世界危重病急救学杂志(英文版)最新文献

{"title":"Critical illness-implications of non-thyroidal illness syndrome and thyroxine therapy.","authors":"Christos Savvidis, Dimitra Ragia, Efthymia Kallistrou, Eleni Kouroglou, Vasiliki Tsiama, Stella Proikaki, Konstantinos Belis, Ioannis Ilias","doi":"10.5492/wjccm.v14.i3.102577","DOIUrl":"10.5492/wjccm.v14.i3.102577","url":null,"abstract":"<p><p>Nonthyroidal illness syndrome (NTIS) is a common finding in critically ill patients, characterized by disruptions in the hypothalamus-pituitary-thyroid axis, resulting in altered levels of thyroxine (T4), triiodothyronine (T3), and reverse T3. This condition, often considered to be an adaptive response aimed at conserving energy, can become maladaptive in prolonged critical illness, contributing to poor outcomes in intensive care unit patients. The pathophysiology of NTIS involves cytokine-driven alterations in thyroid hormone (TH) metabolism, impaired hormone transport, and reduced receptor sensitivity, which-collectively-suppress thyroid function. Despite these insights, the therapeutic role of TH replacement in patients with NTIS remains uncertain. Low doses of levothyroxine and T3 have been trialed, particularly in patients with cardiovascular comorbidities, but clinical studies report conflicting results regarding their impact on mortality and overall patient outcomes. While some evidence suggests potential benefits of T3 administration in specific subgroups, such as patients with septic shock or severe coronavirus disease 2019, robust clinical trials have yet to conclusively demonstrate improved survival or recovery. The heterogeneity in NTIS presentation and treatment protocols, as well as the complex nature of TH regulation in critically ill patients, complicates efforts to establish clear guidelines for hormone therapy. Future research should prioritize individualized approaches, optimizing hormone dosing and timing, while aiming to elucidate the long-term effects of such interventions on critically ill patients to improve morbidity and mortality outcomes.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"102577"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of proning with and without inhaled pulmonary vasodilators and neuromuscular blocking agents in COVID acute respiratory distress syndrome.","authors":"Matthew Cabrera, Sarika Bharil, Meghan Chin, Seife Yohannes, Paul Clark","doi":"10.5492/wjccm.v14.i3.101327","DOIUrl":"10.5492/wjccm.v14.i3.101327","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A major cause of mortality in the coronavirus disease 2019 (COVID-19) pandemic was acute respiratory distress syndrome (ARDS). Currently, moderate to severe ARDS induced by COVID-19 (COVID ARDS) and other viral and non-viral etiologies are treated by traditional ARDS protocols that recommend 12-16 hours of prone position ventilation (PPV) with neuromuscular blocking agents (NMBA) and a trial of inhaled vasodilators (IVd) if oxygenation does not improve. However, debate on the efficacy of adjuncts to PPV and low tidal volume ventilation persists and evidence about the benefits of IVd/NMBA in COVID ARDS is sparse. In our multi-center retrospective review, we evaluated the impact of PPV, IVd, and NMBA on outcomes and lung mechanics in COVID ARDS patients with moderate to severe ARDS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To evaluate the impact of PPV used alone or in combination with pulmonary IVd and/or NMBA in mechanically ventilated patients with moderate to severe ARDS during the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study at two tertiary academic medical centers compared outcomes between COVID ARDS patients receiving PPV and patients in the supine position. PPV patients were divided based on concurrent use of ARDS adjunct therapies resulting in four subgroups: (1) PPV alone; (2) PPV and IVd; (3) PPV and NMBA; and (4) PPV, IVd, and NMBA. Primary outcomes were hospital and intensive care unit (ICU) length of stay (LOS), mortality, and venovenous extracorporeal membrane oxygenation (VV-ECMO) status. Secondary outcomes included changes in lung mechanics at 24-hour intervals for 7 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Total 114 patients were included in this study. Baseline respiratory parameters and Sequential Organ Failure Assessment scores were significantly worse in the PPV group. ICU LOS and LOS were significantly longer for patients who were proned, but no mortality benefit or difference in VV-ECMO status was found. Among the subgroups, no difference in primary outcomes were found. In the secondary analysis, PPV was associated with a significant improvement in arterial oxygen partial pressure (PaO&lt;sub&gt;2&lt;/sub&gt;)/fractional inspired oxygen (FiO&lt;sub&gt;2&lt;/sub&gt;) (P/F) ratio from day 1 to day 4 (&lt;i&gt;P&lt;/i&gt; &lt; 0.05) and higher driving pressures day 5 to day 7 (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). The combination of PPV and IVd together resulted in improvements in P/F ratio from day 1 to day 7 and plateau pressure on day 4 and day 6 (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). PPV with NMBA was not associated with improvements in any of the secondary outcomes. The use of all three rescue therapies together resulted in improvements in lung compliance on day 2 (&lt;i&gt;P&lt;/i&gt; &lt; 0.05) but no other improvements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In mechanically ventilated patients diagnosed with moderate to severe COVID ARDS, PPV and PPV with the addition of IVd produced a significant and sustained increase in P/F ratio. The combination of PPV, IVd and NMBA im","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"101327"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting weaning failure from invasive mechanical ventilation: The promise and pitfalls of clinical prediction scores.","authors":"Maneesh Gaddam, Dedeepya Gullapalli, Zayaan A Adrish, Arnav Y Reddy, Muhammad Adrish","doi":"10.5492/wjccm.v14.i3.108272","DOIUrl":"10.5492/wjccm.v14.i3.108272","url":null,"abstract":"<p><p>Prediction of weaning success from invasive mechanical ventilation remains a challenge in everyday clinical practice. Several prediction scores have been developed to guide success during spontaneous breathing trials to help with weaning decisions. These scores aim to provide a structured framework to support clinical judgment. However, their effectiveness varies across patient populations, and their predictive accuracy remains inconsistent. In this review, we aim to identify the strengths and limitations of commonly used clinical prediction tools in assessing readiness for ventilator liberation. While scores such as the Rapid Shallow Breathing Index and the Integrative Weaning Index are widely adopted, their sensitivity and specificity often fall short in complex clinical settings. Factors such as underlying disease pathophysiology, patient characteristics, and clinician subjectivity impact score performance and reliability. Moreover, disparities in validation across diverse populations limit generalizability. With growing interest in artificial intelligence (AI) and machine learning, there is potential for enhanced prediction models that integrate multidimensional data and adapt to individual patient profiles. However, current AI approaches face challenges related to interpretability, bias, and ethical implementation. This paper underscores the need for more robust, individualized, and transparent prediction systems and advocates for careful integration of emerging technologies into clinical workflows to optimize weaning success and patient outcomes.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"108272"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of lung ultrasound in assessing positive end expiratory pressure induced lung recruitment in patients on mechanical ventilation.","authors":"Shreyas S Anegundi, Madhuri S Kurdi, Jagadish G Sutagatti, Kaushik A Theerth","doi":"10.5492/wjccm.v14.i3.102609","DOIUrl":"10.5492/wjccm.v14.i3.102609","url":null,"abstract":"<p><strong>Background: </strong>Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure (PEEP) adjustments and to evaluate the weaning process from mechanical ventilation. The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores (LUSs).</p><p><strong>Aim: </strong>To assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.</p><p><strong>Methods: </strong>An observational study was conducted over 18 months in a tertiary care hospital. Patients of both genders, aged between 18-75 years, who had been admitted to the intensive care unit, and required mechanical ventilation, were studied. A standard ventilatory strategy was used and incremental levels of PEEP [5, 10, and 15 cm water (H₂O)] were applied. Baseline characteristics, including oxygen saturation (SpO₂), LUS, mean arterial pressure (MAP), heart rate (HR), and their changes with incremental PEEP levels, were recorded and analyzed.</p><p><strong>Results: </strong>In this study, 45.9% of patients required a PEEP of 5 cm H₂O to achieve the endpoint of lung aeration (LUS of 0). In addition, 86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H₂O, respectively. The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels (<i>P</i> < 0.001 for 5 and 10 cm H₂O and <i>P</i> = 0.032 for 15 cm H₂O). SpO₂ increased significantly with higher PEEP levels (<i>P</i> < 0.001), confirming the effectiveness of PEEP in improving oxygenation. The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.</p><p><strong>Conclusion: </strong>Increasing PEEP levels in mechanically ventilated patients improves lung aeration, which can be effectively assessed using bedside lung ultrasonography.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"102609"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing artificial intelligence as an arbitrary tool in managing difficult COVID-19 cases in critical care medicine.","authors":"Lyubomir Chervenkov, Dimitrina Georgieva Miteva, Tsvetelina Velikova","doi":"10.5492/wjccm.v14.i3.102808","DOIUrl":"10.5492/wjccm.v14.i3.102808","url":null,"abstract":"<p><p>This opinion review paper explores the application of artificial intelligence (AI) as a decisive tool in managing complex coronavirus disease 2019 (COVID-19) cases within critical care medicine. Available data have shown that very severe cases required intensive care, most of which required endotracheal intubation and mechanical ventilation to avoid a lethal outcome if possible. The unprecedented challenges posed by the COVID-19 pandemic necessitate innovative approaches to patient care. AI offers significant potential in enhancing diagnostic accuracy, predicting patient outcomes, and optimizing treatment strategies. By analyzing vast amounts of clinical data, AI can support healthcare professionals in making informed decisions, thus improving patient outcomes. We also focus on current technologies, their implementation in critical care settings, and their impact on patient management during the COVID-19 crisis. Future directions for AI integration in critical care are also discussed.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"102808"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine in cardiac arrest protocols: Comparative impact of video and audio dispatcher assistance.","authors":"Sarah Hussain, Jonathan Soldera","doi":"10.5492/wjccm.v14.i3.103402","DOIUrl":"10.5492/wjccm.v14.i3.103402","url":null,"abstract":"<p><strong>Background: </strong>In recent years, the utilization of telemedicine in emergency situations, particularly in the context of cardiac arrest, has garnered increasing attention. This study addresses the comparative effectiveness of video-instructed dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) <i>vs</i> audio-instructed DA-CPR, offering valuable insights into the evolving landscape of emergency medical guidance through telecommunication methods.</p><p><strong>Aim: </strong>To compare the effectiveness of video-instructed DA-CPR and audio-instructed DA-CPR in terms of survival rates to hospital discharge.</p><p><strong>Methods: </strong>We conducted a comprehensive search of electronic databases, including PubMed, from inception to October 2023, using keywords such as cardiopulmonary resuscitation (CPR), cardiac arrest, and telemedicine combined with Boolean operators. Language was restricted to English, with no date of publication restrictions. We included studies assessing the impact of DA-CPR guidance through video or audio instruction on the quality of CPR performed by bystanders in real-life and simulated environments.</p><p><strong>Results: </strong>Our research strategy yielded 537 references. After the final analysis, we selected 27 articles from the PubMed database that met our inclusion criteria. The mean age of the included participants was 37.1 years. The study presents compelling evidence in favor of video-instructed DA-CPR, showing a significant improvement in survival rates to discharge compared to audio-instructed DA-CPR.</p><p><strong>Conclusion: </strong>DA-CPR plays a crucial role in the chain of survival for out-of-hospital cardiac arrest patients. Extensive research has consistently demonstrated its effectiveness in increasing bystander-initiated CPR and improving patient outcomes. Ongoing technological advancements, such as video calls and automated external defibrillator integration, continue to refine and enhance the delivery of DA-CPR. However, continuous efforts are required to standardize dispatcher training and further optimize communication strategies to ensure the highest quality of care for cardiac arrest victims.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"103402"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine issues in critically ill transgender patients: A narrative review.","authors":"Charalampos Milionis, Emmanouil Zoumakis, Athanasios Tselebis, Ioannis Ilias","doi":"10.5492/wjccm.v14.i3.100660","DOIUrl":"10.5492/wjccm.v14.i3.100660","url":null,"abstract":"<p><p>Transgender individuals often undergo gender-affirming hormonal therapy (GAHT) to align their physical characteristics with their gender identity, which introduces unique challenges in the management of critically ill patients. In the setting of critical illness, the interactions between GAHT and the body's endocrine response are complex. GAHT can influence the hypothalamic-pituitary-adrenal axis, sex hormone levels, and metabolic parameters, potentially complicating the clinical picture. For example, estrogen therapy in transgender women increases the risk of venous thromboembolism, which is further exacerbated by the immobility and hypercoagulable state often present in critically ill patients. Testosterone therapy in transgender men can lead to erythrocytosis, increasing the risk of thromboembolic events during critical illness. The potential for drug interactions, particularly with medications used in the intensive care unit, also requires careful consideration. Monitoring hormone levels and adjusting GAHT in the acute setting are crucial, although evidence-based guidelines are lacking. The need for individualized care and vigilant monitoring of endocrine and metabolic parameters is paramount to improve outcomes in this vulnerable population.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"100660"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative atrial fibrillation in emergent non-cardiac surgery: Risk factors and outcomes from a ten-year intensive-care unit retrospective study.","authors":"Dimitrios Giannis, Ruby Zhao, Luis Fernandez, Nicole Nikolov, Christina Sneed, Patrick Kiarie, Andrew Miele, Martine A Louis, Nageswara Rao Mandava","doi":"10.5492/wjccm.v14.i3.102991","DOIUrl":"10.5492/wjccm.v14.i3.102991","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) represents a common arrhythmia with significant implications and may occur pre-, intra-, or postoperatively (POAF). After cardiac surgery POAF occurs in approximately 30% of patients, while non-cardiac/non-thoracic surgery has a reported incidence between 0.4% to 15%, with new onset POAF occurring at a rate of 0.4% to 3%. While AF has been extensively studied, it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting (ICU).</p><p><strong>Aim: </strong>To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.</p><p><strong>Methods: </strong>This retrospective study included patients ≥ 18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU. Data of interest included occurrence of POAF, demographic characteristics, comorbidities, laboratory values, administered fluids, medications, and postoperative outcomes. Statistical analyses consisted of identifying predictors of POAF and associations of POAF with outcomes of interest.</p><p><strong>Results: </strong>A total of 347 ICU patients were included, 16.4% had a history of AF, 13.0% developed POAF, and 7.9% developed new-onset POAF. Patients with new-onset POAF were older (79.6 ± 9.1 <i>vs</i> 68.1 ± 14.8 years, < 0.001), of white race (47.8% <i>vs</i> 28.8, <i>P</i> < 0.001), hypertensive (87.0% <i>vs</i> 71.2%, <i>P =</i> 0.011), had longer ICU length of stay (ICU-LOS) (13.4 <i>vs</i> 6.7 days, <i>P =</i> 0.042), higher mortality (43.5% <i>vs</i> 17.6%, <i>P =</i> 0.016) and higher rate of cardiac arrest (34.8% <i>vs</i> 14.6%, <i>P =</i> 0.005) compared to patients without new-onset POAF. Multivariable analysis revealed increased POAF risk with advanced age (OR = 1.06; 95%CI: 1.02-1.10, <i>P =</i> 0.005), white race (OR = 2.85; 95%CI: 1.26-6.76, <i>P =</i> 0.014), high intraoperative fluid (OR > 1; 95%CI: 1.00-1.00, <i>P =</i> 0.018), and longer ICU-LOS (OR = 1.04; 95%CI: 1.00-1.08, <i>P =</i> 0.023). After adjusting for demographics, new onset POAF significantly predicted mortality (OR = 3.07; 95%CI: 1.14-8.01, <i>P =</i> 0.022).</p><p><strong>Conclusion: </strong>POAF was associated with prolonged ICU-LOS, white race, and high intraoperative fluid. New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"102991"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of colonoscopic decompression in acute colonic pseudo-obstruction: A systematic review and meta-analysis.","authors":"Suprabhat Giri, Veeraraghavan Krishnamurthy, Devank Shah, Abel Joseph, Sravan Kumar Korrapati, Sudhir Maharshi, Sridhar Sundaram","doi":"10.5492/wjccm.v14.i3.102733","DOIUrl":"10.5492/wjccm.v14.i3.102733","url":null,"abstract":"<p><strong>Background: </strong>Acute colonic pseudo-obstruction (ACPO) is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor. Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.</p><p><strong>Aim: </strong>To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.</p><p><strong>Methods: </strong>A search was conducted in MEDLINE, EMBASE, and Scopus from inception to August 2024. Studies reporting the clinical success, perforation, recurrence, and need for surgery after colonoscopic decompression in ACPO were included. A random-effects inverse-variance model was used to calculate the pooled proportion.</p><p><strong>Results: </strong>Sixteen studies were included in the final analysis. The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8% (95%CI: 72.0-85.6) and 91.5% (95%CI: 87.0-96.0), respectively. The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85 (95%CI: 2.00-7.42). The pooled incidence of perforation was 0.9% (95%CI: 0.0-2.0), while recurrence was observed in 17.1% (95%CI: 12.9-21.3) of the patients after clinical success. The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5% (95%CI: 5.0-15.9) and 3.7% (95%CI: 0.3-7.1), respectively. Subgroup analysis, excluding the low-quality studies, did not significantly change the event rates.</p><p><strong>Conclusion: </strong>Colonoscopic decompression for ACPO is associated with a clinical success rate of > 90% with a perforation rate of < 1%, demonstrating high efficacy and safety.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"102733"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of lethal outcome in patients with immunoinflammatory diseases hospitalized in the intensive care unit.","authors":"Natalia N Abramova, Ilia S Avrusin, Olga P Kozlova, Liudmila A Firsova, Anastasia G Kuleshova, Gleb V Kondratiev, Dmitry O Ivanov, Yury S Aleksandrovich, Mikhail M Kostik","doi":"10.5492/wjccm.v14.i3.101890","DOIUrl":"10.5492/wjccm.v14.i3.101890","url":null,"abstract":"<p><strong>Background: </strong>Systemic immunoinflammatory diseases can affect multiple systems and organs. They have a severe course and severe complications, causing multiple organ failure and death. Quite often these patients are required to be hospitalized in the intensive care unit (ICU). Approximately 50% of patients with multisystem inflammatory syndrome associated with coronavirus disease 2019 in children and systemic lupus erythematosus need admission to the ICU.</p><p><strong>Aim: </strong>To find early predictors of death in patients with immunoinflammatory diseases who are hospitalized in the ICU.</p><p><strong>Methods: </strong>The retrospective continuous cohort study included 51 patients (23 males, 28 females) with immunoinflammatory diseases, including multisystem inflammatory syndrome associated with coronavirus disease 2019 (<i>n</i> = 18), systemic rheumatic diseases (<i>n</i> = 24), and generalized infections (<i>n</i> = 9). The patients ranged in age from 7 months to 17 years old and were admitted to the ICU of the clinic of Saint Petersburg State Pediatric Medical University from 2007 to 2023.</p><p><strong>Results: </strong>Thirteen patients (25.5%) died within 39 (17; 62) days after ICU admission. Patients with an unfavorable outcome were significantly older and were admitted to the ICU later than patients who survived (30 days <i>vs</i> 7 days, <i>P</i> = 0.013) and had a longer stay in the ICU (30 days <i>vs</i> 6 days, <i>P</i> = 0.003). The main predictors of the fatal outcome were age > 162 months [odds ratio (OR) = 10.7; 95% confidence interval (CI): 2.4-47.2], <i>P</i> = 0.0006], time to ICU admission > 26 days from the disease onset (OR = 12.0; 95%CI: 2.6-55.3, <i>P</i> = 0.008), preceding immune suppression treatment (OR = 6.2; 95%CI: 1.6-24.0, <i>P</i> = 0.013), invasive mycosis during the ICU stay (OR = 18.8; 95%CI: 1.9-184.1, <i>P</i> = 0.0005), systemic rheumatic diseases (OR = 7.2; 95%CI: 1.7-31.1, <i>P</i> = 0.004), and ICU stay over 15 days (OR = 19.1; 95%CI: 4.0-91.8, <i>P</i> = 0.00003). Multiple regression analysis (<i>r</i> ² = 0.422, <i>P</i> < 0.000002) identified two predictors of the fatal outcomes: Systemic rheumatic diseases (<i>P</i> = 0.015) and ICU stay over 15 days (<i>P</i> = 0.00002).</p><p><strong>Conclusion: </strong>Identifying patients at high risk of an unfavorable outcome is the subject of the most careful monitoring and appropriate treatment program. Avoiding ICU stays for patients with systemic rheumatic diseases, close monitoring, and preventing invasive mycosis might improve the outcome in children with systemic immune-mediated diseases.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"101890"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}