Endogenous sulfur dioxide (SO₂) used to be perceived as a notorious, toxic pollutant of the atmosphere. However, recently several studies revealed that in vivo generated mainly from sulfur-containing amino acids, SO₂ serves as an essential novel gasotransmitter involved in the regulation of extensive biological activities. Several studies indicate that endogenous SO₂ protects against inflammation by inhibiting the production of inflammatory mediators via different molecular pathways. The present review, therefore, summarized the anti-inflammatory effect of endogenous SO₂ and its molecular mechanisms.

During assisted mechanical ventilation, the respiratory system is exposed to the positive pressure from the ventilator and the negative pressure generated by the respiratory muscles. Both excessively high and low respiratory drive and effort can injure the respiratory muscles and lungs resulting in worse patient's outcomes. Monitoring respiratory drive and inspiratory effort are key to prevent harm by adjusting sedation and ventilation to meet safe targets of respiratory drive and inspiratory effort. Based on physiological studies and observational data, it is currently recommended to target an intermediate range of drive and effort in most patients, however, these targets need to be validated prospective and adjusted for different patient populations. The gold standard for measuring inspiratory effort requires the insertion of an esophageal catheter and additional equipment. However, recently, several noninvasive techniques using end-expiratory or end-inspiratory occlusions on the ventilator have been validated to estimate respiratory drive and effort allowing clinicians to monitor drive and effort easily at the bedside. In this narrative review, we discuss potential beneficial and deleterious consequences of breathing effort during assisted ventilation, available monitoring techniques, and propose a structured approach for bedside implementation.

Objective: The objective of the study is to describe the clinical characteristics, risk factors, and prognosis for acute kidney injury (AKI) among patients with coronavirus disease (COVID-19). Methods: Retrospective study of 456 consecutive patients with confirmed COVID-19 infection at the whole hospital from January 1 to March 1, 2020 was enrolled. Demographic, clinical characteristics, the risk factors, and prognosis were collected and analyzed. Results: Of 456 patients with COVID-19, 38 patients developed AKI. Patients with AKI were older and predominantly male sex and were more likely to have comorbidities such as hypertension, cardiovascular, and cerebrovascular diseases. Among patients with AKI, the white blood cell count, neutrophil count, neutrophil-to-lymphocyte ratio, alanine aminotransferase, and C-reaction protein were increased, and lymphocyte and platelet count were decreased. Multivariate analysis showed that age, hypertension, and lymphocyte count were independent risk factors for AKI. The overall mortality rate of 456 patients was 9.9%, and the mortality rate of patients with AKI was 23.7%. In particular, increasing AKI severity was associated with increased risk. Conclusions: The risk of AKI was high in patients with COVID-19. Older age, hypertension, and lower lymphocyte count were independent risk factors for AKI. COVID-19-associated AKI was associated with higher risk of death in patients with COVID-19.

Background: The effect of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) on the coronavirus disease 2019 (COVID-19) remains controversial from clinic evidence. Objectives: The objectives of this study were to report the major characteristics and clinical outcomes of COVID-19 patients treated with ACEIs and ARBs and compare the different effects of the two drugs for outcomes of COVID-19 patients. Methods: This is a retrospective, two-center case series of 198 consecutive COVID-19 patients with a history of hypertension. Results: Among 198 patients, 58 (29.3%) and 16 (8.1%) were on ARB and ACEI, respectively. Patients who were on ARB or ACEI/ARB had a significantly lower rate of severe illness and acute respiratory distress syndrome (ARDS) when compared with patients treated with ACEI alone or not receiving RAAS blocker (P < 0.05). The Kaplan–Meier survival curve showed that patients with ARB in their antihypertensive regimen had a trend toward a higher survival rate when compared with individuals without ARB (adjusted hazard ratio, 0.27; 95% confidence interval [CI], 0.07–1.02; P = 0.054). The occurrence rates of severe illness, ARDS, and death were similar in the two groups regardless of receiving ACEI. The Cox regression analyses showed a better survival in the ARB group than the ACEI group (adjusted hazard ratio, 0.03; 95% CI, 0.00–0.58; P = 0.02). Conclusions: Our data may provide that some evidence of using ARB, but not ACEI, was associated with a reduced rate of severe illness and ARDS, indicating their potential protective impact in COVID-19. Further large sample sizes and multiethnic populations are warranted to confirm our findings.

Regional citrate anticoagulation (RCA) is the preferred anticoagulation method of continuous renal replacement therapy (CRRT) which is recommended by international guidelines, but the use of citrate anticoagulation is relatively complicated. If correct prescription and timely adjustment of RCA are not performed, disorders of fluid electrolyte and acid-base balance are prone to occur, especially hypocalcemia, which is a fatal complication. This article introduces the use of RCA with calcium-containing replacement fluid for postdilution continuous veno-venous hemofiltration, which provides a simple and easy CRRT anticoagulation protocol for clinical practice.

Background: COVID-19 outbreak has spread around the world. Liver dysfunction (LD) was related with high mortality in COVID-19. Methods: Retrospective, single-center study case series of 425 consecutive hospitalized COVID-19 patients were enrolled. Demographic, clinical, laboratory, and treatment data were collected. Results: A total of 425 patients were included in this study, 145 of whom had LD. The overall mortality rate was 8.9%, while 17.9% in the LD group and 4.3% in the nonliver dysfunction (NLD) group. Age, sex, and hypertension were the independent risk factors of LD. LD was an independent risk factor for incidence of severe illness, acute respiratory distress syndrome, and death. The survival rate of patients in LD group was lower than that in NLD group (P < 0.001). A similar trend was observed by the multivariate regression analysis (adjusted hazard ratio, 3.52; 95% confidence interval [CI], 1.69–7.33; P = 0.001). Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers had effect to reduce LD (odds ratio of 0.48 [95% CI, 0.232–0.989; P = 0.045]). Conclusions: LD is one of the main features of hospitalized patients of COVID-19, with a worse prognosis. Patients of COVID-19 with LD on admission should be more cautions.

Background and Objectives: To explore the superiority of flipping-classroom lended learning in which the stay-home e-learning and traditional internship complements each other in resident training of endcorinology during coronavirus disease 2019 restriction period. Materials and Methods: A total of 44 residents were randomized as the study population. In the endocrine-rotation training, we reformed the clinical learning by unified online-teaching led by teachers' combination with individual guidance by residents. Moreover, the final implementation assessment was conducted by standard double-blind examinations. Results: After 4–8 weeks training, the 44 residents were assessed for clinical skills from six dimensions, including medical history collection, physical examination, history report and inpatient record writing, case analysis, and overviewing capability. Compared with the mean scores of 68 residents rotated in internal medicine in 2019, the mean scores on physical examination, inpatient record writing, and overviewing capability in 2020 group were higher with significance ([85.72 ± 8.33] vs.[79.22 ± 10.12], P = 0.0006), ([90.28 ± 10.70] vs. [81.82 ± 8.03], P < 0.0001), ([80.31 ± 8.70] vs. [73.04 ± 12.74], P = 0.0012), whereas scores on skills of medical history collection and history report were slightly lower ([82.11 ± 9.02] vs. [85.06 ± 7.23], P = 0.0586), ([79.30 ± 8.17] vs. [83.21 ± 5.01], P = 0.0022), while scores on case analysis did not show huge gap but with polarized performance in 2020 group ([74.38 ± 10.29] vs. [78.13 ± 8.53], P = 0.0386). Conclusions: Providing the novel pattern of unified online-teaching combined with individual-guidance at the bedside to the front-line residents can reduce the risk of cluster epidemics and effectively ensure the training effect on them but still with shortcomings. The future online teaching reform is better for focus more on how to make up for or reduce the actual problem of disconnection between theory and practice in the process of online clinical skills training for residents and teachers.

Introduction: The diagnostic and prognostic value of thromboelastogram (TEG) in sepsis has not been determined. This study aimed to assess whether TEG is an early predictor of coagulopathy and is associated with mortality in patients with sepsis. Methods: In total, 518 patients with sepsis on the intensive care unit (ICU) admission were prospectively evaluated. We measured TEG and conventional coagulation tests on preadmission to ICU and observed for the development of 1 and 3 days and 1, 3, and 7 days, respectively. Multivariable logistic regression was utilized to determine the odds of ICU/hospital mortality. The parameter of TEG (maximum amplitude, reaction time; MA/R ratio) was calculated to evaluate sepsis-induced coagulopathy. The patients were divided into three groups : MA/R0 group (MA/R = 5–14 mm/min); MA/R1 group (MA/R <5 mm/min); and MA/R2 group (MA/R >14 mm/min). Results: Four hundred and ten patients were included. At enrolment, 10.73%, 65.85%, and 23.41% of the patients had lower, normal, and higher MA/R state, respectively. Compared to MA/R0 group, patients with lower and higher MA/R both had significantly increase risk of hospital mortality (hazards ratio [HR] 2.83 [95% confidence interval [CI] 1.577–5.079], P < 0.01); (HR 1.982 [95% CI 1.073–3.66], P = 0.029), respectively (adjusted with Acute Physiology and Chronic Health Evaluation [APACHEII] score) and ICU mortality (HR 2.512 [95% CI 1.301–4.852], P = 0.006); (HR1.644 [95% CI 1.024–2.639], P = 0.002) (adjusted with APACHEII score). Patients with higher MA/R had significantly increase risk of hospital mortality APACHE II score (HR 1.635 [95% CI 1.016–2.632], P = 0.043). Conclusions: In our cohort of patients with severe sepsis, coagulopathy defined by MA/R ratio was associated with increased risk of ICU/hospital mortality.

It has been described that COVID-19 is a dynamic behavior and systemic affectation entity, so it is essential to develop the diagnostic and prognostic tools which allows to specifically identify target organ damage. The electrocardiographic finding of an inverse T-wave suggests transient apical dysfunction of the left ventricle, generating confusion among different heart diseases. However, despite the lack of troponin elevation and other myocardial injury signs, this finding is unspecific, especially in the patient with COVID-19. The aim of this manuscript is to present the case of a patient with COVID-19 without a previous diagnosis of heart disease, which manifests an isolated inverse T-wave.

This review discusses the clinical beneficial effects of peptide-based enteral nutrition (EN) for critically ill patients, especially those with gastrointestinal (GI) dysfunction. The GI dysfunction is very common in critically ill patients and always leads to intolerance of enteral feeding. Experimental and clinical studies suggest that peptide-based EN can be easily digested and absorbed by the GI tract which improving the feeding intolerance and provide better nutritional effects for critically ill patients. In addition, peptide-based EN may also have anti-inflammation, anti-oxidation, and immune-modulation effects and can facilitate muscle protein synthesis to improve muscle weakness which is commonly seen in critically ill patients. Peptide-based EN may have both nutritional and nonnutritional beneficial effects for critically ill patients. Further, large prospective randomized clinical trials should to be done to make the definite results.

Sepsis is one of the most common severe diseases in clinic. With the progression of the disease, it is very likely to occur acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Despite years of research, the mortality rate from sepsis-associated lung injury remains high. MicroRNAs (miRNAs) are a class of non-coding small RNAs with the function of regulating gene expression. In recent years, miRNAs have become a research hotspot in the field of biomedicine. Therefore, this review summarizes a large body of evidence implicating miRNAs and their target molecules in ALI/ARDS originating largely from studies using animal and cell culture model systems of ALI/ARDS. First, the pathophysiology and potential molecular mechanism of sepsis-associated ALI were briefly discussed at the cellular level, and the regulatory effect of miRNA on sepsis-associated ALI was summarized from the molecular mechanism so as to provide the possibility to find new targets for the treatment of sepsis-associated lung injury. Finally, some promising methods and some shortcomings of existing research are introduced.

Background: The prevalence of clinical manifestations in severe patients with COVID-19 was highly variable across region, populations, and assessment methods. We investigated the characteristics in patients with COVID-19 and the risk factors associated with severe cases and progression to severe patients during hospitalization. Methods: In this retrospective, multicenter observational study, we collected the clinical manifestations and laboratory regarding from 125 patients with laboratory-confirmed COVID-19 in Liaoning province, China. The collected COVID-19 patients were divided into two groups, including nonsevere group and severe group which were according to the Chinese national guideline for COVID-19 diagnosis and treatment. Results: One hundred and twenty-five laboratory-confirmed COVID-19 patients from three centralized diagnosis and treatment centers were enrolled. The median age was 44 years old, 68 (54.4%) were male. One hundred and twelve (81.6%) patients were in nonsevere group and 23 (18.4%) were in severe group. The overall hospital mortality is 1.6%. About 34% patients had been to Wuhan, 35.2%patients had contact with confirmed COVID-19 patient in Wuhan. Thirty-five (28%) patients were local and 11 (8.8%) patients had a history of direct contact with wildlife. About 20.8% of the patients had comorbidity, hypertension was the most common comorbidity (14.4%). Four patients changed from nonsevere to severe during hospitalization. Most patients were admitted in January and February (98.4%). The median hospital stay was 16 days (interquartile range [IQR]: 12–21). On admission, fever was the most common symptom (60.8%). Duration from onset symptom to hospitalization was 5 days (IQR, 2–8). Compared with nonsevere group, severe cases were associated with significant increased NE (74.19 ± 13.87 vs. 62.32 ± 12.80, P = 0.001), C-reactive protein (CRP) (33.27 ± 38.60 vs. 15.53 ± 29.35, P = 0.003), D2 (1.52 ± 2.83 vs. 0.44 ± 0.93, P = 0.021), lower lymphocyte count (0.81 ± 0.41 vs. 2.32 ± 6.63, P = 0.042), and lymphocyte percentage (LY%) (15.94 ± 10.47 vs. 28.83 ± 11.66, P < 0.001). Kaletra and Chinese medicine were most widely used, the proportion was 61.6% and 66.4%, respectively. Age (odds ratio [OR] = 1.030, 95% confidence interval [CI], 0.99–1.09; P = 0.042), fever on admission (OR = 5.23, 95% CI, 1.32–20.79; P = 0.019), increased NE (OR = 10.53, 95% CI, 3.55–31.25; P = 0.000), and decreased LY% (OR = 7.72, 95% CI, 2.61–22.83; P = 0.000) were independently associated with the severe COVID-19. Age (OR, 1.12; 95% CI, 1.01–1.23; P = 0.025), myalgia (OR, 30.82; 95% CI, 1.58–600.16; P = 0.024), and CRP (OR = 1.04, 95% CI, 1.004–1.073; P = 0.030) were associated with higher risk of development to severe COVID-19 cases. Conclusions: 1. Identification of individuals at risk for severe COVID-19 after severe acute respiratory syndrome coronavirus 2 infection is important 2. The effects of conventional methods on predicting those patients who will go on to develop severe COVID-19 are limited 3. Age, fever on admission, increased NE, and decreased LY% were independently associated with the severe COVID-19 4. Age, myalgia, and CRP were independent risk factors associated with development to severe COVID-19.

Objective: Postoperative cognitive dysfunction (POCD) and neurologic deficit continues to be an important neuropsychological adverse affecting patients' outcome. We conducted this systematic review to investigate the relationship between regional cerebral oxygen saturation (rSO2) and early POCD in postoperative patients. Materials and Methods: Our search included MEDLINE (PubMed) and Cochrane library, from inception to October 31, 2018. We included studies reporting values of rSO2 at the beginning of and/or during surgery, and the primary outcome was POCD, and excluded articles who do not put postoperative cognitive function as the main observation. Two reviewers assessed the quality of the included articles using the Newcastle-Ottawa Scale and extracted the data. Results: Seven prospective cohort studies that included 532 patients incorporate into this systematic review. About 37.78% (201/532) patients achieved POCD. POCD was associated with significantly lower overall values of rSO2 during surgery compared to the population that did not achieve POCD (mean difference [MD] −1.98; 95% confidence interval [CI] −3.30 to −0.66; P = 0.003). In the subgroup, the lowest rSO2 values intraoperative period were a better predictor of POCD (MD −2.91; 95% CI −4.37 to − 1.46; P < 0.0001) than the mean rSO2 values (MD − 2.94; 95% CI −5.71 to − 0.17; P = 0.04). However, all of two were proved superior to baseline rSO2 values (MD −0.13; 95% CI -1.33 to 1.07; P = 0.83); patients with intraoperative cerebral oxygen <50% are nearly four times more likely to have early POCD (odds ratio = 3.65; 95% CI 1.62–8.23, P = 0.002). Conclusions: Patients with POCD have significantly lower cerebral oxygenation during operation than their counterparts. The lowest rSO2 values intraoperative period and patients with intraoperative cerebral oxygen <50% were a better predictor of POCD.

Artificial intelligence provides a vast opportunity and conquest of the science of knowledge. Twenty-first-century medicine will be characterized by an extraordinary ability to access and process medical information to provide patient-specific, timely, and effective clinical decision support. The knowledge gained by patient care experience and clinicians' expertise has led to many clinical care advances. Access to a large volume of data, along with ever-growing information and knowledge of diseases, can allow us to optimize diagnoses and management strategies by using advances in machine learning and artificial intelligence. Changing the medical culture from only relying on the experts to use medical informatics advances to improve the experts' clinical judgment would be an uphill battle. It is necessary to overcome the clinicians' traditional training to empower them into moving in the data science, statistics, and artificial intelligence era. As the incorporation of artificial intelligence in clinical practice seems inevitable, a thorough understanding of its capacities and flaws is essential to the emergence of a new clinical practice world. This review paper describes some of the nuances of past, current, and future clinical decision support systems and artificial intelligence's impact on this process.

Coagulopathy is common in critically ill patients. Under pathogenic factors, the homeostasis of coagulation, anticoagulation, and fibrinolytic system is disrupted, causing a series of cascade reactions that ultimately lead to coagulopathy. The pathophysiology of coagulopathy markedly varies according to the etiology. For sepsis-induced coagulopathy, inflammation interacts with coagulation. This process involves various cells, including endothelial cells, neutrophils, and platelets. Thrombocytopenia, as a common coagulopathy disorder among intensive care unit (ICU) patients, is indicative of poor outcome, and its differential diagnosis is crucial. However, the standardized diagnostic criteria for disseminated intravascular coagulation are yet to be established, and the existing ones have limitations. Therefore, we used PubMed to search literature related to “thrombocytopenia,” “sepsis,” “coagulopathy,” “disseminated intravascular coagulation,” and “coagulation biomarkers” and expected ICU doctors to fully understand knowledgeable of the pathophysiology of Coagulopathy. The traditional coagulation indicators can be combined with novel coagulation-related biomarkers for the accurate diagnosis and treatment of coagulopathy.

Introduction: The characteristics for the planned ICU admissions were not surprising. However, the reasons for unplanned ICU admission are multi-factorial and may be beyond the scope of the anaesthesiologist's role in patient care. Unplanned intensive care admission may be a useful indicator of the quality of the overall process of peri-operative care. With this background, this study was undertaken to do a prospective evaluation, analysis of post-op admissions in the Intensive Care Unit of a tertiary care hospital. Material and Methods: The present observational study was conducted in the Intensive Care Unit of a defence Tertiary Care Hospital for a period of one-year wef 1Apr 18 to 31 March 19 and all the post-operative patients were divided into two groups: Group 1 – Planned Admissions: This included those patients where surgeon and/or the anaesthesiologist had decided pre-operatively for post-op ICU admission. Group 2 – Unplanned Admissions and Emergency admission: This included those patients, whose admissions were not anticipated pre-operatively, however, due to some unexpected peri-op complications arising within 48 hours of surgery led them to ICU admission. This group also comprised of patients who were admitted after forty-eight hours of primary surgery for post-operative complications. Result: In one year, the total operated patients (excluding paediatric, cardiac) in various OTs were 18157 and out of which, 261 patients were admitted to ICU. In planned group, maximum patients were of ASA III and in unplanned/emergency admissions ASA II patients were predominant. Post-operative gastrointestinal surgery patients formed a substantial percentage of the ICU admissions in both planned (94/211; 44.55%) and unplanned admission (20/50; 40.00%). GA with endotracheal intubation was technique of anaesthesia in both planned and unplanned admission. The predominant reason for unplanned ICU admission was post-operative care and treatment following unanticipated intra-operative complications. Conclusion: Thorough pre-operative evaluation and pre-operative optimization of patients whenever possible can reduce the incidence of unplanned admission to ICU. Early recognition of complications, timely intervention and timely intensive care and monitoring are essential to improve outcomes.

Tissue fibrosis is initially an adaptive response to organ injury, but eventually, parenchymal scarring and subsequent cellular dysfunction and organ failure ensue. Few therapies currently exist for fibrosis, especially those that target fibrogenesis. Galectin-3 (Gal-3) is a member of the lectin family of proteins, is produced predominantly by macrophages, and has essential functions in inflammation and angiogenesis. Gal-3 is activated in fibrotic models and abnormally elevated in fibrotic patients. Gal-3 inhibitors help to ameliorate or prevent fibrosis. For this review, we searched for original articles and reviews published between Jul 1, 2014, and Nov 1, 2019, using the following search terms (or combination of words) in PubMed: “galectin 3”, “fibrosis”, “heart”, “cardiac”, “liver”, “hepatic”, “lung”, “pulmonary”, “kidney”, and “renal”.

Biomarkers play important roles in clinical practices including diagnosis and treatment selection. With regard to acute kidney injury (AKI), the use of biomarkers to guide clinical trials is very promising. The committee of the 19th Acute Dialysis Quality Initiative (ADQI) conference met in April 2017 and discussed the integration of biomarkers within clinical trials of acute kidney injury. Consensus had been reached for the significant benefits of integration of biomarkers in clinical trials as well as some potential limitations. Authors concluded the potential role of biomarkers from risk stratification to identification of AKI as well as to monitor therapeutic effects. The group also concluded that biomarkers included within clinical trails could provide both sensitivity and specificity to facilitate trial design. Then the group discussed the role of biomarkers within the PICO (Patient, Intervention, Comparator, Outcome) framework, including the use of biomarkers in patient selection, intervention guidance, comparator and end-point decision. Finally, the committee concluded both the benefits and potential drawbacks of implementing biomarkers in clinical trials of acute kidney injury.

Many patients suffer from multiple organ dysfunction syndrome (MODS), which represents a dominant cause of death in the intensive care unit. Current theories about the mechanisms of MODS include inflammation, dysregulated immune response, reduced cellular oxygen utilization, cytopathic hypoxia, and apoptosis. Moreover, an increasing number of studies have shown that endoplasmic reticulum stress (ERS) is related to organ dysfunction. The endoplasmic reticulum is an organelle that is responsible for secretion and membrane protein synthesis and assembly as well as some other physiological activities. Under certain conditions, the homeostasis of ER can be lost, causing the accumulation of unfolded or misfolded protein, which is termed as ERS. During ERS, unfolded protein response (UPR) is activated. Once UPR fails to rebuilt cellular homeostasis, cell function will be impaired and apoptosis will be induced. To better understand the relationship between ERS and severe diseases, we summarize the current research in the context of ERS and UPR signaling associated with various organ dysfunction and severe diseases, including acute lung injury, hepatic injury, heart failure, hemorrhagic shock with multiple organ dysfunction, sepsis, and some other diseases. We also discuss ERS or UPR as a novel therapeutic target and their future directions.

Liver injury is one of the most common critical clinical illnesses and is one of the manifestations of multiple organ dysfunction induced by sepsis. The liver plays a central role in the development of sepsis. The role of the liver in removing bacteria and regulating immune inflammation is crucial, and the liver is the target of sepsis-related injuries. However, the mechanism of liver injury in sepsis is still not clear. This review discusses the pathophysiology, clinical manifestations, and treatment of sepsis-related liver injury. Liver injury, pathophysiological mechanism, sepsis, sepsis-related liver injury

Myxedema coma is a rare life-threatening form of severe hypothyroidism with physiological decompensation. It occurs as a result of long-standing, undiagnosed, or undertreated hypothyroidism and is usually precipitated by an acute event similar to infection, cerebrovascular accident, myocardial infarction, trauma, cold exposure, surgery, or drug therapy. Patients with myxedema coma are generally severely ill with hypothermia and depressed mental status. It is a medical emergency with a high mortality rate. If the diagnosis is suspected, immediate management is necessary before confirming the diagnosis. Patients with myxedema coma should be treated in an intensive care unit with continuous cardiac monitoring. Initial steps in management include airway management, thyroid hormone replacement, glucocorticoid therapy, and supportive measures. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread availability of thyroid-stimulating hormone assays. The following presentation is a case of postoperative myxedema coma that was successfully managed with multidisciplinary effort. The patient has had a complete recovery.

Introduction: The importance of blood ammonia detection and nonhepatic hyperammonemia (NHH) in the treatment and prognosis of patients has been neglected clinically. The purpose of this study was to evaluate the etiology, diagnosis, treatment, and prognosis of NHH in intensive care unit adults in Heilongjiang province, China. To solve this problem, we designed a provincial-level survey of severe adult NHH, including its etiology, risk factors, incidence, prognosis, and treatment strategies. Methods: The present study refers to a cross-sectional survey of the whole province, involving five cities in Heilongjiang province. All patients who met the inclusion criteria were eligible to apply to participate in the study, which included baseline demographics, clinical presentation, and follow-up related to diagnosis and treatment. Results: The total number of patients to be recruited in this study was estimated to reach 759. All patients who met the inclusion criteria were eligible to apply to participate in the study, which included baseline demographics, clinical presentation, and follow-up related to diagnosis and treatment. Conclusion: This study is expected to provide a theoretical basis for the development of more scientific and standardized NHH diagnosis and treatment methods. Ethics and Dissemination: Ethical approval was obtained from the ethics committee of The Second Affiliated Hospital of Harbin Medical University (registration number KY2019-184). The findings of this review will be communicated through peer-reviewed publications and scientific presentations. Trial Registration Number: ChiCTR1900026632.

Neurotoxicity has been an adverse effect described for almost all B-lactams; since its launch in 1994, there are numerous reports of patients treated with cefepime, covering a wide spectrum of clinical manifestations ranging from delirium to a nonconvulsive status epilepticus (NCSE), being the most of them reported in patients with decreased renal function, but also in patients with preserved renal function. We attempted to illustrate the clinical spectrum of cefepime neurotoxicity in relation to neurocritical care. We identified 13 publications describing neurotoxicity following cefepime administration from PubMed using search terms were cefepime, neurotoxicity, seizures, delirium, encephalopathy, NCSE, myoclonus, confusion, aphasia, agitation, coma, disability, and death. Two reviewers independently assessed identified articles for eligibility and used for this review writing. Most reports occur in elderly patients, although cases have been described in children and newborns. In general, patients recover soon after stopping beta-lactams or after reducing the dose or replacing them with another antibiotic; however, there is a likelihood of recurrence of symptoms after reintroducing Cefepime again at a dose low.

Severely ill neurosurgical patients are those who present with pathologies of the nervous system associated with either a high mortality or that which leaves significant sequelae in those who survive. Desmopressin is a synthetic analog of the antidiuretic hormone that is stored in neurohypophysis. Its function is to decrease urinary volume by increasing reabsorption of water in the convoluted tubules and nephron collectors, additionally increasing the expression of coagulation factor VII and the von Willebrand factor. For this reason, its usefulness in the management of various pathologies has been tested, from coagulopathies to posttraumatic and postsurgical diabetes insipidus. It contributes in improving hyponatremia and in maintaining the balance of fluids and electrolytes in traumatic brain injury and subarachnoid hemorrhage (SAH) patients. It has been additionally studied for its role in the risk of rebleeding in SAH patients and in those with coagulopathies, where its implicated mechanism of action is through platelet anti-aggregation.

Acute pulmonary embolism is an uncommon complication after pacemaker insertion. This report describes, in view of multiple finding, we found the exact cause of the present scenario of the patient which is rare and successfully managed.

Objective: The information about the critically ill coronavirus disease 2019 (COVID-19) was limited and controversy. This study was to analyze the clinical feature and predictors for outcome in critically ill COVID-19. Design: This was a descriptive study from two hospitals. Setting: This study was conducted in intensive care units (ICUs) from university hospitals. Methods: Critically ill COVID-19 patients admitted in ICU from Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital from January 8 to February 20, 2020, were screened. Interventions: None. Measurements and Main Results: Clinical, laboratory data were collected with management strategies and outcomes. Sixty-eight critically ill patients were enrolled. Their median age was 64 (interquartile range, 54–72) years, and 67.65% were male. In this cohort, 44 (65%) patients survived for 28 days. The invasive mechanical ventilator was used in 51 (75%) patients, with 20 of them requiring prone positioning, and 17 switched to extracorporeal membrane oxygenation. The compliance scores of lungs on the day of intubation among survivors were higher than those in nonsurvivors (25.00 [13.50–39.00] vs. 17.00 [12.00–22.00], P = 0.01). The blood interlukin-6 (IL-6) levels at the ICU admission were significantly higher in nonsurvivors compared to survivors (71.27 [51.48–144.15] vs. 18.15 [7.55–68.02] ng/ml, P = 0.025). The heart rates, lung injury scale, and positive end-expiratory pressure were constantly higher for 10 days in nonsurvivors. The frequency of vasopressor uses and neuromuscular blockers was higher in nonsurvivors from day 5 to day 10 (P < 0.05). In the whole cohort, the most common complications were acute respiratory distress syndrome (95.59%), shock (48.53%), arrhythmia (33.82%), acute cardiac injury (33.82%), and acute kidney injury (27.94%). Multivariate analysis indicated that lower lung compliance at the day of intubation and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) at ICU admission were related to higher mortality (P = 0.02 and 0.05, respectively). Conclusion: COVID-19-related critical illness predominantly affected old individuals and was characterized by severe hypoxemic respiratory failure, often requiring prolonged mechanical ventilation and rescue therapies. High APACHE II scores and low lung compliance indicated poor outcomes.

Circulatory shock is characterized by a decrease in oxygen delivery to the tissues associated with impairment in oxygen metabolism and tissue hypoxia. Clinical and biological signs of impaired tissue perfusion and tissue hypoxia are used as bedside to detect circulatory failure and trigger resuscitation procedures. The most popular signs of tissue hypoperfusion include mean arterial pressure, capillary refill time and mottling score, central venous oxygen saturation (ScvO₂), veno-arterial difference in PCO₂ (PvaCO₂), microcirculation assessment, and lactate. Both the severity and duration of the alterations in any of these variables are associated with a poor outcome so that it sounds logical to trigger therapy based on these. Using these variables as target for therapy is much more complex. Some of the limits for using some of these variables as targets include an incertitude about the target to reach (should we aim at normalizing or improving the variable, and by how much?) and the time lag between resolution of impaired tissue perfusion/hypoxia and normalization of the variable. The ideal target variable should have a well-defined end point and a rapid response time. Interestingly, hemodynamic resuscitation targeting these variables gave variable results. In this review, we will discuss the interest and limitations of the above-mentioned indices of tissue perfusion and hypoxia as trigger as well as end point of resuscitation in critically ill patients.