ObjectiveTo investigate the risk factors, prognostic factors and prognosis of Multidrug-Resistant Acinetobacter Baumannii (MDR-AB) infection of lower respiratory tract in Intensive Care Unit (ICU) of the Second Affiliated Hospital of Anhui Medical University. MethodsUsing retrospective analysis, we reviewed and compared clinical data of 77 AB infections in lower respiratory tract cases in ICU from January 2013 to March 2015. According to the resistance, patients were divided into a MDR-AB group and a NMDR-AB group. Then the risk factors, prognostic factors and prognosis of MDR-AB infection were analyzed. ResultsA total of 58 cases in the MDR-AB group, 19 cases in the NMDR-AB group were included. The result showed that, the MDR-AB infection in lower respiratory tract could significantly prolong the length of ICU stay (18.5±16.0 vs. 10.6±9.3 days, P<0.05) and increase the mortality (44.8% vs. 11.1%, P<0.01). Logistic regression analysis showed that the independent risk factors for MDR-AB infection in lower respiratory tract included Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score >15 (OR=0.138, 95%CI 0.03 to 0.625, P=0.01) and use of carbapenems (OR=0.066, 95%CI 0.012 to 0.0346, P=0.001). The independent prognostic factors included placement of drainage tube (OR=8.743, 95%CI 1.528 to 50.018, P=0.015) and use of vasoactive drugs (OR=12.227, 95%CI 2.817 to 53.074, P=0.001). ConclusionThe MDR-AB infection in lower respiratory tract can significantly prolong the length of ICU stay and increase the mortality. The Apache Ⅱ score >15 and use of carbapenems are the risk factors, and the placement of drainage tube and use of vasoactive drugs can increase the mortality of MDR-AB infection of lower respiratory tract in ICU.
Objective To identify the predictors for readmission in the ICU among cardiac surgery patients. Methods We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016. Results The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%, P<0.001). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=1.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 to1.259, P<0.001), and the drainage on the day of surgery (OR=1.001, 95%CI1.001 to 1.002, P<0.001) were the independent risk factors for readmission to the cardiac surgery ICU. Conclusion The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient healthcare planning and resources allocation.
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.
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.
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.
Objective To explore the effect of “net bottom” management in the control of device-associated infections (DAIs) in elderly patients by setting infection monitoring doctors and nurses in the emergency intensive care unit (EICU). Methods Elderly patients who aged≥60 years old admitted to the EICU of the First People’s Hospital of Lianyungang between April 2018 and March 2021 were selected as the research subjects. A “net bottom” management mode was established and implemented for the purpose of infection prevention and control, taking medical and other departments as the coordination and management subjects, and infection monitoring doctors and nurses as the core. The effectiveness of the management intervention was evaluated by comparing the incidences of DAIs in elderly patients, the compliance rates of medical staff in hand hygiene, and the consumption of hand sanitizer per bed day in EICU among the primary stage (from April 2018 to March 2019), intermediate stage (from April 2019 to March 2020), and later stage (from April 2020 to March 2021). Results During the primary stage, intermediate stage, and later stage, there were 540, 497, and 507 elderly inpatients in EICU monitored, respectively, and the incidences of nosocomial infections were 7.22% (39/540), 5.84% (29/497), and 4.14% (21/507), respectively, showing a decreasing trend (χ2trend=4.557, P=0.033). The incidences of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections decreased from 4.82‰, 2.53‰, and 0.95‰, respectively in the primary stage, to 0.51‰, 1.01‰, and 0.53‰, respectively in the later stage, among which the difference in the incidence of ventilator-associated pneumonia was statistically significant (P<0.05). The hand hygiene compliance rate of EICU medical staff increased from 70.39% to 86.67% (P<0.05), and the consumption of hand sanitizer per bed day increased from 33.70 mL to 67.27 mL. The quarterly hand hygiene compliance rate was positively correlated with the quarterly consumption of hand sanitizer per bed day (rs=0.846, P=0.001), and negatively correlated with the quarterly incidence of nosocomial infections (rs=–0.769, P=0.003). Conclusion The “net bottom” management by setting up infection monitoring doctors and nurses in the EICU and multi-department collaboration can reduce the incidence of DAIs in elderly patients in EICU, which plays a positive role in promoting the hospital infection management and improving the quality of hospital infection management.
ObjectiveTo determine the effects of the management mode participated by doctors, nurses and patients on the safety of medical tubes for restlessness patients in the Neurosurgery Intensive Care Unit (NICU). MethodsA total of 133 restlessness patients treated between May 17 and November 22, 2013 were included in the study as control group, who were admitted to the NICU before application of the management mode participated by doctors, nurses and patients; another 119 restlessness patients treated between May 17 and November 22, 2014 were included in the study as research group, who were admitted to the NICU after application of the management mode participated by doctors, nurses and patients. Then we compared the accidental extubation situation between the two groups. ResultsThe accidental extubation rate of all kinds of medical tubes in the research group was lower than that in the control group, among which the extubation rate of urethral catheter (0.67% vs. 4.32%), gastric tube (2.26% vs. 10.14%), trachea cannula (1.08% vs. 7.84%), and arterial cannulation pipeline (1.12% vs. 6.93%) was significantly different between the two groups (P<0.05). ConclusionThe management mode participated by doctors, nurses and patients can effectively reduce the accidental extubation rate of medical tubes for restlessness patients, prevent the occurrence of adverse events and ensure the treatment and nursing safety in the NICU.