ObjectiveTo analyze the influencing factors of ventilator-associated pneumonia (VAP) in comprehensive intensive care units (ICUs) in a certain district of Shanghai, and to provide evidence for developing targeted measures to prevent and reduce the occurrence of VAP.MethodsThe target surveillance data of 1 567 inpatients with mechanical ventilation over 48 hours in comprehensive ICUs of 5 hospitals in the district from January 2015 to December 2017 were retrospectively analyzed to determine whether VAP occurred. The data were analyzed with SPSS 21.0 software to describe the occurrence of VAP in patients and to screen the influencing factors of VAP.ResultsThere were 133 cases of VAP in the 1 567 patients, with the incidence of 8.49% and the daily incidence of 6.01‰; the incidence of VAP decreased year by year from 2015 to 2017 (χ2trend=11.111, P=0.001). The mortality rate was 12.78% in VAP patients while was 7.25% in non-VAP patients; the difference was significant (χ2=5.223, P=0.022). A total of 203 pathogenic bacteria were detected in patients with VAP, mainly Gram-negative bacteria (153 strains, accounting for 75.37%). The most common pathogen was Pseudomonas aeruginosa. The single factor analysis showed that gender, age, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, the length of ICU stay, and the length of mechanical ventilation were the influencing factors of VAP (χ2=9.572, 5.237, 34.759, 48.558, 44.960, P<0.05). Multiple logistic regression analysis found that women [odds ratio (OR)=1.608, 95% confidence interval (CI) (1.104, 2.340), P=0.013], APACHE Ⅱ score >15 [OR=4.704, 95%CI (2.655, 8.335), P<0.001], the length of ICU stay >14 days [OR=2.012, 95%CI (1.188, 3.407), P=0.009], and the length of mechanical ventilation >7 days [OR=2.646, 95%CI (1.439, 4.863), P=0.002] were independent risk factors of VAP.ConclusionsNosocomial infection caused by mechanical ventilation in this area has a downward trend, and the mortality rate of patients with VAP is higher. For the patients treated with mechanical ventilation in ICU, we should actively treat the primary disease, shorten the length of ICU stay and the length of mechanical ventilation, and strictly control the indication of withdrawal, thereby reduce the occurrence of VAP.
With the continuous development of critical care medicine, the survival rate of critical ill patients continues to increase. However, the residual dysfunction will have a far-reaching impact on the burden on patients, families, and health-care systems, and will significantly increase the demand of the follow-up rehabilitation treatment. Critical illness rehabilitation intervenes patients who are still in the intensive care unit (ICU). It can prevent complications, functional deterioration and dysfunction, improve functional activity and quality of life, shorten the time of mechanical ventilation, the length of ICU stay and hospital stay, and also reduce medical expenses. Experts at home and abroad believe that early rehabilitation of critical ill patients is safe and effective. So rehabilitation should be involved in critical ill patients as early as possible. However, the promotion of this model is still limited by the setting of safety parameters, the ICU culture, the lack of critical rehabilitation professionals, and the physiological and mental cognitive status of patients. Rehabilitation treatment in ICU is constantly being practiced at home and abroad.
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.
ObjectiveTo investigate the causes of ventilator-associated pneumonia (VAP) in patients with tumor in Intensive Care Unit (ICU), and take effective intervention measures to reduce the incidence of VAP. MethodsThe targeted monitoring was conducted for the ICU patients who underwent the mechanical ventilation for over 48 hours from January 2013 to December 2014. Then the conventional nursing measures where adopted in 2013 without any field intervention measure implemented. While the prevention and control method was conducted in 2014 and the causes of VAP was valued and anyzed. ResultsAfter adopting intervention measures, the thousand-day rate of VAP decreased from 8.71‰ before the interventions to 2.30‰ after the interventions. The utilization rate of ventilators increased from 63% to 72% after the interventions were taken in 2014. The constituent ratio of the multidrug-resistant bacteria among the isolated pathogens in each year presented a downward trend. ConclusionVAP is common in ICU patients. It is necessary to reach preventive measures and designated position and ventilator management so as to prevent the occurrence of new nosocomial infection.
ObjectiveTo explore the safety of ventilator support in hyperbaric oxygen chamber and the prevention of related complications.MethodsFrom July 2016 to December 2018, there were 127 intensive care unit patients underwent hyperbaric oxygen therapy with ventilator. Medical professionals in hyperbaric medicine or intensive care medicine were arranged to accompany the patients in the treatment process, to observe the patients’ condition changes closely, monitor their heart rate, respiration, blood pressure, and oxygen saturation, and perform sputum suction at any time if needed and monitor the airway peak pressure change to prevent pneumothorax.ResultsDuring the process of hyperbaric oxygen therapy, 13 patients (10.24%) were treated with analgesia/sedation for patient-ventilator asynchrony, 4 patients (3.15%) exited the champer emergently for acute left heart failure, 3 patients (2.36%) had epileptic seizures, 3 patients (2.36%) had aspiration, and 1 patient (0.79%) had breath and cardiac arrest. After emergency treatment, all the patients returned to the ward safely.ConclusionDuring the treatment of hyperbaric oxygen therapy for intensive care unit patients with ventilator, the accompany of qualified professionals in hyperbaric medicine or intensive care medicine in the hyperbaric oxygen chamber can treat the patients’ symptoms timely and reduce the risk greatly.
ObjectiveTo identify the risk factors of Intensive Care Unit (ICU) nosocomial infection in ICU ward in a first-class hospital in Wuxi, and discuss the effective control measures, in order to provide evidence for making strategies in preventing and controlling nosocomial infection. MethodsAccording to the principle of random sampling and with the use of case-control study, a sample of 100 nosocomial infection patients were selected randomly from January 2012 to December 2014 as survey group, and another 100 patients without nosocomial infection as control group. The data were input using EpiData 2.0, and SPSS 13.0 was used for statistical analysis; t-test and χ2 test were conducted, and the risk factors were analyzed using multi-variate logistic regression model. The significant level of P-value was 0.05. ResultsBased on the results of univariate analysis, there were 13 risk factors for ICU nosocomial infection, including diabetes mellitus, hypoproteinemia, being bedridden, surgical operation, immunosuppression, glucocorticoids, organ transplantation, tracheal intubation, length of hospitalization, length of mechanical ventilation, length of central venous catheter, length of urinary catheter, and length of nasogastric tube indwelling. Multi-variate logistic analysis indicated that hospitalization of 7 days or longer[OR=1.106, 95%CI (1.025, 1.096), P=0.001], diabetes mellitus[OR=2.770, 95%CI (1.068, 7.186), P=0.036], surgical operation[OR=7.524, 95%CI (2.352, 24.063), P=0.001], mechanical ventilation of 7 days or longer[OR=1.222, 95%CI (1.116, 1.339), P<0.001], and nasogastric tube indwelling of 7 days or longer[OR=1.110, 95%CI (1.035, 1.190), P=0.003] were considered as independent risk factors for ICU nosocomial infection. ConclusionHospitalization of 7 days or longer, diabetes mellitus, surgical operation, tracheal intubation of 7 days or longer, and gastric intubation of 7 days or longer are the major risk factors for nosocomial infection in ICU ward. Advanced intervention and comprehensive prevention measures are helpful to reduce the nosocomial infection rate and ensure the safety of medical treatment.