Objective: To evaluate the effect of online objective structured clinical examination (OSCE) in critical care teaching. Methods: This is a self-controlled prospective study performed in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from 2020 to 2021. Consecutive students came from various surgical departments. Online tests were conducted for each student pre-and post-ICU round. There were three spots in online OSCE including clinical case, electrocardiography and chest X-ray. Results: Twenty-four students completed the tests. The median age is 27 years (24–28) in the cohort. There are 18 males and 6 females. Of twenty-four students, 7 came from department of neurologic or head-neck surgery, 3 from department of thoracic surgery, 12 from department of abdominal surgery, and 2 from others. There was significant difference in scores between pre-round and post-round ICU test in the chest X-ray spot, which was 3.33±4.81 and 6.67±4.81 respectively (P = 0.029). Scores in the postround ICU test in the electrocardiography spot was higher than that in the pre-round test (5.85±5.05 vs. 8.33±3.80)however no significance was reached (P = 0.056). There was no significant difference in the scores between pre-round and post-round ICU test in the clinical case spot (63.33±18.33 vs 71.67 ± 13.07, P = 0.116). Lastly, there were significant differences in total scores between pre-round and post-round ICU test (72.50±19.83 vs 86.67±13.40, P = 0.019). Conclusions: Online OSCE was feasible in the teaching evaluation of surgical rotation residents in ICU. Surgery rotation residents in ICU should receive more training in electrocardiography and chest X-ray.

Pain is common in severe acute pancreatitis (SAP) and is associated with the disease severity and outcomes. The management of pain in SAP may not only relieve pain but also improve outcomes. However, pancreatic pain in SAP involves several complicated mechanisms. Poor understanding about the pain mechanism in SAP and lack of enough high-quality data on pharmacological and nonpharmacological intervention lead to a limited analgesia strategy in patients with SAP mainly managed using nonsteroidal anti-inflammatory drugs and opioids. This makes pain management in SAP challenging and may cause potential harm. This article reviewed the current management of pain in SAP by combining pain mechanisms with animal or clinical studies and proposed an analgesic ladder based on available evidence to improve pain management in patients with SAP.

Acute pancreatitis (AP) is an acute inflammation of the pancreas. Many of the mild AP and moderately severe AP (SAP) are self-limiting with a good prognosis, but the management of 15%–20% of SAP is very difficult and results in a mortality rate of 36%–50%. It poses a great challenge in clinical diagnosis and treatment. Infected pancreatic necrosis develops in approximately 20% to 30% of patients with AP, which is treated with the use of a step-up approach, with catheter drainage often delayed until the infected necrosis is encapsulated.

Background: Vasopressin receptor antagonists increase serum sodium through increased aquaresis via inhibition of V2 receptors. The purpose of this study was to compare the efficacy and safety of conivaptan versus tolvaptan for the treatment of hyponatremia. Subject and Methods: This was a retrospective study of patients who received conivaptan or tolvaptan for hyponatremia admitted to the neurocritical care unit. Serum sodium values were collected at baseline and daily up to 4 days after the last dose. The primary efficacy outcome was an increase in serum sodium ≥4 mEq/L in 24 h after the first vaptan dose. The primary safety outcome was overcorrection defined by an increase in serum sodium >12 mEq/L in 24 h. Results: Thirty-four encounters (14 conivaptan and 20 tolvaptan) were included. Baseline serum sodium was similar between groups (conivaptan 126 mEq/L and tolvaptan 125 mEq/L). Each group received a median of one vaptan dose received on days 5 and 7 of hospitalization for conivaptan and tolvaptan, respectively. The primary efficacy outcome was similar between conivaptan (9 of 14, 64.3%) and tolvaptan (14 of 20, 70%) groups, P = 1.0, and the median change in serum sodium 24 h after the first vaptan dose was 5 versus 7 mEq/L (P = 0.377), respectively. The rate of overcorrection was similar between conivaptan and tolvaptan patients (7.1% vs. 15% P = 0.627). Conclusion: In this study, conivaptan compared to tolvaptan for the treatment of hyponatremia in patients admitted with a primary neurological diagnosis appears efficacious and safe. Further studies are warranted given the sample size of this cohort.

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.

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.

Background: There are controversies regarding corticosteroids using in coronavirus disease-2019 (COVID-19) pneumonia in the current pandemic. Objectives: This study investigates the efficacy and safety profiles of corticosteroids therapy in COVID-19 patients. Methods: Retrospective, multicenter study case series of consecutive patients with confirmed COVID-19 infection at the whole hospital from January 1 to March 1, 2020, were enrolled. Demographic, clinical, radiological, laboratory, and treatment data were collected and analyzed. The effect of corticosteroids therapy on death and organ-failure complications of pneumonia were analyzed by logistic regression. Results: A total of 470 COVID-19 patients at the whole hospital were enrolled. According to the time of corticosteroids initiation and severity of illness, there were 159 patients stratified into critical ill group and 64% (102 of 159) patients received corticosteroids treatments. Ninety-four percent (166 of 176) of corticosteroids were methylprednisolone. The median cumulative corticosteroids dosage was 300 mg equivalent of methylprednisolone over a median duration of 6 days. Multivariate regression analysis showed that corticosteroids use did not affect the mortality. However, corticosteroids therapy at moderate cumulative doses (total exposure 480 mg to 1200 mg) was associated with deceased occurrence of organ-failure complications in critically ill COVID-19. Conclusions: Corticosteroids have no effect to mortality in COVID-19 patients. The moderate cumulative doses of corticosteroids might decrease organ-failure complications in critically ill COVID-19. Further large-scale randomized controlled trials are warranted to confirm our findings, until then use of corticosteroids should be used with caution COVID-19 patients.