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find Keyword "重症监护病房" 61 results
  • Progress in antimicrobial stewardship in intensive care units

    Antimicrobial stewardship (AMS) is an important means to control bacterial resistance. The unique situation of intensive care unit (ICU) poses a challenge to AMS. This article reviews the literature on AMS in the ICU at home and abroad in recent years, and summarizes the related measures of AMS. Effective AMS measures in the ICU include setting up a multidisciplinary AMS team, using rapid microbial diagnosis technology to shorten the time of diagnosis, using non-culture methods to assess the necessity of antimicrobial therapy for patients with suspected sepsis, and evaluating the effectiveness of antimicrobial therapy as early as possible and optimizing it. These initiatives aim to increase the rational use of antimicrobials in ICU, reduce the risk of multidrug-resistant infections, and improve patients’ condition.

    Release date:2022-04-25 03:47 Export PDF Favorites Scan
  • Predictors for carbapenem-resistant bacteria as the pathogens of bloodstream infections

    Objective To investigate the predictors for carbapenem-resistant Acinetobacter baumannii, Enterobacteriaceae and Pseudomonas aeruginosa (CR-AEP) as the pathogens of bloodstream infection (BSI) for intensive care unit (ICU) patients. Methods A retrospective case-control study based on ICU- healthcare-associated infection (HAI) research database was carried out. The patients who have been admitted to the central ICU between 2015 and 2019 in the ICU-HAI research database of West China Hospital of Sichuan University were selected. The included patients were divided into two groups, of which the patients with ICU-acquired BSI due to CR-AEP were the case group and the patients with BSI due to the pathogens other than CR-AEP were the control group. The clinical features of the two groups of patients were compared. Logistic regression model was used to identify the predictors of BSI due to CR-AEP.ResultsA total of 197 patients with BSI were included, including 83 cases in the case group and 114 cases in the control group. A total of 214 strains of pathogenic bacteria were isolated from the 197 BSI cases, including 86 CR-AEP strains. The results of multivariate logistic regression analysis showed that previous use of tigecycline [odds ratio (OR)=2.490, 95% confidence interval (CI) (1.141, 5.436), P=0.022] was associated with higher possibility for CR-AEP as the pathogens of BSI in ICU patients with BSI, while previous use of antipseudomonal penicillin [OR=0.497, 95%CI (0.256, 0.964), P=0.039] was associated with lower possibility for that. Conclusion Previous use of tigecycline or antipseudomonal penicillin is the predictor for CR-AEP as the pathogens of BSI in ICU patients with BSI.

    Release date:2023-03-17 09:43 Export PDF Favorites Scan
  • Evidence-Based Nursing for an Unconscious Patient Undergoing Mechanical Ventilation with Eye Complication

    Objective To formulate an evidence-based nursing scheme of eye care for an unconscious patient undergoing mechanical ventilation with eye complication. Methods Under the principle of PICO, the issue was put forward aiming directly at patient’s clinical manifestations, and the following databases as The Cochrane Library (Issue 12, 2011), PubMed (January 1980 to November 2011), EMbase (1974 to 2011) and CBM (1978 to 2011) were searched. Results A total of 3 guidelines, 2 systematic reviews and 9 randomized controlled trials (RCTs) were included. The evidence showed that eye cleaning was the very important part of eye care, and the commonly-used cleaning or rinsing solutions were saline and sterile water. Both moist cover and lubricating eye drops / ointment were used to prevent dryness in the eyes. For instance, polyethylene moisture covers could effectively prevent corneal abrasion, and lubricating eye drops / ointment were beneficial to eye observation, so these two methods needed to be properly selected in combination with patient’s conditions. Nurses had to assess the ability of the patient to close eyelids daily and helped the patient to close eyes, but the passive eyelids closure was inferior to the artificial tear ointment in the effect on preventing corneal abrasions; the integrated intervention of maintaining eyelids closure and forming eyeballs moisture chamber was more effective to prevent eye complications. According to the available evidence mentioned herein and the patient’s conditions, the following nursing scheme of eye care was formulated: cleaning the eyelids and peripheral skin using 0.9% saline gauze, covering the eyes with sterile polyethylene films which were fixed by anti-allergic adhesive tapes, changing the dressing every 12 hours, and observing closure of the eyelids every day. Seven days later, eye symptoms got obviously improved, with decreasing secretion, without congestion and chemosis, and negative results of fluorescein staining test. Conclusion Eye cleaning removes secretion and bacteria from the eyes. Polyethylene film prevents tear from evaporation and fully promotes the immune function of tears which can reduce the risk of infection. Eyelids closure and local moisture environment benefit the corneal epithelial repair.

    Release date:2016-09-07 10:58 Export PDF Favorites Scan
  • 多功能肠内营养泵用于重症监护病房危重患者鼻饲的临床效果观察

    目的探讨多功能肠内营养泵对鼻饲管堵管率以及冲洗鼻饲管护理时间的影响。 方法将2013年7月-12月收治的危重症并行肠内营养患者100例按入重症监护病房的先后顺序依次分入试验组和对照组,对照组选取普通输液泵鼻饲,试验组选取多功能肠内营养泵鼻饲,比较两组患者鼻饲管堵管率、鼻饲管冲洗花费的护理时间。 结果试验组与对照组分别发生鼻饲管堵管2例(4%)和14例(28%),两组比较差异有统计学意义(χ2=10.714,P=0.001);试验组冲洗鼻饲管无需占用护理人员时间,而对照组则需花费(20.78±1.88)s。 结论多功能肠内营养泵能降低鼻饲管堵管率,可减少冲洗鼻饲管的护理时间。

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  • Evidence-based practice of oxygenation strategies therapy for intensive care unit adult patients with tracheal intubation after extubation

    Objective To evaluate and summarize the relevant evidence of oxygenation strategies with tracheal intubation after extubation for adult in intensive care unit (ICU), and to provide evidence-based practice for the development of scientific and effective strategies tracheal intubation after extubation for ICU adult patients. Methods Evidence-based databases, related guideline websites, association websites and original databases were searched by computer for literature about oxygenation strategies with tracheal intubation after extubation for ICU adults patients was extracted. The retrieval time was from the establishment of the databases to May 2023. Two researchers trained in evidence-based practice evaluated the quality of the included literature and extracted evidence from the literature that met the quality evaluation criteria. Results A total of 18 articles were included, including 7 guidelines, 4 clinical decisions, 2 expert consensus, 4 systematic reviews and 1 randomized controlled trial. A total of 22 pieces of best evidence were formed, including 7 aspects of basic principles, evaluation, selection, parameter setting, withdrawal, effect evaluation and precautions. ConclusionThe medical staff should select the best evidence based on the actual clinical situation and the patient’s own needs, and adjust the oxygenation strategies to reduce the rate of tracheal intubation and improve the prognosis of patients.

    Release date:2024-09-23 01:22 Export PDF Favorites Scan
  • The Targeted Surveillance of Newly-defined Ventilator-associated Pneumonia

    ObjectiveTo carry out targeted surveillance on ventilator-associated pneumonia (VAP) newly defined by the Centers for Disease Control and Prevention of the United States in 2013, and to understand its applicability and influence on the prognosis, and infection rate and risk factors of the disease. MethodsTargeted surveillance was carried out on all patients receiving mechanical ventilation in the general ICU of our hospital between January and December 2014. VAP infection rate was studied, and patients were divided into groups based on the development of the disease. SPSS 18.0 was used for statistical analysis of the prognostic indicators. ResultsA total of 885 patients received mechanical ventilation and were monitored, 31 of whom had VAP. The VAP case infection rate was 3.5% and its daily infection rate was 3.9‰. The results of multiple factors regression analysis showed that age (OR=1.025, P=0.025) and combining other types of hospital infection (OR=4.874, P<0.001) were independent risk factors for the development of VAP. VAP was the independent risk factor for both length of stay in the ICU and length of mechanical ventilation (P<0.001), but it was not the independent risk factor for mortality in the ICU (P=0.515). ConclusionThe applicability of the newly defined ventilator-associated pneumonia may be under restrictions in developing countries. It may influence the outcomes of patients by prolonging the length of stay in ICU and the length of mechanical ventilation.

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  • 霍桑效应对重症监护病房手卫生依从性的影响研究

    目的 探索霍桑效应对重症监护病房(Intensive Care Unit,ICU)医护人员手卫生依从性的影响。 方法 2014 年 10 月—12 月科室根据世界卫生组织手卫生调查方法,采用现场直接观察法和隐蔽式观察法,分别对 ICU 122 名护士、12 名医生、4 名保洁、14 名工人的手卫生情况进行明访和暗访,并将明访和暗访监测到的手卫生时机的洗手执行情况进行对比分析;2015 年 1 月研究者对中国知网数据库中所报道的手卫生依从性调查的文章进行了文献回顾,检索关键词为“手卫生”“依从性”,对搜索获取到的文献进行分析。 结果 ICU 医护人员手卫生依从性明访、暗访结果分别为 70.05%(1 275/1 820)和 57.28%(1 023/1 786),差异有统计学意义(P<0.001)。对中国知网数据库中检索到的 62 篇核心期刊的研究方法采用明访的居多,其中明访 36 篇,暗访 24 篇,明暗访相结合的 2 篇;仅有 3 篇提及霍桑效应,其中 2 篇采取了避免霍桑效应的措施;手卫生依从性<50% 的文献占总文献的 25.8%,依从性在 50%~80% 的文献占总文献的 46.8%,依从性在 80%~90% 的文献占总文献的 12.9%,依从性>90% 的文献占总文献的 14.5%。 结论 ICU 医护人员手卫生依从性可能受霍桑效应影响,因此在进行手卫生依从性的调查时要避免霍桑效应,以取得真实的调查结果。

    Release date:2017-06-22 02:01 Export PDF Favorites Scan
  • The predictive value of monocyte-lymphocyte ratio for mortality in intensive care unit patients: a cohort study

    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.

    Release date:2022-06-10 01:02 Export PDF Favorites Scan
  • 重症医学科构建外周静脉置入中心静脉导管医护一体的工作模式探讨

    目的在重症医学科(ICU)开展外周静脉置入中心静脉导管(PICC)医护一体合作的工作模式,以提高PICC置管的成功率,解决重症患者置管的相关问题,降低导管相关性血流感染(CRBSI)发生率。 方法选择2010年4月-2012年3月入住ICU的置入PICC的患者229例,按照入住日期单双数分为对照组和试验组,比较两组CRBSI的发生率和PICC置管成功率。 结果试验组CRBSI发生率明显低于对照组;且试验组的PICC置管成功率明显高于对照组,差异均有统计学意义(P<0.01)。 结论ICU构建PICC医护一体的工作模式,能显著提高重症患者PICC置管成功率和安全性,降低CRBSI发生率,减少了重症患者反复静脉穿刺的痛苦,保护患者外周静脉,提高护理质量及工作效率。

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  • The impact of prognostic nutritional index on short-term prognosis in critically chronic obstructive pulmonary disease patients

    Objective To investigate the predictive value of the prognostic nutritional index (PNI) for 28-day all-cause mortality in patients with chronic obstructive pulmonary disease (COPD) in intensive care unit (ICU). Methods The relationship between PNI and short-term mortality in COPD patients was analysed using COX proportional hazards and restricted cubic spline (RCS) models. Receiver operating characteristic (ROC) curves were plotted and area under the ROC curve (AUC) was calculated to assess the predictive performance of PNI. The optimal cut-off value for PNI was determined using the Youden index, and the data were divided into a low PNI group and a high PNI group. Kaplan-Meier curves were then constructed and the log-rank test was used to assess differences in survival between the two groups. Results A total of 980 COPD patients were included in the study. Multivariable COX regression analysis showed that PNI was an independent factor influencing short-term mortality in the severe COPD patients (HR=0.972, 95%CI 0.948 - 0.995, P=0.019). RCS curve results showed a non-linear relationship between PNI and short-term mortality in the severe COPD patients (P for non-linear=0.032), with the risk of death gradually decreasing as PNI increased. The ROC curve indicated that PNI had some predictive power, comparable to that of SOFA score [(AUCPNI=0.693) vs. (AUCSOFA=0.672)]. Kaplan-Meier curve analysis showed a significant difference in survival time between the low (≤38.3) PNI group and the high (>38.3) PNI group (P<0.05). Conclusions PNI has a certain predictive role for short-term all-cause mortality in patients with severe COPD. Patients with low PNI at ICU admission have a higher risk of short-term mortality.

    Release date:2024-04-30 05:47 Export PDF Favorites Scan
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