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Objective:To develop a prone position management program and evaluate its effectiveness in preventing ventilator-associated pneumonia (VAP) in children with congenital heart disease combined with acute respiratory distress syndrome, in order to provide experience for clinical application.Methods:This was a quasi-experimental study. Convenient sampling method was used to select children with congenital heart defect who underwent mechanical ventilation in the Cardiothoracic Surgical Care Unit of Shanghai Children′s Medical Center, Shanghai Jiao Tong University, School of Medicine from June 2018 to December 2021 as the study subjects. The control group consisted of 80 hospitalized children from June 2018 to December 2019. They were used general nursing interventions to prevent VAP. The 42 hospitalized children from January 2020 to December 2021 were the intervention group, who usd the prone position management program on the basis of the control group. The differences in the incidence of VAP, duration of mechanical ventilation, duration of ICU stay, oxygenation index and the incidence of adverse events between the two groups were compared.Results:The incidence of VAP and mechanical ventilation duration in the intervention group were 4.8% (2/42) and 67.50 (55.00/101.50), which were lower than 35.0% (28/80) and 92.50 (68.00/142.00) of the control group, and the differences were statistically significant ( χ2=11.98, Z=3.40, both P<0.01). And the trend of increasing oxygenation index with the intervention group was better than the control group ( F=8.38, P<0.05). There was no statistical difference in the incidence of adverse events between the two groups (all P>0.05). Conclusions:The application of prone ventilation program with congenital heart disease children complicated with acute respiratory distress syndrome is safe and can significantly improve the oxygenation index, shorten the duration of mechanical ventilation and reduce the incidence of VAP.
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Objective:To develop a scale of caregivers′ knowledge, attitude and practice (KAP) on safety precautions of children′s falling from bed in hospital, and test its reliability and validity.Methods:Based on the theory of KAP, the item pool was constructed by literature review and expert consultation. A convenient sampling method was used to investigate 380 caregivers of children admitted to Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University in May 2021. The reliability and validity of the scale was tested. Critical ratio method and correlation analysis method were used for item analysis of the scale. Validity analysis was conducted by detecting content validity and construct validity; reliability analysis was conducted by detecting internal consistency reliability and split-half reliability.Results:The formal scale finally developed comprised 17 items in 3 dimensions on knowledge, attitude and practice. The Cronbach′s α coefficient and split-half reliability of the overall scale were 0.739 and 0.841. The content validity of the scale was 0.991, and the content validity of each item was 0.890-1.000. Exploratory factor analysis has extracted 3 common factors, and the cumulative variance contribution rate was 60.57%.Conclusion:The scale of caregivers′ KAP on safety precautions of children′s falling from bed in hospital has good reliability and validity, and can be used as a tool to evaluate the knowledge, willingness or behavior of caregivers' participation in preventing falls.
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Objective@#To explore the effect of cluster skin management (SSKIN) on reducing the incidence of stress skin injury in children with congenital heart disease during perioperative period.@*Methods@#Delphi method was used to establish cluster skin management specialty to formulate SSKIN. Skin outcomes of 863 children before SSKIN implementation (control group) and 819 children after SSKIN implementation (experimental group) were analyzed and compared through personnel training, program application and supervision.@*Results@#The incidence of stress skin injury, stage I stress skin injury and occipital pressure injury were 5.1% (44/863), 4.4% (38/863), 2.5% (22/863) in the control group and 2.3% (19/819), 2.2% (18/819), 0.7% (6/819) in the experimental group, respectively. There were significant differences between the two groups (χ2 = 8.999, 6.350, 8.472, P < 0.01 or 0.05). The incidence of stress skin injury in delayed chest closure and continuous positive airway pressure were 27.9%(17/61), 23.4%(18/77) in the control group and 11.5%(6/52), 8.9%(7/79) in the experimental group, respectively. There were significant differences between the two groups(χ2=4.618, 6.105, P<0.05).@*Conclusions@#The SSKIN is effective at prevent congenital heart disease patients with high risk of stress skin injury. It can improve the skin outcomes in children.
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Objective@#To improve the clinical outcomes and critical care quality for pediatric extracorporeal membrane oxygenation (ECMO), the multidisciplinary team including doctors, nurses and respiratory therapist designed a daily checklist for patients with ECMO and evaluated the effect of the checklist.@*Methods@#A daily checklist for ECMO patients was designed based on the expert consensus and multi-centers relevant researches. ECMO patients from January 2015 and May 2017 in the pre-application group, while the other patients from June 2017 to December 2018 in the post-application group were compared in the clinical outcomes.@*Results@#All 78 pediatric patients used the venoarterial extracorporeal membrane oxygenation (VA-ECMO) including 27 patients in the pre-application group and the other 51 patients in the post-application group. The mortality rate was 49.02%(25/51) in the post-application group and 81.48%(22/27) in the pre-application group, the differences were significant (χ2=7.768, P=0.005). The rates of central line-associated bloodstream infection, pressure injury and the body weight change was 2/5, 4/5, -2.70(-3.50--2.05) in the pre-application group and 3.85%(1/26), 26.92%(7/26), -0.09(-1.00-0.00) in the post-application group,the differences were significant (χ2=4.505, 5.161, Z=3.252, P<0.05 or 0.01).@*Conclusions@#It is helpful for clinical staff to follow up the progress of the multiple organs when using the daily checklist, to facilitate team communication for, and to improve nursing management through setting the daily targets for individual VA-ECMO patients.
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Objective To explore the effect of cluster skin management (SSKIN) on reducing the incidence of stress skin injury in children with congenital heart disease during perioperative period. Methods Delphi method was used to establish cluster skin management specialty to formulate SSKIN. Skin outcomes of 863 children before SSKIN implementation (control group) and 819 children after SSKIN implementation (experimental group) were analyzed and compared through personnel training, program application and supervision. ResuLts The incidence of stress skin injury, stage I stress skin injury and occipital pressure injury were 5.1% (44/863), 4.4% (38/863), 2.5% (22/863) in the control group and 2.3% (19/819), 2.2% (18/819), 0.7% (6/819) in the experimental group, respectively. There were significant differences between the two groups (χ2=8.999, 6.350, 8.472, P<0.01 or 0.05). The incidence of stress skin injury in delayed chest closure and continuous positive airway pressure were 27.9%(17/61), 23.4%(18/77) in the control group and 11.5%(6/52), 8.9% (7/79) in the experimental group, respectively. There were significant differences between the two groups(χ2=4.618, 6.105, P＜0.05). ConcLusions The SSKIN is effective at prevent congenital heart disease patients with high risk of stress skin injury. It can improve the skin outcomes in children.
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Objective To study the relationship between mean platelet volume(MPV)and severity of acute pancreatitis.Methods MPV was examined by hematology analyzer.Relationship between MPV and the severity of acute pancreatitis and the effect of sandostatin on MPV in acute pancreatitis were analyzed.Results The MPV of severe acute pancrcatitis was significantly higher than that of controls(P＜0.05),whereas the MPV of mild acute pancreafitis was not(P＞0.05).The APACHE Ⅱ Score and MPV of GH group was significantly lower than that of SS group and control(P＜0.05).Conclusion The MPV could reflect the severity of acute pancreatitis,evaluate the prognosis of acute pancreatitis.