ObejectiveTo summarize the research progress of risk factors contributing to postoperative pulmonary infection in gastric cancer, so as to provide reference for medical decision-makers and clinical practitioners to effectively control the incidence of postoperative pulmonary infection in gastric cancer, ensure medical safety and improve the quality of life of patients. MethodThe researches at home and abroad on the factors contributing to pulmonary infection after gastric cancer surgery in recent years were reviewed and analyzed. ResultsThere was currently no uniform diagnostic standard for pulmonary infection. The incidence of postoperative pulmonary infection for gastric cancer varied in the different countries and regions. The pathogenic bacteria that caused postoperative pulmonary infection of gastric cancer was mainly gram-negative bacteria, especially Pseudomonas aeruginosa, Escherichia coli, Acinetobacter boulardii, and Klebsiella pneumoniae. The patient’s age, history of smoking, preoperative pulmonary function, preoperative laboratory indicators, preoperative comorbidities, preoperative nutritional status, preoperative weakness, anesthesia, tumor location, surgical modality, duration of surgery, blood transfusion, indwelling gastrointestinal decompression tube, wound pain, and so on were possible factors associated with postoperative pulmonary infection of gastric cancer. ConclusionsThe incidence of postoperative pulmonary infection for gastric cancer is not promising. Based on the recognition of related factors, it is proposed that it is necessary to develop a risk prediction model for postoperative pulmonary infection of gastric cancer to identify high-risk patients. In addition to the conventional intervention strategy, taking the pathogenesis as the breakthrough, finding the key factors that lead to the occurrence of postoperative pulmonary infection of gastric cancer is the fundamental way to reduce its occurrence.
Objective To investigate the influence of pulmonary infection on noninvasive ventilation ( NIV) therapy in hypercapnic acute respiratory failure ( ARF) due to acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) , and evaluate the predictive value of simplified version of clinical pulmonary infection score ( CPIS) for the efficacy of NIV therapy in ARF patients with AECOPD. Methods Eighty-four patients with ARF due to AECOPD were treated by NIV, and were divided into a successful group and an unsuccessful group by the therapeutic effect of NIV. The CPIS and simplified version of CPIS between two groups was compared. The predictive value of simplified version of CPIS for the efficacy of NIV wasevaluated using ROC curve analysis. Results The CPIS and the simplified version of CPIS of the successful treatment group ( 4. 0 ±2. 8, 3. 2 ±2. 4) were lower than those of the unsuccessful group ( 8. 0 ±2. 1, 7. 2 ±1. 8) significantly ( P =0. 006, 0. 007) . The area under ROC curve ( AUC) of CPIS and simplified version of CPIS were 0. 884 and 0. 914 respectively, the cut oint of CPIS and simplified version of CPIS were 6 ( sensitivity of 78. 0% , specificity of 91. 2% ) and 5 ( sensitivity of 80. 0% , specificity of 91. 2% ) respectively. Conclusions The level of pulmonary infection is an important influencing factor on the therapeutic effect of NIV in patients with ARF due to AECOPD. Simplified version of CPIS is a helpful predictor for the effect of NIV on ARF of AECOPD.
ObjectiveTo systematically evaluate the risk factors for postoperative pulmonary infection in patients with esophageal cancer. MethodsCNKI, Wangfang Data, VIP, CBM, PubMed, EMbase, The Cochrane Library were searched from inception to January 2021 to collect case-control studies, cohort studies and cross-sectional studies about risk factors for postoperative pulmonary infection in patients with esophageal cancer. Two researchers independently conducted literature screening, data extraction and quality assessment. RevMan 5.3 software and Stata 15.0 software were used for meta-analysis. ResultsA total of 20 articles were included, covering 5 409 patients of esophageal cancer. The quality score of included studies was 6-8 points. Meta-analysis results showed that age (MD=1.99, 95%CI 0.10 to 3.88, P=0.04), age≥60 years (OR=2.68, 95%CI 1.46 to 4.91, P=0.001), smoking history (OR=2.41, 95%CI 1.77 to 3.28, P<0.001), diabetes (OR=2.30, 95%CI 1.90 to 2.77, P<0.001), chronic obstructive pulmonary disease (OR=3.69, 95%CI 2.09 to 6.52, P<0.001), pulmonary disease (OR=2.22, 95%CI 1.16 to 4.26, P=0.02), thoracotomy (OR=1.77, 95%CI 1.32 to 2.37, P<0.001), operation time (MD=14.08, 95%CI 9.64 to 18.52, P<0.001), operation time>4 h (OR=3.09, 95%CI 1.46 to 6.55, P=0.003), single lung ventilation (OR=3.46, 95%CI 1.61 to 7.44, P=0.001), recurrent laryngeal nerve injury (OR=5.66, 95%CI 1.63 to 19.71, P=0.006), and no use of patient-controlled epidural analgesia (PCEA) (OR=2.81, 95%CI 1.71 to 4.61, P<0.001) were risk factors for postoperative pulmonary infection in patients with esophageal cancer. ConclusionThe existing evidence shows that age, age≥60 years, smoking history, diabetes, chronic obstructive pulmonary disease, pulmonary disease, thoracotomy, operation time, operation time>4 h, single lung ventilation, recurrent laryngeal nerve injury, and no use of PCEA are risk factors for postoperative pulmonary infection in patients with esophageal cancer. Due to the limitation of the quantity and quality of included literature, the conclusion of this study still needs to be confirmed by more high-quality studies.
The morbidity and mortality of pulmonary infection are high among infectious diseases worldwide. Rapid and accurate etiological diagnosis is the key to timely and effective treatment. Metagenomic next-generation sequencing (mNGS) technology has brokenthrough the limitations of traditional pathogenic microorganism detection methods and improved the detection rate of pathogens. In this paper, the application and advantages of mNGS technology in the diagnosis of bacteria, fungi, viruses and mixed infections in the lungs are analyzed, and the challenges and breakthroughs in RNA detection, wall breaking of firmicutes and host DNA clearance are described, in order to achieve targeted and accurate etiological diagnosis through mNGS, so as to effectively treat pulmonary infections.
Whipple’s disease is a multisystemic disease caused by Tropheryma (T.) whipplei that primarily affects the gastrointestinal tract. In literature, T. whipplei can also cause pulmonary infections. The detection of T. whipplei depends on nucleic acid-based test. With the application of next-generation sequencing (NGS), cases with T. whipplei detected from respiratory tract samples by NGS are increasingly found but there is lack of recognized diagnostic criteria for these cases. Within the context, we propose a grading diagnostic scheme for the situation that T. whipplei is detected from respiratory tract samples, based on clinical experience and diagnostic thinking, and referring to the international classifications of invasive fungal infections. The scheme comprises five levels: confirmed, probable, possible, impossible, and excluded. There were 26 such cases from West China Hospital of Sichuan University and we used our diagnostic scheme to define probable in 6 cases, possible in 9 cases, impossible in 8 cases, and excluded in 3 cases. Based on this, we also propose specific suggestions for sample collection and testing, patient management, and further research directions. These recommendations are preliminary based on the existing cases from West China Hospital of Sichuan University and therefore needs to be verified, modified, optimized, and even reconstructed when more clinical evidence and further clinical studies become available.
ObjectiveTo study the application of non-real-time ultrasound bronchoscopy combined with Metagenomic Next-Generation Sequencing (mNGS) for diagnosis in focal pulmonary infectious diseases. MethodsProspective inclusion of patients with focal pulmonary infection were randomly divided into two groups, the experimental group used non-real-time ultrasound bronchoscopy positioning to collect bronchial alveolar lavage fluid (BALF), while the control group used chest CT position. BALF was subjected to mNGS and traditional microbial detection including traditional culture, the fungal GM test and Xpert (MTB/RIF). ResultThe positive rate of traditional culture (39.58% vs. 16.67%, P=0.013) and mNGS (89.58% vs. 72.92%, P=0.036) in experimental group was higher. The positive rate of Xpert MTB/RIF (4.17% vs. 2.08%, P=1) and fungal GM test (6.25% vs. 4.17%, P=0.765) was similar. The positive rate of bacteria and fungi detected by mNGS was higher than traditional culture (61.46% vs. 28.13%, P<0.001). Mycobacterium tuberculosis was similar to Xpert MTB/RIF (8.33% vs. 3.13%, P=0.21). Aspergillus was similar to GM test (7.29% vs. 5.21%, P=0.77). The total positive rate of traditional microbial methods was 36.46%, but 81.25% in mNGS (P<0.001). mNGS showed that 35 cases were positive and 13 kinds of pathogens were detected in control group, but 43 patients and 17 kinds of pathogens were detected in experimental group. The average hospitalization time [(12.92±3.54) days vs. (16.35±7.49) days] and the cost [CNY (12209.17±3956.17) vs. CNY (19044.10±17350.85)] of experimental group was less (P<0.001). ConclusionsNon-real-time ultrasound bronchoscopy combined with mNGS can improve the diagnostic rate of focal pulmonary infectious diseases which is worthy of popularization and application in clinical practice.
Objective To explore the related factors of postoperative pulmonary infection (PPI) in patients undergoing laparoscopic colorectal cancer surgery, and analyze the perioperative management strategy of pulmonary infection combined with the concept of enhanced recovery after surgery (ERAS). Methods Total of 687 patients who underwent laparoscopic colorectal cancer surgery in the colorectal cancer professional treatment group of Gastrointestinal Surgery Center of West China Hospital of Sichuan University from January 2017 to May 2019 were retrospectively included. According to the occurrence of PPI, all the included cases were divided into infection group (n=97) and non-infection group (n=590). The related factors and prevention strategies of PPI were analyzed. Results The rate of PPI among patients underwent laparoscopic resection in our study was 14.1% (97/687). Compared with the non-infection group, the proportions of patients with preoperative complications other than cardiopulmonary, receiving preoperative neoadjuvant radiotherapy and/or chemotherapy, preoperative Eastern Cooperative Oncology Group (ECOG) score 1–2, preoperative Nutrition Risk Screening 2002 (NRS2002) score 1–3, tumor located in the left colon and rectum, combined organ resection, operative time >3 h and postoperative TNM stage Ⅱ patients in the infection group were higher (P<0.05). However, the proportions of patients who used intraoperative lung protective ventilation strategy and incision infiltration anesthesia in the infection group were lower than those in the non-infection group (P<0.05). In the infection group, the proportions of patients who received regular sputum excretion, atomization therapy, balloon blowing/breathing training, stomatology nursing after operation and postoperative analgesia were all significantly lower than those of the non-infection group (P<0.05), whereas the proportions of patients receiving antibiotics and intravenous nutrition after operation were significantly higher than those in the non-infection group (P<0.05). Logistic regression analysis showed that low preoperative NRS2002 score, intraoperative protective ventilation strategy, postoperative respiratory training, and postoperative regular sputum excretion were the protective factors of PPI, while preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor located in the left colon and rectum, late TNM staging and postoperative antibiotics were risk factors for pulmonary infection.Conclusions Preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor location in the left colon and rectum, late TNM staging and postoperative antibiotics are risk factors for pulmonary infection in patients with laparoscopic colorectal cancer. Preoperative good nutritional status, intraoperative protective ventilation strategy, postoperative respiratory training and regular sputum excretion may reduce the incidence of PPI to a certain extent.
Objective To establish a rat model of chronic pulmonary infection by inoculating Pseudomonas aeruginosa to Sprague-Dawley(SD) rats.Metods Sixty SD rats were divided into 2 groups,ie.the P.aeruginosa group and the control group. Silicone tube precoated with P.aeruginosa was placed into the main bronchus. For the control group, sterile silicon tube was intubated. Results P ． aeruginosa was detected from lung tissue of rats in infected groups.Bacterial number was higher than 103cfu ／ g 28 days after inoculation.The pathological study showed fibrinous proliferation and granulomas formation in the lungs of infected rats 28 days after inoculation.Microscopy examination showed a inflammation predominantly with lymphocyte infiltration.In control group, no bacterial and pathological changes could be detected. Conclusions The animal model with P.aeruginosa chronic pulmonary infection can be established successfully by silicone tubes precoated with P.aeruginosa intubated into the main bronchus.
ObjectiveTo assess the value of simplified clinical pulmonary infection score (sCPIS) in predicting prognosis of patients with ventilator-associated pneumonia (VAP). MethodsThe clinical data of 52 patients with VAP,admitted in ICU between January 2011 and December 2012,were retrospectively analyzed. The sCPIS was calculated at the onset,and on 3rd,5th and 7th day after onset of VAP. Results24 cases survived and 28 cases died in 28-day's hospitalization. 28-day mortality was 53.8%. A significant decrease in sCPIS scores was found on 3rd,5th and 7th day after onset compared with at the onset of VAP in the survivors(4.8±1.2,4.0±1.1,3.3±1.6 vs. 5.5±1.4,P<0.05). An increase in sCPIS scores was found on 3rd,5th and 7th days after onset compared with at the onset of VAP in the non-survivors (6.8±1.3,7.5±1.4,7.8±1.2 vs. 5.8±1.5,P<0.05). The sCPIS determined at the time of VAP diagnosis and on 3rd,5th and 7th day after onset was significantly higher in the non-survivors than that in the survivors respectively (P<0.05). The duration of mechanical ventilation and the length of ICU stay were longer in the non-survivors than those in the survivors[(18.4±5.2) d vs. (12.0±4.1) d,(22.5±8.5) d vs. (16±6.3) d,P<0.05]. ConclusionSerial measurement of sCPIS is valuable in evaluating the severity of illness and predicting the prognosis.
ObjectiveTo investigate the clinical value of serum proadrenomedullin (pro-ADM) for diagnosis of ventilator-associated pneumonia(VAP). MethodsA prospective study was carried out in eighty-nine patients with clinically suspected diagnosis of VAP who underwent invasive mechanical ventilation between June 2014 and July 2015.The patients were divided into a VAP group (n=52) and a non-VAP group (n=37) according to clinical and microbiological culture results.The levels of serum pro-ADM were measured by sandwich ELISA on 1st, 3rd and 5th day of VAP suspicion.The diagnostic value of pro-ADM for VAP was assessed by receiver operating characteristic (ROC) curve analysis. ResultsOn 1st day, 3rd day and 5th day, the pro-ADM levels [3.10(2.21, 4.61) nmol/L, 3.01(2.04, 4.75)nmol/L and 1.85(1.12, 3.54)nmol/L, respectively] in the VAP group were significantly higher than those in the non-VAP group [1.53(1.07, 2.24)nmol/L, 1.52(1.05, 2.17) nmol/L and 1.26(1.02, 2.17) nmol/L, respectively] (all P < 0.05).For diagnosis of VAP, the area under the ROC curve (AUC) for pro-ADM on 1st, 3rd and 5th were 0.896 (95%CI 0.799-0.940), 0.863(95%CI 0.791-0.935) and 0.651 (95%CI 0.538-0.765), respectively.When using 2.53 nmol/L as the best cutoff on 1st day, pro-ADM had 84.6% sensitivity and 86.5% specificity.When using 2.40 nmol/L as the best cutoff on 3rd day, pro-ADM had 82.7% sensitivity and 83.8% specificity. ConclusionSerum level of pro-ADM in the diagnosis of VAP has good sensitivity and specificity, which may be used as a marker to diagnose VAP early.