BACKGROUND Hemodynamic instability and shock are associated with untoward outcomes in gastrointestinal bleeding.However,there are no studies in the existing literature on the proportion of patients who developed these...BACKGROUND Hemodynamic instability and shock are associated with untoward outcomes in gastrointestinal bleeding.However,there are no studies in the existing literature on the proportion of patients who developed these outcomes after gastrointestinal bleeding.AIM To determine the pooled event rates in the available literature and specify them based on the bleeding source.METHODS The protocol was registered on PROSPERO in advance(CRD42021283258).A systematic search was performed in three databases(PubMed,EMBASE,and CENTRAL)on 14^(th) October 2021.Pooled proportions with 95%CI were calculated with a random-effects model.A subgroup analysis was carried out based on the time of assessment(on admission or during hospital stay).Heterogeneity was assessed by Higgins and Thompson’s I^(2) statistics.The Joanna Briggs Institute Prevalence Critical Appraisal Tool was used for the risk of bias assessment.The Reference Citation Analysis(https://www.referencecitationanalysis.com/)tool was applied to obtain the latest highlight articles.RESULTS We identified 11589 records,of which 220 studies were eligible for data extraction.The overall proportion of shock and hemodynamic instability in general gastrointestinal bleeding patients was 0.25(95%CI:0.17-0.36,I^(2)=100%).In non-variceal bleeding,the proportion was 0.22(95%CI:0.14-0.31,I^(2)=100%),whereas it was 0.25(95%CI:0.19-0.32,I^(2)=100%)in variceal bleeding.The proportion of patients with colonic diverticular bleeding who developed shock or hemodynamic instability was 0.12(95%CI:0.06-0.22,I^(2)=90%).The risk of bias was low,and heterogeneity was high in all analyses.CONCLUSION One in five,one in four,and one in eight patients develops shock or hemodynamic instability on admission or during hospitalization in the case of non-variceal,variceal,and colonic diverticular bleeding,respectively.展开更多
Septic shock is a state of physiological disarray that disrupts perfusion,overwhelms inflammatory control,and,as evidence now shows,compromises the structural and functional integrity of the brain.In their recent stud...Septic shock is a state of physiological disarray that disrupts perfusion,overwhelms inflammatory control,and,as evidence now shows,compromises the structural and functional integrity of the brain.In their recent study,Li et al explored how specific hemodynamic derangements,such as reduced cardiac index,low mean arterial pressure,and elevated lactate,correlate with neuropsychiatric outcomes including delirium,depression,anxiety,and post-traumatic stress disorder.The findings reframe psychiatric symptoms not only as downstream consequences,but as measurable,clinically relevant expressions of unstable physiology.This editorial argues that neuropsychiatric outcomes in sepsis should be regarded as a vital sign worth tracking,and maybe more importantly,worth preventing.Rather than viewing altered cognition and mood as potentially unavoidable sequelae,perhaps we should begin monitoring them with the same intensity as lactate clearance and oxygen saturation.Doing so may not only preserve cognitive health,but also refine our hemodynamic goals themselves.Psychiatry,critical care,and neuroscience each have a role to play in defining this new frontier of care,one where protecting the mind begins in the intensive care unit.展开更多
BACKGROUND Splenic peliosis is a disease characterized by widespread blood-filled cystic cavities within the parenchyma. Patients with this disease are usually asymptomatic;therefore, spontaneous or trauma-related rup...BACKGROUND Splenic peliosis is a disease characterized by widespread blood-filled cystic cavities within the parenchyma. Patients with this disease are usually asymptomatic;therefore, spontaneous or trauma-related rupture of the hemorrhagic cysts can occasionally cause life-threatening hemorrhagic shock.CASE SUMMARY A 51-year-old male patient with abdominal pain visited our emergency medical center two times with an interval of 2 mo. The patient was discharged from the hospital without treatment at his first visit;however, at the time of second admission, the hemoperitoneum with multiple cystic lesions of the spleen was found incidentally on the abdomen computed tomography scan. Since the patient was stable hemodynamically, a scheduled surgery was performed. The operative findings were consistent with splenic peliosis, and laparoscopic splenectomy was performed to prevent recurrent rupture of the hemorrhagic cysts.CONCLUSION Splenic peliosis is extremely rare, and we suggest splenectomy is necessarily required as a definite treatment for ruptured splenic peliosis to rescue patients with hemodynamic instability and to prevent recurrent rupture of hemorrhagic cysts in patients with stable hemodynamics.展开更多
基金The Ministry of Innovation and Technology of Hungary from the National Research,Development,and Innovation Fund(ITM-NRDIF),No.TKP2021-EGA-23.
文摘BACKGROUND Hemodynamic instability and shock are associated with untoward outcomes in gastrointestinal bleeding.However,there are no studies in the existing literature on the proportion of patients who developed these outcomes after gastrointestinal bleeding.AIM To determine the pooled event rates in the available literature and specify them based on the bleeding source.METHODS The protocol was registered on PROSPERO in advance(CRD42021283258).A systematic search was performed in three databases(PubMed,EMBASE,and CENTRAL)on 14^(th) October 2021.Pooled proportions with 95%CI were calculated with a random-effects model.A subgroup analysis was carried out based on the time of assessment(on admission or during hospital stay).Heterogeneity was assessed by Higgins and Thompson’s I^(2) statistics.The Joanna Briggs Institute Prevalence Critical Appraisal Tool was used for the risk of bias assessment.The Reference Citation Analysis(https://www.referencecitationanalysis.com/)tool was applied to obtain the latest highlight articles.RESULTS We identified 11589 records,of which 220 studies were eligible for data extraction.The overall proportion of shock and hemodynamic instability in general gastrointestinal bleeding patients was 0.25(95%CI:0.17-0.36,I^(2)=100%).In non-variceal bleeding,the proportion was 0.22(95%CI:0.14-0.31,I^(2)=100%),whereas it was 0.25(95%CI:0.19-0.32,I^(2)=100%)in variceal bleeding.The proportion of patients with colonic diverticular bleeding who developed shock or hemodynamic instability was 0.12(95%CI:0.06-0.22,I^(2)=90%).The risk of bias was low,and heterogeneity was high in all analyses.CONCLUSION One in five,one in four,and one in eight patients develops shock or hemodynamic instability on admission or during hospitalization in the case of non-variceal,variceal,and colonic diverticular bleeding,respectively.
文摘Septic shock is a state of physiological disarray that disrupts perfusion,overwhelms inflammatory control,and,as evidence now shows,compromises the structural and functional integrity of the brain.In their recent study,Li et al explored how specific hemodynamic derangements,such as reduced cardiac index,low mean arterial pressure,and elevated lactate,correlate with neuropsychiatric outcomes including delirium,depression,anxiety,and post-traumatic stress disorder.The findings reframe psychiatric symptoms not only as downstream consequences,but as measurable,clinically relevant expressions of unstable physiology.This editorial argues that neuropsychiatric outcomes in sepsis should be regarded as a vital sign worth tracking,and maybe more importantly,worth preventing.Rather than viewing altered cognition and mood as potentially unavoidable sequelae,perhaps we should begin monitoring them with the same intensity as lactate clearance and oxygen saturation.Doing so may not only preserve cognitive health,but also refine our hemodynamic goals themselves.Psychiatry,critical care,and neuroscience each have a role to play in defining this new frontier of care,one where protecting the mind begins in the intensive care unit.
文摘BACKGROUND Splenic peliosis is a disease characterized by widespread blood-filled cystic cavities within the parenchyma. Patients with this disease are usually asymptomatic;therefore, spontaneous or trauma-related rupture of the hemorrhagic cysts can occasionally cause life-threatening hemorrhagic shock.CASE SUMMARY A 51-year-old male patient with abdominal pain visited our emergency medical center two times with an interval of 2 mo. The patient was discharged from the hospital without treatment at his first visit;however, at the time of second admission, the hemoperitoneum with multiple cystic lesions of the spleen was found incidentally on the abdomen computed tomography scan. Since the patient was stable hemodynamically, a scheduled surgery was performed. The operative findings were consistent with splenic peliosis, and laparoscopic splenectomy was performed to prevent recurrent rupture of the hemorrhagic cysts.CONCLUSION Splenic peliosis is extremely rare, and we suggest splenectomy is necessarily required as a definite treatment for ruptured splenic peliosis to rescue patients with hemodynamic instability and to prevent recurrent rupture of hemorrhagic cysts in patients with stable hemodynamics.
