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Objective:To analyze the correlation between capillary filling time (CRT) and lactate clearance rate in patients with septic shock, so as to provide reference for the clinical application of CRT in patients with septic shock.Methods:A prospective study was conducted on 70 patients with septic shock. CRT, mean arterial pressure (map) and sequential organ failure (SOFA) score, Acute Physiology and Chronic Health Evaluation Scoring System (APACHE Ⅱ) score, mechanical ventilation and lactate clearance rate were collected at 3 sites (forehead, knee and nail bed) respectively at 2 time points after admission and 6 hours after admission. The correlation between CRT changes and lactate clearance rate was compared.Results:When lactate clearance rate of more than 10% in 6 hours, the Pearson coefficients of the three sites were 0.823 for nail bed ( P<0.05), 0.232 for forehead and 0.254 for knee ( P>0.05). When lactate clearance rate of less than 10% in 6 hours, the Pearson coefficients of the three sites were 0.299 for nail bed, 0.247 for forehead and 0.254 for knee ( P>0.05). Conclusion:When lactate clearance rate of more than 10% in 6 hours, there is a good correlation between the CRT of nail bed and the lactate clearance rate of patients. The CRT of nail bed can be a practical tool for clinical evaluation of microcirculation.
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Objective@#To establish a practical framework for critical ultrasonography to provide a basis for clinical practice.@*Methods@#With reference to domestic and foreign literature, expert interviews and research groups developed a preliminary draft of the practice framework for critical ultrasonography, and conducted two rounds of consultation using the Delphi method.@*Results@#A practical framework for critical ultrasonography was developed, including 5 primary indicators and 20 secondary indicators. In the two rounds of expert consultation, the expert′s positive coefficient was 100% and the authoritative coefficient was 0.836.@*Conclusions@#Expert opinion has good coordination and high authority, which can provide clinical basis for ICU nurses to carry out ultrasound examination.
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Objective@#We reported nursing care of a patient with postpartum cardiomyopathy treated by extracorporeal membrane oxygenation (ECMO) combined with intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT) and prone position ventilation.@*Methods@#Multidisciplinary cooperation was made to guide the monitor of patients' condition. Refined integrated management measures of multi-equipment were adopted and standardized management process was formulated. Strict requirements were made in treatment and nursing care to prevent hospitalized infection, humanistic care and rehabilitation exercise were conducted to improve patient′s quality of life.@*Results@#After 47 days of nursing care, the patient′s vital signs were stable, the condition was improved and then discharged.@*Conclusions@#Close observation under the guidance of multiple disciplines is an important prerequisite for the treatment. Integrative management of multi-equipment, strict control of hospitalized infection, humanistic care and rehabilitation exercise can effectively improve the prognosis and quality of life of perinatal cardiomyopathy patient.
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Objective:We reported nursing care of a patient with postpartum cardiomyopathy treated by extracorporeal membrane oxygenation (ECMO) combined with intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT) and prone position ventilation.Methods:Multidisciplinary cooperation was made to guide the monitor of patients' condition. Refined integrated management measures of multi-equipment were adopted and standardized management process was formulated. Strict requirements were made in treatment and nursing care to prevent hospitalized infection, humanistic care and rehabilitation exercise were conducted to improve patient′s quality of life.Results:After 47 days of nursing care, the patient′s vital signs were stable, the condition was improved and then discharged.Conclusions:Close observation under the guidance of multiple disciplines is an important prerequisite for the treatment. Integrative management of multi-equipment, strict control of hospitalized infection, humanistic care and rehabilitation exercise can effectively improve the prognosis and quality of life of perinatal cardiomyopathy patient.
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Objective:To establish a practical framework for critical ultrasonography to provide a basis for clinical practice.Methods:With reference to domestic and foreign literature, expert interviews and research groups developed a preliminary draft of the practice framework for critical ultrasonography, and conducted two rounds of consultation using the Delphi method.Results:A practical framework for critical ultrasonography was developed, including 5 primary indicators and 20 secondary indicators. In the two rounds of expert consultation, the expert′s positive coefficient was 100% and the authoritative coefficient was 0.836.Conclusions:Expert opinion has good coordination and high authority, which can provide clinical basis for ICU nurses to carry out ultrasound examination.
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Objective@#To evaluate the feasibility of ICU nurse-performed lung ultrasound in screening the reason of dyspnea in ICU patients, and to explore the effect on nursing decisions.@*Methods@#ICU nurses trained on lung ultrasound with 16 hours performed point-of-care lung ultrasound in patient with acute respiratory failure to assess the condition of the patient′s lungs and screen for pleural effusion, atelectasis/lung consolidation. Etc; Repeated examinations by ICU physicians accredited by the International Critical Ultrasound Alliance to evaluate the accuracy of ICU nurse interpretation.@*Results@#A total of 510 lung ultrasonographic examinations were performed in 51 patients. Compared with physicians, ICU nurses correctly interpreted 472 ultrasound signs, accounting for 92.53%. ICU nurses found that the sensitivity of the pleural effusion was 86.7%, the specificity was 95.2%, and the diagnostic accuracy rate was 90.2%, and Youden index was 81.9%. The ultrasonography revealed a sensitivity of 92.1% for atelectic/pulmonary consolidation and a specificity of 92.3.%, the diagnostic accuracy rate was 92.2% and Youden index was 84.4%.@*Conclusion@#ICU nurses who have undergone standardized training can correctly interpret lung ultrasound signs and have good diagnostic value for screening of pleural effusions and atelectasis/lung consolidation; they provide the basis for optimization of chest physiotherapy programs.
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Objective To explore the nursing effect of modified prone position and traditional prone position in the skin protection of patients with prone position in ICU. Methods A total of 60 ICU patients with prone position treatment were selected in June 2014 to May 2015. According to the digital method the patients were randomly divided into the control group and the experimental group with 30 cases in each.The control group adopted traditional way of prone position with the head and chest pad pushed up. used by patients not pad up way of improvement of prone position. The incidence of skin pressure injury and the incidence of stress in the two groups were compared. Results The incidence of skin pressure injury was 20.0％(6/30) in the experimental group and 66.7％(20/30) in the control group, and the difference was statistically significant (χ2=13.30, P < 0.05). Conclusions Modified prone position has obvious advantages in reducing the incidence of skin pressure ulcer and is suitable for patients with clinical prone position.
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Objective To investigate the current status of application of the Confusion assessment method for the Intensive Care Unit (Cam-ICU),and to explore its influencing factors.Methods A total of 300 patients admitted to were enrolled.The researchers and nurses used Cam-ICU to assess patients' delirium,respectively,and the differences in deliriun assessment were analyzed.Results For delirium assessment,the Kappa value was 0.546 between the researchers and nurses.The consensus rate was 17.6％ for hypoactive delirium,and 77.8％ for hyperactive delirium in 44 delirium patients.Logistic regression analysis showed that APACHE Ⅱ score,RASS score and delirium type were influencing factors of accurate assessment of delirium.Conclusion The consistence of assessment of delirium by ICU nurses is generally good,but the accuracy of assessment of hypoactive delirium is the worst.