Lung transplantation has been proved to be an effective treatment after more than forty years of fast development, while more than 4000 cases of lung transplantation performed globally each year. Recently, lung transplantation in China has been advanced rapidly, and the number of transplants has increased year by year. Respiratory and Critical Care Medicine team has been recognized to play a crucial role in lung transplantation. It has an irreplaceable role and status in promoting lung transplantation, improving the preoperative evaluation of lung transplantation and the maintenance of donors, and carrying out perioperative management, as well as long-term follow-up. Lung transplantation is a systematic project, requiring the perfect cooperation and collaboration of team members and contributing to recipients’ recovery.
Objective To retrospectively analyze the clinical features of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU), so as to improve the level of clinical diagnosis and treatment. Methods A total of 81 patients diagnosed as IPA from March, 2017 to March, 2022 in the ICU of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China were selected as infection group. A total of 81 non-IPA patients with pulmonary infection and Aspergillus negative sputum culture were selected as the control group. The host factors, Acute Physiology and Chronic Health Assessment Ⅱ score at admission, underlying diseases, clinical symptoms and signs, relevant laboratory test results, and lung CT findings were compared between the two groups. Univariate analysis and multivariate conditional logistic regression analysis were used to identify the risk factors for the occurrence of pulmonary aspergillosis in IPA patients in ICU. At the same time, the types of aspergillus in the IPA group and the outcomes of the two groups at 28 days after ICU admission were analyzed. Results Of the 81 IPA patients, 4 were proven diagnosed and 77 were putative diagnosed. IPA patients were mainly infected with Aspergillus fumigatus and Aspergillus flavus. Symptoms and signs such as fever, cough and expectoration, dyspnea and pulmonary rales occurred in both groups. The level of procalcitonin in IPA group was higher than that in non-IPA group, and the difference was statistically significant (P=0.016). The positive rate of serum galactomannan antigen test (GM test) in the IPA group was higher than that in the non-IPA group, and the differences was statistically significant (P=0.000). The incidence of pulmonary imaging cavities in IPA group was higher than that in non-IPA group, and the difference was statistically significant (P=0.022). Univariate analysis showed that central venous catheterization, septic shock, complete parenteral nutrition, chronic obstructive pulmonary disease, and immunosuppression were risk factors for IPA (P<0.05); Multivariate conditional logistic regression analysis showed that complete parenteral nutrition, chronic obstructive pulmonary disease, and immunosuppression were independent risk factors for IPA (P<0.05). The 28-day fatality rate in IPA group was higher than that in non-IPA group (55.6% vs. 34.6%, P=0.007). Conclusions IPA patients have no specific clinical symptoms and signs, and are mainly infected with Aspergillus fumigatus and Aspergillus flavus; GM test has guiding significance for the diagnosis of IPA. Serum GM test and pulmonary imaging have cavity findings that are helpful for the diagnosis of IPA. Patients with a history of chronic obstructive pulmonary disease, immunosuppression, or complete parenteral nutrition need to be on high alert for the possibility of IPA during ICU stay.
目的 监测重症医学科（ICU）呼吸机相关性肺炎（VAP）的发病率，探讨实施干预组合措施对VAP发病率的影响。 方法 对2011年6月1日－2012年5月31日ICU使用呼吸机患者478例为监测对象并按时间先后分为两组，对照组按规范方法进行干预，试验组在规范干预基础上再采取组合干预措施，包括：每日评估患者、用一次性呼吸机螺纹管、用床角量角标识抬高床头、床尾设置黄色警示线、调查手卫生依从性等，统计分析两组VAP发病率。 结果 共监测ICU患者5 937个住院日，使用呼吸机1 510个机械通气日，呼吸机使用率25.43%，发生VAP 60例，VAP发病率为39.74例/1 000机械通气日，其中对照组发生VAP 21例，使用呼吸机343个机械通气日，VAP发病率为61.22例/1 000机械通气日；试验组发生VAP 39例，使用呼吸机1 167个机械通气日，VAP发病率为33.42例/1 000机械通气日，两组发病率差异有统计学意义（χ2=12.702，P=0.000）。 结论 实施干预组合措施可使VAP发病率显著下降，但仍高于国内外大型医院，基层医院还需不断努力控制好VAP的发病率。
Objective To analyze the hot spot and future application trend of artificial intelligence technology in the field of intensive care medicine. Methods The CNKI, WanFang Data, VIP and Web of Science core collection databases were electronically searched to collect the related literature about the application of artificial intelligence in the field of critical medicine from January 1, 2013 to December 31, 2022. Bibliometrics was used to visually analyze the author, country, research institution, co-cited literature and key words. Results A total of 986 Chinese articles and 4 016 English articles were included. The number of articles published had increased year by year in the past decade, and the top three countries in English literature were China, the United States and Germany. The predictive model and machine learning were the most frequent key words in Chinese and English literature, respectively. Predicting disease progression, mortality and prognosis were the research focus of artificial intelligence in the field of critical medicine. ConclusionThe application of artificial intelligence in the field of critical medicine is on the rise, and the research hotspots are mainly related to monitoring, predicting disease progression, mortality, disease prognosis and the classification of disease phenotypes or subtypes.
With the continuous development of critical care medicine, the survival rate of critical ill patients continues to increase. However, the residual dysfunction will have a far-reaching impact on the burden on patients, families, and health-care systems, and will significantly increase the demand of the follow-up rehabilitation treatment. Critical illness rehabilitation intervenes patients who are still in the intensive care unit (ICU). It can prevent complications, functional deterioration and dysfunction, improve functional activity and quality of life, shorten the time of mechanical ventilation, the length of ICU stay and hospital stay, and also reduce medical expenses. Experts at home and abroad believe that early rehabilitation of critical ill patients is safe and effective. So rehabilitation should be involved in critical ill patients as early as possible. However, the promotion of this model is still limited by the setting of safety parameters, the ICU culture, the lack of critical rehabilitation professionals, and the physiological and mental cognitive status of patients. Rehabilitation treatment in ICU is constantly being practiced at home and abroad.
Objective To analyze the species distribution and resistance of the pathogens isolated fromblood cultures of the patients in intensive care unit ( ICU) , and provide a basis for prevention and control of bloodstream infections in critically ill patients. Methods The data of blood cultures of the patients in ICUduring January 2009 to December 2011 was investigated retrospectively.Results In the last 3 years, positive rate of blood cultures of ICU patients was 15. 4% , 15. 7% , and 17. 6% respectively. Among the isolates, Gram-positive bacteria were predominant ( 52. 3% ) , followed in order by gram-negative bacteria ( 33. 1% ) and fungi ( 14. 7% ) . Aerobe and facultative anaerobe were the predominant bacterial isolates ( 99. 7% ) . Enterococcus faeciumand Staphylococcus spp. were the most common gram-positive bacteria, and 4. 5% of E. faecium isolates were resistant to vancomycin. Rate of methicillin-resistance for S. aureus and S. epidermidis was 73. 5% and 93. 7% respectively. In terms of gram-negative bacteria, Acinetobacter calcoaceticus- A. baumannii complex were the leading species, 96. 9% of the isolates had multi-drug resistance and 14. 1% of the isolates had extra-drug resistance. Klebsiella pneumonia and Escherichia coli isolates were less frequently isolated and those producing extended spectrum beta-lactamases accou ted for 70. 3% and 80. 0% of the isolates respectively. Candida spp. was the most common fungi isolates ( 96. 7% )with an annual change of species distribution and declining susceptibility to azoles.Conclusions Gram-positive bacteria should be the major target for prevention and control of bloodstream infections in critically ill patients. Whereas, more attention should be paid to the infection caused by candida spp. and multidrug resistant gram-negative bacteria.
目的 探讨床旁超声在重症监护治疗决策中的价值及应用方案。 方法 回顾2010年6月－2012年2月期间床旁超声应用情况及提供的信息对治疗决策的影响及临床效果，总结重症诊治临床实践中可行的应用方案。 结果 研究期间共使用床旁超声219例次，其中血流动力学监测（评估心脏前负荷、收缩力）41例次，低氧原因检查45例次，血栓筛查19例次，胎心监测22例次，引导深静脉穿刺48例次，引导胸、腹腔穿刺及置管37例次，引导动脉置管4例次，气道情况检查3例次。循环监测中经验判断容量准确性为63.4%，床旁超声能提供85.4%的正确信息，其中纠正了13例临床经验判断错误（31.7%），明显提高了诊断正确率（P＜0.05）；低氧原因判断中临床判断正确率62.2%，超声检查能提供86.7%的正确信息，发现16例临床经验判断错误，纠正错误判断35.6% （P＜0.05）。 结论 床旁超声能很好地协助重症医学科医生提高临床判断准确性，控制医疗风险。