What can we see through the study of 52 critically ill patients at Jinyintan Hospital

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Not long ago, a retrospective study based on 52 newly diagnosed critically ill patients with pneumonia was published in The Lancet Respiratory Medicine Journal. The study was led by institutions such as Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan Jinyintan Hospital, Wuhan University People's Hospital and other institutions. This is the first study to characterize a critically ill patient with newly diagnosed pneumonia. The clinical electronic medical records, nursing records, laboratory examination results, imaging examinations, and admission data of 52 critically ill patients admitted to Wuhan Jinyintan Hospital in the initial stage of the new official pneumonia epidemic were retrospectively analyzed. What were the main findings of this study? What are the recommendations for the next clinical treatment? In this regard, the reporter interviewed the study authors and relevant experts. Age and underlying illness increase the risk of death. In this study, critically ill patients were defined as patients who were admitted to the intensive care unit and required mechanical ventilation or inhaled air with an oxygen concentration above 60%. The 52 critically ill patients with newly diagnosed pneumonia included in the study were all residents of Wuhan City, with an average age of 59.7 years. Studies have shown that older patients over 65 years of age with underlying disease and acute respiratory distress syndrome have a higher risk of death. In addition, 61. 5% of patients died within 28 days of admission to the intensive care unit, and the average time from admission to death was 7 days. Patients with a history of cerebrovascular disease are at higher risk of death if they are infected with the new coronavirus. "We found that critically ill patients with newly diagnosed pneumonia are usually older, and most have serious underlying diseases. Severe organ failure occurs easily during the disease process and the mortality rate is relatively high." The person in charge, Shang You, deputy director of the Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, said that the dead are more likely to have acute respiratory distress syndrome, more likely to receive invasive or non-invasive mechanical ventilation support, and may have chronic diseases . Elderly patients with poor basic conditions are likely to get worse. In future clinical treatment, we should pay attention to such patients, closely observe the patient's condition, and provide early and reasonable intervention for signs of deterioration. "We should also be alert to mild patients and reduce the transition from mild to severe or even severe during treatment. If we do not pay attention in advance, treatment will be very difficult." Shang You emphasized that early intervention and treatment can be effectively controlled Progress of the disease. Wang Guiqiang, director of the Department of Infectious Diseases, Peking University First Hospital, revealed that some indicators that can be used for early prediction, early warning and timely intervention were discovered through clinical exploration not long ago. Including rapid changes in the patient's condition, such as persistent high fever, gradual decrease in lymphocytes, rapid increase in inflammatory indicators such as lactic acid levels or interleukin-6 and C-reactive protein, and rapid imaging progression. "By monitoring these clinical early warning indicators, early intervention can be carried out to prevent the disease from worsening, thereby greatly improving the cure rate." Wang Guiqiang said. Understanding the clinical characteristics of critically ill patients is critical to reducing mortality. Three studies have been published on patients with newly diagnosed pneumonia, but the number of critically ill patients involved is too small to summarize the characteristics of critically ill patients. It is understood that the Chinese Center for Disease Control and Prevention recently released an epidemiological analysis based on 72,314 patients with new coronary artery pneumonia. The data show that the crude mortality rate in critical cases is 49%. What do you think of the differences between these two studies? "This large sample study is similar to a cross-sectional analysis. These cases come from all over the country and are more representative. This can reflect the large amount of medical resources the country has invested in responding to this epidemic. However, this study The case was not followed up after 28 days. In addition, Academician Zhong Nanshan's team mentioned in a paper published in the New England Journal of Medicine that the mortality rate of patients with complications was 73.3%.

For the elderly with underlying diseases and imperfect organ function itself, hypoxia can rapidly worsen their underlying diseases and ultimately lead to death. Therefore, it is very important to ensure effective oxygen supply, and organ protection and maintenance is a key link in treatment. Wang Guiqiang said that in addition to the treatment of the cause, strong symptomatic treatment is needed to fight for the timing of the cause. The correct approach is a two-pronged approach. Shang You said that while ensuring sufficient oxygen supply for symptomatic treatment, it should also be reduced. Oxygen consumption, such as analgesics and sedatives for critically ill patients who are intubated with a ventilator. For those who have already caused organ damage, more supportive measures should be taken. For example, continuous renal replacement therapy should be performed in a timely manner to ensure The stability of the body's water and electrolyte balance, and to prevent secondary hazards in the case of oliguria and high creatinine-induced acute kidney injury. In the treatment of pathogenic diseases, human plasma containing new coronavirus antibodies can be used for disease progression Patients who are rapidly, seriously ill, or critically ill can be used as a realistic choice for specific antiviral treatment. A few days ago, intensive medical experts across the country jointly formulated the Expert Consensus on the Diagnosis and Treatment of New and Coronary Pneumovirus Pneumonia. You also participated. He said that the Consensus showed that Corticosteroid therapy is not recommended for patients with new-onset pneumonia, but glucocorticoids should be considered for patients with indications that reduce or prevent the progression of acute respiratory distress syndrome. Also, for severe acute hypoxic respiratory failure or acute breathing Distress syndrome requires further respiratory support treatment as soon as possible. Basic research shows that the most common first symptoms of 52 critically ill patients are fever, cough, and dyspnea. The median time from the appearance of pneumonia to the radiological diagnosis is 5 days. . However, it is worth mentioning that 11% of the patients in the study did not have a fever at the time of onset, but did not have a fever until 2 to 8 days after the symptoms associated with the new coronavirus infection. "The delay in fever symptoms will be hindered to some extent Early identification of patients infected with new coronavirus. "Lobbying still. The treatment of critically ill patients is the key to reducing mortality and improving the ability to identify severe cases early in the disease change, which is of great significance to clinical treatment. In this regard, Shangyou believes that the identification of critically ill patients is a basic skill for clinicians It is also a problem that doctors continue to think about in critical medicine. No matter how many grades, instruments and monitoring systems, I think the most fundamental thing is to closely observe the condition, find signs of deterioration as soon as possible, and plan ahead. "" Although newly diagnosed pneumonia The number of cases is rapidly increasing, but the number of critically ill and critically ill patients is increasing, exceeding the capacity of the intensive care unit force. In the first period, the lack of manpower objectively increased the mortality of critically ill patients. The first author of this study, Yang Xiaobo, Department of Critical Care Medicine, Sheikh Hospital, Tongji Medical College, Huazhong University of Science and Technology believes that high mortality in critically ill patients is still a problem that needs to be solved in clinical practice, but the professional knowledge, technology and quantity of intensive care personnel And equipment help to reduce mortality As medical teams from across the country come to help, nearly 10% of domestic intensive care specialists and nurses are concentrated in Wuhan. They have set up more intensive care units in Wuhan, so that more patients can get better treatment in a timely manner, and patient mortality has increased. "At present, Hubei Province has entered the" waiting for beds "stage, and there are some remaining beds in the intensive care unit. This is a very good phenomenon. "Yang Xiaobo said. Wen: Health news reporter, special reporter, editor: Guan Zhongyao comment: and Cao tell us that you are" looking ", if you want