In recent years, with the advancement of medical, extracorporeal life support technology has become an important strategy for critically ill patients, such as continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), etc. Effective anticoagulation and less bleeding complications are the main contradictions that need to be solved urgently during extracorporeal life support. Currently, unfractionated heparin remains the most commonly used for anticoagulation. However, hemorrhage associated with systemic heparinization remains a major complication and is directly related to patient outcomes. Various improved anticoagulation techniques have been used to reduce the risk of bleeding. Nafamostat Mesylate (NM) is a synthetic ultra-short-acting serine protease inhibitor, which can play an anticoagulant role by inactivating thrombin and inhibiting the activation of coagulation factors. Evidences show that NM can reduce the incidence of bleeding without increasing the incidence of thromboembolism. We aim to summarize the anticoagulation application of NM in CRRT and ECMO in critically ill patients on the basis of existing literature reports, in order to provide reference for the anticoagulation management during treatment.

Analgesia and sedation are crucial for critically ill patients. In recent years, a comprehensive strategy featuring prioritized analgesia, light sedation, delirium screening and prevention, early mobility and sleep improvement has been formed. However, a concise and easy-to-operate flow chart still needs to be improved. We have developed a protocolized process for pain and agitation management for critically ill patients to provide a hands-on tool in clinical practice.

To evaluate the value of electric sequential organ failure assessment (eSOFA), quick sequential organ failure assessment (qSOFA) and system inflammatory reaction syndrome (SIRS) scoring system in predicting the prognosis of patients with sepsis in the non-ICU environment.

Patients with sepsis in 10 non-ICU wards of Peking Union Medical College Hospital from October 2016 to March 2017 were prospectively analyzed. The clinical outcome of survival status 28 days after admission was taken as the prognostic index. The eSOFA, qSOFA and SIRS scores of the patients were calculated and the ROC curve was used to evaluate the prognostic value of eSOFA, qSOFA and SIRS scores.

A total of 193 patients met the Sepsis-3 diagnosis criteria. The AUROC of eSOFA, qSOFA and SIRS scores for predicting the prognosis of sepsis patients were 0.766 (95%CI: 0.700-0.824), 0.798 (95%CI: 0.700-0.896) and 0.589 (95%CI: 0.475-0.703) respectively. Among them, qSOFA had the best predictive performance, and both of qSOFA and eSOFA were better than SIRS.

In non-ICU wards, qSOFA performed best in predicting prognosis of sepsis patients, eSOFA is the next and SIRS is the worst.

To investigate the application of pulse-indicated continuous cardiac output (PiCCO) guided fluid resuscitation in septic shock patients with cardiac insufficiency.

One hundred and fifty four septic shock patients with cardiac insufficiency in Department of Intensive Care Unit of Dongtai People's Hospital from June 2019 to December 2022 were randomly divided into research group (79 cases) and control group (75 cases). PiCCO guided fluid resuscitation in research group was compared the River's early goal-directed therapy (EGDT) guided fluid resuscitation in the control group. The total resuscitated fluid, lactic acid and lactate clearance at each time point, duration of mechanical ventilation, morality in ICU and mortality at 28 day were recorded and compared between two groups.

After resuscitation: (1) In terms of the total amount of resuscitation fluid, (2602±1086) ml in research group and (3296±919) ml in control group, there was significant difference between 2 groups (P＜0.05); (2) In terms of central venous pressure (CVP), there was no significant difference (P＞0.05) at initial time point, but much lower after 24 h in research group with significant difference (P＜0.05); (3) In terms of lactated and lactate clearance, lactate level at 6 hour was (4.44±1.67) mmol/L in research group and (5.03±1.74) mmol/L in control group, all 2 groups had decreased lactate levels compared with the initial levels, and lactate level at 6 and 24 hour were lower in research group, with significant differences (P＜0.05); Lactate clearance rate was significantly higher in research group than that in the control group at each time point, with significant differences (P＜0.05); (4) The mean arterial pressure (MAP) at different time points was increased compared with the initial MAP, but there was no statistically significant difference (P＞0.05). N terminal pro -brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) at 6 hour were lower in research group than those in the control group with significant differences (P＜0.05). In terms of dose of vasoactive drugs, dose of norepinephrine was significantly reduced in research group, with significant differences(P＜0.05). In terms of prognosis, duration of mechanical ventilation was significantly lower in research group, with significant differences (P＜0.05), but there was no significant difference in motalities (P＞0.05).

PiCCO has important clinical value in guiding fluid resuscitation in septic shock patients with cardiac insufficiency, by reducing total amount of resuscitation fluid, decreasing lung water and cardiac preload, but still improving tissue perfusion.

To construct and compare the nomogram prediction model of perioperative acute kidney injury (AKI) in Stanford type A and type B acute aortic dissection (AAD) patients.

The data of patients diagnosed with AAD in our hospital from January 2019 to December 2021 were collected. The independent risk factors of TAAAD-AKI and TBAAD-AKI were screened by LASSO regression and multi-factor logistic regression, respectively, and the nomogram prediction model was constructed. Through the internal verification of bootstrapping, the advantages and disadvantages of the model were evaluated from three aspects: accuracy, calibration, and clinical benefit.

Data from 464 patients with AAD were collected. The incidence of TAAAD-AKI was 83.5% (147/176), whereas TBAAD-AKI was 41.0% (118/288). First serum creatinine (SCr) on admission, D-dimer value on admission, cardiopulmonary bypass time, mechanical ventilation time, and perioperative use of pressor medications were the independent risk variables for the creation of the TAAAD-AKI nomogram. The variables screened by TBAAD-AKI were first SCr on admission, poor renal perfusion on admission, days of ICU retention, and perioperative use of loop diuretics. The area under the curve (AUC) of receiver operating characteristic curves (ROC) of TAAAD-AKI model was 0.899, which implied a high level of accuracy. The AUC value of the TBAAD-AKI model was 0.825, indicating moderate accuracy. The two nomogram models had good calibration, according to the model's calibration curve and the Hosmer-Lemeshow test. The decision-making curve also found that the model had good clinical benefits.

The predictors of TAAAD-AKI and TBAAD-AKI are distinct except for the first SCr on admission. While the majority of the TBAAD-AKI are preoperative, the significant TAAAD-AKI variables are primarily focused during and after the procedure. Constructing and verifying two feasible nomograms is crucial for clinical early warning of AKI.

To evaluate the value of plasma heparin binding protein (HBP) in the early diagnosis of sepsis, and to explore the application value of HBP for the severity and prognosis assessment of sepsis.

A prospective observational study was conducted in Department of Critical Care Medicine of Northern Jiangsu People's Hospital. One hundred and ninety-eight patients with confirmed infections from June 2019 to June 2021 were enrolled in this study. According to the illness severity of sepsis, patients were assigned as non-sepsis (n=48), sepsis (n=52) and septic shock (n=98). Forty patients in the same period without infection were selected as control group. The differences in HBP, procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and lactate (Lac) levels were compared and analyzed. The prognostic values on sepsis diagnosis and 28-day mortality were evaluated through drawing receiver operating characteristic (ROC) curve. Logistic regression analysis was used to clarify the factors affecting the prognosis of sepsis.

The plasma level of HBP was obviously elevated in septic shock group than patients in other three groups (P＜0.05), while patients in sepsis group had higher HBP than patients in non-sepsis group (P＜0.05). Take an optimal cutoff value of 35.8 ng/ml, the area under the curve (AUC) for HBP to distinguish sepsis from from non-sepsis was 0.922. The levels of HBP and Lac were also significantly elevated in non-survivors compared to survival group (P＜0.05). Ho sever, no significant differences of PCT, CRP and WBC levels were found between the two groups. Plasma HBP＞97.6 ng/ml was associated with elevated mortality, AUC of HBP predicting 28-day mortality of sepsis patients was 0.750, with a sensitivity of 65.5% and a specificity of 77.7%. The plasma HBP levels in death group were higher than those in survival group at 0 h, 24 h, 48 h and 72 h after admission (P＜0.05). Meanwhile, in death group, the plasma HBP level showed no statistical differences in each time point compared with that in the previous time point (P＞0.05).

HBP can be a better and more specific early predictor of sepsis compared with PCT, CRP, WBC and Lactate. Meanwhile, the level and tendency of HBP has valuable to evaluate the severity of sepsis and mortality.

Neurocritical care is an important branch of critical care medicine. Neurocritical care patients characterize with poor prognosis, ie. high mortality and high disability rate.S100 calcium binding protein B (S100B) is a protein biomarker mainly distributed in astrocytes of brain. Previous studies have shown that abnormal expression and distribution of S100B were significantly associated with the progression and prognosis of serveral neurocritical care diseases such as severe traumatic brain injury, stroke, sepsis-associated encephalopathy, hypoxie-ischemic encephalopathy, and central nervous system infection. The detection of S100B may valuable in the early identification and severity assessment of neurological injury, and in screening patients with poor prognosis and long-term disability risk for early intervention. Targeting S100B may be a potential target for future brain-protective therapy in neurocritical care patients. This article reviews the clinical and basic research progress of S100B in the field of severe neurological diseases, in order to provide guidance for the subsequent research work.

Hypoxic-ischemic encephalopathy is a common sequela after cardiac arrest, and the prognosis of such patients with a markedly reduced quality of survival is often unsatisfactory. We present a case study of neurologic music therapy（NMT）for a maternal women with hypoxic-ischemic encephalopathy, to provide experience for the rehabilitation of critically maternal women with similar diseases. A critical care plan was formulated following a comprehensive assessment of the patient's condition, and NMT was gradually administered. After 46 days in the hospital, the patient was safely discharged with a good prognosis due to attentive nursing and NMT.

To evaluate the effect of high density lipoprotein (HDL) level on the occurrence of sepsis-related acute respiratory distress syndrome (ARDS).

A total of 222 patients with sepsis admitted to the Intensive Care Department of the Space Center Hospital were divided into ARDS group (102 cases) and non-ARDS group (120 cases) according to the occurrence of ARDS. Clinical data of all patients were collected. Unifactor and multifactor logistic regression were used to analyze the risk factors of ARDS in patients with sepsis. Receiver operating characteristic curves (ROC) was used to analyze the predictive efficacy of HDL for sepsis related ARDS patients.

(1) 102 cases of sepsis developed ARDS, the incidence rate was 45.95%. (2) The levels of HDL, albumin (ALB) in peripheral blood of ARDS patients were significantly lower than those of non-ARDS patients, but acute physiological and chronic health score (APACHE Ⅱ), the levels of procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) were significantly higher than those of non ARDS patients, all the differences were statistically significant (P＜0.05). Multifactor logistic regression analysis showed that high APACHE Ⅱ score, high level of CRP and low level of HDL were risk factors for ARDS in sepsis patients. (3) The area under curve (AUC) of ROC of HDL for predicting ARDS patients with sepsis was 0.722, and 0.81 mmol/L was used as the critical point for predicting ARDS. The sensitivity was 76.67%, and the specificity was 65.69%.

Low level of HDL is an independent risk factor of sepsis complicated with ARDS. HDL level has certain predictive value in the occurrence and prognosis of ARDS induced by sepsis.

To analyze the correlation between the cytokine levels in serum and bronchoalveolar lavage fluid (BALF) and intrapulmonary and extrapulmonary acute respiratory distress syndrome (ARDS).

A single-center retrospective study was conducted to collect the clinical data of all ARDS patients requiring mechanical ventilation who were admitted to the Department of Critical Care Medicine of Shandong Provincial Hospital from August 2021 to January 2022. According to the inclusion criteria and exclusion criteria, 30 patients were finally included. ARDS patients were divided into intrapulmonary group caused by direct lung injury and extrapulmonary group that caused by indirect lung injury. Clinical data, cytokine levels (IL -6, IL-10, IL-1β, TNF-α, IL-8), neutrophil ratio (Neu%), lymphocyte ratio (Lym%), disease severity and clinical outcome and clinical biological indicators were collected. Spearman analysis was used for correlation analysis of continuous variables, and logistic regression analysis was used to determine the influencing factors of different type of ARDS.

The duration of mechanical ventilation in extrapulmonary group was shorter than that in intrapulmonary group (Z=2.593, P=0.008). There were no significant differences of serum Lym%, BALF IL-10, BALF/serum IL-10, BALF/serum TNF-α and BALF/serum Neu% while significant differences in other variables between the two groups (P<0.05). Spearman correlation analysis showed that the level of IL-1β in BALF/ serum was positively correlated with the duration of mechanical ventilation in the intrapulmonary group (r=0.773, P=0.015). Logistic regression analysis showed that serum TNF-α and Neu% were the influencing factors of ARDS patients (OR=2.833, 95%CI: 1.136-7.063, P=0.025; OR=0.879, 95%CI: 0.776-0.995, P=0.041).

The level of IL-1β in BALF/serum is positively correlated with the duration of mechanical ventilation inpatients with intrapulmonary ARDS. Although the expression levels of cytokines in serum and BALF are significantly different between patients with intrapulmonary and extrapulmonary ARDS, TNF-α and Neu% in serum can distinguish them.

To investigate the psychological status and its related factors of maternal women in the intensive care unit (ICU).

A total of 101 maternal women in the ICU were included in the study. The Hospital Anxiety and Depression Scale was used to screen the anxiety and/or depression of include patients. The factors that associated with anxiety and depression were analyzed.

The anxiety rate was 50.5% (51/101) and depressive rate was 49.5% (50/101) in these patients. Univariate analysis showed that education (χ²=8.755, P＜0.05; χ²=12.695, P＜0.01), pregnancy outcome (χ²=6.179, P＜0.05), VAS score (Z=2.091, P＜0.05) and APACHE Ⅱ score (Z=2.663, P＜0.01) other than age, marriage, health insurance payment status, number of deliveries, the experience of miscarriage, receive mechanical ventilation and sedative drug (P＞0.05) were associated with anxiety and depression. Multivariable logistic regression analysis showed that high VAS score (OR=1.185, P＜0.05), high APACHE Ⅱ score (OR=1.095, P＜0.05) and adverse pregnancy outcome (OR=4.067, P＜0.01) were risk factors of the development of anxiety and depression, while high education was a protective factor for the development of anxiety and depression (OR=0.253, P＜0.01; OR=0.183, P＜0.01; OR=0.148, P＜0.001).

There is a high incidence of maternal anxiety and depression in the ICU in maternal patients. The pregnancy outcome, severity of illness, pain severity and education level are associated with anxiety and depression.