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Sang L, Xu Y, Huang Y, Li Z, Wen D, Liu C, Wang Y, Xian L, Cheng L, Ye F, Wu H, Deng X, Li Y, Ye W, Zhong N, Li Y, Li S, Liu X. More attention should be paid to Omicron-associated sepsis: a multicenter retrospective study in south China. J Thorac Dis 2024; 16:1313-1323. [PMID: 38505014 PMCID: PMC10944721 DOI: 10.21037/jtd-23-808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/19/2024] [Indexed: 03/21/2024]
Abstract
Background The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly transmissible but causes less severe disease compared to other variants. However, its association with sepsis incidence and outcomes is unclear. This study aimed to investigate the incidence of Omicron-associated sepsis, as per the Sepsis 3.0 definition, in hospitalized patients, and to explore its relationship with clinical characteristics and prognosis. Methods This multicenter retrospective study included adults hospitalized with confirmed SARS-CoV-2 infection across six tertiary hospitals in Guangzhou, China from November 2022 to January 2023. The Sequential Organ Failure Assessment (SOFA) score and its components were calculated at hospital admission to identify sepsis. Outcomes assessed were need for intensive care unit (ICU) transfer and mortality. Receiver operating characteristic curves evaluated the predictive value of sepsis versus other biomarkers for outcomes. Results A total of 299 patients (mean age: 70.1±14.4 years, 42.14% female) with SOFA score were enrolled. Among them, 152 were categorized as non-serious cases while the others were assigned as the serious group. The proportion of male patients, unvaccinated patients, patients with comorbidity such as diabetes, chronic cardiovascular disease, and chronic lung disease was significantly higher in the serious than non-serious group. The median SOFA score of all enrolled patients was 1 (interquartile range, 0-18). In our study, 147 patients (64.19%) were identified as having sepsis upon hospital admission, with the majority of these septic patients (113, representing 76.87%) being in the serious group, the respiratory, coagulation, cardiovascular, central nervous, and renal organ SOFA scores were all significantly higher in the serious compared to the non-serious group. Among septic patients, 20 out of 49 (40.81%) had septic shock as indicated by lactate measurement within 24 hours of admission, and the majority of septic patients were in the serious group (17/20, 76.87%). Sepsis was present in 118 out of 269 (43.9%) patients in the general ward, and among those with sepsis, 34 out of 118 (28.8%) later required ICU care during hospitalization. By contrast, none of the patients without sepsis required ICU care. Moreover, the mortality rate was significantly higher in patients with than without sepsis. Conclusions A considerable proportion of patients infected with Omicron present with sepsis upon hospital admission, which is associated with a poorer prognosis. Therefore, early recognition of viral sepsis by evaluation of the SOFA score in hospitalized coronavirus disease 2019 patients is crucial.
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Affiliation(s)
- Ling Sang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou National Lab, Guangzhou, China
| | - Yonghao Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongbo Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhengtu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Deliang Wen
- Department of Critical Care Medicine, The Second Affiliated Hospital of Guangzhou Medical, Guangzhou, China
| | - Changbo Liu
- Department of Critical Medicine, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yichun Wang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lewu Xian
- Department of Intensive Care Unit, Affiliate Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Linling Cheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongkai Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xilong Deng
- Department of Critical Care Medicine, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yueping Li
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Weiyan Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou National Lab, Guangzhou, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou National Lab, Guangzhou, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Sang L, Lin Z, Zhao Z. How often do we need to update PEEP setting during prone positioning in ARDS? Crit Care 2024; 28:60. [PMID: 38409024 PMCID: PMC10898165 DOI: 10.1186/s13054-024-04847-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Affiliation(s)
- Ling Sang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou National Laboratory, Guangzhou, China
| | - Zhimin Lin
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Zhanqi Zhao
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangzhou National Laboratory, Guangzhou, China.
- School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China.
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany.
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Zeng X, Zhu J, Li J, Chen C, Sang L, Liu M, Song L, Liu H. Patient Controlled Subcutaneous Analgesia of Hydromorphone Versus Morphine to Treat Moderate and Severe Cancer Pain: A Randomized Double-Blind Controlled Trial. J Pain Symptom Manage 2024; 67:50-58. [PMID: 37742793 DOI: 10.1016/j.jpainsymman.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/17/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
CONTEXT Hydromorphone and morphine are the common drugs used for the treatment of moderate to severe cancer pain. Patient controlled subcutaneous analgesia (PCSA) is an effective technique to manage cancer pain. However, few studies have been conducted to show the efficacy and safety of PCSA of hydromorphone for the relief of cancer pain. OBJECTIVES To explore the short-term efficacy and safety of PCSA elicited by hydromorphone for moderate to severe cancer pain. METHODS This was a single-center, randomized, active-controlled, double-blind trial (from April 2019 to August 2021). Sixty patients with moderate to severe cancer pain were randomized (1:1) to hydromorphone or morphine groups according to drug delivery by PCSA. The primary outcome was the pain intensity measured by a numerical rating scale (NRS) at 72 hours. Secondary outcomes included pain intensity measured by NRS at baseline, 15 minutes, 30 minutes, two hours, eight hours, 24 hours and 48 hours. The daily occurrence of breakthrough pain (BTP), impact of pain on quality of life measured by the brief pain inventory (BPI), the daily additional consumption of opioids and the incidence of adverse events were also recorded. Adverse events included nausea, vomiting, dizziness, constipation and respiratory depression. RESULTS A total of 57 patients (28 patients in the hydromorphone group and 29 patients in the morphine group) in the West China Hospital of Sichuan University were investigated. The mean (standard deviation [SD]) NRS in the two groups at baseline was 7.8 (1.7) in the hydromorphone group and 7.6 (1.7) in the morphine group, and at 72 hours were 3.4 (1.8) and 3.2 (1.5), respectively. The postoperative NRS in both groups was decreased significantly compared to baseline. The mean (SD) NRS at 30 minutes in the hydromorphone group was significantly lower than in the morphine group (3.9 [2.6] vs. 5.3 [2.1], P = 0.035). The daily occurrence of BTP in both groups at 48 hours and 72 hours decreased significantly compared to the corresponding baseline (P < 0.05), and there was no significant difference between the two groups. The total scores and sub-item scores of BPI at 24 hours and 72 hours after PCSA in both groups decreased significantly from baseline. A comparison of daily additional consumption of opioids between the two groups revealed no statistically significant difference. There were no significant differences in the incidences of nausea, vomiting, dizziness or constipation between the two groups (P > 0.05). CONCLUSION This study found that the PCSA of both hydromorphone and morphine could effectively and safely relieve short-term moderate to severe cancer pain. Of note, the PCSA of hydromorphone took effect more quickly than that of morphine.
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Affiliation(s)
- Xianzheng Zeng
- Department of Pain Management (X.Z, J.L., Li.S., H.L.), West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Zhu
- Department of Thoracic Oncology (J.Z.), West China Hospital, Sichuan University, Chengdu, China; Department of Medical Oncology (J.Z.), Shangjin Nanfu Hospital, Chengdu, China
| | - Jun Li
- Department of Pain Management (X.Z, J.L., Li.S., H.L.), West China Hospital, Sichuan University, Chengdu, China
| | - Chan Chen
- Department of Anesthesiology (C.C, Ling.S., M.L.), West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine (C.C), National-Local Joint Engineering Research Centre of Translational Medicine of nesthesiology (C.C), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Sang
- Department of Anesthesiology (C.C, Ling.S., M.L.), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Maotong Liu
- Department of Anesthesiology (C.C, Ling.S., M.L.), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Song
- Department of Pain Management (X.Z, J.L., Li.S., H.L.), West China Hospital, Sichuan University, Chengdu, China.
| | - Hui Liu
- Department of Pain Management (X.Z, J.L., Li.S., H.L.), West China Hospital, Sichuan University, Chengdu, China
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Sang L, Liu Z, Huang C, Xu J, Wang H. Multiparametric MRI-based radiomics nomogram for predicting the hormone receptor status of HER2-positive breast cancer. Clin Radiol 2024; 79:60-66. [PMID: 37838543 DOI: 10.1016/j.crad.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/28/2023] [Accepted: 09/12/2023] [Indexed: 10/16/2023]
Abstract
AIM To investigate the value of multiparametric magnetic resonance imaging (MRI)-based radiomics nomograms for predicting the hormone receptor (HR) status of HER2-positive breast cancer. MATERIALS AND METHODS Patients with HER2-positive invasive breast cancer were divided randomly into training (68 patients) and validation (30 patients) sets. All were classified as either HR-positive (HR+) or negative (HR-) at histopathology. Two radiologists outlined the three-dimensional (3D) volumetric regions of interest (VOI) on the MRI images. Features (n=1,096) were extracted from the T2-weighted imaging (WI), apparent diffusion coefficient (ADC), and dynamic contrast-enhanced (DCE) images separately. Dimensionality was reduced using feature screening. Binary radiomics prediction models were established using a logistic regression classifier and were validated in the validation set. To construct a nomogram, independent predictors were identified using multivariate logistic regression analysis. The predictive efficacy of the model was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS Ten radiomics features were obtained after feature dimensionality reduction based on the merged T2WI, ADC, and DCE images. The diagnostic efficacy of the radiomics signature using the three sequences was better than that of any single sequence (training set AUC: 0.797; validation set AUC: 0.75). Using multivariate logistic regression analysis, the independent predictors for identifying HR status were combined radiomics signature and peritumoural oedema. Nomograms constructed by combining the radiomics signature and peritumoural oedema showed good discrimination in both the training and validation sets (AUC: 0.815 and 0. 805, respectively). CONCLUSION A multiparametric MRI-based nomogram incorporating the radiomics signature and peritumoural oedema can assess the HR status of HER2-positive breast cancer. The resulting model can improve diagnostic accuracy, improving patient outcomes.
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Affiliation(s)
- L Sang
- Department of Radiology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Huaiyin District, Jinan 250012, Shandong, China
| | - Z Liu
- Department of Radiology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Huaiyin District, Jinan 250012, Shandong, China
| | - C Huang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of, PHD Technology Co. Ltd, Beijing, China
| | - J Xu
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of, PHD Technology Co. Ltd, Beijing, China
| | - H Wang
- Department of Radiology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Huaiyin District, Jinan 250012, Shandong, China.
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Zheng Y, Wang J, Ling Z, Zhang J, Zeng Y, Wang K, Zhang Y, Nong L, Sang L, Xu Y, Liu X, Li Y, Huang Y. A diagnostic model for sepsis-induced acute lung injury using a consensus machine learning approach and its therapeutic implications. J Transl Med 2023; 21:620. [PMID: 37700323 PMCID: PMC10498641 DOI: 10.1186/s12967-023-04499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/01/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND A significant proportion of septic patients with acute lung injury (ALI) are recognized late due to the absence of an efficient diagnostic test, leading to the postponed treatments and consequently higher mortality. Identifying diagnostic biomarkers may improve screening to identify septic patients at high risk of ALI earlier and provide the potential effective therapeutic drugs. Machine learning represents a powerful approach for making sense of complex gene expression data to find robust ALI diagnostic biomarkers. METHODS The datasets were obtained from GEO and ArrayExpress databases. Following quality control and normalization, the datasets (GSE66890, GSE10474 and GSE32707) were merged as the training set, and four machine learning feature selection methods (Elastic net, SVM, random forest and XGBoost) were applied to construct the diagnostic model. The other datasets were considered as the validation sets. To further evaluate the performance and predictive value of diagnostic model, nomogram, Decision Curve Analysis (DCA) and Clinical Impact Curve (CIC) were constructed. Finally, the potential small molecular compounds interacting with selected features were explored from the CTD database. RESULTS The results of GSEA showed that immune response and metabolism might play an important role in the pathogenesis of sepsis-induced ALI. Then, 52 genes were identified as putative biomarkers by consensus feature selection from all four methods. Among them, 5 genes (ARHGDIB, ALDH1A1, TACR3, TREM1 and PI3) were selected by all methods and used to predict ALI diagnosis with high accuracy. The external datasets (E-MTAB-5273 and E-MTAB-5274) demonstrated that the diagnostic model had great accuracy with AUC value of 0.725 and 0.833, respectively. In addition, the nomogram, DCA and CIC showed that the diagnostic model had great performance and predictive value. Finally, the small molecular compounds (Curcumin, Tretinoin, Acetaminophen, Estradiol and Dexamethasone) were screened as the potential therapeutic agents for sepsis-induced ALI. CONCLUSION This consensus of multiple machine learning algorithms identified 5 genes that were able to distinguish ALI from septic patients. The diagnostic model could identify septic patients at high risk of ALI, and provide potential therapeutic targets for sepsis-induced ALI.
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Affiliation(s)
- Yongxin Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Jinping Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong,, China
| | - Zhaoyi Ling
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Jiamei Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Yuan Zeng
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Ke Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Yu Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Lingbo Nong
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Ling Sang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Yonghao Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Xiaoqing Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China
| | - Yimin Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China.
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China.
| | - Yongbo Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
- Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China.
- State Key Laboratory of Respiratory Diseases, Guangzhou, 510120, China.
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Sang L, Song L. The Current Status of the Use of Internet Hospitals for Outpatients With Pain: Retrospective Study. J Med Internet Res 2023; 25:e44759. [PMID: 37695652 PMCID: PMC10520772 DOI: 10.2196/44759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND The national "Internet +" policies and the emergence of internet hospitals have created a new direction for the management of pain outside of the hospital. Nevertheless, there are no consolidated studies conducted by pain physicians on the current state of internet hospital-based online medical services used by patients with pain outside of a hospital setting. OBJECTIVE In this retrospective study, we aimed to examine the status of the use of internet hospitals by patients who experience pain. Moreover, we identified the factors that influenced patients' decisions to make an online visit through the internet hospital. METHODS Detailed information was collected online and offline from outpatients with pain at the information technology center of West China Hospital of Sichuan University from February 2020 to April 2022. Binary logistic regression analysis was conducted to identify the determinants that influenced patients' decisions to make an online visit to the internet hospital. RESULTS Over a 2-year period, 85,266 pain-related clinic visits were recorded. Ultimately, 39,260 patients were enrolled for the analysis, with 12.9% (5088/39,260) having online visits. Both online and offline clinics had a greater number of visits by women than men. The average age of patients attending the online clinic was 46.85 (SD 16.56) years, whereas the average age of patients attending the offline clinic was 51.48 (SD 16.12) years. The majority of online clinic visitors (3059/5088, 60.1%) were employed, and one of the most common occupations was farming (721/5088, 14.2%). In addition, 51.8% (2635/5088) of patients who participated in the online clinics lived outside the hospital vicinity. Young (odds ratio [OR] 1.35, 95% CI 1.01-1.81; P=.045) and middle-aged (OR 1.98, 95% CI 1.81-2.16; P<.001) patients, employed patients (OR 1.11, 95% CI 1.04-1.18; P=.002), nonlocal patients (OR 1.57, 95% CI 1.48-1.67; P<.001), and the ordinary staff (OR 1.19, 95%CI 1.01-1.39; P=.03) were more likely to have the intention to choose online visits through the internet hospitals. CONCLUSIONS Internet hospitals are flourishing as a more efficient and promising method of pain management and follow-up for patients with pain outside the hospital. People with pain who are young, working, and not in the vicinity of hospitals are more likely to visit internet hospitals.
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Affiliation(s)
- Ling Sang
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Li Song
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
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Zheng H, Xu Z, Zhou J, Lin Z, Wang Y, He W, Xu Y, Liu X, Li Y, Huang Y, Zhao Z, Sang L. The accuracy of simplified calculation of mechanical power: a simulation study. J Thorac Dis 2023; 15:3237-3244. [PMID: 37426144 PMCID: PMC10323543 DOI: 10.21037/jtd-22-1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/12/2023] [Indexed: 07/11/2023]
Abstract
Background Mechanical ventilation (MV) is an important life-saving method in the intensive care unit (ICU). A lower mechanical power (MP) is associated with a better MV strategy. However, traditional MP calculating methods are complicated, and algebraic formulas seem to be rather practical. The aim of the present study was to compare the accuracy and application of different algebraic formulas calculating MP. Methods A lung simulator, TestChest, was used to simulate pulmonary compliance variations. Using the TestChest system software, the parameters, including compliance and airway resistance, were set to simulate various acute respiratory distress syndrome (ARDS) lungs. Ventilator was also set to volume- and pressure-controlled modes with various parameter values (respiratory rate, RR, time of inspiration, Tinsp, positive end-expiratory pressure, PEEP) to ventilate the simulated lung of ARDS (with various respiratory system compliance, Crs). For the lung simulator, resistance of airway (Raw) was fixed to 5 cmH2O/L/s. Crs below lower inflation point (LIP) or above upper inflation point (UIP) was set to 10 mL/cmH2O. The reference standard geometric method was calculated offline with a customized software. Three algebraic formulas for volume-controlled and three for pressure-controlled were used to calculate MP. Results The performances of the formulas were different, although the derived MP were significantly correlated with that derived from the reference method (R2>0.80, P<0.001). Under volume-controlled ventilation, medians of MP calculated with one equation was significantly lower than that with the reference method (P<0.001). Under pressure-controlled ventilation, median of MP calculated with two equations were significantly higher (P<0.001). The maximum difference was over 70% of the MP value calculated with the reference method. Conclusions The algebraic formulas may introduce considerably large bias under the presented lung conditions, especially in moderate to severe ARDS. Cautious is required when selecting adequate algebraic formulas to calculate MP based on the formula's premises, ventilation mode, and patients' status. In clinical practice, the trend rather than the value of MP calculated by formulas should require more attention.
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Affiliation(s)
- Haichong Zheng
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiheng Xu
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Zhou
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhimin Lin
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingzhi Wang
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiqun He
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanda Xu
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongbo Huang
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi’an, China
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Ling Sang
- Department of Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Laboratory, Guangzhou, China
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8
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Deng Q, Zhang B, Li W, Liang H, Jiang Z, Zhang J, Xu Y, He W, Liu X, Sang L, Zeng H, Xu Y. Changes of blood gas analysis in moderate-to-severe acute respiratory distress syndrome patients during long-term prone position ventilation: a retrospective cohort study. Ann Transl Med 2023; 11:86. [PMID: 36819546 PMCID: PMC9929834 DOI: 10.21037/atm-22-5907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/06/2023] [Indexed: 01/31/2023]
Abstract
Background Prone position ventilation (PPV) has been recommended for patients with acute respiratory distress syndrome (ARDS) to improve oxygenation. However, whether prolonged prone ventilation will aggravate hyperoxia and whether abdominal compression will aggravate permissive hypercapnia acidosis are topics of concern. We carried out a retrospective analysis to investigate the issues above. Methods Clinical data were collected from 97 moderate-to-severe ARDS patients who received PPV as part of their treatment in the intensive care unit (ICU) of the First Affiliated Hospital of Guangzhou Medical University from November 2015 to May 2021. We collected arterial blood gas of patients according to the 3 periods: supine position ventilation (SPV), PPV early stage (within 4 hours), and PPV middle and late stage (6 hours or later). We established a linear mixed-effects models with "body position changes, times of PPV, gender, age, baseline SOFA, and baseline APACHE II" as fixed effects, and individual and the number of prone positions as random intercept and random slope to investigate the effect of body position changes on blood gas analysis. Results Among the 97 patients received PPV included, 51 were ICU survivors. Arterial partial pressure of oxygen (PaO2) and PaO2/fraction of inspired oxygen (FiO2) ratio were significantly higher at the early, middle and late stages of PPV than those in SPV [PFR (mmHg): 158 (118.00, 203.00) vs. 161 (129.00, 202.75) vs. 123 (91.75, 163.00), P<0.05]. Despite the synchronized reduction of FiO2, the incidence of hyperoxia in the prone position was still significantly higher than that in the supine position [hyperoxia (%):33.33 vs. 33.56 vs. 12.42, P<0.05]; there was no significant change in arterial carbon dioxide partial pressure (PaCO2) at each stage of PPV, but there was a significant increase in PH at PPV middle and late stages than those at early stage [PH: 7.39 (7.34, 7.42) vs. 7.37 (7.31, 7.41), P<0.05]. Conclusions Although PPV improves the patients' oxygenation, the associated incidence of hyperoxia exceeds 33%. Down-regulate FiO2 more sharply after PPV is necessary, if oxygenation conditions permit. PPV may alleviate the acidosis associated with permissive hypercapnia in ARDS patients treated with lung protective ventilation strategy (LPVS).
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Affiliation(s)
- Qiuxue Deng
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Baozhu Zhang
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenjing Li
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hanwen Liang
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenjie Jiang
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiesen Zhang
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yonghao Xu
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiqun He
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Sang
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huiqing Zeng
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Yuanda Xu
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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9
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Tang Q, Zhou Q, Chen W, Sang L, Xing Y, Liu C, Wang K, Liu WV, Xu L. A feasibility study of reduced full-of-view synthetic high-b-value diffusion-weighted imaging in uterine tumors. Insights Imaging 2023; 14:12. [PMID: 36645541 PMCID: PMC9842823 DOI: 10.1186/s13244-022-01350-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 12/05/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the feasibility of reduced full-of-view synthetic high-b value diffusion-weighted images (rFOV-syDWIs) in the clinical application of cervical cancer based on image quality and diagnostic efficacy. METHODS We retrospectively evaluated the data of 35 patients with cervical cancer and 35 healthy volunteers from May to November 2021. All patients and volunteers underwent rFOV-DWI scans, including a 13b-protocol: b = 0, 25, 50, 75, 100, 150, 200, 400, 600, 800, 1000, 1200, and 1500 s/mm2 and a 5b-protocol: b = 0, 100, 400, 800,1500 s/mm2. rFOV-syDWIs with b values of 1200 (rFOV-syDWIb=1200) and 1500 (rFOV-syDWIb=1500) were generated from two different multiple-b-value image datasets using a mono-exponential fitting algorithm. According to homoscedasticity and normality assessed by the Levene's test and Shapiro-Wilk test, the inter-modality differences of quantitative measurements were, respectively, examined by Wilcoxon signed-rank test or paired t test and the inter-group differences of ADC values were examined by independent t test or Mann-Whitney U test. RESULTS A higher inter-reader agreement between SNRs and CNRs was found in 13b-protocol and 5b-protocol rFOV-syDWIb=1200/1500 compared to 13b-protocol rFOV-sDWIb=1200/1500 (p < 0.05). AUC of 5b-protocol syADCmean,b=1200/1500 and syADCminimum,b=1200/1500 was equal or higher than that of 13b-protocol sADCmean,b=1200/1500 and sADCminimum,b=1200/1500. CONCLUSIONS rFOV-syDWIs provide better lesion clarity and higher image quality than rFOV-sDWIs. 5b-protocol rFOV-syDWIs shorten scan time, and synthetic ADCs offer reliable diagnosis value as scanned 13b-protocol DWIs.
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Affiliation(s)
- Qian Tang
- grid.443573.20000 0004 1799 2448Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei China ,grid.443573.20000 0004 1799 2448Biomedical Engineering College, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei China
| | - Qiqi Zhou
- grid.443573.20000 0004 1799 2448Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei China
| | - Wen Chen
- grid.443573.20000 0004 1799 2448Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei China
| | - Ling Sang
- grid.443573.20000 0004 1799 2448Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei China
| | - Yu Xing
- grid.443573.20000 0004 1799 2448Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei China
| | - Chao Liu
- grid.443573.20000 0004 1799 2448Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei China
| | - Kejun Wang
- grid.443573.20000 0004 1799 2448Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei China
| | | | - Lin Xu
- grid.443573.20000 0004 1799 2448Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei China
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10
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Zheng Y, Liu B, Deng X, Chen Y, Huang Y, Zhang Y, Xu Y, Sang L, Liu X, Li Y. Corrigendum: Construction and validation of a robust prognostic model based on immune features in sepsis. Front Immunol 2023; 14:1146121. [PMID: 36949955 PMCID: PMC10025525 DOI: 10.3389/fimmu.2023.1146121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2022.994295.].
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Affiliation(s)
- Yongxin Zheng
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Baiyun Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiumei Deng
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yubiao Chen
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yongbo Huang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yu Zhang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yonghao Xu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Ling Sang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Yimin Li,
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11
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Lin Z, Huang W, Gao Z, Yang L, Li Y, Lu Y, Dai M, Fu F, Sang L, Zhao Z. The influence of reference electrode in electrical impedance tomography. Heliyon 2022; 8:e12454. [PMID: 36590551 PMCID: PMC9800185 DOI: 10.1016/j.heliyon.2022.e12454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/26/2022] [Accepted: 12/12/2022] [Indexed: 12/26/2022] Open
Abstract
Background Some electrical impedance tomography (EIT) devices equip reference electrodes. In practice, it is not uncommon to observe high contact impedance for the reference electrode. The influence of bad contact reference electrode on data quality is unknown. The study aimed to investigate the influence of reference electrode on EIT image reconstruction. Methods Thirty lung healthy volunteers were prospectively examined with EIT. The subjects were spontaneously breathing in supine position. Three scenarios were constructed: 1. Normal measurement; 2. Reference electrode disconnected without recalibration; 3. Reference electrode disconnected, and the measurement restarted after recalibration of the system. EIT-based parameters measuring spatial and temporal ventilation distributions were calculated and compared. A so-call deviation score was calculated to assess the differences in EIT parameters between scenarios 2 and 1, between 3 and 1. Results The absolute differences for all parameters were significantly higher than zero (p < 0.01 for all parameters and scenarios). Deviation score for scenario 2 was 4.5 ± 3.5. Four subjects had a deviation score of 0 in scenario 2 and five subjects had a score of 1. The deviation in scenario 3 was higher (6.1 ± 3.1). No subjects had a score of 0 and only two subjects had a score of 1. Conclusions For EIT systems that equips with reference electrode, it is important to ensure the proper contact and functionality of the reference electrode. The EIT data quality would remain unchanged in only a small portion of subjects.
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Affiliation(s)
- Zhimin Lin
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, The First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, Guangzhou, China
| | - Weixiang Huang
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, The First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, Guangzhou, China
| | - Zhijun Gao
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China
| | - Lin Yang
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China,Corresponding author.
| | - Yimin Li
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, The First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, Guangzhou, China
| | - Yu Lu
- Herz Medical, Suzhou, China
| | - Meng Dai
- Department of Biomedical Engineering, Air Force Medical University, Xi'an, China
| | - Feng Fu
- Department of Biomedical Engineering, Air Force Medical University, Xi'an, China
| | - Ling Sang
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, The First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine, Guangzhou, China,Guangzhou Laboratory, Guangzhou, China,Corresponding author.
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Air Force Medical University, Xi'an, China,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
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12
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Liu X, Liu X, Meng J, Liu D, Huang Y, Sang L, Xu Y, Xu Z, He W, Chen S, Zhang R, Liu X, Li Y. Electrical impedance tomography for titration of positive end-expiratory pressure in acute respiratory distress syndrome patients with chronic obstructive pulmonary disease. Crit Care 2022; 26:339. [PMCID: PMC9635124 DOI: 10.1186/s13054-022-04201-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is one of most common comorbidities in acute respiratory distress syndrome (ARDS). There are few specific studies on the appropriate ventilation strategy for patients with ARDS comorbid with COPD, especially regarding on positive end-expiratory pressure (PEEP) titration. Methods To compare the respiratory mechanics in mechanical ventilated ARDS patients with or without COPD and to determine whether titration of PEEP based on electrical impedance tomography (EIT) is superior to the ARDSnet protocol. This is a single center, perspective, repeated measure study. ARDS patients requiring mechanical ventilation who were admitted to the intensive care unit between August 2017 and December 2020 were included. ARDS patients were divided according to whether they had COPD into a COPD group and a non-COPD group. Respiratory mechanics, gas exchange, and hemodynamics during ventilation were compared between the groups according to whether the PEEP level was titrated by EIT or the ARDSnet protocol. Results A total of twenty-seven ARDS patients including 14 comorbid with and 13 without COPD who met the study eligibility criteria were recruited. The PEEP levels titrated by EIT and the ARDSnet protocol were lower in the COPD group than in the non-COPD group (6.93 ± 1.69 cm H2O vs. 12.15 ± 2.40 cm H2O, P < 0.001 and 10.43 ± 1.20 cm H2O vs. 14.0 ± 3.0 cm H2O, P < 0.001, respectively). In the COPD group, the PEEP level titrated by EIT was lower than that titrated by the ARDSnet protocol (6.93 ± 1.69 cm H2O vs. 10.43 ± 1.20 cm H2O, P < 0.001), as was the global inhomogeneity (GI) index (0.397 ± 0.040 vs. 0.446 ± 0.052, P = 0.001), plateau airway pressure (16.50 ± 4.35 cm H2O vs. 20.93 ± 5.37 cm H2O, P = 0.001), dead space ventilation ratio (48.29 ± 6.78% vs. 55.14 ± 8.85%, P < 0.001), ventilation ratio (1.63 ± 0.33 vs. 1.87 ± 0.33, P < 0.001), and mechanical power (13.92 ± 2.18 J/min vs. 15.87 ± 2.53 J/min, P < 0.001). The cardiac index was higher when PEEP was treated by EIT than when it was titrated by the ARDSnet protocol (3.41 ± 0.50 L/min/m2 vs. 3.02 ± 0.43 L/min/m2, P < 0.001), as was oxygen delivery (466.40 ± 71.08 mL/min/m2 vs. 411.10 ± 69.71 mL/min/m2, P = 0.001). Conclusion Titrated PEEP levels were lower in patients with ARDS with COPD than in ARDS patients without COPD. In ARDS patient comorbid with COPD, application of PEEP titrated by EIT was lower than those titrated by the ARDSnet protocol, which contributed to improvements in the ventilation ratio, mechanical energy, cardiac index, and oxygen delivery with less of an adverse impact on hemodynamics. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04201-y.
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Affiliation(s)
- Xuesong Liu
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
| | - Xiao Liu
- Department of Critical Care Medicine, Huadu District People’s Hospital, Guangzhou, 510800 China
| | - Jue Meng
- grid.79703.3a0000 0004 1764 3838Department of Respiratory Medicine, Nanhai District People’s Hospital and Sixth Affiliated Hospital of South China University of Technology, Foshan, 528200 Guangdong China
| | - Dongdong Liu
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
| | - Yongbo Huang
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
| | - Ling Sang
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
| | - Yonghao Xu
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
| | - Zhiheng Xu
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
| | - Weiqun He
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
| | - Sibei Chen
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
| | - Rong Zhang
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
| | - Xiaoqing Liu
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
| | - Yimin Li
- grid.470124.4State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120 Guangdong China
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13
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Xi Y, Zhou J, Lin Z, Liang W, Yang C, Liu D, Xu Y, Nong L, Chen S, Yu Y, He W, Zhang J, Zhang R, Liu X, Liu X, Sang L, Xu Y, Li Y. Patients with infectious diseases undergoing mechanical ventilation in the intensive care unit have better prognosis after receiving metagenomic next-generation sequencing assay. Int J Infect Dis 2022; 122:959-969. [PMID: 35908725 DOI: 10.1016/j.ijid.2022.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES To evaluate the relation between mNGS and the prognosis of patients with infectious diseases undergoing mechanical ventilation in the intensive care unit (ICU). DESIGN This is a single-center observational study, comparing non-randomly assigned diagnostic approaches. We analyzed the medical records of 228 patients with suspected infectious diseases undergoing mechanical ventilation in the ICU from March 2018 to May 2020. The concordance of pathogen results was also assessed for the results of mNGS, culture and PCR assays. RESULTS The 28-day mortality of the patients in the mNGS group was lower after the baseline difference correction (19.23% (20/104) vs. 29.03% (36/124) , p=0.039). Subgroup analysis showed that mNGS assay associates with improved 28-day mortality of non-immunosuppressive patients (14.06% vs. 29.82%, p=0.018) . Not performing mNGS assay, higher APACHE II score and hypertension are independent risk factors for 28-day mortality. The mNGS assay presented advantage in pathogen positivity (69.8% double positive and 25.0% mNGS positive only), and the concordance between thest two assays were 79.0%. CONCLUSIONS mNGS survey may be associated with a better prognosis as the reduction of 28-day mortality of patients with infectious diseases on mechanical ventilation in ICU. This technique presented advantage in pathogen positivity than traditional methods.
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Affiliation(s)
- Yin Xi
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Jing Zhou
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Zhimin Lin
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Weibo Liang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Chun Yang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Dongdong Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Yonghao Xu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Lingbo Nong
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Sibei Chen
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Yuheng Yu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Weiqun He
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Jie Zhang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Rong Zhang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Xuesong Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Ling Sang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China..
| | - Yuanda Xu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China..
| | - Yimin Li
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China..
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14
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Sang L, Li YM. [Mechanical ventilation strategy for acute respiratory distress syndrome patients supported by veno-venous extracorporeal membrane oxygenation]. Zhonghua Yi Xue Za Zhi 2022; 102:1895-1898. [PMID: 35768387 DOI: 10.3760/cma.j.cn112137-20220207-00241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The mortality of acute respiratory distress syndrome (ARDS) patients is very high, veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been proved to improve the prognosis of these patients, but the maximization of this benefit relies on the appropriate mechanical ventilation strategy; with the new research evidence arise, scholars have reached a certain consensus on how to implement mechanical ventilation in ARDS patients supported by VV-ECMO, but there are still many controversies. Based on the evidences of current researches and clinical experiences, this article analyzes the hot issues of mechanical ventilation strategy for these patients, including the implementation of early 'overprotective' ventilation strategy, whether spontaneous breathing allowed, prone ventilation and ventilator weaning.
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Affiliation(s)
- L Sang
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Y M Li
- Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
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15
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Wang M, Ding Q, Sang L, Song L. Prevalence of Pain and Its Risk Factors Among ICU Personnel in Tertiary Hospital in China: A Cross-Sectional Study. J Pain Res 2022; 15:1749-1758. [PMID: 35756365 PMCID: PMC9231536 DOI: 10.2147/jpr.s366536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023] Open
Abstract
Background Although pain is commonly observed among medical staff, studies on pain among intensive care unit personnel are uncommon, especially intensive care unit (ICU) doctors and workers. Moreover, few studies have focused on the prevalence of pain and the associated factors. Purpose The aim of this study was to estimate the prevalence of pain among ICU personnel (including doctors, nurses and workers) and explore the risk factors for their pain. Methods We conducted an online survey that included sociodemographic and work-related items and questions about pain, ergonomics, and psychological factors. We used the short version of the validated Depression-Anxiety-Stress Scale (DASS-21) to assess the relationship between pain and mental disorders. All ICU personnel at West China Hospital of Sichuan University participated in this study. Results A total of 356 ICU personnel were included in the final analysis. The prevalence of pain was 72.2% among ICU nurses, 64.4% among ICU doctors and 52.9% among ICU workers. The most frequent location of pain was the lower back among nurses (65.9%) and workers (47.1%) and the neck among doctors (49.1%). The factors contributing to pain among ICU personnel were bending or twisting the neck, high levels of psychological fatigue, low self-perceived health status, female sex and high body mass index (BMI). Moreover, participants with pain indicated significantly higher depression (p ≤ 0.001), anxiety (p ≤ 0.001), and stress levels (p = 0.002) than those without pain. Conclusion This study indicates that ICU personnel exhibit a high prevalence of pain. Many factors, especially psychosocial and ergonomic factors, contribute to pain levels among ICU personnel and the poorer mental health levels observed in those experiencing pain. Therefore, disease prevention and health promotion measures are needed to protect the health of ICU personnel.
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Affiliation(s)
- Maoying Wang
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Qianrong Ding
- Department of Intensive Care Unit Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Ling Sang
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Li Song
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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16
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Sang L, Cheng B, Yu Y, Xi Y, Wang Y, Fan B, Li J, Dai J, Gan G, Tong S, Sun B, Qi X, Liang W, He J, Zhong N. The efficacy and safety of IBI314 on delta and omicron variant of SARS-CoV-2: First-in-human evidence. J Infect 2022; 85:334-363. [PMID: 35691517 PMCID: PMC9183246 DOI: 10.1016/j.jinf.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Ling Sang
- Department of Intensive Care Unit, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Guangzhou Laboratory, Guangzhou International Biotech Island, Guangzhou 510320, China; Department of Emergency Intensive Care Unit (EICU), Qinghai Provincial Fourth People's Hospital, China
| | - Bo Cheng
- Department of Thoracic Surgery and Oncology, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China; Guangzhou Laboratory, Guangzhou International Biotech Island, Guangzhou 510320, China
| | - Yuheng Yu
- Department of Intensive Care Unit, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Guangzhou Laboratory, Guangzhou International Biotech Island, Guangzhou 510320, China; Department of Emergency Intensive Care Unit (EICU), Qinghai Provincial Fourth People's Hospital, China
| | - Yin Xi
- Department of Intensive Care Unit, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Guangzhou Laboratory, Guangzhou International Biotech Island, Guangzhou 510320, China; Department of Emergency Intensive Care Unit (EICU), Qinghai Provincial Fourth People's Hospital, China
| | - Yun Wang
- Department of Emergency Intensive Care Unit (EICU), Qinghai Provincial Fourth People's Hospital, China
| | - Bingdong Fan
- Department of Emergency Intensive Care Unit (EICU), Qinghai Provincial Fourth People's Hospital, China
| | - Jijie Li
- Department of Respiratory Medicine, Qinghai Provincial Fourth People's Hospital, China
| | - Jingtao Dai
- Department of Respiratory Intensive Care Medicine, The Qinghai Provincial Fourth People's Hospital, China
| | - Guifen Gan
- Department of Critical Care Medicine, The Affiliated Hospital of Qinghai University, China
| | - Shijun Tong
- Department of Critical Care Medicine, The Affiliated Hospital of Qinghai University, China
| | - Bin Sun
- Department of Critical Care Medicine, Qinghai Provincial People's Hospital, China
| | - Xiaojing Qi
- Department of Respiratory and Critical Care Medicine, Qinghai Provincial People's Hospital, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China; Guangzhou Laboratory, Guangzhou International Biotech Island, Guangzhou 510320, China.
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China; Guangzhou Laboratory, Guangzhou International Biotech Island, Guangzhou 510320, China.
| | - Nanshan Zhong
- Guangzhou Laboratory, Guangzhou International Biotech Island, Guangzhou 510320, China; Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
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17
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Sang L, Song L. Analgesia Drugs are the Fundamental Treatment for Herpes Zoster-related Pain. Pain Physician 2022; 25:E406. [PMID: 35323000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ling Sang
- Department of Pain Management, Sichuan University West China Hospital, Chengdu, Sichuan Province, China
| | - Li Song
- Department of Pain Management, Sichuan University West China Hospital, Chengdu, Sichuan Province, China
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18
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Chen Y, Xie J, Wu W, Li S, Hu Y, Hu M, Li J, Yang Y, Huang T, Zheng K, Wang Y, Kang H, Huang Y, Jiang L, Zhang W, Zhong M, Sang L, Zheng X, Pan C, Zheng R, Li X, Tong Z, Qiu H, Weng L, Du B. Intravenous Immunoglobulin Therapy for Critically Ill COVID-19 Patients With Different Inflammatory Phenotypes: A Multicenter, Retrospective Study. Front Immunol 2022; 12:738532. [PMID: 35154067 PMCID: PMC8828477 DOI: 10.3389/fimmu.2021.738532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background The benefits of intravenous immunoglobulin administration are controversial for critically ill COVID-19 patients. Methods We analyzed retrospectively the effects of immunoglobulin administration for critically ill COVID-19 patients. The primary outcome was 28-day mortality. Inverse probability of treatment weighting (IPTW) with propensity score was used to account for baseline confounders. Cluster analysis was used to perform phenotype analysis. Results Between January 1 and February 29, 2020, 754 patients with complete data from 19 hospitals were enrolled. Death at 28 days occurred for 408 (54.1%) patients. There were 392 (52.0%) patients who received intravenous immunoglobulin, at 11 (interquartile range (IQR) 8, 16) days after illness onset; 30% of these patients received intravenous immunoglobulin prior to intensive care unit (ICU) admission. By unadjusted analysis, no difference was observed for 28-day mortality between the immunoglobulin and non-immunoglobulin groups. Similar results were found by propensity score matching (n = 506) and by IPTW analysis (n = 731). Also, IPTW analysis did not reveal any significant difference between hyperinflammation and hypoinflammation phenotypes. Conclusion No significant association was observed for use of intravenous immunoglobulin and decreased mortality of severe COVID-19 patients. Phenotype analysis did not show any survival benefit for patients who received immunoglobulin therapy.
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Affiliation(s)
- Yan Chen
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Wenjuan Wu
- Department of Critical Care Medicine, Wuhan Jin-Yintan Hospital, Wuhan, China
| | - Shusheng Li
- Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Ming Hu
- Department of Infection Disease, Wuhan Pulmonary Hospital, Wuhan, China
| | - Jinxiu Li
- Department of Critical Care Medicine, Shenzhen Third Hospital, Shenzhen, China
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Tingrong Huang
- Department of Critical Care Medicine, Huangshi Hospital of Chinese Medicine, Huangshi, China
| | - Kun Zheng
- Department of Critical Care Medicine, Huangshi Central Hospital, Huangshi, China
| | - Yishan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hanyujie Kang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yingzi Huang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Emergency Department, The 900th Hospital of Joint Service Corps of Chinese PLA, Fuzhou, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ling Sang
- Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chun Pan
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, China
| | - Xuyan Li
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Li Weng
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Du
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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19
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Zhong M, Sun A, Xiao T, Yao G, Sang L, Zheng X, Zhang J, Jin X, Xu L, Yang W, Wang P, Hu K, Zhang D, Ge J. A Randomized, Single-Blind, Group Sequential, Active-Controlled Study to Evaluate the Clinical Efficacy and Safety of α-Lipoic Acid for Critically Ill Patients With Coronavirus Disease 2019 (COVID-19). Front Med (Lausanne) 2022; 8:566609. [PMID: 35186959 PMCID: PMC8854372 DOI: 10.3389/fmed.2021.566609] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/15/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECT To evaluate the clinical efficacy and safety of α-Lipoic acid (ALA) for critically ill patients with coronavirus disease 2019 (COVID-19). METHODS A randomized, single-blind, group sequential, active-controlled trial was performed at JinYinTan Hospital, Wuhan, China. Between February 2020 and March 2020, 17 patients with critically ill COVID-19 were enrolled in our study. Eligible patients were randomly assigned in a 1:1 ratio to receive either ALA (1200 mg/d, intravenous infusion) once daily plus standard care or standard care plus equal volume saline infusion (placebo) for 7 days. All patients were monitored within the 7 days therapy and followed up to day 30 after therapy. The primary outcome of this study was the Sequential Organ Failure Estimate (SOFA) score, and the secondary outcome was the all-cause mortality within 30 days. RESULT Nine patients were randomized to placebo group and 8 patients were randomized to ALA group. SOFA score was similar at baseline, increased from 4.3 to 6.0 in the placebo group and increased from 3.8 to 4.0 in the ALA group (P = 0.36) after 7 days. The 30-day all-cause mortality tended to be lower in the ALA group (3/8, 37.5%) compared to that in the placebo group (7/9, 77.8%, P = 0.09). CONCLUSION In our study, ALA use is associated with lower SOFA score increase and lower 30-day all-cause mortality as compared with the placebo group. Although the mortality rate was two-folds higher in placebo group than in ALA group, only borderline statistical difference was evidenced due to the limited patient number. Future studies with larger patient cohort are warranted to validate the role of ALA in critically ill patients with COVID-19. CLINICAL TRIAL REGISTRATION http://www.chictr.org.cn/showproj.aspx?proj=49534.
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Affiliation(s)
- Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Wuhan JinYinTan Hospital, Wuhan, China
| | - Aijun Sun
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
- Institute of Biomedical Sciences, Fudan University, Shanghai, China
| | - Ting Xiao
- Intensive Care Unit of the Six Floor of South Building, Wuhan JinYinTan Hospital, Wuhan, China
| | - Ge Yao
- Intensive Care Unit of the Six Floor of South Building, Wuhan JinYinTan Hospital, Wuhan, China
| | - Ling Sang
- Department of Critical Care Medicine, GuangZhou Institute of Respiratory Health, The First Affiliated Hospital of GuangZhou Medical University, Guangzhou, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jinyan Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Xuejuan Jin
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Lei Xu
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Wenlong Yang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Peng Wang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Kai Hu
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | | | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
- Institute of Biomedical Sciences, Fudan University, Shanghai, China
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20
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Zhao Z, Sang L, Oh TI. Editorial: CardioPulmonary Physiology: Novel Approaches to Pulmonary Function and Critical Care. Front Physiol 2022; 12:825098. [PMID: 35046843 PMCID: PMC8762205 DOI: 10.3389/fphys.2021.825098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Ling Sang
- State Key Lab of Respiratory Diseases, Guangzhou Laboratory, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tong In Oh
- College of Medicine, Kyung Hee University, Seoul, South Korea
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21
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Luo J, Liu L, Chen L, Xu X, Wang Y, Wei B, Ju C, Wang X, Huang L, Zeng W, Miao X, Sang L, Huang D, Pan G, Peng G, Chen Z, Zhao Z, Yang C, Cui W, Jiang W, Xu J, Li SC, He J. Over-shedding of donor-derived cell-free DNA at immune-related regions into plasma of lung transplant recipient. Clin Transl Med 2022; 12:e622. [PMID: 35020272 PMCID: PMC8754174 DOI: 10.1002/ctm2.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jiaqi Luo
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Liping Liu
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of The Translational Medicine LaboratoryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Lingxi Chen
- City University of Hong Kong Shenzhen Research InstituteShenzhenChina
| | - Xin Xu
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of Thoracic SurgeryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Yanfei Wang
- City University of Hong Kong Shenzhen Research InstituteShenzhenChina
| | - Bing Wei
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of Thoracic SurgeryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Chunrong Ju
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of Respiratory and Critical Care MedicineDepartment of lung transplantationThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xuedong Wang
- City University of Hong Kong Shenzhen Research InstituteShenzhenChina
| | - Liyan Huang
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of The Translational Medicine LaboratoryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Wenchuang Zeng
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of The Translational Medicine LaboratoryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xinyao Miao
- City University of Hong Kong Shenzhen Research InstituteShenzhenChina
| | - Ling Sang
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of Critical Care MedicineThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Danxia Huang
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of Thoracic SurgeryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Guangze Pan
- City University of Hong Kong Shenzhen Research InstituteShenzhenChina
| | - Guilin Peng
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of Thoracic SurgeryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Zhuxing Chen
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of The Translational Medicine LaboratoryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Zicheng Zhao
- City University of Hong Kong Shenzhen Research InstituteShenzhenChina
| | - Chao Yang
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of Cardiac SurgeryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Weixue Cui
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of Thoracic SurgeryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | | | - Jinjin Xu
- BGI GenomicsBGI‐ShenzhenShenzhenChina
| | - Shuai Cheng Li
- City University of Hong Kong Shenzhen Research InstituteShenzhenChina
| | - Jianxing He
- National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
- Department of Thoracic SurgeryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
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22
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Liang H, Guo Y, Chen X, Ang KL, He Y, Jiang N, Du Q, Zeng Q, Lu L, Gao Z, Li L, Li Q, Nie F, Ding G, Huang G, Chen A, Li Y, Guan W, Sang L, Xu Y, Chen H, Chen Z, Li S, Zhang N, Chen Y, Huang D, Li R, Li J, Cheng B, Zhao Y, Li C, Xiong S, Wang R, Liu J, Wang W, Huang J, Cui F, Xu T, Lure FYM, Zhan M, Huang Y, Yang Q, Dai Q, Liang W, He J, Zhong N. Artificial intelligence for stepwise diagnosis and monitoring of COVID-19. Eur Radiol 2022; 32:2235-2245. [PMID: 34988656 PMCID: PMC8731211 DOI: 10.1007/s00330-021-08334-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/06/2021] [Accepted: 08/07/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Main challenges for COVID-19 include the lack of a rapid diagnostic test, a suitable tool to monitor and predict a patient's clinical course and an efficient way for data sharing among multicenters. We thus developed a novel artificial intelligence system based on deep learning (DL) and federated learning (FL) for the diagnosis, monitoring, and prediction of a patient's clinical course. METHODS CT imaging derived from 6 different multicenter cohorts were used for stepwise diagnostic algorithm to diagnose COVID-19, with or without clinical data. Patients with more than 3 consecutive CT images were trained for the monitoring algorithm. FL has been applied for decentralized refinement of independently built DL models. RESULTS A total of 1,552,988 CT slices from 4804 patients were used. The model can diagnose COVID-19 based on CT alone with the AUC being 0.98 (95% CI 0.97-0.99), and outperforms the radiologist's assessment. We have also successfully tested the incorporation of the DL diagnostic model with the FL framework. Its auto-segmentation analyses co-related well with those by radiologists and achieved a high Dice's coefficient of 0.77. It can produce a predictive curve of a patient's clinical course if serial CT assessments are available. INTERPRETATION The system has high consistency in diagnosing COVID-19 based on CT, with or without clinical data. Alternatively, it can be implemented on a FL platform, which would potentially encourage the data sharing in the future. It also can produce an objective predictive curve of a patient's clinical course for visualization. KEY POINTS • CoviDet could diagnose COVID-19 based on chest CT with high consistency; this outperformed the radiologist's assessment. Its auto-segmentation analyses co-related well with those by radiologists and could potentially monitor and predict a patient's clinical course if serial CT assessments are available. It can be integrated into the federated learning framework. • CoviDet can be used as an adjunct to aid clinicians with the CT diagnosis of COVID-19 and can potentially be used for disease monitoring; federated learning can potentially open opportunities for global collaboration.
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Affiliation(s)
- Hengrui Liang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yuchen Guo
- Institute for Brain and Cognitive Sciences, Tsinghua University, Beijing, 100084, China.,Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China
| | - Xiangru Chen
- Beijing XiaoBaiShiJi Network Technical Co., Ltd, Beijing, 100084, China
| | - Keng-Leong Ang
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Yuwei He
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China.,School of Software, Tsinghua University, Beijing, 100084, China
| | - Na Jiang
- Department of Gastroenterology, Wuhan Hankou Hospital, Wuhan, 430000, China
| | - Qiang Du
- Beijing XiaoBaiShiJi Network Technical Co., Ltd, Beijing, 100084, China
| | - Qingsi Zeng
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Radiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Ligong Lu
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000, China
| | - Zebin Gao
- Beijing XiaoBaiShiJi Network Technical Co., Ltd, Beijing, 100084, China
| | - Linduo Li
- College of Engineering, Northeastern University, 360 Huntington Ave., Boston, MA, 02115, USA
| | - Quanzheng Li
- Department of Radiology, Massachusetts General Hospital, White-427 55 Fruit St, Boston, MA, 02114, USA
| | - Fangxing Nie
- Beijing XiaoBaiShiJi Network Technical Co., Ltd, Beijing, 100084, China
| | - Guiguang Ding
- Institute for Brain and Cognitive Sciences, Tsinghua University, Beijing, 100084, China.,Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China.,School of Software, Tsinghua University, Beijing, 100084, China
| | - Gao Huang
- Beijing XiaoBaiShiJi Network Technical Co., Ltd, Beijing, 100084, China.,School of Software, Tsinghua University, Beijing, 100084, China
| | - Ailan Chen
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Cardiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yimin Li
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Intensive Care Unit, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Weijie Guan
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Ling Sang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Intensive Care Unit, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yuanda Xu
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Intensive Care Unit, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Huai Chen
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Radiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Zisheng Chen
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Shiyue Li
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Nuofu Zhang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Ying Chen
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Danxia Huang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Run Li
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jianfu Li
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Bo Cheng
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yi Zhao
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Caichen Li
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Shan Xiong
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Runchen Wang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jun Liu
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Wei Wang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jun Huang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Fei Cui
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Tao Xu
- Biomanufacturing Center Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | | | - Meixiao Zhan
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Jinan University, Zhuhai, 519000, China
| | - Yuanyi Huang
- Department of Radiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China
| | - Qiang Yang
- Hong Kong University of Science and Technology and weBank, Hong Kong, China
| | - Qionghai Dai
- Institute for Brain and Cognitive Sciences, Tsinghua University, Beijing, 100084, China. .,Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, 100084, China.
| | - Wenhua Liang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China. .,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
| | - Jianxing He
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China. .,Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China. .,South China Medical University, Guangzhou, 510000, China.
| | - Nanshan Zhong
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
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23
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Wang Y, Lei L, Yang H, He S, Hao J, Liu T, Chen X, Huang Y, Zhou J, Lin Z, Zheng H, Lin X, Huang W, Liu X, Li Y, Huang L, Qiu W, Ru H, Wang D, Wu J, Zheng H, Zuo L, Zeng P, Zhong J, Rong Y, Fan M, Li J, Cai S, Kou Q, Liu E, Lin Z, Cai J, Yang H, Li F, Wang Y, Lin X, Chen W, Gao Y, Huang S, Sang L, Xu Y, Zhang K. Weaning critically ill patients from mechanical ventilation: a protocol from a multicenter retrospective cohort study. J Thorac Dis 2022; 14:199-206. [PMID: 35242382 PMCID: PMC8828530 DOI: 10.21037/jtd-21-1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/15/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mechanical ventilation (MV) is an important lifesaving method in intensive care unit (ICU). Prolonged MV is associated with ventilator associated pneumonia (VAP) and other complications. However, premature weaning from MV may lead to higher risk of reintubation or mortality. Therefore, timely and safe weaning from MV is important. In addition, identification of the right patient and performing a suitable weaning process is necessary. Although several guidelines about weaning have been reported, compliance with these guidelines is unknown. Therefore, the aim of this study is to explore the variation of weaning in China, associations between initial MV reason and clinical outcomes, and factors associated with weaning strategies using a multicenter cohort. METHODS This multicenter retrospective cohort study will be conducted at 17 adult ICUs in China, that included patients who were admitted in this 17 ICUs between October 2020 and February 2021. Patients under 18 years of age and patients without the possibility for weaning will be excluded. The questionnaire information will be registered by a specific clinician in each center who has been evaluated and qualified to carry out the study. DISCUSSION In a previous observational study of weaning in 17 ICUs in China, weaning practices varies nationally. Therefore, a multicenter retrospective cohort study is necessary to be conducted to explore the present weaning methods used in China. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR) (No. ChiCTR2100044634).
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Affiliation(s)
- Yingzhi Wang
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liming Lei
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Huawei Yang
- Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | | | - Junhai Hao
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Tao Liu
- Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | | | - Yongbo Huang
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Zhou
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhimin Lin
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haichong Zheng
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoling Lin
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weixiang Huang
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Linxi Huang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Wenbing Qiu
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Huangyao Ru
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Danni Wang
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Jianfeng Wu
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huifang Zheng
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liuer Zuo
- Shunde Hospital of Southern Medical University, Foshan, China
| | - Peiling Zeng
- Shunde Hospital of Southern Medical University, Foshan, China
| | - Jian Zhong
- Shunde Hospital Guangzhou University of Chinese Medicine (Shunde District Hospital of Chinese Medicine of Foshan City), Foshan, China
| | - Yanhui Rong
- Shunde Hospital Guangzhou University of Chinese Medicine (Shunde District Hospital of Chinese Medicine of Foshan City), Foshan, China
| | - Min Fan
- The Third Affiliated Hospital of Sun Yat-sen University- Lingnan Hospital, Guangzhou, China
| | - Jianwei Li
- Zhongshan People’s Hospital, Zhongshan, China
| | | | - Qiuye Kou
- Foresea Life Insurance Guangzhou General Hospital, Guangzhou, China
| | - Enhe Liu
- Foresea Life Insurance Guangzhou General Hospital, Guangzhou, China
| | - Zhuandi Lin
- Guangzhou panyu Central Hospital, Guangzhou, China
| | - Jingjing Cai
- Guangzhou panyu Central Hospital, Guangzhou, China
| | - Hong Yang
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Fen Li
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yanhong Wang
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinfeng Lin
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weitao Chen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Youshan Gao
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shifang Huang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ling Sang
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanda Xu
- Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kouxing Zhang
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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24
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Zheng Y, Liu B, Deng X, Chen Y, Huang Y, Zhang Y, Xu Y, Sang L, Liu X, Li Y. Construction and validation of a robust prognostic model based on immune features in sepsis. Front Immunol 2022; 13:994295. [PMID: 36532037 PMCID: PMC9756843 DOI: 10.3389/fimmu.2022.994295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Sepsis, with life-threatening organ failure, is caused by the uncontrolled host response to infection. Immune response plays an important role in the pathophysiology of sepsis. Immune-related genes (IRGs) are promising novel biomarkers that have been used to construct the diagnostic and prognostic model. However, an IRG prognostic model used to predict the 28-day mortality in sepsis was still limited. Therefore, the study aimed to develop a prognostic model based on IRGs to identify patients with high risk and predict the 28-day mortality in sepsis. Then, we further explore the circulating immune cell and immunosuppression state in sepsis. Materials and methods The differentially expressed genes (DEGs), differentially expressed immune-related genes (DEIRGs), and differentially expressed transcription factors (DETFs) were obtained from the GEO, ImmPort, and Cistrome databases. Then, the TFs-DEIRGs regulatory network and prognostic prediction model were constructed by Cox regression analysis and Pearson correlation analysis. The external datasets also validated the reliability of the prognostic model. Based on the prognostic DEIRGs, we developed a nomogram and conducted an independent prognosis analysis to explore the relationship between DEIRGs in the prognostic model and clinical features in sepsis. Besides, we further evaluate the circulating immune cells state in sepsis. Results A total of seven datasets were included in our study. Among them, GSE65682 was identified as a discovery cohort. The results of GSEA showed that there is a significant correlation between sepsis and immune response. Then, based on a P value <0.01, 69 prognostic DEIRGs were obtained and the potential molecular mechanisms of DEIRGs were also clarified. According to multivariate Cox regression analysis, 22 DEIRGs were further identified to construct the prognostic model and identify patients with high risk. The Kaplan-Meier survival analysis showed that high-risk groups have higher 28-day mortality than low-risk groups (P=1.105e-13). The AUC value was 0.879 which symbolized that the prognostic model had a better accuracy to predict the 28-day mortality. The external datasets also prove that the prognostic model had an excellent prediction value. Furthermore, the results of correlation analysis showed that patients with Mars1 might have higher risk scores than Mars2-4 (P=0.002). According to the previous study, Mars1 endotype was characterized by immunoparalysis. Thus, the sepsis patients in high-risk groups might exist the immunosuppression. Between the high-risk and low-risk groups, circulating immune cells types were significantly different, and risk score was significantly negatively correlated with naive CD4+ T cells (P=0.019), activated NK cells (P=0.0045), monocytes (P=0.0134), and M1 macrophages (P=0.0002). Conclusions Our study provides a robust prognostic model based on 22 DEIRGs which can predict 28-day mortality and immunosuppression status in sepsis. The higher risk score was positively associated with 28-day mortality and the development of immunosuppression. IRGs are a promising biomarker that might facilitate personalized treatments for sepsis.
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Affiliation(s)
- Yongxin Zheng
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Baiyun Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiumei Deng
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yubiao Chen
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yongbo Huang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yu Zhang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yonghao Xu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Ling Sang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Yimin Li,
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25
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Amaral TF, Grázia JGV, Gonella-Diaza AM, Martinhão LAG, Heredia D, Melo GD, Pohler KG, Estrada-Cortés E, Dikmen S, Sosa F, Jensen LM, Sang L, Siqueira LGB, Viana JHM, Hansen PJ. 84 Actions of DKK1 on the bovine embryo during the morula-to-blastocyst stage of development on pregnancy outcomes and placental hormone secretion after embryo transfer. Reprod Fertil Dev 2021; 34:279. [PMID: 35231213 DOI: 10.1071/rdv34n2ab84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- T F Amaral
- Department of Animal Sciences, University of Florida, Gainesville, FL, USA
| | - J G V Grázia
- FIVX Apoyar Biotech LTDA, Juiz de Fora, Minas Gerais, Brazil
| | - A M Gonella-Diaza
- Department of Animal Sciences, University of Florida, North Florida Research and Education Center, Marianna, FL, USA
| | - L A G Martinhão
- Biological Science Institute, University of Brasília, Brasília, DF, Brazil
| | - D Heredia
- Department of Animal Sciences, University of Florida, North Florida Research and Education Center, Marianna, FL, USA
| | - G D Melo
- Department of Animal Sciences, Texas A&M University, College Station, TX, USA
| | - K G Pohler
- Department of Animal Sciences, Texas A&M University, College Station, TX, USA
| | - E Estrada-Cortés
- Department of Animal Sciences, University of Florida, Gainesville, FL, USA
| | - S Dikmen
- Department of Animal Science, Faculty of Veterinary Medicine, Bursa Uludag University, Bursa, Turkey
| | - F Sosa
- Department of Animal Sciences, University of Florida, Gainesville, FL, USA
| | - L M Jensen
- Department of Animal Sciences, University of Florida, Gainesville, FL, USA
| | - L Sang
- Institute of Animal Husbandry and Veterinary Medicine, Fujian Academy of Agricultural Sciences, Fuzhou, China
| | - L G B Siqueira
- Brazilian Agricultural Research Corporation (Embrapa), Juiz de Fora, Minas Gerais, Brazil
| | - J H M Viana
- Brazilian Agricultural Research Corporation (Embrapa), Juiz de Fora, Minas Gerais, Brazil
| | - P J Hansen
- Department of Animal Sciences, University of Florida, Gainesville, FL, USA
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26
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Xu Z, Huang Y, Zhou J, Deng X, He W, Liu X, Li Y, Zhong N, Sang L. Current Status of Cell-Based Therapies for COVID-19: Evidence From Mesenchymal Stromal Cells in Sepsis and ARDS. Front Immunol 2021; 12:738697. [PMID: 34659231 PMCID: PMC8517471 DOI: 10.3389/fimmu.2021.738697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/13/2021] [Indexed: 12/29/2022] Open
Abstract
The severe respiratory consequences of the coronavirus disease 2019 (COVID-19) pandemic have prompted the urgent need for novel therapies. Cell-based therapies, primarily using mesenchymal stromal cells (MSCs), have demonstrated safety and potential efficacy in the treatment of critical illness, particularly sepsis and acute respiratory distress syndrome (ARDS). However, there are limited preclinical data for MSCs in COVID-19. Recent studies have shown that MSCs could decrease inflammation, improve lung permeability, enhance microbe and alveolar fluid clearance, and promote lung epithelial and endothelial repair. In addition, MSC-based therapy has shown promising effects in preclinical studies and phase 1 clinical trials in sepsis and ARDS. Here, we review recent advances related to MSC-based therapy in the context of sepsis and ARDS and evaluate the potential value of MSCs as a therapeutic strategy for COVID-19.
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Affiliation(s)
- Zhiheng Xu
- State Key Laboratory of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Medical University, Guangzhou, China
| | - Yongbo Huang
- State Key Laboratory of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Medical University, Guangzhou, China
| | - Jianmeng Zhou
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiumei Deng
- State Key Laboratory of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Medical University, Guangzhou, China
| | - Weiqun He
- State Key Laboratory of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- State Key Laboratory of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Medical University, Guangzhou, China
| | - Ling Sang
- State Key Laboratory of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Medical University, Guangzhou, China.,Guangzhou Laboratory, Guangzhou, China
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27
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Li X, Hu M, Zheng R, Wang Y, Kang H, Jiang L, Zhong M, Sang L, Zheng X, Pan C, Zhang W, Qiu H, Du B, Tong Z. Delayed Initiation of ECMO Is Associated With Poor Outcomes in Patients With Severe COVID-19: A Multicenter Retrospective Cohort Study. Front Med (Lausanne) 2021; 8:716086. [PMID: 34604257 PMCID: PMC8481658 DOI: 10.3389/fmed.2021.716086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/20/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) is a rapidly evolving therapy for acute lung and/or heart failure. However, the information on the application of ECMO in severe coronavirus disease 2019 (COVID-19) is limited, such as the initiation time. Especially in the period and regions of ECMO instrument shortage, not all the listed patients could be treated with ECMO in time. This study aimed to investigate and clarify the timing of ECMO initiation related to the outcomes of severe patients with COVID-19. The results show that ECMO should be initiated within 24 h after the criteria are met. Methods: In this retrospective, multicenter cohort study, we enrolled all ECMO patients with confirmed COVID-19 at the three hospitals between December 29, 2019 and April 5, 2020. Data on the demographics, clinical presentation, laboratory profile, clinical course, treatments, complications, and outcomes were collected. The primary outcomes were successful ECMO weaning rate and 60-day mortality after ECMO. Successful weaning from ECMO means that the condition of patients improved with adequate oxygenation and gas exchange, as shown by the vital signs, blood gases, and chest X-ray, and the patient was weaned from ECMO for at least 48 h. Results: A total of 31 patients were included in the analysis. The 60-day mortality rate after ECMO was 71%, and the ECMO weaning rate was 26%. Patients were divided into a delayed ECMO group [3 (interquartile range (IQR), 2–5) days] and an early ECMO group [0.5 (IQR, 0–1) days] based on the time between meeting the ECMO criteria and ECMO initiation. In this study, 14 and 17 patients were included in the early and delayed treatment groups, respectively. Early initiation of ECMO was associated with decreased 60-day mortality after ECMO (50 vs. 88%, P = 0.044) and an increased ECMO weaning rate (50 vs. 6%, P = 0.011). Conclusions: In ECMO-supported patients with COVID-19, delayed initiation of ECMO is a risk factor associated with a poorer outcome. Trial Registration: Clinical trial submission: March 19, 2020. Registry name: A medical records-based study for the clinical application of extracorporeal membrane oxygenation in the treatment of severe respiratory failure patients with novel coronavirus pneumonia (COVID-19). Chinese Clinical Trial Registry: https://www.chictr.org.cn/showproj.aspx?proj=51267,identifier:~ChiCTR2000030947.
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Affiliation(s)
- Xuyan Li
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Ming Hu
- Department of Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yishan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Hanyujie Kang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ling Sang
- Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Chun Pan
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Wei Zhang
- Emergency Department, The 900th Hospital of Joint Service Corps of Chinese People's Liberation Army (PLA), Fuzhou, China
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bin Du
- Medical Intensive Care Unit (ICU), Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
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Zhang Z, Liu X, Sang L, Chen S, Wu Z, Zhang J, Sun Y, Huang Y, Xu Y, He W, Li Y, Liu X. Cytomegalovirus reactivation in immunocompetent mechanical ventilation patients: a prospective observational study. BMC Infect Dis 2021; 21:1026. [PMID: 34592936 PMCID: PMC8482357 DOI: 10.1186/s12879-021-06698-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) reactivation is associated with adverse prognoses of critically ill patients. However, the epidemiology and predictors of CMV reactivation in immunocompetent patients receiving mechanical ventilation (MV) are not clear. The aim of this study was to investigate the epidemiology and predictors of CMV reactivation in immunocompetent patients requiring MV. METHODS A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with MV at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week for 28 days (Days 1, 7, 14, 21, and 28). CMV serology, laboratory findings, and clinical data were obtained during hospitalization. RESULTS Among 71 patients, 13 (18.3%) showed CMV reactivation within 28 days in the ICU. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body mass index (BMI), sepsis, N-terminal pro-b-type natriuretic peptide (NT-proBNP), blood urea nitrogen (BUN), and hemoglobin (Hb) levels (P < 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were independently associated with CMV reactivation patients (P < 0.05). Moreover, the area under the receiver operating characteristic (AUROC) of BMI, Hb, and BMI combined with Hb was 0.69, 0.70, and 0.76, respectively. The duration of MV, hospitalization expense, length of ICU stay, and 90 day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P < 0.05). CONCLUSIONS Among immunocompetent patients with MV, the incidence of CMV reactivation was 18.3%. CMV reactivation was associated with several adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation.
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Affiliation(s)
- Zhihui Zhang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China.,Guangzhou Medical University, Guangzhou, Guangdong, 511436, People's Republic of China
| | - Xuesong Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Ling Sang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Sibei Chen
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Zhan Wu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China.,Guangzhou Medical University, Guangzhou, Guangdong, 511436, People's Republic of China
| | - Jierong Zhang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China.,Guangzhou Medical University, Guangzhou, Guangdong, 511436, People's Republic of China
| | - Yining Sun
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China.,Guangzhou Medical University, Guangzhou, Guangdong, 511436, People's Republic of China
| | - Yongbo Huang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Yonghao Xu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Weiqun He
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Yimin Li
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China.
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Zhou J, Lin Z, Deng X, Liu B, Zhang Y, Zheng Y, Zheng H, Wang Y, Lai Y, Huang W, Liu X, He W, Xu Y, Li Y, Huang Y, Sang L. Optimal Positive End Expiratory Pressure Levels in Ventilated Patients Without Acute Respiratory Distress Syndrome: A Bayesian Network Meta-Analysis and Systematic Review of Randomized Controlled Trials. Front Med (Lausanne) 2021; 8:730018. [PMID: 34540872 PMCID: PMC8440859 DOI: 10.3389/fmed.2021.730018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background: To find the optimal positive end expiratory pressure (PEEP) in mechanical ventilated patients without Acute Respiratory Distress Syndrome (ARDS), we conducted a Bayesian network meta-analysis and systematic review of randomized controlled trials (RCTs) comparing different level of PEEP based on a novel classification of PEEP level: ZEEP group (PEEP = 0 cm H2O); lower PEEP group (PEEP = 1–6 cm H2O); intermediate PEEP group (PEEP = 7–10 cm H2O); higher PEEP group (PEEP > 10 cm H2O). Result: Twenty eight eligible studies with 2,712 patients were included. There were no significant differences in the duration of mechanical ventilation between higher and intermediate PEEP (MD: 0.020, 95% CI: −0.14, 0.28), higher and lower PEEP (MD: −0.010, 95% CI: −0.23, 0.22), higher PEEP and ZEEP (MD: 0.010, 95% CI: −0.40, 0.22), intermediate and lower PEEP (MD: −0.040, 95% CI: −0.18, 0.040), intermediate PEEP and ZEEP (MD: −0.010, 95% CI: −0.42, 0.10), lower PEEP and ZEEP (MD: 0.020, 95% CI: −0.32, 0.13), respectively. Higher PEEP was associated with significantly higher PaO2/FiO2 ratio(PFR) when compared to ZEEP (MD: 73.24, 95% CI: 11.03, 130.7), and higher incidence of pneumothorax when compared to intermediate PEEP, lower PEEP and ZEEP (OR: 2.91e + 12, 95% CI: 40.3, 1.76e + 39; OR: 1.85e + 12, 95% CI: 29.2, 1.18e + 39; and OR: 1.44e + 12, 95% CI: 16.9, 8.70e + 38, respectively). There was no association between PEEP levels and other secondary outcomes. Conclusion: We identified higher PEEP was associated with significantly higher PFR and higher incidence of pneumothorax. Nonetheless, in terms of other outcomes, no significant differences were detected among four levels of PEEP. Systematic Review Registration: The study had registered on an international prospective register of systematic reviews, PROSPERO, on 09 April 2021, identifier: [CRD42021241745].
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Affiliation(s)
- Jing Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhimin Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiumei Deng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Baiyun Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongxin Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haichong Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingzhi Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yan Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weixiang Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiqun He
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanda Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongbo Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Sang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Laboratory, Guangdong, China
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30
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Wang SY, Liang HW, Lu GS, Jiang ZJ, Zhang BZ, Deng QX, Sun QW, Lin ZM, Chen Q, Yang C, Xu YD, Sang L. Effect of sequential high-flow nasal cannula oxygen therapy and non-invasive positive-pressure ventilation in patients with difficult weaning from mechanical ventilation after extubation on respiratory mechanics. Ann Transl Med 2021; 9:1251. [PMID: 34532388 PMCID: PMC8421953 DOI: 10.21037/atm-21-3408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022]
Abstract
Background Patients with difficult weaning who undergo mechanical ventilation are more likely to be at risk of reintubation and the sequential use of oxygen therapy after extubation is a concern for clinicians. Therefore, the aim of the present study was to compare the effects of transnasal high-flow nasal cannula (HFNC) oxygen therapy and non-invasive positive-pressure ventilation (NIV) on respiratory mechanics in patients with difficult weaning. Methods The present study was a single-center, retrospective, observational study. Twenty-nine patients with difficult weaning off invasive mechanical ventilation from the Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, from December 2018 to April 2021, were included. Within 48 h after extubation, alternate respiratory support with HFNC and NIV was provided. Relevant indicators were recorded after each support mode had been maintained for at least 60 min. These included esophageal pressure (Pes), gastric pressure (Pga), transdiaphragmatic pressure (Pdi), pressure-time product of Pes (PTPes), pressure-time product of Pga (PTPga), pressure-time product of Pdi (PTPdi), ratio of the PTPdi to the PTPes (PTPdi/PTPes), and ratio of the Pes to the Pdi (Pes/Pdi), diaphragmatic electromyogram (EMGdi), percentage of esophageal pressure coefficient of variation (CVes%),diaphragmatic electromyogram coefficient of variation (CVEMG),inspiratory time (Ti), expiratory time (Te) and respiratory cycle time (Ttot). Results Of the 29 patients included, 22 were males and 7 were females [age: 63.97±15.34 years, Acute Physiological and Chronic Health Estimation II (APACHE II) score: 18.00±5.63]. The CVes% and the Pes/Pdi were significantly higher in patients with NIV than HFNC using 40 L/min, CVes%: 9 (−6, 20) vs. −7 (−23, 6) and Pes/Pdi: 0.17 (−0.1, 0.53), vs. −0.12 (−0.43, 0.08) (P<0.05). The remaining indicators were not statistically different. Conclusions The sequential NIV and HFNC can be tolerated in patients with such difficult weaning off mechanical ventilation after extubation, and more patients tend to choose HFNC subjectively. Compared with HFNC, NIV reduces the work of adjunctive respiratory muscle, but the patient’s Pes dispersion is high when NIV is used, and it is necessary to pay attention to patient–ventilator coordination in clinical practice. We recommend alternating HFNC and NIV during the sequential respiratory therapy after extubation.
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Affiliation(s)
- Shi-Ya Wang
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Han-Wen Liang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guang-Sheng Lu
- Department of Critical Care Medicine, First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Zhen-Jie Jiang
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bao-Zhu Zhang
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiu-Xue Deng
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qing-Wen Sun
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhi-Min Lin
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Laboratory, Guangzhou, China
| | - Qiang Chen
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chun Yang
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuan-Da Xu
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Laboratory, Guangzhou, China
| | - Ling Sang
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Laboratory, Guangzhou, China
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Sang L, Li YM. [The application prospect of electrical impedance tomography in chronic airway disease]. Zhonghua Jie He He Hu Xi Za Zhi 2021; 44:784-786. [PMID: 34496518 DOI: 10.3760/cma.j.cn112147-20210427-00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Yu J, Wang Y, Lin S, Jiang L, Sang L, Zheng X, Zhong M. Severe COVID-19 has a distinct phenotype from bacterial sepsis: a retrospective cohort study in deceased patients. Ann Transl Med 2021; 9:1054. [PMID: 34422966 PMCID: PMC8339852 DOI: 10.21037/atm-21-1291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 01/08/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) has caused more than 2 million deaths worldwide. Viral sepsis has been proposed as a description for severe COVID-19, and numerous therapies have been on trials based upon this hypothesis. However, whether the clinical characteristics of severe COVID-19 are similar to those of bacterial sepsis has not been elucidated. Methods We retrospectively compared the clinical data of non-surviving COVID-19 patients who were admitted to a 30-bed intensive care unit (ICU) in Wuhan Infectious Diseases Hospital (Wuhan, China) from 22 January 2020, to 28 February 2020, with those of non-surviving patients with bacterial sepsis who were admitted to the ICU in Zhongshan Hospital, Fudan University (Shanghai, China) from 3 July 2018, to 30 June 2020. Results A total of 53 COVID-19 patients and 26 septic patients were included in the analysis. The mean ages were 65.6 [standard deviation (SD): 11.1] and 70.4 (SD: 14.3) years in the COVID-19 cohort and sepsis cohort, respectively. The proportion of participants with hypertension was higher in non-survivors with COVID-19 than in non-survivors with sepsis (41.5% vs. 15.4%, P=0.020). The Sequential Organ Failure Assessment (SOFA) score of non-survivors with COVID-19 was lower than that of non-survivors with sepsis at ICU admission {4.0 [interquartile range (IQR): 3.0–6.0] vs. 7.5 [IQR: 5.8–11.0], P<0.001}. The clinical parameters at ICU admission assessed with principal component analysis and hierarchical cluster analysis showed that COVID-19 patients were distinct from bacterial septic patients. Compared with non-survivors with sepsis, non-survivors with COVID-19 had a higher neutrophil/lymphocyte ratio, total protein, globulin, lactate dehydrogenase (LDH), and D-dimer; a lower eosinophil count, procalcitonin, interleukin-6 (IL-6), total bilirubin, direct bilirubin, myohemoglobin, albumin/globulin ratio, activated partial thromboplastin time (APTT), prothrombin time (PT), and international normalization ratio (INR) at ICU admission. In addition, the levels of total protein, globulin, LDH, D-dimer, and IL-6 were significantly different between the two groups during the ICU stay. Conclusions Patients with critical COVID-19 have a phenotype distinct from that of patients with bacterial sepsis. Therefore, caution should be used when applying the previous experience of bacterial sepsis to patients with severe COVID-19.
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Affiliation(s)
- Jie Yu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingqin Wang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shilong Lin
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ling Sang
- Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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Sang L, Xi Y, Lin Z, Pan Y, Song B, Li CA, Zheng X, Zhong M, Jiang L, Pan C, Zhang W, Lv Z, Xia J, Chen N, Wu W, Xu Y, Chen S, Liu D, Liang W, Liu X, Liu X, Li S, Zhong N, Ye D, Xu Y, Zhang N, Zhang D, Li Y. Secondary infection in severe and critical COVID-19 patients in China: a multicenter retrospective study. Ann Palliat Med 2021; 10:8557-8570. [PMID: 34379989 DOI: 10.21037/apm-21-833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Since 2020 COVID-19 pandemic became an emergent public sanitary incident. The epidemiology data and the impact on prognosis of secondary infection in severe and critical COVID-19 patients in China remained largely unclear. METHODS We retrospectively reviewed medical records of all adult patients with laboratory-confirmed COVID-19 who were admitted to ICUs from January 18th 2020 to April 26th 2020 at two hospitals in Wuhan, China and one hospital in Guangzhou, China. We measured the frequency of bacteria and fungi cultured from respiratory tract, blood and other body fluid specimens. The risk factors for and impact of secondary infection on clinical outcomes were also assessed. RESULTS Secondary infections were very common (86.6%) when patients were admitted to ICU for >72 hours. The majority of infections were respiratory, with the most common organisms being Klebsiella pneumoniae (24.5%), Acinetobacter baumannii (21.8%), Stenotrophomonas maltophilia (9.9%), Candida albicans (6.8%), and Pseudomonas spp. (4.8%). Furthermore, the proportions of multidrug resistant (MDR) bacteria and carbapenem resistant Enterobacteriaceae (CRE) were high. We also found that age ≥60 years and mechanical ventilation ≥13 days independently increased the likelihood of secondary infection. Finally, patients with positive cultures had reduced ventilator free days in 28 days and patients with CRE and/or MDR bacteria positivity showed lower 28-day survival rate. CONCLUSIONS In a retrospective cohort of severe and critical COVID-19 patients admitted to ICUs in China, the prevalence of secondary infection was high, especially with CRE and MDR bacteria, resulting in poor clinical outcomes.
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Affiliation(s)
- Ling Sang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China; Guangzhou Laboratory, Jinyintan Hospital, Wuhan, China
| | - Yin Xi
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Zhimin Lin
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Ying Pan
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Bin Song
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Chang-An Li
- Department of Nosocomial Infection Management, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chun Pan
- Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wei Zhang
- Emergency Department, 900th Hospital of Joint Service Corps of Chinese PLA, Fuzhou, China
| | - Zheng Lv
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaan Xia
- Department of Tuberculosis, Wuhan Jinyintan Hospital, Wuhan, China
| | - Nanshan Chen
- Department of Respiratory and Critical Care Medicine Wuhan Jinyintan Hospital. Wuhan, China
| | - Wenjuan Wu
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China
| | - Yonghao Xu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Sibei Chen
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Dongdong Liu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Weibo Liang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Xuesong Liu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China; Guangzhou Laboratory, Jinyintan Hospital, Wuhan, China
| | - Dan Ye
- Department of Nosocomial Infection Management, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanda Xu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Nuofu Zhang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
| | - Dingyu Zhang
- Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Wuhan, China; Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, China
| | - Yimin Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, China
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Lin Z, Zhou J, Lin X, Wang Y, Zheng H, Huang W, Liu X, Li Y, Zhong N, Huang Y, Xu Y, Sang L. Reverse Trigger in Ventilated Non-ARDS Patients: A Phenomenon Can Not Be Ignored! Front Physiol 2021; 12:670172. [PMID: 34393811 PMCID: PMC8359823 DOI: 10.3389/fphys.2021.670172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The role of reverse trigger (RT) was unknown in ventilated non-acute respiratory distress syndrome (ARDS) patients. So we conducted a retrospective study to evaluate the incidence, characteristics and physiologic consequence of RT in such population. Method Six ventilated non-ARDS patients were included, the esophageal balloon catheter were placed for measurements of respiratory mechanics in all patients. And the data were analyzed to identified the occurrence of RT, duration of the entrainment, the entrainment pattern or ratio, the phase difference (dP) and the phase angle (θ), phenotypes, Effects and clinical correlations of RT. Result RT was detected in four patients of our series (66.7%), and the occurrence of RT varying from 19 to 88.6% of their recording time in these 4 patients. One patient (No.2) showed a stable 1:1 ratio and Mid-cycle RT was the most common phenotype. However, the remained patients showed a mixed ratios, and Late RT was the most common phenotype, followed by RT with breath stacking. The average values of mean phase delay and phase angles were 0.39s (0.32, 0.98) and 60.52° (49.66, 102.24). Mean phase delay and phase angles were shorter in early reverse triggering with early and delayed relaxation, and longer in mid, late RT and RT with breath stacking. Pmus was variable between patients and phenotypes, and larger Pmus was generated in Early RT, Delayed Relaxation and mid cycle RT. When the RT occurred, the Peso increased 17.27 (4.91, 19.71) cmH2O compared to the controlled breathing, and the average value of incremental ΔPeso varied widely inter and intra patients (Table 3B and Figure 1). Larger ΔPeso was always generated in Early RT, Delayed Relaxation and mid cycle RT, accompanied by an significant increase of PL with 19.12 (0.75) cmH2O and 16.10 (6.23) cmH2O. Conclusion RT could also be observed in ventilated non-ARDS patients. The characteristics of pattern and phenotype was similar to RT in ARDS patients to a large extent. And RT appeared to alter lung stress and delivered volumes.
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Affiliation(s)
- Zhimin Lin
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Jing Zhou
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Xiaoling Lin
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Yingzhi Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Haichong Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Weixiang Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Xiaoqing Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Yimin Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Nanshan Zhong
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Yongbo Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Yuanda Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Ling Sang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China.,Guangzhou Laboratory, Guangzhou, China
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Zhou J, Pan J, Yu Y, Huang W, Lai Y, Liang W, Nong L, Liu X, Chen S, Xu Y, He W, Xu Y, Liu X, Li Y, Huang Y, Sang L. Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection. Ann Palliat Med 2021; 10:7388-7397. [PMID: 34263634 DOI: 10.21037/apm-21-1428] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/18/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study aimed to investigate independent risk factors of postoperative hypoxemia in patients with acute type A aortic dissection (ATAAD). METHODS A single-center retrospective study was conducted with enrolled 75 ATAAD patients following surgery, which were stratified into three groups on the basis of the postoperative PaO2/FiO2 ratio: severe hypoxemia group (PaO2/FiO2 ratio ≤100 mmHg); moderate hypoxemia group (100 mmHg < PaO2/FiO2 ratio ≤200 mmHg); and non-hypoxemia group (PaO2/FiO2 ratio >200 mmHg). The patient's demography, perioperative laboratory results, operative details, clinical outcomes were collected and analyzed. Univariable and multivariable analyses were performed and logistic regression model was established. RESULTS The incidence of postoperative severe hypoxemia and hypoxemia was 32% and 52%, respectively. Among the three groups, severe hypoxemia group exhibited a high significance of body mass index (BMI) and preoperative white blood cell (WBC) and main distribution of hypertension; meanwhile, Marfan syndrome was mainly distributed in non-hypoxemia group. On intensive care unit (ICU) admission, severe hypoxemia group exhibited a high significance of Acute Physiology and Chronic Health Evaluation (APACHE II) score of postoperative patients, and more patients would present shock. Moreover, severe hypoxemia group patients had a higher incidence of postoperative acute kidney injury (AKI) and usage of renal replacement therapy, longer length of stay (LOS) of ICU, and shorter 28 days ventilator-free days (VFDs). CONCLUSIONS The incidence of postoperative hypoxemia was high in ATAAD patients owing to comprehensive high-risk factors. Besides, postoperative complications negatively impacted their clinical outcomes.
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Affiliation(s)
- Jing Zhou
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Jieyi Pan
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Yuheng Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Weixiang Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Yan Lai
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Weibo Liang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Lingbo Nong
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Xuesong Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Sibei Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Yonghao Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Weiqun He
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Yuanda Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Xiaoqing Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Yimin Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Yongbo Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Ling Sang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Health, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; Guangzhou Laboratory, Guangzhou, China
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Wang J, Sun S, Chen Y, Chen D, Sang L, Xie X. Characterization of Staphylococcus aureus ST3320 clone causing fatal respiratory infection in rabbits. World Rabbit Sci 2021. [DOI: 10.4995/wrs.2021.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
<em>Staphylococcus aureus</em> is a well-known pathogen that infects humans and animals. However, information on the fatal respiratory infection in rabbits caused by<em> S. aureus</em> is still limited. In the present study, a <em>S. aureus</em> isolate designated ND01 was recovered from lung samples of rabbits that died of fatal respiratory infection, and the ND01 was characterised by intranasal infection of rabbits, multi-locus sequencing typing, screening virulence genes and testing antimicrobial susceptibility. Clinical signs of matted forepaws and pathological lesions of haemorrhagic tracheitis and necrotising haemorrhagic pneumonia were observed in the ND01 infected rabbits, which were identical to those of naturally infected ones. The sequence type of the ND01 was defined as ST3320 and the ND01 was further grouped into the clonal complex 398. Notably, the ND01 was <em>pvl-positive</em> <em>S. aureus</em> and carried the human-associated scn gene. Moreover, the ND01 was methicillin-susceptible <em>S. aureus</em> and was susceptible to 6 of 10 tested antibiotics. This study described the characteristics of the ND01 causing fatal respiratory infection in rabbits. The results are helpful to further the understanding of the pathogenicity of S. aureus ST3320 clone in rabbits. The results also highlighted that operators must be on the alert for the colonisation of <em>pvl-positive</em> <em>S. aureus</em> in rabbits and potential transmission events between rabbits and humans.
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Chen YJ, Jian WH, Liang ZY, Guan WJ, Liang WH, Chen RC, Tang CL, Wang T, Liang HR, Li YM, Liu XQ, Sang L, Cheng LL, Ye F, Li SY, Zhang NF, Zhang Z, Fang Y, He JX, Zhong NS, Zheng JP. Earlier diagnosis improves COVID-19 prognosis: a nationwide retrospective cohort analysis. Ann Transl Med 2021; 9:941. [PMID: 34350256 PMCID: PMC8263884 DOI: 10.21037/atm-20-7210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/23/2021] [Indexed: 12/20/2022]
Abstract
Background Risk of adverse outcomes in COVID-19 patients by stratifying by the time from symptom onset to confirmed diagnosis status is still uncertain. Methods We included 1,590 hospitalized COVID-19 patients confirmed by real-time RT-PCR assay or high-throughput sequencing of pharyngeal and nasal swab specimens from 575 hospitals across China between 11 December 2019 and 31 January 2020. Times from symptom onset to confirmed diagnosis, from symptom onset to first medical visit and from first medical visit to confirmed diagnosis were described and turned into binary variables by the maximally selected rank statistics method. Then, survival analysis, including a log-rank test, Cox regression, and conditional inference tree (CTREE) was conducted, regarding whether patients progressed to a severe disease level during the observational period (assessed as severe pneumonia according to the Chinese Expert Consensus on Clinical Practice for Emergency Severe Pneumonia, admission to an intensive care unit, administration of invasive ventilation, or death) as the prognosis outcome, the dependent variable. Independent factors included whether the time from symptom onset to confirmed diagnosis was longer than 5 days (the exposure) and other demographic and clinical factors as multivariate adjustments. The clinical characteristics of the patients with different times from symptom onset to confirmed diagnosis were also compared. Results The medians of the times from symptom onset to confirmed diagnosis, from symptom onset to first medical visit, and from first medical visit to confirmed diagnosis were 6, 3, and 2 days. After adjusting for age, sex, smoking status, and comorbidity status, age [hazard ratio (HR): 1.03; 95% CI: 1.01–1.04], comorbidity (HR: 1.84; 95% CI: 1.23–2.73), and a duration from symptom onset to confirmed diagnosis of >5 days (HR: 1.69; 95% CI: 1.10–2.60) were independent predictors of COVID-19 prognosis, which echoed the CTREE models, with significant nodes such as time from symptom onset to confirmed diagnosis, age, and comorbidities. Males, older patients with symptoms such as dry cough/productive cough/shortness of breath, and prior COPD were observed more often in the patients who procrastinated before initiating the first medical consultation. Conclusions A longer time from symptom onset to confirmed diagnosis yielded a worse COVID-19 prognosis.
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Affiliation(s)
- Yi-Jun Chen
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Wen-Hua Jian
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Zhen-Yu Liang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Wen-Hua Liang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ru-Chong Chen
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Chun-Li Tang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Tao Wang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Heng-Rui Liang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yi-Min Li
- Department of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao-Qing Liu
- Department of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Sang
- Department of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lin-Ling Cheng
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Feng Ye
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Shi-Yue Li
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Nuo-Fu Zhang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Zhe Zhang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Ying Fang
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Jian-Xing He
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nan-Shan Zhong
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Jin-Ping Zheng
- National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
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Wang T, Tang R, Ruan H, Chen R, Zhang Z, Sang L, Su X, Yi S, Ni Z, Hu Y, Liu L, Shan H, Lei C, Peng Y, Liu C, Li J, Hong C, Zhang N, Zhong N, Li S. Predictors of fatal outcomes among hospitalized COVID-19 patients with pre-existing hypertension in China. Clin Respir J 2021; 15:915-924. [PMID: 33942518 PMCID: PMC8239823 DOI: 10.1111/crj.13382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/26/2021] [Indexed: 01/19/2023]
Abstract
Background Coronavirus disease 2019 (COVID‐19) is an emerging, rapidly evolving pandemic, hypertension is one of the most common co‐existing chronic conditions and a risk factor for mortality. Nearly one‐third of the adult population is hypertensive worldwide, it is urgent to identify the factors that determine the clinical course and outcomes of COVID‐19 patients with hypertension. Methods and results 148 COVID‐19 patients with pre‐existing hypertension with clarified outcomes (discharge or deceased) from a national cohort in China were included in this study, of whom 103 were discharged and 45 died in hospital. Multivariate regression showed higher odds of in‐hospital death associated with high‐sensitivity cardiac troponin (hs‐cTn) > 28 pg/ml (hazard ratio [HR]: 3.27, 95% confidence interval [CI]: 1.55–6.91) and interleukin‐6 (IL‐6) > 7 pg/ml (HR: 3.63, 95% CI:1.54–8.55) at admission. Patients with uncontrolled blood pressure (BP) (n = 52) which were defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg for more than once (≥2 times) during hospitalization, were more likely to have ICU admission (p = 0.037), invasive mechanical ventilation (p = 0.028), and renal injury (p = 0.005). A stricter BP control with the threshold of 130/80 mm Hg was associated with lower mortality. Treatment with renin‐angiotensin‐aldosterone system (RAAS) suppressors, including angiotensin‐converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and spironolactone, was associated with a lower rate of ICU admission compared to other types of anti‐hypertensive medications (8 (22.9%) vs. 25 (43.1%), p = 0.048). Conclusion Among COVID‐19 patients with pre‐existing hypertension, elevated hs‐cTn and IL‐6 could help clinicians to identify patients with fatal outcomes at an early stage, blood pressure control is associated with better clinical outcomes, and RAAS suppressors do not increase mortality and may decrease the need for ICU admission.
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Affiliation(s)
- Tao Wang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Key Laboratory of Vascular Diseases, Guangzhou Medical University, Guangzhou, China
| | - Ruidi Tang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Key Laboratory of Vascular Diseases, Guangzhou Medical University, Guangzhou, China
| | - Honglian Ruan
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Ruchong Chen
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zili Zhang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Key Laboratory of Vascular Diseases, Guangzhou Medical University, Guangzhou, China
| | - Ling Sang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xi Su
- Guangzhou Medical University, Guangzhou, China
| | - Shuting Yi
- Guangzhou Medical University, Guangzhou, China
| | - Zhengyi Ni
- Wuhan Jin-yin tan Hospital, Wuhan, China
| | - Yu Hu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Liu
- Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Hong Shan
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chunliang Lei
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yixiang Peng
- The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
| | - Chunli Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Li
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cheng Hong
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nuofu Zhang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Lv F, Zhong Y, Sang L, Wu X. MiR-1179 is downregulated in cervical cancer and its overexpression suppresses cancer cells invasion by targeting CHAF1A/ZEB1. Acta Biochim Pol 2021; 68:193-199. [PMID: 33740340 DOI: 10.18388/abp.2020_5499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022]
Abstract
The anticancer effect of miR-1179 has been extensively studied in many tumors. The mechanism of miR-1179 action in cervical cancer, however, remains largely unknown. In the present study, miR-1179 was downregulated in both cervical cancer cell lines and cancer tissues. In addition, miR-1179 mimic suppressed cancer cells invasion and epithelial-mesenchymal transition (EMT) in cervical cancer SiHa and Caski cells. We found that chromatin assembly factor 1 subunit A (CHAF1A) might be a direct target of miR-1179 and could be regulated by miR-1179. Furthermore, CHAF1A shRNA suppressed the cervical cancer cells invasion and the expression of EMT-promoted proteins. Reversely, CHAF1A overexpression not only promoted cervical cancer cells invasion but also upregulated the level of Zinc finger E-box binding protein 1 (ZEB1), an EMT-related protein. The induction of ZEB1 could be counteracted by miR-1179 overexpression. It was observed that in cervical cancer patients' tissues, miR-1179 was downregulated while the pathway of CHAF1A/ZEB1 was upregulated. In summary, our research indicated that the miR-1179 might regulate CHAF1A/ZEB1 axis and inhibit the invasion of cervical cancer cells.
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Affiliation(s)
- Fahui Lv
- Department of Obstetrics and Gynaecology, The No.2 People's Hospital of Hefei, Hefei, Anhui Province, 230011, China
| | - Youwen Zhong
- School of Economics and Finance, School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi Province,710061, China
| | - Ling Sang
- Department of Obstetrics and Gynaecology, The No.2 People's Hospital of Hefei, Hefei, Anhui Province, 230011, China
| | - Xiaoling Wu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710004, China
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Zhao Z, Sang L, Li Y, Frerichs I, Möller K, Fu F. Identification of lung overdistension caused by tidal volume and positive end-expiratory pressure increases based on electrical impedance tomography. Br J Anaesth 2021; 126:e167-e170. [PMID: 33640117 DOI: 10.1016/j.bja.2021.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China; Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Ling Sang
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Critical Care Medicine, Guangzhou, China.
| | - Yimin Li
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Critical Care Medicine, Guangzhou, China
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Knut Möller
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Feng Fu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
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Zhang W, Sang L, Shi J, Zhong M, Jiang L, Song B, Kang L, Zhang Y, Zhang D, Yu Y, Zheng X. Association of D-dimer elevation with inflammation and organ dysfunction in ICU patients with COVID-19 in Wuhan, China: a retrospective observational study. Aging (Albany NY) 2021; 13:4794-4810. [PMID: 33591951 PMCID: PMC7950237 DOI: 10.18632/aging.202496] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/19/2020] [Indexed: 12/21/2022]
Abstract
Coronavirus disease 2019 (COVID-19)-associated coagulation dysfunction is gaining attention. In particular, dynamic changes in the D-dimer level may be related to disease progression. Here, we explored whether elevated D-dimer level was related to multiple organ failure and a higher risk of death. This study included 158 patients with COVID-19 who were admitted to the intensive care unit (ICU) at Jinyintan Hospital in Wuhan, China between January 20, 2020 and February 26, 2020. Clinical and laboratory data were collected. The relationship between D-dimer elevation and organ dysfunction was analyzed, as were dynamic changes in inflammation and lipid metabolism. Approximately 63.9% of patients with COVID-19 had an elevated D-dimer level on ICU admission. The 14 day ICU mortality rate was significantly higher in patients with a high D-dimer level than in those with a normal D-dimer level. Patients with a D-dimer level of 10-40μg/mL had similar organ function on ICU admission to those with a D-dimer level of 1.5-10μg/mL. However, patients with higher levels of D-dimer developed organ injuries within 7 days. Furthermore, significant differences in inflammation and lipid metabolism markers were observed between the two groups. In conclusion, the D-dimer level is closely related to COVID-19 severity and might influence the likelihood of rapid onset of organ injury after admission.
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Affiliation(s)
- Wang Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Ling Sang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, P.R. China
| | - Jiaran Shi
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Bin Song
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, Hubei, P.R. China
| | - Liang Kang
- Department of Critical Care Medicine, Jinyintan Hospital, Wuhan, Hubei, P.R. China
| | - Yun Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Dingyu Zhang
- Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Hubei, P.R. China
- Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Hubei, P.R. China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
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Zheng R, Zhou J, Song B, Zheng X, Zhong M, Jiang L, Pan C, Zhang W, Xia J, Chen N, Wu W, Zhang D, Xi Y, Lin Z, Pan Y, Liu X, Li S, Xu Y, Li Y, Tan H, Zhong N, Luo X, Sang L. COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU. Exp Hematol Oncol 2021; 10:6. [PMID: 33522958 PMCID: PMC7848868 DOI: 10.1186/s40164-021-00202-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/21/2021] [Indexed: 01/30/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities which are indicators of higher mortality especially in severe cases. Methods We studied patients with proven COVID-19 disease in the intensive care unit of Jinyintan Hospital, Wuhan, China from 30 to 2019 to 31 March 2020. Results Of 180 patients, 89 (49.44 %) had died, 85 (47.22 %) had been discharged alive, and 6 (3.33 %) were still hospitalised by the end of data collection. A D-dimer concentration of > 0.5 mg/L on admission was significantly associated with 30 day mortality, and a D-dimer concentration of > 5 mg/L was found in a much higher proportion of non-survivors than survivors. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) scoring systems were dichotomised as < 4 or ≥ 4 and < 5 or ≥ 5, respectively, and the mortality rate was significantly different between the two stratifications in both scoring systems. Enoxaparin was administered to 68 (37.78 %) patients for thromboembolic prophylaxis, and stratification by the D-dimer concentration and DIC score confirmed lower mortality in patients who received enoxaparin when the D-dimer concentration was > 2 than < 2 mg/L or DIC score was ≥ 5 than < 5. A low platelet count and low serum calcium concentration were also related to mortality. Conclusions A D-dimer concentration of > 0.5 mg/L on admission is a risk factor for severe disease. A SIC score of > 4 and DIC score of > 5 may be used to predict mortality. Thromboembolic prophylaxis can reduce mortality only in patients with a D-dimer concentration of > 2 mg/L or DIC score of ≥ 5.
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Affiliation(s)
- Runhui Zheng
- Hematology Department, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Jing Zhou
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Bin Song
- Department of Tuberculosis and Respiratory Disease, Wuhan Jinyintan Hospital, 430023, Wuhan, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
| | - Chun Pan
- Department of Critical Care Medicine, Zhongda Hospital, Southeast University, 210009, Nanjing, China
| | - Wei Zhang
- Emergency Department, The 900th Hospital of Joint Service Corps of Chinese PLA, 350025, FuZhou, China
| | - Jiaan Xia
- Department of Tuberculosis and Respiratory Disease, Wuhan Jinyintan Hospital, 430023, Wuhan, China
| | - Nanshan Chen
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China
| | - Wenjuan Wu
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China
| | - Dingyu Zhang
- Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Wuhan, China.,Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, 430023, Wuhan, Hubei, China
| | - Yin Xi
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Zhimin Lin
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Ying Pan
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Xiaoqing Liu
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Shiyue Li
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Yuanda Xu
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Yimin Li
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Huo Tan
- Hematology Department, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China.
| | - Nanshan Zhong
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China.
| | - Xiaodan Luo
- Hematology Department, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China.
| | - Ling Sang
- State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China.
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Sang L, Zheng X, Zhao Z, Zhong M, Jiang L, Huang Y, Liu X, Li Y, Zhang D. Lung Recruitment, Individualized PEEP, and Prone Position Ventilation for COVID-19-Associated Severe ARDS: A Single Center Observational Study. Front Med (Lausanne) 2021; 7:603943. [PMID: 33553203 PMCID: PMC7862746 DOI: 10.3389/fmed.2020.603943] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Patients with coronavirus disease 2019 (COVID-19) may develop severe acute respiratory distress syndrome (ARDS). The aim of the study was to explore the lung recruitability, individualized positive end-expiratory pressure (PEEP), and prone position in COVID-19-associated severe ARDS. Methods: Twenty patients who met the inclusion criteria were studied retrospectively (PaO2/FiO2 68.0 ± 10.3 mmHg). The patients were ventilated under volume-controlled mode with tidal volume of 6 mL/kg predicted body weight. The lung recruitability was assessed via the improvement of PaO2, PaCO2, and static respiratory system compliance (Cstat) from low to high PEEP (5-15 cmH2O). Patients were considered recruitable if two out of three parameters improved. Subsequently, PEEP was titrated according to the best Cstat. The patients were turned to prone position for further 18-20 h. Results: For recruitability assessment, average value of PaO2 was slightly improved at PEEP 15 cmH2O (68.0 ± 10.3 vs. 69.7 ± 7.9 mmHg, baseline vs. PEEP 15 cmH2O; p = 0.31). However, both PaCO2 and Cstat worsened (PaCO2: 72.5 ± 7.1 vs. 75.1 ± 9.0 mmHg; p < 0.01. Cstat: 17.5 ± 3.5 vs. 16.6 ± 3.9 ml/cmH2O; p = 0.05). Only four patients (20%) were considered lung recruitable. Individually titrated PEEP was higher than the baseline PEEP (8.0 ± 2.1 cmH2O vs. 5 cmH2O, p < 0.001). After 18-20 h of prone positioning, investigated parameters were significantly improved compared to the baseline (PaO2: 82.4 ± 15.5 mmHg. PaCO2: 67.2 ± 6.4 mmHg. Cstat: 20.6 ± 4.4 ml/cmH2O. All p < 0.001 vs. baseline). Conclusions: Lung recruitability was very low in COVID-19-associated severe ARDS. Individually titrated PEEP and prone positioning might improve lung mechanics and blood gasses.
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Affiliation(s)
- Ling Sang
- State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Min Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongbo Huang
- State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- State Key Lab of Respiratory Diseases, Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dingyu Zhang
- Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Wuhan, China.,Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, China
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Sang L, Chen S, Nong L, Xu Y, Liang W, Zheng H, Zhou L, Sun H, He J, Liu X, Li Y. The Prevalence, Risk Factors, and Prognosis of Acute Kidney Injury After Lung Transplantation: A Single-Center Cohort Study in China. Transplant Proc 2020; 53:686-691. [PMID: 33334610 DOI: 10.1016/j.transproceed.2020.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this study is to evaluate the incidence, risk factors, and prognosis of acute kidney injury (AKI) after lung transplantation (LTx). METHODS Records of patients who underwent LTx in a single center were retrospectively reviewed. The prevalence of post-transplant AKI, the use of continuous renal replacement therapy (CRRT), and the risk factors for AKI were investigated. The effects of AKI and CRRT on short-term outcomes and long-term survival were measured. RESULTS This study included 148 patients, 67 of which developed postoperative AKI. Of these, 31 patients underwent CRRT; the percentage of cases with no AKI was 6.2%, and the percentage of cases with stage 1, 2, and 3 who used CRRT was 0%, 10%, and 86.2%, respectively. Patients with AKI had significantly higher intensive care unit mortality and in-hospital mortality. The 1-year post-LTx survival rate of patients with AKI was 47.8%, significantly lower than those without AKI (74.1%). There was no difference in 1-year survival rate of those with stage 1 and stage 2 AKI, but patients with stage 3 AKI showed the worst survival. Patients who underwent CRRT had an inferior survival outcome (9.7% vs 76.1%, P < .05). We found that higher acute physiologic assessment and chronic health evaluation (APACHE) II scores (odds ratio [OR] 1.082, P = .009) and higher intraoperative fluid balance (OR 1.001, P = .012) were independent risk factors, and female sex (OR 2.539) and pulmonary hypertension (OR 2.869) were potential risk factors for post-LTx AKI. A prediction model integration of the above factors showed a good concordance with actual risks and had a concordance index (C-index) of 0.76 (95% confidence interval [CI], 0.66-0.87). CONCLUSION Severe AKI requiring CRRT had a negative impact on the short-term and long-term outcomes of patients.
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Affiliation(s)
- Ling Sang
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Sibei Chen
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Lingbo Nong
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Yonghao Xu
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Wenhua Liang
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Haichong Zheng
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Liang Zhou
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Huadong Sun
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Xiaoqing Liu
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.
| | - Yimin Li
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.
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Shi J, Zhang W, Sang L, Qu Z, Zhong M, Jiang L, Song B, Kang L, Zhang Y, Wang X, Zhang D, Zheng X. Coagulation dysfunction in ICU patients with coronavirus disease 2019 in Wuhan, China: a retrospective observational study of 75 fatal cases. Aging (Albany NY) 2020; 13:1591-1607. [PMID: 33318314 PMCID: PMC7880373 DOI: 10.18632/aging.202223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022]
Abstract
Coagulation dysfunction in critically ill patients with coronavirus disease 2019 (COVID-19) has not been well described, and the efficacy of anticoagulant therapy is unclear. In this study, we retrospectively reviewed 75 fatal COVID-19 cases who were admitted to the intensive care unit at Jinyintan Hospital (Wuhan, China). The median age of the cases was 67 (62-74) years, and 47 (62.7%) were male. Fifty patients (66.7%) were diagnosed with disseminated intra-vascular coagulation. Approximately 90% of patients had elevated D-dimer and fibrinogen degradation products, which decreased continuously after anticoagulant treatment and was accompanied by elevated albumin (all P<0.05). The median survival time of patients treated with anticoagulant was 9.0 (6.0-14.0) days compared with 7.0 (3.0-10.0) days in patients without anticoagulant therapy (P=0.008). After anticoagulation treatment, C-reactive protein levels decreased (P=0.004), as did high-sensitivity troponin (P=0.018), lactate dehydrogenase (P<0.001), and hydroxybutyrate dehydrogenase (P<0.001). In conclusion, coagulation disorders were widespread among fatal COVID-19 cases. Anticoagulant treatment partially improved hypercoagulability, prolonged median survival time, and may have postponed inflammatory processes and cardiac injury.
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Affiliation(s)
- Jiaran Shi
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
| | - Wang Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
| | - Ling Sang
- Department of Critical Care Medicine, The First Affiliated Hospital of GuangZhou Medical University, GuangZhou Institute of Respiratory Health, Guangzhou, Guangdong, PR China
| | - Zhaohui Qu
- Department of Critical Care Medicine, Jinyintan Hospital, Wuhan, Hubei, PR China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Bin Song
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, Hubei, PR China
| | - Liang Kang
- Department of Critical Care Medicine, Jinyintan Hospital, Wuhan, Hubei, PR China
| | - Yun Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
| | - Xingxiang Wang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
| | - Dingyu Zhang
- Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Hubei, PR China.,Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Hubei, PR China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
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Sang L, Zhao Z, Lin Z, Liu X, Zhong N, Li Y. A narrative review of electrical impedance tomography in lung diseases with flow limitation and hyperinflation: methodologies and applications. Ann Transl Med 2020; 8:1688. [PMID: 33490200 PMCID: PMC7812189 DOI: 10.21037/atm-20-4984] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Electrical impedance tomography (EIT) is a functional radiation-free imaging technique that measures regional lung ventilation distribution by calculating the impedance changes in the corresponding regions. The aim of the present review was to summarize the current literature concerning the methodologies and applications of EIT in lung diseases with flow limitation and hyperinflation. PubMed was searched up to May 2020 to identify studies investigating the use of EIT in patients with asthma, bronchiectasis, bronchitis, bronchiolitis, chronic obstructive pulmonary disease, and cystic fibrosis. The extracted data included study design, EIT methodologies, interventions, validation and comparators, population characteristics, and key findings. Of the 44 included studies, seven were related to simulation, animal experimentation, or reconstruction algorithm development with evaluation on patients; 27 studies had the primary objective of validating EIT technique and measures including regional ventilation distribution, regional EIT-spirometry parameters, end-expiratory lung impedance, and regional time constants; and 10 studies had the primary objective of applying EIT to monitor the response to therapeutic interventions, including various ventilation supports, patient repositioning, and airway suctioning. In pediatric and adult patients, EIT has been successfully validated for assessing spatial and temporal ventilation distribution, measuring changes in lung volume and flow, and studying regional respiratory mechanics. EIT has also demonstrated potential as an alternative or supplement to well-established measurement modalities (e.g., conventional pulmonary function testing) to monitor the progression of obstructive lung diseases, although the existing literature lacks prediction values as references and lacks clinical outcome evidence.
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Affiliation(s)
- Ling Sang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Department of Crit Care Med, Guangzhou, China
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Zhimin Lin
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Department of Crit Care Med, Guangzhou, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Department of Crit Care Med, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Department of Crit Care Med, Guangzhou, China
| | - Yimin Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Department of Crit Care Med, Guangzhou, China
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Sang L, Chen S, Zheng X, Guan W, Zhang Z, Liang W, Zhong M, Jiang L, Pan C, Zhang W, Xia J, Chen N, Wu W, Wu H, Xu Y, Liu X, Liu X, He J, Li S, Zhang D, Zhong N, Li Y. The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study. BMC Pulm Med 2020; 20:290. [PMID: 33167955 PMCID: PMC7649893 DOI: 10.1186/s12890-020-01305-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/01/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The clinical correlates, prognosis and determinants of acute kidney injury (AKI) in patients with coronavirus disease 2019 (Covid-19) remain largely unclear. METHODS We retrospectively reviewed medical records of all adult patients with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. RESULTS Among 210 patients, 131 were males (62.4%). The median Age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) were classified as being at stage 1, 2 and 3, respectively. 54 patients (58.7%) received continuous renal replacement therapy. Age, sepsis, nephrotoxic drug, invasive mechanical ventilation and elevated baseline serum creatinine levels were associated with the occurrence of AKI. Renal recovery during hospitalization was identified among 16 patients with AKI (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher ratio of partial pressure of oxygen to the fraction of inspired oxygen. Of 210 patients, 93 deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater Age and the lowest ratio of partial pressure of oxygen to the fraction of inspired oxygen being < 150 mmHg were independently associated with death. CONCLUSIONS Among patients with Covid-19, the incidence of AKI was high. Our findings of the risk factors of the development of AKI and factors associated with renal function recovery may inform clinical management of patients with critical illness of Covid-19.
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Affiliation(s)
- Ling Sang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sibei Chen
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Zhejiang, Hangzhou, China
| | - Weijie Guan
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhihui Zhang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thorax Surgery, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chun Pan
- Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wei Zhang
- Emergency Department, the 900th Hospital of Joint Service Corps of Chinese PLA, FuZhou, China
| | - Jiaan Xia
- Department of tuberculosis, Wuhan Jinyintan Hospital, Wuhan, China
| | - Nanshan Chen
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China
| | - Wenjuan Wu
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China
| | - Hongkai Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yonghao Xu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuesong Liu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- Department of Thorax Surgery, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dingyu Zhang
- Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Wuhan, China
- Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, China
| | - Nanshan Zhong
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Ye Z, Rochwerg B, Wang Y, Adhikari NK, Murthy S, Lamontagne F, Fowler RA, Qiu H, Wei L, Sang L, Loeb M, Shen N, Huang M, Jiang Z, Arabi YM, Colunga-Lozano LE, Jiang L, Koh Y, Liu D, Liu F, Phua J, Shen A, Huo T, Du B, Zhai S, Guyatt GH. Traitement des patients atteints d’une forme modérée ou grave de maladie à coronavirus 2019: Ligne directrice fondée sur des données probantes. CMAJ 2020; 192:E1323-E1333. [PMID: 33106308 PMCID: PMC7577570 DOI: 10.1503/cmaj.200648-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Zhikang Ye
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Bram Rochwerg
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Ying Wang
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Neill K Adhikari
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Srinivas Murthy
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - François Lamontagne
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Robert A Fowler
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Haibo Qiu
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Li Wei
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Ling Sang
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Mark Loeb
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Ning Shen
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Minhua Huang
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Zhaonan Jiang
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Yaseen M Arabi
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Luis Enrique Colunga-Lozano
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Li Jiang
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Younsuck Koh
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Dong Liu
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Fang Liu
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Jason Phua
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Aizong Shen
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Tianyi Huo
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Bin Du
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Suodi Zhai
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
| | - Gordon H Guyatt
- Départements de méthodes, données et impacts de la recherche en santé (Ye, Rochwerg, Guyatt, Colunga-Lozano) et de médecine (Rochwerg), Université McMaster, Hamilton, Ont.; Service de pharmacie (Wang), Hôpital Chaoyang de Beijing, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de médecine, Division interdépartementale des soins intensifs (Adhikari, Fowler), Université de Toronto, Toronto, Ont.; Département de médecine de soins intensifs et Institut de recherche Sunnybrook (Adhikari, Fowler), Centre des sciences de la santé Sunnybrook, Toronto, Ont.; Département de pédiatrie (Murthy), Université de la Colombie-Britannique, Vancouver, C-B.; Département de médecine (Lamontagne), Université de Sherbrooke; Centre de recherche du CHU de Sherbrooke (Lamontagne), Sherbrooke, Qué; Département de médecine de soins intensifs (Qiu), Hôpital de Zhongda, Faculté de médecine, Université du Sud-Est, Nanjing, Chine; Service de pharmacie (Wei), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou; Service de médecine de soins intensifs (Sang), Premier hôpital affilié au Centre hospitalier universitaire de Guangzhou, Institut de pneumologie de Guangzhou, Guangzhou, Chine; Département de pathologie, de médecine moléculaire et de méthodes, données et impacts de la recherche en santé (Loeb), Université McMaster, Hamilton, Ont.; Service de pneumologie et de médecine de soins intensifs (Shen), Troisième hôpital universitaire de Pékin, Beijing, Chine; Guangdong Kuaiwen Technology Co. Ltd. (Huang), Guanzhong, Chine; Kunshan Guanghui Precise Metal Co. Ltd. (Jiang), Kunshan, Chine; Département de soins intensifs (Arabi), Centre hospitalier universitaire du Roi Saud bin Abdulaziz, Arabie saoudite; Département de médecine clinique (Colunga-Lozano), Centre des sciences de la santé, Université de Guadalajara, Guadalajara, Mexique; Département de médecine de soins intensifs (Jiang), Hôpital de Xuanwu, Faculté de médecine de l'Université de Pékin, Beijing, Chine; Département de pneumologie et de médecine de soins intensifs (Koh), Faculté de médecine de l'Université d'Ulsan, Séoul, Corée du Sud; Service de pharmacie (Liu), Hôpital de Tongji, Collège médical de Tongji, Université des sciences et de la technologie de Huazhong, Wuhan, Hubei, Chine; Service de pharmacie (Liu, Zhai), Troisième hôpital universitaire de Pékin, Beijing, Chine; Programmes de soins aigus et chroniques (Phua), Hôpital Alexandra, Centre hospitalier universitaire national, Singapour; Service de pharmacie, Premier hôpital affilié USTC, Division des sciences de la vie et de médecine, Université des sciences et de la technologie de Chine, Hefei (Shen), Anhui, Chine; Service de chirurgie générale (Huo), Troisième hôpital universitaire affilié à l'Université de Pékin, Beijing, Chine; Unité de soins intensifs médicaux (Du), Collège médical Union de Pékin, Beijing
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49
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Chen Z, Zhong M, Jiang L, Chen N, Tu S, Wei Y, Sang L, Zheng X, Zhang C, Tao J, Deng L, Song Y. Effects of the Lower Airway Secretions on Airway Opening Pressures and Suction Pressures in Critically Ill COVID-19 Patients: A Computational Simulation. Ann Biomed Eng 2020; 48:3003-3013. [PMID: 33078367 PMCID: PMC7571532 DOI: 10.1007/s10439-020-02648-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023]
Abstract
In patients with critically ill COVID-19 pneumonia, lower airways are filled with plenty of highly viscous exudates or mucus, leading to airway occlusion. The estimation of airway opening pressures and effective mucus clearance are therefore two issues that clinicians are most concerned about during mechanical ventilation. In this study we retrospectively analyzed respiratory data from 24 critically ill patients with COVID-19 who received invasive mechanical ventilation and recruitment maneuver at Jinyintan Hospital in Wuhan, China. Among 24 patients, the mean inspiratory plateau pressure was 52.4 ± 4.4 cmH2O (mean ± [SD]). Particularly, the capnograms presented an upward slope during the expiratory plateau, indicting the existence of airway obstruction. A computational model of airway opening was subsequently introduced to investigate possible fluid dynamic mechanisms for the extraordinarily high inspiratory plateau pressures among these patients. Our simulation results showed that the predicted airway opening pressures could be as high as 40-50 cmH2O and the suction pressure could exceed 20 kPa as the surface tension and viscosity of secretion simulants markedly increased, likely causing the closures of the distal airways. We concluded that, in some critically ill patients with COVID-19, limiting plateau pressure to 30 cmH2O may not guarantee the opening of airways due to the presence of highly viscous lower airway secretions, not to mention spontaneous inspiratory efforts. Active airway humidification and effective expectorant drugs are therefore strongly recommended during airway management.
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Affiliation(s)
- Zhenglong Chen
- School of Medical Instrumentation, Shanghai University of Medicine & Health Sciences, 257 Tianxiong Road, Shanghai, 201318, China
| | - Ming Zhong
- Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Nanshan Chen
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, 1 Yintan Road, Dongxihu District, Wuhan, 430023, China
| | - Shengjin Tu
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, 1 Yintan Road, Dongxihu District, Wuhan, 430023, China
| | - Yuan Wei
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, 1 Yintan Road, Dongxihu District, Wuhan, 430023, China
| | - Ling Sang
- Department of Critical Care Medicine, GuangZhou Institute of Respiratory Health, The First Affiliated Hospital of GuangZhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Chunyuan Zhang
- NMPA Key Laboratory for Respiratory and Anaesthetic Equipment, 1 Jinyinhua Road, Shanghai, 201321, China
| | - Jiale Tao
- Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Linhong Deng
- Changzhou Key Laboratory of Respiratory Medical Engineering, Institute of Biomedical Engineering and Health Sciences, Changzhou University, Changzhou, 213164, Jiangsu, China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
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50
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Wang Y, Zhang L, Sang L, Ye F, Ruan S, Zhong B, Song T, Alshukairi AN, Chen R, Zhang Z, Gan M, Zhu A, Huang Y, Luo L, Mok CKP, Al Gethamy MM, Tan H, Li Z, Huang X, Li F, Sun J, Zhang Y, Wen L, Li Y, Chen Z, Zhuang Z, Zhuo J, Chen C, Kuang L, Wang J, Lv H, Jiang Y, Li M, Lin Y, Deng Y, Tang L, Liang J, Huang J, Perlman S, Zhong N, Zhao J, Malik Peiris JS, Li Y, Zhao J. Kinetics of viral load and antibody response in relation to COVID-19 severity. J Clin Invest 2020; 130:5235-5244. [PMID: 32634129 DOI: 10.1172/jci138759] [Citation(s) in RCA: 393] [Impact Index Per Article: 98.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent for coronavirus 2019 (COVID-19) pneumonia. Little is known about the kinetics, tissue distribution, cross-reactivity, and neutralization antibody response in patients with COVID-19. Two groups of patients with RT-PCR-confirmed COVID-19 were enrolled in this study: 12 severely ill patients in intensive care units who needed mechanical ventilation and 11 mildly ill patients in isolation wards. Serial clinical samples were collected for laboratory detection. Results showed that most of the severely ill patients had viral shedding in a variety of tissues for 20-40 days after onset of disease (8/12, 66.7%), while the majority of mildly ill patients had viral shedding restricted to the respiratory tract and had no detectable virus RNA 10 days after onset (9/11, 81.8%). Mildly ill patients showed significantly lower IgM response compared with that of the severe group. IgG responses were detected in most patients in both the severe and mild groups at 9 days after onset, and remained at a high level throughout the study. Antibodies cross-reactive to SARS-CoV and SARS-CoV-2 were detected in patients with COVID-19 but not in patients with MERS. High levels of neutralizing antibodies were induced after about 10 days after onset in both severely and mildly ill patients which were higher in the severe group. SARS-CoV-2 pseudotype neutralization test and focus reduction neutralization test with authentic virus showed consistent results. Sera from patients with COVID-19 inhibited SARS-CoV-2 entry. Sera from convalescent patients with SARS or Middle East respiratory syndrome (MERS) did not. Anti-SARS-CoV-2 S and N IgG levels exhibited a moderate correlation with neutralization titers in patients' plasma. This study improves our understanding of immune response in humans after SARS-CoV-2 infection.
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Affiliation(s)
- Yanqun Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Lu Zhang
- Institute of Infectious disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ling Sang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Shicong Ruan
- Yangjiang People's Hospital, Yangjiang, Guangdong, China
| | - Bei Zhong
- Sixth Affiliated Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, Guangdong, China
| | - Tie Song
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Abeer N Alshukairi
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Rongchang Chen
- Shenzhen Institute of Respiratory Disease, First Affiliated Hospital (Shenzhen People's Hospital), South University of Science and Technology of China, Shenzhen, Guangdong, China
| | - Zhaoyong Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Mian Gan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Airu Zhu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Yongbo Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Ling Luo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Chris Ka Pun Mok
- HKU-Pasteur Research Pole, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | | | - Haitao Tan
- Yangjiang People's Hospital, Yangjiang, Guangdong, China
| | - Zhengtu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Xiaofang Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Fang Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Jing Sun
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Yanjun Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Liyan Wen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Yuming Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Zhao Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Zhen Zhuang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Jianfen Zhuo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Chunke Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Lijun Kuang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Junxiang Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Huibin Lv
- HKU-Pasteur Research Pole, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Yongliang Jiang
- Sixth Affiliated Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, Guangdong, China
| | - Min Li
- Sixth Affiliated Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, Guangdong, China
| | - Yimin Lin
- Sixth Affiliated Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, Guangdong, China
| | - Ying Deng
- Sixth Affiliated Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, Guangdong, China
| | - Lan Tang
- Sixth Affiliated Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, Guangdong, China
| | - Jieling Liang
- Sixth Affiliated Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, Guangdong, China
| | - Jicheng Huang
- Technology Centre, Guangzhou Customs, Guangzhou, Guangdong, China
| | - Stanley Perlman
- Department of Microbiology and Immunology, University of Iowa, Iowa City, Iowa, USA
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Jingxian Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - J S Malik Peiris
- HKU-Pasteur Research Pole, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Yimin Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and
| | - Jincun Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, and.,Institute of Infectious disease, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
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