本周危重病医学进展
admin — 四, 05/31/2007 - 12:47
本周要闻
1. 灾难爆发时医务人员安排策略的计算机模型（from: Medscape）：Computer Model Determines Efficient Strategies for Inoculating Hospital Staff in Pandemic Outbreak.Laurie Barclay, MD.May 24, 2007 — A computer model can determine efficient strategies for inoculating hospital staff in a pandemic outbreak, according to the results of a study reported in the May issue of Infection Control and Hospital Epidemiology......(Infect Control Hosp Epidemiol. 2007;28:618-621.)
2.每日呼吸与觉醒试验加速撤机（from:Medscape）:Daily Breathing and Awakening Tests Speed Weaning From Mechanical Ventilation. Rabiya S. Tuma, PhD.May 24, 2007 (San Francisco) –– Previous studies have shown that daily spontaneous breathing tests significantly reduce the number of days a patient spends on mechanical ventilation. Similarly, past studies demonstrated that stopping sedatives once daily to induce spontaneous awakenings also speeds ventilation weaning. Now, a multicenter randomized clinical trial shows that intensive care unit (ICU) patients who undergo a daily routine of spontaneous awakenings and breathing tests come off mechanical ventilation 4 days sooner, on average, than do patients managed with spontaneous breathing trials and standard goal-directed sedation, according to data presented here at the American Thoracic Society (ATS) 103rd International Conference.....
3.危重症患者低ACTH刺激试验反应的预测：回顾性队列研究. (from :Critical care )de Jong MFC. Predicting a low cortisol response to ACTH in the critically ill: a retrospective cohort study.
4.美国危重症患者维生治疗的困境 John M. Luce and Douglas B. White.The Pressure to Withhold or Withdraw Life-sustaining Therapy from Critically Ill Patients in the United States.Am J Respir Crit Care Med. 2007; 175: 1104-1108.
5.对肺通气-灌注扫描诊断肺栓塞的客观评价 Benjamin Harris, et al. Objective Analysis of Tomographic Ventilation–Perfusion Scintigraphy in Pulmonary Embolism.Am J Respir Crit Care Med. 2007; 175: 1173-1180.
6.五月号的《Acta Anaesthesiologica Scandinavica》“危重监护与生理”栏目本期要点是老年危重病患者的预后分析。其实预后与危险因素分析时最好做的危重病选题，其中数据库的设计最重要。
7.6月号的《Critical care medicine》出来了！要目：
1454．ADDRESS研究的一年随访ADDRESS (ADministration of DRotrecogin alfa [activated] in Early stage Severe Sepsis) long-term follow-up: One-year safety and efficacy evaluation. (之前的Blog介绍过)
1467．人类志愿者对注射内毒素后免疫反应与血管反应的性别差异Gender differences in the innate immune response and vascular reactivity following the administration of endotoxin to human volunteers .
1470．中心医院际转运对资源利用的影响与后果Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center
1477．危重患者由急诊室向ICU转运延迟的影响Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit .
1484．去甲肾上腺素提高急性贫血耐受阈值Norepinephrine increases tolerance to acute anemia
1493．CAPUCI Study Group社区获得性肺炎与休克患者抗生素联合治疗提高生存率Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock
1500. 高频震荡通气+气管内吹气治疗ARDS的效果Acute effects of combined high-frequency oscillation and tracheal gas insufflation in severe acute respiratory distress syndrome
1509. 增量治疗的随机对照研究：固定性治疗方案始料未及的后果Randomization in clinical trials of titrated therapies: Unintended consequences of using fixed treatment protocols. (之前的Blog介绍过)
1517．ICU内尼古丁替代治疗与病死率关系.The association of nicotine replacement therapy with mortality in a medical intensive care unit.
1522． 成年ARDS患者高频震荡通气潮气量分布Tidal volume delivery during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome
1530． 内科ICU内对高危患者积极对症治疗对住院日的影响Proactive palliative care in the medical intensive care unit: Effects on length of stay for selected high-risk patients.
1536．抵抗素显著升高与Severe Sepsis和Septic shock病情程度有关Pronounced elevation of resistin correlates with severity of disease in severe sepsis and septic shock.
1543. 机械通气患者半卧位时气管插管气囊压力自动调控的随机研究Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: A randomized trial.
1550．肺切除并单肺通气羊模型的血管外肺水分分布Extravascular lung water after pneumonectomy and one-lung ventilation in sheep.
1560. 小鼠致死性炭疽杆菌休克模型中补液疗法造成预后恶化并抵消抗原单克隆抗体治疗的收益Fluid support worsens outcome and negates the benefit of protective antigen-directed monoclonal antibody in a lethal toxin-infused rat Bacillus anthracis shock mode
1568. 酸中毒猪模型中氨基丁三醇逆转凝血功能异常的评价Evaluation of tris-hydroxymethylaminomethane on reversing coagulation abnormalities caused by acidosis in pigs
1575. 腹腔内高压食道与中心静脉压力的静态与动态部分Static and dynamic components of esophageal and central venous pressure during intra-abdominal hypertension
1582. 活性氧片断激活NF-KB 途径可引发小鼠应激性胃损伤Sustained activation of nuclear factor-[kappa]B by reactive oxygen species is involved in the pathogenesis of stress-induced gastric damage in rats.
1592. 实验性感染性急性肾衰竭尿液检查的系统综述Review Articles A systematic review of urinary findings in experimental septic acute renal failure
1599. 综述：脓毒症诱发心功能障碍的机制Mechanisms of sepsis-induced cardiac dysfunction.
以下述评和书评就略了
8. 《Intensive care monitor》今年第2季要目 March/April 2007 （tmd，翻译的时候还在纳闷怎么好像都看过，翻译完了才想起来做过了！难怪很熟悉）,看来这个要闻介绍离关门不远了。
CARDIOVASCULAR
个体化目标治疗监控围术期液体 Bundgaard-Nielsen M, Holte K, Secher NH, Kehlet H. Monitoring of peri-operative fluid administration by individualized goal-directed therapy. Acta Anaesthesiol Scand 2007;51:331-340. 71 references.
ENDOCRINOLOGY
心血管患者术中强化血糖控制与常规血糖控制Gandhi GY, Nuttall GA, Abel MD et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery. Ann Intern Med 2007; 146: 233Ð243.
ICU内强化血糖控制：难于实施循证医学的一个实例Schultz MJ, Royakkers AANM, Levi M, Moeniralam HS, Spronk PE. Intensive insulin therapy in intensive care: An example of the struggle to implement evidence-based medicine. PLOS Med 2006;3:e456. 51 references.
GASTROENTEROLOGY
危重患者补充微量营养素进展Berger MM, Shenkin A. Update on clinical micronutrient supplementation studies in the critically ill. Curr Opin Clin Nutr Metab Care 2006;9:711-716. 42 references.
HAEMATOLOGY
血栓性血小板减少性紫癜血浆置换疗法的系统回顾Brunskill SJ, Tusold A, Benjamin S, Stanworth SJ, Murphy MF. A systematic review of randomized controlled trials for plasma exchange in the treatment of thrombotic thrombocytopenic purpura. Transfusion Med 2007;17:17-35. 42 references.
ICU内的TIP(肝素相关性血小板减少症)：诊断与治疗Napolitano LM, Warkentin TE, AlMahameed A, Nasraway SA. Heparin-induced thrombocytopenia in the critical care setting: Diagnosis and management. Crit Care Med 2006;34:2898-2911. 101 references.
NEUROLOGY
严重脑创伤患者院前高级声明支持治疗中快速插管对预后的影响 Klemen P, Grmec S. Effect of pre-hospital advanced life support with rapid sequence intubation on outcome of severe traumatic brain injury. Acta Anaesthesiol Scand 2006; 50: 1250Ð1254.
ORGANIZATION
超长转运中的医疗差错、不良时间以及其他失误 Barger LK, Ayas NT, Cade BE et al. Impact of extended-duration shifts on medical errors, adverse events, and attentional failures. PloS Med 2006; 3(12): e487.
何时危重医学物有所值:系统综述 Talmor D, Shapiro N, Greenberg D, Stone PW, Neumann PJ. When is critical care medicine cost-effective? A systematic review of the cost-effectiveness literature. Crit Care Med 2006; 34: 2738Ð2747.
ICU成本中的医生差异，单中心研究Garland A, Shaman Z, Baron J, Connors Jr AF. Physician-attributable differences in intensive care unit costs. A single-center study. Am J Respir Crit Care Med 2006;174:1206Ð1210.
急诊队伍：担负扩大监护的责任吗？neman A, Parr M. Medical emergency teams: a role for expanding intensive care? Acta Anaesthesiol Scand 2006;50:1255-1265. 65 references.
改变ICU工作环境以病人为中心McCauley K, Irwin RS. Changing the work environment in ICUs to achieve patient-focused care. Chest 2006; 130:1571-1578. 18 references.
住院医生超时工作与医疗差错 Szklo-Coxe M. Are residentsÕ extended shifts associated with adverse events? PLOS Med 2006;3:e497. 26 references.
快速反应队伍：莫要操之过急Winters BD, Pham J, Pronovost PJ. Rapid response teams Ð walk donÕt run. JAMA 2006;296: 1645-1647. 25 references.
病人的合作 与ICU内安全Wu AW, Sexton B, Pronovost PJ. Partnership with patients: a prescription for ICU safety. Chest 2006;130:1291-1293. 11 references.
OUTCOME
危重患者血清渗透压与预后Holtfreter B, Bandt C, Kuhn S-O et al. Serum osmolality and outcome in intensive care unit patients. Acta Anaesthesiol Scand 2006; 50: 970Ð977.
ICU内决策参照物的准确性Li LLM, Cheong KYP, Yaw LK, Liu EHC. The accuracy of surrogate decisions in intensive care scenarios. Anaesth Intensive Care 2007; 35: 46Ð51.
重症后的远期神经功能Hopkins RO, Jackson JC. Long-term neurocognitive function after critical illness. Chest 2006;130:869-878. 53 references.
PAEDIATRIC
恶性疟疾白蛋白扩容与佳乐施扩容得比较研究Akech S, Gwer S, Idro R et al. Volume expansion with albumin compared to Gelofusine in children with severe malaria: results of a controlled trial. PloS Clin Trials 2006; 1(5): e21.
RENAL
多中心随机研究：多脏衰CVVH与间断血滤的比较研究Vinsonneau C, Camus C, Combes A et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet 2006; 368: 379Ð385.
液体复苏与肾Bagshaw SM, Bellomo R. Fluid resuscitation and the septic kidney. Curr Opin Crit Care 2006;12:527-530. 35 references.
RESPIRATORY
间断自主呼吸试验成功后拔管失败的危险因素Frutos-Vivar F, Ferguson ND, Esteban A et al. Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 2006; 130: 1664Ð1671.
腹部手术后预防肺部并发症的呼吸理疗：系统综述Pasquina P, Tram?r MR, Granier J-M, Walder B. Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest 2006; 130: 1887Ð1899.
无创正压通气治疗急性呼吸衰竭：正点还是操作？（老天，Justified翻译成“正点”简直绝配，哈！）Crummy F, Naughton MT. Non-invasive positive pressure ventilation for acute respiratory failure: justified or just hot air? Intern Med J 2007;37:112-118. 36 references.
试验与临床研究中呼吸机相关性肺损伤生物标志物的意义Frank JA, Parsons PE, Matthay MA. Pathogenic significance of biological markers of ventilator-associated lung injury in experimental and clinical studies. Chest 2006;130:1906-1914. 64 references.
SEPSIS
减少icu内导管相关性血行性感染的措施Pronovost P, Needham D, Berenholtz S et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355: 2725Ð2732.
肺炎球菌脑膜炎激素治疗脑脊液中万古霉素水平：前瞻性观察研究 Ricard J-D, Wolff M, Lacherade J-C et al. Levels of vancomycin in cerebrospinal fluid of adult patients receiving adjunctive corticosteroids to treat pneumococcal meningitis: a prospective multicenter observational study. Clin Infect Dis 2007; 44: 250Ð255.
血滤依赖病人患MRSA菌血症万古霉素与一代头孢作为一线治疗的比较 Stryjewski ME, Szczech LA, Benjamin DK et al. Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis-dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia. Clin Infect Dis 2007; 44: 190Ð196.
IDSA/ATS成人VAP治疗共识Mandell LA, Wunderinck RG, Anzueto A et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44:S27-S72. 335 references.
TRAUMA
重组凝血因子七治疗创伤性出血 Rizoli SB, Nascimento B, Osman F et al. Recombinant activated coagulation factor VII and bleeding trauma patients. J Trauma 2006; 61: 1419Ð1425.
严重创伤后出血治疗：欧洲指南 Spahn DR, Cerny V, Coats TJ et al. Management of bleeding follow major trauma: a European guideline. Crit Care 2007;11;R17. 220 references.
