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@#BACKGROUND: It is controversial whether prophylactic endotracheal intubation (PEI) protects the airway before endoscopy in critically ill patients with upper gastrointestinal bleeding (UGIB). The study aimed to explore the predictive value of PEI for cardiopulmonary outcomes and identify high-risk patients with UGIB undergoing endoscopy. METHODS: Patients undergoing endoscopy for UGIB were retrospectively enrolled in the eICU Collaborative Research Database (eICU-CRD). The composite cardiopulmonary outcomes included aspiration, pneumonia, pulmonary edema, shock or hypotension, cardiac arrest, myocardial infarction, and arrhythmia. The incidence of cardiopulmonary outcomes within 48 h after endoscopy was compared between the PEI and non-PEI groups. Logistic regression analyses and propensity score matching analyses were performed to estimate effects of PEI on cardiopulmonary outcomes. Moreover, restricted cubic spline plots were used to assess for any threshold effects in the association between baseline variables and risk of cardiopulmonary outcomes (yes/no) in the PEI group. RESULTS: A total of 946 patients were divided into the PEI group (108/946, 11.4%) and the non-PEI group (838/946, 88.6%). After propensity score matching, the PEI group (n=50) had a higher incidence of cardiopulmonary outcomes (58.0% vs. 30.3%, P=0.001). PEI was a risk factor for cardiopulmonary outcomes after adjusting for confounders (odds ratio [OR] 3.176, 95% confidence interval [95% CI] 1.567-6.438, P=0.001). The subgroup analysis indicated the similar results. A shock index >0.77 was a predictor for cardiopulmonary outcomes in patients undergoing PEI (P=0.015). The probability of cardiopulmonary outcomes in the PEI group depended on the Charlson Comorbidity Index (OR 1.465, 95% CI 1.079-1.989, P=0.014) and shock index >0.77 (compared with shock index ≤0.77 [OR 2.981, 95% CI 1.186-7.492, P=0.020, AUC=0.764]). CONCLUSION: PEI may be associated with cardiopulmonary outcomes in elderly and critically ill patients with UGIB undergoing endoscopy. Furthermore, a shock index greater than 0.77 could be used as a predictor of a worse prognosis in patients undergoing PEI.
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Objective:To explore the application of beside wheelchair seating training in patients with acute respiratory distress syndrome (ARDS) and mechanical ventilation, so as to provide the reference for the nursing of acquired myasthenia in EICU.Methods:A total of 66 ARDS patients with mechanical ventilation treated in Beijing Hospital from July 2017 to July 2019 were assigned to the experimental group and the control group according to the admission time, 33 cases in each group. Patients in the control group received routine nursing, while the experimental group implemented beside wheelchair seating training. The differences in muscle strength, self care ability, duration of mechanical ventilation, length of EICU stay as well as complications between the two groups were compared.Results:The incidence of EICU acquired myasthenia in the experimental group was 18.2% (6 cases), which was significantly lower than that in the control group 42.4% (14 cases), the difference was statistically significant ( χ2=4.59, P<0.05). Out of EICU, the Medical Research Council (MRC) scores and Modified Barthel Index (MBI) scores were (48.27 ± 5.11), (59.67 ± 7.33) points in the experimental group, which were significantly higher than those in the control group (44.88 ± 6.75), (54.06 ± 8.53) points, the differences were statistically significant ( t=2.30, 2.86, both P<0.05). The length of EICU stay and duration of mechanical ventilation were (8.24 ± 1.48) d, (7.15 ± 1.48) d, in the experimental group, which were significantly lower than those in the control group (9.85 ± 2.99) d, (8.24 ± 1.77) d, the differences were statistically significant ( t=2.77, 2.72, both P<0.05). The oxygenation index after 30 minutes of weaning was (296.64 ± 15.45) mmHg (1 mmHg=0.133 kPa), which was significantly higher than that in the control group (288.36 ± 16.75) mmHg, the difference was statistically significant ( t value was 2.09, P<0.05). Conclusions:The beside wheelchair seating training can effectively decrease the incidence of EICU acquired myasthenia as well as shorten the duration of mechanical ventilation and length stay in EICU of patients with ARDS. It is safe and effective, and has good clinical application value.
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OBJECTIVE The status and risk factors of nosocomial infection(NI) in patients in emergency intensive care units were invrstigated to make the intervention strategy. METHODS The prospective monitoring and retrospective investigation were used analyze the 72 nosocomial infection patients in EICU. RESULTS Incidence rate of NI in patients in EICU was 29.50%. It was significantly higher than average incidence rate of NI of the whole hospital at the same time; ≥60-year-old of rate of NI in patients was 60.52%; The average hospitalization days were 28 days; The lower respiratory tract was the most common infection site. The most common infection microorganism in EICU was Gram-negative bacteria. CONCLUSIONS The incidence rate of EICU is much higher than that in other departments. The invasive procedure, the quality of disinfection and sterilization, and patients immunity status especially in the old. were the risk factors General intervention strategy should be adopted in the control of EICU nosocomial infection to reduce the infection rate and raise the rescue rate.
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OBJECTIVE To investigate the hospital infection rate and sites of patients in emergency intensive care(unit)(EICU),and provide basis for prevention and treatment of hospital infection.METHODS Patients who were hospitalized in EICU were investigated by retrospective study.RESULTS Among the hospital infection sites,(respiratory) tract was the most frequent one(65.63%),the next was urinary tract(28.13%),and the deep vein was the third(6.25%).The most common hospital infection bacteria were Staphylococcus aureus,Pseudomonas aeruginosa and Acinetobacter baumannii.CONCLUSIONS The analysis of the subjective and objective factors of hospital infection,and the acknowledge of relationship between nursing and hospital infection sites are(important) basis for hospital infection prevention and treatment.
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OBJECTIVE To investigate the distribution of Pseudomonas aeruginosa and its antibiotic resistance in(emergency) intensive care unit(EICU) patients with lower respiratory infections.METHODS The data of the pathogens isolated in sputum from the 25 patients with lower respiratory infections admitted to EICU from(Aug) 2005 to Feb 2006 were collected and analyzed.RESULTS Eighty-one bacteria strains were found in these 25 EICU cases.The Gram-negative bacteria were the main pathogens of infection(43.2%),after them were Gram-positive bacteria(32.1%),and fungi(24.7%).The percentage of P.aeruginosa infection was 13.6% of all(patients).The antibiotic resistance for P.aeruginosa was found to the antibiotics,such as cefotaxime,gentamicin,(SMZ-TMP),minocycline,levofloxacin,and gatifloxacin.CONCLUSIONS The P.aeruginosa infection and its(antibiotic) resistance should be paid more attention in the treatment of the lower respiratory infection patients in EICU.