Objective To analyze the occurrence of acute gastrointestinal injury (AGI) after pediatric cardiac surgery with cardiopulmonary bypass (CPB) and its impact on prognosis, and to explore the risk factors and early warning indicators for AGI, in order to identify and diagnose AGI at an early stage. Methods This is a prospective observational study. The patients under 14 years with congenital heart disease receiving surgeries with CPB who were admitted to the pediatric ICU of West China Hospital, Sichuan University from December 2020 to December 2021 were included. The general information, perioperative gastrointestinal symptoms and intra-abdominal pressure, surgery-related information, postoperative organ function and prognosis of the children were collected. The patients were divided into an AGI group and a non-AGI group according to the 2012 European Society of Critical Care Medicine AGI diagnostic criteria. ResultsA total of 137 patients were enrolled, including 68 males and 69 females with a median age of 20.0 (6.0, 43.0) months. There were 60 patients in the AGI group and 77 patients in the non-AGI group, with an AGI incidence of 43.80%. The incidences of overall adverse outcomes, low cardiac output syndrome, and infectious complications were higher in the AGI group, and the vasoactive-inotropic score (VIS), mechanical ventilation time, ICU stay, and hospital stay were higher or longer in the AGI group, the differences were statistically significant (P<0.001). AGI was an independent risk factor for the overall adverse outcomes (OR=3.191, 95%CI 1.187 to 8.579, P=0.021). Univariate and multivariate logistic regression analyses indicated that weight, male, CPB time and intraoperative VIS were independent predictors for AGI after pediatric cardiac surgery. The receiver operating characteristic curve indicated that the patients with an intraoperative VIS>10.5 points and CPB time>96.5 min might have a higher possibility of postoperative AGI. ConclusionThe incidence of AGI in pediatric cardiac surgery with CPB is high, and it is an independent risk factor for overall adverse outcomes. Weight, male, CPB time , and intraoperative VIS are independent risk factors for AGI.
Objective To analyze death causes and relevant factors in victims of Wenchuan earthquake．Methods Medical records of 27 dead patients admitted to W est China Hospital during the first 30 days after Wenchuan earthquake were analyzed retrospectively．Patient census data，diagnoses，dispositions，and prognoses were collected． Results A total of 2702 patients with earthquake related injuries were admitted to West China Hospital．The overall mortality rate was 1％(27／2702 patients)．The death were associated with age≥70．severe cerebral injuries and severe underlying illness．Mortality rate was highest in aged patients with comorbidities．Conclusions Insufficient pre-hospital treatment and inappropriate transfer procedure may contribute to the early death．Complicated with comorbidities is the leading cause of late death．Earlier involvement of intensivist in medical intervention in such a disaster is demanded．
ObjectiveTo investigate the correlation between lung ultrasonography and pulmonary complications after cardiac surgery.MethodsFifty-two patients after cardiac surgery in our hospital from January to May 2017 were recruited. There were 27 males and 25 females, aged 60.50±10.43 years. Lung ultrasonography was performed by specially trained observers, video data were saved, and lung ultrasound score (LUS) were recorded. The correlation between the LUS and the patients' pulmonary function was evaluated.ResultsLUS was 17.80±3.87, which was negatively correlated to the ratio of arterial PO2 to the inspired oxygen fraction (PaO2/FiO2) during examination, without significant difference (r=–0.363, P=0.095), but significantly negatively correlated to PaO2/FiO2 changes 24 hours postoperatively (r=–0.464, P=0.034).ConclusionThe changes of lung ventilation area may occur earlier than the changes of lung function. Bedside LUS is an effective method for clinical monitoring of pulmonary complications.
ObjectiveTo provide recommendations for the management of intensive care unit patients without novel coronavirus disease 2019 (COVID-19).MethodsWe set up a focus group urgently and identified five key clinical issues through discussion. Total 23 databases or websites including PubMed, National Guideline Clearing-House, Chinese Center for Disease Control and Prevention and so on were searched from construction of the library until February 28, 2020. After group discussion and collecting information, we used GRADE system to classify the evidence and give recommendations. Then we apply the recommendations to manage pediatric intensive care unit in the department of critical care medicine in our hospital. ResultsWe searched 13 321 articles and finally identified 21 liteteratures. We discussed twice, and five recommendations were proposed: (1) Patients should wear medical surgical masks; (2) Family members are not allowed to visit the ward and video visitation are used; (3) It doesn’t need to increase the frequency of environmental disinfection; (4) We should provide proper health education about the disease to non-medical staff (workers, cleaners); (5) Medical staff do not need wear protective clothing. We used these recommendations in intensive care unit management for 35 days and there was no novel coronavirus infection in patients, medical staff or non-medical staff. ConclusionThe use of evidence-based medicine for emergency recommendation is helpful for the scientific and efficient management of wards, and is also suitable for the management of general intensive care units in emergent public health events.