Application of outcome-based education combined with team-based learning in practice teaching of pediatric emergency and critical care nursing / 中华医学教育探索杂志

Objective:To investigate the application value of outcome-based education (OBE) combined with team-based learning (TBL) in the practice teaching of pediatric emergency and critical care nursing.Methods:A total of 84 nursing students who studied in the pediatric intensive care unit (PICU) of The First Affiliated Hospital of Air Force Medical University were selected and divided into control group and observation group. The 41 nursing students in the control group received traditional teaching, and the 43 nursing students in the observation group received OBE+TBL teaching. The two groups were assessed in terms of theoretical knowledge, practical operation ability, clinical thinking ability, and self-learning ability after teaching, and the degrees of satisfaction with teaching and participation in teaching were compared between the two groups. SPSS 22.0 was used for the t-test and the chi-square test. Results:After teaching, the observation group had significantly better theoretical knowledge, practical operation ability, and self-learning ability than the control group ( P<0.05). Compared with the control group, the observation group had significantly higher scores of learning engagement (recognition, behavior, emotion) ( P<0.05) and satisfaction with classroom effect, knowledge mastery, and learning interest ( P<0.05). Conclusion:The application of OBE+TBL teaching in PICU nursing students can effectively improve their self-learning ability and participation and help them to understand PICU nursing priorities and improve their practical operation ability.

Relationship between serum thyroid hormone level and prognosis in critically ill children with euthyroid sick syndrome / 中国小儿急救医学

Objective:To investigate the association between serum thyroid level and prognosis of critically ill children with euthyroid sick syndrome(ESS).Methods:The clinical data and serum thyroid hormone levels of 176 children with ESS who were admitted to the Department of Pediatric Intensive Care Medicine at West China Second Hospital of Sichuan University from January 2015 to April 2021 were retrospectively collected.According to the prognosis, the children were divided into improved group and invalid group, as well as basic disease group and non basic disease group, and the differences of thyroid hormone between two groups were compared.The pediatric risk of mortality Ⅲ(PRISMⅢ) scores within 24 hours of admission were assessed, and the correlation between thyroid hormone level and PRISMⅢ score was analyzed.Results:Among 176 critically ill children with ESS, the most common diseases were sepsis(31.8%), severe pneumonia (23.8%) and heart failure(10.7%), respectively.The levels of free T3(FT3), T3, free T4(FT4) and T4 in invalid group were significantly lower than those in improved group ( P<0.05), but there was no statistical difference in thyroid-stimulating hormone(TSH) level between two groups( P>0.05). The levels of FT3, T3, FT4 and T4 were negatively correlated with PRISMⅢ score( r=-0.419, -0.459, -0.341, -0.383, respectively, P<0.05), and there was no correlation between TSH level and PRISMⅢ score ( P>0.05). The common underlying diseases of severe children with ESS were malnutrition(31/98), heart disease(30/98), hematologic neoplasms(15/98), and bronchopulmonary dysplasia(10/98). The median age of children in basic disease group was younger than that in non-basic disease group(0.7 years old vs. 2.0 years old, P<0.05); The proportion of children with underlying diseases in invalid group was 24.5%, which was significantly higher than that of children without underlying diseases (6.4%), and the difference was statistically significant ( P<0.05); There were no significant differences in the levels of FT3, T3, FT4, T4 and TSH between two groups ( P>0.05). Conclusion:In critically ill children, a variety of diseases can lead to ESS, and sepsis is the most common disease.Young children with underlying diseases should be more alert to ESS.The more severe the disease, the greater the decline of FT3, T3, FT4 and T4 levels.When low T3, T4 and TSH occur simultaneously, the prognosis of the children may be worse.Thyroid hormone level could be used as an indicator to evaluate the prognosis of critically ill children, which is needed further studies to explore.

Características del síndrome post cuidado intensivo: revisión de alcance / Characteristic of post ICU syndrome: a review of scope / Características da síndrome pós-cuidados intensivos: revisão do escopo

Objetivo: identificar la evidencia disponible de las características del síndrome post unidad de cuidado intensivo en el paciente que egresa de la unidad de cuidado intensivo. Método: revisión de alcance con la metodología del Joanna Briggs Institut, en cinco bases de datos con la estrategia de búsqueda ([PostIntensive AND Care AND Syndrome] [Nursing AND Care AND PICS]). Se incluyeron estudios primarios publicados entre los años 2010 y 2020, disponibles en texto completo. Resultados: después del análisis de los 48 estudios primarios se extrajeron seis categorías temáticas así: aspecto cognitivo en el síndrome post UCI, osteomusculares, psicoemocionales, estrategias de prevención con modelos de sobrevivientes de UCI, síndrome post unidad cuidado intensivo en la familia y herramientas de evaluación. Conclusiones: mejorar la calidad de atención de los pacientes que presentan este síndrome, prevenir la aparición y aumentar la calidad de vida prestada a los sobrevivientes de UCI y sus familias. La evidencia reporta que entre los cuidadores se pueden desencadenar distintos trastornos que disminuyen su calidad de vida. La enfermería juega un papel crucial en la prevención de la aparición del síndrome mediante estrategias en la UCI e interdisciplinares; los planes de egreso y seguimiento a los pacientes pueden lograr que estos se rehabiliten más rápido y eviten discapacidades o secuelas a largo plazo.

Objective: to identify the available evidence regarding the post ICU syndrome in patients leaving the intensive care unit. Methods: it is a review of scope according to the Joanna Briggs Institut methodology, in 5 data bases with the search strategy ([PostIntensive AND Care AND Syndrome] [Nursing AND Care AND PICS]). Primary studies published between 2010 and 2020 with full text available were included. Results: having analyzed 48 primary studies, 6 thematic categories were created: cognitive aspect in post ICU syndrome, musculoskeletal, psycho-emotional, prevention strategies with models of ICU survivors, post ICU syndrome in the family and evaluation tools. Conclusions: To improve the health care in patient in post ICU syndrome, to prevent the syndrome emergence and increase the quality of life provided to the ICU survivors and their families. Evidence shows that caregivers can develop different disorders that impact their quality of life. Nursing plays a crucial role in preventing the syndrome advent by using interdisciplinary and ICU strategies. This charge and follow-up plans can make these patients to achieve a faster rehabilitation and avoid impairment or sequels in the future

Objetivo: identifcar a evidência disponível das características da síndrome pós-unidade de terapia intensiva em pacientes egressos da unidade de terapia intensiva. Método: revisão do escopo com a metodologia do Joanna Briggs Institut, em cinco bases de dados com a estratégia de busca ([PostIntensive AND Care AND Syndrome] [Nursing AND Care AND PICS]). Incluíram-se estudos primários publicados entre 2010 e 2020, disponíveis em texto completo. Resultados: após análise dos 48 estudos primários foram extraídas seis categorias temáticas: aspecto cognitivo na síndrome pós-UTI, osteomuscular, psicoemocional, estratégias de prevenção com modelos de sobrevivência na UTI, síndrome pós-unidade de Terapia intensiva na família e ferramentas de avaliação. Conclusões: melhorar a qualidade da atenção dos pacientes que apresentam a síndrome, prevenir a aparição e aumentar a qualidade de vida prestada aos sobreviventes da UTI e suas famílias. Evidências relatam que diversos transtornos podem se desencadear entre os cuidadores que reduzem sua qualidade de vida. A enfermagem tem um papel crucial na prevenção da aparição da síndrome mediante estratégias na UTI e interdisciplinares; planos de alta e acompanhamento aos pacientes podem conseguir uma reabilitação mais rápida e evitar incapacidades ou sequelas no longo praz

El paciente pediátrico crítico con COVID-19. Puesta al día / Critically-ill pediatric patients with COVID-19. An update

La pandemia por COVID-19 ha acaparado la atención mundial. Los distintos países se esfuerzan en optimizar recursos y brindar tratamientos efectivos en la medida que estos son avalados por la evidencia, con un ritmo de producción acorde a la urgencia. En el ámbito pediátrico, el COVID-19 acarrea una baja tasa de gravedad, en comparación con la población adulta. Un 6 % de los casos presentan una evolución grave, que se observa en los pacientes menores de 1 año de edad y/o con patologías subyacentes.Los enfoques terapéuticos en los pacientes pediátricos con COVID-19 no están claros. La escasa casuística en pediatría dificulta realizar recomendaciones en el paciente crítico que estén sustentadas en la evidencia. Esta revisión tiene como objetivo resumir las distintas publicaciones existentes sobre el curso de esta enfermedad y su tratamiento en los pacientes pediátricos críticamente enfermos

The COVID-19 pandemic has grabbed worldwide attention. The different national governments are making an effort to optimize resources and provide effective treatments inasmuch as they are supported by the evidence, at a rate of production in line with the pressing needs. In the field of pediatrics, COVID-19 has a low severity rate compared to the adult population. Approximately 6 % of cases present with a severe course, accounting for patients younger than 1 year and/or with underlying conditions.The therapeutic approach to pediatric patients with COVID-19 is unclear. The small number of pediatric cases hinders the possibility of making evidence-based recommendations for critically-ill patients. The objective of this review is to summarize the different current publications about the clinical course of COVID-19 and its management in critically-ill pediatric patien

Prognostic model of small sample critical diseases based on transfer learning / 生物医学工程学杂志

Aiming at the problem that the small samples of critical disease in clinic may lead to prognostic models with poor performance of overfitting, large prediction error and instability, the long short-term memory transferring algorithm (transLSTM) was proposed. Based on the idea of transfer learning, the algorithm leverages the correlation between diseases to transfer information of different disease prognostic models, constructs the effictive model of target disease of small samples with the aid of large data of related diseases, hence improves the prediction performance and reduces the requirement for target training sample quantity. The transLSTM algorithm firstly uses the related disease samples to pretrain partial model parameters, and then further adjusts the whole network with the target training samples. The testing results on MIMIC-Ⅲ database showed that compared with traditional LSTM classification algorithm, the transLSTM algorithm had 0.02-0.07 higher AUROC and 0.05-0.14 larger AUPRC, while its number of training iterations was only 39%-64% of the traditional algorithm. The results of application on sepsis revealed that the transLSTM model of only 100 training samples had comparable mortality prediction performance to the traditional model of 250 training samples. In small sample situations, the transLSTM algorithm has significant advantages with higher prediciton accuracy and faster training speed. It realizes the application of transfer learning in the prognostic model of critical disease with small samples.

Clinical features of severe or critical ill patients with COVID-19 / 南方医科大学学报

OBJECTIVE@#To analyze the clinical features of severe or critical ill adult patients with coronavirus disease (COVID-19).@*METHODS@#The clinical data of 75 patients with severe or critical COVID-19 in Honghu People's Hospital from January to March in 2020 were collected.@*RESULTS@#Of the 75 patients with COVID-19 pneumonia, 41 were male (54.67%) and 34 were female (45.33%) with a mean age of 67.53 ±12.37 years; 43 patients had severe and 32 had critical COVID-19, and 49.3% of the patients had underlying diseases. The main clinical manifestations included fever (78.67%) and coughing (70.67%). Compared with the severe patients, the critically ill patients had higher proportions of patients over 60 years old with elevated white blood cell count, increased prothrombin time, and higher levels of hsCRP, PCT, D-dimer, ALT, LDH, cTnI and NT-proBNP. Univariate logistic regression analysis showed that an age over 60 years, leukocytosis, hs-CRP elevation, prolonged prothrombin time, and increased levels of D-dimer, NT-proBNP and cTnI were associated with severe COVID-19. Multivariate logistic regression showed that an age over 60 years (OR=8.165, 95% : 1.483-45.576, =0.017), prolonged prothrombin time (OR=7.516, 95% : 2.568-21.998, =0.006) and elevated NT-proBNP (OR=6.194, 95% : 1.305-29.404, =0.022) were independent risk factors for critical type of COVID-19.@*CONCLUSIONS@#An age over 60 years, a prolonged prothrombin time and elevated NT-proBNP level are important clinical features of critically ill patients with COVID-19, and can be deemed as early warning signals for critical conditions of the disease.

Clinical rescue of 690 neonates with extremely low birth weight and very low birth weight in the latest 10 years: Experience from a single center / 第二军医大学学报

Objective: To explore the clinical rescue, clinical outcomes and complications in neonates with extremely low birth weight (ELBW, 0.05). In 2013-2017, there was a significant increase in the occurrence of neonatal respiratory distress syndrome (NRDS) (70.1% [314/448] vs 26.9% [65/242], P<0.01), bronchopulmonary dysplasia (BPD) (19.4% [87/448] vs 9.5% [23/242], P<0.01), necrotizing enterocolitis (NEC) (16.3% [73/448] vs 6.2% [15/242], P<0.01) and infection (50.4% [226/448] vs 29.8% [72/242], P<0.01), while asphyxia (36.6% [164/448] vs 41.7% [101/242], P<0.01), retinopathy of prematurity (ROP) (1.3% [6/448] vs 5.0% [12/242], P<0.01) and hypoglycemia (11.2% [50/448] vs 17.8% [43/242], P<0.05) were decreased as compared with those in 2008-2012. Conclusion: The overall survival rate is still low in neonates with ELBW and VLBW. Asphyxia and infection are still poorly controlled. The cooperation between institutions of obstetrics and neonatalogy is needed to improve the outcome of neonates with ELBW and VLBW.

Influence of serum creatinine at different time-points on prognosis of critically ill patients with acute kidney injury / 中华急诊医学杂志

Objective@#To investigate the influence of serum creatinine (sCr) at different time-points on prognosis of critically ill patients with acute kidney injury (AKI).@*Methods@#This study was retrospectively analyzed the clinical data of critical patients with AKI who admitted to the mixed ICU of Xiaolan Hospital of Southern Medical University during March 2015 and January 2016. According to the clinical prognosis, the patients were divided into the renal replacement therapy (RRT) group and non-renal replacement therapy (non-RRT) group, 28-day renal loss group and renal recover group, hospital death group and survival group. Serum Cr at different time-points and clinical data were collected. The receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to evaluate the capability of sCr at different time-points in predicting clinical prognosis.@*Results@#During the study, 85 AKI patients were enrolled. The in-hospital mortality was 20%, RRT rate was 15.3%, and renal lose at 28 days after ICU admission was 31.8%. The levels of sCr out of ICU (o-sCr) and the peak of sCr were significantly higher in the RRT group than the non-RRT group (P<0.01). The o-sCr and p-sCr predicted RRT during the hospital stay with a higher AUC value (0.806 vs 0.833) than b-sCr and a-sCr. The levels of b-sCr, a-sCr, o-sCr, and p-sCr were all significantly higher in the28-day renal loss group than the kidney recover group (P<0.01). The levels of o-sCr and p-sCr were significantly higher in the hospital death group than the survival group (P<0.05). The o-sCr predicted renal lose at 28 days and hospital death with the highest AUC value of 0.850 and 0.797, respectively.@*Conclusions@#It cannot be ignored to monitor dynamically the level of sCr at different time-points in critical patients with AKI, which can predict the clinical prognosis such as hospital death, RRT and renal lose at 28 days after ICU admission.

Influence of serum creatinine at different time-points on prognosis of critically ill patients with acute kidney injury / 中华急诊医学杂志

Objective To investigate the influence of serum creatinine (sCr) at different time-points on prognosis of critically ill patients with acute kidney injury (AKI).Methods This study was retrospectively analyzed the clinical data of critical patients with AKI who admitted to the mixed ICU of Xiaolan Hospital of Southern Medical University during March 2015 and January 2016. According to the clinical prognosis, the patients were divided into the renal replacement therapy (RRT) group and non-renal replacement therapy (non-RRT) group, 28-day renal loss group and renal recover group, hospital death group and survival group. Serum Cr at different time-points and clinical data were collected. The receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to evaluate the capability of sCr at different time-points in predicting clinical prognosis.Results During the study, 85 AKI patients were enrolled. The in-hospital mortality was 20％, RRT rate was 15.3％, and renal lose at 28 days after ICU admission was 31.8％. The levels of sCr out of ICU (o-sCr) and the peak of sCr were significantly higher in the RRT group than the non-RRT group (P<0.01). The o-sCr and p-sCr predicted RRT during the hospital stay with a higher AUC value (0.806vs 0.833) than b-sCr and a-sCr. The levels of b-sCr, a-sCr, o-sCr, and p-sCr were all significantly higher in the28-day renal loss group than the kidney recover group (P<0.01). The levels of o-sCr and p-sCr were significantly higher in the hospital death group than the survival group (P<0.05). The o-sCr predicted renal lose at 28 days and hospital death with the highest AUC value of 0.850 and 0.797, respectively.Conclusions It cannot be ignored to monitor dynamically the level of sCr at different time-points in critical patients with AKI, which can predict the clinical prognosis such as hospital death, RRT and renal lose at 28 days after ICU admission.

Observation on safety and effects of analgesic and sedative treatment in severely burned patients during shock stage / 中华烧伤杂志

Objective@#To observe the safety and effects of application of analgesic and sedative drugs in severely burned patients during shock stage.@*Methods@#One hundred and eighty patients with severe burns, conforming to the study criteria, were admitted to our unit from August 2014 to August 2016. Patients were divided into analgesia and sedation group and control group according to whether receiving analgesic and sedative treatment or not, with 90 cases in each group. Patients in control group received conventional treatment, while those in analgesia and sedation group received analgesic and sedative treatment for 24 hours besides conventional treatment. Before and at drug administration hour 2, 8, 16, and 24, pain degree of patients in two groups was scored by visual analogue scale (VAS). At drug administration hour 2, 8, 16, and 24, sedation degree of patients in two groups was scored by richmond agitation sedation scale, and the success rate of sedation was calculated. Mental state of patients within 24 hours of drug administration was observed, while pulse oxygen saturation (SpO2), respiratory rate, heart rate, and blood pressure were observed and dynamically evaluated every 2 hours. The accidental extubation, tachycardia, hypertension, hypoxia, bradycardia, hypotension, urinary retention, and respiratory depression of patients within 24 hours of drug administration were monitored and recorded. Data were processed with analysis of variance for repeated measurement, one-way analysis of variance, t test, chi-square test, Wilcoxon rank sum test, and Fisher′s exact probability test.@*Results@#(1) The VAS scores of patients in two groups were close before drug administration (t=0.675, P>0.05). The VAS scores of patients in analgesia and sedation group at drug administration hour 2, 8, 16, and 24 were (3.8±0.4), (3.9±0.6), (3.9±0.5), and (3.9±0.9) points, respectively, significantly lower than (6.0±0.9), (6.0±1.2), (6.2±0.6), and (6.3±0.4) points in control group (t=0.785, 0.730, 0.805, 0.895, P<0.05). The success rate of sedation of patients in analgesia and sedation group at drug administration hour 2, 8, 16, and 24 were 91.1% (82/90), 86.7% (78/90), 93.3% (84/90), and 90.0% (81/90), respectively, significantly higher than 7.8% (7/90), 6.7% (6/90), 14.4% (13/90), and 5.6% (5/90) in control group (Z=8.035, 7.946, 8.129, 8.014, P<0.05). (2) The respiratory rate of patients in analgesia and sedation group at drug administration hour 8, 16, and 24 were (15.78±0.69), (16.08±0.59), and (16.21±0.20) times per minute, and the heart rate were (87±9), (83±7), and (76±9) times per minute, respectively, significantly lower than (16.80±0.81), (17.09±0.50), and (17.02±0.61) times per minute and (89±8), (86±7), and (85±6) times per minute in control group (t=7.655, 7.022, 6.536, -6.931, -7.053, -10.196, P<0.01). There were no statistically significant difference in SpO2, systolic blood pressure, and diastolic blood pressure before and at drug administration hour 2, 8, 16, and 24 between the two groups (t=3.417, -2.894, -6.501, -3.719, -4.573, 2.336, 3.315, 0.942, -1.583, 1.907, 1.147, -0.968, 0.931, -1.682, 1.076, P>0.05). (3) The rates of respiratory depression, hypoxia, bradycardia, urinary retention, and hypotension of patients in the two groups were close (χ2=0.310, P>0.05). The rates of hypertension, accidental extubation, and tachycardia of patients in analgesia and sedation group were significantly lower than those in control group (χ2=16.364, 5.143, 73.309, P<0.05 or P<0.01).@*Conclusions@#Proper application of analgesic and sedative drugs in severely burned patients during shock stage has good clinical effect with low incidence rates of complications.

Status analysis of the emergency ability of the pediatrics in township hospitals / 中国小儿急救医学

Objective@#To understand the present situation of the emergency ability of the pediatrics in township hospital of Hunan province, and to provide the basis for improving the treatment of critical diseases and strengthening the medical quality in basic hospital.@*Methods@#Status survey, expert consultation, on-spot examination, and questionnaire were conducted.One representative of the 1 217 township hospitals participating in the appropriate health technologies for pediatric emergency was sent to a face-to-face survey by investigators.@*Results@#In 1 217 township hospitals, only 965 pediatricians had been certified.Among them, 58 township hospitals did not purchase the first aid equipment in the scope of the survey, and 211 township hospitals were not equipped with first aid drug.Less than 30% of township hospitals had tracheotomy kits, cardiac defibrillator and first aid equipment such as neonatal incubator, newborn radiation table and infusion pump.Among the trained 1 095 general practitioners, only 305(27.85%) understood the basic first-aid knowledge of this training in pediatrics; 258(258/1 217, 21.20%) township hospitals could not carry out 7 pediatric emergency projects of this survey.The proportion of the capable of carrying out rescue treatment including acute respiratory failure (191/1 217, 15.69%), heart failure (201/1 217, 16.52%) and shock(227/1 217, 18.65%) in township hospitals were less than 30%.@*Conclusion@#The primary hospital is the basis for the treatment of critical diseases in pediatrics, but the level of diagnosis and treatment and basic equipment need to be further strengthened.The urgent task is to strengthen the training of medical and nursing staff in the treatment of critical diseases in pediatrics.

Establishing intraosseous access and central intravenous line placement in critically ill patients: a randomized controlled study / 中华急诊医学杂志

Objective To compare the time consumed for the procedure done,satisfaction and safety of the establishment of intraosseous (IO) access and central intravenous line placement (CVL) in critically ill patients using a randomized controlled trial.Methods The patients were randomly divided into the IO access group versus CVL group according to the inclusion criteria.The IO access and CVL were established,respectively for medicine or fluid administration.The success rates at the first attempt,time required for procedure completed,satisfaction and complications were recorded.Results During the study period,24 patients were enrolled,and divided equally and randomly into IO group (n=12) and CVL group (n=12).There were no significant differences in age,gender,BMI between the two groups.The patients with shock and cardiac arrest accounted for 83.3 ％ in IO group and 58.3 ％ in CVL group,respectively.The success rates at the first attempt was 91.7 ％ in IO access group versus 66.7 ％ in CVL group (P=0.158).the time required for procedure done was significantly shorter in IO access group (74.9 ±43.7)s compared with CVL group (944.0 s±491.5 s) (P＜0.01).The satisfaction of operators at the instruments used was 8.0±1.1 for IO access group versus 7.2±0.8 for CVL group (P==0.053).The overall satisfaction of the operators at the entire course of procedure was 3.7 + 0.7 in IO access group versus 3.9±0.3 in CVL group (P=0.377).Complications were not observed during the study period in the two groups.Conclusions The success rate at the first attempt was significantly higher in IO access group compared with CVL grouThe mean time consumed for procedure completed in IO group was much shorter than that in CVL group,and the operation was simple and practicable.During the emergency care of critical patients,if the peripheral intravenous line placement was difficult to establish,and IO access could be a choice of alternative used as a bridging procedure to rapidly establish the vascular access and win the rescue opportunity.

Effect of extracorporeal membrane oxygenation on critical patients with non-pulmonary primary disease in the emergency department:a meta-analysis / 中华急诊医学杂志

Objective To investigate the effect of extracorporeal membrane oxygenation (ECMO) on critical patients with non-pulmonary primary disease in the emergency department. Methods The literature of English and Chinese clinical studies on the ECMO treating critical patients with non-pulmonary primary disease published before August 2017 were electronically searched on PubMed, Embase and other databases. The obtained articles were selected, their qualities were strictly evaluated, and the in-hospital survival rate, 3-month, 6-month and 1-year survival rate, as well as the average intensive care unit (ICU) and length of hospital stay were extracted. This meta-analysis were performed using RevMan software (Version 5.0, Cochrane collaboration). Results A total of 11 articles (n=3043) were enrolled including 616 cases of ECMO treatment group and 2427 cases of control group. Fitting results showed that compared with the traditional treatment, application of ECMO can improve the in-hospital survival rate[52.1％(321/616) vs. 32.1％ (780/2427); OR=2.02; 95％CI:1.11-3.67, P=0.02] and the survival rate more than 90 days[42.1％ (61/145) vs. 17.1％ (38/222); OR=3.98; 95％CI:2.30-6.89, P<0.01];and prolong the average length of hospital stay (MD=-5.35, 95％CI:-8.10--2.60, P<0.01) and ICU time(MD=-8.99, 95％CI:-8.20--1.80, P<0.01). Conclusions Meta-analysis of existing studies showed that application of ECMO can improve the short-term and long-term prognosis of critical patients with non-pulmonary primary disease. However, due to the small number of studies and the large heterogeneity of the study population, it is necessary to carry out more, large samples and high quality randomized controlled clinical trials.

Epidemiological analysis and disease spectrum characteristics of emergency patients with critical illness:3 176 emergency cases in 2017 in a hospital in Beijing were analyzed / 中华危重病急救医学

Objective To investigate the epidemiological characteristics of emergency critical illness and disease spectrum in emergency department of a hospital in Beijing. Methods A retrospective study was conducted. The data of 3 176 critically ill patients aged ≥ 14 years old admitted to the emergency room of Xuanwu Hospital Capital Medical University from January 1st to December 31st in 2017 were analyzed, including gender, age, clinical time, discharge diagnosis, outcomes, etc. To analyze the epidemiological characteristics and disease spectrum distribution of emergency critically ill patients, annual and daily 24-hour emergency visits in 2017 were analyzed. Results Among the 3 176 cases of acute critical illness, there were more males than females (1 824 vs. 1 352, 1.35 : 1); the age ranged from 14 to 100 years old, with an average of (66.52±17.18) years old; the highest incidence age was 75-89 years old (35.2%, 516 males and 603 females), followed by 60-70 years old (30.0%, 572 males and 381 females). The top four prevalence diseases in the emergency critical disease spectrum were cardiovascular diseases [41.8%, 716 males and 610 females, age (70.25±15.08) years old], nervous system diseases [26.7%, 502 males and 346 females, age (60.28±17.57) years old], respiratory disease [12.3%, 226 males and 166 females, age (72.96±16.23) years old] and digestive system diseases [5.6%, 119 males and 60 females, age (65.40±17.96) years old], accounting for 86.4% of the total. There were more males than females (all P < 0.05), and the age difference was statistically significant (F = 84.094, P < 0.001). Arrhythmia was the most common cardiovascular disease (16.7%), followed by acute coronary syndrome (12.0%) and heart failure (9.1%); the main nervous system diseases were stroke (20.9%); respiratory diseases mainly included severe pneumonia (8.3%); digestive system diseases were mainly with digestive tract bleeding (4.4%). The high incidence of acute critical illness in the emergency department occurred in winter (287 cases in December and 277 cases in January) and the early stage of spring (282 cases in March). The daily peak period was midday and at night, especially from 18:00 to 23:00 (163 cases at 18:00, 173 cases at 19:00, 172 cases at 20:00, 186 cases at 21:00, 167 cases at 22:00, 169 cases at 23:00). The average treatment time of critically ill patients in emergency room was 1.5 days (the longest was 23.0 days, the shortest was 6 minutes), among them, 85.6% of the patients could be discharged from the emergency within 3 days, and 1.9% of the patients stayed in the emergency for more than 7 days. There were 305 deaths (9.6%), mainly among the elderly, with an average age of (71.10±16.08) years old. Conclusions Cardiovascular and cerebrovascular diseases, respiratory and digestive diseases are the main causes of acute critical diseases in department of emergency of Xuanwu Hospital Capital Medical University in 2017. Male and elderly patients are more common; different types of acute and severe patients tend to attack at different ages.

Acute stress response after critical burn / 中华烧伤杂志

The stress response is a preexisting and adaptive behavioral mode of all living beings, which may bring deleterious consequences of dysfunction or failure of tissue and organ. This article aims to elaborate theories of stress response, summarize the manifestation and mechanism of acute stress response in critically burned patients, and help to improve clinical curative efficacy and prognosis of these patients by physiological, psychological and pharmacological methods.

Clinical study of two kinds of different invasive arterial blood pressure flushing liquid / 中国实用护理杂志

Objective To discuss the clinical effect of normal saline flushing and heparinized saline flushing in invasive arterial blood pressure monitoring in the critical patients. Methods A total of 140 critical patients were randomly divided into the experimental group and the control group with 70 cases in each group according to the envelope method. The experimental group used normal saline for tube flushing, the control group used heparinized saline (5 U/ml) for tube flushing. The incidence of complications and coagulation index were compared between two groups. Results There was no statistically difference in the incidence of the catheter jam and local infection (P>0.05). The incidence of bleeding events was 14.3% (10/70) in the control group, which was higher than 2.9% (2/70) of the experimental group. The difference was statistically significant(χ2=4.466, P<0.05). The activated partial thromboplastin time, prothrombin time of the control group were (32.22 ± 4.22) s, (11.56 ± 2.12) s, which were longer than (29.84 ± 3.64) s, (10.66 ± 1.48) s of the experimental group. And international normalized ratio of the control group was 1.12±0.14, which was higher than 1.03±0.20 of the experimental group. The difference was statistically significant (t values were-3.573,-2.912,-3.084, P <0.05). Conclusions The normal saline flushing liquid was more safer and reliable in the invasive arterial blood pressure monitoring.

The effectiveness evaluation of helicopter emergency medical services on transporting critical patients / 中华急诊医学杂志

Objective To explore the advantages and disadvantages of helicopter emergency medical services of South China in the long-distance transport for critical patients.Methods A total of 30 patients who received helicopter emergency medical services by Guangdong Generral Hospital from August 2004 to December 2014 were selected as the observation group,and the other 30 patients with similar conditions who received ground emergency medical services were selected as the control group.To analyses the difference between the two groups in the disease,transport distance,transportation time,costs and compliction by χ2-test,t-test and nonparametric test according types of data.Results There were significantly difference between two groups in transport distances (km) [578.0 (313.0,707.5)vs.214.5 (101.5,313.5),P 0.05).Conclusions Helicopter emergency medical services could shorten the transportation time of critical patients on long distance transportation,and improve the efficiency of first-aid.However,there were many disadvantages that need to be improved in the helicopter emergency medical service of China.

Significance of warning score of potential critical disease in predicting changes in patients with traumatic brain injury / 中国综合临床

Objective To explore the significance of warning score of potential critical disease in predicting changes in patients with traumatic brain injury. Methods The clinic information of 75 patients with traumatic brain injury who were treated in the People's Hospital of Huangshan Affiliated to Wannan Medical College from Jan. to Dec. 2013 were analyzed retrospectively. The warning score of potential critical disease, modified early warning score( MEWS)and glasgow coma score( GCS)of all patients and the rates of changes in patients were calculated. Results Of 75 patients enrolled,60 were survived and 15 were died. Seventy-five patients were performed 448 times of warning score of potential critical disease,MEWS and GCS. The maximum, minimum of warning score of potential critical disease were 24 and 0,and the median score(P25,P75)was 4(2, 7). The maximum,minimum of MEWS were 24 and 0,and the median score( P25,P75 )was 4( 3,7 ). The maximum,minimum of GCS were 8 and 3,and the median score(P25,P75)was 5(4,7). The area under ROC of warning score of potential critical disease was 0. 76(95%CI =0. 66 -0. 86,P ﹤0. 01),Youden index was 0. 42 when score was taken 5. 5. The area under the ROC of MEWS was 0. 71( 95%CI =0. 61 -0. 81,P﹤0. 01),Youden index was 0. 4 when taken 3. 5 score. The area under the ROC of GCS was 0. 51(95%CI=0. 37-0. 63,P=0. 99),Youden index was 0. 27 when score was taken 4. 5. Conclusion The warning score of potential critical disease is effective to predict changes in conditions of patients with multiple injuries and better than MEWS and GCS.

The significance of monitoring blood coagulation function in children with severe hand,foot and mouth disease / 中国中西医结合急救杂志

Objective To investigate the relationship between the coagulation system status and the pulmonary hemorrhage in children with severe hand,foot and mouth disease(HFMD)and approach the clinical significance of early detection of coagulation function. Methods By prospective case design method,89 cases with HFMD admitted to Department of Critical Care Medicine of Hebei Provincial Children Hospital from July 2010 to July 2012 were enrolled. The children were divided into severe group(46 cases)and critical group(43 cases)according to the severity of disease,and the children in critical group were subdivided into survivor group(26 cases)and non-survivor group (17 cases). Forty-four healthy children with the same age and in the same period were served as healthy control group. The blood of children was collected immediately after admission for determination of blood routine, prothrombin time(PT),thrombin time(TT),activated partial thrombin time(APTT),fibrinogen(Fg),and D-dimer (DD). Results There were no significant differences in PT,TT,APTT and Fg among severe group,critical group and health control group(all P>0.05). The blood platelets count(PLT)in severe group and critical group was significantly lower than that in health control group(×109/L:245±130,237±156 vs. 389±120),while the DD was significantly higher than that in healthy control group(mg/L:0.34±0.67,0.41±0.08 vs. 0.24±0.13),and the DD in critical group was obviously higher than that in severe group(all P0.05),but the DD in non-survivor group was significantly lower than that in survivor group(mg/L:0.60±0.09 vs. 0.12±0.09,P<0.05). Conclusions In children with severe or critical HFMD, the coagulation factor and blood platelet were in a state of mobilization,mild consumption state with the existence of fibrinolytic inhibition,but without systemic bleeding tendency,therefore it is in a compensatory stage of disseminated intravascular coagulation(DIC),not the mechanism of pulmonary hemorrhage. The monitor of DD has its clinical significance in evaluations of the disease situation and its prognosis.

The value of waring score of potential critical disease in predicting changes in condition of patients with multiple injuries / 实用医学杂志

Objective To explore the value of waring score of potential critical disease in predicting changes in condition of patients with multiple injuries. Methods From January 1, 2013 to July 31, 2013, all patients with multiple injuries were included prospectively. Patients were observed as soon as ICU admission. The waring score of potential critical disease and MEWS of all patients and the rates of changes in condition of patients were calculated then statistic analysis was performed. Results Of 50 patients enrolled, 44 were survived and 6 were died and 295 changes were found. The maximum , minimum median (P25, P75) of waring score of potential critical disease were 22, 0, 5 (3, 7). The maximum, minimum median (P25, P75) of MEWS were 12, 0, 4 (2, 6). The area under the ROC of waring score of potential critical disease was 0.880 (95% CI, 0.813-0.947, P < 0.001). Youden index was the biggest when waring score of potential critical disease was 6.5. The area under the ROC of MEWS was 0.767 (95% CI, 0.661-0.873, P < 0.001). Youden index was the biggest when MEWS was 5.5. Conclusion The waring score of potential critical disease was effective to predict changes in conditions of patients with multiple injuries and better than MEWS.