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The QI program involving protocol-directed weaning is associated with beneficial clinical outcomes in mechanically ventilated patients.

Aims/Introduction: Hyperglycemia, hypoglycemia, and blood glucose fluctuation are associated with the outcome in critically ill patients, but the target of blood glucose control is debatable especially in patients with diabetes regarding the status of blood glucose control before admission to ICU. This study aimed to investigate the association between the glycemic gap which is calculated as the mean blood glucose level during the first 7 days after admission to ICU minus the A1C-derived average glucose and the outcome of critically ill patients with diabetes. Method: This study was undertaken in two intensive care units (ICUs) with a total of 30 beds. Patients with diabetes who were expected to stay for more than 24 h were enrolled, the HbA1c was tested within 3 days after admission and converted to the A1C-derived average glucose (ADAG) by the equation: ADAG = [(HbA1c * 28.7) -46.7 ] * 18 -1 , arterial blood glucose measurements were four per day routinely during the first 7 days after admission, the APACHE II score within the first 24 h, the mean blood glucose level (MGL), standard deviation (SD), and coefficient of variation (CV) during the first 7 days were calculated for each person, the GAP adm and GAP mean were calculated as the admission blood glucose and MGL minus the ADAG, respectively, the incidence of moderate hypoglycemia (MH) and severe hypoglycemia (SH), the total dosage of glucocorticoids and average daily dosage of insulin within 7 days, the duration of renal replacement therapy (RRT), ventilator-free hours, and non-ICU stay days within 28 days were also collected. The enrolled patients were divided into a survival group and a nonsurvival group according to survival or not at 28 days and 1 year after admission, and the relationship between parameters derived from blood glucose and mortality in the enrolled critically ill patients was explored. Results: Five hundred and two patients were enrolled and divided into a survival group (n = 310) and a nonsurvival group (n = 192). It was shown that the two groups had a comparable level of HbA1c, the nonsurvivors had a greater APACHE II, MGL, SD, CV, GAP adm , GAP mean , and a higher incidence of hypoglycemia. A lesser duration of ventilatorfree, non-ICU stay, and a longer duration of RRT were recorded in the nonsurvival group, who received a lower carbohydrate intake, a higher daily dosage of insulin and glucocorticoid. GAP mean had the greatest predictive power with an AUC of 0.820 (95%CI: 0.781-0.850), the cut-off value was 3.60 mmol/L (sensitivity 78.2% and specificity 77.3%). Patients with a low GAP mean tended to survive longer than the high GAP mean group 1 year after admission. Conclusions: Glycemic GAP between the mean level of blood glucose within the first 7 days after admission to ICU and the A1C-derived average glucose was independently associated with a 28 day mortality of critically ill patients with diabetes, the predictive power extended to 1 year. The incidence of hypoglycemia was associated with mortality either.

Objectives Dysglycemia is associated with poor outcomes in critically ill patients,which is uncertain in patients with diabetes regarding to the situation of glucose control before hospitalization. This study was aimed to investigate the effect of the difference between the level of blood glucose during ICU stay and before admission to ICU upon the outcomes of critically ill patients with diabetes. Method Patients with diabetes expected to stay for more than 24hs were enrolled, HbA1c was converted to A1C-derived average glucose (ADAG) by the equation: ADAG  =  [ (HbA1c * 28.7) – 46.7 ] * 18−1, blood glucose were measured four times a day during the first 7 days after admission, the mean glucose level(MGL) and SOFA (within 3, 5, and 7days) were calculated for each person, GAPadm and GAPmean was calculated as admission blood glucose and MGL minus ADAG, the incidence of moderate hypoglycemia(MH), severe hypoglycemia (SH), total dosage of glucocorticoids and average daily dosage of insulin, duration of renal replacement therapy(RRT), ventilator-free hours, and non-ICU days were also collected. Patients were divided into survival group and nonsurvival group according to survival or not at 28-day, the relationship between GAP and mortality were analyzed. Results 431 patients were divided into survival group and nonsurvival group. The two groups had a comparable level of HbA1c, the nonsurvivors had greater APACHE II, SOFA, GAPadm, GAPmean-3, GAPmean-5, GAPmean-7 and higher MH and SH incidences. Less duration of ventilator-free, non-ICU stay and longer duration of RRT were recorded in the nonsurvival group. GAPmean-5 had the greatest predictive power with an AUC of 0.807(95%CI: 0.762-0.851), the cut-off value was 3.6 mmol/L (sensitivity 77.7% and specificity 76.6%). The AUC was increased to 0.852(95%CI: 0.814-0.889) incorporated with SOFA5 (NRI  =  11.34%). Conclusion Glycemic GAP between the MGL within 5 days and ADAG was independently associated with 28-day mortality of critically ill patients with diabetes. The predictive power was optimized with addition of SOFA5.

Objectives: Dysglycemia is pervasive and associated with poor outcomes in critically ill patients. Hyperglycemia, hypoglycemia and blood glucose fluctuation might all affect the outcomes, but appropriate level of blood glucose is uncertain especially in patients with diabetes regarding to the situation of glucose control before hospitalization. This study was aimed to investigate the effect of difference between mean blood glucose during ICU stay and level of blood glucose prior to admission to ICU upon outcomes of critically ill patients with diabetes.Method: This retrospective study undertaken in a 24-bed intensive care unit(ICU). Patients with diabetes expected to stay for more than 24hs were enrolled, HbA1c was tested within 3 days after admission and converted to the A1C-derived average glucose (ADAG) by the equation: ADAG = [ ( HbA1c * 28.7 ) – 46.7 ] * 18-1, arterial blood glucose measurements were fourth per day routinely during the first 7 days after admission, the mean glucose level(MGL) and SOFA (within 3 days, 5 days and 7days) were calculated for each person, GAPadm and GAPmean was calculated as admission blood glucose and MGL minus ADAG respectively, the incidence of moderate hypoglycemia(MH), severe hypoglycemia (SH), total dosage of glucocorticoids and average daily dosage of insulin within 7 days, duration of renal replacement therapy(RRT), ventilator-free hours and non-ICU stay days within 28 days were also collected. Patients enrolled were divided into survival group and non-survival group according to survival or not at 28-day, compare GAPadm and GAPmean between the two groups and explore the relationship between GAP and mortality in these critically ill patients.Results: 431 patients were enrolled and divided into survival group (n=256) and non-survival group (n=175). It was shown that two groups had comparable level of HbA1c, the non-survivors had greater APACHE II, SOFA, GAPadm, GAPmean-3, GAPmean-5, GAPmean-7 and higher MH and SH incidences. Less duration of ventilator-free, non-ICU stay and longer duration of RRT were recorded in non-survival group, of whom received less carbohydrates intake, higher insulin daily dosage and glucocorticoid dosage. GAPmean-5 had the greatest predictive power with AUC of 0.807(95%CI: 0.762-0.851), the cut-off value was 3.6mmol/L(sensitivity 77.7% and specificity 76.6%). The AUC was increased to 0.852(95%CI: 0.814-0.889) incorporated with SOFA5 (NRI = 11.34%, P < 0.001 ). Conclusion: Glycemic GAP between mean level of blood glucose especially MGL within 5 days after admission to ICU and A1C-derived average glucose was independently associated with 28-day mortality of critically ill patients with diabetes. The predictive power was optimized with addition of the top level of SOFA within 5 days.

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Background QRFPR is a recently identified member of the G protein‐coupled receptor and is an orphan receptor for 26Rfa, which plays important role in the regulation of many physiological functions. Methods Here, we employed whole exome sequencing (WES) to examine the patients with intellectual disability (ID) and difficulty in feeding. We performed SIFT and PolyPhen2 predictions for the variants. The structure model was built from scratch by I‐TASSER. Here, results derived from a number of cell‐based functional assays, including shRNA experiment, intracellular Ca2+ measurement, the expression of PI3 K‐AKT‐mTOR, and phosphorylation. The functional effect of QRFPR variants on PI3K‐AKT‐mTOR signaling was evaluated in vitro transfection experiments. Result Here, we identified two QRFPR variants at c.202 T>C (p.Y68H) and c.1111C>T (p.R371W) in 2 unrelated individuals. Structural analysis revealed that p.Y68H and p.R371W variants may affect the side chain structure of adjacent amino acids causing reduced binding of QRFPR to 26Rfa. The results show that QRFPR stimulated by 26Rfa leading to the transient rise of intracellular Ca2+. The QRFPR variations p.Y68H and p.R371 W can reduce the mobilization of intracellular Ca2+. The phosphorylation levels of the PI3K, Akt, and mTOR were significantly up‐ or downregulated by QRFPR overexpression or silencing, respectively. The QRFPR variations inhibited PI3K‐AKT‐mTOR signaling, resulting in downregulation of p‐mTOR. Conclusions Our findings suggest that QRFPR acts as important role in neurodevelopment, and the effects of QRFPR are likely to be mediated by the Ca2+‐dependent PI3K‐AKT‐mTOR pathways. Importantly, these findings provide a foundation for future elucidation of GPCR‐mediated signaling and the physiological implications.

ObjectiveAnalgesia and sedation assessments vary widely in clinical performance. This study investigated the cognition of intensivist and the importance of training for analgesia and sedation through the Chinese Analgesia and Sedation Education &amp; Research (CASER) group training program.MethodsA total of 107 participants studied the training courses on the “Sedation, Analgesia and Consciousness Assessment of Critically Ill Patients” held by CASER from June 2020 to June 2021. Ninety-eight valid questionnaires were recovered. The content of the questionnaire included the preface, general information of the trainees, students’ awareness of the importance of analgesia and sedation evaluation and related guidelines, and professional test questions.ResultsAll respondents were senior professionals engaged in the ICU. A total of 92.86% believed that analgesia and sedation treatment were very important parts of the ICU, and 76.5% believed that they had mastered relevant professional knowledge. However, when evaluating the relevant professional theory and practice of the respondents from an objective point of view, it can be seen that only 28.57% of the respondents could reach the passing line in the specific case analysis scenario. Before participating in the training, 42.86% of the medical staff believed that analgesia and sedation treatment should be evaluated in the daily work of the ICU; after participating in the training, 62.24% of the medical staff believed that the evaluation was necessary and believed that they had improved after the training. Moreover, 69.4% of the respondents affirmed the necessity and significance of jointly undertaking the task of analgesia and sedation in Chinese ICUs.ConclusionThis study revealed that the assessment of analgesia and sedation is not standardized in the ICU in mainland China. The importance and significance of standardized training for analgesia and sedation are presented. The CASER working group thus established has a long way to go in its future work.