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REVIEW ARTICLE:
Update of Thoracic Epidural Analgesia Used in Acute Pancreatitis
Bao Fu, Zhengguang Geng, Xiaoyun Fu
J Transl Crit Care Med
2022, 4:6 (17 March 2022)
DOI
:10.4103/JTCCM-D-21-00021
Acute pancreatitis (AP) is one of the common gastrointestinal diseases requiring hospitalization. Once AP develops into severe AP, the mortality markedly increases. Animal studies have confirmed that thoracic epidural analgesia (TEA) has many benefits for AP and can provide the survival rate of experimental animals. Existing clinical studies have also shown the safety and effectiveness of TEA in AP. This paper reviews the potential benefits and possible mechanisms of TEA for AP.
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Review Article:
Diaphragm-Protective Mechanical Ventilation: Saving the Diaphragm from the Detrimental Effects of Mechanical Ventilation
Zhonghua Shi, Jian-Xin Zhou, Leo Heunks
J Transl Crit Care Med
2022, 4:5 (18 February 2022)
DOI
:10.4103/JTCCM-D-21-00017
Diaphragm weakness develops in up to 80% of the critically ill patients, and is associated with adverse clinical outcomes. Mechanical ventilation has been proposed to play a role in the development of diaphragm weakness in critically ill patients, especially by ventilator under-assist or ventilator over-assist. Therefore, in addition to the concept of lung-protective ventilation to protect the lung, diaphragm-protective ventilation has been recently proposed to limit the development of diaphragm weakness. In this concise review, we will discuss the current evidence for diaphragm-protective ventilation and the clinical consequences.
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Review Article:
Endogenous Sulfur Dioxide, a Novel Gaseous Transmitter Involved in the Regulation of Inflammatory Responses
Siyao Chen, Junbao Du
J Transl Crit Care Med
2021, 3:14 (18 November 2021)
DOI
:10.4103/2665-9190.330664
Endogenous sulfur dioxide (SO
2
) 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, SO
2
serves as an essential novel gasotransmitter involved in the regulation of extensive biological activities. Several studies indicate that endogenous SO
2
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 SO
2
and its molecular mechanisms.
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Review Article:
Monitoring Respiratory Drive and Effort during Mechanical Ventilation
Irene Telias, Megan Abbott, Laurent Brochard
J Transl Crit Care Med
2021, 3:13 (16 November 2021)
DOI
:10.4103/2665-9190.330536
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.
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Review Article:
Peptide-Based Enteral Nutrition for Critically Ill Patients
Ke Wang, Zhidan Zhang
J Transl Crit Care Med
2021, 3:2 (23 August 2021)
DOI
:10.4103/jtccm.jtccm_11_21
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.
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Review Article:
Recent Advances of MicroRNA in Sepsis-associated Acute Lung Injury
Xuehao Lu, Feng Zhang, Longzhu Li, Meilian Li, Hai Hu, Zhongkai Qu, Chuiyan Qiu, Zhigang Wang, Haiyan Yin, Hui Liu
J Transl Crit Care Med
2021, 3:1 (23 August 2021)
DOI
:10.4103/jtccm.jtccm_14_21
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.
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Review Article:
The Doctors in ICU Need to Know the Basics of Coagulopathy
Ziwei Hu, He Miao, Xiaochun Ma, Renyu Ding
J Transl Crit Care Med
2020, 2:69 (25 June 2021)
DOI
:10.4103/jtccm.jtccm_31_20
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.
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Review Article:
Galectin-3 and Fibrosis: Research in the Last 5 Years
Isaac Eliaz
J Transl Crit Care Med
2019, 1:117 (31 December 2020)
DOI
:10.4103/jtccm.jtccm_15_19
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”.
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Review Article:
Indices of Tissue Perfusion: Triggers of Targets of Resuscitation?
Daniel De Backer, Marie Van Hove, Pierre Foulon, Joe Kadou, Gregoire Michiels, Simone Giglioli
J Transl Crit Care Med
2020, 2:1 (31 December 2020)
DOI
:10.4103/jtccm.jtccm_1_20
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 (ScvO
2
), veno-arterial difference in PCO
2
(PvaCO
2
), 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.
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