Journal of intensive medicine最新文献

{"title":"HAT therapy for sepsis: A review of the therapeutic rationale and current clinical evaluation status","authors":"Yali Sun ,&nbsp;Yongfang Yang ,&nbsp;Zhuoyi Ye ,&nbsp;Tongwen Sun","doi":"10.1016/j.jointm.2023.04.003","DOIUrl":"10.1016/j.jointm.2023.04.003","url":null,"abstract":"<div><p>Vitamin C-based cluster therapy, which involves the combined application of hydrocortisone, vitamin C, and thiamine (HAT), is a recently proposed new treatment option for sepsis on top of conventional treatment. This therapy has a strong theoretical basis, but its clinical efficacy remains inconclusive. This review summarizes the rationale for HAT therapy for sepsis and describes the evaluation of its efficacy in clinical observational studies and randomized controlled trials, with the aim of providing a reference for the future clinical practice application of HAT therapy in sepsis.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45956679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of therapeutic plasma exchange to modify the functionality of heparin-induced thrombocytopenia antibodies and correct profound thrombocytopenia: A case report and literature review","authors":"Audrey Graser ,&nbsp;Anne Bauters ,&nbsp;Jean-Luc Auffray ,&nbsp;Caroline Vayne ,&nbsp;François Provot ,&nbsp;Merce Jourdain ,&nbsp;Laurent Robriquet","doi":"10.1016/j.jointm.2023.04.001","DOIUrl":"10.1016/j.jointm.2023.04.001","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44717215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood–brain barrier dysfunction in intensive care unit","authors":"Loic Le Guennec ,&nbsp;Nicolas Weiss","doi":"10.1016/j.jointm.2023.01.001","DOIUrl":"10.1016/j.jointm.2023.01.001","url":null,"abstract":"<div><p>The central nervous system is characterized by a peculiar vascularization termed blood–brain barrier (BBB), which regulates the exchange of cells and molecules between the cerebral tissue and the whole body. BBB dysfunction is a life-threatening condition since its presence corresponds to a marker of severity in most diseases encountered in the intensive care unit (ICU). During critical illness, inflammatory response, cytokine release, and other phenomena activating the brain endothelium contribute to alterations in the BBB and increase its permeability to solutes, cells, nutrients, and xenobiotics. Moreover, patients in the ICU are often old, with underlying acute or chronic diseases, and overly medicated due to their critical condition; these factors could also contribute to the development of BBB dysfunction. An accurate diagnostic approach is critical for the identification of the mechanisms underlying BBB alterations, which should be rapidly managed by intensivists. Several methods were developed to investigate the BBB and assess its permeability. Nevertheless, in humans, exploration of the BBB requires the use of indirect methods. Imaging and biochemical methods can be used to study the abnormal passage of molecules through the BBB. In this review, we describe the structural and functional characteristics of the BBB, present tools and methods for probing this interface, and provide examples of the main diseases managed in the ICU that are related to BBB dysfunction.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42688014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxidative stress as a bridge between age and stroke: A narrative review","authors":"Shengjie Feng ,&nbsp;Miaoxian Yang ,&nbsp;Shengpeng Liu ,&nbsp;Yu He ,&nbsp;Shuixiang Deng ,&nbsp;Ye Gong","doi":"10.1016/j.jointm.2023.02.002","DOIUrl":"10.1016/j.jointm.2023.02.002","url":null,"abstract":"<div><p>Stroke is the third most common cause of death globally and a leading cause of disability. The cellular and molecular changes following stroke and causes of neuronal death are not fully understood, and there are few effective treatments currently available. A rapid increase in the levels of reactive oxygen species (ROS) post stroke can overwhelm antioxidant defenses and trigger a series of pathophysiologic events including the inflammatory response, blood-brain barrier (BBB) disruption, apoptosis, and autophagy, ultimately leading to neuron degeneration and apoptosis. It is thought that beyond a certain age, the ROS accumulation resulting from stroke increases the risk of morbidity and mortality. In the present review, we summarize the role of oxidative stress (OS) as a link between aging and stroke pathogenesis. We also discuss how antioxidants can play a beneficial role in the prevention and treatment of stroke by eliminating harmful ROS, delaying aging, and alleviating damage to neurons.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47560253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal membrane oxygenation in fatal methemoglobinemia caused by sodium nitrite: A case report and review of the literature","authors":"Xiaoshu Zuo,&nbsp;Xiaoyu Fang,&nbsp;Guang Li,&nbsp;Liying Zhan","doi":"10.1016/j.jointm.2023.03.003","DOIUrl":"10.1016/j.jointm.2023.03.003","url":null,"abstract":"","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46163146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The intensity of organ support: Restrictive or aggressive therapy for critically ill patients","authors":"Hongxiang Li,&nbsp;Yuting Li,&nbsp;Yao Fu,&nbsp;Xinyu Zhang,&nbsp;Dong Zhang","doi":"10.1016/j.jointm.2023.04.002","DOIUrl":"10.1016/j.jointm.2023.04.002","url":null,"abstract":"<div><p>The intensity of organ support has received attention in recent years. To make better clinical decisions, we should understand the mechanisms and benefits, and disadvantages of the different intensities of organ support in critically ill patients. Therapeutic strategies such as supplemental oxygen therapy, mechanical ventilation, respiratory stimulant, vasoactive agents, transfusion, albumin infusion, fluid management, renal placement, and nutrition support, if they are implemented in accordance with an aggressive strategy, could result in side effects and/or complications, resulting in iatrogenic harm in critically ill patients. It is found that the intensity of organ support is not a determining factor in prognosis. A normal rather than supernormal physiological target is recommended for support therapy.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49528632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intestinal microbiota dysbiosis and liver metabolomic changes during brain death","authors":"Ruolin Tao ,&nbsp;Wenzhi Guo ,&nbsp;Tao Li ,&nbsp;Yong Wang ,&nbsp;Panliang Wang","doi":"10.1016/j.jointm.2023.02.006","DOIUrl":"https://doi.org/10.1016/j.jointm.2023.02.006","url":null,"abstract":"<div><h3>Background</h3><p>Whether a causative link exists between brain death (BD) and intestinal microbiota dysbiosis is unclear, and the distortion in liver metabolism associated with BD requires further exploration.</p></div><div><h3>Methods</h3><p>A rat model of BD was constructed and sustained for 9 h (BD group, <em>n</em>=6). The sham group (<em>n</em>=6) underwent the same procedures, but the catheter was inserted into the epidural space without ballooning. Intestinal contents and portal vein plasma were collected for microbiota sequencing and microbial metabolite detection. Liver tissue was resected to investigate metabolic alterations, and the results were compared with those of a sham group.</p></div><div><h3>Results</h3><p>α-diversity indexes showed that BD did not alter bacterial diversity. Microbiota dysbiosis occurred after 9 h of BD. At the family level, Peptostreptococcaceae and Bacteroidaceae were both decreased in the BD group. At the genus level, <em>Romboutsia, Bacteroides, Erysipelotrichaceae_UCG_004, Faecalibacterium,</em> and <em>Barnesiella</em> were enriched in the sham group, whereas <em>Ruminococcaceae_UCG_007, Lachnospiraceae_ND3007_group,</em> and <em>Papillibacter</em> were enriched in the BD group. Short-chain fatty acids, bile acids, and 132 other microbial metabolites remained unchanged in both the intestinal contents and portal vein plasma of the BD group. BD caused alterations in 65 metabolites in the liver, of which, carbohydrates, amino acids, and organic acids accounted for 64.6%. Additionally, 80.0% of the differential metabolites were decreased in the BD group livers. Galactose metabolism was the most significant metabolic pathway in the BD group.</p></div><div><h3>Conclusions</h3><p>BD resulted in microbiota dysbiosis in rats; however, this dysbiosis did not alter microbial metabolites. Deterioration in liver metabolic function during extended periods of BD may reflect a continuous worsening in energy deficiency.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71776197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of initial fluid resuscitation volume on clinical outcomes in patients with heart failure and septic shock","authors":"Adam L. Wiss ,&nbsp;Bruce A. Doepker ,&nbsp;Brittany Hoyte ,&nbsp;Logan M. Olson ,&nbsp;Kathryn A. Disney ,&nbsp;Eric M. McLaughlin ,&nbsp;Vincent Esguerra ,&nbsp;Jessica L. Elefritz","doi":"10.1016/j.jointm.2023.05.001","DOIUrl":"10.1016/j.jointm.2023.05.001","url":null,"abstract":"<div><h3>Background</h3><p>Fluid resuscitation is a key treatment for sepsis, but limited data exists in patients with existing heart failure (HF) and septic shock. The objective of this study was to determine the impact of initial fluid resuscitation volume on outcomes in HF patients with reduced or mildly reduced left ventricular ejection fraction (LVEF) with septic shock.</p></div><div><h3>Methods</h3><p>This multicenter, retrospective, cohort study included patients with known HF (LVEF ≤50%) presenting with septic shock. Patients were divided into two groups based on the volume of fluid resuscitation in the first 6 h; &lt;30 mL/kg or ≥30 mL/kg. The primary outcome was a composite of in-hospital mortality or renal replacement therapy (RRT) within 7 days. Secondary outcomes included acute kidney injury (AKI), initiation of mechanical ventilation, and length of stay (LOS). All related data were collected and compared between the two groups. A generalized logistic mixed model was used to assess the association between fluid groups and the primary outcome while adjusting for baseline LVEF, Acute Physiology and Chronic Health Evaluation (APACHE) II score, inappropriate empiric antibiotics, and receipt of corticosteroids.</p></div><div><h3>Results</h3><p>One hundred and fifty-four patients were included (93 patients in &lt;30 mL/kg group and 61 patients in ≥30 mL/kg group). The median weight-based volume in the first 6 h was 17.7 (12.2–23.0) mL/kg in the &lt;30 mL/kg group <em>vs.</em> 40.5 (34.2–53.1) mL/kg in the ≥30 mL/kg group (<em>P</em> &lt;0.01). No statistical difference was detected in the composite of in-hospital mortality or RRT between the &lt;30 mL/kg group compared to the ≥30 mL/kg group (55.9% <em>vs.</em> 45.9%, <em>P</em>=0.25), respectively. The &lt;30 mL/kg group had a higher incidence of AKI, mechanical ventilation, and longer hospital LOS.</p></div><div><h3>Conclusions</h3><p>In patients with known reduced or mildly reduced LVEF presenting with septic shock, no difference was detected for in-hospital mortality or RRT in patients who received ≥30 mL/kg of resuscitation fluid compared to less fluid, although this study was underpowered to detect a difference. Importantly, ≥30 mL/kg fluid did not result in a higher need for mechanical ventilation.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b3/58/main.PMC10391556.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929864","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":"The duration of acute kidney injury is an additional parameter to predict 1-year survival in very elderly patients","authors":"Qinglin Li ,&nbsp;Yan Wang ,&nbsp;Feihu Zhou","doi":"10.1016/j.jointm.2023.02.004","DOIUrl":"10.1016/j.jointm.2023.02.004","url":null,"abstract":"<div><h3>Background</h3><p>Acute kidney injury (AKI) is primarily defined and classified according to the magnitude of the elevation of serum creatinine (Scr). We aimed to determine whether the duration of AKI adds prognostic value in addition to that obtained from the magnitude of injury alone.</p></div><div><h3>Methods</h3><p>This retrospective study enrolled very elderly inpatients (≥75 years) in the Chinese PLA General Hospital from January 2007 to December 2018. AKI was stratified by magnitude according to KDIGO stage (1, 2, and 3) and duration (1–2 days, 3–4 days, 5–7 days, and &gt;7 days). The primary outcome was the 1-year mortality after AKI. Multivariable Cox regression analysis was performed to identify covariates associated with the 1-year mortality. The probability of survival was estimated using the Kaplan–Meier method, and curves were compared using the log-rank test.</p></div><div><h3>Results</h3><p>In total, 688 patients were enrolled, with the median age was 88 (84–91) years, and the majority (652, 94.8%) were male. According to the KDIGO criteria, 317 patients (46.1%) had Stage 1 AKI, 169 (24.6%) had Stage 2 AKI, and 202 (29.3%) had Stage 3 AKI. Of the 688 study subjects, 61 (8.9%) with a duration of AKI lasted 1–2 days, 104 (15.1%) with a duration of AKI lasted 3–4 days, 140 (20.3%) with a duration of AKI lasted 5–7 days, and 383 (55.7%) with a duration of AKI lasted &gt;7 days. Within each stage, a longer duration of AKI was slightly associated with a higher rate of 1-year mortality. However, within each of the duration categories, the stage of AKI was significantly associated with 1-year mortality. When considered separately in multivariate analyses, both the duration of AKI (3–4 days: HR=3.184; 95% CI: 1.733–5.853; <em>P</em> &lt;0.001, 5–7 days: HR=1.915; 95% CI: 1.073–3.416; <em>P</em>=0.028; &gt;7 days: HR=1.766; 95% CI: 1.017–3.065; <em>P</em>=0.043) and more advanced AKI stage (Stage 2: HR=3.063; 95% CI: 2.207–4.252; <em>P</em> &lt;0.001; Stage 3: HR=7.333; 95% CI: 5.274–10.197; <em>P</em> &lt;0.001) were independently associated with an increased risk of 1-year mortality.</p></div><div><h3>Conclusions</h3><p>In very elderly AKI patients, both a higher stage and duration were independently associated with an increased risk of 1-year mortality. Hence, the duration of AKI adds additional information to predict long-term mortality.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/64/main.PMC10391574.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9935875","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":"Is COVID-19 different from other causes of acute respiratory distress syndrome?","authors":"François M. Beloncle","doi":"10.1016/j.jointm.2023.02.003","DOIUrl":"10.1016/j.jointm.2023.02.003","url":null,"abstract":"<div><p>Coronavirus disease 2019 (COVID-19) pneumonia can lead to acute hypoxemic respiratory failure. When mechanical ventilation is needed, almost all patients with COVID-19 pneumonia meet the criteria for acute respiratory distress syndrome (ARDS). The question of the specificities of COVID-19-associated ARDS compared to other causes of ARDS is of utmost importance, as it may justify changes in ventilatory strategies. This review aims to describe the pathophysiology of COVID-19-associated ARDS and discusses whether specific ventilatory strategies are required in these patients.</p></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4a/ac/main.PMC10085872.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9694287","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}