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Acute respiratory distress syndrome (ARDS) is a common life-threatening clinical syndrome which accounts for 10% of intensive care unit admissions. Since the Berlin definition was developed, the clinical diagnosis and therapy have changed dramatically by adding a minimum positive end-expiratory pressure (PEEP) to the assessment of hypoxemia compared to the American-European Consensus Conference (AECC) definition in 1994. High-flow nasal cannulas (HFNC) have become widely used as an effective respiratory support for hypoxemia to the extent that their use was proposed in the expansion of the ARDS criteria. However, there would be problems if the diagnosis of a specific disease or clinical syndrome occurred, based on therapeutic strategies. [ABSTRACT FROM AUTHOR]

Sepsis-induced coagulopathy (SIC) is a critical condition in sepsis patients, with varying outcomes depending on the type of infection. This study aims to analyze the prognosis of different infections in SIC cohort. A retrospective cohort study was conducted on 525 patients diagnosed with SIC in the intensive care unit from December 2013 to December 2022. These patients were divided into four groups: a non-pneumonia or bacteremia group, a severe pneumonia group, a bacteremia group, and a severe pneumonia concomitant with bacteremia group. The 28-day mortality was 18% (49/271) in the other infections group, 31% (33/106) in the lung infections group, 23% (29/126) in the blood infections group and 36% (8/36) in the lung and blood co-infections group, respectively. Pearson correlation analysis showed that procalcitonin (PCT) correlated strongly with all detected hemostatic markers (p <0.001). The 28-day mortality rate in Lung infections group was significantly higher (p = 0.019), while Blood infections group had a higher incidence of disseminated intravascular coagulation (p = 0.011). By multivariable model analyses, longer duration of ventilation (p = 0.039) and severe pneumonia (p = 0.040) are risk factors associated with mortality. Different infections, including Lung and Blood infections, indicated different conditions in vivo. Longer duration of ventilation is associated with mortality, while Lung infections indicated higher 28-day mortality rate. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES This study aimed to review surgical experiences in patients with infracardiac total anomalous pulmonary venous connection (TAPVC). METHODS This retrospective study included 63 infants who underwent conventional repair (n  = 27) and sutureless repair (n  = 36) from 1 February 2009 to 31 June 2019. Kaplan–Meier curves and Cox regressions were applied to analyse the overall survival and risk factors. Cumulative incidence curves and competing risk models were used to evaluate postoperative pulmonary venous obstruction (PVO). RESULTS There were 4 hospital deaths and 2 late deaths, and 8 patients experienced postoperative PVO. The survival rates at 30 days, 1 year and 5 years were 95.2%, 90.5% and 90.5%, respectively. The overall survival rate was significantly higher in the sutureless group than that in the conventional group. The cumulative incidence of postoperative PVO in the conventional group was higher than that in the sutureless group. Univariable Cox regression analyses showed that lower surgical weight, increase in preoperative international normalized ratio, prolonged cardiopulmonary bypass time and aortic cross-clamp time and longer duration of postoperative ventilation were associated with higher mortality. Longer cardiopulmonary bypass time, lower preoperative prothrombin activity and the increasing preoperative international normalized ratio before surgical repair were associated with a higher incidence of postoperative PVO. CONCLUSIONS Both sutureless and conventional repairs for patients with infracardiac TAPVC achieved favourable postoperative outcomes. There was no death in the sutureless repair group. Compared to conventional repair, sutureless repair was associated with lower mortality and lower incidence of restenosis in pulmonary veins and anastomosis. [ABSTRACT FROM AUTHOR]

Background Studies on the outcomes of surgical repair for supracardiac total anomalous pulmonary venous connection through the superior approach are uncommon. Methods From January 2004 to January 2016, 198 patients with supracardiac total anomalous pulmonary venous connection underwent side-to-side anastomosis between the common pulmonary vein and left atrium through the superior approach. Kaplan-Meier curve was used to demonstrate the survival estimates. Cox proportional hazard model and competing risk regression model were used to identify risk factors for death and postoperative pulmonary venous obstruction. Results There were six in-hospital deaths and no late deaths. The survival rates at 30 days, 1 year, and 12 years were 97%, 97%, and 97%, respectively. Follow-up was completed in 92.2% of the survivors. Median follow-up was 47 months (range: 0 to 136 months). Twenty-seven patients (14.1%, 27 of 192) required reoperation for pulmonary venous obstruction, residual atrial septal defect, or superior cava vena syndrome. Multivariable analysis showed that preoperative pulmonary venous obstruction ( p = 0.012), longer duration of ventilation ( p = 0.011), and emergency operation ( p = 0.010) were incremental risk factors for death. Aortic cross-clamp time ( p < 0.001) and preoperative pulmonary venous obstruction ( p = 0.002) were associated with postoperative pulmonary venous obstruction. Conclusions Side-to-side anastomosis through a superior approach in surgical repair of supracardiac total anomalous pulmonary venous connection can achieve satisfactory results. [ABSTRACT FROM AUTHOR]