Since the outbreak of coronavirus disease 2019 (COVID-19), there have been numerous studies confirming that physiotherapy is an essential part of the comprehensive treatment during hospitalization and can facilitate recovery in COVID-19 patients. However, physiotherapy protocols for COVID-19 patients in intensive care units are still lacking. This article reviews the literature and incorporates practical experience around recommendations for the safe protection during physiotherapy, recommendations for evaluation criteria and intervention of physiotherapy, and future work for COVID-19 patients, so as to provide a standardized recommendation for physiotherapists working in intensive care units.
Objective To investigate the correlation between monocyte-lymphocyte ratio (MLR) and intensive care unit (ICU) results in ICU hospitalized patients. Methods Clinical data were extracted from Medical Information Mart for Intensive Care Ⅲ database, which contained health data of more than 50000 patients. The main result was 30-day mortality, and the secondary result was 90-day mortality. The Cox proportional hazards model was used to reveal the association between MLR and ICU results. Multivariable analyses were used to control for confounders. Results A total of 7295 ICU patients were included. For the 30-day mortality, the hazard ratio (HR) and 95% confidence interval (CI) of the second (0.23≤MLR<0.47) and the third (MLR≥0.47) groups were 1.28 (1.01, 1.61) and 2.70 (2.20, 3.31), respectively, compared to the first group (MLR<0.23). The HR and 95%CI of the third group were still significant after being adjusted by the two different models [2.26 (1.84, 2.77), adjusted by model 1; 2.05 (1.67, 2.52), adjusted by model 2]. A similar trend was observed in the 90-day mortality. Patients with a history of coronary and stroke of the third group had a significant higher 30-day mortality risk [HR and 95%CI were 3.28 (1.99, 5.40) and 3.20 (1.56, 6.56), respectively]. Conclusion MLR is a promising clinical biomarker, which has certain predictive value for the 30-day and 90-day mortality of patients in ICU.
ObjectiveTo investigate clinical characteristics and influencing factors of lower respiratory tract infection of Acinetobacter baumannii (AB-LRTI) in respiratory intensive care unit (RICU).MethodsClinical data were collected from 204 RICU patients who were isolated Acinetobacter baumannii (AB). The bacteriological specimens were derived from sputum, bronchoscopic endotracheal aspiration, bronchoalveolar lavage fluid, pleural effusion and blood. The definition of bacterial colonization was based on the responsible criteria from Centers for Disease Control and Prevention/National Medical Safety Network (CDC/NHSN). The patients were divided into three groups as follows, AB colonization group (only AB was isolated, n=40); simple AB-LRTI group (only AB was isolated and defined as infection, n=63), AB with another bacteria LRTI group (AB and another pathogen were isolated simultaneously, n=101). The epidemiology, clinical characteristics and influencing factors of each group were analyzed and compared. ResultsCompared with the AB colonization group, the AB with another bacteria LRTI group had higher proportion of patients with immunosuppression, specimens from sputum and bronchoalveolar lavage fluid, more than 4 invasive procedures, 90-day mortality, white blood cell count >10×109/L (or <4×109/L), neutrophil percent >75% (or <40%), lymphocyte count <1.1×109/L, platelet count <100×109/L, albumin <30 g/L, high sensitivity C-reactive protein >10 mg/L, and neutrophil-to-lymphocyte ratio (NLR). The frequency of bronchoscopy and days of infusing carbapenem within 90 days before isolating AB, the Acute Physiology and Chronic Health Evaluation Ⅱ score, the proportion of patients with invasive mechanical ventilation and the duration of invasive mechanical ventilation in the AB with another pathogen LRTI group were higher than those in the AB colonization group (all P<0.05). Days of infusing carbapenem and β-lactams/β-lactamase inhibitors within 90 days before isolating AB, proportion of septic shock, NLR and 90-day mortality of the patients from the AB with another pathogen LRTI group were more than those in the simple AB-LRTI group (all P<0.05). After regression analysis, more than 4 invasive procedures, or immunosuppression, or with more days of infusing carbapenem within 90 days before isolating AB were all the independent risk factors for AB-LRTI.ConclusionsThere are significant differences in epidemiology, clinical symptoms and laboratory indicators between simple AB-LRTI, AB with another pathogen LRTI and AB colonization in RICU patients. For RICU patients, who suffered more than 4 invasive procedures, immunosuppression, or with more days of infusing carbapenem within 90 days before isolating AB, are more susceptible to AB-LRTI.
Objective
To explore risk factors related to acute kidney injury (AKI) in children who underwent corrective surgery for tetralogy of Fallot (TOF).
Methods
We retrospectively analyzed the clinical data of 726 children with corrective procedures for TOF aged less than 3 years in our hospital from March 1st 2010 to March 1st 2013. Children with AKI were picked using Acute Kidney Injury Network criteria. Demographic and perioperative variables of the remaining patients were reviewed. Univariate analysis was performed to compare the AKI group (240 patients) with the non-AKI group (486 patients). Multivariable analysis was carried out to identify significant determinants of AKI.
Results
A total of 240 children were with AKI. The result of univariate analysis showed that there was a statistical difference in age, Nakata index, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), transannular right ventricular outflow tract (RVOT) patch, or fresh frozen plasma (FFP) in prime solution between the AKI group and the non-AKI group. Multivariable logistic regression showed that in older children (OR=1.425, 95% CI 1.071 to 1.983, P=0.011) with more transfusion of FFP in the priming solution (OR=1.486, 95% CI 1.325 to 2.674, P<0.001) led to higher morbidity of mild AKI. In addition, there was an increase in morbidity related to AKI when children had less Nakata index (OR=0.282, 95% CI 0.092 to 0.869, P=0.013).
Conclusion
Postoperative AKI increases in older children group. Infusion of more FFP in priming solution increases morbidity of AKI. The less Nakata index is significantly associated with severe AKI.
ObjectiveTo survey the current situation of post-intensive care syndrome (PICS) among patients in respiratory intensive careunit (RICU), and explore the effect factors of PICS.MethodsBy convenience sampling, 125 patients in the RICU of Peking University First Hospital were recruited in the study. The patients were tested for PICS using Mini-mental State Examination (MMSE), Confusion Assessment Method for the ICU (CAM-ICU), Hospital Anxiety and Depression Scale (HADS), Medical Research Council (MRC), Activities of Daily Living (ADL), Pittsburg Sleep Quality Index (PSQI), Fatigue Scale-14 (FS-14), including three aspects of cognition, psychology and physiology. The effect factors of PICS were measured through researcher-created Questionnaire on Patients’ General Information and Questionnaire on Disease-Related Information.ResultsIn this study, the actual effective sample size was 110 cases, among which 59 cases developed PICS, with an incidence of 53.6%. Logistic regression showed that effect factors of PICS were age, invasive mechanical ventilation time, noninvasive ventilator assisted ventilation time and coronary atherosclerotic heart disease (P< 0.05).ConclusionsThe incidence of PICS in RICU patients is 53.6%, which is at a high level. Advanced age, long duration of invasive mechanical ventilation, long duration of non-invasive ventilator assisted ventilation, and coronary atherosclerotic heart disease are the risk factors of PICS. Medical and nursing staff should pay more attention to PICS, intervene in the risk factors of the patient, and take targeted measures to prevent the occurrence of PICS.
Objective To investigate the clinical features, etiology and treatment strategies of patients with delirium in emergency intensive care unit ( EICU) . Methods Patients with delirium during hospitalization between January 2010 and January 2012 were recruited from respiratory group of EICU of Beijing Anzhen Hospital. Over the same period, same amount of patients without delirium were randomly collected as control. The clinical datawere retrospectively analyzed and compared. Results The incidence of delirium was 7.5% ( 42/563) . All delirium patients had more than three kinds of diseases including lung infections, hypertension, coronary heart disease, respiratory failure, heart failure, renal failure, hyponatremia, etc. 50% of delirium patients received mechanical ventilation ( invasive/noninvasive) . The mortality of both the delirium patients and the control patients was 11.9% ( 5 /42) . However, the patients with delirium exhibited longer hospital stay [ 14(11) d vs. 12(11) d, P gt;0. 05] and higher hospitalization cost [ 28, 389 ( 58,999) vs. 19, 373( 21, 457) , P lt;0.05] when compared with the control group. 52.4% ( 22/42) of delirium patients were associated with primary disease. 9. 5% ( 4/42) were associated with medication. 38. 1% (16/42) were associated with ICU environment and other factors. Conclusions Our data suggest that the causes of delirium in ICU are complex. Comprehensive treatment such as removal of the relevant aggravating factors, treating underlying diseases, enhancing patient communication, and providing counseling can shorten their hospital stay, reduce hospitalization costs, and promote rehabilitation.
ObjectiveTo analyze the trend of disease spectrum and main diagnosis and therapeutic technologies in respiratory intensive care unit (RICU) in recent years, and find out the trend of change of patient’s characteristics and commonly used interventions in order to provide evidence for planning discipline development and improving personnel training program.MethodsPatients information and main diagnosis and therapeutic technologies of 1503 inpatients in RICU of Shenzhen People's Hospital from January, 2017 to December, 2020 were collected. The changes of disease spectrum and diagnosis and treatment technologies in different years were compared and analyzed.ResultsAmong all the patients, 66.3% were directly admitted into RICU, 12.1% were transferred from respiratory department, and 21.6% were transferred from other departments. The proportion of patients with non-respiratory diseases as principal diagnosis had an increasing trend, from 18.8% in 2017 to 37.3% in 2020 (P<0.05). The diseases with most obvious increasing trend were sepsis, nervous system diseases, circulatory system diseases and extra-pulmonary malignancies (P<0.05). The use of respiratory related diagnosis and therapeutic technologies was gradually increasing, meanwhile, the use of non-traditional respiratory related technologies, especially continuous renal replacement therapy, was also increasing. There was no significant difference in fatality rate among different years (P>0.05).ConclusionsThe number of patients with extra-pulmonary diseases and the use of non-traditional respiratory related diagnosis and therapeutic technologies in RICU were increasing. The development of RICU and the allocation of technical personnel needed to be improved accordingly.
ObjectiveTo analyze the perdictive value of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) for malnutrition or postoperative complications in children with critical congenital heart disease (CHD).MethodsA total of 875 children with critical CHD who were hospitalized in West China Hospital, Sichuan University form August 2019 to February 2021, including 442 males and 433 females with a median age of 30 (12, 48) months, were assessed by STAMP in Health Information System. Clinical data of postoperative complications were collected.Results(1) Based on World Health Organization Z-score as gold standard, 24.5% had malnutrition risk, and 34.3% were diagnosed with malnutrition. According to STAMP, the children were with medium malnutrition risk of 37.9% and high malnutrition risk of 62.1%. There was a statistical difference of incidence rate of malnutrition and detection rate of STAMP malnutrition risk in gender, age, ICU stay or length of mechanical ventilation (P<0.05); (2) with the optimal cut-off point of 5.5 in STAMP for malnutrition, the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) were 68.3%, 84.3%, 48.1%, 88.3% and 0.82, respectively; (3) 12.0% of the children were with postoperative complications; (4) with the optimal cut-off point of 5.5 in STAMP for postoperative complications, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 83.8%, 73.1%, 18.8%, 99.1% and 0.85, respectively.ConclusionChildren with critical CHD have a higher incidence of malnutrition risk and postoperative complications. STAMP has a good perdictive value for malnutrition or postoperative complications, however, the sensitivity and specificity of STAMP are affected by the gold standard or the cut-off point.
Objective
To identify the predictors for readmission in the ICU among cardiac surgery patients.
Methods
We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016.
Results
The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%, P<0.001). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=1.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 to1.259, P<0.001), and the drainage on the day of surgery (OR=1.001, 95%CI1.001 to 1.002, P<0.001) were the independent risk factors for readmission to the cardiac surgery ICU.
Conclusion
The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient healthcare planning and resources allocation.
Objective To explore factors affecting the shunt safety of patients in emergency intensive care unit (EICU), construct a shunt safety evaluation model, and evaluate its prediction effectiveness, so as to provide a theoretical basis for the decision-making of shunt safety in EICU. Methods The demographic data, vital signs, laboratory examinations and other indicators of patients transferred to the general ward from the EICU of West China Hospital of Sichuan University from 0:00 on August 1, 2019 to 23:59 on May 31, 2021 were collected and analyzed. The short-term poor prognosis after being transferred out of the EICU was regarded as the end-point event. Of the patients, 70% were randomly selected as the model construction cohort, and 30% were the model validation cohort. In the model construction cohort, multivariate logistic regression analysis was used to screen the influencing factors affecting shunt safety, and the shunt safety evaluation model of patients in EICU was constructed. In the validation cohort, receiver operating characteristic curve was used to evaluate the effectiveness of the model in evaluating the shunt safety of patients in EICU. Results A total of 582 patients were included, of whom 59 patients (10.1%) had a poor short-term prognosis. Multivariate logistic regression analysis showed that the patients’ respiratory rate when leaving the EICU [odds ratio (OR)=0.863, 95% confidence interval (CI) (0.794, 0.938), P=0.001], Glasgow Coma Scale scores [OR=1.575, 95%CI (1.348, 1.841), P<0.001], albumin [OR=1.137, 95%CI (1.008, 1.282), P=0.036], prothrombin time [OR=0.956, 95%CI (0.914, 1.000), P=0.048] were the influencing factors of shunt safety. Based on the above indicators, a shunt safety evaluation model for patients in EICU was created. The area under the curve for the shunt safety assessment model to predict poor short-term prognosis was 0.815, the best cut-off value was 4 points, the sensitivity was 93.3%, and the specificity was 61.5%. Conclusions The patients’ respiratory rate when leaving EICU, Glasgow Coma Scale scores, albumin and prothrombin time are factors affecting the shunt safety for patients in EICU. The shunt safety assessment model can better predict the short-term poor prognosis of patients transferred from EICU to general ward.
