High-flow nasal cannula oxygen therapy and noninvasive ventilation for preventing extubation failure during weaning from mechanical ventilation assessed by lung ultrasound score: A single-center randomized study.

BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen (HFNCO2) therapy and noninvasive ventilation (NIV) using lung ultrasound score (LUS) in comparison with standard care among patients in the intensive care unit (ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days. METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points (at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO2. Patients with an LUS score ≥14 points (at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress; patients received HFNCO2 therapy combined with sessions of preventive NIV (4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation. RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference (P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure (P=0.61). The length of ICU stay (9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate (at 48 hours: 18.4% vs. 10.2%; seven days: 22.4% vs. 12.2%) significantly varied between the two groups (P<0.05). There was no significant difference in the 28-day mortality rate (6.1% vs. 8.2%) between the control and treatment groups. CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO2 protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.

Risk factors and clinical significance of trauma-induced coagulopathy in ICU patients with severe trauma.

OBJECTIVE: To investigate the incidence and risk factors for trauma-induced coagulopathy (TIC) and the impact of TIC on outcomes of patients with severe trauma admitted to an emergency intensive care unit. METHODS: We retrospectively reviewed clinical data from 223 patients with severe trauma admitted to emergency intensive care unit within 24 h after injury. Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation II score, coagulation function, routine blood and biochemical tests, and blood gas parameters were obtained from medical records. Patients were divided into two groups according to the presence or absence of coagulopathy. ISS, Acute Physiology and Chronic Health Evaluation II score, and the incidence rates of hypothermia and tissue hypoperfusion were compared. The risk factors of TIC were analyzed and a multivariate logistic regression equation was developed. Coagulation function and the incidence of TIC were also compared between surviving and dead patients. RESULTS: Overall, 52/223 (23.3%) patients fulfilled the diagnostic criteria for TIC. Their mortality rate was significantly higher than that of patients without coagulopathy (36.5 vs. 9.4%, P<0.01). ISS, incidence rates of hypothermia and tissue hypoperfusion, and the prevalence of severe traumatic brain injury were significantly higher (P<0.01), whereas Glasgow Coma Scale, hemoglobin, hematocrit, and platelet counts were significantly lower (P<0.01) in patients with coagulopathy than those without. Base deficit at least 6, Glasgow Coma Scale 8 or less, and platelet count were independent risk factors for TIC. Compared with surviving patients, the patients who died had significantly reduced coagulation function. CONCLUSION: The incidence of TIC is particularly high among patients with severe trauma. TIC is associated with increased ISS, brain injury, shock and hypothermia, and mortality.

Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter.

OBJECTIVE: To evaluate the efficacy and safety of the treatment of traumatic hemothorax by closed pleural drainage using a central venous catheter (CVC), compared with using a conventional chest tube. METHODS: A prospective controlled study with the Ethics Committee approval was undertaken. A total of 407 patients with traumatic hemothorax were involved and they were randomly assigned to undergo closed pleural drainage with CVCs (n=214) or conventional chest tubes (n=193). The Seldinger technique was used for drainage by CVC, and the conventional technique for drainage by chest tube. If the residual volume of the hemothorax was less than 200 ml after the daily volume of drainage decreased to below 100 ml for two consecutive days, the treatment was considered successful. The correlative data of efficacy and safety between the two groups were analyzed using t or chi-squared tests with SPSS 13.0. A P value of less than 0.05 was taken as indicating statistical significance. RESULTS: Compared with the chest tube group, the operation time, fraction of analgesic treatment, time of surgical wound healing, and infection rate of surgical wounds were significantly decreased (P<0.05) in the CVC group. There were no significant differences between the two groups in the success rate of treatment and the incidence of serious complications (P>0.05), or in the mean catheter/tube indwelling time and mean medical costs of patients treated successfully (P>0.05). CONCLUSIONS: Management of medium or large traumatic hemothoraxes by closed thoracic drainage using CVC is minimally invasive and as effective as using a conventional large-bore chest tube. Its complications can be prevented and it has the potential to replace the large-bore chest tube.

[Netrin-1 protein expression in gastric cancer and its correlation with clinicopathologic features and prognosis].

OBJECTIVE: To evaluate the relationship between netrin-1 protein, clinicopathologic features and prognosis in gastric cancer patients. METHODS: Tissue micro-array and immunohistochemistry were used to detect expression of netrin-1 protein and Ki67. And clinicopathological relevance of netrin-1 protein and Ki67 in gastric cancer were analyzed. Survival rates was evaluated by Kaplan-Meier survival curves. Cox regression analysis was performed to evaluate the possibility of netrin-1 expression as an independent prognostic factor for gastric cancer. RESULTS: The positive-expression rate of netrin-1 protein, paracancerous netrin-1 protein and Ki67 in tumor tissue from 67 patients with gastric cancer were 49%, 42% and 60%, respectively. netrin-1 protein expression might be related to depth of invasion, lymth node metastasis and distant metastasis (P<0.05). But no correlation was observed in sex, tumor diameter and tumor grade (P>0.05). There was correlation between different degrees of netrin-1 expression and distant metastases (P<0.05). No correlation was found in the expression of Ki67 and clinicopathological features. The correlation between the expression of netrin-1 and Ki67 was observed (r=0.359, P<0.05). Using Kaplan-Meier survival curves and the log-rank test, the correlation of netrin-1 expression, different degrees of netrin-1 expression and survival (P<0.05) were also observed. But netrin-1 expression was not significantly correlated with the prognosis of gastric cancer (RR = 1.335, 95% CI: 0.612-2.914). CONCLUSION: netrin-1 protein may be related with tumorigenesis and tumor progression by affecting proliferation. The detection for netrin-1 may be helpful to evaluate the clinicopathological parameters and survival time. However, it is not an independent prognostic factor for gastric cancer.

Basic fibroblast growth factor alleviates brain injury following global ischemia reperfusion in rabbits.

The aim of this study was to explore the protective effect of basic fibroblast growth factor (bFGF) on brain injury following global ischemia reperfusion and its mechanisms. Brain injury following global ischemia was induced by four vessels occlusion and systemic hypotension. Twenty-four rabbits were randomized into three groups: group A, only dissection of vessels; group B, intravenous infusion of normal saline after reperfusion for 6 h; group C, 30 microg/kg bFGF injected intravenously at the onset of reperfusion, then infused with 10 microg/(kg.h) for 6 h. Serum neuron specific enolase (NSE), S-100B, tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), interleukin-8 (IL-8) were measured before ischemia, 30 min after ischemia, 0.5, 1, 3, 6 h after reperfusion. Brain water content was determined and cerebral histopathological damages were compared. NSE and S-100B were increased 1 h after reperfusion and reached their peaks 6 h after reperfusion, but were much higher in group B than those in group C 3, 6 h after reperfusion. In groups B and C, TNF-alpha was increased after ischemia and IL-1 and IL-8 were increased significantly 0.5 h after reperfusion, then reached their peaks 6 h, 3 h, 6 h after reperfusion respectively. TNF-alpha and IL-8 at the time points of 1 h and 3 h and IL-1 at 3 h and 6 h in group C were correspondingly lower than those in group B. These indices in group A were nearly unchanged. There were less severe cerebral histopathological damages in group C compared with group B, but no difference in brain water content. It could be concluded that bFGF alleviates brain injury following global ischemia and reperfusion by down-regulating expression of inflammatory factors and inhibiting their activities.