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| 1 | Expert consensus on the glycemic management of critically ill patients显示文摘Introduction The incidence of hyperglycemia is 40-60%in critically ill patients and is up to 60-80%in those who have undergone car-diac surgery.[1]The results of an epidemiological study in the United States showed that 28.6%of diabetic patients and 9.3%of non-diabetic patients had elevated mean daily glucose on the day of ICU admission.[2]In critically ill patients,elevated blood glucose is primarily the result of stress,and stress-induced hy-perglycemia is an independent risk factor associated with prog-nosis,regardless of a previous diagnosis of diabetes.Nutritional therapy has become an integral treatment option for patients in the ICU,[3,4]though nearly 30%of patients with enteral nu-trition and 44-50%with parenteral nutrition(PN)experience elevated glucose.[5,6]Intensive insulin therapy(IIT)is an impor-tant treatment for controlling hyperglycemia in critically ill pa-tients,but it also carries a corresponding risk of hypoglycemia. | Zhixiong Wu Jiao Liu Dong Zhang Kai Kang Xiangrong Zuo Qianghong Xu Aijun Pan Wei Fang Fen Liu You Shang Haiyan Yin Juntao Hu Jinglun Liu Jiangquan Fu Wei Zhang Yuan Zong Min Shao Feng Zhao Mei Meng Yanfei Mao Yingchuan Li Dechang Chen | 2022 | Journal of Intensive Medicine2022，2，3： | 9 |
| 2 | Ten golden rules for individualized mechanical ventilation in acute respiratory distress syndrome显示文摘Considerable progress has been made over the last decades in the management of acute respiratory distress syndrome(ARDS).Mechanical ventilation(MV)remains the cornerstone of supportive therapy for ARDS.Lung-protective MV minimizes the risk of ventilator-induced lung injury(VILI)and improves survival.Several parame-ters contribute to the risk of VILI and require careful setting including tidal volume(V_(T)),plateau pressure(P_(plat)),driving pressure(ΔP),positive end-expiratory pressure(PEEP),and respiratory rate.Measurement of energy and mechanical power allows quantification of the relative contributions of various parameters(V_(T),P_(plat),ΔP,PEEP,respiratory rate,and airflow)for the individualization of MV settings.The use of neuromuscular blocking agents mainly in cases of severe ARDS can improve oxygenation and reduce asynchrony,although they are not known to confer a survival benefit.Rescue respiratory therapies such as prone positioning,inhaled nitric oxide,and extracorporeal support techniques may be adopted in specific situations.Furthermore,respiratory weaning protocols should also be considered.Based on a review of recent clinical trials,we present 10 golden rules for individualized MV in ARDS management. | Denise Battaglini Marco Sottano Lorenzo Ball Chiara Robba Patricia R.M.Rocco Paolo Pelosi | 2021 | Journal of Intensive Medicine2021，1，1： | 3 |
| 3 | HMGB1 is a critical molecule in the pathogenesis of Gram-negative sepsis显示文摘Gram-negative sepsis is a severe clinical syndrome associated with significant morbidity and mortality.Lipopolysaccharide(LPS),expressed on Gram-negative bacteria,is a potent pro-inflammatory toxin that induces inflammation and coagulation via two separate receptor systems.One is Toll-like receptor 4(TLR4),expressed on cell surfaces and in endosomes,and the other is the cytosolic receptor caspase-11(caspases-4 and-5 in hu-mans).Extracellular LPS binds to high mobility group box 1(HMGB1)protein,a cytokine-like molecule.The HMGB1-LPS complex is transported via receptor for advanced glycated end products(RAGE)-endocytosis to the endolysosomal system to reach the cytosolic LPS receptor caspase-11 to induce HMGB1 release,inflammation,and coagulation that may cause multi-organ failure.The insight that LPS needs HMGB1 assistance to generate severe inflammation has led to successful therapeutic results in preclinical Gram-negative sepsis studies target-ing HMGB1.However,to date,no clinical studies have been performed based on this strategy.HMGB1 is also actively released by peripheral sensory nerves and this mechanism is fundamental for the initiation and prop-agation of inflammation during tissue injury.Homeostasis is achieved when other neurons actively restrict the inflammatory response via monitoring by the central nervous system and the vagus nerve through the cholinergic anti-inflammatory pathway.The neuronal control in Gram-negative sepsis needs further studies since a deeper understanding of the interplay between HMGB1 and acetylcholine may have beneficial therapeutic implications.Herein,we review the synergistic overlapping mechanisms of LPS and HMGB1 and discuss future treatment opportunities in Gram-negative sepsis. | Ulf Andersson Huan Yang | 2022 | Journal of Intensive Medicine2022，2，3： | 3 |
| 4 | Timely renal replacement therapy linked to better outcome in patients with sepsis-associated acute kidney injury显示文摘Background:Recent studies suggest that acute kidney injury(AKI)can be treated with renal replacement therapy(RRT).However,its benefits to patients with sepsis-associated AKI(SA-AKI),which is linked to high mortality and morbidity rates,remain under debate.The aim of this study was to compare the outcomes of different RRT strategies for patients with SA-AKI.Methods:This retrospective study evaluated patients who were admitted to the hospital with sepsis and devel-oped SA-AKI during hospitalization from 1st January 2014 to 31st January 2019.Mortality,renal recovery,and systemic organ function at 90 days following admission were compared between the RRT group(RG)and non-RRT group(NRG),as well as the early-RRT group(EG)and delayed-RRT group(DG).The groups were defined according to the time from admission to RRT initiation(criterion 1,EG1 and DG1)and Kidney Disease Improving Global Outcomes(KDIGO)classification(criterion 2,EG2 and DG2).Categorical and continuous variables were compared using the chi-squared test or Fisher’s exact test and Student’s t-test or Wilcoxon test.Kaplan-Meier curves were constructed to determine the unadjusted survival rates for the different subgroups.Results:A total of 116 patients were included in this study;of those,38 received RRT and 46 expired within 90 days.Among different strategies of RRT,there were no significant differences found in 90-day mortality(RG vs.NRG:��2=0.610,P=0.435;EG1 vs.DG1:��2=0.835,P=0.360;EG2 vs.DG2:��2=0.022,P=0.899)and renal recovery.However,the values of change in sequential organ failure assessment(ΔSOFA)max-min of patients in the EG and RG were significantly higher than those recorded in the NRG(ΔSOFA RG=7.0,ΔSOFA NRG=3.60,ΔSOFA EG1=9.00,ΔSOFA EG2=6.30;P<0.050).Also,the 90-day renal recovery in the EG was better than that noted in the DG with criterion 1(87.5%vs.38.5%,respectively,��2=10.425,P=0.032),suggesting that RRT(especially timely RRT)may be beneficial to the restoration of systemic organ function in patients with SA-AKI.Conclusion:RRT did not reduce the 90-day mortality among patients with SA-AKI.However,timely RRT may benefit the restoration of systemic organ function,thereby improving the quality of life of patients. | Yiwen Fan Liang Chen Shaowei Jiang Yingying Huang Yuxin Leng Chengjin Gao | 2022 | Journal of Intensive Medicine2022，2，3： | 2 |
| 5 | Septic cardiomyopathy: Diagnosis and management显示文摘There is an extensive body of literature focused on sepsis-induced myocardial dysfunction,but results are con-flicting and no objective definition of septic cardiomyopathy(SCM)has been established.SCM may be defined as a sepsis-associated acute syndrome of non-ischemic cardiac dysfunction with systolic and/or diastolic left ventricular(LV)dysfunction and/or right ventricular dysfunction.Physicians should consider this diagnosis in patients with sepsis-associated organ dysfunction,and particularly in cases of septic shock that require vasopres-sors.Echocardiography is currently the gold standard for diagnosis of SCM.Left ventricular ejection fraction is the most common parameter used to describe LV function in the literature,but its dependence on loading condi-tions,particularly afterload,limits its use as a measure of intrinsic myocardial contractility.Therefore,repeated echocardiography evaluation is mandatory.Evaluation of global longitudinal strain(GLS)may be more sensi-tive and specific for SCM than LV ejection fraction(LVEF).Standard management includes etiological treatment,adapted fluid resuscitation,use of vasopressors,and monitoring.Use of inotropes remains uncertain,and heart rate control could be an option in some patients. | Florence Boissier Nadia Aissaoui | 2022 | Journal of Intensive Medicine2022，2，1： | 2 |
| 6 | The role of peripheral perfusion markers and lactate in septic shock resuscitation显示文摘Septic shock leads to progressive hypoperfusion and tissue hypoxia.Unfortunately,numerous uncertainties exist around the best monitoring strategy,as available techniques are mere surrogates for these phenomena.Never-theless,central venous oxygen saturation(ScvO 2),venous-to-arterial CO 2 gap,and lactate normalization have been fostered as resuscitation targets for septic shock.Moreover,recent evidence has challenged the central role of lactate.Following the ANDROMEDA-SHOCK trial,capillary refill time(CRT)has become a promissory target,considering the observed benefits in mortality,treatment intensity,and organ dysfunction.Interpretation of CRT within a multimodal approach may aid clinicians in guiding resuscitative interventions and stop resuscitation earlier,thus avoiding the risk of morbid fluid overload.Integrative assessment of a patient’s perfusion status can be easily performed using bedside clinical tools.Based on its fast kinetics and recent supporting evidence,targeting CRT(within a holistic assessment of perfusion)may improve outcomes in septic shock resuscitation. | Eduardo Kattan Glenn Hernández | 2022 | Journal of Intensive Medicine2022，2，1： | 2 |
| 7 | Analysis of the correlation between the longitudinal trajectory of SOFA scores and prognosis in patients with sepsis at 72 hour after admission based on group trajectory modeling显示文摘Background:To identify the distinct trajectories of the Sequential Organ Failure Assessment(SOFA)scores at 72 h for patients with sepsis in the Medical Information Mart for Intensive Care(MIMIC)-IV database and determine their effects on mortality and adverse clinical outcomes.Methods:A retrospective cohort study was carried out involving patients with sepsis from the MIMIC-IV database.Group-based trajectory modeling(GBTM)was used to identify the distinct trajectory groups for the SOFA scores in patients with sepsis in the intensive care unit(ICU).The Cox proportional hazards regression model was used to investigate the relationship between the longitudinal change trajectory of the SOFA score and mortality and adverse clinical outcomes.Results:A total of 16,743 patients with sepsis were included in the cohort.The median survival age was 66 years(interquartile range:54-76 years).The 7-day and 28-day in-hospital mortality were 6.0%and 17.6%,respectively.Five different trajectories of SOFA scores according to the model fitting standard were determined:group 1(32.8%),group 2(30.0%),group 3(17.6%),group 4(14.0%)and group 5(5.7%).Univariate and multivariate Cox regression analyses showed that,for different clinical outcomes,trajectory group 1 was used as the reference,while trajectory groups 2-5 were all risk factors associated with the outcome(P<0.001).Subgroup analysis revealed an interaction between the two covariates of age and mechanical ventilation and the different trajectory groups of patients’SOFA scores(P<0.05).Conclusion:This approach may help identify various groups of patients with sepsis,who may be at different levels of risk for adverse health outcomes,and provide subgroups with clinical importance. | Rui Yang Didi Han Luming Zhang Tao Huang Fengshuo Xu Shuai Zheng Haiyan Yin Jun Lyu | 2022 | Journal of Intensive Medicine2022，2，1： | 1 |
| 8 | Critical care aspects of lung transplantation显示文摘 | Lau CL Patterson GA Palmer SM | 2004 | Journal of Intensive Care Medicine2004，19，2： | 1 |
| 9 | Cerebral oximetry monitoring with near infrared spectrosco- py detects alterations in oxygenation before pulse oximetry显示文摘 | Tobias JD | 2008 | Journal of Intensive Care Medicine2008，23，6： | 1 |
| 10 | Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era:a meta-analysis显示文摘 | Beitler JR Shaefi S Montesi SB | 2014 | European Journal of Intensive Care Medicine2014，40，3： | 1 |
| 11 | Anticoagulation monitoring during extracorporeal membrane oxygenation:Is anti-factor Xa assay (heparin level) a better test?显示文摘 | Trung Nguyen Matthew Musick Jun | 2014 | Pedi- atric Critical Care Medicine:A Journal of the Soeiety of Critical Care Medicine and the World Federation of Pedi- atric Intensive and Critical Care Societies2014，15，2： | 1 |
| 12 | Analytic reviews: hyperbaric oxygen therapy 显示文摘 | R Thom | 2007 | Journal of Intensive Care Medicine2007，117，5： | 1 |
| 13 | The role of the al- pha2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit显示文摘 | MARTIN E RAMSAY G MANTZ J | 2003 | Journal of Intensive Care Medicine2003，18，1： | 1 |
| 14 | Posterior reversible en- cephalopathy syndrome 显示文摘 | SAYKOVT D SCHWAB S | 2012 | Journal of Intensive Care medicine2012，27，1： | 1 |
| 15 | A random- ized,double-blind pilot study of dexmedetomidine versus midazolam for intensive care unit sedation:Patient recall of their experiences and short-term psychological out- comes显示文摘 | Robert ML Preslaski CR Mueller SW | 2015 | Journal of Intensive Care Medicine2015，30，3： | 1 |
| 16 | Nonventilatory interventions in the acute respiratory distress syndrome显示文摘 | Alouidor R Barquist ES | 2008 | Journal of intensive care medicine2008，，： | 1 |
| 17 | In acute organophosphate poisoning, the efficacy of hemoperfusion on clinical status and mortality 显示文摘 | Ahintop L Aygun D Sahin H | 2005 | Journal of Intensive Care Medicine2005，20，6： | 1 |
| 18 | The role of the alpha2-a- drenoceptor agonist dexmedetomidine in postsurgical se- dation in the intensive care unit 显示文摘 | Martin E Ramsay G Mantz J | 2003 | Journal of Intensive Care Medicine2003，18，1： | 1 |
| 19 | Analytic reviews:hyperbaric oxygen therapy显示文摘 | R Thom | 2007 | Journal of Intensive Care Medicine2007，117，5： | 1 |
| 20 | How much underfeeding can the critically ill adult patient tolerate?显示文摘Critical illness leads to significant metabolic alterations that should be considered when providing nutritional support.Findings from key randomized controlled trials(RCTs)indicate that underfeeding(<70%of energy expenditure[EE])during the acute phase of critical illness(first 7 days of intensive care unit[ICU]admission)may not be harmful and could instead promote autophagy and prevent overfeeding in light of endogenous energy production.However,the optimal energy target during this period is unclear and full starvation is unlikely to be beneficial.There are limited data regarding the effects of prolonged underfeeding on clinical outcomes in critically ill patients,but recent studies show that oral food intake is suboptimal both in the ICU and following discharge to the acute care setting.It is hypothesized that provision of full nutrition(70–100%of EE)may be important in the recovery phase of critical illness(>7 days of ICU admission)for promoting recovery and rehabilitation;however,studies on nutritional intervention delivered from ICU admission through hospital discharge are needed.The aim of this review is to provide a narrative synthesis of the existing literature on metabolic alterations experienced during critical illness and the impact of underfeeding on clinical outcomes in the critically ill adult patient. | Oana A Tatucu-Babet Emma J Ridley | 2022 | Journal of Intensive Medicine2022，2，2： | 1 |
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