Objective To summarize and explore the clinical features, diagnosis and treatment of severe pulmonary tuberculosis (TB). Methods One death case of pulmonary TB in The First Affiliated Hospital of Soochow University was analyzed, related publications of case reports and articles relevant on the analysis and study of pulmonary tuberculosis deaths from Pubmed between January 2012 and March 2022 were also reviewed. Results A 25-year-old female patient was admitted for "intermittent cough with sputum for more than 1 year, aggravated with chest tightness and shortness of breath for 5 days". She had no underlying disease. Pulmonary TB was diagnosed by TB bacterium smear and next-generation sequencing of bronchoalveolar lavage fluid. The patient was in shock compensation period and developed acute respiratory distress syndrome immediately after admission. Through active anti-tuberculosis, invasive mechanical ventilation, intra-aortic balloon counterpulsation and continuous renal replacement therapy, the disease continued to deteriorate and she died on the third day after admission. A total of 269 pulmonary TB deaths were retrieved. An analysis of 244 patients' past medical history showed that human immunodeficiency virus co-infection was the most common among young people and chronic diseases were the most common among the elderly. All 269 patients died of septic shock, respiratory failure and multiple organ dysfunction syndrome (MODS), among which hyponatremia was also a significant complication. The shortest time from admission to death was 7 days, while the longest average time was only 35 days. Conclusions Pulmonary TB could develop into septic shock and MODS with poor prognosis and high mortality. Health education on TB should be strengthened.
Objective To evaluate the effect of hemoperfusion for absorption of inflammatory cytokines on sepsis . Method A prospective randomized controlled study was carried out to collect 60 sepsis patients admitted to the Department of Critical Care Medicine of this hospital from June 2019 to December 2021. They were randomly divided into a study group (30 cases) and a control group (30 cases) by using the random number table method. Both groups of patients received routine treatment according to the guidelines, including fluid resuscitation, mechanical ventilation, antibiotic and vasoactive agents. For the patients with renal failure, renal replacement therapy (RRT) was used. Routine vital sign monitoring and serum procalcitonin (PCT) and interleukin-6 (IL-6) determination were recorded. The study group received two times of hemoperfusion to absorb inflammatory cytokines at 0 h and 24 h after enrollment. At 24 h and 48 h after treatment, the vital signs and related physical and chemical indexes of patients were recorded again, including norepinephrine dose, oxygenation index, PCT, IL-6 and blood lactic acid. The changes of physical and chemical indexes and the 28-day survival rate of the two groups were compared. Results There was no difference in the general situation of the two groups when they were enrolled (P>0.05). The dosage of norepinephrine [(0.77±0.48)μg·kg–1·min–1 vs. (0.92±0.62) μg·kg–1·min–1, P=0.030] and the level of blood lactic acid [(2.70±1.43)mmol/L vs. (4.05±2.60)mmol/L, P=0.001] in the study group were significantly lower than those in the control group 24 h and 48 h after treatment. The oxygenation index in the study group was higher than that of the control group 24 h after treatment (212±68)mm Hg vs. (197±42)mm Hg, P=0.042). The inflammation related indexes PCT [(17±24)ng/mL vs. (32±36)ng/mL, P=0.013] and IL-6 [299 (102, 853)pg/mL vs. 937 (247, 2230)pg/mL, P=0.026] in the study group were significantly lower than those in the control group 48 h after treatment. The dosage of noradrenaline, oxygenation index, PCT, IL-6 and blood lactate level in the study group after treatment were improved compared with those before treatment (P<0.05), while those in the control group were not significantly improved after treatment (P>0.05), and oxygenation index in the two groups had no significant difference before and after treatment (P>0.05). There was no significant difference in the 28-day survival rate between the two groups (χ2=0.211, P=0.646). Conclusion Although the hemoperfusion for absorption of inflammatory cytokine factors can not reduce the 28-day mortality of sepsis, it can significantly improve the early physical and chemical indicators of patients, and provide opportunities for follow-up treatment.
Objective To systematically evaluate the effect of vitamin C supplementation on the mortality of patients with sepsis and septic shock. Methods The Cochrane Library, PubMed, EMbase, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure Database and Chinese Science and Technology Periodical Database were searched by computer for randomized controlled trials (RCTs) on the effect of vitamin C on the mortality of patients with sepsis. The retrieval time of each database was from the establishment of the database to January 20, 2022. Two researchers independently screened the literature, extracted data, and evaluated the quality, and then used STATA 16.0 software for meta-analysis. Results A total of 15 RCTs were included, with a total of 2077 patients, including 1041 in the experimental group and 1036 in the control group. The results of literature quality showed that 7 studieswere grade A and 8 studies were grade B, indicating that the overall quality of the included literature was good. The results of meta-analysis showed that compared with the control group, the mortality of patients with sepsis and septic shock in the experimental group were effectively reduced [odds ratio (OR)=0.81, 95% confidential interval (CI) 0.67 - 0.98, P=0.027]. The results of subgroup analysis showed that vitamin C supplementation therapy for more than 4 days could significantly reduce the mortality of the patients with sepsis (OR=0.67, 95%CI 0.49 - 0.90, P=0.008); single treatment could significantly reduce the mortality rate of patients with sepsis (OR=0.50, 95%CI 0.34 - 0.74, P=0.001); vitamin C supplementation can effectively reduce the short-term (≤30 days) mortality of patients with sepsis (OR=0.77, 95%CI 0.63 - 0.96, P=0.017). The funnel plot showed that the included literature was basically symmetrical, and publication bias could not be considered. Conclusions Vitamin C supplementation can effectively reduce the mortality rate of patients with sepsis and septic shock. Vitamin C supplementation treatment course of 4 days or less and single treatment can reduce the mortality rate of patients with sepsis and septic shock, but cannot reduce the long-term (90 days) mortality rate of patients.
Objective To evaluate the effects of intensive care unit (ICU)-acquired hypernatremia (IAH) on the outcome of septic shock patients. Methods This retrospective study analyzed 116 septic shock patients admitted to the ICU of the First Affiliated Hospital of Soochow University from August 2018 to December 2022. Patients were divided into two groups: IAH group and normonatremia group. χ2 test, t test and the Mann-Whitney U test of the non-parametric test were used to compare the differences in clinical data between the two groups. Independent risk factors for IAH were identified by unconditioned Logistic regression analysis, and receiver operating characteristic (ROC) curves were constructed to determine their role in predicting IAH. The Kaplan-Meier curve was used to evaluate the effects of IAH and its duration on 28-day survival. Results Renal insufficiency, K+ concentration, body temperature max, mechanical ventilation, chronic critical illness, rapid recovery, sepsis-associated encephalopathy, persistent inflammation, immunosuppression and catabolism syndrome, and the length of stay in ICU had significant differences (P<0.05). Multivariate logistic regression analysis showed: total urine volume in the previous 3 days [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.01 - 1.16, P=0.019] and sodium content in enteral nutrition preparations (670 mg) (OR 6.00, 95%CI 1.61 - 22.42, P=0.006) were independent risk factors for IAH. In addition, the area under the ROC curve of total urine output in the first 3 days was 0.800 (95%CI 0.678 - 0.922, P=0.001). Finally, the duration of IAH was significantly correlated with 28-day survival rate (P=0.020). Conclusions IAH is a common and serious complication in septic shock, and is the main cause of poor prognosis. Sodium status may act as an ideal screening tool for patients with septic shock.