Zhongheng Zhang

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

Objective Although sodium bicarbonate (SB) solution has been widely used in clinical practice, its effect on mortality when administered to a large population of patients with acidosis is not known. The study aimed to investigate the effectiveness of SB infusion in septic patients with metabolic acidosis. Methods Septic patients with metabolic aci...

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...

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...

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...

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...

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...

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...

Background: Organ/space surgical site infections (OSSI) after pancreaticoduodenectomy (PD) are not rare events. The role of diagnosis and treatment for pancreatic and biliary diseases with an endoscopic retrograde cholangio-pancreatography (ERCP) procedure is currently controversial. However, the ERCP procedure might play a role in surgical outcom...

Background and objective Post-cardiac arrest (CA) syndrome is heterogenous in their clinical presentations and outcomes. This study aimed to explore the transition and stability of subphenotypes (profiles) of CA treated in the intensive care unit (ICU). Patients and methods Clinical features of CA patients on day 1 and 3 after ICU admission were m...

Background: Little is known about the role of artificial intelligence (AI) as a decisive technology in the clinical management of COVID-19 patients. We aimed to systematically review and critically appraise the current evidence on AI applications for COVID-19 in intensive care and emergency settings. Methods: We systematically searched PubMed, Emba...

Background: Identification of risk factors for poor prognosis of patients with coronavirus disease 2019 (COVID-19) is necessary to enable the risk stratification and modify the patient's management. Thus, we performed a systematic review and meta-analysis to evaluate the in-hospital mortality and risk factors of death in COVID-19 patients. Method...

Whether autophagy affects methicillin-resistant Staphylococcus aureus (MRSA)-induced sepsis and the associated mechanisms are largely unknown. This study investigated the role of autophagy in MRSA-induced sepsis. The levels of microtubule-associated protein light chain 3 (LC3)-II/I, Beclin-1 and p62 after USA300 infection were examined by Western b...

Introduction: Studies have shown nonlinear relationships between systolic blood pressure (SBP) and outcomes, with increased risk observed at both low and high blood pressure levels. However, the relationships between cumulative times at different SBP levels and outcomes in critically ill patients remain unclear. We hypothesized that an appropriate...

Among drug-eluting stents (DESs), the durable polymer everolimus-eluting stent (EES) and resolute zotarolimus-eluting stent (R-ZES) are widely used in clinical practice and have contributed to improve the outcomes of patients undergoing percutaneous coronary intervention (PCI). Few studies addressed their long-term comparative performance in patien...

Background: A major challenge in clinical research is population heterogeneity and we need to consider both historical response and current condition of an individual in considering medical decision making. The idea of precise medicine cannot be fully accounted for in traditional randomized controlled trials. Reinforcement learning (RL) is develop...

Background and Objective : Patient-ventilator asynchrony (PVA) is the result of a mismatch between the need of patients and the assistance provided by the ventilator during mechanical ventilation. Because the poor interaction between the patient and the ventilator is associated with inferior clinical outcomes, effort should be made to identify and...

Background: Little is known about the role of artificial intelligence (AI) as a decisive technology in the clinical management of COVID-19 patients. We aimed to systematically review and critically appraise the current evidence on AI applications for COVID-19 in intensive care and emergency settings, focusing on methods, reporting standards, and cl...

The role of artificial intelligence and its applications has been increasing at a rapid pace in the field of gastroenterology. The application of artificial intelligence in gastroenterology ranges from colon cancer screening and characterization of dysplastic and neoplastic polyps to the endoscopic ultrasonographic evaluation of pancreatic diseases...

Heart failure is one of the most important reasons for hospitalization among elderly individuals and is associated with significant mortality and morbidity. Epidemiological studies require the establishment of high-quality databases. Several datasets that primarily involve heart failure populations have been established in Western countries and hav...

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...

2017 ESCMID practice guidelines reported safety concerns and weak evidence of benefit supporting use of aerosolized antibiotics in mechanically ventilated patients. Our primary goal was to assess current patterns of aerosolized antibiotic prescription in mechanically ventilated patients. A sequential global survey was performed prior to the release...

Background: Many severity scores are widely used for clinical outcome prediction for critically ill patients in the intensive care unit (ICU). However, for patients identified by sepsis-3 criteria, none of these have been developed. This study aimed to develop and validate a risk stratification score for mortality prediction in sepsis-3 patients. M...

Objectives: Light sedation is recommended over deep sedation for invasive mechanical ventilation to improve clinical outcome but may increase the risk of agitation. This study aimed to develop and prospectively validate an ensemble machine learning model for the prediction of agitation on a daily basis. Design: Variables collected in the early m...

To identify differences in perception on multi-drug-resistant (MDR) organisms and their management at intensive care units (ICU). A cross-sectional survey was conducted. A proposal addressing a pathogen priority list (PPL) for ICU, arising from the TOTEM study, was compared with a sample of global experts in infections in critically ill patients. T...

Background Although protective mechanical ventilation (MV) has been used in a variety of applications, lung injury may occur in both patients with and without acute respiratory distress syndrome (ARDS). The purpose of this study is to use machine learning to identify clinical phenotypes for critically ill patients with MV in intensive care units (I...

Background: Persistent critical illness is common in critically ill patients and is associated with vast medical resource use and poor clinical outcomes. This study aimed to define when patients with sepsis would be stabilized and transitioned to persistent critical illness, and whether such transition time varies between latent classes of patient...

Background: The aim of this study is to assess the prevalence of abnormal urine analysis and kidney dysfunction in COVID-19 patients and to determine the association of acute kidney injury (AKI) with the severity and prognosis of COVID-19 patients. Methods: The electronic database of Embase and PubMed were searched for relevant studies. A meta-a...

Background Sepsis is a heterogenous syndrome and individualized management strategy is the key to successful treatment. Genome wide expression profiling has been utilized for identifying subclasses of sepsis, but the clinical utility of these subclasses was limited because of the classification instability, and the lack of a robust class prediction...

Background Corticoid therapy has been recommended in the treatment of critically ill patients with COVID-19, yet its efficacy is currently still under evaluation. We investigated the effect of corticosteroid treatment on 90-day mortality and SARS-CoV-2 RNA clearance in severe patients with COVID-19. Methods 294 critically ill patients with COVID-1...

With the robust growth in the social environment, millions of families have vast medical plans nowadays. Each client requires a personalized medical rescue decision, making an intelligent recommendation system highly important. In practice, wealthy families tend to purchase tailored medical services, while others tend to seek medical services from...

Background and objectives The timing of invasive mechanical ventilation (IMV) is controversial in COVID-19 patients with acute respiratory hypoxemia. The study aimed to develop a novel predictor called cumulative oxygen deficit (COD) for the risk stratification. Methods The study was conducted in four designated hospitals for treating COVID-19 pat...