AIM: To assay the pattern of thyroid hormone alternations in systemic inflammatory response syndrome (SIRS) patients. METHODS: 50 SIRS patients were enrolled, divided into two groups as to whether they got MODS. Thyroid hormone measurements were taken, including total T_3 (TT_3), total T_4 (TT_4), free T_3 (FT_3), free T_4 (FT_4) and TSH. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was calculated according to clinical data. Outcome (recovery or deterioration) was recorded, as well as the length of time from the onset of SIRS to the day when thyroid hormones were measured (the duration of SIRS). RESULTS: Euthyroid sick syndrome (ESS) was presented in 45 cases. TT_3 level was negatively correlated with APACHEⅡscore (r=-0.330, P0.05). CONCLUSION: SIRS patients has high possibility to get ESS, which happens more frequently and severely in MODS patients. With the persistence and aggravation of SIRS, there is a progression of thyroid hormone reduction.

Objective To discuss causes, characteristics and clinical treartment measures for negative fluid balance and systemic edema in patients with traumatic hemorrhagic shock. Methods A retrospective chart study was done on 205 cases with systemic edema posterior to traumatic hemorrhagic shock admitted to ICU between May 1994 and August 2002. Results All cases showed systemic edema at various degrees. The survived 173 cases demonstrated spontaneous diuresis and negative fluid balance at different time in the first week but the died 32 ones not. The negative fluid balance and the spontaneous diuresis were not more severe than that in the control group under conditions of age (≥60 years old), injury severity score (ISS ≥16), acute physiological and chronic health evaluation (APACHE) Ⅱ≥12 and Cr≥2.0 g/L ( P

The patients with systemic inflammatory reaction syndrome had high possibility to get euthyroid sick syndrome, which happened more frequently and severely in patients with multiple organ dysfunction syndrome, reflecting that inflammation or cytokines may affect the hypothalamic- pituitary-thyroid axis.

Objective: To sum up our experience in percutaneous dilatational tracheostomy (PDT) in ICU patient with severe brain injury.
Methods: Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, efficacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively.
Results: The operations took 4-15 minutes (mean 9.1 minutes±4.2 minutes). Totally 4 cases suffered from complications in the operations: 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, or clinically significant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT.
Conclusion: Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in difficult airway management.