Objective To investigate the effect of a real-time compliance dashboard to help reduce ventilator-associated pneumonia ( VAP) with ventilator bundle. Methods 240 patients who were admitted into the intensive care unit ( ICU) of Shougang Hospital of Peking University and had received mechanical ventilation ( MV) for over 48 hours, between January 2010 and November 2011, were studied prospectively. The patients were divided into two groups by random number table, ie. a dashboard group ( n = 120) with implementation of a real-time compliance dashboard to help reduce VAP with ventilator bundle, and a control group ( n=120) with implementation of usually routine order to help reduce VAP with ventilator bundle. The success rate of ventilator bundle implementation, incidence of VAP, duration of MV, duration within ICU, mortality within 28 days, cost within ICU were compared between two groups. Results Compared with the control group, the success rate of ventilator bundle implementation obviously increased ( 81.6% vs. 52.5%) , incidence of VAP ( 14. 5/1000 days of MV vs. 36.2 /1000 days of MV) , duration of MV [ 5( 4,7) days vs. 8( 6,11) days] , duration within ICU [ 8( 6,12) days vs. 13( 8,16) days] , mortality of 28 days ( 12.6% vs. 28.6% ) , and cost within ICU ( 36,437 vs. 58,942) in the dashboard group obviously reduced ( Plt;0.05) . Conclusions Implementation of a real time compliance dashboard to help reduce VAP with ventilator bundle can obviously improve medical personnel compliance and reduce incidence of VAP, duration of MV, duration within ICU, mortality and cost in ICU than those of routine medical order to help reduce VAP with ventilator bundle.
Objective To evaluate the diagnostic accuracy of procalcitonin (PCT) for ventilator-associated pneumonia (VAP). Methods We searched MEDLINE, EMbase, The Cochrane Library, CBM, BIOSIS to identify all diagnostic tests which evaluated the diagnostic value of PCT in patients with VAP. QUADAS items were used to evaluate the quality of the included studies. Pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), summary receiver operating characteristic (SROC) curve, and the heterogeneity of the included studies were calculated by using the Meta-disk software. Results Five studies which were identified from 103 references met the inclusion criteria. The summary sensitivity, specificity, +LR, and –LR values were 0.70 (95%CI 0.62 to 0.77), 0.76 (95%CI 0.69 to 0.82), 5.651 (95%CI 1.237 to 25.810), and 0.349 (95%CI 0.155 to 0.784), respectively. Overall area under the curve (AUC) of SROC curve was 0.884 (DOR=19.416, 95%CI 2.473 to 152.47), demonstrating significant heterogeneity (I2gt;50%). Conclusion The use of PCT for VAP diagnosis has only a moderate sensitivity and specificity. Although the overall accuracy of VAP diagnosis is relatively high, there is significant heterogeneity between the studies, so more high-quality studies are needed. Besides, using PCT alone to diagnose VAP is not sufficient, and a combination with other clinical evaluations is necessary.
Objective To explore whether hospitalized elderly patients with severe communityacquired pneumonia ( SCAP) have better outcomes if they are treated with dual-therapy consisting of a β-lactam/macrolide or fluoroquinolone.Methods A prospective study was conducted in patients with SCAP aged 65 years or older between January 2007 and January 2012. These patients were assigned to a combination therapy group or a β-lactam monotherapy group by the attending physicians. Time to clinical stability( TCS) and total mortality were calculated. Prognostic factors for death were analyzed. Results Among the 232 patients, 153 patients were given β-lactam/macrolide or β-lactam/ fluoroquinolone ( macrolide in 67 patients and fluoroquinolone in 86) , while 79 were treated with β-lactam monotherapy. Compared with the monotherapy group, the combination therapy group was associated with significant decreased TCS ( median TCS, 10 days vs. 13 days) , and lower overall in-hospital mortality( 24.2% vs. 43.0%, P lt;0. 01) . Compared with fluoroquinolone, macrolide use was associated with lower ICU mortality ( 14.9% vs. 31.4% , P lt;0. 01) . Simplified acute physiology score Ⅱ, pneumonia severity index, mutilobar infiltration, and β-lactam monotherapy were confirmed as independent predictors of death. Conclusion β-lactam/macrolide or β-lactam/ fluoroquinolone combination therapy, especially with macrolide, has superiority over β-lactam monotherapy in elderly patients with SCAP, and should be recommended.
Objective To investigate the pleural effusion lymphocyte subsets in patients with pneumonia complicated with pleural effusion and its relationship with the occurrence of critical illness. MethodsPatients with pneumonia complicated with pleural effusion (246 cases) admitted to our hospital from January 2020 to June 2022 were selected as the research subjects. According to the severity of pneumonia, they were divided into a critical group (n=150) and a non-critical group (n=96). After 1:1 matching by propensity score matching method, there were 60 cases in each group. The general data of the two groups were compared. CD3+, CD4+, CD8+, CD4+/CD8+ ratio were detected by flow cytometry. Multivariate logistic regression was used to analyze the risk factors of critical pneumonia, and a nomogram prediction model was constructed and evaluated. The relationship between PSI score and lymphocyte subsets in pleural effusion was analyzed by local weighted regression scatter smoothing (LOWESS). Results After matching, the differences between the two groups of patients in the course of disease, heat peak, heat course, atelectasis, peripheral white blood cell count (WBC), C-reactive protein (CRP), D-dimer (D-D), procalcitonin (PCT) and hemoglobin were statistically significant (P<0.05). Compared with the non-critical group, the proportion of CD3+, CD4+, CD4+/CD8+ cells in critical group was lower (P<0.05), and the proportion of CD8+ cells was higher (P<0.05). Combined atelectasis, increased course of disease, fever peak and fever course, increased WBC, CRP, D-D, CD8+ and PCT levels, and decreased CD3+, CD4+, CD4+/CD8+ and Hb levels were independent risk factors for the occurrence of critical pneumonia (P<0.05). The nomogram prediction model based on independent influencing factors had high discrimination, accuracy and clinical applicability. There was a certain nonlinear relationship between pneomonia severity index and CD3+, CD4+, CD8+ and CD4+/CD8+. Conclusions Lymphocyte subsets in pleural effusion are closely related to the severity of pneumonia complicated with pleural effusion. If CD3+, CD4+, CD8+ and CD4+/CD8+ are abnormal, attention should be paid to the occurrence of severe pneumonia.
Objective To observe the gamma-glutamyltransferase ( GGT) activity and total antioxidant capacity ( T-AOC) in serum and platelet during the course of community-acquired pneumonia ( CAP) . Methods Ninety cases of hospitalized CAP were recruited from the respiratory wards in the Affiliated Hospital of XuzhouMedical College fromSeptember 2010 to September 2011, and 30 healthy cases who underwent physical examination in the same hospital were enrolled as control. GGT activity and T-AOC were compared between the CAP patients and the control subjects, and also between the CAP patients who developed reactive thrombocytosis ( platelet count gt;300 ×109 /L) and those without thrombocytosis ( platelet count ≤300 ×109 /L) . Results Compared with the control subjects, serumand platelet GGT activity of the CAP patients were significantly higher [ ( 45. 6 ±25. 4) U/L vs. ( 17. 9 ±3. 7 ) U/L, ( 179. 9 ±41. 3) mU/109plt vs. ( 49. 5 ±8. 0) mU/109plt, P lt; 0. 05] , serum T-AOC at admission was significantly lower [ ( 12. 6 ±1. 6) U/mL vs. ( 17. 7 ±2. 1) U/mL, P lt; 0. 05] , and platelet T-AOC at admission was significantly higher [ ( 61. 6 ±18. 3) mU/109plt vs. ( 48. 6 ±9. 9) mU/109 plt, P lt; 0. 05] . Platelet T-AOC of the CAP patients at discharge was significantly lower than that of the CAP patients at admission and the control subjects. Compared with the CAP patients without thrombocytosis, serum T-AOC and serum GGT activity of the CAP patients who developed reactive thrombocytosis were significantly higher( P lt;0. 05) , and platelet T-AOC and platelet GGT activity were both significantly lower ( P lt; 0. 05) . There were negative correlations of the platelet count with platelet T-AOC and GGT activity in the CAP patietns( r = - 0. 316,P =0.003; r = - 0. 318, P =0. 002) . Conclusions There is a correlation between the oxidative stress and the platelet function in the inflammatory process of CAP. There might be an indicative role of platelets in resolving the inflammatory process and in maintaining the oxidative-antioxidative balance.
Objective To compare the clinical efficacy of intravenous polymyxin B alone and intravenous drip combined with nebulized inhaled polymyxin B in treatment of patients with carbapenem-resistant organism (CRO) pneumonia. Methods The clinical data of 85 patients with CRO pneumonia admitted to the Intensive Care Unit of Nanjing Drum Tower Hospital from September 2020 to June 2023 were collected using a retrospective study. According to the different ways of administration of polymyxin B, the patients receiving polymyxin B intravenous drip therapy alone were included in group A, and the patients receiving polymyxin B intravenous drip therapy combined with nebulized inhalation therapy were included in group B. The therapeutic effective rate, bacterial clearance rate, 30-day all-cause mortality and the level of infection indexes before and after the use of medication were compared between the two groups. The occurrence of acute kidney injury during the use of drugs in the two groups was observed and recorded. Results The pathogenicity culture results showed that there was no statistically significant difference between the two groups (P=0.144). Serum procalcitonin and C-reactive protein were significantly lower in the two groups after drug administration compared with those before drug administration (both P<0.05). The therapeutic efficiency and bacterial clearance rate in group B were higher than those in group A (both P<0.05). There was no statistically significant difference in 30-day all-cause mortality between the two groups (P=0.664). And there was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.650). Conclusion When polymyxin B is used to treat patients with CRO pneumonia, the intravenous drip combined with nebulized inhalation regimen is superior to intravenous drip therapy alone and does not increase the risk of developing nephrotoxicity.
Objective To investigate the clinical characteristics of interstitial pneumonia patients with positive anti-signal recognition particle antibody (SRP-IP), and compare those with interstitial pneumonia patients with positive anti-Jo-1 antibody (Jo1-IP). Methods Clinical data of SRP-IP patients admitted to Department of Respiratory and Critical Care Medicine of Drum Tower Hospital affiliated to Nanjing University Medical School from May 2017 to May 2021, including clinical manifestations, laboratory examinations, pulmonary function tests and radiographic types, were retrospectively analyzed. The results were compared with those of Jo1-IP patients admitted during the same period. Results The SRP-IP patients were older than Jo1-IP patients (P=0.044). There were no significant differences in clinical manifestations or pulmonary function tests results between the two groups. The proportion of SRP-IP patients combined with positive anti-EJ antibody (P<0.001) or perinuclear anti-neutrophil cytoplasmic antibody (P=0.028) was significantly higher than that of Jo1-IP patients, while the proportion of SRP-IP patients combined positive anti-Ro-52 antibody was significantly lower than that of Jo1-IP patients (P=0.009). The erythrocyte sedimentation rate (ESR) of SRP-IP patients was faster than that of Jo1-IP patients (P=0.026). The serum IgM level (P=0.039) and peripheral NK cell counts (P=0.013) of SRP-IP patients were significantly lower than those of Jo1-IP patients. The most common chest CT findings in SRP-IP patients were organizing pneumonia and the proportion of usual interstitial pneumonia in SRP-IP patients was higher than that of Jo1-IP patients (P=0.032). The levels of creatine kinase (P=0.010), creatine kinase myocardial brand (P=0.025) and alanine aminotransferase (P=0.045) in interstitial pneumonia patients with high titer (++~+++) SRP antibody were higher than those in interstitial pneumonia patients with low titer (+) SRP antibody. SRP-IP and Jo1-IP patients were mainly treated with glucocorticoids combined with or without immunosuppressants, and there was no significant difference in the choice of treatment between the two groups. The proportion of patients with Jo1-IP evaluated as improved was significantly higher than that of patients with SRP-IP (p=0.005), while the proportion of patients with SRP-IP evaluated as stable was significantly higher than that of patients with Jo1-IP (P=0.035). The mortality of SRP-IP patients within 3 months was significantly higher than that of Jo1-IP patients (P=0.028). Conclusion Compared with Jo1-IP patients, SRP-IP patients are older, have faster ESR, are more likely to be combined with other autoantibodies, have lower serum IgM level and peripheral blood NK cell count, have more UIP imaging manifestations, and have a worse short-term prognosis.
Objective To investigate the potential effect of glucocorticoids (referred to as 'hormones' here) on decreasing case fatality rate in patients with human immunodeficiency virus (HIV) negative Pneumocystis jirovecii pneumonia (PJP). Methods The clinical data of a cohort of 93 patients that were diagnosed with HIV-negative PJP at Jiangxi Provincial People's Hospital between April 2019 and April 2022 were retrospectively analyzed. These patients were classified into two groups based on the partial pressure of oxygen in arterial blood (PaO2), specifically PaO2 ≥70 mm Hg and PaO2 <70 mm Hg. The association between case fatality rate and various factors such as underlying diseases, hormone use, mechanical ventilation, and others was examined. Results Over a period of three years, 93 cases of HIV-negative PJP were identified. The most prevalent underlying diseases were solid organ transplantation (n=34, 36.6%), rheumatic system diseases (n=26, 28.0%), and malignant tumors (n=15, 16.1%). 51 cases had arterial PaO2 levels ≥70 mm Hg, while 42 cases had levels <70 mm Hg. Moreover, 19 patients required invasive ventilation, 39 patients were treated with non-invasive ventilation, while 50 patients received oxygenation using a nasal cannula. Out of the 93 patients, 31 died from the disease, resulting in an overall case fatality rate of 33.3%. Meanwhile, 62 patients survived. In patients with arterial PaO2 levels ≥70 mm Hg, the administration of hormones did not significantly affect the case fatality rate (P > 0.05); In patients with arterial PaO2 level <70 mm Hg, the administration of hormones did not significantly affect the case fatality rate (P > 0.05). Conclusion Hormone use did not contribute to improved survival rates in HIV-negative PJP patients, regardless of arterial PaO2 level.
ObjectiveTo predict the total hospitalization expenses of bronchopneumonia inpatients in a tertiay hospital of Sichuan Province through BP neural network and support vector machine models, and analyze the influencing factors.MethodsThe home page information of 749 cases of bronchopneumonia discharged from a tertiay hospital of Sichuan Province in 2017 was collected and compiled. The BP neural network model and the support vector machine model were simulated by SPSS 20.0 and Clementine softwares respectively to predict the total hospitalization expenses and analyze the influencing factors.ResultsThe accuracy rate of the BP neural network model in predicting the total hospitalization expenses was 81.2%, and the top three influencing factors and their importances were length of hospital stay (0.477), age (0.154), and discharge department (0.083). The accuracy rate of the support vector machine model in predicting the total hospitalization expenses was 93.4%, and the top three influencing factors and their importances were length of hospital stay (0.215), age (0.196), and marital status (0.172), but after stratified analysis by Mantel-Haenszel method, the correlation between marital status and total hospitalization expenses was not statistically significant (χ2=0.137, P=0.711).ConclusionsThe BP neural network model and the support vector machine model can be applied to predicting the total hospitalization expenses and analyzing the influencing factors of patients with bronchopneumonia. In this study, the prediction effect of the support vector machine is better than that of the BP neural network model. Length of hospital stay is an important influencing factor of total hospitalization expenses of bronchopneumonia patients, so shortening the length of hospital stay can significantly lighten the economic burden of these patients.
Objective To analyze the clinical features of immune checkpoint inhibitor-related pneumonia (CIP) in patients with lung cancer. Methods The case data of patients with CIP admitted to Zhongshan Hospital of Fudan University from January 2017 to December 2020 were retrospectively collected, and the basic data, clinical manifestations, imaging data, laboratory examination results, treatment and prognosis of the patients were analyzed. Results The ratio of male to female was 18:1, and the median age was 65 years (from 41 to 74 years). Fourteen patients received a programmed death protein-1 (PD-1) inhibitor and five patients received a programmed death protein-ligand-1 (PD-L1) inhibitor. The median time to CIP was 3.5 months. The respiratory symptoms of 15 patients were dyspnea in 11 cases, cough in 9 cases, chest tightness in 8 cases, fever in 4 cases, expectoration in 4 cases and hemoptysis in 2 cases. Chest CT findings mainly showed interstitial pneumonia, including 8 cases of implicit organizational pneumonia (COP), 7 cases of non-specific interstitial pneumonia (NSIP), 2 cases of acute interstitial pneumonia, and 2 cases of allergic pneumonia. C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase were higher in CIP than before, and the difference was statistically significant. Follow-up observation was performed in 3 patients alone, 14 patients were treated with glucocorticoid alone, 2 patients were treated with immunosuppressant therapy, 19 patients had stable or more absorption of pneumonia lesions, and 5 patients had restarted immunotherapy. There were no deaths from CIP. Conclusions CIP mainly occurs in men, with slow onset, lack of specificity in clinical manifestations, and increased inflammatory indicators. Imaging findings are mainly NSIP and COP changes. Early identification, diagnosis and rational application of glucocorticoid therapy have good effects.