critically ill patient

危重患者
  • 文章类型: Journal Article
    多种病原真菌可在免疫功能低下的患者中产生严重的感染,从而证明重症监护病房(ICU)入院是合理的。在某些情况下,感染可发生在先前入住ICU的免疫功能低下患者中.曲霉属。,肺孢子虫jirovecii,念珠菌属。,而毛霉则是这些感染中最常见的真菌。诊断仍然具有挑战性,因为症状和体征不明确。在这里,我们对诊断进行了深入的回顾,强调最近的进展,并在ICU环境中治疗这些侵袭性真菌感染。
    Diverse pathogenic fungi can produce severe infections in immunocompromised patients, thereby justifying intensive care unit (ICU) admissions. In some cases, the infections can develop in immunocompromised patients who were previously admitted to the ICU. Aspergillus spp., Pneumocystis jirovecii, Candida spp., and Mucorales are the fungi that are most frequently involved in these infections. Diagnosis continues to be challenging because symptoms and signs are unspecific. Herein, we provide an in-depth review about the diagnosis, with emphasis on recent advances, and treatment of these invasive fungal infections in the ICU setting.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    罕见和超罕见的遗传条件显著有助于婴儿的发病率和死亡率,通常表现为非典型特征和遗传异质性,使管理复杂化。快速基因组测序(RGS)提供了一种及时且具有成本效益的诊断方法,帮助早期临床管理,减少不必要的干预措施。这项初步研究代表了下一代测序(NGS)作为土耳其医院环境中危重新生儿和儿科ICU患者的诊断工具的首次使用。
    根据预定义的纳入标准登记了10名婴儿,并进行了三重奏RGS。参与者的平均年龄是124天,先天性异常是最常见的测试适应症。三名患者的父母有血亲。从入学到结果交付的平均周转时间为169小时,诊断产率为50%。
    三名患者接受了明确的分子诊断,影响他们的临床管理。两名患者受益于孟德尔疾病的排除,导致替代诊断。
    这项研究证明了RGS在土耳其医院环境中的可行性和结果,强调及时进行基因诊断在减少家庭诊断和改善患者护理方面的重要性。需要进一步的研究来评估RGS在土耳其医疗保健系统中对病因不确定的儿童的成本效益和适用性。
    UNASSIGNED: Rare and ultra-rare genetic conditions significantly contribute to infant morbidity and mortality, often presenting with atypical features and genetic heterogeneity that complicate management. Rapid genome sequencing (RGS) offers a timely and cost-effective approach to diagnosis, aiding in early clinical management and reducing unnecessary interventions. This pilot study represents the inaugural use of next-generation sequencing (NGS) as a diagnostic instrument for critically ill neonatal and pediatric ICU patients in a Turkish hospital setting.
    UNASSIGNED: Ten infants were enrolled based on predefined inclusion criteria, and trio RGS was performed. The mean age of the participants was 124 days, with congenital abnormalities being the most common indication for testing. Three patients had consanguineous parents. The mean turnaround time from enrollment to delivery of results was 169 h, with a diagnostic yield of 50%.
    UNASSIGNED: Three patients received a definitive molecular diagnosis, impacting their clinical management. Two patients benefited from the exclusion of Mendelian conditions, leading to alternative diagnoses.
    UNASSIGNED: This study demonstrates the feasibility and results of RGS in Turkish hospital settings, emphasizing the importance of timely genetic diagnosis in reducing the diagnostic odyssey for families and improving patient care. Further research is needed to evaluate the cost-effectiveness and applicability of RGS in the Turkish healthcare system for children with diseases of uncertain etiology.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:获得性危重病无力(AWCIP)是重症监护医学科中最常见的神经肌肉疾病。它的重要性在于住院时间的延长以及住院后患者的康复延迟。这项研究的主要目的是研究神经肌肉阻断剂与危重病人获得性虚弱发展之间的关系。
    方法:我们对103例接受定期肌电图监测的危重患者进行了前瞻性研究。
    结果:在63例患者中观察到AWCIP的发展。开发AWCIP的患者组的神经肌肉阻滞剂利用率明显高于未开发AWCIP的患者组[79.4%vs50%,OR:3.85(1.63-9.39),p<0.02];同样,这组患者的ICU住院时间较长[32天比14天,OR:1.11(1.06-1.17),p<0。001]和更长的机械通气时间[24天比9天,OR:1.2(1.11-1.32),p<0.001]。
    结论:神经肌肉阻断剂是与AWCIP发生相关的因素。
    BACKGROUND: Acquired critical illness weakness (AWCIP) is the most frequent neuromuscular disease in intensive care medicine departments. Its importance is given by the prolongation of hospital stay and the delayed recovery it causes to patients after hospitalization. The main objective of this study was to investigate the association between neuromuscular blocking agents and the development of acquired weakness in critically ill patients.
    METHODS: We conducted a prospective study of 103 critically ill patients who were periodically monitored with electromyography.
    RESULTS: The development of AWCIP was observed in 63 patients. The group of patients who developed AWCIP had a significantly higher utilization of neuromuscular blocking agents than the group who did not develop AWCIP [79.4% vs 50%, OR:3.85 (1.63-9.39), p <0.02]; likewise, this group of patients had a longer ICU stay [32 days vs 14 days, OR: 1.11 (1.06-1.17), p <0. 001] and a longer mechanical ventilation time [24 days vs 9 days, OR:1.2 (1.11-1.32), p <0.001].
    CONCLUSIONS: Neuromuscular blocking agents are a factor associated with the occurrence of AWCIP.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    背景:压力损伤是指由于长时间的压力而对皮肤和/或组织的局部损伤,它最近被定义为包括与医疗设备有关的压力伤害。与医疗设备相关的压力损伤发生在不同的部位并且难以检测。即使它被检测到,医疗器械对危重病人的生活至关重要。因此,很难移除或改变医疗设备的位置;因此,预防至关重要。本研究旨在整合有关危重病人与医疗器械相关的压力损伤预防方案的文献。
    方法:文献纳入标准为(1)危重患者,(2)与设备相关的压力伤害干预措施,(3)随机对照试验和准实验设计,和(4)用韩语或英语写的。在PRISMA指南的支持下,根据Cochrane干预措施系统审查手册进行文献检索和选择。
    结果:最终选择了12篇文章。医疗器械相关压力性损伤的发生率从干预前的8.1-96.7%下降到干预后的0.3-53.3%,分别。医疗器械相关压力性损伤预防应用于各年龄段患者均能有效降低医疗器械相关压力性损伤发生率,从新生儿到成人,在各种重症监护病房。与医疗器械相关的压力性损伤预防策略包括护士教育,评估,文档,和干预措施(卫生,重新定位,紧急治疗,如保护性敷料或设计的减压设备)压力损伤。压力损伤敷料主要包括水胶体泡沫敷料,但透明的水胶体配方也有效降低了医疗器械相关压力损伤的发生率。
    结论:在未来,有必要通过针对不同的医疗设备和压力伤害领域应用专门的与医疗设备相关的压力伤害预防方法来提高证据水平,并验证其有效性。
    背景:审查协议已注册(PROSPERO注册号:CRD42022346450)。
    BACKGROUND: A pressure injury refers to localized damage to the skin and/or tissue due to prolonged pressure, and it has recently been defined to include pressure injuries related to medical devices. Medical device-related pressure injuries occur in various sites and are difficult to detect. Even if it is detected, medical devices are essential to life for critically ill patients. Thus, it is difficult to remove or change the position of the medical device; therefore, prevention is essential. This study aims to integrate the literature on medical device-related pressure injury prevention protocols among critically ill patients.
    METHODS: The literature inclusion criteria were (1) critically ill patients, (2) device-related pressure injury interventions, (3) randomized controlled trials and quasi-experimental designs, and (4) written in Korean or English. The literature search and selection were performed following the Cochrane Handbook for Systematic Reviews of Interventions with the support of the PRISMA Guidelines.
    RESULTS: Twelve articles were finally selected. The incidence of medical device-related pressure injury decreased from 8.1-96.7% before intervention to 0.3-53.3% after intervention, respectively. Medical device-related pressure injury prevention was effective in reducing medical device-related pressure injury incidence when applied to patients of all ages, from neonates to adults, in a variety of intensive care units. Medical device-related pressure injury prevention strategies include nurse education, assessment, documentation, and interventions (hygiene, repositioning, emergent therapy such as protective dressing or designed equipment reducing pressure) of pressure injury. Pressure injury dressings primarily included hydrocolloid foam dressings, but transparent hydrocolloid formulations also effectively reduced medical device-related pressure injury incidence rates.
    CONCLUSIONS: In the future, it is necessary to increase the level of evidence by applying specialized medical device-related pressure injury prevention methods for different medical devices and areas of pressure injuries, and verifying their effectiveness.
    BACKGROUND: The review protocol was registered (PROSPERO registration number: CRD42022346450).
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    接受连续性肾脏替代治疗(CRRT)的急性肾损伤(AKI)危重患者的生存率高度依赖于其营养状况。
    预后营养指数(PNI)是用于评估营养状况的指标,其计算公式为:PNI=(以g/dL为单位的血清白蛋白)×10(以/mm3为单位的总淋巴细胞计数)×0.005。在这项回顾性研究中,在接受CRRT治疗的AKI危重患者中,我们调查了该指标与临床结局之间的相关性.
    我们分析了彰化基督教医院重症监护室收治的2076名危重病人的数据,台湾中部的一家三级医院,2010年1月1日至2021年4月30日之间。所有这些患者均符合研究的纳入标准。使用logistic回归模型检查PNI与无肾脏替代治疗生存率(RRTFS)和死亡率之间的关系,Cox比例风险模型,和倾向得分匹配。在我们的研究中观察到肠外营养(PN)的高利用率。进行亚组分析以探讨PNI和PN对死亡率的交互作用。
    PNI水平较高的患者表现出更大的实现RRTFS的可能性,调整后的比值比为2.43(95%置信区间[CI]:1.98-2.97,p值<0.001)。此外,这些患者表现出更高的生存率,28天死亡率的校正风险比为0.84(95%CI:0.72-0.98),90天死亡率为0.80(95%CI:0.69-0.92)(所有p值<0.05),与低PNI组相比。虽然观察到肠外营养(PN)的高利用率,78.86%的CRRT患者接受PN,亚组分析显示,高PNI对接受CRRT的AKI患者的死亡结局有独立的保护作用,不管他们的PN状态如何。
    PNI可以作为一个简单的,简单,以及淋巴细胞和白蛋白水平的有效测量,以预测需要CRRT的AKI患者的RRTFS和死亡率。
    UNASSIGNED: The survival of critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT) is highly dependent on their nutritional status.
    UNASSIGNED: The prognostic nutritional index (PNI) is an indicator used to assess nutritional status and is calculated as: PNI = (serum albumin in g/dL) × 10 + (total lymphocyte count in/mm3) × 0.005. In this retrospective study, we investigated the correlation between this index and clinical outcomes in critically ill patients with AKI receiving CRRT.
    UNASSIGNED: We analyzed data from 2076 critically ill patients admitted to the intensive care unit at Changhua Christian Hospital, a tertiary hospital in central Taiwan, between January 1, 2010, and April 30, 2021. All these patients met the inclusion criteria of the study. The relationship between PNI and renal replacement therapy-free survival (RRTFS) and mortality was examined using logistic regression models, Cox proportional hazard models, and propensity score matching. High utilization rate of parenteral nutrition (PN) was observed in our study. Subgroup analysis was performed to explore the interaction effect between PNI and PN on mortality.
    UNASSIGNED: Patients with higher PNI levels exhibited a greater likelihood of achieving RRTFS, with an adjusted odds ratio of 2.43 (95% confidence interval [CI]: 1.98-2.97, p-value < 0.001). Additionally, these patients demonstrated higher survival rates, with an adjusted hazard ratio of 0.84 (95% CI: 0.72-0.98) for 28-day mortality and 0.80 (95% CI: 0.69-0.92) for 90-day mortality (all p-values < 0.05), compared to those in the low PNI group. While a high utilization rate of parenteral nutrition (PN) was observed, with 78.86% of CRRT patients receiving PN, subgroup analysis showed that high PNI had an independent protective effect on mortality outcomes in AKI patients receiving CRRT, regardless of their PN status.
    UNASSIGNED: PNI can serve as an easy, simple, and efficient measure of lymphocytes and albumin levels to predict RRTFS and mortality in AKI patients with require CRRT.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:以前的研究已经探讨了败血症和创伤等危重疾病的病例数与患者预后之间的关系,以及各种手术,期望更多的病例将对患者预后产生更有利的影响。这项研究的目的是阐明重症监护病房(ICU)病例量之间的关系,专业化,和危重急诊患者的患者结局,并确定ICU病例量和专业化如何影响日本ICU中这些患者的结局。
    方法:利用2015年4月至2021年3月日本重症监护患者数据库(JIPAD)的数据,这项回顾性队列研究在日本80个ICU中进行,包括72,214名年龄≥16岁的急诊患者。主要结局指标是住院死亡率,次要结局包括ICU死亡率,28天死亡率,无呼吸机日,以及ICU和住院时间的长短。使用贝叶斯分层广义线性混合模型来调整患者和ICU级别的变量。
    结果:本研究揭示了ICU病例量增加与住院死亡率降低之间的显著关联。特别是,急诊患者比例较高(>75%)的ICU表现出更明显的效果,在较高病例量四分位数(Q2,Q3和Q4)中住院死亡率的比值比为0.92(95%可信区间[CI]:0.88-0.96),0.70(95%CI:0.67-0.73),和0.78(95%CI:0.73-0.83),分别,与最低四分位数(Q1)相比。对于各种次要结果观察到类似的趋势。
    结论:在主要治疗危重急诊患者的日本ICU中,较高的ICU病例量与较低的住院死亡率显著相关。这些发现强调了ICU专业化的重要性,并强调了集中护理对危重急诊患者的潜在益处。这些发现是改善日本医疗保健政策的潜在见解,并且可能在其他拥有类似医疗保健系统的国家的紧急护理环境中很有价值。在仔细考虑上下文差异之后。
    BACKGROUND: Previous studies have explored the association between the number of cases and patient outcomes for critical illnesses such as sepsis and trauma, as well as various surgeries, with the expectation that a higher number of cases would have a more favorable effect on patient outcomes. The aim of this study was to elucidate the association among intensive care unit (ICU) case volume, specialization, and patient outcomes in critically ill emergency patients and to determine how ICU case volumes and specializations impact the outcomes of these patients in Japanese ICUs.
    METHODS: Utilizing data from the Japanese Intensive Care PAtient Database (JIPAD) from April 2015 to March 2021, this retrospective cohort study was conducted in 80 ICUs across Japan and included 72,214 emergency patients aged ≥ 16 years. The primary outcome measure was in-hospital mortality, and the secondary outcomes encompassed ICU mortality, 28-day mortality, ventilator-free days, and the lengths of ICU and hospital stays. Bayesian hierarchical generalized linear mixed models were used to adjust for patient- and ICU-level variables.
    RESULTS: This study revealed a significant association between a higher ICU case volume and decreased in-hospital mortality. In particular, ICUs with a higher percentage (> 75%) of emergency patients showed more pronounced effects, with the odds ratios for in-hospital mortality in the higher case volume quartiles (Q2, Q3, and Q4) being 0.92 (95% credible interval [CI]: 0.88-0.96), 0.70 (95% CI: 0.67-0.73), and 0.78 (95% CI: 0.73-0.83), respectively, compared with the lowest quartile (Q1). Similar trends were observed for various secondary outcomes.
    CONCLUSIONS: Higher ICU case volumes were significantly associated with lower in-hospital mortality rates in Japanese ICUs predominantly treating critically ill emergency patients. These findings emphasize the importance of ICU specialization and highlight the potential benefits of centralized care for critically ill emergency patients. These findings are potential insights for improving health care policy in Japan and may be valuable in emergency care settings in other countries with similar healthcare systems, after careful consideration of contextual differences.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:抗感染药物如利奈唑胺的治疗药物监测(TDM)通常在重症监护病房(ICU)患者的血液中进行,以优化目标实现。然而,感染部位的浓度被认为对成功的治疗更为重要。直到现在,支气管肺泡灌洗(BAL)是测定肺内抗感染药物浓度的金标准.然而,这是一种侵入性方法,不适合常规TDM。这项概念验证研究的目的是研究是否有可能通过气管内抽吸(ENTA)可靠地确定利奈唑胺的肺内浓度。
    方法:对每天两次静脉注射600mg利奈唑胺的插管ICU患者进行稳态检查。首先,在6例患者中进行了初步实验,以研究哪些患者适合在ENTA中进行利奈唑胺测量。第二步,在9例合适的患者中测定了利奈唑胺的血浆和ENTA的谷和峰浓度.
    结果:利奈唑胺可以在具有粘性质地和>0.5mL体积的ENTA中有效检测到。平均(SD)利奈唑胺谷浓度在血浆中为2.02(1.27)mg/L,在ENTA中为1.60(1.36)mg/L,导致肺穿透率中位数为104%。血浆和ENTA的平均(SD)峰浓度为10.77(5.93)和4.74(2.66)mg/L。
    结论:利奈唑胺可以在具有足够质地和体积的ENTA中有效测定。渗透率与已经公布的BAL浓度相当。这种方法可能为感染部位“肺”的TDM提供一种简单而非侵入性的方法。由于可行性研究的有希望的结果,同一患者中ENTA和BAL的比较应在进一步的试验中进行研究.
    BACKGROUND: Therapeutic drug monitoring (TDM) of anti-infectives such as linezolid is routinely performed in blood of intensive care unit (ICU) patients to optimize target attainment. However, the concentration at the site of infection is considered more important for a successful therapy. Until now, bronchoalveolar lavage (BAL) is the gold standard to measure intrapulmonary concentrations of anti-infective agents. However, it is an invasive method and unsuitable for regular TDM. The aim of this proof-of-concept study was to investigate whether it is possible to reliably determine the intrapulmonary concentration of linezolid from endotracheal aspiration (ENTA).
    METHODS: Intubated ICU patients receiving 600 mg intravenous linezolid twice daily were examined in steady state. First, preliminary experiments were performed in six patients to investigate which patients are suitable for linezolid measurement in ENTA. In a second step, trough and peak linezolid concentrations of plasma and ENTA were determined in nine suitable patients.
    RESULTS: Linezolid can validly be detected in ENTA with viscous texture and > 0.5 mL volume. The mean (SD) linezolid trough concentration was 2.02 (1.27) mg/L in plasma and 1.60 (1.36) mg/L in ENTA, resulting in a median lung penetration rate of 104%. The mean (SD) peak concentration in plasma and ENTA was 10.77 (5.93) and 4.74 (2.66) mg/L.
    CONCLUSIONS: Linezolid can validly be determined in ENTA with an adequate texture and volume. The penetration rate is comparable to already published BAL concentrations. This method might offer a simple and non-invasive method for TDM at the site of infection \"lung\". Due to promising results of the feasibility study, comparison of ENTA and BAL in the same patient should be investigated in a further trial.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    气管内套囊压力(ETCP)是确定与有创机械通气相关的并发症发展的重要因素。为避免因固定而产生可预防的并发症,身体定位的频繁变化是必要的。身体位置的这种变化会影响机械通气的重症患者的ETCP。所以,本研究旨在评估机械通气患者体位变化对ETCP的影响.
    这项前瞻性观察性研究包括31名危重患者。首先将每个研究对象放置在中立的起始位置,头部高度为30º。然后,作为重症监护病房(CCU)日常工作的一部分,他们根据16个最常用的体位顺序改变体位.每次改变后测量气管内套囊压力。使用标准统计检验分析数据。
    在颈部前屈期间观察到ETCP的统计学显着差异,颈部过度伸展,颈部左外侧屈,颈部右外侧屈,颈部左侧旋转,颈部右侧旋转,10卧位,仰卧位,特伦德伦堡位置,和右侧30°和45°位置。在颈部前屈期间,可以看到ETCP的最大增加(31±4.5;22-42cmH2O)。
    我们的研究表明,在机械通气患者的身体位置变化后,ETCP与推荐范围存在显着偏差,强调了ETCP测量后的每个位置变化和保持在目标范围内的必要性。
    RoyO,DasguptaS,钱德拉A,BiswasP,乔杜里A,GhoshS,etal.重症患者机械通气时气管内套管压力与体位变化的关系:一项观察性研究。印度J暴击护理中心2024;28(1):36-40。
    UNASSIGNED: Endotracheal tube cuff pressure (ETCP) is an important factor to determine the development of complications associated with invasive mechanical ventilation. To avoid preventable complications arising out of immobilization, frequent changes in body positioning are necessary. Such variations in body position can affect ETCP in critically ill patients who are on mechanical ventilation. So, our study aimed to assess the effect of changes in body position on ETCP in patients who are on mechanical ventilation.
    UNASSIGNED: This prospective observational study included 31 critically ill intubated patients. Each study subject was first placed in a neutral starting position with a 30º head elevation. Then, they were subjected to a sequential change in body position based on the 16 most used positions as part of the critical care unit\'s (CCUs) daily routine. Endotracheal tube cuff pressure was measured after each position change. Data were analyzed using standard statistical tests.
    UNASSIGNED: Statistically significant difference in ETCP was observed during anteflexion of neck, hyperextension of neck, left lateral flexion of neck, right lateral flexion of neck, left lateral rotation of neck, right lateral rotation of neck, 10o recumbent position, supine position, Trendelenburg position, and right lateral 30° and 45° positions. Maximum increase in ETCP was seen during anteflexion of neck (31 ± 4.5; 22-42 cm H2O).
    UNASSIGNED: Our study demonstrates significant deviations in ETCP from the recommended range following changes in the body position of mechanically ventilated patients, highlighting the need for the measurement of ETCP after each position change and maintenance of the same within the target range.
    UNASSIGNED: Roy O, Dasgupta S, Chandra A, Biswas P, Choudhury A, Ghosh S, et al. Relationship of Endotracheal Tube Cuff Pressures with Changes in Body Positions of Critically Ill Patients on Mechanical Ventilation: An Observational Study. Indian J Crit Care Med 2024;28(1):36-40.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    A szepszis életet veszélyeztető, komplex klinikai állapot, melynek kezelése jelentős kihívást és számottevő költségráfordítást jelent a betegellátás számára. A szepszis által előidézett patofiziológiai változások jelentős mértékben megváltoztatják a gyógyszerek és a szervezet kölcsönhatását, megnehezítve az optimális gyógyszerelést. A kapillárisszivárgás jelensége, valamint az ellátás során alkalmazott folyadékterápia hatására megemelkedhet egyes antibiotikumok megoszlási térfogata. A hypalbuminaemia következtében megnövekedett szabad frakció a nagy fehérjekötődésű antibiotikumok gyorsabb eliminációját okozhatja. A megnövekedett perctérfogat és a vascularis ellenállás csökkenése a fiatalabb betegpopulációkban megnövekedett renalis clearance-t idézhet elő. A betegek nagyobb hányadában azonban a hipoperfúzió miatt szepszis indukálta akut veseelégtelenség jellemző, melynek hatására a renalis clearance csökken. A klinikai képet tovább árnyalja, ha vesepótló vagy extracorporalis membránoxigenizációs kezelést alkalmazunk. Az antibiotikumok fizikai-kémiai jellemzői meghatározzák, hogy a patofiziológiai változások milyen mértékben befolyásolják az egyes gyógyszermolekulák farmakokinetikai paramétereit. A várttól eltérő gyógyszer-expozíciót előidéző folyamatok ellensúlyozására a farmakokinetikai-farmakodinamikai indexek, valamint a fizikokémiai értékek ismeretében többféle klinikai stratégia áll rendelkezésre. A terápia racionális szempontok szerint történő személyre szabásával és a terápiás gyógyszerszint monitorozásával növelhető a hatékonyság, és csökkenthető az antibiotikumrezisztencia kialakulásának esélye. Orv Hetil. 2024; 165(11): 403–415.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    入住重症监护病房(ICU)的患者经常会出现内毒素血症,医院感染和败血症。多形核和单核细胞髓源性抑制细胞(PMN-MDSCs和M-MDSCs)可对感染性疾病的发生发展产生重要影响。但对其在危重患者中的潜在预测价值知之甚少。这里,我们使用无监督流式细胞术分析对接受内毒素攻击的健康受试者和入住重症监护病房并有感染风险的危重患者的MDSC样细胞进行定量.与PMN-MDSC和M-MDSC表型相似的细胞在内毒素攻击后增加。ICU入院时患者的相似细胞升高,ICU出院时恢复正常。表达中等水平CD15的M-MDSC样细胞亚群(CD15intM-MDSC)与总死亡率相关(p=0.02)。有趣的是,PMN-MDSCs和CD15intM-MDSCs的高丰度是死亡率的良好预测因子(p=0.0046和0.014),死亡率的ROC曲线下面积为0.70(95%CI=0.4-1.0)和0.86(0.62-1.0),分别。总的来说,我们的观察结果支持以下观点:MDSCs是脓毒症的生物标志物,流式细胞术监测MDSCs可用于ICU患者靶向治疗的风险分层.
    Patients admitted to the intensive care unit (ICU) often experience endotoxemia, nosocomial infections and sepsis. Polymorphonuclear and monocytic myeloid-derived suppressor cells (PMN-MDSCs and M-MDSCs) can have an important impact on the development of infectious diseases, but little is known about their potential predictive value in critically ill patients. Here, we used unsupervised flow cytometry analyses to quantify MDSC-like cells in healthy subjects challenged with endotoxin and in critically ill patients admitted to intensive care units and at risk of developing infections. Cells phenotypically similar to PMN-MDSCs and M-MDSCs increased after endotoxin challenge. Similar cells were elevated in patients at ICU admission and normalized at ICU discharge. A subpopulation of M-MDSC-like cells expressing intermediate levels of CD15 (CD15int M-MDSCs) was associated with overall mortality (p = 0.02). Interestingly, the high abundance of PMN-MDSCs and CD15int M-MDSCs was a good predictor of mortality (p = 0.0046 and 0.014), with area under the ROC curve for mortality of 0.70 (95% CI = 0.4-1.0) and 0.86 (0.62-1.0), respectively. Overall, our observations support the idea that MDSCs represent biomarkers for sepsis and that flow cytometry monitoring of MDSCs may be used to risk-stratify ICU patients for targeted therapy.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

公众号