Objective To verify the association between admission serum phosphate level and short-term (<30 days) mortality of severe pneumonia patients admitted to intensive care unit (ICU) / respiratory intensive care unit (RICU). Methods Severe pneumonia patients admitted to the ICU/RICU of Quanzhou First Hospital Affiliated to Fujian Medical University from November 2019 to September 2021 were included in the study. Serum phosphate was demonstrated as an independent risk factor for short-term mortality of severe pneumonia patients admitted to ICU/RICU by logical analysis and receiver operator characteristic (ROC) curve. The patients were further categorized by serum phosphate concentration to explore the relationship between serum phosphate level and short-term mortality. Results Comparison of baseline indicators at admission between the survival group (n=54) and the non survival group (n=46) revealed that there was significant difference in serum phosphate level [0.9 (0.8, 1.2) mmol/L vs. 1.2 (0.9, 1.5) mmol/L, P<0.05]. Logical analysis showed serum phosphate was an independent risk factor for short-term mortality. ROC curve showed that the prediction ability of serum phosphate was close to pneumonia severity index (PSI). After combining serum phosphate with PSI score, CURB65 score, and sequential organ failure score, the predictive ability of these scores for short-term mortality was improved. Compared with the normophosphatemia group, hyperphosphatemia was found be with significantly higher short-term mortality (85.7% vs. 47.3%, P<0.05), which is absent in hypophosphatemia (25.8%). Conclusions Serum phosphate at admission has a good predictive value on short-term mortality in severe pneumonia patients admitted to the ICU/RICU. Hyperphosphatemia at admission is associated with a higher risk of short-term death.
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.
Medical device-related pressure injury (MDRPI) is a kind of pressure injury that occurs in the course of diagnosis and treatment, and its appearance is similar to that of medical device. Neonatal intensive care unit (NICU) infants are more likely to develop MDRPI than children and adults because of the physiological characteristics of skin and the influence of disease. At present, the occurrence of MDRPI in NICU infants is attracting worldwide attention. Its treatment and nursing consume a large amount of medical resources, which not only affect the outcome of the disease, but also increase the economic burden of the family and society. This article summarizes the MDRPI from three aspects: summary, influencing factors, and evaluation tools. It is expected that NICU nurses will carry out large sample clinical investigation of MDRPI in the future, so as to provide a reference for risk prediction model and risk assessment tools to identify high-risk infants and take effective measures in advance to reduce the incidence of MDRPI.
ObjectiveTo explore the infection condition of Acinetobacter baumannii at the Neurosurgery Intensive Care Unit (NICU), and analyze the possible risk factors.
MethodsWe retrospectively analyzed the clinical data of Acinetobacter baumannii infection patients with craniocerebral injury treated at the NICU between January 2011 and June 2013. We collected such information as infection patients' population distribution, infection site, invasive operations and patients' nurse-in-charge level and so on, and analyzed the possible risk factors for the infection.
ResultsThirty-one patients were infected with Acinetobacter baumannii, and they were mainly distributed between 60 and 80 years old. The main infection site was lower respiratory tract, followed in order by urinary tract, gastrointestinal tract, skin and soft tissue. The risk factors might be related to age, invasive operation, nurse working ability, etc.
ConclusionThe patients at the NICU are vulnerable to infection of Acinetobacter baumannii. Reducing invasive diagnosis and nursing procedures, providing optimal care, and carrying out specialized nurse standardization training may be the important means to effectively reduce the infection.
Objective To explore the effect of “net bottom” management in the control of device-associated infections (DAIs) in elderly patients by setting infection monitoring doctors and nurses in the emergency intensive care unit (EICU). Methods Elderly patients who aged≥60 years old admitted to the EICU of the First People’s Hospital of Lianyungang between April 2018 and March 2021 were selected as the research subjects. A “net bottom” management mode was established and implemented for the purpose of infection prevention and control, taking medical and other departments as the coordination and management subjects, and infection monitoring doctors and nurses as the core. The effectiveness of the management intervention was evaluated by comparing the incidences of DAIs in elderly patients, the compliance rates of medical staff in hand hygiene, and the consumption of hand sanitizer per bed day in EICU among the primary stage (from April 2018 to March 2019), intermediate stage (from April 2019 to March 2020), and later stage (from April 2020 to March 2021). Results During the primary stage, intermediate stage, and later stage, there were 540, 497, and 507 elderly inpatients in EICU monitored, respectively, and the incidences of nosocomial infections were 7.22% (39/540), 5.84% (29/497), and 4.14% (21/507), respectively, showing a decreasing trend (χ2trend=4.557, P=0.033). The incidences of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections decreased from 4.82‰, 2.53‰, and 0.95‰, respectively in the primary stage, to 0.51‰, 1.01‰, and 0.53‰, respectively in the later stage, among which the difference in the incidence of ventilator-associated pneumonia was statistically significant (P<0.05). The hand hygiene compliance rate of EICU medical staff increased from 70.39% to 86.67% (P<0.05), and the consumption of hand sanitizer per bed day increased from 33.70 mL to 67.27 mL. The quarterly hand hygiene compliance rate was positively correlated with the quarterly consumption of hand sanitizer per bed day (rs=0.846, P=0.001), and negatively correlated with the quarterly incidence of nosocomial infections (rs=–0.769, P=0.003). Conclusion The “net bottom” management by setting up infection monitoring doctors and nurses in the EICU and multi-department collaboration can reduce the incidence of DAIs in elderly patients in EICU, which plays a positive role in promoting the hospital infection management and improving the quality of hospital infection management.
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.
Objective To investigate the differences in bacteria distribution and drug resistance of pathogens in patients with lower respiratory tract infection between respiratory general wards and respiratory intensive care unit ( RICU) .Methods All the clinical isolates fromsputumor secretion of lower respiratory tract from2007. 1-2010. 10 were analyzed retrospectively. Antibiotic susceptibility was tested by Kirby-Bauer method. Results The total number of isolated strains was 3202. Among 1254 strains isolated from respiratory general wards, Gram-positive bacteria accounted for 2. 63% , Gram-positive bacteria accounted for 42. 42% , and fungi accounted for 54. 95% . Streptococcus pneumoniae ranked first place among Gram-positive bacteria, accounting for 51. 52% . Haemophilus parainfluenzae bacillus ranked first place among Gramnegative bacteria, accounting for 21. 99% . Both were sensitive to the most commonly used antibiotics. Among 1948 strains isolated from RICU ward, Gram-positive bacteria accounted for 4. 52% , Gram-positive bacteria accounted for 37.73% , and fungi accounted for 57. 75% . Staphylococcus aureus ranked first place among Gram-positive bacteria, accounting for 52. 27% . Acinetobacter baumannii ranked first place in Gramnegative bacteria, accounting for 27. 35% . Both were resistant to most commonly used antibiotics. Pseudomonas aeruginosa had a higher rate of infection both in the general wards and RICU, and was resistant to most commonly used antibiotics.Conclusions In lower respiratory tract infection of respiratory general ward, Gram-positive bacteria with Streptococcus pneumoniae mainly and Gram-negative bacteria with Haemophilus parainfluenzae mainly are both sensitive to the most commonly used antibiotics. While in the RICU ward, Gram-positive bacteria infections with Staphylococcus aureus mainly and Gram-negative bacteria infections with Acinetobacter baumannii mainly are both resistant to most commonly used antibiotics.
Objective To systematically assess the risk factors for the occurrence of multidrug-resistant organism (MDRO) infections in general intensive care units (ICU). Methods A computerized search was conducted to identify literature on the risk factors for MDRO infection in ICUs in the Chinese Biomedical Literature Service system, CNKI, Wanfang, VIP, PubMed, Web of Science, Cochrane Library, and Embase databases from January 1, 2012, to June 1, 2024. The literature meeting the inclusion and exclusion criteria was subjected to two-person data extraction and quality evaluation, and then meta-analysis was conducted by using Revman5.4 software. Results A total of 25 articles were included, with a cumulative total of 19 280 patients, including 3 945 patients with MDRO infection (20.5%). Twenty-four risk factors were analyzed, and the difference between 19 of them was statistically significant (P<0.050). The risk factors for MDRO infection included: (1) three general factors: length of hospital stay, ICU length of stay, and APACHE Ⅱ score; (2) seven invasive operation-related factors: mechanical ventilation, duration of mechanical ventilation, fiberoptic bronchoscopy, arterial intubation , length of venous catheterization, ureteral intubation, and urinary catheter retention; (3) four antibiotic-related factors: use of antimicrobials prior to ICU admission, concomitant antimicrobials, antimicrobial species, and duration of antimicrobials use; (4) five factors related to the underlying diseases: hypoproteinemia, pulmonary diseases, combined underlying diseases, number of combined underlying diseases, and mixed infections. Conclusions The current research evidence suggests that multiple factors are associated with the occurrence of MDRO infections in patients in general ICU, which may provide a basis for early screening of patients at risk for MDRO infections by ICU healthcare professionals.
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.
ObjectiveTo investigate the protein intake of patients in the general surgery intensive care unit (ICU) and to analyze the factors, both hindering and facilitating, that affecting protein intake from the perspective of healthcare professionals. MethodsA mixed-methods approach was used in this study, including a quantitative study and a qualitative study. The quantitative study was use to assess the protein intake in the ICU patients. The qualitative study was used to analyze the perspectives of healthcare professionals via semi-structured interviews. In the quantitative study, 32 variables were analyzed, and the sample size was estimated to be 10 times the number of study variables. The qualitative study employed the maximum difference sampling strategy, with the sample size determined by data saturation. The multiple linear regression was used to identify the risk factors affecting protein intake achievement, with a significance level of α=0.05. ResultsThe quantitative study included 459 patients, with a protein intake of (0.739±0.552) g/(kg·d). Of the patients, 90 (19.6%) had a protein intake of 1.2–2.0 g/(kg·d), 11 (2.3%) had 2.0 g/(kg·d) or more, and 358 (78.0%) had less 1.2 g/(kg·d). The multiple linear regression analysis identified several risk factors influencing protein intake attainment, including male, higher body mass index, elevated blood glucose levels upon ICU admission, early initiation of enteral nutrition (≤48 h), nasoenteric tube placement, and the only use of enteral nutrition feedings. In the qualitative study, three key themes relevant protein intake attainment were identified from the interviews: inadequate infrastructure, healthcare workers’ factors, and patient-related factors. ConclusionsThe findings of this study suggest a substantial gap between the protein intake of general surgical ICU patients and the guideline-recommended intake. The study highlights patient groups at risk for inadequate protein intake based on identified risk factors. Future efforts should focus on improving the efficiency of protein supplementation, enhancing the nutritional status of patients, standardizing protein supplementation protocols, and increasing education for both healthcare workers and patients.
