Bo Wang

OBJECTIVE: To evaluate the feasibility of conducting a trial comparing targeted temperature management (TTM) at 35°C–37°C in intubated heatstroke patients, while collecting preliminary data on safety and clinical outcomes. DESIGN: Pilot multicenter randomized clinical trial (June to December 2024). SETTING: Ten tertiary ICUs in China. PATIENTS: Thirty-five intubated adults (18 yr or older) with heatstroke meeting predefined diagnostic criteria. Key exclusions: nonenvironmental hyperthermia, expected death within 24 hours, or contraindications to temperature management. INTERVENTIONS: Patients were randomly assigned 1:1 to two TTM strategies. The therapeutic hypothermia group received protocolized rapid cooling using a combination of ice packs, precooled blankets, and ice-cold IV saline to achieve the target of 35.0°C within 2 hours, which was then maintained for 48 hours. The controlled normothermia group received conventional cooling measures (ice packs, 32°C blankets) only if body temperature exceeded 38.0°C, with the goal of maintaining core temperature between 36.5°C and 37.5°C. Shivering was managed according to a stepwise protocol, with a “lytic cocktail” (chlorpromazine, promethazine, and meperidine) available as rescue therapy for refractory shivering in both groups. MEASUREMENTS AND MAIN RESULTS: Recruitment rate was 83.7%, retention rate was 97.2%, and protocol adherence exceeded 88%. For clinical outcomes, no significant differences were observed in 28-day poor functional outcome (17.6% vs. 16.7%) or survival (82.4% vs. 83.3%). However, therapeutic hypothermia was associated with significantly higher rates of severe gastrointestinal injury (Acute Gastrointestinal Injury grade 3–4: 52.9% vs. 0%; p < 0.001) and arrhythmias (41.2% vs. 11.1%; p = 0.045). The lytic cocktail was required in 100% of hypothermia-group patients vs. 27.8% in the normothermia group ( p < 0.001). CONCLUSIONS: This pilot study confirms the operational feasibility of a large-scale randomized clinical trial. However, therapeutic hypothermia was associated with significantly worse gastrointestinal injury and higher arrhythmia incidence, without evidence of neurologic or survival benefit. The universal requirement for pharmacological shivering control in the hypothermia group raises additional safety considerations. Based on current evidence, this strategy should not be routinely adopted in ICU heatstroke management.

Rationale: Pulmonary embolism-induced cardiac arrest (PE-CA) remains a life-threatening condition with high mortality despite conventional management strategies. This case series explores the potential benefits of combining mechanical circulatory support (MCS) and endovascular therapy (ET) for optimizing outcomes in PE-CA. Patient concerns: Seven patients with PE-CA, presenting with sudden respiratory distress, hypotension, and loss of consciousness, were treated at our institution between January 2021 and May 2025. These patients exhibited significant hemodynamic instability, requiring immediate intervention to restore circulatory support and address the underlying thrombotic burden. Diagnoses: Diagnosis was confirmed via computed tomography pulmonary angiography and echocardiography, revealing extensive pulmonary emboli and evidence of right ventricular strain. Interventions: Patients were categorized into 3 treatment groups: conventional therapy (n = 2), single intervention (either MCS or ET, n = 2), and combined therapy (MCS + ET, n = 3). The combined therapy group received early MCS to restore circulatory support, followed by ET to remove the thrombotic burden. Outcomes: Descriptive analysis suggested that combined therapy was associated with shorter return of spontaneous circulation times (12–16 minutes vs 20–32 minutes in other groups) and favorable neurological recovery in all 3 cases. However, no statistical comparisons were performed due to the small sample size and heterogeneity of the cohort. Lessons: This case series highlights the feasibility of integrating MCS and ET in PE-CA management. While the findings suggest potential synergistic interactions between these therapies, larger comparative studies are required to confirm these preliminary observations and establish evidence-based protocols.

This retrospective multicenter study was conducted across 83 intensive care units (ICUs) in 16 cities in Sichuan, China. Critically ill patients diagnosed with heatstroke and lung infections were included in the study. Specimens from the lower respiratory tract were collected for microbiological testing, and the characteristics of the pathogens were described. A total of 462 patients diagnosed with heatstroke-related pulmonary infections were included, 134 patients (29.0%) tested positive for respiratory pathogens. The most frequently isolated strain was Klebsiella pneumoniae (34.3%), followed by Escherichia coli (28.4%), Staphylococcus aureus (20.9%). The results revealed that in the hyperthermic resistance group, there was a higher proportion of Pseudomonas aeruginosa [14(34.1%) vs 11(11.8%), p=0.002] and Stenotrophomonas maltophilia [4(9.8%) vs 1(1.1%), p=0.030] compared to the hyperthermic control group. And a higher proportion of Staphylococcus aureus [27(29.7%) vs 1(2.3%), pKlebsiella pneumoniae (38.3 ± 1.9°C), Staphylococcus aureus (38.5 ± 2.2°C), and Pseudomonas aeruginosa (38.7 ± 1.9°C) exhibited a higher temperature environment. Our study provides crucial insights into the lower respiratory tract pathogenesis of heatstroke patients, identifying key pathogens and their temperature-dependent characteristics, thus providing a foundation for future empirical treatment strategies in heatstroke.

Background: Postoperative pulmonary complication (PPC) is a leading cause of mortality and poor outcomes in postoperative patients. No studies have enrolled intensive care unit (ICU) patients after noncardiac thoracic surgery, and effective prediction models for PPC have not been developed. This study aimed to explore the incidence and risk factors and construct prediction models for PPC in these patients. Methods: This study retrospectively recruited patients admitted to the ICU after noncardiac thoracic surgery at West China Hospital, Sichuan University, from July 2019 to December 2022. The patients were randomly divided into a development cohort and a validation cohort at a 70% versus 30% ratio. The preoperative, intraoperative and postoperative variables during the ICU stay were compared. Univariate and multivariate logistic regression analyses were applied to identify candidate predictors, establish prediction models, and compare the accuracy of the models with that of reported risk models. Results: A total of 475 ICU patients were enrolled after noncardiac thoracic surgery (median age, 58; 72% male). At least one PPC occurred in 171 patients (36.0%), and the most common PPC was pneumonia (153/475, 32.21%). PPC significantly increased the duration of mechanical ventilation (p < 0.001), length of ICU stay (p < 0.001), length of hospital stay (LOS) (p < 0.001), and rate of reintubation (p = 0.047) in ICU patients. Seven risk factors were identified, and then the prediction nomograms for PPC were constructed. At ICU admission, the area under the curve (AUC) was 0.766, with a sensitivity of 0.71 and specificity of 0.60; after extubation, the AUC was 0.841, with a sensitivity of 0.75 and specificity of 0.83. The models showed robust discrimination in both the development cohort and the validation cohort, and they were well calibrated and more accurate than reported risk models. Conclusions: ICU patients who underwent noncardiac thoracic surgery were at high risk of developing PPCs. Prediction nomograms were constructed and they were more accurate than reported risk models, with excellent sensitivity and specificity. Moreover, these findings could help assess individual PPC risk and enhance postoperative management of patients.

In this report, we report a case of a middle-aged male, admitted to the ICU with cerebral hemorrhage resulting from a severe high-altitude fall. The patient encountered significant challenges in oxygenation index correction, attributed to extensive embolism in both the primary and branch pulmonary arteries. Consequently, the patient underwent an immediate initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy, persisting for 20 days. During this treatment period, a mutation in the protein C (PROC) gene was identified. The medical team meticulously navigated the delicate balance between anticoagulation and bleeding risks. Eventually, the patient was successfully weaned off VA-ECMO and subsequently discharged. This report aims to delve into the etiology and therapeutic approaches of this uncommon case, with the intention of offering insightful reference for managing similar clinical scenarios in the future.

Introduction: Previous studies suggested that electrical impedance tomography (EIT) has the potential to guide positive end-expiratory pressure (PEEP) titration via quantifying the alveolar collapse and overdistension. The aim of this trial is to compare the effect of EIT-guided PEEP and acute respiratory distress syndrome (ARDS) network low PEEP/fraction of inspired oxygen (FiO ₂ ) table strategy on mortality and other clinical outcomes in patients with ARDS. Methods: This is a parallel, two-arm, multicentre, randomised, controlled trial, conducted in China. All patients with ARDS under mechanical ventilation admitted to the intensive care unit will be screened for eligibility. The enrolled patients are stratified by the aetiology (pulmonary/extrapulmonary) and partial pressure of arterial oxygen/FiO ₂ (≥150 mm Hg or 2 table proposed by the ARDS Network. The primary outcome is 28-day survival. Analysis: Qualitative data will be analysed using the χ ² test or Fisher’s exact test, quantitative data will be analysed using independent samples t-test or Mann-Whitney U test. Kaplan-Meier analysis with log-rank test will be used to evaluate the 28-day survival rate between two groups. All outcomes will be analysed based on the intention-to-treat principle. Ethics and dissemination: The trial is approved by the Institutional Research and Ethics Committee of the Peking Union Medical College Hospital. Data will be published in peer-reviewed journals. Trial registration number: NCT05307913 .

Sepsis is an organ dysfunction caused by a dysregulated host response to infection and remains an ongoing threat to human health worldwide. Septic shock is the most severe subset of sepsis as characterized by abnormalities in cells, circulation, and metabolism. As a time-dependent condition, early recognition allowing appropriate therapeutic measures to be started in a timely manner becomes the most effective way to improve prognosis. However, because of the lack of a criterion standard, most diagnoses merely rely on medical history, empirical diagnosis, and blood culture results. Gene expression profiles have specific diagnostic value, as they reflect a subjective host response to pathogens. We propose a method, Condition Control based on Real-life Medical Scenarios, to control for factors in realistic medical scenarios. Restricted variables are used as much as possible to identify unique differential genes and progressively test their diagnostic value by relaxing restrictions. In total, three data sets were included in the study; the first two data sets were from the Gene Expression Omnibus database, and the third involved patients who were diagnosed with sepsis or septic shock within 7 days of admission to the intensive care unit at West China Hospital of Sichuan University from 2020 to 2021. DDX47 showed preferable diagnostic value in various scenarios, especially in patients with common infections or sepsis and septic shock. Here we also show that hub genes may regulate immune function and immune cell counts through the interaction of different apoptotic pathways and immune checkpoints based on the high correlation. DDX47 is closely associated with B cells according to single-cell sequencing results.