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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 describes and compare the effect of humidity heat exchanger and ultrasound on artificial airway patients in a hospital at high altitude. Methods The patients with artificial airway admitted to the People's Hospital of Tibet Autonomous Region from August to December 2017 were divided into two groups according to the time of admission. A total of 125 patients in the humid heat exchanger group were humidified by the humid heat exchanger during the offline process. In the ultrasonic humidification group, 106 patients underwent airway humidification with an ultrasonic humidifier during weaning. After 24, 48 and 72 hours offline, sputum viscosity, eschar formation, airway temperature, PaO2 and PaCO2 were investigated. Results Before humidification , 1 day after humidification, 2 days after humidification and 3 days after humidification, the proportion of first degree sputum in the ultrasonic humidification group was 77.36% (82/106), 80.19% (85/106), 95.28% (101/106) and 99.06% (105/106), respectively. In the heat-moisture exchange group, 99.20% (124/125), 99.20% (124/125), 95.20% (119/125), 72.80% (94/125), respectively. There were differences between the two groups before, 1 day and 3 days after humidification. There was statistical significance (χ2=28.35, 24.06, 28.75, P<0.01). There was no significant difference in PaCO2 between the two groups (P>0.05). PaO 2 in the two and three days after humidification was (92.62 ± 5.76), (91.34 ± 4.85) mmHg, which was lower than that in the ultrasonic humidification group (97.38 ± 5.55), (99.16 ± 5.43) mmHg. There were significant differences between the two groups (t = 6.367, 11.558, P < 0.01). There were significant differences between the two groups (t=6.367, 11.558, P < 0.01). Conclusions The rate of eschar formation was higher in the wet heat exchanger group, and the frequency of sputum suction was higher in the ultrasonic wetting group.
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Objective@#To describes and compare the effect of humidity heat exchanger and ultrasound on artificial airway patients in a hospital at high altitude.@*Methods@#The patients with artificial airway admitted to the People's Hospital of Tibet Autonomous Region from August to December 2017 were divided into two groups according to the time of admission. A total of 125 patients in the humid heat exchanger group were humidified by the humid heat exchanger during the offline process. In the ultrasonic humidification group, 106 patients underwent airway humidification with an ultrasonic humidifier during weaning. After 24, 48 and 72 hours offline, sputum viscosity, eschar formation, airway temperature, PaO2 and PaCO2 were investigated.@*Results@#Before humidification, 1 day after humidification, 2 days after humidification and 3 days after humidification, the proportion of first degree sputum in the ultrasonic humidification group was 77.36% (82/106), 80.19% (85/106), 95.28% (101/106) and 99.06% (105/106), respectively. In the heat-moisture exchange group, 99.20% (124/125), 99.20% (124/125), 95.20% (119/125), 72.80% (94/125), respectively. There were differences between the two groups before, 1 day and 3 days after humidification. There was statistical significance (χ2= 28.35, 24.06, 28.75, P < 0.01). There was no significant difference in PaCO2 between the two groups (P > 0.05). PaO 2 in the two and three days after humidification was (92.62 ± 5.76), (91.34 ± 4.85) mmHg, which was lower than that in the ultrasonic humidification group (97.38 ± 5.55), (99.16 ± 5.43) mmHg. There were significant differences between the two groups (t= 6.367, 11.558, P < 0.01). There were significant differences between the two groups (t=6.367, 11.558, P < 0.01).@*Conclusions@#The rate of eschar formation was higher in the wet heat exchanger group, and the frequency of sputum suction was higher in the ultrasonic wetting group.
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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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Clinicians monitor the gastric residual volume(GRV) of critical ill patients to minimize or prevent side effect of EN.Nevertheless,recommendations about the threshold GRV in critically ill patients treated with EN are not uniform.Many recent clinical studies had demonstrated that increasing the limit of GRV was associated with the increase in the diet volume ratio of ICU patients receiving EN,and it was not associated with adverse effects in gastrointestinal complications.This review summarizes the influence factors of GRV monitoring to evaluate the feasibility and necessity of increasing the threshold of GRV.
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In patients with a functional gut,enteral nutrition is the preferred route of nutrition support.The favorable effects of enteral nutrition include prevention of mucosal atrophy,maintaining of the integrity of gut flora,and improvement of immunocompetence.The guidlines recommend EN be withheld in patients requiring significant hemodynamic support,because of highdose catecholamine agents which could reduce EN tolerance.Splanchnic perfusion is reduced in sepsis shock,yet vasoactive agents have demonstrated both improved and diminished perfusion.Inadequate perfusion increases the risk of experiencing rare but serious adverse events.This study summarizes the tolerability and safety of enteral nutritionin in critically iH patients with hemodynamic instability and provides theoretical basis for the early administration of EN.
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BACKGROUND: Critically ill patients may show significant weight change in their course of disease during ICU stay. However, what weight changes occur and their effects on patient outcome have not yet been reported to our knowledge. Therefore, we evaluated weight change in critically ill patients in the medical ICU and the effect this may have on clinical outcome. METHODS: We measured body weight in patients admitted to the medical ICU daily and evaluated their clinical characteristics and outcome. RESULTS: Thirty-eight patients (M:F = 30:8, mean age = 65.7 +/- 12.5) were enrolled. Thirteen patients (34.2%) showed weight gain and the mean change was 12.8 +/- 4.2%. In contrast, 25 patients (65.8%) showed weight loss and the mean change was 6.3 +/- 6.9%. Patients who showed weight change over 5% or 10% were 26 (68.4%), and 12 (31.6%), respectively, and their mortality rates were 61.5% and 75%, respectively, showing no statistical significance (p > 0.05). However, when the degree of weight change was stratified with 10%, it was associated with death (p = 0.002). Factors like ICU stay, day of mechanical ventilation, initial APACHE II and SOFA score, body mass index (BMI) and serum albumin were not associated with more than 5% change of weight. BMI at admission was only associated with > 10% change of weight (p < 0.05). CONCLUSIONS: The majority of critically ill patients showed a significant weight change during their ICU stay and these patients may have a tendency to have worse clinical outcome.
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Humans , APACHE , Body Mass Index , Body Weight , Critical Illness , Respiration, Artificial , Serum Albumin , Weight Gain , Weight LossABSTRACT
It was reported that 30-50% of inpatients are in a malnutrition status. Measuring the prealbumin level is a sensitive and cost-effective method for assessing the severity of illness in critically or chronically ill patients. However it is uncertain whether or not the prealbumin level correlates with the level of nutrition support and outcomes in critically ill patients. The aim of this study was to evaluate serum prealbumin level as an indicator of the effectiveness of nutrition support and the prognosis in critically ill patients. Forty-four patients who received total parenteral nutrition for more than 7 days at an intensive care unit (ICU) were studied. The serum prealbumin was measured at the initial time of nutrition support and at the almost seventh day since the first measurement. The patients were allocated into two groups. In Group 1 (n=31) and 2 (n= 13), the prealbumin level increased and decreased, respectively. Age, APACHE II score, nutrition status, nutritional requirement and amount of supply, mortality, hospital day and ICU day in the two groups were compared. The serum prealbumin level increased in 31 out of the 44 patients. The average calorie intake was 1334 Kcal/day (83% of energy requirement) in Group 1 and 1170 kcal/day (76% of energy requirement) in Group 2 (p=0.131). The mortality was 42% in Group 1 and 54% in Group 2 (p=0.673). The average hospital day/ ICU day in Groups 1 and 2 were 80 days/38 days and 60 days/31 days respectively. In conclusion, in critically ill patients, the serum prealbumin level did not respond sensitively to nutritional support. In addition an increase in the prealbumin level dose not indicate a better prognosis for critically ill patients.