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Objective To study the risk factors of mortality in severe sepsis and septic shock patients. Methods 142 patients with severe sepsis and septic shock in ICU were observed and divided into alive group (98 patients)and dead group (44 patients)by using hospital mortality.The risk factors of mortality in severe sepsis and septic shock patients were assessed by binary logistic regression.Results Independent mortality risk factors were inotropic agents (OR =4.329,95%CI:1.045 -17.937,P =0.043),blood glucose >10 mmol/L (OR =3.771,95%CI:1.214 -11.710,P =0.022)and APACHE Ⅱ score (OR =3.098,95%CI:2.012 -4.760,P =0.000),while PaO2 /FiO2 after early goal -directed therapy (EGDT)was protective factor (OR =0.682,95%CI:0.500 -0.930, P =0.016).Conclusion Severe sepsis and septic shock patients with inotropic agents,blood glucose >10mmol/L, high APACHE Ⅱ score and decreased PaO2 /FiO2 after EGDT indicate poorly prognosis.
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Objective To explore the job burnout and its related factors among nurses.Methods 486 clinical nurses from a three grade second level general hospital were investigated by Moreno-Jimenez nursing burnout scale (NBS) and using SPSS17.0 software and ANOVA method to analyse the data.Results NBS results showed the score of job burnout in 486 objects was (164.92 ± 25.60).Significant differences of job burnout levels were showed among ages,marital status,professional titles,working periods,working relationship,work load,income,and housework periods (P ＜ 0.05).Conclusion Job burnout is a general phenomenon in these investigated nurses and its level is above average.Administrators should pay more attention to these related factors which can easily cause job burnout and take positive feasibility assistant strategies.
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Objective To determine the differences of risk factors for non-albicans candida and candida albicans infections among patients in the intensive care unit (ICU). Methods One hundred and three patients with ICU-acquired candida infections were retrospectively analyzed from February 2003 to April 2009. These patients were divided into non-albicans candida species group and candida albicans group.Multiple risk factors were analyzed between two groups. Results Of these patients, 46 patients (44.7%)had infections of non-albicans candida species and 57 patients (55.3%) had candida albicans infection.Among non-albicans candida species, candida glabrata, candida parapsilosis, candida tropicalis, candida krusei and others candida accounted for 19 patients (18.4%), 13 patients (12.6%), 10 patients (9.7%), 2 patients (1.9%) and 2 patients ( 1.9% ), respectively. Multivariate Logistic regression models revealed that central venous catheter (CVC) insertion time > 2 d (OR = 32.477,95% CI:4.905-215.035,P=0.000),total parenteral nutrition (OR =3.119,95% CI:1.214-8.015,P =0.018) and fluconazole prophylaxis therapy (OR = 5.084,95%CI: 1.319-19.596,P = 0.018) were highly correlated with non-albicans candida species infections. Conclusion CVC insertion time > 2 d, total parenteral nutrition and fluconazole prophylaxis therapy are independent risk factors of non-albicans candida species infections and can be used in empirical antifungal therapy.
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Objective To assess the role of stroke volume variation (SVV) in predicting the volume responsiveness of mechanically ventilated patients with severe sepsis and septic shock. Method A total of 28 mechanically ventilated patients with severe sepsis and septic shock were admitted from January 2009 to March 2010. Every patient was treated with volume loading test. Cardiac index (CI), stroke volume index (SVI), systemic vascular resistance (SVR) and SVV were measured non-invasively by Ultrasonic Cardiac Output Monitor (USCOM) device.Patients with an increase in CI ＞ 12% and ＜ 12% after volume loading test were classified as responders and nonresponders, respectively. The comparisons between these two sorts of patients were assessed by using two sample Student' s t -test, and comparisons between changes before and after volume loading test were assessed by using a paired Student's t -test. The roles of SVV, central venous pressure (CVP) and the changes of CVP (△CVP) after fluid administration in predicting volume responsiveness were evaluated by receiver operating characteristic (ROC) curves. Results Before volume loading test, the SVV was higher in responders in comparison with non-responders [(18.2 ± 4.7)% vs. (12.7 ± 4.2)%, P = 0.003] and the CVP was not significantly different between two groups [(10.2±4.0) cmH2O vs. (10.8±4.8) cmH2O, P ＞0.05]. After volume loading test,the CVP was lower in responders [(2.9 ± 3.1 ) cmH2O vs. (5.3 ± 2.7) cmH2O, P = 0.003]. The areas under the ROC curves (AUC) were 0.836 (95% CI:0.680 ～ 0.992,P = 0.003),0.549 (95% CI:0.329 ～ 0.768,P = 0.662)and 0.762 (95% CI:0.570 ～ 0.953,P = 0.019)for SVV, CVP and △CVP, respectively. The 15.5% of SVV value had the 84.6% of sensitivity and 80% of specificity for prediction of volume responsiveness. Conclusions SVV can serve as a valid indicator of predicting volume responsiveness in mechanically ventilated patients with severe sepsis and septic shock and it is more reliable than conventional indicators such as CVP and/△CVP.
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Objective To evaluate, the safety of keeping watching central venous catheter and whether it decreased unnecessary catheter removal in unexplained fever patients. Methods Eighty-two unexplained fever patients with suspected catheter-related infection whose clinical conditions were relatively stable were retrospectively analyzed and divided into keep watching group (31 patients) and immediate removal group (51 patients). ICU mortality, sequential organ failure assessment (SOFA) score, temperature, the rate of catheter-related infection, and the rate of central venous catheter removal were compared. Results There was no significant difference in ICU mortality, SOFA score, temperature and the rate of catheter-related infection between two groups (P > 0.05). Eleven of 31 (35.5%) were removed central venous catheter at last, versus all patients (100.0%) in the immediate removal group (P < 0.05). Conclusion Keep watching central venous catheter will decrease a substantial unnecessary catheter removal without increased morbidity in unexplained fever patients with suspected catheter-related infection if their clinical conditions are relatively stable.
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Objective To study the diagnostic and prognostic value of procalcitonin (PCT)in patients with sepsis in early stage. Methods In the perspective study, 168 patients enrolled were classified into three groups,ncluding 31 cases in control group,37 cases in SIRS group and 100 cases in general sepsis group. The latter were com-posed of moderate sepsis sub-group with 36 cases, severe sepsis sub-group with 40 cases and septic shock sub-group with 24 cases. Indexes of inflammation, SOFA and concentration of PCT in all patients were determined and their cor-relation with sepsis prognosis was analyzed. Results The level of PCT and CRP is 3.1 ± 2.3 μg/L and 34.7 ± 28.0 mg/L in SIRS group,is 10.8 ± 8.1 μg/L and 106.8 ± 69.3 mg/L in general sepsis group respectively. Which are higher than the level of PCT (0.3 ± 0.2 μg/L )and CRP (4.1 ± 2.9 mg/L)in control group (P < 0.01 ). Higher con-centration of PCT and CRP were found in general sepsis groups than these in SIRS group. The difference is prominem.Moreover,an increasing trend of PCT with the more serious of illness was found in subgroup analysis ,but not in CRP.According to the receiver operating characteristic curves( ROC curves) ,The best cutoff values in the diagnosis of sep-sis were >4.395 μg/L for PCT,>51.8 mg/L for CRP and >4.0 for SOFA score. Condusion PCT and CRP are useful diagnostic parameters with high specificity in early sepsis. PCT combining with SOFA score can be used as ide-al quantitative index to estimate the severity of sepsis and prognosis in patients with sepsis.