• cardiopulmonary parameters
• intensive care unit treatment
• serum lactate
• traumatic brain injury

• NICU
• intracerebral hemorrhage
• serum biomarker
• serum lactate

Primary graft dysfunction (PGD) is a form of acute respiratory failure that complicates 30% of bilateral lung transplants. Higher grades of PGD correlate with higher severity of respiratory failure and unfavorable outcomes. Immediate PGD determination posttransplant‚ however, is not always predictive of PGD over subsequent days or intensive care unit outcomes. We aimed to evaluate whether extravascular lung water index (ELWI) measured immediately post bilateral lung transplant was associated with higher severity of PGD at 72 h and duration of mechanical ventilation.

• anaesthesia in cardiology
• anaesthetics
• cardiac surgery
• thoracic surgery

• Cardiac Surgical Procedures
• Fluid Therapy
• Hemodynamics
• Humans
• Reproducibility of Results
• Stroke Volume
• Thoracic Surgery

• Accuracy
• Indocyanine green
• Measurement
• Plasma volume

Pediatric living donor liver transplantation (LDLT) has become the gold standard for patients with end-stage liver disease. With improvements in organ preservation, immunosuppression, surgical and anesthesia techniques, the survival rates and long-term outcomes of patients after LDLT have significantly improved worldwide. However, data on anesthetic management and postoperative survival rate of pediatric LDLT in China are rare.

To review the status of pediatric LDLT in Shanghai and investigate the factors related to anesthetic management and survival rate in pediatric LDLT.

We conducted a retrospective observational study to investigate the status of pediatric LDLT in Shanghai by reviewing 544 records of patients who underwent pediatric LDLT since the first operation on October 21, 2006 until August 10, 2016 at Renji Hospital and Huashan Hospital.

The 30-d, 90-d, 1-year, and 2-year survival rates were 95.22%, 93.38%, 91.36%, and 89.34%, respectively. The 2-year patient survival rate after January 1, 2011 significantly improved compared with the previous period (74.47% vs 90.74%; hazard ratio: 2.92; 95% confidence interval (CI): 2.16–14.14; P = 0.0004). Median duration of mechanical ventilation in the intensive care unit (ICU) was 18 h [interquartile range (IQR), 15.25–20.25], median ICU length of stay was 6 d (IQR: 4.80–9.00), and median postoperative length of stay was 24 d (IQR: 18.00–34.00). Forty-seven (8.60%) of 544 patients did not receive red blood cell transfusion during the operation.

Pediatric end-stage liver disease (PELD) score, anesthesia duration, operation duration, intraoperative blood loss, and ICU length of stay were independent predictive factors of in-hospital patient survival. Pediatric end-stage liver disease score, operation duration, and ICU length of stay were independent predictive factors of 1-year and 3-year patient survival.

• Living donor
• Liver transplantation
• Anesthesia
• Survival
• Pediatric
• Outcome

• Anesthesia/methods
• Anesthesia/mortality
• Blood Loss, Surgical
• China
• End Stage Liver Disease/mortality
• End Stage Liver Disease/surgery
• Female
• Humans
• Infant
• Length of Stay
• Liver Transplantation/methods
• Liver Transplantation/mortality
• Living Donors
• Male
• Operative Time
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Survival Rate
• Treatment Outcome

• Hemodynamic monitoring
• intensive care
• pulmonary edema
• transpulmonary thermodilution (TPTD)
• trauma

Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS.

To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.

Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO₂/FiO₂ ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals.

Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h.

Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.

• Pulse index continuous cardiac output
• Elderly patients
• Cardiogenic shock
• Acute myocardial infarction

• Critically ill, Risk stratification
• EVLWI
• Intensive Care Unit
• PiCCO
• Thermodilution

• Aged
• Cardiac Output
• Critical Illness
• Extravascular Lung Water
• Female
• Heart Failure/diagnosis
• Heart Failure/physiopathology
• Humans
• Male
• Prospective Studies
• Retrospective Studies
• Thermodilution

• Critical care
• Critically ill
• Intensive care unit
• Invasive hemodynamic measurement
• Pulse contour cardiac output

To investigate the effects of target temperature management on hemodynamic changes, inflammatory and immune factors, and clinical outcomes of sepsis patients with fever.

Patients diagnosed with sepsis with a core temperature of ≥39°C were randomly divided into two groups: a low-temperature group (LT group: 36.5°C–38°C) and a high-temperature group (HT group: 38.5°C–39.5°C). A target core temperature was achieved within 6 hrs posttreatment and maintained for 24 hrs. Then, the hemodynamic changes, inflammatory and immune factors, and clinical outcomes were evaluated.

Compared with the HT group, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) showed a significant decrease in the LT group (P < 0.05). In contrast, IL-4 and IL-10 were higher in the LT group than in the HT group (P < 0.05). The CD4-T lymphocyte (CD4+), CD8-T lymphocyte (CD8+), and monocytic human leukocyte antigen-DR (mHLA-DR) in the LT group were higher than in the HT group (P < 0.05). The ICU stay and the anti-infection treatment costs were higher in the LT group (P < 0.05).

Low-temperature management of patients resulted in a low level of proinflammatory cytokines. Excessive temperature control in sepsis patients with fever may be harmful.

• Acupuncture
• Acupuncture therapy
• Electroacupuncture
• Heart failure
• Systematic review

• Acupuncture Therapy/methods
• Clinical Trials as Topic/methods
• Databases, Factual
• Heart Failure/diagnosis
• Heart Failure/epidemiology
• Heart Failure/therapy
• Humans

• (170.0170) Medical optics and biotechnology
• (170.3880) Medical and biological imaging
• (170.3890) Medical optics instrumentation
• (170.4580) Optical diagnostics for medicine
• (170.5120) Photoacoustic imaging

• Acute care nurses' perspective
• Dimensional analysis
• Intensive care nurses' perspective
• Patient deterioration

AIM: To investigate extravascular lung water indexed to predicted body weight (EVLWIp) and actual body weight (EVLWIa) on outcome of patients with severe sepsis.

METHODS: Transpulmonary thermodilution was prospectively used to measure cardiovascular hemodynamics, EVLWIp and EVLWIa via an arterial catheter placed in each patient within 48 h of meeting the criteria for severe sepsis from a medical intensive care unit (ICU) at a university affiliated hospital. Survival was the single dependent variable. In order to examine and compare the predictive power of EVLWIp, EVLWIa and other clinically significant factors in predicting the in-hospital survival status of severe sepsis patients in the medical ICU, a receiver operating characteristic (ROC) curve method to analyze the significant variables and the area under the ROC curve (AUC) of the variables, P value and 95%CI were calculated.

RESULTS: In total, 33 patients were studied. In the ROC curve method analyses, EVLWIp (the AUC: 0.849; P = 0.001, 95%CI: 0.72-0.98) was as predictive for in-hospital survival rate as variables with EVLWIa (AUC, 0.829; P = 0.001, 95%CI: 0.68-0.98). The proportion of patients surviving with a low EVLW (EVLWI < 10 mL/kg) was better than that of patients with a higher EVLW, whether indexed by actual (HR = 0.2; P = 0.0002, 95%CI: 0.06-0.42) or predicted body weight (HR = 0.13; P < 0.0001, 95%CI: 0.05-0.35) during their hospital stay with the Kaplan-Meier method (76% vs 12.5%, respectively).

CONCLUSION: This investigation proposed that EVLWIp is as good a predictor as EVLWIa to predict in-hospital survival rate among severe sepsis patients in the medical ICU.

• Extravascular lung water index
• Predicted body weight
• Actual body weight
• In-hospital survival
• Severe sepsis

Hemodynamic monitoring and management has greatly improved during the past decade. Technologies have evolved from very invasive to non-invasive, and the philosophy has shifted from a static approach to a functional approach. However, despite these major changes, the critical care community still has potential to improve its ability to adopt the most modern standards of research methodology in order to more effectively evaluate new monitoring systems and their impact on patient outcome. Today, despite the huge enthusiasm raised by new hemodynamic monitoring systems, there is still a big gap between clinical research studies evaluating these monitors and clinical practice. A few studies, especially in the perioperative period, have shown that hemodynamic monitoring systems coupled with treatment protocols can improve patient outcome. These trials are small and, overall, the corpus of science related to this topic does not yet fit the standard of clinical research methodology encountered in other specialties such as cardiology and oncology. Larger randomized trials or quality improvement processes will probably answer questions related to the real impact of these systems.

• Acute respiratory distress syndrome
• Extravascular lung water index
• Hemodynamics
• Lung protective ventilation
• Lung recruitment maneuver
• Oxygenation index
• Respiratory mechanics

• Aorta/physiology
• Blood Flow Velocity
• Cardiac Output
• Humans
• Indicator Dilution Techniques
• Monitoring, Physiologic/methods

• CS/08/08/17 Department of Health

• Aged
• Aged, 80 and over
• Cardiac Output/physiology
• Cardiac Surgical Procedures
• Catheterization, Swan-Ganz
• Critical Care
• Female
• Heart Rate/physiology
• Humans
• Male
• Middle Aged
• Prospective Studies
• Thermodilution

• Cardiac Output
• Catheterization, Swan-Ganz/instrumentation
• Catheterization, Swan-Ganz/methods
• Critical Care/methods
• Hemodynamics
• Humans
• Monitoring, Physiologic/instrumentation
• Monitoring, Physiologic/methods
• Pulse
• Thermodilution/methods
• Thorax
• Water-Electrolyte Balance

Over the past decade the practice of acute resuscitation and its monitoring have undergone significant changes. Utilization of noninvasive mechanical ventilation, goal-directed therapy, restricted fluid volume, blood transfusion and minimally invasive technology for monitoring tissue oxygenation have changed the practice of acute resuscitation. Early diagnosis and definitive treatment of the underlying cause of shock remains the mainstay for survival after successful resuscitation. Patient-centered outcome end-points, in addition to survival, are being utilized to appraise the effectiveness of treatment. Application of medical ethics to the ever changing practice of acute resuscitation has also become a societal expectation.

• Age Factors
• Aged
• Blood Transfusion
• Critical Illness
• Emergency Service, Hospital
• Fluid Therapy
• Hemodynamics/physiology
• Humans
• Monitoring, Physiologic
• Oxygen/metabolism
• Patient-Centered Care
• Randomized Controlled Trials as Topic
• Respiration, Artificial
• Resuscitation/ethics
• Resuscitation/methods
• Risk Factors
• Shock/physiopathology
• Shock/therapy
• Shock, Septic/physiopathology
• Shock, Septic/therapy
• Time Factors
• Treatment Outcome