OBJECTIVE: To investigate the relationship between the trajectories of serum potassium changes after intensive care unit (ICU) admission and 30-day death risk in patients with sepsis. METHODS: A retrospective cohort study was conducted, including adult patients with sepsis admitted to the comprehensive ICU, medical intensive care unit (MICU) and emergency intensive care unit (EICU) of Guizhou Medical University Affiliated Hospital from January 2020 to January 2024. The patients who had a minimum of 5 days' hospitalisation in the ICU and who had at least 7 consecutive days of the serum potassium measurements were classified into five trajectories groups according to group-based trajectory modelling (GBTM) using SAS software. This was based on tendency changes in serum potassium levels in patients after admission to the ICU, which was categorized as follows: slowly increased from a low level group, slowly increased from a medium level of normal range group, slowly decreased from a medium level of normal range group, slowly decreased from a high level group, and slowly increased from a high level of normal range group. The patient's gender, age, medical history, and white blood cell count (WBC), platelet count (PLT), procalcitonin (PCT), activated partial thromboplastin time (APTT), prothrombin time (PT), blood sodium, and serum creatinine (SCr) at the time of admission to the ICU were collected. At the same time, the patient's worst sequential organ failure assessment (SOFA) score within 24 hours of admission to the ICU, length of ICU stay, and 30-day outcome were record. The differences in clinical data among different groups of patients were compared. The 30-day cumulative survival rates of the various serum potassium trajectories were plotted using Kaplan-Meier survival curves, the groups were then compared using the Log-Rank test. A multivariate Cox proportional risk regression analysis was developed to evaluate the independent effect of serum potassium trajectory on 30-day death risk. RESULTS: Finally, 342 ICU sepsis patients were enrolled, of which 42 patients in the slowly increased from a low level group (12.28%), 127 patients in the slowly increased from a medium level of normal range group (37.14%), 118 patients in the slowly decreased from a medium level of normal range group (34.50%), 28 patients in the slowly decreased from a high level group (8.19%), and 27 patients in the slowly increased from a high level of normal range group (7.89%). Except for age and APTT differences, there were no statistically significant differences in other clinical characteristics among the patients in the different serum potassium trajectories groups. Kaplan-Meier survival curves showed that there was statistically significant difference in the 30-day cumulative survival rate among the patients in the different serum potassium trajectories groups (Log-Rank test: χ² = 14.696, P = 0.005), with the lowest in the slowly increased from a high level of normal range group (39.3%). Multivariate Cox proportional risk regression analysis showed that the patients with the serum potassium trajectory of slowly increased from a high level of normal range had the highest 30-day death risk [hazard ratio (HR) = 2.341, 95% confidence interval (95%CI) was 1.049-5.226, P = 0.038]. This association persisted after adjustment for variables such as gender, age, medical history, SOFA score, WBC, PLT, PCT, APTT, PT, blood sodium, and SCr (HR = 3.058, 95%CI was 1.249-7.488, P = 0.014). CONCLUSION Compared with the patients whose serum potassium fluctuated within the normal range, the sepsis patients in the ICU with a serum potassium trajectory that slowly increased from a high level of normal range had a significantly higher 30-day death risk.
Humans ; Retrospective Studies ; Intensive Care Units ; Sepsis/blood* ; Potassium/blood* ; Male ; Female ; Middle Aged ; Aged ; Risk Factors ; Hospital Mortality ; Prognosis

OBJECTIVE: To investigate time-related association between fluid balance and prognosis in sepsis patients. METHODS: A retrospective cohort study was conducted based on the data of sepsis patients in the Medical Information Database for Intensive Care-IV 2.0 (MIMIC-IV 2.0) from 2008 to 2019. Sepsis patients aged ≥ 18 years who were admitted to intensive care unit (ICU) for at least 2 days were included. The daily fluid balance and cumulative fluid balance (CFB) were calculated from days 1 to 7 after ICU admission. According to CFB,the patients were divided into negative fluid balance group (CFB% < 0%), fluid balance group (0% ≤ CFB% ≤ 10%), and fluid overload group (CFB% > 10%). In-hospital mortality was the primary outcome. Multifactorial Logistic regression was used to analyze time-related association between different CFB and the risk of in-hospital mortality in patients with sepsis during 7 days after ICU admission. In addition, subgroup analysis was performed on patients with septic shock and patients with sepsis who stayed in the ICU for 7 days or longer. RESULTS: A total of 11 437 patients with sepsis were included, of which 6 595 were male and 4 842 were female. The mean age was (64.4±16.4) years. A total of 10 253 patients (89.6%) survived and 1 184 patients (10.4%) died during hospitalization. Compared with the survival group, patients in the death group were older, lighter, had higher sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II), longer ICU stay, higher incidence of septic shock, and higher proportion of invasive mechanical ventilation, renal replacement therapy (RRT) and vasoactive drugs. In terms of comorbidities, congestive heart failure, renal disease, liver disease, and malignancy were more common in the death group. The death group had a higher daily fluid balance than the survival group during 7 days after ICU admission, the CFB in the two groups gradually increased with length of ICU stay. After adjusting variables such as age, gender, race, SOFA score, SAPS II score, comorbidities, and the use of invasive mechanical ventilation, RRT and vasoactive drugs, multivariate Logistic regression analysis showed that fluid overload on day 1 after ICU admission was a protective factor for the reduced risk of in-hospital mortality in sepsis patients [odds ratio (OR) = 0.74, 95% confidence interval (95%CI) was 0.64-0.86, P = 0.001]. However, fluid overload on day 3 was a risk factor for in-hospital mortality in sepsis patients (OR = 1.70, 95%CI was 1.47-1.97, P < 0.001) and the risk of in-hospital mortality was significantly increased from day 4 to day 7. Furthermore, the same results were obtained in patients with septic shock and sepsis patients who stayed in the ICU for 7 days or longer. CONCLUSIONS Fluid overload on day 1 was associated with reduced in-hospital mortality. However, from the third day, fluid overload increases the risk of in-hospital mortality. Thus, managing fluid balance at different times may improve prognosis.
Humans ; Male ; Female ; Middle Aged ; Aged ; Aged, 80 and over ; Shock, Septic ; Cohort Studies ; Retrospective Studies ; Sepsis ; Intensive Care Units ; Water-Electrolyte Balance ; Heart Failure ; Prognosis

Objective:To investigate the standardized construction of critical care departments in different cities and counties of Guizhou province to promote the homogenization development of critical care medicine in Guizhou Province.Methods:Using research methods such as field investigation and data collection, the public hospitals of 88 counties and urban areas in 9 prefectures and cities of Guizhou province were divided into five routes: southeast, northeast, northwest, southwest, and Guiyang. To design the survey form for the standardized construction of ICU, the e-form was sent to the director of ICU or his/her designated personnel by email or wechat 2-3 days in advance. Check the authenticity of data item by item on site, and leave the hospital after checking the receipt form.Results:From April to July 2021, the survey and research data collection was completed for 146 public hospitals (excluding provincial hospitals) with intensive care departments in 88 counties and cities of 9 dizhou cities in Guizhou Province, including 24 Grade-Ⅲ Level A hospitals. 122 Grade-Ⅱ and above hospitals (including 8 Grade-Ⅲ Level B hospitals, 11 Grade-Ⅲ comprehensive hospitals, 97 Level-Ⅱ A hospitals, 3 Level-Ⅱ B hospitals, and 3 Level-Ⅱ comprehensive hospitals). 146 public hospitals have a total of 80 983 beds and 104 017 open beds. The department of Critical Care has 2 035 beds. The ratio of actual beds in ICU to total beds in hospital was 2.51%. From 1999 to 2010, 18 (12.33%) established departments, and from 2011 to 2021, 128 (87.67%) established departments. The total area of the discipline is 113 355.48 m 2, with an average bed area of 55.70 m 2. There were 97 hospitals with 1.5-2.0 m bed spacing, accounting for 66.44%, and 49 hospitals with 2.1- > 2.5 m spacing, accounting for 33.56%. The number of negative pressure wards: 1 in each of 43 hospitals, accounting for 29.45%; 103 hospitals did not have, accounting for 70.55%. The number of single rooms: 288 in 140 hospitals, accounting for 95.89%; 6 hospitals did not have, accounting for 4.11%. Central oxygen supply: 138 hospitals have (94.52%); 8 hospitals did not have, accounting for 5.48%. Natural ventilation: in 129 hospitals with 88.36%; 17 hospitals did not have, accounting for 11.64%. Specialized ICU construction: 66 hospitals, accounting for 45.21%; none in 80 hospitals, accounting for 54.79%. There are 3 712 doctors and nurses in 146 public hospitals. The total number of doctors was 1 041, and the ratio of doctors to beds was 0.51∶1. The total number of nurses was 2 675, and the ratio of nurses to beds was 1.31∶1. Conclusions:All 88 counties and districts in 9 prefectures and cities of Guizhou province have established intensive care medicine departments. The standardization of the discipline construction has been significantly improved. Lack of talents is still an important factor restricting the rapid development of the discipline.

Objective:To discuss the feasibility of offering specialized courses of critical care medicine in undergraduate clinical medicine education, so as to alleviate the shortage of critical care medicine staffs and lay a foundation for improving the success rate for the treatment of critical cases.Methods:The undergraduates majoring in clinical medicine from 2008 to 2011 in Guizhou Medical University (the former Guiyang Medical College) were enrolled. After they had been enrolled in the undergraduate education for 3 years and were ready for Grade four, which meant basic medicine teaching had been completed and clinical medicine teaching was about to start, they were introduced and preached to each discipline, including critical care medicine. The undergraduates were free to choose professional direction of clinical training in Grade four. Students majoring in clinical medicine from 2012 to 2014 were free to choose their major direction when they entered the school.Results:From September 2011 to July 2019, the university had cultivated 246 undergraduates majoring in clinical critical care medicine from 2008 to 2014, and the critical care medicine professional team of affiliated hospital had undertaken 540 teaching hours. By July 2019, all students had graduated on time, with an employment rate of 100%. Forty students took postgraduate programs in our school and other schools, accounting for 16.3%.Conclusions:Professional education of critical care medicine in the undergraduate course of clinical medicine can mobilize students' interest in learning and subjective initiative, which is conducive to career selection. During the clinical training, the students can identify and timely cure critical care cases in the early stage, and partly alleviate the current shortage of critical care medical staffs.

Objective? To?observe?the?effects?of?enteral?nutrition?(EN)?emulsion?with?different?components?on?nutritional?index,?blood?glucose,?inflammatory?reaction,?gastrointestinal?tolerance?and?prognosis?in?patients?with?severe?traumatic?brain?injury?(sTBI).? Methods? Patients?with?sTBI?[Glasgow?coma?scale?(GCS)??0.05].? Conclusion? For?patients?with?sTBI,?short?peptide?EN?preparations?(Baipuli)?is?much?better?in?gastrointestinal?tolerance?but?it?can?cause?fluctuations?of?blood?glucose;?the?whole?protein?EN?containing?ω-3?fatty?acid?(Ruineng,?Ruisu)?has?relatively?less?fluctuation?on?blood?glucose,?the?duration?of?MV?and?the?length?of?ICU?stay?can?be?shortened?by?Ruineng,?therefore?it?is?more?suitable?to?be?applied?for?such?patients.

Objective To approach the value of red cell distribution width (RDW) on the prognostic assessment of patients with abdominal sepsis. Methods The clinical data of adult patients with abdominal sepsis admitted to intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2015 to September 2017 were retrospectively analyzed. The patients were divided into survival group and death group according to ICU prognosis. The levels of serum lactate (Lac), procalcitonin (PCT), RDW, and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score within 24 hours were recorded. Receiver operating characteristic (ROC) curve was plotted to analyze the prognostic value of Lac, PCT, RDW and APACHE Ⅱ score. Results 162 patients with abdominal sepsis were enrolled, 132 survived, and 30 died. Compared with survival group, the Lac, PCT, APACHE Ⅱ score, and RDW in death group were significantly increased [Lac (mmol/L): 4.21±2.42 vs. 2.27±1.51, PCT (mg/L): 32.08±12.95 vs. 11.87±8.81, APACHEⅡ score: 30.13±6.42 vs. 23.36±5.29, RDW: (16.64±1.38)% vs. (13.49±2.03)%, all P < 0.01]. ROC curve analysis showed that all indicators could be used to predict the prognosis of abdominal sepsis, with the maximum predictive value of RDW. The area under the ROC curve (AUC) was 0.888, it was greater than that of APACHE Ⅱ score (AUC = 0.787), Lac (AUC = 0.767) and PCT (AUC = 0.696). When threshold value of RDW was 15.40%, the sensitivity was 83.3%, and the specificity was 85.6%. Conclusion RDW can evaluate the prognosis of patients with abdominal sepsis, and its predictive value is greater than traditional evaluation parameters such as APACHEⅡscore, Lac, and PCT.

Objective To observe the effect of hydrogen-rich water on the chondriosome damage and cytokines change in brain tissue of rats with traumatic brain injury (TBI). Methods Fifty-four health male Sprague-Dawley (SD) rats were divided into three groups by random number table: sham group, trauma group (TBI group), and trauma+hydrogen-rich water group (TBI+HW group), the rats in each group were subdivided into 1, 3 and 7 days subgroups according to the time points after trauma, with 6 rats in each subgroup. The TBI model was reproduced by using a modified Feency method for free fall impact, and the rats in sham group were not given brain impact after craniotomy. The rats in TBI+HW group were given intraperitoneal injection of hydrogen-rich water (5 mL/kg) after TBI model reproduction, and then once a day until being sacrificed; and the rats in sham group and TBI group were given the same amount of normal saline. The neurological severity scores (NSS) for neurologic deficits were calculated at corresponding time points, and then the rats were sacrificed to harvest brain tissue at 3 mm around lesion boundary. The cytokines including tumor necrosis factor-α (TNF-α) and interleukin-1β(IL-1β) were determined by enzyme linked immunosorbent assay (ELISA); the protein expressions of Bax, Bcl-2 were determined by Western Blot; the RFU of reactive oxygen species (ROS), mitochondrial membrane potential (MMP) and mitochondrial membrane permeability (MPTP) were determined by fluorescence and enzyme sign method. Results TBI and TBI+HW groups appeared obvious neurologic damage after injury in rats. NSS scores in TBI and TBI+HW groups showed a decreased tendency with time prolongation after TBI. NSS scores in TBI+HW group at 3 days and 7 days were significantly lower than those of TBI group (NSS score: 9.67±0.82 vs. 11.17±1.17, 6.83±0.75 vs. 8.50±1.04, both P < 0.05). Compared with sham group, the expressions of TNF-α, IL-1β, RFU of ROS in chondriosome, protein expression of Bax in brain tissue in TBI group and TBI+HW group were significantly increased, peaked at 1 day, then they gradually declined. Each time point of RFU of MMP, MPTP in chondriosome and protein expression of Bcl-2 were significantly decreased, and gradually increased after one-day valley value. Compared with TBI group, the expressions of TNF-α, IL-1β, RFU of ROS in chondriosome and protein expression of Bax in brain tissue were all declined at corresponding time points [TNF-α(ng/L): 54.14±1.11 vs. 81.49±2.76, IL-1β(ng/L):74.53±1.75 vs. 119.44±3.56, ROS (RFU): 92.30±2.46 vs. 121.33±6.57, Bax: 0.89±0.01 vs. 1.10±0.01, all P <0.01]; RFU of MMP, MPTP in chondriosome and the protein expression of Bcl-2 were all increased at corresponding time points [MMP (RFU): 99.28±3.97 vs. 74.72±3.00, MPTP (RFU): 188.82±4.44 vs. 160.01±2.04, Bcl-2: 0.52±0.02 vs. 0.30±0.02, all P < 0.01]. Conclusions The high expressions of cytokines and chondriosome damage were involved in the early TBI. Early treatment with an intraperitoneally injection of hydrogen-rich water can reduce chondriosome damage and inflammation factor release, reduce the nerve cell apoptosis after TBI, and protect brain function.

Objective To analyze the pathogenic factors, clinical features and treatment measures of critically ill pregnant women so as to provide experience for improving the success rate of treatment. Methods The clinical data of 167 cases of critically ill pregnant women who admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from January 2013 to December 2017 were collected, and the disease distribution of patients, the causes of postpartum hemorrhage, the treatment situation and the results. Patients were divided into obstetrical complications group, pregnancy complicated with basic diseases group and other complicated diseases group according to disease types, and the treatment status of each group was analyzed. Results Among 167 critically ill pregnant women, 118 cases (70.6%) were in the obstetric complications group, 26 cases (15.6%) were in the pregnancy complicated with basic diseases group, and 23 cases (13.8%) were in the other complicated diseases group. Nine cases died in 167 critically ill pregnant women, with a mortality rate of 5.4%. Postpartum hemorrhage was the major obstetric complication (35.3%), and the coagulation function of 59 patients with postpartum hemorrhage was significantly improved 48 hours after active hemostasis and reasonable blood transfusion [compared to entering the ICU, prothrombin time (PT, s): 14.49±4.66 vs. 23.39±8.11, activated partial thromboplastin time (APTT, s): 52.94±36.36 vs. 87.35±74.69, fibrinogen (Fib, g/L): 2.91±1.03 vs. 1.03±0.65, platelet count (PLT, ×109/L): 94.85±30.09 vs. 43.15±24.07, all P < 0.01]. Compared with pregnancy complicated basic diseases group and other complicated diseases group, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores was reduced significantly in obstetrical complications group (10.41±4.85 vs. 16.46±13.87, 16.90±8.82, both P < 0.05), the length of ICU stay was significantly reduced (hours: 57.83±34.67 vs. 79.64±36.01, 278.30±83.72, both P < 0.05). Compared with other complicated diseases group, the mechanical ventilation time [hours :14 (6, 38) vs. 43 (12, 396)] and mortality (0.8% vs. 13.0%) were significantly decreased in obstetrical complications group (both P < 0.05). Conclusions Observe the changes of the condition closely, necessary hemodynamic treatment, respiratory support, and organ function support with critically ill pregnant women can improve the rescue success rate and prognosis.

Objective Assess the value of several biomarkers and disease severity scores for the prognostic assessment of sepsis.Methods The clinical data of adult patients, who met the diagnostic criteria for Sepsis-3 and admitted to the intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2015 to December 2016 were retrospectively analyzed. These patients were divided into survival group and death group. The levels of serum lactate (Lac), lactate clearance rate of 24 hours later (24 h LCR), procalcitonin (PCT), quick sequential organ failure assessment (qSOFA) score, SOFA score, simplified acute physiology score Ⅱ (SAPS Ⅱ), acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) score were determined, and the receiver operating characteristic curve (ROC) were used to analyze the prognostic value of the indicators above.Results 110 of 152 sepsis patients survived, while the others died. Compared with survival group, serum Lac, PCT, SOFA score, qSOFA score, SAPS Ⅱ score, APACHE Ⅱ score of death group were increased, and 24 h LCR was decreased. SAPS Ⅱ[area under the ROC curve (AUC) = 0.877,P = 0.000, when threshold value was 41.50, sensitivity was 94.3%, specificity was 68.5%], 24 h LCR (AUC = 0.869,P = 0.000, when threshold value was 40.2%, sensitivity was 92.1%, specificity was 75.5%) and SOFA score (AUC = 0.815,P = 0.000, when threshold value was 7.60, sensitivity was 79.9%, specificity was 78.5%) showed better predictive value of sepsis. However, the predictive value of PCT (AUC = 0.759), Lac (AUC = 0.725), qSOFA (AUC = 0.701) and APACHE Ⅱ score (AUC = 0.680) were poorer (AUC = 0.6-0.8). For sepsis caused by abdominal cavity infection, the most accurate index was SOFA score (AUC = 0.889,P = 0.000, when threshold value was 9.50, sensitivity was 81.2%, specificity was 83.5%), and for sepsis caused by pneumonia, the most accurate index was PCT (AUC = 0.891,P = 0.001, when threshold value was 3.95 mg/L, sensitivity was 84.7%, specificity was 94.1%).Conclusion SOFA score and qSOFA score cannot take the place of traditional evaluation index for the evaluation of the prognosis of patients with sepsis.

Objective To provide decision-making basis for promoting the rapid and healthy development of critical care medicine/intensive care unit (ICU) through discussing the mode of development and construction of the department of ICU.Methods The situations of ICU of Affiliated Hospital of Guizhou Medical University from July 1994 to December 2016 were analyzed and summed up. Data of the situations in different development stages included the location and area of the ward, the number of beds, the number of physicians and nurses, the structure of academic titles and educational levels, the number of patients admitted to ICU per year, the proportion of patients used ventilator per year, the mortality, the mode of the discipline management, the number of medical postgraduates and undergraduates trained in the ICU, the number of teaching hours, the achievements, the number of research projects, the number of published monographs and papers, the number of the multicenter trials that we participated in, the construction of the team, the personal honor, and so on.Results From 1994 to 2016, the department of ICU had three development stages: the initial development stage of the discipline (from July 1994 to March 2005), the standardization development stage of the discipline (from April 2005 to December 2015), the acceleration development stage of the discipline (from December 2015 to December 2016). The scale of the department expanded from an open unit with 6 beds which was shared with the department of cardiothoracic surgery to 6 enclosed units with 90 beds which were managed independently by the intensivists. The area of thedepartment increased from less than 300 m2 to more than 7000 m2. There were 46 beds in the mixed ICU, which covered an area of 4210 m2. There was only one physician in 1994 while the number of the physicians increased to 19 in 2016. The number of nurses increased from 4 in 1994 to 69 in 2016. The proportion of highly educated talents significantly increased. Furthermore, from 1994 to 2016, the number of beds increased from 6 to 46; the number of patients admitted to ICU per year increased from 138 to 1080; and the number of patients used ventilator increased from 24 to 1057. The mean acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was > 24.0 at admission, while < 12.6 at discharge. From 1997 to 2016, a total of 79 postgraduates had studied in the department, and 390 teaching hours we had undertaken. From 2011 to 2016, a total of 250 undergraduates had studied in the department, and 540 teaching hours we had undertaken. From 1994 to 2016, 8 achievements were obtained, 22 projects were undertook, 4 monographs were published, 6 books were edited that the physicians in the ICU as key editors, 104 papers were published, and 8 national multicenter trials that the physicians in the ICU were as key participants, and multiple team and individual honors were obtained.Conclusions The construction of ICU hardware is the basis and prerequisite for the development of the discipline and the construction of ICU software is the soul and motivation of the discipline. The operation indexes of clinical medical treatment, teaching and scientific researches reflect the overall operation status of the discipline and the hospital.