BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum leve...BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.展开更多
BACKGROUND：Glutamine （Gin） supplementation is known to decrease oxidative stress and inflammatory response, enhance resistance to infectious pathogens, shorten hospital stay, and decrease medical costs of patients....BACKGROUND：Glutamine （Gin） supplementation is known to decrease oxidative stress and inflammatory response, enhance resistance to infectious pathogens, shorten hospital stay, and decrease medical costs of patients. This study was undertaken to evaluate the relationship between the effect of early parenteral glutamine （Gin） supplement on acute liver injury （ALl） and heat shock protein 70 （HSP-70） expression in critical patients. METHODS：Forty-four patients who had been admitted to the emergency intensive care unit （EICU） of Nanjing First Hospital Affiliated to Nanjing Medical University were randomly divided into a control group （n=22） and a Gin group （n=22）. The patients of the two groups received enteral and parenteral nutrition. In addition, parenteral Gin 0.4 g/kg per day was given for 7 days in the Gin group. Serum HSP-70 and Gin were measured at admission and at 7 days after admission. Serum alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, and total bilirubin （TBiL）, serum levels of HSP-70 and Gin, mechanical ventilation （MV） time, ICU stay, peripheral blood of TNF-α, IL- 6, CD3, CD4 and CD4/CD8 levels were also measured in the two groups. RESULTS： In the Gin group, the levels of serum HSP-70 and Gin were significantly higher after Gin treatment than those before the treatment （P〈0.01）. HSP-70 level was positively correlated with the Gin level in the Gin group after administration of parenteral Gin （P〈0.01）. The levels of serum ALT, AST, TBiL and TNF-a, IL-6 were lower in the Gin group than in the non-Gin group （P〈0.01）. MV time and ICU stay were significantly different between the two groups （P〈0.05）. The levels of CD3, CD4 and CD4/ CD8 were significantly higher in the Gin group than in the control group after treatment （P〈0.05）. CONCLUSION：Parenteral Gin significantly increases the level of serum HSP70 in critically ill patients. The enhanced expression of HSP70 is correlated with improved outcomes of Gin-treated patients with acute liver injury.展开更多
BACKGROUND:When critically ill patients require specialized treatment that exceeds the capability of the index hospitals,patients are frequently transferred to a tertiary or quaternary hospital for a higher level of c...BACKGROUND:When critically ill patients require specialized treatment that exceeds the capability of the index hospitals,patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care.Therefore,appropriate and efficient care for patients during the process of transport between two hospitals(interfacility transfer)is an essential part of patient care.While medical adverse events may occur during the interfacility transfer process,there have not been evidence-based guidelines regarding the equipment or the practice for patient care during transport.METHODS:We conducted searches from the PubMed,Cumulative Index of Nursing and Allied Health(CINAHL),and Scopus databases up to June 2022.Two reviewers independently screened the titles and abstracts for eligibility.Studies that were not in the English language and did not involve critically ill patients were excluded.RESULTS:The search identified 75 articles,and we included 48 studies for our narrative review.Most studies were observational studies.CONCLUSION:The review provided the current evidence-based management of diverse disease states during the interfacility transfer process,such as proning positioning for respiratory failure,extracorporeal membrane oxygenation(ECMO),obstetric emergencies,and hypertensive emergencies(aortic dissection and spontaneous intracranial hemorrhage).展开更多
文摘BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.
文摘BACKGROUND：Glutamine （Gin） supplementation is known to decrease oxidative stress and inflammatory response, enhance resistance to infectious pathogens, shorten hospital stay, and decrease medical costs of patients. This study was undertaken to evaluate the relationship between the effect of early parenteral glutamine （Gin） supplement on acute liver injury （ALl） and heat shock protein 70 （HSP-70） expression in critical patients. METHODS：Forty-four patients who had been admitted to the emergency intensive care unit （EICU） of Nanjing First Hospital Affiliated to Nanjing Medical University were randomly divided into a control group （n=22） and a Gin group （n=22）. The patients of the two groups received enteral and parenteral nutrition. In addition, parenteral Gin 0.4 g/kg per day was given for 7 days in the Gin group. Serum HSP-70 and Gin were measured at admission and at 7 days after admission. Serum alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, and total bilirubin （TBiL）, serum levels of HSP-70 and Gin, mechanical ventilation （MV） time, ICU stay, peripheral blood of TNF-α, IL- 6, CD3, CD4 and CD4/CD8 levels were also measured in the two groups. RESULTS： In the Gin group, the levels of serum HSP-70 and Gin were significantly higher after Gin treatment than those before the treatment （P〈0.01）. HSP-70 level was positively correlated with the Gin level in the Gin group after administration of parenteral Gin （P〈0.01）. The levels of serum ALT, AST, TBiL and TNF-a, IL-6 were lower in the Gin group than in the non-Gin group （P〈0.01）. MV time and ICU stay were significantly different between the two groups （P〈0.05）. The levels of CD3, CD4 and CD4/ CD8 were significantly higher in the Gin group than in the control group after treatment （P〈0.05）. CONCLUSION：Parenteral Gin significantly increases the level of serum HSP70 in critically ill patients. The enhanced expression of HSP70 is correlated with improved outcomes of Gin-treated patients with acute liver injury.
文摘BACKGROUND:When critically ill patients require specialized treatment that exceeds the capability of the index hospitals,patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care.Therefore,appropriate and efficient care for patients during the process of transport between two hospitals(interfacility transfer)is an essential part of patient care.While medical adverse events may occur during the interfacility transfer process,there have not been evidence-based guidelines regarding the equipment or the practice for patient care during transport.METHODS:We conducted searches from the PubMed,Cumulative Index of Nursing and Allied Health(CINAHL),and Scopus databases up to June 2022.Two reviewers independently screened the titles and abstracts for eligibility.Studies that were not in the English language and did not involve critically ill patients were excluded.RESULTS:The search identified 75 articles,and we included 48 studies for our narrative review.Most studies were observational studies.CONCLUSION:The review provided the current evidence-based management of diverse disease states during the interfacility transfer process,such as proning positioning for respiratory failure,extracorporeal membrane oxygenation(ECMO),obstetric emergencies,and hypertensive emergencies(aortic dissection and spontaneous intracranial hemorrhage).
