Sepsis 已经成为危重症医学中较为常见的一种综合征，它定义为因病原体感染而引起的全身性炎症反应综合征。严重Sepsis患者预后不佳，治疗上也较为困难，特别是合并Septic Shock和多器官功能不全综合征（MODS）的患者，死亡率仍然较高，因此近年来在临床及研究上均已引起明显的重视。为了能促进Sepsis的研究及治疗，国际上多个医学专科分会联合发起“拯救Sepsis运动（Surviving Sepsis Campaign, SSC）”，并于2004年首次发表了相应的指南，即Surviving Sepsis Campaign Guideline for Management of Severe Sepsis and Septic Shock。今年初SSC再次发表了新版的指南，主要是结合近年的研究成果而在原版的基础上进行适当的补充和更新，以指导临床上严重Sepsis的抢救及治疗。
Objective To explore the incidence and severity of symptoms of the lung cancer patients undergoing concurrent chemoradiation therapy, and reveal the influence of symptom clusters on the patients’ daily activities. Method From December 2016 to June 2017, a total of 150 patients with lung cancer who underwent concurrent chemoradiation therapy were investigated by using M. D. Anderson Symptom Inventory of Chinese Version and the revised lung cancer module. Results For the patients during the period of concurrent chemoradiation therapy, the symptoms with severity score >5 were fatigue, nausea, poor appetite, cough, distress, disturbed sleep, vomiting, expectoration, and grief; the symptoms with incidence >80% were fatigue, nausea, disturbed sleep, poor appetite, grief, and cough. Joy of life (87.33%), emotion (74.38%), and work (72.67%) were the top three in terms of high incidence of symptom distress. Exploratry factor analysis revealed 4 major symptom clusters, which were fatigue-related symptom cluster, gastrointestinal symptom cluster, emotion symptom cluster, and respiratory symptom cluster. Conclusions During the period of concurrent chemoradiation therapy, lung cancer patients suffer from multiple symptom clusters. Medical staff should assess symptoms timely, and provide effective interventions, to improve the patients’ quality of life.
Objective To compare the advantages between SmartCare weaning and protocoldirected weaning in COPD patients regarding five aspects including comfort degree of COPD patients in weaning stage, workload of medical staff, weaning success rate, weaning time, and complications associated with mechanical ventilation. Methods COPD patients who’s planning to receive ventilation weaning were randomly divided into a SmartCare weaning group ( SC group) and a protocol-directed weaning group ( SBT group) . The comfort degree of patients and workload of medical staff were assessed by the visual analogue scale ( VAS) as the weaning plan started. 0 was for the most discomfort and maximal workload, and 10 was for the most comfort and minimal workload. Data fromthe following aspects had been recorded: times of blood gas analysis, weaning success rate, weaning time, self-extubation rate, the rate of re-intubation within 48 hours, and ventilator-associated pneumonia ( VAP) incidences. Results 40 patients were selected and divided into the SC group ( n =19) and the SBT group ( n =21) . There was no significant difference in the enrolled age and APACHEⅡ between two groups. The VAS scores was higher in the SC group than that in the SBT group in the first three days ( Plt;0.01) . The weaning time was shorter in the SBT group than that in the SBT group [ ( 4.7 ±2.7) days vs. ( 5.5 ±3.2) days] , without significant difference between two groups ( P gt;0.05) . There were no differences in times of blood gas analysis, weaning success rate, weaning time, self-extubation rate, the rate of re-intubation within 48 hours, and ventilator-associated pneumonia ( VAP) incidences between two groups ( P gt; 0.05) .Conclusion As compared with protocol-directed weaning, SmartCare weaning can increase comfort degree of patients and reduce the workload of medical staff with similar weaning success rate, weaning time, and complications associated with mechanical ventilation.
Objective To explore the effect of motivational interviewing (MI) on anxiety and depression in patients with lung cancer undergoing initial chemotherapy. Methods From May 2015 to April 2016, patients with lung cancer who underwent initial chemotherapy after operation were collected and randomly divided into the control group and the MI group. The patients in the control group received traditional health education, psychological care, and post-discharge follow up; while the patients in the MI group were given routine nursing cares and three motivational interviews and one telephone follow up. At the admission and one month after chemotherapy, all patients were evaluated by the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Distress Thermometer (DT). Results At the admission, the SAS, SDS, and DT scores of patients in the two groups had no significant differences (P>0.05). After one month of chemotherapy, the SAS, SDS, and DT scores in the MI group were much better compared to the admission (P<0.05). The differences in the SAS, SDS, and DT scores between the two groups were significant (P<0.05). Conclusion MI can significantly alleviate anxiety and depression of patients with lung cancer undergoing initial chemotherapy.
ObjectiveTo investigate the clinical features, diagnosis and treatment of scedosporiosis in lung transplant patients.MethodsA retrospective analysis was carried out on a lung transplant patient with scedosporiosis admitted to the First Affiliated Hospital of Guangzhou Medical University. A literature review was performed with “scedosporium”/“scedosporiosis”+“lung transplant” or “scedosporium”/“scedosporiosis”+“lung transplantation” as the key words in Pubmed, Wanfang Database and China Knowledge Resource Integrated Database. The date of retrieval was up to May 2018. Related articles of scedosporiosis in lung transplant patients were retrieved. Clinical characters, diagnosis, treatment and outcome were analyzed.ResultsThe patient was a 65 years old male who received the right lung transplantation 7 months before. He presented with seizure, dyspnea and multiple organ failure. The CT scan illustrated right lower pulmonary nodular lesions. The culture and DNA sequencing of the bronchoalveolar lavage fluid established the diagnosis of scedosporium prolificans. The patient died finally despite the combined anti-fungal treatment. Literature review found 20 relative articles, and all of which were case report with a total of 35 patients. Scedosporium was always disseminated and with a high mortality, with no specificity in chest CT and bronchoscopy. The diagnosis always established by the culture and DNA sequencing, and the combination of anti-fugal agents was needed.ConclusionsScedosporium in lung transplant patient is a disseminated disease with high mortality. The high risk patients should be focused on and early diagnosis and treatment was demanded.
ObjectiveTo investigate the factors affecting enteral nutrition tolerance in patients accepting prone position ventilation.MethodsA retrospective study was conducted to analyze the tolerance of enteral nutrition in patients with prone position ventilation from January 2013 to December 2018. The single factor and multiple factors were used to analyze the influencing factors of enteral nutrition tolerance in patients accepting prone position ventilation.ResultsNinety-two patients who met the inclusion criteria were divided into 2 groups according to enteral nutrition tolerance table: 45 patients with good tolerance and 47 patients with poor tolerance. Univariate analysis showed age, use of muscle relaxants, albumin, prealbumin, feeding amount per unit time, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), nutrition risk in critically ill (NUTRIC) score and gastric residual volume were factors affecting the patient's tolerance (P<0.05). Logistic analysis showed that the factors affecting the patient's tolerance during the prone position were age, use of muscle relaxant, albumin, prealbumin, APACHEⅡ, SOFA, and NUTRIC scores (P<0.05).ConclusionFactors affecting enteral nutrition tolerance in patients accepting prone position ventilation are age, use of muscle relaxants, albumin, prealbumin, APACHEⅡ, SOFA and NUTRIC scores.
Objective To investigate the value of Malnutrition Screening Tool (MST) in ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A single center retrospective observational study was conducted. The AECOPD patients who needed mechanical ventilation, admitted to ICU from January 2015 to June 2016 were enrolled in the study. They were divided into two groups according to the MST score, ie. a high risk malnutrition group (MST score≥2) and a low risk malnutrition group (MST score<2). The principle factors were analyzed including ICU mortality, in-hospital mortality, duration of invasive mechanical ventilation (IMV), length of ICU stay, and ICU readmission rate within 48 hours. Meanwhile the patients’ demographic and laboratory data were analyzed. Results A total of 101 patients were enrolled with 77 cases in the high risk malnutrition group and 24 cases in the low risk malnutrition group. The gender (χ2=1.882, P=0.172), age (t=1.091, P=0.33) and APACHE Ⅱ score (t=1.475, P=0.16) were similar in two groups. The high risk malnutrition group had significantly lower BMI (t=2.887, P=0.004) and lymphocyte count (t=3.402, P<0.001) than the low risk malnutrition group. Hemoglobin (t=0.817, P=0.36), albumin (t=0.706, P=0.44), pre-albumin (t=1.782, P=0.08) and procalcitonin (t=1.296, P=0.17) were similar in two groups. The high risk malnutritiongroup had significantly longer IMV duration (χ2=2.181, P=0.035) and length of ICU stay (χ2=2.364, P=0.02) than the low risk malnutrition group. While the ICU mortality (χ2=0.212, P=0.645), in-hospital mortality (χ2=0.212, P=0.645) and ICU readmission rate within 48 hours (χ2=1.656, P=1.0) were similar in two groups. Conclusion MST is a valuable tool in ICU to evaluated the nutrition status of ventilated AECOPD patients, and MST≥2 indicates longer IMV duration and length of ICU stay.
ObjectiveTwitch transdiaphragmatic pressure is used to evaluate the diaphragm function of mechanical ventilated chronic obstructive pulmonary disease patients before weaning in the intensive care unit, and compared with healthy normal values.MethodsPatients were recruited if they were with acute exacerbation of chronic obstructive pulmonary disease, admitted between May to November in 2013 and December 2014 to February 2016 to the intensive care unit in the First Affiliated Hospital of Guangzhou Medical University, intubated and mechanical ventilated more than 72 hours, and recovered to the clinical stability states after passing the readiness to wean, getting ready for spontaneous breathing test. The newly designed esophageal electrode catheter and bilateral anterolateral magnetic phrenic nerves stimulation were utilized to detect the twitch transdiaphragmatic pressure. At the same time, the function of diaphragm was detected in 10 healthy adults for comparison.ResultsTwenty-two patients were recruited in this study. Two cases had no twitch signals. In the rest 20 cases, the twitch transdiaphragmatic pressure was (7.6±2.5) cm H2O. In 10 healthy adults, twitch transdiaphragmatic pressure was (26.7±4.9) cm H2O. There was significant difference between the patients and the health control subjects (P<0.05).ConclusionTwitch transdiaphragmatic pressure is significantly decreased in weaning chronic obstructive pulmonary disease patients compared with healthy adults.
Objective To study the effect of mechanical stretch on the microenvironment of BEAS-2B on macrophage polarization and the role of polarized macrophages in the epithelial-mesenchymal transition (EMT) of BEAS-2B. Methods Using enzyme linked immunosorbent assay to detect the changes in the levels of cytokines such as interferon-γ, granulocyte-macrophage colony stimulating factor, tumor necrosis factor-α, interleukin (IL)-4, IL-6, IL-10 in the supernatant of lung epithelial cells cultured statically and mechanically stretched. The M0 macrophages (derived from THP-1) were stimulated by stretch/static conditioned medium of BEAS-2B. The surface markers of M1 (CD197) /M2 (CD206) macrophages were detected by flow cytometer. Stretch/static conditioned medium were used to stimulate the co-culture system of macrophages and BEAS-2B in the presence or absence of platelet-derived growth factor receptor inhibitor (PDGFRi), then the protein expression level of EMT makers was examined by Western blot. Results Exposure of BEAS-2B to mechanical stretch resulted in significantly higher production of the pro-M1/M2 polarized factor. The EMT of the co-culture system of M0 and BEAS-2B could be induced by stretch conditioned medium, epithelial marker cytokeratin (CK)-8 and E-cadherin were decreased, while mesenchymal marker α-smooth muscle actin, N-cadherin and vimentin were increased in stretch conditioned medium group. The expression of platelet-derived growth factor (PDGF) was significantly higher in stretch conditioned medium group. The PDGFRi can block the EMT in stretch conditioned medium group. Conclusions The lung epithelial cell supernatant induced by mechanical stretch can promote the polarization of macrophages to M1 and M2. Polarized macrophages promote EMT in human lung epithelial cells via PDGF, and blocking PDGF might attenuate the VILI-associated lung fibrosis.
ObjectiveTo investigate the application value of noninvasive ventilation (NIV) performed in patients with unplanned extubation (UE) in intensive care unit (ICU).MethodsThis was a retrospective analysis. The clinical data, application of NIV, reintubation rate and prognosis of UE patients in the ICU of this hospital from January 2014 to December 2018 were reviewed, and the patients were assigned to the control group or the NIV group according to the application of NIV after UE. The data between the two groups were compared and the application effects of NIV in UE patients were evaluated.ResultsA total of 66 UE patients were enrolled in this study, including 44 males and 22 females and with an average age of (64.2±16.1) years. Out of them, 41 patients (62.1%) used nasal catheter or mask for oxygenation as the control group, 25 patients (37.9%) used NIV as the NIV group. The Acute Physiology andChronic Health EvaluationⅡ score of the control group and the NIV group were (18.6±7.7) vs. (14.8±6.3), P=0.043. The causes of respiratory failure in the control group and the NIV group were as follows: pneumonia 16 patients (39.0%) vs. 7 patients (28.0%), postoperative respiratory failure 7 patients (17.1%) vs. 8 patients (32.0%), chronic obstructive pulmonary disease 8 patients (19.5%) vs. 6 patients (24.0%), others 5 patients (12.2%) vs. 4 patients (16.0%), heart failure 3 patients (7.3%) vs. 0 patients (0%), nervous system diseases 2 (4.9%) vs. 0 patients (0%), which showed no significant difference between the two groups. Mechanical ventilation time before UE were (12.5±19.8) vs (12.7±15.2) d (P=0.966), PaO2 of the control group and the NIV group before UE was (114.9±37.4) vs. (114.4±46.3)mm Hg (P=0.964), and oxygenation index was (267.1±82.0) vs. (257.4±80.0)mm Hg (P=0.614). Reintubation rate was 65.9% in the control group and 24.0% in the NIV group (P=0.001). The duration of mechanical ventilation was (23.9±26.0) vs. (21.8±26.0)d (P=0.754), the length of stay in ICU was (34.4±36.6) vs. (28.5±25.8)d (P=0.48). The total mortality rate in this study was 19.7%. The mortality rate in the control group and NIV group were 22.0% and 16.0% (P=0.555).ConclusionPatients with UE in ICU may consider using NIV to avoid reintubation.