Publications by authors named "Chuanlai Zhang"

2 Publications

  • Page 1 of 1

Early Improvement of Acute Respiratory Distress Syndrome in Patients With COVID-19 in the Intensive Care Unit: Retrospective Analysis.

JMIR Public Health Surveill 2021 03 9;7(3):e24843. Epub 2021 Mar 9.

Department of Intensive Care Unit, Chongqing Sixth People's Hospital, Chongqing, China.

Background: Since the start of the COVID-19 pandemic, there have been over 2 million deaths globally. Acute respiratory distress syndrome (ARDS) may be the main cause of death.

Objective: This study aimed to describe the clinical features, outcomes, and ARDS characteristics of patients with COVID-19 admitted to the intensive care unit (ICU) in Chongqing, China.

Methods: The epidemiology of COVID-19 from January 21, 2020, to March 15, 2020, in Chongqing, China, was analyzed retrospectively, and 75 ICU patients from two hospitals were included in this study. On day 1, 56 patients with ARDS were selected for subgroup analysis, and a modified Poisson regression was performed to identify predictors for the early improvement of ARDS (eiARDS).

Results: Chongqing reported a 5.3% case fatality rate for the 75 ICU patients. The median age of these patients was 57 (IQR 25-75) years, and no bias was present in the sex ratio. A total of 93% (n=70) of patients developed ARDS during ICU stay, and more than half had moderate ARDS. However, most patients (n=41, 55%) underwent high-flow nasal cannula oxygen therapy, but not mechanical ventilation. Nearly one-third of patients with ARDS improved (arterial blood oxygen partial pressure/oxygen concentration >300 mm Hg) in 1 week, which was defined as eiARDS. Patients with eiARDS had a higher survival rate and a shorter length of ICU stay than those without eiARDS. Age (<55 years) was the only variable independently associated with eiARDS, with a risk ratio of 2.67 (95% CI 1.17-6.08).

Conclusions: A new subphenotype of ARDS-eiARDS-in patients with COVID-19 was identified. As clinical outcomes differ, the stratified management of patients based on eiARDS or age is highly recommended.
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March 2021

Safety Assessment Criteria for Early Active Mobilization in Mechanically Ventilated ICU Subjects.

Respir Care 2021 Feb 8;66(2):307-315. Epub 2020 Sep 8.

Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Background: Although studies have confirmed the safety and feasibility of early active mobilization, its implementation status is still unsatisfactory. The most important obstacle is ensuring patient safety. Comprehensively assessing the physical condition of patients considered for mobilization is the basis of safety. However, appropriate guidance is lacking. We performed a systematic review to extract and summarize current safety assessment criteria for the early active mobilization of mechanically ventilated patients in the ICU.

Methods: A systematic literature search was conducted using English and Chinese databases according to the PRISMA checklist and guidelines to identify relevant original studies that evaluated safety assessment variables and specific parameters.

Results: A total of 24 medium- and high-quality articles involving a total of 4,842 subjects were included in the analysis. Among these studies, there were 15 randomized controlled trials involving 1,777 subjects (888 in the control groups, 889 in the interventional groups) and 9 cohort studies involving 3,065 subjects (1,240 in the control groups, 1,825 in the exposure groups). There were 5 safety assessment criteria, including cardiovascular, respiratory, neurological, musculoskeletal, and other. Within these were 17 different variables and 48 specific parameters.

Conclusions: The safety assessment criteria should focus on cardiac reserve, respiratory reserve, consciousness, and muscle strength. It is especially important to note whether the parameters are stable because parameter stability can be more representative of a patient's condition than absolute values. We provide a flow diagram for clinical safety assessments; however, some limitations exist, and this assessment requires further validation and optimization.
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February 2021