BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outc...BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.展开更多
BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely ...BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.展开更多
BACKGROUND In the intensive care unit(ICU)setting,patients with end-stage gastrointestinal cancer(GIC)frequently bear a heavier symptom burden,see faster functional regression,and struggle with eating impairments.Thes...BACKGROUND In the intensive care unit(ICU)setting,patients with end-stage gastrointestinal cancer(GIC)frequently bear a heavier symptom burden,see faster functional regression,and struggle with eating impairments.These further increase the demands and complexities of nursing care.AIM To discuss the development of Kano model-driven ICU end-of-life care(ICUEOLC)strategies for patients with GIC and its implications for quality of death(QoD).METHODS This study enrolled 115 patients with end-stage GIC admitted to the ICU from June 2021 to June 2024.A Kano model-driven ICU-EOLC protocol was applied to the observation group(n=65),contrasting with routine care in the control group(n=50).Pre-intervention and post-intervention comparisons were made in terms of psychological well-being[Hospital Anxiety and Depression Scale(HADS)],quality of life(QoL)[European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care Version(EORTC QLQ-C15-PAL)],QoD(Chinese version of the Quality of Dying and Death in the ICU Scale),death-related attitudes[Revised Death Attitude Profile(DAP-R)],and nursing care satisfaction.RESULTS Compared with controls,patients in the observation group scored markedly lower on HADS(all domains),EORTC QLQ-C15-PAL(symptom domain),and DAP-R(escape acceptance,fear of death,and death avoidance),while achieving statistically higher scores on EORTC QLQ-C15-PAL(physical function and overall QoL dimensions),C-QDD-ICU,DAP-R(natural and approaching acceptance),and nursing care satisfaction measures.CONCLUSION Kano model-driven ICU-EOLC interventions significantly reduced anxiety and depression in patients with endstage GIC,and patients’quality of life,QoD,death-related attitudes,and nursing satisfaction were improved.展开更多
BACKGROUND Return of spontaneous circulation(ROSC)following cardiopulmonary resuscitation(CPR)is a critical determinant of survival in patients experiencing cardiac arrest.This study aimed to investigate the relations...BACKGROUND Return of spontaneous circulation(ROSC)following cardiopulmonary resuscitation(CPR)is a critical determinant of survival in patients experiencing cardiac arrest.This study aimed to investigate the relationship between the duration of CPR,the achievement of ROSC,and both short-term[intensive care unit(ICU)and in-hospital]and long-term survival outcomes in patients admitted to the medical intensive care unit(MICU)of Dr.Moopen’s Medical College Hospital,Wayanad,Kerala,India.AIM To assess how cardiopulmonary resuscitation duration impacts short-term and long-term survival in cardiac arrest patients in intensive care.METHODS A retrospective observational cohort study was conducted on adult patients who received CPR in the MICU between March 2023 and March 2024.Data were extracted from electronic medical records,including demographics,duration of CPR,ROSC achievement,and survival outcomes.Short-term survival was defined as survival to ICU discharge and in-hospital mortality,while long-term survival was assessed at six months post-arrest.Statistical analysis was performed using SPSS software,with Kaplan-Meier survival analysis and Cox regression used to identify predictors of mortality.RESULTS A total of 142 patients were included in the study.The median duration of CPR was 15 minutes.ROSC was achieved in 68 patients(47.9%).A significant association was observed between the duration of CPR and ROSC achievement(P<0.001).Patients who achieved ROSC early had significantly higher rates of short-term and longterm survival compared to those who did not(P<0.001).Each additional minute of CPR was associated with a 7%decrease in the odds of achieving ROSC.Longer CPR duration(HR:1.05,95%CI:1.02-1.08),absence of ROSC(HR:4.87,95%CI:2.31-10.28),older age(HR:1.03,95%CI:1.01-1.06)and unwitnessed arrest(HR:1.89,95%CI:1.05-3.41)were independent predictors of mortality.CONCLUSION Timely,effective cardiopulmonary resuscitation improves survival in intensive care.Duration significantly predicts return of circulation and outcomes.Further research should explore factors affecting resuscitation length and optimize treatment strategies.展开更多
BACKGROUND Systemic lupus erythematosus(SLE)patients are admitted to the intensive care unit(ICU)for disease flares and infections,both of which carry a high mortality risk.Studies characterizing the outcome predictor...BACKGROUND Systemic lupus erythematosus(SLE)patients are admitted to the intensive care unit(ICU)for disease flares and infections,both of which carry a high mortality risk.Studies characterizing the outcome predictors of SLE are few in the Asian continent.This study characterized the clinical profile,treatment,and outcome predictors of ICU admissions with SLE.AIM To ascertain the reasons for ICU admission among SLE patients and to explore outcome predictors in these patients.The primary outcome was ICU mortality.Secondary outcomes included need for ventilation,inotropes,renal replacement therapy,and length of ICU and hospital stay.METHODS A retrospective study of 77 SLE patients was conducted in the medical ICU of a tertiary care teaching hospital in India.Clinical features,treatment,and outcomes of patients admitted between January 2018 and December 2022 were recorded.Factors associated with mortality were explored using bivariate and multivariate logistic regression analysis and reported as adjusted odds ratios with 95%confidence intervals.RESULTS The mean(SD)age was 31.1(10.3)years;83.1%were female.The median(interquartile)duration of SLE before admission was 12(1-60)months;SLE was newly diagnosed in the current admission in 23.4%.The median Acute Physiology and Chronic Health Evaluation II score was 16.3(14.5-18.2)and similar among survivors and nonsurvivors;32 had evidence of disease flare,44 had an infection,and one patient had an intracranial bleed.ICU admission was for respiratory failure(46.7%),hemodynamic instability(32.5%),and status epilepticus(14.3%).Twenty-nine patients(37.7%)had autoimmune hemolytic anemia,and 11(14.3%)had diffuse alveolar hemorrhage.Immunomodulation included corticosteroids(96.1%),cyclophosphamide(33.8%),mycophenolate(23.4%),plasma exchange(13%),and immunoglobulins(11.7%).All patients received broad-spectrum antibiotics.Respiratory support,inotropes,and renal replacement therapy were required in 93.5%,51.7%,and 32.5%,respectively.ICU mortality was 50.7%(95%confidence interval:39%-62%).The mean±SD hospital length of stay was 18.9±14.3 days.On multivariate analysis,only shock(P=0.004)was independently associated with mortality.CONCLUSION Intercurrent infection and disease flare are common reasons for ICU admission in SLE patients.Despite multimodal therapy,mortality is high.Shock was independently associated with mortality.展开更多
BACKGROUND Excessive noise in healthcare environments—commonly described as"unwanted sound"—has been linked to a range of negative impacts on both patients and staff.In clinical settings,elevated noise lev...BACKGROUND Excessive noise in healthcare environments—commonly described as"unwanted sound"—has been linked to a range of negative impacts on both patients and staff.In clinical settings,elevated noise levels have been associated with sleep disruption,heightened cardiovascular stress,and an increased risk of delirium in patients.Among healthcare workers,noise can impair focus and cognitive performance,potentially compromising care quality.AIM To evaluate the effectiveness of educational and behavioural interventions in reducing noise levels within intensive care units(ICUs),recognizing their potential impact on patient outcomes and healthcare effectiveness.METHODS A prospective interventional study in two Singaporean teaching hospitals compared peak and average sound levels between control and intervention groups.An educational and behavioural intervention comprising talks,posters,and self-audits by nurse champions was initiated in two ICUs in one hospital on November 18,2023.Sound measurements were collected at 4 Locations within each ICU before and after intervention.Baseline measurements were taken from October 22,2023 to October 29,2023,and post-intervention measurements from December 21,2023 to December 22,2023.The hospitals served as the primary exposure variable,controlled for ICU type(medical vs surgical)and hour of the day.RESULTS Our analysis generated 48 pairs of peak and average sound level readings for each unit(control n=48 readings;intervention n=48 readings).The effect of the intervention was associated with a significant 4.8 dB decrease in average sound level(P=0.009)and a nonsignificant 4.3 dB decrease in peak sound level(P=0.104),adjusted for hour of day and type of ICU.CONCLUSION Educational and behavioural interventions successfully reduced average sound levels,emphasizing their positive impact on noise control.These findings contribute valuable insights for optimizing noise reduction efforts in critical care settings.Future studies may explore additional systemic and environmental interventions to enhance noise management strategies.展开更多
BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,len...BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,length of hospital stay,duration of mechanical ventilation,or laboratory parameters,remains unknown.METHODS:This retrospective cohort study included patients with shock in the intensive care unit(ICU)from January 2013 to January 2020.Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not.Demographic characteristics,Acute Physiology and Chronic Health Evaluation(APACHE)II scores,quick Sequential Organ Failure Assessment(qSOFA)scores,14-day mortality,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels at 0,1,3 and 7 days after onset of shock,duration of mechanical ventilation,length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching(PSM).RESULTS:Real-world analysis of 1,583 ICU patients suff ering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups(36.2%vs.32.6%,P=0.343).Duration of mechanical ventilation,hospital stay,and hospitalization costs were also similar between the two groups(P>0.05).No diff erences in changes of NT-proBNP levels on days 0,1,3,and 7 as compared to baseline were noted between the two groups(P>0.05).CONCLUSIONS:The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation,length of hospital stay,or reduce hospitalization costs,nor will it bring survival benefi ts to ICU patients suff ering shock.展开更多
BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity o...BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity or location of the pain,discriminating the cause of their irritability and agitation can be more complicated than in adults.Thus,sedation therapy for children requires more careful attention.AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit(PICU)postoperatively.METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan.The internal parental care protocol was developed and implemented by critical care team.During the pandemic,restrictions were also placed on parental presence in the PICU.We compare two groups:During restriction and after return to normal.The level of agitation was evaluated using the Richmond Agitation-Sedation Scale.Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy.RESULTS A total of 289 patients were included in the study.Of them,167 patients were hospitalized during and 122 after the restrictions of parental care.In multivariate analysis,parental care was associated with lower odds of prescribing diazepam(odds ratio=0.11,95%confidence interval:0.05-0.25),controlling for age,sex,cerebral palsy,and type of surgery.CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs,while no differences were observed for analgesics.展开更多
BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive c...BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive care unit(ICU)admission and compared it with the Acute Physiology and Chronic Health Evaluation(APACHE)II score.There are no studies comparing its accuracy with APACHE III score.AIM To describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.METHODS We conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney.We included all adult patients(age>16 years)admitted to ICU with COVID-19 infection over a 5-month period(July 1,2021 to November 30,2021).We collected the data on demographics,clinical characteristics,interventions and outcomes for all patients.We calculated the 4C Mortality Score for each patient using eight variables as described previously.We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve(AUROC).We determined the optimal cut-off value for each of these scores using the‘nearest’method and its 95%confidence interval by bootstrapping.RESULTS A total of 140 patients(62%males,mean age 56±17 years,mean APACHE II score 13±57)were included in the study.Nineteen(13.6%)of 140 patients died in the hospital.Compared to survivors,the non-survivors were older,males,had more comorbidities,higher rate of mechanical ventilation and vasopressor use.The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75,0.80.0.75 and 0.79 respectively.The optimal cut-off value for these four scores was 9,10,14 and 56 respectively.The cut-point for all the scores had higher sensitivity than specificity.CONCLUSION The 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission.The predictive accuracy was similar to that for APACHE III score.The 4C score at ICU admission needs to be validated in future studies.展开更多
BACKGROUND Colonization with multidrug-resistant organisms(MDROs)is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units(ICUs).However,whether colonization directly lead...BACKGROUND Colonization with multidrug-resistant organisms(MDROs)is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units(ICUs).However,whether colonization directly leads to infections or adversely impacts clinical outcomes remains unclear.Clarifying this relationship may help deter-mine the prognostic significance of colonization in these patients.AIM To evaluate the clinical relevance of MDRO colonization and infection at ICU admission in patients with cirrhosis.METHODS This retrospective single-center cohort study included 107 ICU admissions of patients with liver cirrhosis at a tertiary care center(2018-2024).Colonization was assessed by rectal and nasal/pharyngeal swabs within 48 hours of ICU admission.Outcomes analyzed included MDRO infection during ICU stay,concordance between colonizing and infecting strains,organ support requirements,and 28-day transplant free survival.Multivariable logistic regression and Kaplan-Meier analyses were used to evaluate predictors of infection and mortality.RESULTS Nearly one-third(29.9%)of patients were colonized with MDROs on admission,more commonly in the acute-onchronic liver failure phenotype than those with acute decompensation(34.5 vs 10.0%,P=0.033).Although infections were established in the majority(85%)of cases,of which 17.6%due to MDROs,colonization alone did not independently predict these infections[odds ratio(OR)=2.18,P=0.383]nor influenced short-term mortality(OR=1.14,P=0.813).However,once MDRO infection occurred,an 82%concordance was observed between colonizing and infecting strains.MDRO infections,unlike colonization,significantly increased the need for organsupport interventions,including mechanical ventilation and vasopressor therapy and prolonged ICU stays.Only severity of organ dysfunction,quantified by the Sequential Organ Failure Assessment score,independently predicted 28-day mortality(OR=1.38,P=0.024).CONCLUSION MDRO colonization at ICU admission is frequent among critically ill patients with cirrhosis,particularly those with acute-on-chronic liver failure.While colonization alone does not predict infection or early mortality,its clinical value emerges in guiding empirical antibiotic treatment once infection is suspected.Ultimately,short-term survival appears to be more strongly influenced by the severity of organ failure than by either MDRO colonization or infection.展开更多
AIM:To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit(ICU)of a middle income country with limited access to ICU resources.METHODS:A prospective cohort study a...AIM:To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit(ICU)of a middle income country with limited access to ICU resources.METHODS:A prospective cohort study and economic evaluation of consecutive patients treated in a recently established medical ICU in Sarajevo,Bosnia and Herzegovina.A cost utility analysis of the intensive care of critically ill patients compared to the hospital ward treatment from the perspective of the health care system was subsequently performed.Incremental cost effectiveness was calculated using estimates of ICU vs non-ICU treatment effectiveness based on a formal systematic review of published studies.Decision analytic modeling was used to compare treatment alternatives.Sensitivity analyses of the key model parameters were performed.RESULTS:Out of 148 patients,seventy patients(47.2%)survived to one year after critical illness with a median quality of life index 0.64[interquartile range(IQR)0.49-0.76].Median number of life years gained per patient was 30(IQR 16-40)or 18 quality adjusted life years(QALYs)(IQR 7-28).The cost of treatment of critically ill patients varied between 1820 dollar and20109 dollar per hospital survivor and between 100 dollar and 2514 dollar per QALY saved.Mean factors that influenced costs were:Age,diagnostic category,ICU and hospital length of stay and number and type of diagnostic and therapeutic interventions.The incremental cost effectiveness ratio for ICU treatment was estimated at 3254 dollar per QALY corresponding to35%of per capita GDP or a Very Cost Effective category according to World Health Organization criteria.CONCLUSION:The ICU treatment of critically ill medica patients in a resource poor country is cost effective and compares favorably with other medical interventions.Public health authorities in low and middle income countries should encourage development of critical care services.展开更多
BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective pr...BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.展开更多
BACKGROUND Mechanical ventilation is a common resuscitation method in the intensive care unit(ICU).Unfortunately,this treatment process prolongs the ICU stay of patients with an increased incidence of delirium,which u...BACKGROUND Mechanical ventilation is a common resuscitation method in the intensive care unit(ICU).Unfortunately,this treatment process prolongs the ICU stay of patients with an increased incidence of delirium,which ultimately affects the prognosis.AIM To evaluate the effect of progressive early rehabilitation training on treatment and prognosis of patients with mechanical ventilation in ICU.METHODS The convenience sampling method selected 190 patients with mechanical ventilation admitted to the Fourth Hospital of Hebei Medical University from March 2020 to March 2021.According to the random number table method,they were divided into the control and intervention groups.The control group received routine nursing and rehabilitation measures,whereas the intervention group received progressive early rehabilitation training.In addition,the incidence and duration of delirium were compared for the two groups along with mechanical ventilation time,ICU hospitalization time,functional independence measure(FIM)score,Barthel index,and the incidence of complications(deep venous thrombosis,pressure sores,and acquired muscle weakness).RESULTS In the intervention group,the incidence of delirium was significantly lower than in the control group(28%vs 52%,P<0.001).In the intervention group,the duration of delirium,mechanical ventilation time,and ICU stay were shorter than in the control group(P<0.001).The FIM and Barthel index scores were significantly higher in the intervention group than the control group(P<0.001).The total incidence of complications in the intervention group was 3.15%,which was lower than 17.89%in the control group(P<0.001).CONCLUSION Progressive early rehabilitation training reduced the incidence of delirium and complications in ICU patients with mechanical ventilation,which improved prognosis and quality of life.展开更多
BACKGROUND Post-intensive care syndrome(PICS)is a term used to describe a constellation of new or worsened dysfunctions in the physical,cognitive,or mental health status of critically ill patients after their discharg...BACKGROUND Post-intensive care syndrome(PICS)is a term used to describe a constellation of new or worsened dysfunctions in the physical,cognitive,or mental health status of critically ill patients after their discharge from the intensive care unit(ICU).These dysfunctions persist beyond the acute phase of illness and have a significant impact on both the patient and their family.Connect,Introduce,Communicate,Ask,Respond,Exit(CICARE)communication advocates that patients should be respected and accepted when receiving medical services.Clinicians should attach importance to the communication mode of feelings,including connection,introduction,communication,ask,response,and exit 6 steps.AIM To assess the impact of CICARE communication on the reduction of anxiety,depression,and post-traumatic stress disorder(PTSD)symptoms in patients transitioning from the ICU to other care settings.METHODS This prospective,randomized,controlled study was performed between October 2021 and March 2023.Intensive Care Unit Memory Tool was used to evaluate patients’ICU memory.The Hospital Anxiety and Depression Scale was employed to determine the presence of anxiety or depression symptoms.Impact of Event Scale-Revised was utilized to assess the presence of PTSD.All data were processed and analyzed using R language software version 4.1.0.The measurement data were expressed as mean±SD,and the t test was used.The count data were analyzed by theχ2 test and expressed as[n(%)].RESULTS In total,248 subjects were included in this study.Among them,206 were successfully followed up for three months after transfer from the ICU,and 42 cases were lost to follow-up.There was no significant difference in the composition of ICU memory between the two groups.The application of the CICARE communication nursing model combined with the motivational psychological intervention nursing model,as well as the adoption of only the motivational psychological intervention nursing model,demonstrated favorable effects on PICS.Both groups of patients showed a reduction in anxiety scores,depression scores,and PTSD scores following the implementation of these two nursing models.However,it is noteworthy that the experimental group exhibited greater improvements compared to the control group.CONCLUSION Our findings suggest that CICARE communication nursing mode may have good influence on relieving PICS.展开更多
BACKGROUND Severe pneumonia is a common severe respiratory infection worldwide,and its treatment is challenging,especially for patients in the intensive care unit(ICU).AIM To explore the effect of communication and co...BACKGROUND Severe pneumonia is a common severe respiratory infection worldwide,and its treatment is challenging,especially for patients in the intensive care unit(ICU).AIM To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU.METHODS We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1,2021 and December 31,2023.We compared and analyzed the respiratory mechanical indexes[airway resistance(Raw),mean airway pressure(mPaw),peak pressure(PIP)],blood gas analysis indexes(arterial oxygen saturation,arterial oxygen partial pressure,and oxygenation index),and serum inflammatory factor levels[C-reactive protein(CRP),procalcitonin(PCT),cortisol(COR),and high mobility group protein B1(HMGB1)]of all patients before and after treatment.RESULTS Before treatment,there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups(P>0.05).However,after treatment,the respiratory mechanical indexes of patients in both groups were significantly improved,and the improvement of Raw,mPaw,plateau pressure,PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group(P<0.05).The serum CRP and PCT levels of patients were significantly decreased,and the difference was statistically significant compared with that of nursing group alone(P<0.05).The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups.CONCLUSION The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators,blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.展开更多
Emergency physicians are required to care for unstable patients with life-threatening conditions,and thus must make decisions that are both quick and precise about unclear clinical situations.There is increasing conse...Emergency physicians are required to care for unstable patients with life-threatening conditions,and thus must make decisions that are both quick and precise about unclear clinical situations.There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations.B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago.Its application in the diagnosis of thoracic diseases has always been considered limited,due to the presence of air in the lung and the presence of the bones of the thoracic cage,which prevent the progression of the ultrasound beam.However,the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds.At the bedside,thoracic ultrasound is based primarily on the analysis of these artifacts,with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly"water-rich"or"air-rich".The indications,contraindications,advantages,disadvantages,and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.展开更多
Aims and objectives:To evaluate intensive care unit(ICU)nurses'knowledge of the updated guidelines for the prevention of intravascular catheter-related infections;to identify the factors that affect the nurses'...Aims and objectives:To evaluate intensive care unit(ICU)nurses'knowledge of the updated guidelines for the prevention of intravascular catheter-related infections;to identify the factors that affect the nurses'knowledge and to explore the barriers to adherence to evidence-based guidelines in clinical practice in China.Methods:Cross-sectional surveys were carried out in Chinese ICUs from January 2013 to March 2014.The nurses'demographic information,knowledge of the guidelines,and barriers to adherence were assessed by a validated questionnaire and then analyzed statistically.Results:The questionnaires were completed by 455 ICU nurses from 4 provinces of China.The mean score was 8.17 of 20,and higher scores were significantly associated with province,years of experience,and years of ICU experience.Forty-nine(10.7%)nurses had not heard of the guidelines,whereas 231(50.7%)nurses heard of the guidelines but did not receive training for them.Trained nurses'scores were higher than untrained nurses'scores.The three main barriers to compliance with the guidelines were an unfamiliarity with them,an excessive workload due to a shortage of nurses,and a lack of training.Conclusions:ICU nurses'knowledge of the updated guidelines is quite low,which could be a potential risk factor for patient safety.Multidisciplinary interventions and continuous.展开更多
Pain is a common experience for inpatients,and intensive care unit(ICU)patients undergo more pain than other departmental patients,with an incidence of 50%at rest and up to 80%during common care procedures.At present,...Pain is a common experience for inpatients,and intensive care unit(ICU)patients undergo more pain than other departmental patients,with an incidence of 50%at rest and up to 80%during common care procedures.At present,the management of persistent pain in ICU patients has attracted considerable attention,and there are many related clinical studies and guidelines.However,the management of transient pain caused by certain ICU procedures has not received sufficient attention.We reviewed the different management strategies for procedural pain in the ICU and reached a conclusion.Pain management is a process of continuous quality improvement that requires multidisciplinary team cooperation,painrelated training of all relevant personnel,effective relief of all kinds of pain,and improvement of patients'quality of life.In clinical work,which involves complex and diverse patients,we should pay attention to the following points for procedural pain:(1)Consider not only the patient's persistent pain but also his or her procedural pain;(2)Conduct multimodal pain management;(3)Provide combined sedation on the basis of pain management;and(4)Perform individualized pain management.Until now,the pain management of procedural pain in the ICU has not attracted extensive attention.Therefore,we expect additional studies to solve the existing problems of procedural pain management in the ICU.展开更多
BACKGROUND Young and middle-aged cancer patients in intensive care unit(ICU)often suffer from stress and pressure,causing huge physical and mental damage.Currently,there is few research on post-traumatic stress disord...BACKGROUND Young and middle-aged cancer patients in intensive care unit(ICU)often suffer from stress and pressure,causing huge physical and mental damage.Currently,there is few research on post-traumatic stress disorder(PTSD)among young and middle-aged cancer patients in ICU in China,and the psychological status of patients who have experienced both cancer development and ICU stay is still unclear.AIM To explore the risk factors for PTSD in young and middle-aged patients with cancer in ICU.METHODS Using convenient sampling method,we enrolled 150 young and middle-aged patients with cancer who were admitted to the ICU of our center during the period from July to December 2020.The general data of the patients and PTSDrelated indicators were collected.The Impact of Event Scale-Revised(IES-R)was used for assessing PTSD one month after the discharge from the ICU.Binary Logistic regression analysis was performed to assess the independent risk factors for PTSD in these patients.RESULTS Among these 150 patients,32(21.33%)were found to be with PTSD.Binary Logistic regression analysis revealed that factors significantly associated with PTSD among young and middle-aged patients with cancer in ICU included monthly income(OR=0.24,P=0.02),planned transfers(OR=0.208,P=0.019),and Acute Physiology and Chronic Health Evaluation(APACHE II)score(OR=1.171,P=0.003).CONCLUSION The low monthly income,unplanned transfers,and increased APACHE II score are the risk factors for PTSD in young and middle-aged patients with cancer in ICU.展开更多
基金Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
文摘BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.
文摘BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.
文摘BACKGROUND In the intensive care unit(ICU)setting,patients with end-stage gastrointestinal cancer(GIC)frequently bear a heavier symptom burden,see faster functional regression,and struggle with eating impairments.These further increase the demands and complexities of nursing care.AIM To discuss the development of Kano model-driven ICU end-of-life care(ICUEOLC)strategies for patients with GIC and its implications for quality of death(QoD).METHODS This study enrolled 115 patients with end-stage GIC admitted to the ICU from June 2021 to June 2024.A Kano model-driven ICU-EOLC protocol was applied to the observation group(n=65),contrasting with routine care in the control group(n=50).Pre-intervention and post-intervention comparisons were made in terms of psychological well-being[Hospital Anxiety and Depression Scale(HADS)],quality of life(QoL)[European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care Version(EORTC QLQ-C15-PAL)],QoD(Chinese version of the Quality of Dying and Death in the ICU Scale),death-related attitudes[Revised Death Attitude Profile(DAP-R)],and nursing care satisfaction.RESULTS Compared with controls,patients in the observation group scored markedly lower on HADS(all domains),EORTC QLQ-C15-PAL(symptom domain),and DAP-R(escape acceptance,fear of death,and death avoidance),while achieving statistically higher scores on EORTC QLQ-C15-PAL(physical function and overall QoL dimensions),C-QDD-ICU,DAP-R(natural and approaching acceptance),and nursing care satisfaction measures.CONCLUSION Kano model-driven ICU-EOLC interventions significantly reduced anxiety and depression in patients with endstage GIC,and patients’quality of life,QoD,death-related attitudes,and nursing satisfaction were improved.
文摘BACKGROUND Return of spontaneous circulation(ROSC)following cardiopulmonary resuscitation(CPR)is a critical determinant of survival in patients experiencing cardiac arrest.This study aimed to investigate the relationship between the duration of CPR,the achievement of ROSC,and both short-term[intensive care unit(ICU)and in-hospital]and long-term survival outcomes in patients admitted to the medical intensive care unit(MICU)of Dr.Moopen’s Medical College Hospital,Wayanad,Kerala,India.AIM To assess how cardiopulmonary resuscitation duration impacts short-term and long-term survival in cardiac arrest patients in intensive care.METHODS A retrospective observational cohort study was conducted on adult patients who received CPR in the MICU between March 2023 and March 2024.Data were extracted from electronic medical records,including demographics,duration of CPR,ROSC achievement,and survival outcomes.Short-term survival was defined as survival to ICU discharge and in-hospital mortality,while long-term survival was assessed at six months post-arrest.Statistical analysis was performed using SPSS software,with Kaplan-Meier survival analysis and Cox regression used to identify predictors of mortality.RESULTS A total of 142 patients were included in the study.The median duration of CPR was 15 minutes.ROSC was achieved in 68 patients(47.9%).A significant association was observed between the duration of CPR and ROSC achievement(P<0.001).Patients who achieved ROSC early had significantly higher rates of short-term and longterm survival compared to those who did not(P<0.001).Each additional minute of CPR was associated with a 7%decrease in the odds of achieving ROSC.Longer CPR duration(HR:1.05,95%CI:1.02-1.08),absence of ROSC(HR:4.87,95%CI:2.31-10.28),older age(HR:1.03,95%CI:1.01-1.06)and unwitnessed arrest(HR:1.89,95%CI:1.05-3.41)were independent predictors of mortality.CONCLUSION Timely,effective cardiopulmonary resuscitation improves survival in intensive care.Duration significantly predicts return of circulation and outcomes.Further research should explore factors affecting resuscitation length and optimize treatment strategies.
文摘BACKGROUND Systemic lupus erythematosus(SLE)patients are admitted to the intensive care unit(ICU)for disease flares and infections,both of which carry a high mortality risk.Studies characterizing the outcome predictors of SLE are few in the Asian continent.This study characterized the clinical profile,treatment,and outcome predictors of ICU admissions with SLE.AIM To ascertain the reasons for ICU admission among SLE patients and to explore outcome predictors in these patients.The primary outcome was ICU mortality.Secondary outcomes included need for ventilation,inotropes,renal replacement therapy,and length of ICU and hospital stay.METHODS A retrospective study of 77 SLE patients was conducted in the medical ICU of a tertiary care teaching hospital in India.Clinical features,treatment,and outcomes of patients admitted between January 2018 and December 2022 were recorded.Factors associated with mortality were explored using bivariate and multivariate logistic regression analysis and reported as adjusted odds ratios with 95%confidence intervals.RESULTS The mean(SD)age was 31.1(10.3)years;83.1%were female.The median(interquartile)duration of SLE before admission was 12(1-60)months;SLE was newly diagnosed in the current admission in 23.4%.The median Acute Physiology and Chronic Health Evaluation II score was 16.3(14.5-18.2)and similar among survivors and nonsurvivors;32 had evidence of disease flare,44 had an infection,and one patient had an intracranial bleed.ICU admission was for respiratory failure(46.7%),hemodynamic instability(32.5%),and status epilepticus(14.3%).Twenty-nine patients(37.7%)had autoimmune hemolytic anemia,and 11(14.3%)had diffuse alveolar hemorrhage.Immunomodulation included corticosteroids(96.1%),cyclophosphamide(33.8%),mycophenolate(23.4%),plasma exchange(13%),and immunoglobulins(11.7%).All patients received broad-spectrum antibiotics.Respiratory support,inotropes,and renal replacement therapy were required in 93.5%,51.7%,and 32.5%,respectively.ICU mortality was 50.7%(95%confidence interval:39%-62%).The mean±SD hospital length of stay was 18.9±14.3 days.On multivariate analysis,only shock(P=0.004)was independently associated with mortality.CONCLUSION Intercurrent infection and disease flare are common reasons for ICU admission in SLE patients.Despite multimodal therapy,mortality is high.Shock was independently associated with mortality.
文摘BACKGROUND Excessive noise in healthcare environments—commonly described as"unwanted sound"—has been linked to a range of negative impacts on both patients and staff.In clinical settings,elevated noise levels have been associated with sleep disruption,heightened cardiovascular stress,and an increased risk of delirium in patients.Among healthcare workers,noise can impair focus and cognitive performance,potentially compromising care quality.AIM To evaluate the effectiveness of educational and behavioural interventions in reducing noise levels within intensive care units(ICUs),recognizing their potential impact on patient outcomes and healthcare effectiveness.METHODS A prospective interventional study in two Singaporean teaching hospitals compared peak and average sound levels between control and intervention groups.An educational and behavioural intervention comprising talks,posters,and self-audits by nurse champions was initiated in two ICUs in one hospital on November 18,2023.Sound measurements were collected at 4 Locations within each ICU before and after intervention.Baseline measurements were taken from October 22,2023 to October 29,2023,and post-intervention measurements from December 21,2023 to December 22,2023.The hospitals served as the primary exposure variable,controlled for ICU type(medical vs surgical)and hour of the day.RESULTS Our analysis generated 48 pairs of peak and average sound level readings for each unit(control n=48 readings;intervention n=48 readings).The effect of the intervention was associated with a significant 4.8 dB decrease in average sound level(P=0.009)and a nonsignificant 4.3 dB decrease in peak sound level(P=0.104),adjusted for hour of day and type of ICU.CONCLUSION Educational and behavioural interventions successfully reduced average sound levels,emphasizing their positive impact on noise control.These findings contribute valuable insights for optimizing noise reduction efforts in critical care settings.Future studies may explore additional systemic and environmental interventions to enhance noise management strategies.
文摘BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,length of hospital stay,duration of mechanical ventilation,or laboratory parameters,remains unknown.METHODS:This retrospective cohort study included patients with shock in the intensive care unit(ICU)from January 2013 to January 2020.Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not.Demographic characteristics,Acute Physiology and Chronic Health Evaluation(APACHE)II scores,quick Sequential Organ Failure Assessment(qSOFA)scores,14-day mortality,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels at 0,1,3 and 7 days after onset of shock,duration of mechanical ventilation,length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching(PSM).RESULTS:Real-world analysis of 1,583 ICU patients suff ering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups(36.2%vs.32.6%,P=0.343).Duration of mechanical ventilation,hospital stay,and hospitalization costs were also similar between the two groups(P>0.05).No diff erences in changes of NT-proBNP levels on days 0,1,3,and 7 as compared to baseline were noted between the two groups(P>0.05).CONCLUSIONS:The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation,length of hospital stay,or reduce hospitalization costs,nor will it bring survival benefi ts to ICU patients suff ering shock.
文摘BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity or location of the pain,discriminating the cause of their irritability and agitation can be more complicated than in adults.Thus,sedation therapy for children requires more careful attention.AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit(PICU)postoperatively.METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan.The internal parental care protocol was developed and implemented by critical care team.During the pandemic,restrictions were also placed on parental presence in the PICU.We compare two groups:During restriction and after return to normal.The level of agitation was evaluated using the Richmond Agitation-Sedation Scale.Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy.RESULTS A total of 289 patients were included in the study.Of them,167 patients were hospitalized during and 122 after the restrictions of parental care.In multivariate analysis,parental care was associated with lower odds of prescribing diazepam(odds ratio=0.11,95%confidence interval:0.05-0.25),controlling for age,sex,cerebral palsy,and type of surgery.CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs,while no differences were observed for analgesics.
文摘BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive care unit(ICU)admission and compared it with the Acute Physiology and Chronic Health Evaluation(APACHE)II score.There are no studies comparing its accuracy with APACHE III score.AIM To describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.METHODS We conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney.We included all adult patients(age>16 years)admitted to ICU with COVID-19 infection over a 5-month period(July 1,2021 to November 30,2021).We collected the data on demographics,clinical characteristics,interventions and outcomes for all patients.We calculated the 4C Mortality Score for each patient using eight variables as described previously.We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve(AUROC).We determined the optimal cut-off value for each of these scores using the‘nearest’method and its 95%confidence interval by bootstrapping.RESULTS A total of 140 patients(62%males,mean age 56±17 years,mean APACHE II score 13±57)were included in the study.Nineteen(13.6%)of 140 patients died in the hospital.Compared to survivors,the non-survivors were older,males,had more comorbidities,higher rate of mechanical ventilation and vasopressor use.The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75,0.80.0.75 and 0.79 respectively.The optimal cut-off value for these four scores was 9,10,14 and 56 respectively.The cut-point for all the scores had higher sensitivity than specificity.CONCLUSION The 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission.The predictive accuracy was similar to that for APACHE III score.The 4C score at ICU admission needs to be validated in future studies.
基金approved by the Institutional Review Board of the University Hospital Centre Zagreb(Approval No:02/013 AG).
文摘BACKGROUND Colonization with multidrug-resistant organisms(MDROs)is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units(ICUs).However,whether colonization directly leads to infections or adversely impacts clinical outcomes remains unclear.Clarifying this relationship may help deter-mine the prognostic significance of colonization in these patients.AIM To evaluate the clinical relevance of MDRO colonization and infection at ICU admission in patients with cirrhosis.METHODS This retrospective single-center cohort study included 107 ICU admissions of patients with liver cirrhosis at a tertiary care center(2018-2024).Colonization was assessed by rectal and nasal/pharyngeal swabs within 48 hours of ICU admission.Outcomes analyzed included MDRO infection during ICU stay,concordance between colonizing and infecting strains,organ support requirements,and 28-day transplant free survival.Multivariable logistic regression and Kaplan-Meier analyses were used to evaluate predictors of infection and mortality.RESULTS Nearly one-third(29.9%)of patients were colonized with MDROs on admission,more commonly in the acute-onchronic liver failure phenotype than those with acute decompensation(34.5 vs 10.0%,P=0.033).Although infections were established in the majority(85%)of cases,of which 17.6%due to MDROs,colonization alone did not independently predict these infections[odds ratio(OR)=2.18,P=0.383]nor influenced short-term mortality(OR=1.14,P=0.813).However,once MDRO infection occurred,an 82%concordance was observed between colonizing and infecting strains.MDRO infections,unlike colonization,significantly increased the need for organsupport interventions,including mechanical ventilation and vasopressor therapy and prolonged ICU stays.Only severity of organ dysfunction,quantified by the Sequential Organ Failure Assessment score,independently predicted 28-day mortality(OR=1.38,P=0.024).CONCLUSION MDRO colonization at ICU admission is frequent among critically ill patients with cirrhosis,particularly those with acute-on-chronic liver failure.While colonization alone does not predict infection or early mortality,its clinical value emerges in guiding empirical antibiotic treatment once infection is suspected.Ultimately,short-term survival appears to be more strongly influenced by the severity of organ failure than by either MDRO colonization or infection.
文摘AIM:To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit(ICU)of a middle income country with limited access to ICU resources.METHODS:A prospective cohort study and economic evaluation of consecutive patients treated in a recently established medical ICU in Sarajevo,Bosnia and Herzegovina.A cost utility analysis of the intensive care of critically ill patients compared to the hospital ward treatment from the perspective of the health care system was subsequently performed.Incremental cost effectiveness was calculated using estimates of ICU vs non-ICU treatment effectiveness based on a formal systematic review of published studies.Decision analytic modeling was used to compare treatment alternatives.Sensitivity analyses of the key model parameters were performed.RESULTS:Out of 148 patients,seventy patients(47.2%)survived to one year after critical illness with a median quality of life index 0.64[interquartile range(IQR)0.49-0.76].Median number of life years gained per patient was 30(IQR 16-40)or 18 quality adjusted life years(QALYs)(IQR 7-28).The cost of treatment of critically ill patients varied between 1820 dollar and20109 dollar per hospital survivor and between 100 dollar and 2514 dollar per QALY saved.Mean factors that influenced costs were:Age,diagnostic category,ICU and hospital length of stay and number and type of diagnostic and therapeutic interventions.The incremental cost effectiveness ratio for ICU treatment was estimated at 3254 dollar per QALY corresponding to35%of per capita GDP or a Very Cost Effective category according to World Health Organization criteria.CONCLUSION:The ICU treatment of critically ill medica patients in a resource poor country is cost effective and compares favorably with other medical interventions.Public health authorities in low and middle income countries should encourage development of critical care services.
基金Supported by Science and Technology Support Program of Qiandongnan Prefecture,No.Qiandongnan Sci-Tech Support[2021]12Guizhou Province High-Level Innovative Talent Training Program,No.Qiannan Thousand Talents[2022]201701.
文摘BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.
文摘BACKGROUND Mechanical ventilation is a common resuscitation method in the intensive care unit(ICU).Unfortunately,this treatment process prolongs the ICU stay of patients with an increased incidence of delirium,which ultimately affects the prognosis.AIM To evaluate the effect of progressive early rehabilitation training on treatment and prognosis of patients with mechanical ventilation in ICU.METHODS The convenience sampling method selected 190 patients with mechanical ventilation admitted to the Fourth Hospital of Hebei Medical University from March 2020 to March 2021.According to the random number table method,they were divided into the control and intervention groups.The control group received routine nursing and rehabilitation measures,whereas the intervention group received progressive early rehabilitation training.In addition,the incidence and duration of delirium were compared for the two groups along with mechanical ventilation time,ICU hospitalization time,functional independence measure(FIM)score,Barthel index,and the incidence of complications(deep venous thrombosis,pressure sores,and acquired muscle weakness).RESULTS In the intervention group,the incidence of delirium was significantly lower than in the control group(28%vs 52%,P<0.001).In the intervention group,the duration of delirium,mechanical ventilation time,and ICU stay were shorter than in the control group(P<0.001).The FIM and Barthel index scores were significantly higher in the intervention group than the control group(P<0.001).The total incidence of complications in the intervention group was 3.15%,which was lower than 17.89%in the control group(P<0.001).CONCLUSION Progressive early rehabilitation training reduced the incidence of delirium and complications in ICU patients with mechanical ventilation,which improved prognosis and quality of life.
文摘BACKGROUND Post-intensive care syndrome(PICS)is a term used to describe a constellation of new or worsened dysfunctions in the physical,cognitive,or mental health status of critically ill patients after their discharge from the intensive care unit(ICU).These dysfunctions persist beyond the acute phase of illness and have a significant impact on both the patient and their family.Connect,Introduce,Communicate,Ask,Respond,Exit(CICARE)communication advocates that patients should be respected and accepted when receiving medical services.Clinicians should attach importance to the communication mode of feelings,including connection,introduction,communication,ask,response,and exit 6 steps.AIM To assess the impact of CICARE communication on the reduction of anxiety,depression,and post-traumatic stress disorder(PTSD)symptoms in patients transitioning from the ICU to other care settings.METHODS This prospective,randomized,controlled study was performed between October 2021 and March 2023.Intensive Care Unit Memory Tool was used to evaluate patients’ICU memory.The Hospital Anxiety and Depression Scale was employed to determine the presence of anxiety or depression symptoms.Impact of Event Scale-Revised was utilized to assess the presence of PTSD.All data were processed and analyzed using R language software version 4.1.0.The measurement data were expressed as mean±SD,and the t test was used.The count data were analyzed by theχ2 test and expressed as[n(%)].RESULTS In total,248 subjects were included in this study.Among them,206 were successfully followed up for three months after transfer from the ICU,and 42 cases were lost to follow-up.There was no significant difference in the composition of ICU memory between the two groups.The application of the CICARE communication nursing model combined with the motivational psychological intervention nursing model,as well as the adoption of only the motivational psychological intervention nursing model,demonstrated favorable effects on PICS.Both groups of patients showed a reduction in anxiety scores,depression scores,and PTSD scores following the implementation of these two nursing models.However,it is noteworthy that the experimental group exhibited greater improvements compared to the control group.CONCLUSION Our findings suggest that CICARE communication nursing mode may have good influence on relieving PICS.
文摘BACKGROUND Severe pneumonia is a common severe respiratory infection worldwide,and its treatment is challenging,especially for patients in the intensive care unit(ICU).AIM To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU.METHODS We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1,2021 and December 31,2023.We compared and analyzed the respiratory mechanical indexes[airway resistance(Raw),mean airway pressure(mPaw),peak pressure(PIP)],blood gas analysis indexes(arterial oxygen saturation,arterial oxygen partial pressure,and oxygenation index),and serum inflammatory factor levels[C-reactive protein(CRP),procalcitonin(PCT),cortisol(COR),and high mobility group protein B1(HMGB1)]of all patients before and after treatment.RESULTS Before treatment,there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups(P>0.05).However,after treatment,the respiratory mechanical indexes of patients in both groups were significantly improved,and the improvement of Raw,mPaw,plateau pressure,PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group(P<0.05).The serum CRP and PCT levels of patients were significantly decreased,and the difference was statistically significant compared with that of nursing group alone(P<0.05).The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups.CONCLUSION The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators,blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.
文摘Emergency physicians are required to care for unstable patients with life-threatening conditions,and thus must make decisions that are both quick and precise about unclear clinical situations.There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations.B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago.Its application in the diagnosis of thoracic diseases has always been considered limited,due to the presence of air in the lung and the presence of the bones of the thoracic cage,which prevent the progression of the ultrasound beam.However,the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds.At the bedside,thoracic ultrasound is based primarily on the analysis of these artifacts,with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly"water-rich"or"air-rich".The indications,contraindications,advantages,disadvantages,and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.
文摘Aims and objectives:To evaluate intensive care unit(ICU)nurses'knowledge of the updated guidelines for the prevention of intravascular catheter-related infections;to identify the factors that affect the nurses'knowledge and to explore the barriers to adherence to evidence-based guidelines in clinical practice in China.Methods:Cross-sectional surveys were carried out in Chinese ICUs from January 2013 to March 2014.The nurses'demographic information,knowledge of the guidelines,and barriers to adherence were assessed by a validated questionnaire and then analyzed statistically.Results:The questionnaires were completed by 455 ICU nurses from 4 provinces of China.The mean score was 8.17 of 20,and higher scores were significantly associated with province,years of experience,and years of ICU experience.Forty-nine(10.7%)nurses had not heard of the guidelines,whereas 231(50.7%)nurses heard of the guidelines but did not receive training for them.Trained nurses'scores were higher than untrained nurses'scores.The three main barriers to compliance with the guidelines were an unfamiliarity with them,an excessive workload due to a shortage of nurses,and a lack of training.Conclusions:ICU nurses'knowledge of the updated guidelines is quite low,which could be a potential risk factor for patient safety.Multidisciplinary interventions and continuous.
文摘Pain is a common experience for inpatients,and intensive care unit(ICU)patients undergo more pain than other departmental patients,with an incidence of 50%at rest and up to 80%during common care procedures.At present,the management of persistent pain in ICU patients has attracted considerable attention,and there are many related clinical studies and guidelines.However,the management of transient pain caused by certain ICU procedures has not received sufficient attention.We reviewed the different management strategies for procedural pain in the ICU and reached a conclusion.Pain management is a process of continuous quality improvement that requires multidisciplinary team cooperation,painrelated training of all relevant personnel,effective relief of all kinds of pain,and improvement of patients'quality of life.In clinical work,which involves complex and diverse patients,we should pay attention to the following points for procedural pain:(1)Consider not only the patient's persistent pain but also his or her procedural pain;(2)Conduct multimodal pain management;(3)Provide combined sedation on the basis of pain management;and(4)Perform individualized pain management.Until now,the pain management of procedural pain in the ICU has not attracted extensive attention.Therefore,we expect additional studies to solve the existing problems of procedural pain management in the ICU.
文摘BACKGROUND Young and middle-aged cancer patients in intensive care unit(ICU)often suffer from stress and pressure,causing huge physical and mental damage.Currently,there is few research on post-traumatic stress disorder(PTSD)among young and middle-aged cancer patients in ICU in China,and the psychological status of patients who have experienced both cancer development and ICU stay is still unclear.AIM To explore the risk factors for PTSD in young and middle-aged patients with cancer in ICU.METHODS Using convenient sampling method,we enrolled 150 young and middle-aged patients with cancer who were admitted to the ICU of our center during the period from July to December 2020.The general data of the patients and PTSDrelated indicators were collected.The Impact of Event Scale-Revised(IES-R)was used for assessing PTSD one month after the discharge from the ICU.Binary Logistic regression analysis was performed to assess the independent risk factors for PTSD in these patients.RESULTS Among these 150 patients,32(21.33%)were found to be with PTSD.Binary Logistic regression analysis revealed that factors significantly associated with PTSD among young and middle-aged patients with cancer in ICU included monthly income(OR=0.24,P=0.02),planned transfers(OR=0.208,P=0.019),and Acute Physiology and Chronic Health Evaluation(APACHE II)score(OR=1.171,P=0.003).CONCLUSION The low monthly income,unplanned transfers,and increased APACHE II score are the risk factors for PTSD in young and middle-aged patients with cancer in ICU.
