Prone positioning ventilation for treatment of acute lung injury and acute respiratory distress syndrome / 中华创伤杂志(英文版)

Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care workers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxygenation without use of expensive, invasive and experimental procedures. Prone positioning is a safe and effective way to improve ventilation when conventional strategies fail to initiate a patient response. Because a specific cure for ARDS is not available, the goal is to support the patients with therapies that cause the least amount of injury while the lungs have an opportunity to heal. Based on current data, a trial of prone positioning ventilation should be offered to the patients who have ALI/ARDS in the early course of the disease. Published studies exhibit substantial heterogeneity in clinical results, suggesting that an adequately sized study optimizing the duration of proning ventilation strategy is warranted to enable definitive conclusions to be drawn.

Effect of sleep quality on day cycle fatigue in ward nurses / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To explore the effect of sleep quality on day cycle work fatigue in ward nurses.</p><p><b>METHODS</b>Through a cluster sampling of three hospitals, 479 clinical frontline nurses were investigated in Hangzhou, Zhejiang, China. Using Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality; Using self-reported work-related fatigue symptom scale to evaluate day cycle fatigue status; common information was also collected.</p><p><b>RESULTS</b>The sleep quality of ward nurses is generally poor, with total PSQI score 7.31 +/- 3.45. 41.75% ward nurses have total PSQI score over 7, the total PSQI score showed a negative linear correlation with educational background (r = -0.11, P = 0.01), educational background also represented a negative correlation with sleep quality, sleep latency and sleep duration; there are no correlation between sleep and marriage, work age, professional title and duty. Work-related fatigue was closely correlated with sleep quality: Total PSQI score showed a positive correlation with four daytime points fatigue in the next day (r = 0.42, r = 0.34, r = 0.25, r = 0.33, P < 0.01). Total PSQI score is also related to five fatigue factors in four daytime points. There are significant correlation between seven factors of sleep and fatigue levels of four time points. Multiple regression analysis showed that Sleep quality, day function; sleep disturbance and drug use pay important part in work fatigue. There is no correlation between sleep quality and delayed off-work (r = 0.06, P = 0.17).</p><p><b>CONCLUSION</b>Managers should think highly of sleep quality of ward nurses, acknowledge its degree of work fatigue and apply evidence based methods arrange work responsibility and follow sheet, then rationalize human resources management, emphasize sleep hygiene education, improve sleep quality and reduce work fatigue.</p>