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25 September 2023, Volume 28 Issue 05 Previous Issue    Next Issue

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Editorial

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Critical care medicine and safety management of high-risk surgical patients CHEN Erzhen 2023, 28 (05):  399-401.  DOI: 10.16139/j.1007-9610.2023.05.01 Abstract ( 59 )   HTML ( 5 )   PDF (755KB) ( 36 )   At present, although the mortality of most patients undergoing major surgery is very low, the increase of so-called high-risk surgery patients with high risk of postoperative complications and death brings new challenges to perioperative safety management. The efficient collaboration of multidisciplinary professional teams based on patient-centered and value-based medicine is a new measure to ensure perioperative safety. Among them, the critical care medical professional team plays a key role in risk assessment, perioperative organ protection, close monitoring and specific early intervention for high-risk patients, so as to achieve timely prevention, early identification and effective treatment of postoperative complications, and to reduce the risk of death and improve the postoperative quality of life. References | Related Articles | Metrics

Experts forum

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Perioperative blood volume monitoring and therapy PAN Qingbo, YAN Jun, LUO Yan 2023, 28 (05):  402-408.  DOI: 10.16139/j.1007-9610.2023.05.02 Abstract ( 56 )   HTML ( 2 )   PDF (877KB) ( 41 )   Perioperative blood volume monitoring and treatment is an important part of clinical anesthesia, which is essential for restoring effective blood volume, ensuring oxygen supply to organs and tissues, and stabilizing the internal environment. It is also an important part of rapid recovery after surgery. Selecting appropriate blood volume monitoring methods and reasonable fluid therapy during the perioperative period can optimize the hemodynamics of patients. But there is still some controversy about the intraoperative blood volume monitoring scheme. This article intended to analyze and review the characteristics and clinical value of various perioperative blood volume monitoring methods, and explore the strategies of perioperative blood volume monitoring and treatment, so as to provide a theoretical basis for preventing or reducing postoperative complications and improving the prognosis of patients. References | Related Articles | Metrics

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Perioperative intensive care for cardiac surgery patients LIU Hua, LUO Minghao, TU Guowei, LUO Zhe 2023, 28 (05):  409-414.  DOI: 10.16139/j.1007-9610.2023.05.03 Abstract ( 64 )   HTML ( 1 )   PDF (866KB) ( 19 )   The rapid development of perioperative intensive care in cardiac surgery has greatly improved the prognosis for patients undergoing major cardiovascular surgery. In the field of hemodynamics, besides traditional methods, such as a variety of arterial catheters and central venous catheter, thermodilution and echocardiography have gradually becoming routines in hemodynamic monitoring, but their clinical values require further investigation. At the same time, optimizing micro-circulation, in order to meet the demand of oxygen and metabolism, is the goal of hemodynamic resuscitation. The management of V-A extracorporeal membrane oxygenation (ECMO) in the perioperative period of cardiac surgery depends on persistent hemodynamic monitoring. Volume management, vasoactive drugs, inotropes and vasodilators are still keys in pharmacological management. In addition, many mechanical circulatory assist devices have brought more treatments and hope for end-stage heart failure and severe cardiopulmonary dysfunction. References | Related Articles | Metrics

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The strategy of extrahepatic organs management in early period after adult liver transplantation DENG Yuxiao, ZHAO Xianyuan, GAO Yuan 2023, 28 (05):  415-419.  DOI: 10.16139/j.1007-9610.2023.05.04 Abstract ( 46 )   HTML ( 1 )   PDF (909KB) ( 14 )   With the improvements in surgical technique, the indications for liver transplantation(LT) are being expanded to more complex and severe patients, who not only have liver function in the terminal stage, but also extrahepatic organs involve of varying degrees dysfunction. It was demonstrated that the strategy of extrahepatic organs management in early period after LT was associated with improving recovery. This paper summarized the strategy of extrahepatic organs management in early period after adult LT. Continuing to monitor system hemodynamics is helpful for stable graft perfusion. It is necessary to manage derangements of preload, myocardial contractility, and afterload. Early postoperative extubation is recommended by current guidelines. Routine screening pulmonary complications may help weaning from the ventilator. The diagnosis of acute kidney injury(AKI) after LT has been reported to using Kidney Disease: Improving Global Outcomes(KDIGO) criteria, a delayed calcineurin inhibitor initiation strategy may be beneficial for renal protection. Currently, there is no consensus on timing of renal replacement therapy initiation in patients with AKI. Patients with cirrhosis and a history of hepatic encephalopathy(HE) displays impaired neurological recovery, the diagnosis of HE is crucial and challenging. Figures and Tables | References | Related Articles | Metrics

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Prevention and control of multidrug-resistant bacteria infection in surgical patients TAN Ruoming, QU Hongping 2023, 28 (05):  420-424.  DOI: 10.16139/j.1007-9610.2023.05.05 Abstract ( 50 )   HTML ( 1 )   PDF (839KB) ( 57 )   The current situation of multidrug-resistant bacteria infection in surgical patients is becoming increasingly severe. Effective prevention of cross transmission of multidrug-resistant bacteria and common site infections in ICU patients is the key step. In response to the key issues in the prevention and control of multidrug-resistant bacteria infection, a comprehensive strategy is implemented. Core measures such as early recognition, preemptive isolation, active screening, and graded prevention and control are taken for patients, and targeted preventive measures for common infection sites are combined to form a detection and control system of multidrug-resistant bacteria for ICU patients. By moving forward and extrapolating to the general ward, the prevention and control system effectively reduced the incidence of multidrug-resistant bacteria colonization/infection in surgical patients. References | Related Articles | Metrics

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Viscoelastic hemostasis assay guided diagnosis and treatment of trauma-induced coagulopathy SHEN Tuo, ZHU Feng 2023, 28 (05):  425-431.  DOI: 10.16139/j.1007-9610.2023.05.06 Abstract ( 48 )   HTML ( 1 )   PDF (896KB) ( 48 )   The diagnosis and treatment of trauma-induced coagulopathy is an important part of the treatment of severe trauma patients. Trauma-induced coagulopathy has two phenotypes: hypercoagulability and hypocoagulability. The phenotype of coagulopathy in the early stage of trauma patients is variable. Viscoelastic hemostatic assay can reflect the full picture of coagulation in trauma patients. It can guide clinicians to quickly identify different phenotypes of trauma-induced coagulopathy, and fine manage different phenotypes of coagulopathy. This paper introduced the detection methods and principles of common viscoelastic hemostasis assays, and summarized the diagnosis and treatment methods based on viscoelastic hemostasis assay in different phenotypes of trauma-induced coagulopathy from literature, aimed to provide elicitation of diagnosis and treatment for clinicians. Figures and Tables | References | Related Articles | Metrics

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The necessity and approach for updating the circulatory system assessment in initial phase post-burn ZHANG Qin, DOU Yi, GAO Min 2023, 28 (05):  432-436.  DOI: 10.16139/j.1007-9610.2023.05.07 Abstract ( 45 )   HTML ( 2 )   PDF (855KB) ( 14 )   For resolving the major problems of the optimization of the formula of resuscitation and the basis for circular decision-making in the treatment of anesthesia and sedation-analgesia in inital phase post-burn, we propose to use a cycle assessment method that combines urine output with circulation-oxygenation quantitative indexes to carry out cycle assessment. Here, we introduced the background and theoretical and practical basis of combining different dimensions of immediate and dynamic circulation to promote more clinical research on circulation assessment methods, so as to make necessary preparations for the future update of fluid resuscitation formula in initial phase post-burn. References | Related Articles | Metrics

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Application of high dose intravenous vitamin C in critical cared diseases ZHAO Bing, YU Xianxian, MAO Enqiang 2023, 28 (05):  437-440.  DOI: 10.16139/j.1007-9610.2023.05.08 Abstract ( 87 )   HTML ( 2 )   PDF (842KB) ( 19 )   Vitamin C is an essential micronutrient for human and its deficiency will lead to scurvy. In recent years, as a new therapeutic strategy, high dose intravenous vitamin C(HDIVC) has been widely studied in critical cared diseases. In this review, we summarized the progress of HDIVC in sepsis, including its research history, rationality of usage, controversy and prospect, problems and outlook. The application of HDIVC in critical cared diseases underwent three periods: early, preheating and outbreaking period. Given the reduction of vitamin C in critical diseases, it requires rapid intravenous supplementation. We confirmed the therapeutic efficacy of HDIVC in COVID-19 and severe acute pancreatitis respectively. It is well known that HDIVC has effect of suppressing inflammatory responses, stabilizing the circulation and improving the immunity. But the application of HDIVC in critical cared diseases is still controversial, for the opposing findings in multiple large-scale randomized controlled trials. Future studies should be better to pay further attention on the dose and time of vitamin C and vitamin C plasma concentration monitoring. References | Related Articles | Metrics

Original article

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Factors influencing early using enteral nutrition in severe burn patients ZHANG Yin, DOU Yi, ZHANG Qin, WANG Wenliang, SHEN Xiaoxian, MA Zhenzhu, WU Beiwen 2023, 28 (05):  441-447.  DOI: 10.16139/j.1007-9610.2023.05.09 Abstract ( 52 )   HTML ( 2 )   PDF (885KB) ( 21 )   Objective To analyze the main factors affecting early using enteral nutrition and the effect of enteral nutrition within 72 h after burning on outcomes by presenting a retrospective cohort study of 11 years of hospitalization data, to provide evidence for enteral nutrition regimens for severe burn patients. Methods A retrospective study analyzed adult extensive burn patients between January 2009 and December 2020. Patients enrolled in this study who admitted to the burn department within 24 h after burning and with a burned area of more than 30%. Univariate and multiple regression were used to analyze the main factors affecting early using enteral nutrition in patients with severe burn. Non parametric Mann-Whitney U test was used to compare the main influencing factors of enteral nutrition implementation within or after 72 h, as well as the impact on the treatment outcomes such as 28-day survival rate and in hospital survival rate. Results The univariate analysis found that total burn area, full-thickness burn area, burn type, and inhalation injury were the main factors of the time to initation of enteral nutrition in patients with severe burn (P<0.05). Incorporating the above single factors into multiple regression analysis, we found that the main factors affecting enteral nutrition using in patients with severe burn were full-thickness burn area (P=0.017) and inhalation injury (P=0.001). To analysis whether enteral nutrition was started within 72 h after burning, we found that inhalation injury and larger area of full-thickness burn area in patients was the main factors for initiating enteral nutrition. After matching injury situation with pre-injury situation, we found that using enteral nutrition within or after 72 h after injury were no significant differences in the survival rate, 28-day survival rate, and positive blood culture rate （P>0.05），but was associated with the lower incidence of bacteria positive in intravenous catheters (P=0.001) and the lower rate of parenteral nutrition treatment used within 7 d after burning (P=0.001). Conclusions The main factor for influencing early implement enteral nutrition in patients with severe burn were large area of full-thickness burn and inhalation injury. Enteral nutrition using within 72 h after burning reduces the incidence of catheter infection and the use of parenteral nutrition, thereby reducing the risk of treatment in patients with severe burn. Figures and Tables | References | Related Articles | Metrics

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Analysis of the effect of double filtration plasmapheresis on hyperlipidemic acute pancreatitis GE Yan, WANG Guoxin, WANG Jiahui, AN Yuan, ZHAO Bing, SHENG Huiqiu, MA Li 2023, 28 (05):  448-453.  DOI: 10.16139/j.1007-9610.2023.05.10 Abstract ( 68 )   HTML ( 1 )   PDF (809KB) ( 26 )   Objective To evaluate the effect of double filtration plasmapheresis (DFPP) on patients with hyperlipidemic acute pancreatitis (HL-AP). Methods The clinical data of the patients with hyperlipidemic severe acute pancreatitis (HL-SAP) or moderately severe acute pancreatitis (HL-MSAP) from January 2019 to May 2022 were collected. The patients were divided into two groups,the control group received conventional treatment, DFPP group received DFPP treatment on the basis of conventional treatment. Results Compared with the control group, the following parameters changed significantly in DFPP group, triglyceride (TG), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) decreased on day 1 and 2, estimated glomerular filtration rate (eGFR) increased on day 1, 2, 3 and 5, leukocyte and neutrophil counts decreased on day 1 and 2, hemoglobin (HGB) decreased on day 1, 2, and 3, C-reactive protein (CRP) decreased on day 1, 2, 3, 5, and 7. And the patients in DFPP group receiving mechanical ventilation decreased compared with that in control group. Conclusion Compared with conventional treatment, DFPP can reduce plasma TG faster, improve lung, liver and kidney function, reduce inflammatory markers, and facilitate early fluid recovery. Figures and Tables | References | Related Articles | Metrics

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Risk factors and prognosis of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in ICU patients: a report of 81 cases LIU Meng, XU Wen, DAI Yunqi, TAN Ruoming, LIU Jialin, GU Feifei, CHEN Erzhen, WANG Xiaoli, QU Hongping, QIU Yuzhen 2023, 28 (05):  454-462.  DOI: 10.16139/j.1007-9610.2023.05.11 Abstract ( 62 )   HTML ( 1 )   PDF (987KB) ( 41 )   Objective Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment in patients with Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSI). Methods Retrospective analysis of the clinical characteristics of 81 CRKP-BSI patients in our intensive care unit from July 2016 to June 2020, to indentify the risk factors of death and treatment effects of different antibiotic regimens. Results In 81 CRKP-BSI cases, the majority source were from abdominal and respiratory, accounting for 56.79% (46 cases) and 22.22% (18 cases), respectively. The 28-day mortality and hospitalization mortality of CRKP-BSI were 54.32% (44 cases) and 65.43% (53 cases). Multivariate regression analysis suggested that biliary tract disease before admission (P=0.026) and increased SOFA score at the onset of BSI (P=0.006) were independent risk factors for 28-day mortality. There was no statistically significant difference in 28-day mortality between the groups of antibiotic treatment based on tigecycline (44 cases) and polymyxin B (26 cases) [56.82% (25/44) vs. 57.69% (15/26), P=0.943]. Patients were evaluated based on their age (≤ 65 years vs. >65 years), gender, body mass index (≤25 kg/m2 vs. >25 kg/m2), and APACHE Ⅱ score (≤20 vs. >20), the use of renal replacement therapy and mechanical ventilation, there was no difference in the mortality among each subgroup. Conclusions Biliary tract disease before admission and SOFA score were independent risk factors for 28-day mortality. There was no significant difference outcomes between tigecycline- and polymyxin B-based therapy. Figures and Tables | References | Related Articles | Metrics

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Efficacy of three-port laparoscopic sleeve gastrectomy in treatment of obesity ZHAN Chongwen, SHEN Qiwei, SHAO Yikai, XU Bo, HUA Rong, YAO Qiyuan 2023, 28 (05):  463-468.  DOI: 10.16139/j.1007-9610.2023.05.12 Abstract ( 62 )   HTML ( 1 )   PDF (3478KB) ( 35 )   Objective To evaluate the feasibility, safety and efficacy of three-port laparoscopic sleeve gastrectomy(LSG). Methods Clinical data of 130 patients with obesity who underwent LSG from April 2020 to January 2021 and completed follow-up in time were analyzed retrospectively. All patients were divided into two groups as surgical method, there were 52 cases in three-port group and 78 cases in four-port group. Perioperative indicators and improvement of obesity in two groups were compared. Results All procedures were performed via LSG. Compared with four-port group, the mean operative time of three-port group was shorter [(88.35±22.64) min vs. (98.29±26.25) min, P=0.027]. There were no significant differences in amount of bleeding intraoperative, postoperative pain, postoperative drainage, hospital stay after operation, postoperative complication rate and weight loss 6 months and 2 years after surgery (P>0.05). Conclusions Under the premise of no increase in surgical complications and operative time, three-port LSG can reduce the number and size of surgical scars, which is conducive to skin beauty, and obtain the same weight loss effect as four-port LSG, and can be used as a routine operation for sleeve gastrectomy. Figures and Tables | References | Related Articles | Metrics

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Prognostic analysis of the patients with HER2-positive breast cancer adjuvant treated with trastuzumab: a report of 1 246 cases LI Yuefeng, HONG Jin, LI Zhian, RUAN Guodong, CHEN Weiguo 2023, 28 (05):  469-476.  DOI: 10.16139/j.1007-9610.2023.05.13 Abstract ( 45 )   HTML ( 1 )   PDF (1106KB) ( 19 )   Objective To analyze the prognostic factors in the patients with HER2-positive breast cancer adjuvant treated with trastuzumab. Methods We conducted a retrospective analysis of clinical data of 1 246 patients diagnosed with HER2-positive breast cancer between January 2009 and December 2019 who received treatment with trastuzumab. We investigated the factors impacting their prognosis by the Log-rank test univariate analysis and multivariate COX regression analysis. Results HER2-positive patients treated with trastuzumab had a poor prognosis in pT2-3(HR=2.10, P=0.003), pN2-3(HR=2.81, P<0.001), and no endocrine therapy (HR=2.50, P<0.001), and that had a better prognosis combined with taxane or other chemotherapy regimens (HR=0.40, P=0.017). We divided the patients into two subgroups according to the status of lymph node metastasis, and we found that in the negative lymph nodes group the patients with pT2-3 stage had poor prognosis (P=0.020), while the patients combined with taxane or other chemotherapy had better prognosis (P=0.032). In the positive lymph nodes group the patients with pT2-3 stage and no endocrine therapy had poor prognosis (P=0.012, P=0.001). Conclusions The patients with HER2-positive breast cancer treated with trastuzumab can be managed in different categories, for individuals without lymph node involvement and small tumor sizes, combining therapy with non-anthracycline chemotherapy is preferable for achieving improved outcomes, for patients with lymph node metastasis and large tumor sizes, if chemotherapy options are available, it is more recommended to use an anthracycline-free regimen to ensure the same prognosis while reducing the harm caused by the toxic side effects of chemotherapy. Figures and Tables | References | Related Articles | Metrics

Review

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The current status of thermal ablation in the treatment of papillary thyroid microcarcinoma LIN Tingyu, ZHAO Yanna, FEI Jian 2023, 28 (05):  477-482.  DOI: 10.16139/j.1007-9610.2023.05.14 Abstract ( 78 )   HTML ( 3 )   PDF (865KB) ( 240 )   Thermal ablations are rapidly developing techniques for minimally invasive treatment, including laser ablation, radiofrequency ablation, and microwave ablation. Such remarkable success has been achieved in treatment malignant neoplasms, for instance, hepatocellular carcinoma and renal cell adenocarcinoma. In recent years, the practice has been gradually adopted into the treatment of papillary thyroid microcarcinoma (PTMC). Many reports have stated that thermal ablations have distinctive advantages over traditional thyroidectomy owing to its efficacy and safety for treatment primary PTMC, meanwhile there are many controversial issues which hotly debated regarding to first-line treatments. Recently, indications and contraindications of thermal ablation for PTMC have been successively proposed by guidelines and consensuses. Many follow-up reports related to thermal ablation in the treatment of PTMC have been reported in clinical practice as well. In this review, we summarized the principles, indications and contraindications, and the efficacy and safety of thermal ablation in the treatment of PTMC, and compared it with traditional surgery. References | Related Articles | Metrics

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Current status and prospect of CAR-T cell immunotherapy for colorectal cancer ZHANG Tianshuai, ZHOU Leqi, YU Guanyu, ZHANG Wei 2023, 28 (05):  483-487.  DOI: 10.16139/j.1007-9610.2023.05.15 Abstract ( 110 )   HTML ( 2 )   PDF (872KB) ( 31 )   Chimeric antigen receptor T (CAR-T) cell therapy is a new method of immunotherapy for cancer that has achieved remarkable results in treating blood tumors. However, colorectal cancer(CRC), as a solid tumor, has different characteristics from hematological tumors, which impose certain constraints on the selection of its therapeutic targets and the effectiveness of treatment of CAR-T therapy. Therefore, it is necessary to select therapeutic targets with high specificity and effectiveness according to the characteristics of CRC, as well as to break through the constraints such as adverse effects caused by the treatment and the solid tumor microenvironment, to make CAR-T therapy applicable in the treatment of CRC. This article aimed to summarize the strategy of selecting therapeutic targets for CAR-T cell immunotherapy for CRC, analyze the restrictive factors of this therapy in the treatment of CRC, and forecast the prospect of CAR-T cell immunotherapy for CRC. References | Related Articles | Metrics