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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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    Comparative study on the incidence of non-COVID-19 viral pneumonia before and after the COVID-19 pandemic:A retrospective analysis based on respiratory non-COVID viral nucleic acid results

    Xiaojiao TanZheng ZhangHuan ZhangJianbo Li...
    491-495页
    查看更多>>摘要：Background:The impact of the coronavirus disease 2019(COVID-19)pandemic on the etiology of non-COVID-19 viral pneumonia remains to be identified.We investigated the evolution of non-COVID-19 viral pneumonia in hospitalized patients before and after the COVID-19 pandemic.Methods:This is a single-center retrospective study.Patients who came to West China Hospital of Sichuan Univer-sity diagnosed with non-COVID-19 viral pneumonia from January 1,2016 to December 31,2021,were included and divided into pre-and post-COVID-19 groups according to the date of the COVID-19 outbreak in China.The results of 13 viral nucleic acid tests were compared between the two groups.Results:A total of 5937 patients(3954 in the pre-COVID-19 group and 1983 in the post-COVID-19 group)were analyzed.Compared with the pre-COVID-19 group,the proportion of patients tested for respiratory non-COVID-19 viral nucleic acid was significantly increased in the post-COVID-19 group(14.78％vs.22.79％,P＜0.05).However,the non-COVID-19 virus-positive rates decreased from 37.9％to 14.6％after the COVID-19 outbreak(P＜0.001).Notably,non-COVID-19 viral pneumonia caused by the influenza A virus H1N1(InfAH1N1)(2009)dropped to 0％after the pandemic.The top three viruses were InfAH1N1(2009)(13.9％),human rhinovirus(7.4％),and human adenovirus(3.4％)in the pre-COVID-19 group,and human rhinovirus(3.8％),human respiratory syncytial virus(2.0％),human parainfluenza virus(1.1％)and InfAH3N2(1.1％)in the post-COVID-19 group.Conclusions:The proportion of non-COVID-19 viral pneumonia decreased significantly after the COVID-19 out-break,among which InfAH1N1(2009)pneumonia decreased the most dramatically.
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    Relevance of plasma lipoproteins and small metabolites in assessment of nutritional status among patients with severe injuries

    Esmee A.H.VerheulSuzan DijkinkPieta KrijnenAswin Verhoeven...
    496-507页
    查看更多>>摘要：Background:This study aimed to identify plasma lipoproteins and small metabolites associated with high risk of malnutrition during intensive care unit(ICU)stay in patients with severe injuries.Methods:This observational prospective exploratory study was conducted at two level-1 trauma centers in the Netherlands.Adult patients(aged ≥18 years)who were admitted to the ICU for more than 48 h between July 2018 and April 2022 owing to severe injuries(polytrauma,as defined by Injury Severity Scores of ≥16)caused by blunt trauma were eligible for inclusion.Partial least squares discriminant analysis was used to analyze the relationship of 112 lipoprotein-related components and 23 small metabolites with the risk of malnutrition(mod-ified Nutrition Risk in Critically Ill score).Malnutrition was diagnosed based on Subjective Global Assessment scores.The relationship of lipoprotein properties and small metabolite concentrations with malnutrition(during ICU admission)was evaluated using mixed effects logistic regression.Results:Overall,51 patients were included.Lower(very)low-density lipoprotein([V]LDL)(free)cholesterol and phospholipid levels,low particle number,and higher levels of LDL triglycerides were associated with a higher risk of malnutrition(variable importance in projection[VIP]value＞1.5).Low levels of most(V)LDL and intermediate-density lipoprotein subfractions and high levels of high-density lipoprotein Apo-A1 were associated with the diagnosis of malnutrition(VIP value＞1.5).Increased levels of dimethyl sulfone,trimethylamine N-oxide,creatinine,N,N-dimethylglycine,and pyruvic acid and decreased levels of creatine,methionine,and acetoacetic acid were also indicative of malnutrition(VIP value＞1.5).Overall,14 lipoproteins and 1 small metabolite were significantly associated with a high risk of malnutrition during ICU admission(P＜0.05);however,the association did not persist after correcting the false discovery rate(P=0.35 for all).Conclusion:Increased triglyceride in several lipoprotein subfractions and decreased levels of other lipoprotein subfraction lipids and several small metabolites(involved in the homocysteine cycle,ketone body formation,and muscle metabolism)may be indicative of malnutrition risk.Following validation in larger cohorts,these indicators may guide institution of preventive nutritional measures in patients admitted to the ICU with severe injuries.
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    Outcomes of intracranial hemorrhage in critically ill patients with acute leukemia:Results of a retrospective cohort study

    Antoine HeraultYannick HourmantEtienne LenglinéAntoine Lafarge...
    508-514页
    查看更多>>摘要：Background:Admission to the intensive care unit(ICU)is frequently required for patients with acute leukemia(AL)because of life-threatening complications such as intracranial hemorrhage(IH).In this study,we evaluated the impact of IH on survival and neurological outcomes in this population.Methods:This was a single-center retrospective cohort study including adult patients with AL requiring ICU ad-mission and experiencing IH between 2002 and 2019 at Saint Louis Hospital.Leukemia type was determined according to the French-American-British classification.Brain imaging(either computed tomography or mag-netic resonance imaging)was available for all the patients.The primary endpoint of the study was to describe the clinical and biological characteristics and evaluate the mortality and neurological outcome of patients hospi-talized in the ICU with newly diagnosed AL and IH.The secondary endpoint was to identify predictive factors of IH in these patients.Results:Thirty-five patients with AL were included,median age of the patients was 59.00(interquartile range[IQR]:36.00-66.00)years.Twenty-nine patients(82.9％)had acute myeloid leukemia,including 12 patients with acute promyelocytic leukemia.Thrombocytopenia was constant,and 48.5％of patients had disseminated intravascular coagulation(DIC).At ICU admission,the median Sequential Organ Failure Assessment score was 5(IQR:3-9).The median time between AL onset and IH was 2.0(IQR:0.0-9.5)days.The ICU and hospital mortality rates were 60.0％(n=21)and 65.7％(n=23),respectively.In univariate analysis,mechanical ventilation and stupor were associated with mortality,but DIC and acute promyelocytic leukemia were not.Upon multivariate analysis,stupor or coma was the only factor significantly associated with a poor outcome(odds ratio=8.56,95％confidence interval:2.40 to 30.46).Conclusion:IH is associated with a high mortality rate in AL patients,with stupor or coma at the onset of intracranial bleeding being independently associated with poor outcomes.
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    Effect of music therapy on short-term psychological and physiological outcomes in mechanically ventilated patients:A randomized clinical pilot study

    Mark EttenbergerRosangela Casanova-LibrerosJosefina Chávez-ChávezJose Gabriel Cordoba-Silva...
    515-525页
    查看更多>>摘要：Background:Elevated anxiety levels are common in patients on mechanical ventilation(MV)and may challenge recovery.Research suggests music-based interventions may reduce anxiety during MV.However,studies inves-tigating specific music therapy techniques,addressing psychological and physiological well-being in patients on MV,are scarce.Methods:This three-arm randomized clinical pilot study was conducted with MV patients admitted to the intensive care unit(ICU)of Hospital San José in Bogotá,Colombia between March 7,2022,and July 11,2022.Patients were divided into three groups:intervention group 1(IG1),music-assisted relaxation;intervention group 2(IG2),patient-preferred therapeutic music listening;and control group(CG),standard care.The main outcome measure was the 6-item State-Anxiety Inventory.Secondary outcomes were:pain(measured with a visual analog scale),resilience(measured with the Brief Resilience Scale),agitation/sedation(measured with the Richmond Agitation-Sedation Scale),vital signs(including heart rate,blood pressure,oxygen saturation,and respiratory rate),days of MV,extubation success,and days in the ICU.Additionally,three patients underwent electroencephalography during the interventions.Results:Data from 23 patients were analyzed in this study.The age range of the patients was 24.0-84.0 years,with a median age of 66.0 years(interquartile range:57.0-74.0).Of the 23 patients,19 were female(82.6％).No statistically significant differences between the groups were observed for anxiety(P=0.330),pain(P=0.624),resilience(P=0.916),agitation/sedation(P=0.273),length of ICU stay(P=0.785),or vital signs.A statistically significant difference between the groups was found for days of MV(P=0.019).Electroencephalography mea-surements showed a trend toward delta and theta band power decrease for two patients and a power increase on both beta frequencies(slow and fast)in the frontal areas of the brain for one patient.Conclusions:In this pilot study,music therapy did not significantly affect the anxiety levels in patients on MV.However,the interventions were widely accepted by the staff,patients,and caregivers and were safe,considering the critical medical status of the participants.Further large-scale randomized controlled trials are needed to investigate the potential benefits of music therapeutic interventions in this population.
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    Association between hyperglycemia at ICU admission and postoperative acute kidney injury in patients undergoing cardiac surgery:Analysis of the MIMIC-Ⅳ database

    Juan RuanWeipeng HuangJun JiangChang Hu...
    526-536页
    查看更多>>摘要：Background:This study aimed to explore the correlation between hyperglycemia at intensive care unit(ICU)admission and the incidence of acute kidney injury(AKI)in patients after cardiac surgery.Methods:We conducted a retrospective cohort study,in which clinical data were extracted from the Medical Information Mart for Intensive Care(MIMIC)-Ⅳ database.Adults(≥ 18 years)in the database who were admitted to the cardiovascular intensive care unit after cardiac surgery were enrolled.The primary outcome was the incidence of AKI within 7 days following ICU admission.Secondary outcomes included ICU mortality,hospital mortality,ICU length of stay,and the 28-day and 90-day mortality.Multivariable Cox regression analysis was used to assess the association between ICU-admission hyperglycemia and AKI incidence within 7 days of ICU admission.Different adjustment strategies were used to adjust for potential confounders.Patients were divided into three groups according to their highest blood glucose levels recorded within 24 h of ICU admission:no hyperglycemia(＜140 mg/dL),mild hyperglycemia(140-200 mg/dL),and severe hyperglycemia(≥200 mg/dL).Results:Of the 6905 included patients,2201(31.9％)were female,and the median(IQR)age was 68.2(60.1-75.9)years.In all,1836(26.6％)patients had severe hyperglycemia.The incidence of AKI within 7 days of ICU admission,ICU mortality,and hospital mortality was significantly higher in patients with severe admission hyperglycemia than those with mild hyperglycemia or no hyperglycemia(80.3％vs.73.6％and 61.2％,respec-tively;2.8％vs.0.9％and 1.9％,respectively;and 3.4％vs.1.2％and 2.5％,respectively;all P＜0.001).Severe hyperglycemia was a risk factor for 7-day AKI(Model 1:hazard ratio[HR]=1.4809,95％confidence interval[CI]:1.3126 to 1.6707;Model 2:HR=1.1639,95％CI:1.0176 to 1.3313;Model 3:HR=1.2014,95％CI:1.0490 to 1.3760;all P＜0.050).Patients with normal glucose levels(glucose levels＜140 mg/dL)had a higher 28-day mortality rate than those with severe hyperglycemia(glucose levels ≥200 mg/dL)(4.0％vs.3.8％,P＜0.001).Conclusions:In post-cardiac surgery patients,severe hyperglycemia within 24 h of ICU admission increases the risk of 7-day AKI,ICU mortality,and hospital mortality.Clinicians should be extra cautious regarding AKI among patients with hyperglycemia at ICU admission after cardiac surgery.
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    The causal role of immune cells in susceptibility and severity of COVID-19:A bidirectional Mendelian randomization study

    Weifeng ShangHang QianSheng ZhangXiaojun Pan...
    537-538页
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