AIM:To investigate the impact of oxy-codone on gastrointestinal function in patients with moderate to severe acute respiratory distress syn-drome undergoing mechanical ventilation.METHODS:Fifty patients with moderate to severe ARDS caused by severe pneumonia admitted to the Intensive Care Department of Fuling Hospital,Chongqing University from January 2022 to June 2023 were selected for the study.The patients were randomly divided into a remifentanil group(n=25)and a hydroxycodone group(n=25).They were treated with remifentanil and hy-droxycodone for pain relief.We observed the inci-dence and severity grading of acute gastrointestinal injury(AGI),clinical outcomes(length of mechanical ventilation,ICU length of stay,and mortality at day 90),gastric emptying indicators(GRV,GER,MI),nu-tritional status(ALB,PAB),respiratory and circulatory indicators(Cst,OI,PaCO2,VIS).RESULTS:The occur-rence of AGI showed no notable disparity between the remifentanil and oxycodone groups(96％vs.72％,P=0.289),yet the remifentanil group exhibited a more severe AGI rating compared to the oxycodone group(P=0.009).The oxycodone groups GRV at 48 and 72 hours post-treatment was less than the remifentanil groups,with the MI surpassing the remifentanil groups(P＜0.05),and the GRE exhibited comparable alterations(P＞0.05).Post-treatment,the oxycodone groups ALB and PAB levels were elevated(P＜0.05),whereas the remifentanil groups pre-treatment and post-treatment PAB remained unchanged(P＞0.05),and the oxycodone groups PAB exceeded the remi-fentanil groups(P=0.035).However,the ALB,PAB,and ALB levels before and post-treatment were almost identical in both groups(P＞0.05).Additionally,there was no significant variance in clinical and respiratory outcomes between the two patient groups(P＞0.05).CONCLUSION:Hydroxycodone has a smaller inhibitory effect on gastric emptying in patients with moderate to severe acute respiratory distress syndrome un-dergoing mechanical ventilation,and has a milder degree of acute gastrointestinal injury.It can also improve the nutritional status of patients and has reliable safety.Hydroxycodone may be more beneficial in protecting the gastrointestinal function of patients with acute respiratory distress syndrome.

Objective To investigate the clinical efficacy of esmolol combined with atorvastatin on se-vere sepsis complicated with cardiac insufficiency.Methods This study was a prospective,double-blind,ran-domized controlled clinical trial.A total of 153 patients with severe sepsis complicated with cardiac insufficien-cy admitted to this hospital from January 2021 to December 2022 were selected and divided into groups A,B,and C by random number table method,with 51 cases in each.Patients in group A were given routine symp-tomatic supportive treatment after admission.On this basis,patients in group B and group C were given esmo-lol,esmolol+atorvastatin,respectively.The hemodynamic indexes,serological indexes and clinical prognosis of the three groups before and after intervention were compared.Results There was no significant difference in baseline data,and hemodynamic and serological indexes of three groups before intervention(P＞0.05).Compared with before intervention,after five days of intervention,heart rate,systemic vascular resistance in-dex(SVRI),blood levels of creatine kinase-MB(CK-MB),cardiac troponin Ⅰ(cTn Ⅰ),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and high sensitive C-reactive protein(hs-CRP)in three groups were de-creased,while the values of cardiac index(CI)were increased,and the differences were statistically significant(P＜0.05).After five days of intervention,the heart rate,SVRI,blood levels of CK-MB,cTn Ⅰ,TNF-α,IL-6,and hs-CRP in group C were lower than those in group A and group B,and the levels in group B were lower than those in group A;the value of CI in group C was higher than that in group A and group B,and group B was higher than that in group A,the differences were statistically significant(P＜0.05).After intervention,the length of stay in intensive care unit(ICU)in group C was the shortest,and that in group B was shorter than that in group A,the difference was statistically significant(P＜0.05).There was no significant difference in 28 d mortality among the three groups(P＞0.05).Conclusion Esmolol combined with atorvastatin can signif-icantly inhibit the inflammatory response in patients with severe sepsis complicated with cardiac insufficiency,relieve myocardial injury and promote rehabilitation,and the therapeutic effect is better than esmolol alone.

AIM:To investigate the impact of oxy-codone on gastrointestinal function in patients with moderate to severe acute respiratory distress syn-drome undergoing mechanical ventilation.METHODS:Fifty patients with moderate to severe ARDS caused by severe pneumonia admitted to the Intensive Care Department of Fuling Hospital,Chongqing University from January 2022 to June 2023 were selected for the study.The patients were randomly divided into a remifentanil group(n=25)and a hydroxycodone group(n=25).They were treated with remifentanil and hy-droxycodone for pain relief.We observed the inci-dence and severity grading of acute gastrointestinal injury(AGI),clinical outcomes(length of mechanical ventilation,ICU length of stay,and mortality at day 90),gastric emptying indicators(GRV,GER,MI),nu-tritional status(ALB,PAB),respiratory and circulatory indicators(Cst,OI,PaCO2,VIS).RESULTS:The occur-rence of AGI showed no notable disparity between the remifentanil and oxycodone groups(96％vs.72％,P=0.289),yet the remifentanil group exhibited a more severe AGI rating compared to the oxycodone group(P=0.009).The oxycodone groups GRV at 48 and 72 hours post-treatment was less than the remifentanil groups,with the MI surpassing the remifentanil groups(P＜0.05),and the GRE exhibited comparable alterations(P＞0.05).Post-treatment,the oxycodone groups ALB and PAB levels were elevated(P＜0.05),whereas the remifentanil groups pre-treatment and post-treatment PAB remained unchanged(P＞0.05),and the oxycodone groups PAB exceeded the remi-fentanil groups(P=0.035).However,the ALB,PAB,and ALB levels before and post-treatment were almost identical in both groups(P＞0.05).Additionally,there was no significant variance in clinical and respiratory outcomes between the two patient groups(P＞0.05).CONCLUSION:Hydroxycodone has a smaller inhibitory effect on gastric emptying in patients with moderate to severe acute respiratory distress syndrome un-dergoing mechanical ventilation,and has a milder degree of acute gastrointestinal injury.It can also improve the nutritional status of patients and has reliable safety.Hydroxycodone may be more beneficial in protecting the gastrointestinal function of patients with acute respiratory distress syndrome.

Objective To investigate the application value of limited liquid resuscitation combined with continuous renal replacement therapy (CRRT) in treatment of severe acute pancreatitis (SAP) companied with abdominal compartment syndrome (ACS).Methods The retrospective cohort study was adopted.The clinical data of 67 patients with SAP companied with ACS who were admitted to the Fuling Center Hospital of Chongqing from January 2005 to December 2014 were collected.Among 67 patients,33 receiving conventional liquid resuscitation between January 2005 and December 2010 were allocated into the control group and 34 receiving limited liquid resuscitation combined with CRRT between January 2011 and December 2014 were allocated into the observation group.Observation indicators included:(1) required fluid volume and time of negative fluid balance in the 2 groups;(2) changes of pathological and physiological indicators after treatment in the 2 groups;(3)outcomes and prognosis of patients in the 2 groups.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using t test.Count data were analyzed using the chi-square test.Repeated measurement data were analyzed by repeated measures ANOVA.Results (1) Required fluid volume and time of negative fluid balance in the 2 groups:required fluid volumes at 6,24,48 and 72 hours after resuscitation were (2 449±339) mL,(4 820±757) mL,(9 428± 1 272) mL,(13 127± 1 565) mL in the control group and (2 360± 314) mL,(4 582±530) mL,(8 564± 970) mL,(11 470± 1 253) mL in the observation group,respectively,with a statistically significant difference in required fluid volume between the 2 groups (F=13.035,P＜0.05) and in required fluid volume at 48 and 72 hours between the 2 groups (t=3.132,4.794,P＜0.05).Time of negative fluid balance in the observation group and control group was (4.3± 1.7)days and (6.4 ±1.8)days,respectively,showing a statistically significant difference between the 2 groups (t =4.913,P＜0.05).(2) Changes of pathological and physiological indicators in the 2 groups after treatment:time factors:from 0 h to 168 h postoperatively,APACHE Ⅱ score,C-reaction protein (CRP),D-dimer,IAP,Bla and oxygenation index were changed from 20.9±4.1 to 13.9±2.6,from (167±39)mg/L to (55±17) mg/L,from (1 652±1 544) μg/L to (993±500)μg/L,from (23.4±3.4)cmH2O (1 cmH2O=0.098 kPa) to (21.4±2.9)cmH2O,from (4.6±1.6) mmol/L to (1.4±0.5)mmol/L,from (189±27) mmHg (1 mmHg =0.133 kPa) to (152±23)mmHg in the control group,and chaged from 21.5±5.1 to 11.0±2.8,from (168±36)mg/L to (44±19)mg/L,from (1 634±1 525) μg/L to (578±350) μg/L,from (23.2±2.5)cmH2O to (17.4±2.6)cmH2O,from (4.5±1.6)mmol/L to (0.8±0.3)mmol/L,from (188±26)mmHg to (196±25)mmHg in the observation group,respectively,showing gradual decreasing with time and statistically significant differences between the 2 groups (F =186.415,581.118,34.618,212.416,262.272,207.645,P＜0.05).Treatment factors:there were no significant differences in changing trends of APACHE Ⅱ score,D-dimer and Bla between the 2 groups (F=3.499,2.350,3.516,P＞0.05),and there were significant differences in changing trends of CRP,IAP and oxygenation index between the 2 groups (F=4.009,15.276,14.959,P＜0.05).Interaction effect between time factors and treatment factors:there were obviously interaction effects between time factors and treatment factors in APACHE Ⅱ score,CRP,IAP and oxygenation index (F=4.890,4.912,23.874,28.615,P＜0.05) and no interaction effects between time factors and treatment factors in D-dimer and Bla (F=2.803,1.920,P＞0.05).(3) Outcomes and prognosis of patients in the 2 groups:numbers of patients with surgery,local complications and infection and duration of hospital stay were 11,16,14,(46±17)days in the control group and 4,6,6,(36±14) days in the observation group,respectively,with statistically significant differences between the 2 groups (x2=4.484,7.221,4.910,t =2.433,P＜0.05).Mortality and hospital expenses were 24.2％ (8/33),(33± 18) x 104 yuan in the control group and 8.8％ (3/34),(27± 14)× 104 yuan in the observation group,respectively,with no statistically significant difference between the 2 groups (x2 =2.901,t =1.283,P＞ 0.05).Conclusion Limited liquid resuscitation combined with CRRT can effectively control IAP of patients with SAP companied with ACS and improve oxygenation index,meanwhile,it can also reduce number of patients with surgery,infection and local complications and duration of hospital stay.

Objective To investigate the accuracy and efficiency of hand-held echocardiography (VSCAN) used by intensivist for the diagnosis and treatment decisions in emergency consultation for patients getting worse at risk of life-threatening setting in non-ICU ward.Methods A prospective study in acutely deteriorated patients needed the intensivist for emergency consultation in general wards was carried out.The consultation process was executed as follows:(1) The intensivist established an initial diagnosis based on medical history,physical examination and laboratory findings,and assessed the hemodynamics and the cause of acute respiratory failure and cardiac arrest according the documented information.The data recorded as control group (Pre-VSCAN) for comparison with the later available data in subsequent analysis.(2) Problem-based ultrasound examination was performed with VSCAN.For patients suffered cardiac arrest,the FEEL protocol was used to find the potential cause of cardiac arrest such as pericardial tamponade and massive pulmonary embolism screened.For the other patients,a simplified eFATE or BLUE-plus protocols were used based on clinical requirement.With the findings of ultrasound examination the intensivist established an final diagnosis and identified the hemodynamics and the lung pathologies.The consultation advice was then provided to the attending doctors of the patient.The intensivist kept the records of echo results,final diagnosis and consultation advice as data of study group data (Post-VSCAN).The response of the treatment and outcome were followed up.Two attending ICU doctors analyzed these data and judged the correctness of Pre-VSCAN and Post-VSCAN based on the response to treatment and the outcome.Results Ninety patients were finally included in statistical analysis.Sixteen (17.8％) cases,40 (44.4％) cases,29 (32.2％) cases and 5 (5.6％) were consulted for acute circulation dysfunction,acute respiratory failure,both reasons and cardiac arrest,respectively.Compared to pre-VSCAN,VSCAN verification can significantly improve the accuracy of the diagnosis (81.1％ vs.58.9％,P =0.001),assessment of hemodynamics (78.3％ vs.52.2％,P =0.009) and can find more accurate judgment of acute respiratory failure (71.0％ vs.43.5％,P =0.001).Conclusion The hand-held echocardiography used by intensivist is valuable for the diagnosis and the assessment of cardiopulmonary status in case of request for emergency consultation in general wards.