[Establishment of a digital remote platform for respiratory support and intelligent early warning in intensive care units].

During the disease progression or treatment of critically ill patients with lung injury, the changes in respiratory mechanics are continuous and dynamic. Establishing a digital platform for respiratory support in the ICU, which enables the continuous recording, dynamic analysis, and real-time alerting of numerical and waveform data from mechanical ventilation, can help intensivists improve their understanding of "dynamic respiratory mechanics", improve respiratory therapy and patient outcomes, as well as reduce workload and increase work efficiency. The construction of a dedicated database for mechanical ventilation, based on ventilator waveforms provides essential data support for projects such as respiratory mechanics data algorithm models. This will facilitate the establishment of an auxiliary decision-making system, enable the realization of intelligent mechanical ventilation, and create a new era of dynamic respiratory mechanics.

[Applications and challenges of large language models in critical care medicine].

The rapid development of big data methods and technologies has provided more and more new ideas and methods for clinical diagnosis and treatment. The emergence of large language models (LLM) has made it possible for human-computer interactive dialogues and applications in complex medical scenarios. Critical care medicine is a process of continuous dynamic targeted treatment. The huge data generated in this process needs to be integrated and optimized through models for clinical application, interaction in teaching simulation, and assistance in scientific research. Using the LLM represented by generative pre-trained transformer ChatGPT can initially realize the application in the diagnosis of severe diseases, the prediction of death risk and the management of medical records. At the same time, the time and space limitations, illusions and ethical and moral issues of ChatGPT emerged as the times require. In the future, it is undeniable that it may play a huge role in the diagnosis and treatment of critical care medicine, but the current application should be combined with more clinical knowledge reserves of critical care medicine to carefully judge its conclusions.

[Technology specification of bedside hypertonic saline-contrast electrical impedance tomography of lung perfusion and clinical application].

Bedside hypertonic saline-contrast electrical impedance tomography (EIT) method for lung perfusion evaluation has several advantages of bedside, simple, noninvasive and radiation-free. For a long time, EIT perfusion image of hypertonic saline was mostly limited to animal experiments, and related clinical research is in the ascendant. This technical specification for clinical application is reached based on our previous researches, review of literatures in this field. The purpose of this technical specification is to facilitate the unified and standardized use of hypertonic saline-contrast EIT technology for regional lung perfusion, to evaluate the safety and quality control of the technology, and to unify the results.

[The relationship between arterial blood lactate clearance, prognosis and myocardial damage in patients with septic shock after early goal-directed therapy].

Objective: To evaluate the prognostic value of arterial blood lactate clearance based on central venous oxygen saturation and perfusion index in patients with septic shock related myocardial injury after early goal-directed therapy. Methods: One hundred and fifty-seven patients with septic shock after early resuscitation were enrolled from August 2013 to July 2016 in ICU at Peking Union Medical College Hospital. Parameters indicating early resuscitation included central venous pressure (CVP) 8-12 mmHg (1 mmHg=0.133 kPa),mean arterial pressure (MAP) >65 mmHg, central venous oxygen saturation(ScvO(2))>70% and urine volume (UO) >0.5ml·kg(-1)·h(-1) and arterial blood lactate (Lac) >2 mmoL/L.Patients were divided into group A [ScvO(2)>80% and perfusion index (PI)>1.4], group B(ScvO(2)>80% and PI<1.4),group C(ScvO(2)<80% and PI>1.4),group D(ScvO(2)<80% and PI<1.4).Hemodynamic parameters and tissue perfusion indexes at 2 hours(T2),4 hours(T4) and 6 hours(T6) after early resuscitation and troponin I which indicated myocardial damage, on day 1 2 3 in ICU were recorded. Results: ⑴Lac clearance in group C was the quickest, which was 34.57% (21.44%, 44.20%) , 58.33% (30.19%, 70.79%) , 71.43% (53.75%, 82.79%) at T2, T4, T6 respectively.⑵The maximal incidence of myocardial damage was in group B(85.0%) and the lowest in group A (45.7%) on day 1 in ICU.Whereas on day 2, group C showed the lowest incidence of myocardial damage (29.3%) and group B the highest(70.0%). On day 3,the proportion of elevated troponin I in group B was 70.0%, which was significantly higher than that of group B (29.3%,P<0.008).⑶Logistic regression analysis suggested that the rate of Lac clearance at T4 in group B was related to the incidence of myocardial damage on day 2 and 3 in ICU. Conclusions: The combination of PI and ScvO(2) as a resuscitation target in patients with septic shock facilitates Lac clearance as the goal of resuscitation.The rate of arterial Lac clearance based on ScvO(2) and PI is correlated with myocardial injury in patients with septic shock after early goal-directed therapy.

[The expression of triggering receptor expressed on myeloid cells receptor-1 in Aspergillus infected mice].

Objective: To investigate the expression of triggering receptor expressed on myeloid cells receptor-1 (TREM-1) in plasma and bronchoalveolar lavage fluid (BALF) and its correlation with Galactomannan, IFNγ, IL-6 and IL-10 in Aspergillus infected mice. Methods: Cyclophosphamide(CTX) was intraperitoneally injected and fumigatus spore suspension was inhaled by nose to establish the immunocompromised invasive pulmonary aspergillosis(IPA) mouse model.Healthy controls, immunocompromised only and IPA only groups were also established. Each group had 6 mice. After inoculation, mice were sacrificed. Lung tissue specimens, BALF, and plasma samples were collected. Plasma and BALF soluble TREM-1 (sTREM-1), Galactomannan, IFNγ, IL-6, and IL-10 were detected by ELISA. Results: Positive Aspergillus fumigatus was found by tissue culture in the lung. Infiltration of inflammatory cells, blood congestion and interstitial lung tissue injury were observed in histological sections of both IPA and immunocompromised IPA mice. Compared to IPA group [(453.78±74.18) ng/L, P<0.001; (10.21±1.46) ng/L, P<0.001] and control group [(245.16±65.85) ng/L, P<0.001; (6.60±3.74) ng/L, P<0.001], the plasma and BALF sTREM-1 significantly increased in immunocompromised IPA group [(1 537.64±359.52) ng/L; (20.12±2.72) ng/L]. Compared to control group, both the BALF sTREM-1 in IPA group (P=0.041) and the plasma and BALF Galactomannan, IFNγ, IL-6, and IL-10 levels in IPA and immunocompromised IPA groups were significantly higher (P<0.01). Pearson correlation analysis showed that plasma and BALF sTREM-1 were significantly correlated with Galactomannan (r=0.83, P<0.001; r=0.82, P<0.001), IFNγ (r=0.79, P<0.001; r=0.61, P<0.01), IL-6 (r=0.81, P<0.001; r=0.66, P<0.01), and IL-10 (r=0.70, P=0.001; r=0.54, P=0.02). Conclusions: Plasma and BALF sTREM-1 appears highly expressed in Aspergillus infected mice. sTREM-1 in mice plasma and BALF is closely correlated with Galactomannan, IFNγ, IL-6, and IL-10 levels, which suggests that sTREM-1 has great diagnostic value during invasive fungal infection.

Ethanol embolization of auricular arteriovenous malformations: preliminary results of 17 cases.

BACKGROUND AND PURPOSE: Because of the relatively rare and extremely varied clinical presentations, arteriovenous malformations (AVMs) involving the auriculae are technically challenging clinical entities to diagnose and, ultimately, manage. The purpose of our study was to present our initial experience of ethanol embolization in a series of 17 patients with auricular AVMs and assess the interim therapeutic outcomes of this method. MATERIALS AND METHODS: Our study group consisted of 17 patients. Transcatheter arterial embolization and/or direct percutaneous puncture embolization were performed. Pure or diluted ethanol was manually injected. Follow-up evaluation was obtained on the basis of physical examination and angiography at 3- to 4-month intervals and telephone questionnaire at 1-month intervals in all patients. RESULTS: During the 29 ethanol embolization procedures, the amount of ethanol used ranged from 4 to 65 mL. The obliteration of ulceration, hemorrhage, pain, infection, pulsation, and bruit in most of the patients was obtained. The reduction of redness, swelling, and warmth was achieved in all of the patients, and 15 of the patients achieved downstaging of the Schobinger status. According to the angiographic findings, AVMs were devascularized 100% in 3 patients, 76% to 99% in 5 patients, 50% to 75% in 6 patients, and less than 50% in 3 patients. The most common complications were reversible necrosis and blister. CONCLUSIONS: Ethanol embolization has proved efficacious and safe in the treatment of auricular AVMs and has the potential to be accepted as the primary mode of therapy in the management of these lesions.

Ethanol embolization of arteriovenous malformations of the mandible.

BACKGROUND AND PURPOSE: Absolute ethanol was reported as an effective embolization of arteriovenous malformations (AVMs), but its use to treat AVMs in the mandible is not yet well established. Here, we present our clinical experience on treatment of mandibular AVMs with absolute ethanol. MATERIALS AND METHODS: Eight consecutive patients with symptomatic AVMs of the mandible between August 2007 and September 2008 were enrolled in this study group. Among them, 6 patients underwent direct puncture embolization with absolute ethanol combined with coils, 1 patient underwent direct puncture embolization with absolute ethanol only, and the last patient had transarterial embolization with absolute ethanol alone. The use of coils decreased the flow and volume of the nidus, and then absolute ethanol embolization was directed against and obliterated the nidus completely. The procedure was performed with the patients under general anesthesia with nasal intubation, and the vital signs of the patients were constantly monitored during the injection of absolute ethanol. The total amount of absolute ethanol used per session was less than 1 mL/kg of body weight. RESULTS: A total of 11 ethanol embolizations were performed on 8 patients, including 3 sessions with transarterial microcatheterization and 8 with direct puncture embolization. A venogram and control arteriogram performed immediately after the procedure were both obtained, which documented a significant thrombosis of the lesion in all patients. Follow-up examinations revealed that oral bleeding was controlled, the expansion of the external jugular vein in 5 cases was obliterated, and satisfactory shrinkage of the facial swelling was achieved. Follow-up angiography (mean, 4.2 months) was available in 4 patients, and there was no angiographic recurrence of the lesions. There were 3 cases with minor complications. CONCLUSIONS: On the basis of our experience, treatment of AVMs in the mandible with absolute ethanol is a feasible, safe, and highly effective method.