The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnos...The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.展开更多
BACKGROUND:Remimazolam is a novel ultra-short-acting sedative,but its safety and adverse events(AEs)in high-risk patients in the intensive care unit(ICU)setting remain unknown.METHODS:This was a single-center,retrospe...BACKGROUND:Remimazolam is a novel ultra-short-acting sedative,but its safety and adverse events(AEs)in high-risk patients in the intensive care unit(ICU)setting remain unknown.METHODS:This was a single-center,retrospective study that compared remimazolam to propofol and midazolam in patients undergoing upper gastrointestinal endoscopy.The primary outcome was the incidence of treatment-related AEs.The secondary outcomes were the time to extubation,the length of ICU stay,and the average cost of sedative per case.RESULTS:Of the 88 patients analyzed,47 were treated with remimazolam(mean dose,7.90±4.84mg),and 41 were treated with propofol(21.19±17.98 mg)or midazolam(3.08±2.17 mg).There was no statistically significant difference in the average duration of the endoscopic procedure(35.89±13.37 min vs.44.51±21.68 min,P=0.133)or the time to extubation(15.00±9.75 h vs.20.59±18.71 h,P=0.211)in the remimazolam group(group I)compared to the propofol or midazolam group(group II).ICU stays(5.40±2.93 d vs.4.63±3.31 d,P=0.072)and treatment-related AEs(48.61%vs.51.38%,P=0.056)were similar between groups.The average cost of sedative per case was significantly lower in the group I than in the group II(RMB 16.07±10.58 yuan vs.RMB 24.37±15.46 yuan,P=0.016).CONCLUSION:Remimazolam-based sedation was noninferior to the classic sedatives and had lower average cost per case,indicating that it may be used as a promising sedative for high-risk patients during endoscopic procedures in the ICU setting.展开更多
Acute respiratory distress syndrome(ARDS),a fatal critical disease,is induced by various insults.ARDS represents a major global public health burden,and the management of ARDS continues to challenge healthcaresystems ...Acute respiratory distress syndrome(ARDS),a fatal critical disease,is induced by various insults.ARDS represents a major global public health burden,and the management of ARDS continues to challenge healthcaresystems globally,especially during the pandemic of the coronavirus disease 2019(COVID-19).There remains noconfirmed specific pharmacotherapy for ARDS,despite advances in understanding its pathophysiology.Debatecontinues about the potential role of glucocorticoids(GCs)as a promising ARDS clinical therapy.Questions regarding GC agent,dose,and duration in patients with ARDS need to be answered,because of substantial variationsin GC administration regimens across studies.ARDS heterogeneity likely affects the therapeutic actions of exogenous GCs.This review includes progress in determining the GC mechanisms of action and clinical applications inARDS,especially during the COVID-19 pandemic.展开更多
The coronavirus disease 2019(COVID-19)threatens the health of humans worldwide,and at the time of this writing,there is no specifically targeted effective drug for COVID-19.The major initial symptoms of patients with ...The coronavirus disease 2019(COVID-19)threatens the health of humans worldwide,and at the time of this writing,there is no specifically targeted effective drug for COVID-19.The major initial symptoms of patients with COVID-19 are fever,dry cough,and fatigue,although some patients mainly experience vomiting,diarrhea,and other gastrointestinal symptoms.Other severe symptoms,namely chest tightness,dyspnea,and respiratory distress,usually appear one week later,with some patients rapidly developing acute respiratory distress syndrome(ARDS),septic shock,and possibly even death.A retrospective study of critically ill patients with COVID-19 has recently reported that 67.3%of patients presented with ARDS,28.9%with acute kidney injury,23.1%with heart injury,and 28.9%with abnormality in liver function.In addition,the 28-day mortality rate was up to 61.5%.[1]展开更多
The coronavirus disease 2019(COVID-19)has been declared a global pandemic and is a major public health issue worldwide.COVID-19 is a systemic disease damaging multiple organs,including the lung as the main target organ.
基金supported(in part)by the National Key Research and Development Program of China(2020YFC0845500)the Special Project for Emergency of Hubei Province(2020FCA008)the First Level Funding of the Second Medical Leading Talent Project in Hubei Province。
文摘The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.
基金supported by China International Medical Foundation(Z-2017-24-2028-33)。
文摘BACKGROUND:Remimazolam is a novel ultra-short-acting sedative,but its safety and adverse events(AEs)in high-risk patients in the intensive care unit(ICU)setting remain unknown.METHODS:This was a single-center,retrospective study that compared remimazolam to propofol and midazolam in patients undergoing upper gastrointestinal endoscopy.The primary outcome was the incidence of treatment-related AEs.The secondary outcomes were the time to extubation,the length of ICU stay,and the average cost of sedative per case.RESULTS:Of the 88 patients analyzed,47 were treated with remimazolam(mean dose,7.90±4.84mg),and 41 were treated with propofol(21.19±17.98 mg)or midazolam(3.08±2.17 mg).There was no statistically significant difference in the average duration of the endoscopic procedure(35.89±13.37 min vs.44.51±21.68 min,P=0.133)or the time to extubation(15.00±9.75 h vs.20.59±18.71 h,P=0.211)in the remimazolam group(group I)compared to the propofol or midazolam group(group II).ICU stays(5.40±2.93 d vs.4.63±3.31 d,P=0.072)and treatment-related AEs(48.61%vs.51.38%,P=0.056)were similar between groups.The average cost of sedative per case was significantly lower in the group I than in the group II(RMB 16.07±10.58 yuan vs.RMB 24.37±15.46 yuan,P=0.016).CONCLUSION:Remimazolam-based sedation was noninferior to the classic sedatives and had lower average cost per case,indicating that it may be used as a promising sedative for high-risk patients during endoscopic procedures in the ICU setting.
文摘Acute respiratory distress syndrome(ARDS),a fatal critical disease,is induced by various insults.ARDS represents a major global public health burden,and the management of ARDS continues to challenge healthcaresystems globally,especially during the pandemic of the coronavirus disease 2019(COVID-19).There remains noconfirmed specific pharmacotherapy for ARDS,despite advances in understanding its pathophysiology.Debatecontinues about the potential role of glucocorticoids(GCs)as a promising ARDS clinical therapy.Questions regarding GC agent,dose,and duration in patients with ARDS need to be answered,because of substantial variationsin GC administration regimens across studies.ARDS heterogeneity likely affects the therapeutic actions of exogenous GCs.This review includes progress in determining the GC mechanisms of action and clinical applications inARDS,especially during the COVID-19 pandemic.
基金United Fund of National Natural Science Foundation of China(No.U2004110)the Scientific and Technological Innovation Leaders in Central Plains(No.194200510017)+4 种基金Provincial Ministry Co-construction Project from Medical Scientific and Technological Research Program of Henan Province of China(No.SBGJ2018020)the"51282"Project Leaders of Scientific and Technological Innovative Talents from Health and Family Planning Commission in Henan Province of China(No.2016-32)Zhengzhou City Science and Technology People-Benefit Project of Henan Province of China(No.2019KJHM0001)Subject of Major National Science and Technology(No.2018ZX10101004)Key Project of Novel Coronavirus Pneumonia Funded by Science and Technology Department of Hubei Province(No.2020FCA025)。
文摘The coronavirus disease 2019(COVID-19)threatens the health of humans worldwide,and at the time of this writing,there is no specifically targeted effective drug for COVID-19.The major initial symptoms of patients with COVID-19 are fever,dry cough,and fatigue,although some patients mainly experience vomiting,diarrhea,and other gastrointestinal symptoms.Other severe symptoms,namely chest tightness,dyspnea,and respiratory distress,usually appear one week later,with some patients rapidly developing acute respiratory distress syndrome(ARDS),septic shock,and possibly even death.A retrospective study of critically ill patients with COVID-19 has recently reported that 67.3%of patients presented with ARDS,28.9%with acute kidney injury,23.1%with heart injury,and 28.9%with abnormality in liver function.In addition,the 28-day mortality rate was up to 61.5%.[1]
基金supported by a grant from the China Health Information and Health Care Big Data Society:Special Research Fund for Analgesia and Sedation of Severe Infection(No.Z-2019-1-001)。
文摘The coronavirus disease 2019(COVID-19)has been declared a global pandemic and is a major public health issue worldwide.COVID-19 is a systemic disease damaging multiple organs,including the lung as the main target organ.
