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重症医学（英文）
重症医学（英文）
重症医学（英文）/Journal Journal of Intensive Medicine
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    Latest Updates and Challenges in infections in intensive care medicine

    Jordi Rello
    1-2页
      原文链接:
    • NETL
    • NSTL
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    Diagnosis and management of malaria in the intensive care unit

    George AkafityNicholas KumiJoyce Ashong
    3-15页
    查看更多>>摘要：Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year.Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia,where the dísease is endemic.In non-endemic areas,malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination programs.Severe malaria often requires in-tensive care unit admission and can be complicated by cerebral malaria,respiratory distress,acute kidney injury,bleeding complications,and co-infection.Intensive care management includes prompt diagnosis and early initi-ation of effective antimalarial therapy,recognition of complications,and appropriate supportive care.However,the lack of diagnostic capacities due to limited advances in equipment,personnel,and infrastructure presents a challenge to the effective diagnosis and management of malaria.This article reviews the clinical classification,diagnosis,and management of malaria as relevant to critical care clinicians,highlighting the role of diagnostic capacity,treatment options,and supportive care.
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    Severe dengue in the intensive care unit

    Alexandre Mestre TejoDebora Toshie HamasakiLetícia Mattos MenezesYeh-Li Ho...
    16-33页
    查看更多>>摘要：Dengue fever is considered the most prolific vector-borne disease in the world,with its transmission rate increas-ing more than eight times in the last two decades.While most cases present mild to moderate symptoms,5％of patients can develop severe disease.Although the mechanisms are yet not fully comprehended,immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients:increased vascular permeability that may shock and thrombocytopenia,and coagulopathy that can in-duce hemorrhage.The risk factors of severe disease include previous infection by a different serotype,specific genotypes associated with more efficient replication,certain genetic polymorphisms,and comorbidities such as diabetes,obesity,and cardiovascular disease.The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality.This review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.
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    • NETL
    • NSTL
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    Optimizing artificial intelligence in sepsis management:Opportunities in the present and looking closely to the future

    Darragh O'ReillyJennifer McGrathIgnacio Martin-Loeches
    34-45页
    查看更多>>摘要：Sepsis remains a major challenge internationally for healthcare systems.Its incidence is rising due to poor public awareness and delays in its recognition and subsequent management.In sepsis,mortality increases with every hour left untreated.Artificial intelligence(AI)is transforming worldwide healthcare delivery at present.This re-view has outlined how AI can augment strategies to address this global disease burden.AI and machine learning(ML)algorithms can analyze vast quantities of increasingly complex clinical datasets from electronic medical records to assist clinicians in diagnosing and treating sepsis earlier than traditional methods.Our review high-lights how these models can predict the risk of sepsis and organ failure even before it occurs.This gives providers additional time to plan and execute treatment plans,thereby avoiding increasing complications associated with delayed diagnosis of sepsis.The potential for cost savings with AI implementation is also discussed,including im-proving workflow efficiencies,reducing administrative costs,and improving healthcare outcomes.Despite these advantages,clinicians have been slow to adopt AI into clinical practice.Some of the limitations posed by AI solutions include the lack of diverse data sets for model building so that they are widely applicable for routine clinical use.Furthermore,the subsequent algorithms are often based on complex mathematics leading to clinician hesitancy to embrace such technologies.Finally,we highlight the need for robust political and regulatory frame-works in this area to achieve the trust and approval of clinicians and patients to implement this transformational technology.
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    Antimicrobial stewardship and targeted therapies in the changing landscape of maternal sepsis

    Nishel M ShahEsmita CharaniDamien MingFook-Choe Cheah...
    46-61页
    查看更多>>摘要：Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide.Moreover,severe maternal infections can have a serious detrimen-tal impact on neonates with almost 1 million neonatal deaths annually attributed to maternal infection or sepsis.In this review we discuss the susceptibility of pregnant women and their specific physiological and immunolog-ical adaptations that contribute to their vulnerability to sepsis,the implications for the neonate,as well as the issues with antimicrobial stewardship and the challenges this poses when attempting to reach a balance between clinical care and urgent treatment.Finally,we review advancements in the development of pregnancy-specific diagnostic and therapeutic approaches and how these can be used to optimize the care of pregnant women and neonates.
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    • NETL
    • NSTL
    • 万方数据

    Extracorporeal membrane oxygenation in adult patients with sepsis and septic shock:Why,how,when,and for whom

    Hongling ZhangYoudong XuXin HuangShunyin Yang...
    62-72页
    查看更多>>摘要：Sepsis and septic shock remain the leading causes of death in intensive care units.Some patients with sepsis fail to respond to routine treatment and rapidly progress to refractory respiratory and circulatory failure,necessi-tating extracorporeal membrane oxygenation(ECMO).However,the role of ECMO in adult patients with sepsis has not been fully established.According to existing studies,ECMO may be a viable salvage therapy in carefully selected adult patients with sepsis.The choice of venovenous,venoarterial,or hybrid ECMO modes is primarily determined by the patient's oxygenation and hemodynamics(distributive shock with preserved cardiac output,septic cardiomyopathy(left,right,or biventricular heart failure),or right ventricular failure caused by acute respiratory distress syndrome).Veno-venous ECMO can be used in patients with sepsis and severe acute respi-ratory distress syndrome when conventional mechanical ventilation fails,and early application of veno-arterial ECMO in patients with sepsis-induced refractory cardiogenic shock may be critical in improving their chances of survival.When ECMO is indicated,the choice of an appropriate mode and determination of the optimal timing of initiation and weaning are critical,particularly in an experienced ECMO center.Furthermore,some special issues,such as ECMO flow,anticoagulation,and antibiotic therapy,should be noted during the management of ECMO support.
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    • NETL
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    Intensive care unit-acquired weakness:Recent insights

    Juan ChenMan Huang
    73-80页
    查看更多>>摘要：Intensive care unit-acquired weakness(ICU-AW)is a common complication in critically ill patients and is associ-ated with a variety of adverse outcomes.These include the need for prolonged mechanical ventilation and ICU stay;higher ICU,in-hospital,and 1-year mortality;and increased in-hospital costs.ICU-AW is associated with multiple risk factors including age,underlying disease,severity of illness,organ failure,sepsis,immobilization,receipt of mechanical ventilation,and other factors related to critical care.The pathological mechanism of ICU-AW remains unclear and may be considerably varied.This review aimed to evaluate recent insights into ICU-AW from several aspects including risk factors,pathophysiology,diagnosis,and treatment strategies;this provides new perspectives for future research.
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    • NETL
    • NSTL
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    Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection

    Marie DejonckheereMassimo AntonelliKostoula ArvanitiKoen Blot...
    81-93页
    查看更多>>摘要：Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)pres-ence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal infection.This study aimed to describe the epidemiology of ICU patients with pan-creatic infection and assess the relationship between the components of the AbSeS-classification and mortality.Methods:This was a secondary analysis of an international observational study("AbSeS")investigating ICU patients with intra-abdominal infection.Only patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU.Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95％confidence interval(CI).Results:The overall mortality was 35.2％(n=58).The independent risk factors for mortality included older age(OR=1.03,95％CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95％CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95％CI:3.8 to 23.9,P＜0.001)or after the implementation of additional source control interventions within the first week(OR=4.0,95％CI:1.3 to 12.2,P=0.013).Gram-negative bacteria were most frequently isolated(n=58,49.2％)without clinically relevant differences in microbial etiology between survivors and non-survivors.Conclusions:In pancreatic infection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome.In this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse peritonitis,and severity of disease expres-sion,were not associated with an increased mortality risk.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Infectious causes of fever of unknown origin in developing countries:An international ID-IRI study

    Hakan ErdemJaffar A.Al-TawfiqMaha AbidWissal Ben Yahia...
    94-100页
    查看更多>>摘要：Background:Fever of unknown origin(FUO)in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO.Methods:A multi-center study for infectious causes of FUO in lower middle-income countries(LMIC)and low-income countries(LIC)was conducted between January 1,2018 and January 1,2023.In total,15 participating centers from seven different countries provided the data,which were collected through the Infectious Diseases-International Research Initiative platform.Only adult patients with confirmed infection as the cause of FUO were included in the study.The severity parameters were quick Sequential Organ Failure Assessment(qSOFA)≥2,intensive care unit(ICU)admission,vasopressor use,and invasive mechanical ventilation(IMV).Results:A total of 160 patients with infectious FUO were included in the study.Overall,148(92.5％)patients had community-acquired infections and 12(7.5％)had hospital-acquired infections.The most common infec-tious syndromes were tuberculosis(TB)(n=27,16.9％),infective endocarditis(n=25,15.6％),malaria(n=21,13.1％),brucellosis(n=15,9.4％),and typhoid fever(n=9,5.6％).Plasmodium falciparum,Mycobacterium tubercu-losis,Brucellae,Staphylococcus aureus,Salmonella typhi,and Rickettsiae were the leading infectious agents in this study.A total of 56(35.0％)cases had invasive procedures for diagnosis.The mean qSOFA score was 0.76±0.94{median(interquartile range[IQR]):0(0-1)}.ICU admission(n=26,16.2％),vasopressor use(n=14,8.8％),and IMV(n=10,6.3％)were not rare.Overall,38(23.8％)patients had at least one of the severity parameters.The mortality rate was 15(9.4％),and the mortality was attributable to the infection causing FUO in 12(7.5％)patients.Conclusions:In LMIC and LIC,tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Prediction of mechanical ventilation outcome by early abdominal-visceral-blood-flow-and-function score in critically ill patients after cardiopulmonary bypass in the ICU:A prospective observational study

    Chaofu YueLongxiang SuJun WangNa Cui...
    101-107页
    查看更多>>摘要：Background:Abdominal organs are important organs that sense and respond to ischemia and hypoxia,but there are few evaluation methods.We use ultrasonography to evaluate abdominal organ function and blood flow in patients with mechanical ventilation(MV)after cardiopulmonary bypass and to obtain a semiquantitative score for abdominal organ function and blood flow.Methods:Patients with cardiopulmonary bypass in the Critical Care Department of Peking Union Medical College Hospital in China from March to July 2021 were enrolled in this prospective observational study.The correlation of the abdominal-visceral-blood-flow-and-function score(AVBFS)with the duration of MV,number of days spent in the intensive care unit(ICU),acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ),sequential organ failure assessment(SOFA),lactate,epinephrine,and norepinephrine use was analyzed,and the results were used to assess the predictive value of the receiver operating characteristic curve(ROC)regression analysis score for the duration of MV.Results:Of the 92 patients who underwent cardiopulmonary bypass,41 were finally included.The AVBFS were significantly correlated with the duration of MV,number of days spent in the ICU,APACHE-Ⅱ score,SOFA score,and norepinephrine use time.The AVBFS in a group of patients using ventilators ≥36 h were significantly higher than those obtained for a group of patients using ventilators＜36 h(P＜0.05).The evaluation results for the AVBFS at 0-12 h after ICU admission were as follows:area under the ROC curve(AUC)=0.876(95％confidence interval[CI]:0.767 to 0.984),cut-off value=2.5,specificity=0.842,and sensitivity=0.773.Conclusions:Abdominal visceral organ function and blood perfusion can be used to evaluate gastrointestinal function.It is related to early and late extubation after cardiac surgery.
      原文链接:
    • NETL
    • NSTL
    • 万方数据