Zhongheng Zhang

Zhejiang Medical University · Department of Emergency Medicine; Sir Run Run Shaw Hospital

Background and objectives Excess fluid balance in acute kidney injury (AKI) may be harmful, and conversely, some patients may respond to fluid challenges. This study aimed to develop a prediction model that can be used to differentiate between volume-responsive (VR) and volume-unresponsive (VU) AKI. Methods AKI patients with urine output < 0.5 ml/...

Purpose Protective mechanical ventilation based on multiple ventilator parameters such as tidal volume, plateau pressure, and driving pressure has been widely used in acute respiratory distress syndrome (ARDS). More recently, mechanical power (MP) was found to be associated with mortality. The study aimed to investigate whether MP normalized to pre...

Background Septic shock comprises a heterogeneous population, and individualized resuscitation strategy is of vital importance. The study aimed to identify subclasses of septic shock with non-supervised learning algorithms, so as to tailor resuscitation strategy for each class. Methods Patients with septic shock in 25 tertiary care teaching hospit...

Various studies have analyzed sepsis subtypes, yet the reproducibility of such results remains unclear. This study aimed to determine the reproducibility of sepsis subtypes across multiple cohorts. The study examined 63,547 sepsis patients from six distinct cohorts who had similar sepsis-related characteristics (vital signs, lactate, sequential org...

Fluid management remains a critical challenge in the treatment of septic shock, with individualized approaches lacking. This study aims to develop a statistical model based on transcriptomics to identify subgroups of septic shock patients with varied responses to fluid strategy. The study encompasses 494 septic shock patients. A benefit score is de...

Background Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (C...

Sepsis is a systemic inflammatory response syndrome (SIRS) caused by infection, which may lead to multiple organ dysfunction in susceptible patient. The most frequently involved organs/systems include the lung, kidney and circulation system. It is well established that sepsis is a risk factor for acute lung injury. While overt pulmonary infiltrates...

Background Sepsis is a heterogeneous syndrome, and enrollment of more homogeneous patients is essential to improve the efficiency of clinical trials. Artificial intelligence (AI) has facilitated the identification of homogeneous subgroups, but how to estimate the uncertainty of the model outputs when applying AI to clinical decision-making remains...

BACKGROUND Challenges in emergency medicine include overcrowding, insufficient emergency care resources and extended Emergency Department (ED) waiting times. These issues contribute to delays in treatment and unfavorable outcomes. Particularly worsened during the Covid-19 pandemic and events with large crowds. The integration of augmented reality (...

The high prevalence of acute kidney injury (AKI) in ICU patients emphasizes the need to understand factors influencing continuous renal replacement therapy (CRRT) circuit lifespan for optimal outcomes. This review examines key pharmacological interventions—citrate (especially in regional citrate anticoagulation), unfractionated heparin (UFH), low m...

Background This study explores time-to-event analysis models, focusing on the comparison between accelerated failure time (AFT) and weighted least square estimation (WLSE) methods in analyzing survival data, emphasizing the challenge of heteroscedasticity in real-world datasets. Methods Using the North Central Cancer Treatment Group (NCCTG) Lung C...

Introduction: This study bridges traditional remedies and modern pharmacology by exploring the synergy between natural compounds and Ceritinib in treating Non-Small Cell Lung Cancer (NSCLC), aiming to enhance efficacy and reduce toxicities. Methods: Using a combined approach of computational analysis, machine learning, and experimental procedures,...

Background Some cohort studies have explored the effects and safety of polymyxin B (PMB) in comparison to other antibiotics for the treatment of nosocomial infections, yielding inconsistent results. This systematic review aims to explore the effectiveness and safety of PMB and compared it with other antibiotics. Methods A systematic literature sea...

Purpose Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP),...

In recent years, radiomics has emerged as a novel research methodology that plays a crucial role in the diagnosis and treatment of ischemic stroke. By integrating multimodal medical imaging techniques such as computed tomography and magnetic resonance imaging, radiomics offers in-depth insights into aspects such as the extent of brain tissue damage...

Emergency and critical illnesses refer to severe diseases or conditions characterized by rapid changes in health that may endanger life within a short period [...]

Cardio-metabolic traits have been reported to be associated with the development of sepsis. It is, however, unclear whether these co-morbidities reflect causal associations, shared genetic heritability, or are confounded by environmental factors. We performed three analyses to explore the relationships between cardio-metabolic traits and sepsis. Me...

The emergence of hypervirulent Klebsiella pneumoniae (hvKp) poses a significant public health threat, particularly regarding its carriage in the healthy population. However, the genomic epidemiological characteristics and population dynamics of hvKp within a single patient across distinct infection episodes remain largely unknown. This study aimed...

Introduction Hemorrhagic stroke may cause changes in intracranial pressure (ICP) and cerebral perfusion pressure (CPP), which may influence the prognosis of patients. The aim of this study was to investigate the relationship between early ICP, CPP, and 28-day mortality in the intensive care unit (ICU) of patients with hemorrhagic stroke. Patients...

OBJECTIVES Although illness severity scoring systems are widely used to support clinical decision-making and assess ICU performance, their potential bias across different age, sex, and primary language groups has not been well-studied. DESIGN, SETTING, AND PATIENTS We aimed to identify potential bias of Sequential Organ Failure Assessment (SOFA) a...

Integrating artificial intelligence (AI) into the realm of emergency and critical care medicine marks a transformative stage in healthcare delivery. In Volume IV of the research compilation titled “Clinical application of artificial intelligence in emergency and critical care medicine,” a collection of 16 articles highlights the burgeoning intersec...

The development of intensive care medicine is inseparable from the diversified monitoring data. Intensive care medicine has been closely integrated with data since its birth. Critical care research requires an integrative approach that embraces the complexity of critical illness and the computational technology and algorithms that can make it possi...

Sepsis is a complex and heterogeneous syndrome that remains a serious challenge to healthcare worldwide. Patients afflicted by severe sepsis or septic shock are customarily placed under intensive care unit (ICU) supervision, where a multitude of apparatus is poised to produce high-granularity data. This reservoir of high-quality data forms the corn...

BACKGROUND Sepsis is a heterogeneous syndrome, and enrollment of more homogeneous patients is essential to improve the efficiency of clinical trials. Artificial intelligence (AI) has facilitated the identification of homogeneous subgroups, but how to estimate the uncertainty of the model outputs when applying AI to clinical decision-making remains...

Septic patients in the intensive care unit (ICU) often develop sepsis-associated delirium (SAD), which is strongly associated with poor prognosis. The aim of this study is to develop a machine learning-based model for the early prediction of SAD. Patient data were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database...

Background: Comorbidity, frailty, and decreased cognitive function lead to a higher risk of death in elderly patients (more than 65 years of age) during acute medical events. Early and accurate illness severity assessment can support appropriate decision making for clinicians caring for these patients. We aimed to develop ELDER-ICU, a machine lear...

Epigenetic modifications like chromatin remodeling play a vital role in regulating sepsis immunity. Understanding the role of chromatin remodeling in sepsis can help identify new potential therapeutic targets. Differentially expressed chromatin remodeling-related genes (DE-CRRGs) were identified between the sepsis and normal groups in GSE65682. LAS...

Introduction: Data from acute ischemic stroke patients throughout 2021 from one district of an archipelago city of China were collected and analyzed retrospectively to determine the management difference due to time lags from onset of symptoms to the arrival at the stroke center (FMCT) of two regions: main island (MI) and outer islets (OIs). Meth...

The medical specialty of critical care, or intensive care, provides emergency medical care to patients suffering from life-threatening complications and injuries. The medical specialty is featured by the generation of a huge amount of high-granularity data in routine practice. Currently, these data are well archived in the hospital information syst...

Background Acute kidney injury (AKI) is a common complication in sepsis. However, the trajectories of sepsis-induced AKI and their transcriptional profiles are not well characterized. Methods Sepsis patients admitted to centres participating in Chinese Multi-omics Advances In Sepsis (CMAISE) from November 2020 to December 2021 were enrolled, and g...

Background Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered...

Neutrophils constitute the largest proportion of nucleated peripheral blood cells, and neutrophils have substantial heterogeneity. We profiled nearly 300,000 human peripheral blood cells in this study using single-cell RNA sequencing. A large proportion (>50%) of these cells were annotated as neutrophils. Neutrophils were further clustered into fou...

Causal inference prevails in the field of laparoscopic surgery. Once the causality between an intervention and outcome is established, the intervention can be applied to a target population to improve clinical outcomes. In many clinical scenarios, interventions are applied longitudinally in response to patients’ conditions. Such longitudinal data c...

Background Although severity scoring systems are used to support decision making and assess ICU performance, the likelihood of bias based on age, gender, and primary language has not been studied. We aimed to identify the potential bias of them such as Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation IVa...

Objective Patients with prolonged mechanical ventilation (PMV) are comprised of a heterogeneous population, creating great challenges for clinical management and study design. The study aimed to identify subclusters of PMV patients based on trajectories of rapid shallow breathing index (RSBI), and to develop a machine learning model to predict the...

There is a large body of evidence showing that delayed initiation of sepsis bundle is associated with adverse clinical outcomes in patients with sepsis. However, it is controversial whether electronic automated alerts can help improve clinical outcomes of sepsis. Electronic databases are searched from inception to December 2021 for comparative effe...

Sepsis is caused by an uncontrolled inflammatory response, whose underlying mechanisms are not fully understood. It is well known that the majority of human genes can be expressed as alternative isoforms. While isoform switching is implicated in many diseases and is particularly prominent in cancer, it has never been reported in the context of seps...

Objective: Some special populations are always excluded from Clinical Practice Guidelines (CPGs), the study was attempted to analyze the characteristic and categories of excluded populations from the relevant CPGs from the field of Critical care medicine (CCM). Methods: Electronic databases of PubMed and Scopus were searched from October 9, 2016 to...

Sepsis is a leading cause of morbidity and mortality in the intensive care unit, which is caused by unregulated inflammatory response leading to organ injuries. Ulinastatin (UTI), an immunomodulatory agent, is widely used in clinical practice and is associated with improved outcomes in sepsis. But its underlying mechanisms are largely unknown. Our...

Patients treated in the intensive care unit (ICU) are closely monitored and receive intensive treatment. Such aggressive monitoring and treatment will generate high-granularity data from both electronic healthcare records and nursing charts. These data not only provide infrastructure for daily clinical practice but also can help to inform clinical...

Background: It remains controversial as how to set positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) patients. This study aims to provide suggestions to the clinicians in selecting PEEP for ARDS patients receiving invasive mechanical ventilation based on artificial intelligence (AI). Methods: Invasively ventilat...

A new research topic "Infections in the Intensive Care Unit" is online in 《Frontiers in medicine》 and 《Frontiers in public health》 https://www.frontiersin.org/research-topics/31320/infections-in-the-intensive-care-unit

Predictive analytics have been widely used in the literature with respect to laparoscopic surgery and risk stratification. However, most predictive analytics in this field exploit generalized linear models for predictive purposes, which are limited by model assumptions—including linearity between response variables and additive interactions between...

Background Septic shock is characterized by an uncontrolled inflammatory response and microcirculatory dysfunction. There is currently no specific agent for treating septic shock. Anisodamine is an agent extracted from traditional Chinese medicine with potent anti-inflammatory effects. However, its clinical effectiveness remains largely unknown. M...

During a pandemic, there are multiple concurrent clinical and scientific priorities, including the need to understand the pathophysiology of the disease, the different modes of transmission, how patient care can be optimized, as well as the need to developmathematicalmodels that can now cast and forecast the progression of infections within given p...

Suboptimal sedation practices continue to be frequent, although the updated guidelines for management of pain, agitation, and delirium in mechanically ventilated (MV) patients have been published for several years. Causes of low adherence to the recommended minimal sedation protocol are multifactorial. However, the barriers to translation of these...

In some patients who require vasopressor therapy, their shock state can be corrected after adequate fluid resuscitation, with the vasopressor weaned off quickly. The difficulty is how we can identify those who would do so at the time when the vasopressor is initiated. The lack of an accurate tool to predict how long a vasopressor is needed for crit...

Measurement of the static compliance of respiratory system (Cstat) during mechanical ventilation requires zero end-inspiratory flow. An inspiratory pause maneuver is needed if the zero end-inspiratory flow condition cannot be satisfied under normal ventilation. We proposed a method to measure the quasi-static respiratory compliance (Cqstat) under p...

Background: The role of sodium bicarbonate therapy (SBT) remains controversial. This study aimed to investigate whether hemodynamic status before SBT contributed to the heterogeneous outcomes associated with SBT in acute critically ill patients. Methods: We obtained data from patients with metabolic acidosis from the Medical Information Mart for In...

Mechanical ventilation is an essential life-support treatment for patients who cannot breathe independently. Patient–ventilator asynchrony (PVA) occurs when ventilatory support does not match the needs of the patient and is associated with a series of adverse clinical outcomes. Deep learning methods have shown a strong discriminative ability for PV...

Background Mechanical ventilation (MV) is the key to the successful treatment of acute respiratory failure (ARF) in the intensive care unit (ICU). The study aims to formalize the concept of individualized MV strategy with finite mixture modeling (FMM) and dynamic treatment regime (DTR). Methods ARF patients requiring MV for over 48 h from 2008 to...

Objectives No standardized algorithm exists to identify patients at risk of bleeding after transcatheter aortic valve replacement (TAVR). The aim of this study was to generate and validate a useful predictive model. Background Bleeding events after TAVR influence prognosis and quality of life and may be preventable. Methods Using machine learning...