Objective To investigate the value of continuous blood purification （CBP）in early treatment of patients with ARDSexp （ARDS caused by extrapulmonary causes），especially in reducing inflammation mediators and extravascular lung water （EVLW）.Methods According the hospital admission sequence，the patients with APACHEⅡ scores from 15 to 20 and PaO2/FiO2 from 100 to 200 were recruited.The ARDSexp patients were divide into an intervention group treated with CBP （Mode：CVVHDF，rate of displacement liquid and dialysate：1.5 L/h，rate of blood：100-200 mL/h，and the time of CBP：72 hours），and a control group without CBP treatment. The NICO and PICCO monitoring data and the survival rates were recorded and analyzed using the SPSS software. Results The mortality rate of the intervention group was lower than that of the control group （6.3% vs. 36.8%，P=0.032）. In the 72 h monitoring dada of NICO and PICCO，the time of improving PCBF，Pm，Cdyn，VCO2，MValv，Pm，PIP，Raw，RSBI，Vd/Vt，and PaO2/FiO2 of the intervention group was severer than those in the control group，and the severety was also more than that of control group which was was significantly different at 72 h（Plt;0.05）. In the PICCO data，the time of decreasing EVWL and PVPI was shorter than the control group，and the decreasing extent was more than the control group，with significant difference at 72 h. But the changes of Apm，CI，and CVP were not significant （Pgt;0.05）. Conclusions In treatment of ARDSexp patients，CBP therapy can induce the PCBC and EVLW，improve pulmonary compliance and MValv，and reduce the mortality rate，while doesn’t influence heart function and the stability of circulation.
Continuous renal replacement therapy (CRRT) originated from intermittent hemodialysis. Over the past 40 years, its application scope has gradually expanded from the initial treatment of kidney diseases alone to the support of multi-organ functions. As a safe, adequate, and flexible therapeutic modality, CRRT has become one of the main means of treating critically ill patients. Continuous innovation in technology, biomaterials and other technologies provides important driving force for the sustainable development of CRRT. This paper reviews the technological innovation and development of CRRT devices. With continuous technological updates and iteration, CRRT can better adapt to clinical needs. Biofeedback, portability, and intelligence are several directions of the development of CRRT, which can provide more accurate and personalized treatment for critically ill patients in different scenarios.
Objective To compare the clinical effect of continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) in the treatment of severe acute renal failure (ARF). Methods A hundred patients with severe ARF treated between May 2011 and December 2014 were chosen to be the study subjects. According to the order of admission, they were divided into control group and observation group with 50 patients in each. Patients of the control group underwent IHD, while those in the observation group underwent CRRT. Serum creatinine (Scr), blood urea nitrogen (BUN), endogenous creatinine clearance rate (Ccr), treatment effective rate and survival rate were compared between the two groups before and after the treatment. Results Scr, BUN and Ccr were all improved after treatment in both the two groups. However, Scr, BUN and Ccr in the observation group [(225.1±162.7) μmol/L, (14.2±9.3) mmol/L, (23.4±10.5) mL/min] were significantly better than those in the control group [(588.4±183.6) μmol/L, (29.1±10.4) mmol/L, (15.9±8.2) mL/min]. The treatment effective rate and patients’ survival rate in the observation group were respectively 60% and 70%, both significantly higher than those in the control group (40% and 52%) All the differences were significant (P<0.05). Conclusion CRRT is superior in the treatment of severe ARF with a higher survival rate of the patients, which is worthy of clinical promotion.
Objective To compare the effect of two types of intermittent pressure on formation of pressure ulcer in rabbit hind l imbs and to investigate the mechanism of gradually changed intermittent pressure produced by waves bed in the prevention of pressure ulcer. Methods Gracil is (3 cm2) in both hind l imbs of 12 adult Japanese white rabbits were randomlyloaded with gradually changed intermittent pressure (50-160 mm Hg, 1 mm Hg=0.133 kPa) and sustained pressure (100 mmHg) serving as the experimental group and the control group, respectively. The experiment was terminated after 4 cycles, and a single cycle included 2 hours of compression and 30 minutes of compression-release. Blood velocity of hind l imbs and blood perfusion of wound were detected by bidirectional doppler blood flow detector and laser doppler perfusion imaging detection system before compression and at every 10 minutes in compression-release period of each cycle (0, 10, 20 and 30 minutes). After the termination, gross observation of the wound was conducted, pathomorphological changes of tissues from compressed area were observed by HE staining, and contents of NO, malondialdehyde (MDA), and superoxide dismutase (SOD) in muscle tissue were measured using colorimetry method. Results No significant difference was evident between two groups in terms of blood flow velocity before compression (P gt; 0.05); the blood flow velocity of two groups decreased significantly at 0 minute in every compressionrelease period of each cycle, and no significant differences were noted between two groups (P gt; 0.05); the blood flow velocity of theexperimental group was higher than that of the control group at 10, 20 and 30 minutes (P lt; 0.05). No significant difference was noted between two groups in terms of wound blood perfusion before compression (P gt; 0.05); the wound blood perfusion of two groups decreased significantly at 0 minute in every compression-release period of each cycle, and no significant differences were noted between two groups (P gt; 0.05); the difference between two groups was not significant at 10 minutes in the first cycle (P gt; 0.05), and the experimental group was higher than the control group at 20 and 30 minutes in the first cycle (P lt; 0.05). In the following 3 cycles, the recovery of perfusion in the experimental group was faster than that of the control group (P lt; 0.05). Gross observation showed the experimental group had less effusion than the control group. The experimental group had intact cutaneous appendage, less inflammatory cell infiltration, and no obvious ulcer formation, whereas the control group had obvious skin ulcer, depletion of cutaneous appendage, and more inflammatory cells infiltration. Significant differences were noted between two groups in terms of NO, MDA, and SOD content (P lt; 0.05). Conclusion Gradually changed intermittent pressure can maintain the blood perfusion of tissue, reduce ischemia-reperfusion injury and cell apoptosis, and prevent the formation of pressure ulcer.
Blood glucose monitoring has become the weakest point in the overall management of diabetes in China. Long-term monitoring of blood glucose levels in diabetic patients has become an important means of controlling the development of diabetes and its complications, so that technological innovations in blood glucose testing methods have far-reaching implications for accurate blood glucose testing. This article discusses the basic principles of minimally invasive and non-invasive blood glucose testing assays, including urine glucose assays, tear assays, methods of extravasation of tissue fluid, and optical detection methods, etc., focuses on the advantages of minimally invasive and non-invasive blood glucose testing methods and the latest relevant results, and summarizes the current problems of various testing methods and prospects for future development trends.
Objective To summarize and analyze the clinical outcomes and experiences of continuous renal replacement therapy(CRRT) in patients with acute renal insufficiency after heart transplantation. Methods There were 39 patients received orthotopic heart transplantation from September 2007 to September 2008 in Fu Wai hospital. Seven cases required the use of PRISMA CRRT machine (Gambro Healthcare,Inc.) because of acute renal insufficiency after heart transplantation, and received continuous venovenous hemodiafiltration(CVVHDF) treatment via M100 blood filter (hemofilters). Activated coagulation time (ACT) was maintained in 160200 s. Results Six survivals with New York Heart Association (NYHA)Ⅰdischarged ，1 case died of multiple system organ failure (MSOF) and severe infection. The time of CRRT was 48658 h, with an average of 252 h. Seven patients were oliguric or anuric during CRRT, but hemodynamics and internal environment were stable. After stopping CRRT, the creatinine level rose to 267.1±68.5 μmol/L， then the creatinine level decreased to normal range with urine increasing gradually. Postoperative glomerular filtration rate (GFR) was 56.5±19.0 ml/min， and there was no statistical significance compared with preoperative GFR（Pgt;0.05）. Six survivals were followed up for 513(9.7±3.8)months，and their creatinine level was in normal range(90.6±26.7 μmol/L). There was no statistical significance compared with the creatinine level at discharge (83.2±26.5 μmol/L, Pgt;0.05）. Conclusion The prognostic outcomes of patients with acute renal insufficiency after heart ransplantation are excellent after using CRRT. No significant renal dysfunction is found.
Acute kidney injury is a common complication and is associated with multiple organ dysfunction syndrome among critically ill patients in intensive care unit. Once renal replacement therapy in required, the mortality rate was high. Using slow and uninterrupted clearance of retained fluid and toxins, continuous renal replacement therapy (CRRT) can avoid hemodynamic instability while provide acid-base, electrolytes, and volume homeostasis. For decades, CRRT has become the dominant form of renal replacement therapy as well as multiple organ support in critically ill patient with acute kidney injury. However, there remains wide practice variation in the CRRT care when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice, despite evidences to guide practice. In addition, CRRT is a complex technology that is resource-intensive, costly, and requires specialized training by health providers.Taiwan Society of Critical Care Medicine organized a group of experts in critical care and nephrology to review the recommendations and provide their clinical practice and concerns to write this operational manual. The purpose of this manual is to provide step-by-step instructions on the practice of CRRT and troubleshooting. In addition, it is designed to help the newbies to carry out this complex treatment correctly and efficiently. We hope that this operational manual is of value to improve clinical skills, quality of care, and patient safety.
ObjectiveTo investigate the risk factors of death in patients undergoing continuous renal replacement therapy (CRRT) after cardiac surgery. MethodsWe retrospectively analyzed records of 66 adult patients without history of chronic renal failure suffering acute kidney injury (AKI) following cardiac surgery and undergoing CRRT in our hospital between July 2007 and June 2014. There were 38 males and 28 females with mean age of 59.11±12.62 years. They were divided into a survival group and a non-survival group according to prognosis at discharge. All perioperative data were collected and analyzed by univariate analysis and multivariate logistic regression analysis. ResultsIn sixty-six adult patients, eighteen patients survived with a mortality rate of 72.7%. Through univariate analysis and multivariate logistic regression, risk factors of death in the post-operative AKI patients requiring CRRT included hypotension on postoperative day 1 (B=2.897, OR=18.127, P=0.001), duration of oliguria until hemofiltration (B=0.168, OR=1.183, P=0.024), and blood platelet on postoperative day 1 (B=-0.026, OR=0.974, P=0.001). ConclusionHypotension on postoperative day 1 (POD1) is the predominant risk factor of death in patients requiring CRRT after cardiac surgery, while blood platelet on POD1 is a protective factor. If CRRT is required, the sooner the better.
ObjectiveTo reduce the incidence of peritoneal dialysis (PD) catheter complications through a continuous quality improvement (CQI) process. MethodsTwenty-nine patients with catheters inserted (from January 2011 to March 2011) before CQI, and another 41 patients with catheters inserted (between April 2011 and January 2012) after CQI were observed and analyzed. The possible causes of complications of catheter were summarized, and then on the basis of that, a PDCA four-step (plan-do-check-act) method was designed with a view to reducing the incidence of postoperative complications. ResultsPD catheter dysfunction decreased from 6.90% to 2.44%. The incidence of leakage decreased from 44.83% to 9.76%. ConclusionCQI is a useful method to reduce the incidence of postoperative complications of PD catheter in peritoneal dialysis.
ObjectiveTo evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. MethodsBetween June 2002 and January 2013,145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia (local anesthesia group).In addition,51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group.No significant difference was found in gender,age,side,disease duration,or cyst size between 2 groups (P>0.05).Then,anesthesia time,analgesia effect,anesthesia satisfaction,operation time,bleeding volume,and anesthesia complication were compared between 2 groups.The guidelines of Rauschning and Lindgren were used to assess the effectiveness,and recurrence rate was recorded. ResultsAll incisions healed primarily,no neurological or vascular injury was found.The patients were followed up 1 year and 1 month to 8 years (mean,3.7 years) in local anesthesia group,and 8 years to 13 years and 7 months (mean,10.8 years) in control group.Local anesthesia group had shorter anesthesia time,higher visual analogue scale (VAS) score,shorter operation time,and lower bleeding volume (P<0.05) than control group.Anesthesia satisfaction was reduced in local anesthesia group,but there was no significant difference (χ2=0.071,P=1.000).The anesthesia complication incidence of control group (15.7%,8/51) was significantly higher than that of local anesthesia group (0) (P=0.000).Recurrence was found in 12 patients of local anesthesia group (curative ratio 91.7%) and in 5 patients of control group (curative ratio 90.2%),showing no significant difference (χ2=0.111,P=0.774).According to the guidelines of Rauschning and Lindgren,there were 131 cases of grade 0,13 cases of grade I,and 1 case of grade Ⅱ in local anesthesia group,and 37 cases of grade 0,12 cases of grade I,and 2 cases of grade Ⅱ in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups (Z=-10.683,P=0.000; Z=-6.385,P=0.000),and between 2 groups at post-operation (Z=-3.145,P=0.002). ConclusionCompared with under continuous epidural anesthesia,arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results.Under local anesthesia,the condition of nerve and vessel can be timely and dynamically observed.Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma,lower recurrence rate,and satisfactory results.