = -0.67, 95%CI = -0.82 to -0.53, P < 0.05), and hyperglycemia time window was shortened (MD = -7.68, 95%CI = -9.03 to -6.33, P < 0.05). The funnel chart revealed that there was publication bias in the MBG, hyperglycemia time window of the articles, and the publication bias was lower in the LAGE and GV. Conclusion Compared with intermittent administration method, the continuous pumping hydrocortisone method can stabilize the blood glucose of septic shock patients, shorten the duration of hyperglycemia and reduce the peak value of blood glucose.