查看更多>>摘要：Background:Sepsis has high prevalence and mortality rate,and it is imperative to identify populations at risk of poor sepsis outcomes.Septic patients with preexisting chronic comorbidities are shown to have worse sepsis outcomes.By identifying comorbidities with greater influence on sepsis progression,we can direct limited resources to septic patients with comorbidities and reduce health care costs.Chronic comorbidities can impact the risk of developing sepsis and having worse outcomes.Coronary artery disease(CAD)is a common comorbidity,especially in the elderly,and a leading cause of death globally.We wished to investigate the influence of CAD as a comorbidity on sepsis and hypothesized that preexisting CAD would increase mortality in hospitalized septic patients.Methods:We conducted retrospective observational study using patient data from Freeman Health System in Joplin,MO.We analyzed patient records from Freeman Health System database from January 1,2019,to June 30,2020.Septic patients were identified using the International Classification of Diseases,Tenth Revision sepsis codes.To identify septic patients with preexisting CAD,we used Interna-tional Classification of Diseases,Tenth Revision codes for CAD.We compared mortality rates for septic patients with and without CAD.Results:Two-sample proportion test was conducted to test the difference in mortality between septic patients with and without preexisting CAD.The difference in mortality for the total population was-0.016(P=0.553).In the male and female subgroups,the differences in mortality were 0.0122(P=0.739)and-0.0511(P=0.208),respectively.The differences in mortality in patients aged 40 to 64 years and 65 years and older were-0.0077(P=0.870)and 0.0007(P=0.983),respectively.The statistical tests failed to find significant differences when comparing septic patients with and without preexisting CAD.There was no significant difference in the age and sex subgroups.Conclusion:Our study showed that CAD alone was not associated with higher mortality due to sepsis in our population.
查看更多>>摘要：Background:Acute respiratory distress syndrome(ARDS)is an acute inflammatory lung injury with a high mortality rate.However,pre-vious ARDS prognostic scoring systems or predictors have been limited by complex formulas that are relatively expensive and inconve-nient to obtain.Thus,this study aimed to explore the clinical significance of the blood lactate/serum albumin ratio(LAR)in assessing the prognosis of ARDS patients and compare it with other indicators related to 28-day mortality in ARDS patients.Methods:We conducted a single-center retrospective study involving patients who fulfilled the Berlin definition of ARDS between 2016 and 2021.Clinical data were collected from medical records within 24 hours after ARDS diagnosis.The LAR,neutrophil-to-lymphocyte ratio,and monocyte-to-lymphocyte ratio(MLR)were calculated.The primary clinical outcome was 28-day mortality.The risk factors for 28-day mortality were determined using conditional logistic regression analysis.The receiver operating characteristic curve was used to evaluate the area under the curve(AUC).Results:A total of 276 ARDS patients met the inclusion criteria and were divided into surviving and nonsurviving groups according to 28-day mortality.There were significant differences in the Acute Physiologic Assessment and Chronic Health Evaluation Ⅱ scores,Sequential Or-gan Failure Assessment scores,MLRs,and LARs between the surviving and nonsurviving groups.The AUC for the LAR was 0.790(P＜0.001),whereas the AUCs for the Acute Physiologic Assessment and Chronic Health Evaluation Ⅱ score,Sequential Organ Failure Assessment score,neutrophil-to-lymphocyte ratio,and MLR were 0.584,0.599,0.524,and 0.587,respectively.After grouping according to an LAR optimal cutoff value of 0.07,28-day mortality was significantly higher in the high-LAR group than in the low-LAR group(47.18 vs.12.69,P＜0.001).Conclusion:The LAR is an independent risk factor for 28-day mortality in ARDS patients and can be used to assess the severity of ARDS to a certain extent,making it superior to other commonly used indicators.
查看更多>>摘要：Background:Pregnancy in women with pulmonary arterial hypertension(PAH)is a fatal condition,despite the effectiveness of PAH-specific therapies.The coverage status and effect of specific therapies in pregnant patients with PAH without cardiac shunts in China remain unclear.To investigate this issue,we conducted a multicenter retrospective study in northern China.Methods:The study included 85 patients who were admitted to 4 clinical centers in Shandong Province between October 2010 and August 2020.Maternal endpoint events included(1)maternal death and/or(2)major adverse cardiac events,both occurring during preg-nancy or within 6 weeks postpartum.Results:Although the overall mortality rate was encouraging(11.8％),the number of patients receiving PAH-specific therapies was ex-tremely low(28.2％).Moreover,only 15.3％of patients received adequate duration of PAH-specific therapy(≥4 weeks)before delivery,and this subgroup showed the lowest major adverse cardiac events rate(7.7％)compared with that in the untreated(19.7％)and short-time treated groups(＜4 weeks;54.5％).Conclusion:Pregnant patients with PAH without cardiac shunts face significantly increased mortality risks.Short-term PAH-specific therapy does not guarantee favorable maternal outcomes.Prepregnancy screening,early identification,and timely intervention are ex-pected to improve maternal outcomes in pregnant women with PAH.
查看更多>>摘要：Background:This study aimed to summarize the clinical characteristics of patients with deep sternal wound infection-induced sepsis after median sternotomy and improve the treatment outcomes of infection-related sepsis.Methods:A retrospective cohort study was conducted on 21 patients with deep sternal wound infection-induced sepsis after median stemotomy who were admitted to the Department of Critical Care.The clinical manifestations,laboratory test results,infection control,and organ and nutritional support of the patients were summarized,and the follow-up data were obtained.Results:The primary symptoms of deep sternal wound infection-induced sepsis included dyspnea,high fever,chills,and altered state of consciousness.Laboratory test results revealed increased inflammatory markers and decreased oxygenation index.Renal and liver func-tion injury were observed in 8 and 4 patients,respectively;18 and 12 patients demonstrated elevated D-dimer and N-terminal Pro B type natriuretic peptide levels,respectively.Of the 8 patients whose wound secretions tested positive for bacteria,Acinetobacter baumannii and Staphylococcus aureus infections were present in 6 and 2 patients,respectively.One of the 6 patients whose blood cultures tested pos-itive for bacteria demonstrated Candida albicans infection.Fifteen patients received ventilator-assisted ventilation and 2 patients received renal replacement therapy.Of all the 21 patients,17 were cured,2 died,and 2 were discharged.Conclusion:Postmedian sternotomy sepsis attributed to a deep sternal wound infection usually results from a preexisting condition.The most prominent clinical manifestation is dyspnea,which is sometimes accompanied by the impairment of organ function.Infection prevention,proper nutrition support,and maintenance of healthy organ function are the cornerstones for successful treatment outcomes.
查看更多>>摘要：Sepsis is a common systemic disease characterized by various physiological and pathological disorders.It can result from infection by various pathogens,such as bacteria,viruses,and fungi.The rate of culture-negative sepsis is almost 42％,indicating that most patients may have nonbacterial infections.With the outbreak of coronavirus disease 2019,viral sepsis has attracted growing attention because many critically ill patients develop sepsis.Viral sepsis can be caused by viral infections and combined with,or secondary to,bacterial infections.Understand-ing the common types of viral sepsis and the main characteristics of its pathogenesis will be helpful for effective diagnosis and treatment,thereby reducing mortality.Early identification of the causative agent of viral sepsis can help reduce the overuse of broad-spectrum antibiotics.In this article,we reviewed the common viruses of sepsis,their potential pathophysiology,targets of diagnosis,and remedies for viral sepsis.
查看更多>>摘要：Background:Ultrasound is widely used in critical care for fluid resuscitation in critically ill patients.We conducted a systematic review to)assess the relationship between ultrasound-guided fluid resuscitation strategies and usual care in septic shock.Methods:We searched PubMed,Embase,Cochrane Library,Web of Science,and registers for randomized controlled trials to evaluate the prognosis of ultrasound-guided fluid resuscitation in patients with septic shock.Results:Twelve randomized controlled studies with 947 participants were included.Ultrasound-guided fluid resuscitation in patients with septic shock was associated with reduced mortality(risk ratio:0.78;95％confidence interval[Cl]:0.65 to 0.94;P=0.007)and 24-hourfluid volume(mean differences[MD]:-1.02;95％Cl:-1.28 to-0.75;P＜0.001),low heterogeneity(/2=29％,I2=0％),and increased dose of norepinephrine(MD:0.07;95％Cl:0.02-0.11;P=0.002)and dobutamine dose(MD:2.2;95％Cl:0.35-4.04;P=0.02),with low heterogeneity(I2=45％,I2=0％).There was no reduction in the risk of dobutamine use(risk ratio:1.67;95％Cl:0.52 to 5.36;P=0.39;I2=0％).Inferior vena cava-related measures reduced the length of hospital stay(MD:-2.91;95％Cl:-5.2 to-0.62;P=0.01;low hetero-geneity,I2=8％)and length of intensive care unit stay(MD:-2.77;95％Cl:-4.51 to-1.02;P=0.002;low heterogeneity,I2=0％).The use of the passive leg-raising test combined with echocardiography to assess fluid reactivity was superior.Ultrasound-guided fluid resuscitation did not significantly change the length of the free intensive care unit stay(MD:1.5;95％Cl:-3.81 to 6.81;P=0.58;I2=0％).Conclusion:Ultrasound-guided fluid resuscitation in patients with septic shock is beneficial,especially when using inferior vena cava-related measures and the passive leg-raising test combined with echocardiography.
查看更多>>摘要：Background:Clarithromycin exerts an immunomodulatory role in several human diseases.However,whether this effect improves the prognosis in patients with sepsis remains controversial,and higher levels of clinical evidence are urgently needed.To the best of our knowl-edge,no meta-analysis to date has reported the clinical efficacy and safety of clarithromycin in sepsis.Methods:A comprehensive literature search of PubMed,EMBASE,and the Cochrane Library was conducted up to December 31,2022.Only randomized controlled trials comparing the clinical efficacy and safety of clarithromycin with controls among patients with sep-sis or septic shock were included.Data were pooled by applying a fixed-effects model and a relative risk(RR)estimate with 95％confi-dence intervals(Cls)using Review Manager(version 5.3;Cochrane Collaboration,Copenhagen,Denmark).Results:Three randomized controlled trials involving a total of 910 patients were included.The pooled results confirmed that clarithromycin had no beneficial effect on progression to multiple organ dysfunction syndrome(RR:1.51;95％Cl:1.02-2.25;P=0.04;I2=0％),28-day mortality(RR:1.09;95％Cl:0.87-1.36;P=0.46;I2=0％),and 90-day mortality(RR:0.86;95％Cl:0.71-1.03;P=0.10;I2=81％)in patients with sepsis or septic shock.Moreover,there was no difference in other serious adverse events between patients who received clarithromycin and those in the control group(RR:1.02;95％Cl:0.87-1.19;P=0.83;I2=18％).Conclusion:Our meta-analysis did not reveal an improvement to short-term outcomes in patients with sepsis treated with clarithromycin.However,administration of clarithromycin did not increase the risk of adverse events.
查看更多>>摘要：Introduction:Awake fiberoptic bronchoscopy has long been considered the criterion standard for the management of difficult airways because of large thyroid malignancies.After an unsuccessful attempt to intubate with a fiberoptic bronchoscope in the supine position,the de-cision to switch to the left lateral position was made.We present this case to propose the utilization of the lateral position for awake intubation.Case presentation:We report a rare case of a patient with a large papillary carcinoma of the thyroid planned for surgical excision.The patient presented to our hospital with complaints of difficulty breathing while lying down in the supine position and oozing blood from the ne-crotic tissue.The breathing difficulties subsided in the lateral position.Conclusion:We demonstrated how the left lateral position with an adjunct maneuver facilitates intubation in large thyroid malignancies.
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