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ABSTRACT: BACKGROUND: Rapid detection of bacteremia is important for critically ill patients. Procalcitonin (PCT) has emerged as a marker of sepsis, but its characterization for predicting bacteremia is still unclear. This study aimed to investigate the role of change of PCT within 6 to 12 hours after new fever in predicting bacteremia. METHODS: An observational study was conducted in the ICU of our hospital from January 2009 to March 2010. Adult patients with new fever were included and grouped as bacteremia and non bacteremia group. Serum PCT concentration was measured at admission and within 6 to12 hours after new fever (designated PCT0 and PCT1). Other results of laboratory tests and therapeutic interventions were recorded. Multivariate Logistic regression analysis was used to identify the risk factors of bacteremia. The area under the ROC curve (AUC) was constructed to evaluate the discriminative power of variables to predict bacteremia. RESULTS: Totally 106 patients were enrolled, 60 of whom had bacteremia and 46 did not have bacteremia,. The acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were 13.1 ± 7.8 and 5.0 ± 2.2 at admission, respectively. There was no significant difference in PCT0 between the bacteremia group and nonbacteremia group; 1.27 µg/L (range, 0.10 - 33.3) vs. 0.98µg/L (range, 0.08 - 25.7), (P = 0.157). However, the PCT1 and the rate of change of PCT were significantly higher in bacteremia group; PCT1 was 6.73 µg/L (1.13 - 120.10) vs. 1.17 µg/L (0.10 - 12.10) (P = 0.001), and the rate of change was 5.62 times (1.05 - 120.6) vs. 0.07 times (-0.03 - 0.18) (P < 0.001). The area under the ROC curve (AUC; 95% confdence interval) of the rate of change of PCT was better for predicting bacteremia than that of PCT1; 0.864 (range, 0.801 - 0.927) vs. 0.715 (range, 0.628 - 0.801), (P < 0.05). The AUCs of PCT0 and other parameters (such as WBC count, granulocyte percentage and temperature) were not significantly different (all P > 0.05). The best cut-off value for the rate of change was 3.54 times, with a sensitivity of 88.5% and a specificity of 98.0%. It was also an independent predictor of bacteremia (odds ratio 29.7, P < 0.0001) and wasn't correlated with the presence or absence of co-infection, neutropenia or immunodefciency (P > 0.05). CONCLUSION: The rate of change of PCT is useful for early detection of bacteremia during new fever and superior to the PCT absolute value and other parameters in non-selected ICU patients.
Chinese medical journal 05/2013; 126(10):1832-1837. · 0.86 Impact Factor
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ABSTRACT: OBJECTIVE: To investigate the effect of the bedside lung ultrasound in emergency(BLUE)-plus lung ultrasound protocol on lung consolidation and atelectasis of critical patients. METHODS: All patients who need to receive mechanical ventilation for more than 48 hours in ICU from June 2010 to December 2011 in Peking Union Medical College Hospital were included in the study. BLUE-plus and BLUE lung ultrasound, bedside X-ray, lung CT examination were performed on all patients at the same time. The condition of lung consolidation and atelectasis discovered by BLUE-plus lung ultrasound protocol was recorded and compared with bedside X-ray or lung CT. The difference in assessment of lung consolidation and atelectasis between BLUE-plus lung ultrasound protocol and BLUE protocol was compared. RESULTS: A total of 78 patients were finally enrolled in the study. The lung CT found 70 cases (89.74%) had different degrees of lung consolidation and atelectasis. The sensitivity, specificity and diagnostic accuracy of lung consolidation and atelectasis by the bedside chest X-ray were 31.29%, 75.00% and 38.46%, respectively. BLUE-plus lung ultrasound protocol found 68 cases with lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 95.71%, 87.50% and 94.87%, respectively, which were significantly higher than those of lung CT. BLUE protocol found 48 cases of lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 65.71%, 75.00% and 66.67%, respectively. The position of lung consolidation and atelectasis which hadn't been found by BLUE protocol was mainly proved to be located in the basement of lung by lung CT. CONCLUSIONS: The incidence of lung consolidation and atelectasis in critical patients who received mechanical ventilation is high. The BLUE-plus lung ultrasound protocol has a relatively higher sensitivity, specificity and diagnostic accuracy for consolidation and atelectasis, which can find majority of consolidation and atelectasis. As BLUE-plus lung ultrasound is a bedside noninvasive method allowing immediate assessment of most lung consolidation and atelectasis, it will be likely the alternative of the CT and play a key role in assessment of lung consolidation and atelectasis.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 12/2012; 51(12):948-951.
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ABSTRACT: To explore the effects of cefoperazone-sulbactam (C/S) plus minocycline on extensively drug resistant Acinetobacter baumannii (XDRAB) infections in critically ill patients.
For this prospective and single-center trial, a total of 101 patients with infection due to XDRAB received the primary therapy of C/S plus minocycline. Combined use of imipenem-cilastatin was considered when primary therapy failed.
Among them, 77 patients were evaluated. There were 49 males and 28 females with a mean age of (69 ± 20) years. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15 ± 5. Among whom 61 had hospital-acquired pneumonia (n = 61), primary bacteremia (n = 5), intra-abdominal infection (n = 3), skin and soft tissue infection (SSTI)(n = 2) and multiple sites infection (n = 6). Twenty-three patients had mixed bacterial infections. Combined use of imipenem-cilastatin therapy was administered in 7 patients. The treatment duration was (16 ± 4) days. The outcomes were cure (n = 21), marked improvement (n = 27), improvement (n = 26) and ineffectiveness (n = 3). The overall effective rate was 62.3% (48/77) and the microbiological clearance rate 46.8% (36/77). The independent factors of decreased efficacy were underlying co-morbidity of impaired ability for infection control (OR = 5.3, P = 0.020), prolonged infection (OR = 3.8, P = 0.029), co-infecting organism (OR = 3.5, P = 0.032) and septic shock (OR = 2.5, P = 0.037).
The combined regimen of C/S and minocycline is efficacious in the treatment of infections caused by XDRAB. But it has a lower rate of microbiological eradication.
Zhonghua yi xue za zhi 10/2012; 92(40):2847-50.
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ABSTRACT: Central venous oxygen saturation (ScvO2) is a useful therapeutic target in septic shock and high-risk postoperative patients. We tested the hypothesis that central venous-to-arterial carbon dioxide difference (ΔPCO(2)) combine with ScvO2 to guide shock resuscitation is better than ScvO2 only.
A retrospective study was conducted for 93 septic shock and high-risk postoperative patients. They underwent resuscitation through early goal-directed therapy. We calculate whether there were correlations between the ΔPCO(2) and tissue perfusion index or blood flow index, including the beginning of resuscitation (T0) and after 6 hour resuscitation (T6). They were divided into 4 groups according to ΔPCO(2) and ScvO2. Then the clearance of lactate was compared between the groups.
No correlation existed between ΔPCO(2) and tissue perfusion index. But there was some correlation between ΔPCO(2) and the indices of blood flow such as CO, ScvO2 and clearance of lactate. At T0, the correlation (r) between ΔPCO(2) and cardiac index was -0.858 (P = 0.029) and the correlation between ΔPCO(2) and ScvO2 -0.403 (P = 0.000). At T6, the correlation (r) between ΔPCO(2) and ScvO2 was -0.363 (P = 0.000) and the correlation between ΔPCO(2) and clearance of lactate -0.314 (P = 0.002). After continuous 6-hour resuscitation, there was significant difference in clearance of lactate between the groups. The clearance of lactate was the highest in the group of patients achieving the goals of both ScvO2 > 70% and ΔPCO(2) < 6 mm Hg. We further analysis the ΔPCO(2) < 6 mm Hg and ScvO2 > 70% subgroup and found that the 6 h lactate clearance rate were statistically significant difference.
The combination of ΔPCO(2) and ScvO2 may guide the shock resuscitation. It helps identify the inadequately resuscitated when the ScvO2 goal is reached.
Zhonghua yi xue za zhi 04/2012; 92(13):909-14.
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ABSTRACT: To investigate the acid-base abnormalities of the patients with hyperlactatemia and explore the relationship of hyperlactatemia and metabolic acidosis so as to seek a more precise index of reflecting organ perfusion.
From August 2009 to April 2010, all consecutive patients admitted into intensive care unit received an analysis of blood gas. Those individuals with arterial lactate ≥ 2 mmol/L were selected.
In the group of hyperlactatemic patients, the occurrence of metabolic acidosis as judged by the traditional method was less than that by the Stewart's method (33.9% vs 56.0%). No typical acidemia was found. And all components of metabolic acidosis were calculated. Lactate and SIG (strong ion gap) contributed a certain percentage to metabolic acidosis in the survivor and nonsurvivor groups [(33.6 ± 17.9)% vs (28.6 ± 23.5)%, (42.1 ± 18.5)% vs (44.9 ± 23.0)%].
Among the hyperlactatemic patients (Lac ≥ 2), lactate and unmeasured anions account for most instances of acidosis. These two indicators may offer a more accurate reflection of tissue perfusion.
Zhonghua yi xue za zhi 09/2011; 91(33):2324-8.
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ABSTRACT: To investigate the impact of extended focus assessed transthoracic echocardiography (eFATE) in septic shock patients.
A total of 83 septic shock patients were recruited. And they were divided into the eFATE and routine groups. In the routine group, the patients were assessed by routine methods. And in the eFATE group, the following parameters of central venous pressure (CVP), mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI) and ScvO(2) (central venous oxygen saturation) were measured routinely. The PiCCO (pulse indicator continuous cardiac output) method was employed when needed. All parameters and the others [acute physiology and chronic health evaluation II (APACHEII) & lactate] were recorded every 6 h. At 6, 24, 72 h and 1 w, the fluid intake volumes were recorded. All values were analyzed by statistic methods. And the mortality rates of intensive care unit and Day 28 were recorded.
In the eFATE group, the 24 h targeting rate was markedly higher than the routine group. Yet there was no effect on the 6 h targeting rate. In the eFATE group, the fluid intake volumes at 6, 24 h and 1 w were markedly lowered than those of the control group. And the myocardial inhibition occurred earlier versus the control group. There was no difference in mortality rate between two groups.
eFATE plays an important role in the correct assessment of septic shock patients. But its prognostic impact remains to be further defined.
Zhonghua yi xue za zhi 07/2011; 91(27):1879-83.
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Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 07/2010; 22(7):443-6.
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ABSTRACT: To evaluate the usefulness of serum galactomannan (GM) for the diagnosis of invasive pulmonary aspergillosis (IPA) in critically ill patients.
Study was conducted between February 2007 and July 2008. Included patients on admission ICU who suffer from suspected IPA. GM test and culture were collected 2 weekly. Clinical feature, mycological evidence and optical density index (ODI) were noted. Clinically invasive fungal infection (IFI) were defined proven, probable and possible. The patients were classified into neutropenia, non-neutropenia and treated with immunosuppressive agents, non-neutropenia and non-immunosuppressive agents. To compared of the sensitivity and specificity of GM in different patients.
94 patients were included, 4 patients were proven, 29 patients were probable, 34 patients were possible IFI, 27 patients were non-IPA. The positive rate of the GM was 31.9% (30/94). The sensitivity and specificity of GM in proven cases and probable cases are 66.7% and 92.6%. GM assay tended to become positive earlier than the culture 2 - 10 (5.33 +/- 2.17) d. We found that differences in patient diagnosis and selection might account for the disparities seen for positive rate for the GM test. There was positive in three of the four patients with proven, the positive rate of GM was 65.5% for probable cases, for possible cases was 17.6%, for non-IPA cases was 7.4% (P = 0.001). For patient with neutropenia, treated with immunosuppressive agents and without immunosuppressive agents, the positive rate of GM was 52.9% vs 41.7% vs 34.6% (P = 0.015); the sensitivity was 80.0% vs 70.0% vs 53.8% (P = 0.011), the ODI was 1.365 (0.582 - 6.736) vs 1.123 (0.623 - 6.868) vs 0.554 (0.522 - 0.823), P = 0.005, respectively.
These results show that GM test is useful for early diagnosis IPA in critically ill patients. Differences in patient selection and diagnosis might account for the disparities seen for positive rate and sensitivity for the GM test. It has been higher sensitivity and ODI in the patient treated by immunosuppressive agents.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 04/2009; 48(3):225-30.
