Objective:To observe the therapeutic effect of blood purification with oXiris on cytokine storm in severe COVID-19 patients.Methods:In February to April, 2020 in the intensive care unit (ICU) of a hospital in Wuhan, 7 cases with severe COVID-19 as the study participant, treated with oXiris for blood purification. The general information of patients, the basic information of the blood purification treatment, blood purification treatment before and after treatment for 24 hours, 48 hours, 72 hours of routine blood, liver and kidney function and inflammatory markers were collected to understand the trend of change.Results:The number of blood purification treatment of 7 patients were 2.13±1.64 times, and the duration of blood purification was 66.31±48.73 hours. Treatment was interrupted twice due to hypothermia. After treatment, the level of interleukin 6 (IL-6) of the patients decreased from (1342.20±1822.01) pg/ml before treatment to (202.69±276.24) pg/ml in 4 cases decreased by more than 90% and in 2 cases decreased by 63% and 77%. The level of TNF decreased from 51.94±59.64 pg/ml before treatment to 18.93±9.84 pg/ml, and TNF decreased by 28%~78% in 4 patients. The hypersensitive C-reactive protein (HS-CRP) of the patients decreased from 147.81±100.54 mg/L before treatment to 89.43±108.31 mg/L after treatment, in 4 cases decreased by 63% to 91%.Conclusions:oXiris blood purification treatment can effectively reduce inflammatory markers in patients with severe COVID-19. Correct use of oXiris filter during treatment can prolong the life of the filter. During the treatment, the pressure monitoring value and whether there is thrombosis in the pipeline should be closely observed and recorded. Meanwhile, it is necessary to keep patients warm to prevent hypothermia in. The application of ultrasound to monitor blood coagulation and venous thrombosis plays a positive role in preventing the occurrence of pulmonary embolism.

Objective To identify the difference in the central venous pressure measured via two different approaches. Methods We had searched the databases including PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure ( CNKI) , VIP Database and Wanfang Database, and Google Scholar was used for supplement search. All the experimental studies with self-control design that investigated the difference in the central venous pressure measured via two different approaches from the database foundation of until 2014 were included. The literature exclusion and data collection were performed independently by two investigators. The literature quality was evaluated by the 2nd edition of quality assessment of diagnostic accuracy studies tool (QUADAS-2). All the studies enrolled were assigned to high-quality and low-quality groups for subsequent stratified meta-analysis. Results A total of 8 studies involving 273 samples were entered in the final analysis. Pooled analyses from all studies revealed a statistically significant difference between the two approaches ( P=0. 002), and the pooled deviation is 0. 436 (95% CI:0. 166-0. 707). Conclusions Consideration of minor difference between the two approaches showed by meta-analysis, peripherally-inserted central catheter ( PICC) remains feasible to measure central venous pressure. The consistency of the two approaches used for measuring central venous pressure requires further validation by large-scale clinical trials.

Objective To compare the value of central venous pressure (CVP) measured by peripherally inserted central catheters (PICC) and centrally inserted central catheters (CICC) in elderly patients with severe diseases.Methods Paired design and self-controlled was applied in the research. CVP was measured by 2 different measurement approaches in patients with PICC and CICC simultaneously. The sample size was calculated by the enumeration method through the accuracy estimation of consistency evaluation of quantitative measurement, and the required number was 70.Results Among the 70 collected samples, the mean values of the measured CVP by PICC and CICC were (7.995±3.435) cmH2O and (7.743±3.277) cmH2O; no statistically significant difference was observed (t=1.622,P=0.109). The pearson's linear correlation coefficient of the CVP measured by 2 different measurement approaches was 0.926 (P<0.0001). A linear regression model through the origin of the CVP measured by 2 different measurement approaches was fitted with the linear regression equation of CVPPICC=1.023 CVPCICC (R2=0.978); and the 95%CI of the prediction line contained the reference line. The Bland-Altman plot showed that 64 samples fell within limits of agreement (LoA), LoA was -2.300-2.804, with a consistent rate of 91.43%. All the plots out of the LoA did not exceeded the 95%CI.Conclusions The CVP measured by CICC and PICC exhibit high consistency. Therefore, PICC can be used to replace the CICC in the CVP monitoring.