CCM2013年7-9月文献荟萃

徐宇军

1

Sodium Bicarbonate Infusion to Reduce Cardiac Surgery-Associated Acute Kidney Injury: A Phase II Multicenter Double-Blind Randomized Controlled Trial*

Venoarterial Extracorporeal Membrane Oxygenation Support for Refractory Cardiovascular Dysfunction During Severe Bacterial Septic Shock*

2

心脏手术患者围手术期使用重碳酸钠灌注并不减少急性肾损伤的发生率 体外膜肺氧合可以挽救70%的产生顽固性心衰的脓毒血症休克患者。存活者的可以保持长期良好生活质量。

3

Benzodiazepine Augmented [gamma]-Amino-Butyric Acid Signaling Increases Mortality From Pneumonia in Mice*

Comparison of Sleep Quality With Mechanical Versus Spontaneous Ventilation During Weaning of Critically Ill Tracheostomized Patients*

4

苯二氮卓类药物增加y氨基丁酸信号通路活性，使患肺炎小鼠死亡率上升

依赖呼吸机辅助通气难以撤机的重症患者使用MV模式比Spont模式有更高的睡眠质量

5

Do Windows or Natural Views Affect Outcomes or Costs Among Patients in ICUs?

Early Antibiotic Discontinuation in Patients With Clinically Suspected Ventilator-Associated Pneumonia and Negative Quantitative Bronchoscopy Cultures*

6

增加窗口（可投射自然光线）或者自然探视（通过窗口）不影响ICU患者的临床结局或花费

临床怀疑呼吸机相关性肺炎并且支气管灌洗培养阴性患者早期停用抗生素不增加死亡率，并可减少耐药菌的发生。

7

Topographic Distribution of Tidal Ventilation in Acute Respiratory Distress Syndrome: Effects of Positive End-Expiratory Pressure and Pressure Support*

The Influence of Prehospital Systemic Corticosteroid Use on Development of Acute Respiratory Distress Syndrome and Hospital Outcomes* 8

ARDS的通气策略：比较高的PEEP和较低的支持水平可以增加肺通气的同质性，改善通气血流灌注比值。

院前全身应用皮质激素应用不减少ARDS的发生，也不影响死亡率或者机械通气的比例

9

End-Expiratory Occlusion Test Predicts Preload Responsiveness Independently of Positive End-Expiratory Pressure During Acute Respiratory Distress Syndrome

Hyperbaric Oxygen Does Not Improve Cerebral Function When Started 2 or 4 Hours After Cerebral Arterial Gas Embolism in Swine* 10

在ARDS患者，呼气末阻塞实验在不同的PEEP水平都可以预测容量负荷

猪气体栓塞后2或4小时进行高压氧疗不会改善大脑功能

和现行理论不一致。 是否造成的气体栓塞太大了？

11

Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients

Body Mass Index Is Associated With Hospital Mortality in Critically Ill Patients: An Observational Cohort Study

12

在神经重症患者中使用标准化内窥镜检查评价气管切开套管的拔除

观察研究----重症患者的BMI和死亡率反向相关

13

Safety of Intrahospital Transport in Ventilated Critically Ill Patients: A Multicenter Cohort Study*

Early Acute Lung Injury: Criteria for Identifying Lung Injury Prior to the Need for Positive Pressure Ventilation*

14

机械通气的重症患者进行院内转运会增加各种各样的并发症，包括气胸、肺不张、低血糖、高血糖、高血钠和呼吸机相关性肺炎。

定义早期急性肺损伤，用于在需要正压通气之前确定肺损伤患者

15

Bacteremia in Patients With Acute Pancreatitis as Revealed by 16S Ribosomal RNA Gene-Based Techniques*

Pleural Pressure and Optimal Positive End-Expiratory Pressure Based on Esophageal Pressure Versus Chest Wall Elastance: Incompatible Results*

16

在重症胰腺炎患者的血液中，检测各种细菌的RNA，可以发现菌血症的存在，主要是来自肠道的机会生长菌群（包括大肠埃希菌、志贺菌属、肠杆科菌属、屎肠球菌等）。出现几率与APACHE-II评分呈正相关。

使用经食道测压和和胸壁电容的方法估算跨肺压指导优化PEEP不完全等同

17

Atypical Sleep in Ventilated Patients: Empirical Electroencephalography Findings and the Path Toward Revised ICU Sleep Scoring Criteria

Early Goal-Directed Sedation Versus Standard Sedation in Mechanically Ventilated Critically Ill Patients: A Pilot Study*

18

使用脑电图评定机械通气患者的睡眠质量，发现很多患者存在不典型睡眠。建议使用改良的睡眠评分来评价ICU患者睡眠情况。

在机械通气的重症患者中，早期目标镇静是可行并且安全的。它比标准镇静可以减少镇静剂用量，减少对患者的约束。

19

Acute Respiratory Distress Syndrome After Spontaneous Intracerebral Hemorrhage*

Pulmonary Vascular Dysfunction Induced by High Tidal Volume Mechanical Ventilation*

20

在脑动脉出血的ARDS患者中使用高潮气量通气策略可增加死亡风险。

高潮气量通气时会出现肺血管的功能不全，以α-肾上腺素诱导的血管收缩、血管内皮依赖性舒张功能减少、缺氧性肺血管收缩增强作为特征。

21

Rapid Cardiotonic Effects of Lipid Emulsion Infusion*

Specific Antibody in IV Immunoglobulin for Postsplenectomy Sepsis

22

乳状脂质灌注可在活体动物或者离体心脏中快速增加心肌收缩和舒张效应。

注射免疫球蛋白IV可以对切脾术后脓毒症患者有保护作用，这是通过增强在肝脏的特异性抗体介导的–吞噬作用来达成的。

特异性抗体的作用非常重要。

23

Ultrasound Monitoring of RBC Aggregation as a Real-Time Marker of the Inflammatory Response in a Cardiopulmonary Bypass Swine Model*

24

使用超声检测红细胞聚集，可以体外循环的猪身上实时监测免疫炎症反应

使用了10只猪接受体外循环。使用脂多糖注射来总成炎症反应。

使用结构因子的大小和衰减估计评价红细胞的聚集（在循环泵或股静脉测量）。

这种方法可以早起揭示血管功能紊乱。

25

A Randomized, Double-Blind, Placebo-Controlled, Phase 2b Study to Evaluate the Safety and Efficacy of Recombinant Human Soluble Thrombomodulin, ART-123, in Patients With Sepsis and Suspected Disseminated Intravascular Coagulation*

26

Objectives: To determine the safety and efficacy of recombinant thrombomodulin (ART-123) in patients with suspected sepsis-associated disseminated intravascular coagulation.

Design: Phase 2b, international, multicenter, double-blind, randomized, placebo-controlled, parallel group, screening trial.

Setting: Two hundred and thirty-three ICUs in 17 countries.

Patients: All adult patients admitted with sepsis and suspected disseminated intravascular coagulation as assessed using a modified International Society on Thrombosis and Hemostasis score.

Interventions: Patients were randomized to receive IV ART-123 (0.06 mg/kg/d) for 6 days or placebo, in addition to standard of care. The primary endpoint was reduction in mortality. Secondary endpoints included reversal of overt disseminated intravascular coagulation and reduction in disease severity.

Measurements and Main Results: A total of 750 patients were randomized, nine of whom did not receive the allocated treatment so that 371 patients received ART-123 and 370 received placebo. There were no meaningful differences between the two groups in any of the baseline variables. Twenty-eight-day mortality was 17.8% in the ART-123 group and 21.6% in the placebo group (Cochran–Mantel–Haenszel two-sided p value of 0.273 in favor of ART-123, which met the predefined statistical test for evidence suggestive of efficacy). There were no statistically significant differences in event-free and alive days between the two groups. d-dimer, prothrombin fragment F1.2 and TATc concentrations were lower in the ART-123 group than in the placebo group. There were no differences between the two groups in organ function, inflammatory markers, bleeding or thrombotic events or in the development of new infections. In post hoc analyses, greatest benefit from ART-123 was seen in patients with at least one organ system dysfunction and an international normalized ratio greater than 1.4 at baseline.

Conclusions: ART-123 is a safe intervention in critically ill patients with sepsis and suspected disseminated intravascular coagulation. The study provided evidence suggestive of efficacy supporting further development of this drug in sepsis-associated coagulopathy including disseminated intravascular coagulation. Future study should focus on using ART-123 in the subgroup of patients most likely to respond to this agent. 27

一项在脓毒症和怀疑DIC患者中开展的随机、双盲、对照，2B期研究，用于评价重组人可溶性血栓调节酶（ART-123）的安全性和有效性

这个研究在17个国家的233个ICU中展开。共750名成人患者。 统一的评价标准—改良的血栓止血国际评分modified

International Society on Thrombosis and Hemostasis score 干预剂量0.06 mg/kg/d 干预周期 6 day 主要终点事件------死亡率下降，次级终点事件----DIC的逆转或者

疾病严重程度的减轻 结果，干预组28天死亡率17.8%，安慰剂组21% 至少有一个器官功能衰竭并且INR大于1.4的患者获益最大。 结论：在怀疑DIC的脓毒症患者中使用ART-123是安全的。

28

The Systemic Inflammatory Response Syndrome in Patients With ST-Segment Elevation Myocardial Infarction*

Heparin Thromboprophylaxis in Medical-Surgical Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Trials*

29

在ST段抬高型心梗患者中的炎症反应综合征 出现炎症反应综合征和ST段抬高型心梗患者的预后相关。

外科术后重症患者使用肝素预防血栓的meta分析

结论：在该种患者中使用肝素可以减少深静脉血栓和肺动脉栓塞的发生率，使用低分子肝素比每日两次的普通肝素更有效。使用肝素的重症术后患者出血率没有显著增加。 30

Feasibility and Cardiac Safety of Inhaled Xenon in Combination With Therapeutic Hypothermia Following Out-of-Hospital Cardiac Arrest*

ICU-Acquired Pneumonia With or Without Etiologic Diagnosis: A Comparison of Outcomes*

31

院外心脏骤停患者使用氙气吸入联合低体温治疗是有效并且可行的，其对心脏

使用了疝气吸入患者的去甲肾维持剂量更低，没有显著的心脏毒性，并且72小时的肌钙蛋白更低。

有病原学诊断和没有病原学诊断的ICU获得性肺炎的比较

结论：病原诊断学阴性的患者存活率更高，住院时间更短

32

Quantitative Diagnosis of Diffuse Alveolar Damage Using Extravascular Lung Water*

Microvascular Effects of Heart Rate Control With Esmolol in Patients With Septic Shock: A Pilot Study*

33

血管外肺水可以协助诊断ARDS和弥漫性肺泡损伤，区分正常肺和弥漫性肺泡损伤的阈值是10mg/kg。

在脓毒症休克患者中使用思莫洛尔控制心率的微血管效应

结论：在脓毒症休克患者中使用思莫洛尔（一种超短效B受体阻滞剂）控制心率（本研究为95次/分），可使去甲肾用量减低，维持正常每搏量和微血管血流。 34

Intestinal Mast Cells Mediate Gut Injury and Systemic Inflammation in a Rat Model of Deep Hypothermic Circulatory Arrest*

35

在低体温循环停止的大鼠模型中，小肠Mast细胞介导了肠损伤和系统性炎症。

36

Airway Fungal Colonization Compromises the Immune System Allowing Bacterial Pneumonia to Prevail

37

气道真菌定值可以抑制免疫系统并促进了细菌性肺炎的产生

实验动物---大鼠 方法----1、气道内灌注白色念珠菌------结果产生定值或不产生定值

2、再次灌注不同种类的细菌（假单胞菌、大肠埃希菌、葡萄球菌）

测量细菌吞噬指标----Y干扰素 对气道真菌定值的大鼠，比较抗真菌药和未抗真菌时假单胞肺炎的发生率。

结论：白色念珠菌定值引起Th1-Th17的免疫系统应答，通过对肺泡的巨噬细胞吞噬作用的抑制促进细菌性肺炎的产生。使用抗真菌药可以减少真菌定值大鼠继发细菌性肺炎。 38