Objective To investigate the prognostic factors and hospitalization cost in patients diagnosed as central line-associated bloodstream infection( CLABSI) in intensive care unit( ICU) .Methods A retrospective study was made to investigate the CLABSI epidemic data in ICU from June 2006 to June 2009. Clinical and physiological parameters were summarized and compared between these patients, which were divided into two groups based on the clinical outcome. Meanwhile, events including blood transfusion,mechanical ventilation, as well as cost of hospitalization were also reviewed. Logistic regression method was introduced to investigate the potential prognostic risk factors. Results There were 49 patients were diagnosed as nosocomial CLABSI, in which 19 cases( 38. 8% ) died in the hospital and 30( 61. 2% ) weresurvival. In univariate analysis, differences in body temperature, central venous pressure, acute physiology and chronic health evaluation( APACHEⅡ ) score, blood transfusion amount, pH value, D-dimer, blood serum alanine transarninase, blood urea nitrogen level, serumcreatinine, serumpotassiumbetween the survivors andthe non-survivors were significant( P lt;0. 05) . However, no significant differences were observed between the two groups in in-hospital days, ICU days and hospitalization cost ( all P gt; 0. 05) . With multiple logistic regressions, higher APACHEⅡ score( OR 0. 78; 95% confidence interval: 0. 66-0. 94; P = 0. 007) , APTTlevel( OR 0. 87; 95% confidence interval: 0. 77-0. 98; P = 0. 026) and serum potassium( OR 0. 09; 95% confidence interval: 0. 01-0. 80; P = 0. 031) were independent predictors of worse outcome. Conclusions Disease severity and coagulation situation may directly predict the prognosis of nosocomial CLABSI patients.But current investigation did not demonstrate significant differences in ICU length of stay and respective cost between the CLABSI patients with different prognosis.
ObjevtiveThe morbidity of intensive care unit-acquired swallowing disorder (ICU-ASD) was clarified through meta-analysis by synthesizing previous evidence, in order to provide an evidence-based basis for early identification and intervention of ICU-ASD. Methods A computerized search of PubMed, Embase, Web of Science, The Cochrane Library, CHINAL, China Knowledge Network, Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal Database was conducted to retrieve the relevant literature on the morbidity of ICU-ASD published in China and abroad from the database establiment to December 2022. Considering the quality of the included literature, the Chinese database excluded master's theses and non-core journals. Meta-analysis of morbidity was performed using Stata 12.0. Results A total of 19 papers, including 4291 patients, were included. Meta-analysis showed that the overall morbidity of ICU-ASD was 36% [95% confidential interval (CI) 26% - 46%; I2=97.62%, P<0.01]. Subgroup analyses showed that the morbidity of ICU-ASD in Asian, European, South American, and North American was 39% (95%CI 28% - 50%), 23% (95%CI 8% - 44%), 52% (95%CI 46% - 57%), and 39% (95%CI 20% - 61%), respectively; and that the morbidity of male and female ICU-ASD was 36% (95%CI 24% - 48%) and 33% (95%CI 22% - 45%), respectively; the morbidity of ICU-ASD was 41% (95%CI 30% - 52%) and 31% (95%CI 18% - 44%) in the patients with and without hypertension, respectively; the morbidity of ICU-ASD was 58% (95%CI 42% - 73%) and 51% (95%CI 36% - 66%) in the patients with and without respiratory disease respectively; the morbidity of ICU-ASD in the patients with and without diabetes mellitus was 37% (95%CI 24% - 51%) and 39% (95%CI 28% - 51%), respectively; the morbidity of ICU-ASD in the patients with and without renal disease was 40% (95%CI 23% - 59%) and 35% (95%CI 24% - 46%), respectively; the morbidity of ICU-ASD in the patients with intubation caliber ≤7.5 mm and >7.5 mm was 31% (95%CI 19% - 45%) and 37% (95%CI 22% - 54%), respectively; the morbidity of ICU-ASD in the patients with and without heart failure was 58% (95%CI 30% - 84%) and 36% (95%CI 23% - 51%), respectively; and the morbidity of ICU-ASD in patients with and without arrhythmia was 36% (95%CI 11% - 65%) and 31% (95%CI 21% - 42%), respectively; the morbidity of ICU-ASD in the patients with and without neurologic disease was 48% (95%CI 24% - 72%) and 34% (95%CI 15% - 57%), respectively. Begg's test P<0.05, Egger's test P<0.05, suggesting publication bias in the study, and the cut-and-patch method corrected for an overall incidence result of 27% (95%CI 18% - 36%). Conclusions Meta-analysis reveals an overall morbidity of 36% for ICU-ASD and 27% for the cut-and-patch correction. Subgroup analysis reveals that the morbidity of ICU-ASD is significantly higher in patients with hypertension, heart failure, and neurological disorders than in patients without these disorders. Current evidence suggests that the prevalence of ICU-ASD is high and needs to be taken seriously. Timely screening and assessment of swallowing disorders is recommended for intensive care unit patients, especially those with hypertension, heart failure, and neurological disorders.
Objective To analyze risk factors for prolonged stay in intensive care unit (ICU) after cardiac valvular surgery. Methods Between January 2005 and May 2005, five hundred and seven consecutive patients undergone cardiac valvular surgery were divided into two groups based on if their length of ICU stay more than 5 days (prolonged stay in ICU was defined as 5 days or more). Group Ⅰ: 75 patients required prolonged ICU stay. Group Ⅱ: 432 patients did not require prolonged ICU stay. Univariate and multivariate analysis (logistic regression) were used to identify the risk factors. Results Seventyfive patients required prolonged ICU stay. Univariate risk factors showed that age, the proportion of previous heart surgery, smoking history and repeat cardiopulmonary bypass (CPB) support, cardiothoracicratio, the CPB time and aortic crossclamping time of group Ⅰ were higher or longer than those of group Ⅱ. The heart function, left ventricular ejection fraction (LVEF), pulmonary function of group Ⅰwere worse than those of group Ⅱ(Plt;0.05, 0.01). Logistic regression identified that preoperative age≥65 years (OR=4.399), LVEF≤0.50(OR=2.788),cardiothoracic ratio≥0.68(OR=2.411), maximal voluntary ventilation observed value/predicted value %lt;71%(OR=4.872), previous heart surgery (OR=3.241) and repeat CPB support during surgery (OR=18.656) were final risk factors for prolonged ICU stay. Conclusion Prolonged ICU stay after cardiac valvular surgery can be predicted through age, LVEF, cardiothoracic ratio, maximal voluntary ventilation, previous heart surgery and repeat CPB support during surgery. The patients with these risk factors need more preoperative care and postoperative care to reduce mortality, morbidity and avoid prolonged ICU stay after cardiac valvular surgery.
Objective
To evaluate the effect of active screening and intervention of multidrug-resistant organisms (MDROs) on control nosocomial infection in the general intensive care unit (ICU).
Methods
A non-concurrent control trial was conducted in patients hospitalized in the ICU for more than 24 hours in the Second Affiliated Hospital of Fujian Medical University. Patients underwent active screening of MDROs for nasal vestibular swab, throat swab and rectal swab combined with further intensive intervention for patients with positive screening result during Sept. 2014 to Aug. 2015 were included as an intervention group, patients only underwent active screening during Sept. 2013 to Aug. 2014 were included as a screening group, and patients without undergoing active screening during Sept. 2012 to Aug. 2013 were as a control group. SPSS 19.0 software was used to compare the hospital infection rate and the infection rate of MDROs among the three groups.
Results
A total of 1?773 patients were included, of which 655 patients were in the intervention group, 515 patients were in the screening group, and 603 patients were in the control group. The difference of hospital infection rates among the three groups was statistically significant (χ2=21.087, P < 0.001), and further pairwise comparison results showed that the intervention group was lower than the screening group (χ2=5.891, P=0.015), and the screening group was lower than the control group (χ2=4.259, P=0.039). The adjustment daily infection rate of the intervention group, screening group and control group were 6.69‰, 10.88‰, and 15.39‰, respectively. The difference of MDROs hospital infection rates among the three groups was statistically significant (χ2=21.039, P < 0.001), and further pairwise comparison results showed that the intervention group was lower than the screening group (χ2=5.936, P=0.015), and the screening group was lower than the control group (χ2=5.798, P=0.016). The MDROs thousand daily infection rate of the intervention group was lower than that of the screening group (3.90‰ vs. 7.30‰, χ2=5.999, P=0.014).
Conclusion
The active screening plus intensive intervention of MDROs can effectively reduce the incidence rates of nosocomial infections and MDROs infections in ICU.
Objective To formulate an evidence-based nursing scheme of eye care for an unconscious patient undergoing mechanical ventilation with eye complication. Methods Under the principle of PICO, the issue was put forward aiming directly at patient’s clinical manifestations, and the following databases as The Cochrane Library (Issue 12, 2011), PubMed (January 1980 to November 2011), EMbase (1974 to 2011) and CBM (1978 to 2011) were searched. Results A total of 3 guidelines, 2 systematic reviews and 9 randomized controlled trials (RCTs) were included. The evidence showed that eye cleaning was the very important part of eye care, and the commonly-used cleaning or rinsing solutions were saline and sterile water. Both moist cover and lubricating eye drops / ointment were used to prevent dryness in the eyes. For instance, polyethylene moisture covers could effectively prevent corneal abrasion, and lubricating eye drops / ointment were beneficial to eye observation, so these two methods needed to be properly selected in combination with patient’s conditions. Nurses had to assess the ability of the patient to close eyelids daily and helped the patient to close eyes, but the passive eyelids closure was inferior to the artificial tear ointment in the effect on preventing corneal abrasions; the integrated intervention of maintaining eyelids closure and forming eyeballs moisture chamber was more effective to prevent eye complications. According to the available evidence mentioned herein and the patient’s conditions, the following nursing scheme of eye care was formulated: cleaning the eyelids and peripheral skin using 0.9% saline gauze, covering the eyes with sterile polyethylene films which were fixed by anti-allergic adhesive tapes, changing the dressing every 12 hours, and observing closure of the eyelids every day. Seven days later, eye symptoms got obviously improved, with decreasing secretion, without congestion and chemosis, and negative results of fluorescein staining test. Conclusion Eye cleaning removes secretion and bacteria from the eyes. Polyethylene film prevents tear from evaporation and fully promotes the immune function of tears which can reduce the risk of infection. Eyelids closure and local moisture environment benefit the corneal epithelial repair.
ObjectiveTo investigate the application value of noninvasive ventilation (NIV) performed in patients with unplanned extubation (UE) in intensive care unit (ICU).MethodsThis was a retrospective analysis. The clinical data, application of NIV, reintubation rate and prognosis of UE patients in the ICU of this hospital from January 2014 to December 2018 were reviewed, and the patients were assigned to the control group or the NIV group according to the application of NIV after UE. The data between the two groups were compared and the application effects of NIV in UE patients were evaluated.ResultsA total of 66 UE patients were enrolled in this study, including 44 males and 22 females and with an average age of (64.2±16.1) years. Out of them, 41 patients (62.1%) used nasal catheter or mask for oxygenation as the control group, 25 patients (37.9%) used NIV as the NIV group. The Acute Physiology andChronic Health EvaluationⅡ score of the control group and the NIV group were (18.6±7.7) vs. (14.8±6.3), P=0.043. The causes of respiratory failure in the control group and the NIV group were as follows: pneumonia 16 patients (39.0%) vs. 7 patients (28.0%), postoperative respiratory failure 7 patients (17.1%) vs. 8 patients (32.0%), chronic obstructive pulmonary disease 8 patients (19.5%) vs. 6 patients (24.0%), others 5 patients (12.2%) vs. 4 patients (16.0%), heart failure 3 patients (7.3%) vs. 0 patients (0%), nervous system diseases 2 (4.9%) vs. 0 patients (0%), which showed no significant difference between the two groups. Mechanical ventilation time before UE were (12.5±19.8) vs (12.7±15.2) d (P=0.966), PaO2 of the control group and the NIV group before UE was (114.9±37.4) vs. (114.4±46.3)mm Hg (P=0.964), and oxygenation index was (267.1±82.0) vs. (257.4±80.0)mm Hg (P=0.614). Reintubation rate was 65.9% in the control group and 24.0% in the NIV group (P=0.001). The duration of mechanical ventilation was (23.9±26.0) vs. (21.8±26.0)d (P=0.754), the length of stay in ICU was (34.4±36.6) vs. (28.5±25.8)d (P=0.48). The total mortality rate in this study was 19.7%. The mortality rate in the control group and NIV group were 22.0% and 16.0% (P=0.555).ConclusionPatients with UE in ICU may consider using NIV to avoid reintubation.
ObjectiveTo analyze the risk factors for the prolonged time of intensive care unit (ICU) stay after isolated heart valve replacement.
MethodWe retrospectively analyzed the clinical data of 400 patients underwent heart valve replacement surgery in our hospital in 2013 year. There were 208 males and 192 females with a mean age of 50.5±11.1 years ranging from 11-85 years. We divided them into an A group with the time of ICU stay shorter than 48 hours and a B group with the time of ICU stay longer than 48 hours. We recorded the demographic characteristics, preoperative data, intraoperative data and postoperative data and analyzed those data with univariate and multivariate methods.
ResultThere was a statictical difference in the demographic characteristics, preoperative data, intraoperative data and postoperative data between the 2 groups (P < 0.05). The logistic result showed that if we didn't consider the postoperative factors the prolonged time of ICU stay statistically related with age over 70 year(OR 2.024, 95%CI 1.182-3.466, P < 0.05), the cardiac grade of New York Heart Association at Ⅲ-Ⅳ(OR 3.295, 95% CI 1.030-10.544, P < 0.05), preoperative hemoglobin concentration less than 120 g/l (OR 0.500, 95%CI 0.263-0.950, P < 0.05), and the cardiopulmonary bypass time more than 180 min (OR 2.486, 95%CI 1.006-6.143, P < 0.05). If we considered the postoperitive factors, the prolonged time of ICU stay statistically linked to the cardiopulmonary bypass time longer than 180 min (OR 3.295, 95% CI 1.030-10.544, P < 0.05), the postoperative blood glucose more than 10 mmol/l (OR 2.954, 95%CI 1.334-6.543, P < 0.05), and the pulling out trachea canula 24 hours after operation (OR 6.742, 95% CI 3.005-15.124, P < 0.05).
ConclusionThe prolonged time of ICU stay after valve replacement surgery is associated with a number of risk factors before, during and after heart valve replacement surgery. Targeting the risk factors, especially the postoperitive risk factors, can be effective to shorten the ICU residence time.
Objective
To identify the predictors of prolonged stay in the intensive care unit (ICU) in patients undergoing surgery for acute aortic dissection type A.
Methods
We retrospectively analyzed the clinical data of 80 patients who underwent surgery for acute aortic dissection type A in Qingdao Municipal Hospital from December 2009 through December 2013. The mean age of the patients was 48.9±12.5 years, including 54 males (67.5%) and 26 females (32.5%). The patients were divided into two groups based on their stay time in the ICU. Prolonged length of ICU stay was defined as 5 days or longer time in the ICU postoperatively. There were 67 patients with length of ICU stay shorter than 5 days, 13 patients with length of ICU stay 5 days or longer time. Univariate and multivariate analysis (logistic regression) were used to identify the predictive risk factors.
Results
The length of ICU stay was 63.2±17.4 hours and 206.9±25.4 hours separately. Overall in-hospital mortality was 3.0% and 15.4% respectively in the two groups. In univariate analyses, there were statistically significant differences with respect to the age, the European system for cardiac operative risk evaluation (EuroSCORE), the preoperative D-dimmer level, total cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA), inotropes and occurrence of postoperative stroke, acute renal failure and acute respiratory failure, ICU stay duration and hospital stay duration between the patients with length of ICU stay shorter than 5 days and longer than 5 days. Multivariate logistic analysis showed that CPB time, occurrence of postoperative stroke, acute renal failure, or acute respiratory failure were independent predictors for prolonged ICU stay.
Conclusion
The incidence of prolonged ICU stay is high after surgery for acute aortic dissection type A. It can be predicted by CPB time, occurrence of postoperative stroke, acute renal failure, and acute respiratory failure were independent predictors for prolonged ICU stay. For patients with these risk factors, more perioperative care strategies are needed in order to shorten the ICU stay time.
Objective To investigate the postoperative treatment of pleuropneumonectomy for tuberculosis destroyed lung in ICU, in order to improve the therapeutical efficacy for these patients. Methods Clinical data of 52 patients who suffered from tuberculosis destroyed lung and underwent pleuropneumonectomy from June 2008 to June 2010 were analyzed retrospectively. All of subjects received routine treatment in ICU after the operation. Meanwhile，appropriate targeting treatments were applied including diagnosis and treatment of postoperative bleeding; application of fiberbronchoscope to aspirate the sputum after the operation,sequential non-invasive ventilation after the invasive ventilation for acute respiratory failure after operation ,etc.Results A total of 52 patients received the pleuropneumonectomy operation. Bleeding occurred in 11 cases after operation and stopped after the integrated therapy. 8 patients suffered from acute respiratory failure and attenuated after sequential ventilation. No patients died for postoperative bleeding or acute respiratory failure. Conclusions Patients who suffered from tuberculosis destroyed lung and received pleuropneumonectomy with postoperative bleeding and acute respiratory failure have a good prognosis after appropriate postoperative treatment in ICU.
ObjectiveTo investigate the baseline of quality control system for intensive care unit (ICU), and to provide a scientific basis for the development of ICU in Anhui province.MethodsA questionnaire was used to investigate the quality control indexes in 108 hospitals in Anhui province from 2013 to 2015. SPSS 20.0 statistical software was used to analyze and statistically describe the survey results.ResultsA total of 110 questionnaires from 108 hospitals were received, including 43 tertiary hospitals and 65 secondary hospitals. In these 110 ICUs, 96.36% were integrated ICU. The total average number of ICU beds was 14.46±7.12, accounting for 1.58%±1.04% of the total hospital beds. The ratios of practicing physicians-beds and registered nurses-beds were 0.57±0.24: 1 and 1.54±0.79: 1, respectively. A total of 29 hospitals (26.36%) met the conditions that the ratio of the total number of beds in the ICU to the hospital was 2% to 8%. Only 5 ICU (4.55%) could meet the conditions that each bed covered an area ≥15 m2. The average incidence of ventilator-associated pneumonia, catheter-related blood stream infection and catheter-related urinary tract infection in ICU patients were (17.30±15.36) ‰, (3.07±3.93) ‰, and (3.49±4.27) ‰, respectively. The incidences in the tertiary hospitals were higher than the secondary hospital. There was no ICU to achieve all 19 key technologies. 42.73% directors of ICU engaged in the professional career more than 10 years. Only 2.73% of the medical institutions in the intensive medical staff performance distribution than the average level of hospital.ConclusionICU in Anhui province has been achieved a rapid development, and has covered all municipal hospitals and more than 80% of the county-level hospitals. But it confronts with a series of problems, such as lack of medical resources, the construction of talent echelon lag, low overall level of discipline, lack of specialist, work intensity, low performance and a series of constraints which restricted the development of disciplines. It strongly suggests that we should further improve the quality control system of critical care medicine, standardize the quality control process, improve and implement the standardized operation standard of critical care medicine, strengthen the construction of disciplines talent echelon. We are expected to enhance the overall level of discipline and to ensure medical quality and safety.
