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Objective:To explore the prognostic risk factors of patients with multiple injuries and establish a nomogram prediction model.Methods:The clinical data of 291 patients with multiple injuries admitted to the Emergency Intensive Care Unit (EICU) of General Hospital of Ningxia Medical University were collected, including sex, age, open injury, norepinephrine use, mechanical ventilation, time to hospital after injury, distance to hospital, relative lymphocyte value, platelet count, lactic acid, injury severity score (ISS), acute physiology and chronic health evaluationⅡ (APACHE Ⅱ), Glasgow coma scale (GCS), number of blood transfusions, number of operations, and previous history of diabetes, hypertension and smoking within 24 h after admission. According to whether the condition worsened during the hospitalization of EICU, the patients were divided into the deterioration group and improvement group. SPSS26.0 software was used for statistical analysis of the data, univariate and multivariate analysis were used to screen the factors affecting the prognosis of patients with multiple injuries, receiver operating characteristic (ROC) curve and forest chart were drawn, and the influencing factors in binary Logistic regression model were used to make the nomogram.Results:Mechanical ventilation, norepinephrine use, age, relative lymphocyte value, lactic acid, APACHE-II score, GCS score, and number of operations were significant for predicting the prognosis of patients with multiple injuries ( P<0.05). The independent influencing factors obtained by binary Logistic regression model were age, lactic acid, APACHE-Ⅱ score and number of operations. ROC curve analysis showed that the area under the curve was the largest in multi-factor combined prediction, followed by APACHE-Ⅱ score. The diagnostic cut-off value of each index was as follows: age >58 years old, relative lymphocyte value≤ 8.62%, lactic acid >1.72, APACHE-Ⅱ score >16, GCS score≤ 6, and number of operations≤ 0. The R software was used to establish a nomogram of the influencing factors in the binary Logistic regression model, which had good predictive value. Conclusions:The nomogram constructed by age, relative lymphocyte value, lactic acid, APACHE-Ⅱ score, GCS score, number of operations, mechanical ventilation, and norepinephrine use has a good predictive value for the prognosis of patients with multiple injuries, and is worthy of promotion..
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Objective:To analyze the risk factors which may lead to tracheostomy in patients receiving invasive mechanical ventilation (IMV) in emergency intensive care unit (EICU).Methods:A case-control study was adopted to retrospectively analyze the clinical data of patients hospitalized in EICU receiving IMV from August 2016 to August 2019. The clinical data of patients were extracted through the electronic medical record system of the hospital information database. Patients were divided into the tracheostomy group and successful extubation group according to whether they received tracheostomy during hospitalization. The different clinical characteristics of the two groups were compared, and logistic regression was used to analyze the independent risk factors of tracheostomy.Results:A total of 109 patients were included in this study, among which, 53 patients underwent tracheotomy and 56 patients were successfully extubated. Logistic regression showed that GCS score ≤ 8 ( OR=5.10, 95% CI: 1.68-15.42, P < 0.01), cervical spinal cord injury ( OR=10.32, 95% CI: 2.74-38.82, P < 0.01), and sepsis ( OR=3.45, 95% CI: 1.39-8.54, P<0.01) were independent risk factors of tracheostomy for patients receiving IMV in EICU. Conclusions:If patients receiving IMV have GCS score ≤ 8, cervical spinal cord injury, or sepsis, they should be given more attention, because they may need early tracheostomy to save lives and improve the prognosis.
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Objective:To study the effect of magnetic nursing concept on improving nurses' nursing ability of extracorporeal membrane oxygenation (ECMO).Methods:In the study, 33 nurses of emergency intensive care unit of The First Affiliated Hospital of Nanjing Medical University from January 2019 to December 2020 were selected as the research objects. From January 2019 to December 2019, the Department carried out routine nursing management, and from January 2020 to December 2020, the Department implemented the management mode of magnetic nursing concept. The mastery of nursing knowledge of ECMO was analyzed by using scale, and the critical thinking ability and self-study ability of the nurses were compared before and after intervention. SPSS 22.0 was used to perform t test on the data. Results:After the intervention, nurses' mastery of respiratory system nursing, circulatory system nursing, fluid balance nursing, skin nursing, digestive system nursing, bleeding, anticoagulant problem nursing, hospital infection prevention and control, and pipeline nursing related knowledge of ECMO patients was significantly better than that before the intervention ( P<0.05). After the intervention, nurses' truth-seeking, open thinking, systematic ability, analytic ability, thinking self-confidence, thirst for knowledge, cognitive maturity and total scale scores were significantly higher than those before the intervention ( P<0.05). After the intervention, nurses' self motivation belief, task analysis, self-monitoring and regulation, self-evaluation and total score were significantly higher than those before the intervention ( P<0.05). Conclusion:The nursing management mode of magnetic nursing concept is of value in improving nurses' autonomous learning ability and critical thinking ability.
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Objective:To explore the relationship between hematocrit, early fluid therapy, and clinical outcomes in patients with septic shock, and to provide evidence for fluid resuscitation therapy and prognosis assessment in these patients.Methods:The clinical information of patients with septic shock who were diagnosed and treated in the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University from January 1, 2018 to December 31, 2020 were collected. Taking the survival or death of patients 28 days after admission as the end point of clinical research, the patients were divided into the survival and death groups. After analyzing the basic data of the two groups, the univariate and multivariate COX regression analyses were used to analyze the evaluation value of Δ Hematocrit (HCT) d2-d1 and ΔHCT d3-d1 on the prognosis of patients with septic shock. At the same time, the Kaplan-Meier survival curve was used to analyze the overall survival rate of patients with septic shock, and the smooth curve fitting graph was used to verify its relationship with net fluid intake and death. Results:There were 241 cases in the survival group and 67 cases in the death group. Univariate COX analysis showed statistically significant differences between the survival and death groups in acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) ( P=0.0006), red cell volume distribution width (RDW) ( P=0.0043), age ( P=0.0184), ΔHCT d2-d1 ( P=0.0136), ΔHCT d3-d1 ( P=0.0204), and white blood cell (WBC) ( P=0.0444). Multivariate COX analysis showed that ΔHCT d2-d1 ( P=0.0115) and ΔHCT d3-d1 ( P=0.0029) were independent risk factors for death in EICU patients with septic shock. ΔHCT d2-d1 and ΔHCT d3-d1 were divided into three groups according to the three-digit method. The Kaplan-Meier survival curve showed no significant difference among the three groups in the overall survival rate related to ΔHCT d2-d1 ( P=0.16), but there was a statistically significant difference in the overall survival rate among the three groups related to ΔHCT d3-d1 ( P=0.025). The smooth fitting curve of ΔHCT d3-d1, net fluid intake, and prognosis showed that ΔHCT d3-d1 was negatively correlated with net fluid intake, and the middle ΔHCT d3-d1 group had the best prognosis. Conclusions:The value of ΔHCT d3-d1 is related to the net fluid intake of patients with septic shock. An appropriate decrease in HCT on the third day can improve the prognosis of patients with septic shock. The dynamic changes of hematocrit can provide a certain basis for fluid resuscitation and prognosis evaluation in patients with septic shock.
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Objective@#To create a model to predict nosocomial infections in emergency intensive care units (EICU), so as to provide insights into early identification and interventions among patients with nosocomial infections. @*Methods@#All nosocomial infections were collected from patients hospitalized in the EICU of a large tertiary hospital from 2017 to 2020. The 2017-2019 data were selected as the training set to create a logistic regression model, and the fitting effectiveness of the predictive model was evaluated using Hosmer-Lemeshow test. The 2020 data were selected as the test set to evaluate the external validation of the predictive model. In addition, the value of the model for prediction of nosocomial infections was examined using the receiver operating characteristic (ROC) curve analysis. @*Results @#Totally 1 546 inpatients in EICU were enrolled, and the prevalence of nosocomial infections was 7.18%. Multivariable logistic regression analysis identified hospital stay duration of >7 days (OR=21.845, 95%CI: 7.901-60.398), use of ventilators (OR=3.405, 95%CI: 1.335-8.682), and surgery (OR=1.854, 95%CI: 1.121-3.064) as risk factors of nosocomial infections. The predictive model was p=ey/(1+ey), y=-6.105+(3.084×duration of hospital stay)+(1.225×use of ventilators)+(0.617×surgery). The area under ROC curve was 0.806 (95%CI: 0.774-0.838) for the training set and 0.723 (95%CI: 0.623-0.823) for the test set, and if the 0.065 cut-off of the predictive model created by the training set was included in the test set, the predictive value yield a 0.739 sensitivity and 0.642 specificity for prediction of nosocomial infections among patients hospitalized in EICU. @*Conclusion@#The created predictive model for nosocomial infections among patients hospitalized in EICU presents a high accuracy, which shows a satisfactory predictive value for high-risk nosocomial infections.
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Objective:To investigate the clinical features, risk factors and prognosis of Clostridium difficile infection/colonization (CDI/CDC) in emergency intensive care unit (EICU) of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, then provides theoretical basis for clinical treatment. Methods:A retrospective case-control study was conducted. The data of EICU patients admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from June 2016 to June 2020 were collected. Taking the CDI/CDC patients as research objects [ Clostridium difficile (CD) positive group] and the CD negative patients with the same gender and age difference less than 5 years who were admitted to the hospital during the same period as the control (CD negative group). Demographic information, risk factors, prognosis and stool samples were collected. Single factor analysis and binary Logistic regression were used to analyze the CD positive infection rate, risk factors, and hospital death of patients with different clinical characteristics. Results:About 487 patients in EICU were included, 76 cases were taken into CD positive group, CD positive rate was 15.6%, including CDI 11 cases, CDC 65 cases. Among the CD positive group, all of the cases used proton pump inhibitor (PPI), and 75 cases used at least one antibiotic. Seventy-six CD negative patients with or without diarrhea (CD negative group) were included in this study. Among them, 75 patients used PPI and 74 patients used at least one antibiotic. Univariate analysis showed that acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), duration of hospitalization, and carbapenem use were the risk factors for CDI/CDC. There were significant differences in the above indicators between CD positive group and CD negative group [APACHEⅡ: 18.0 (12.2, 25.8) vs. 10.0 (7.0, 14.0), duration of hospitalization (days): 46.0 (30.5, 72.5) vs. 18.5 (9.2, 37.0), proportion of carbapenems: 81.6% (62/76) vs. 64.5% (49/76), all P < 0.05]. Binary Logistic analysis regression analysis showed that APACHEⅡ score [odds ratio ( OR) = 0.802, 95% confidence interval (95% CI) was 0.730-0.882, P < 0.01] and duration of hospitalization ( OR = 0.960, 95% CI was 0.942-0.978, P < 0.01) were independent risk factors for CDI/CDC. There was no difference in overall mortality between the CD positive group and CD negative group [27.6% (21/76) vs. 38.2% (29/76), P = 0.167]. Conclusions:Critically ill patients in EICU routinely use PPI and antibiotics, and the use of antibiotics does not affect the CD positive rate. The independent risk factors of CDI/CDC are the APACHEⅡ score and the duration of hospitalization, but fecal CD positive has no obvious influence on death.
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Objective To investigate whether the nursing staff scheduling pattern of different shifts in Emergency Intensive Care Unit (EICU) of a third-grade first-class hospital in Guizhou Province could be rationally arranged by using the therapeutic intervention scoring system-28 (TISS-28). Methods The nursing workload of 129 patients in EICU was evaluated by TISS-28 from March to June 2017 in the Affiliated Hospital of Guizhou Medical University to look for the best nursing staff scheduling pattern. Results The TISS-28 was used to predict the workload of nurses on night shift and day shift. The TISS-28 scores of day shift and night shift were similar, and they were respectively 38.75±5.01 and 38.66±5.04 scores. There was no statistical significant difference in predicting the nurse-patient ratio between day shift and night shift by using TISS-28 (1 :0.83±0.22 vs. 1 :0.83±0.24, P > 0.05). The number of nursing staff was adjusted from originally 9 nurses during day shift and 5 nurses during night shift to 7 nurses during day shift and 7 nurses during night shift. Conclusions According to TISS-28 score to arrange the numbers of nurses on night shift and day shift is reasonable, the nurse workload of night shift can be reduced and their working enthusiasm improved, thus the degrees of satisfaction of nurses and patients are getting higher.
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Objective To compare clinical data of the death in different intensive care unit,in order to provide the medical strategies for patients in EICU.Methods The clinical data of lethal cases from January 1,2013 to December 31,2014 in EICU,SICU and MICU of the First Affiliated Hospital of Sun Yat-sen University were compared.EICU (252 cases),SICU (93 cases) and MICU (80 cases) were enrolled.The demographics of each patient,clinical condition such as critical score (APACHE Ⅱ score),length of stay,overall costs,and the patient families' different opinions to the treatment in each ICU were analyzed.The data was analyzed with SPSS 13.0 software,averaged value was presented as mean ± standard and the non-normal distributions were expressed as median (25％,75％).The one-way analysis of variance was followed by the Tukey post hoc test for pairwise comparisons and chi-square test was used for comparison of percentage between two groups.Results Two hundred and fifty-two cases in EICU had gender ration of 148/96 (male/female),92 cases in SICU 68/24,80 cases in MICU 56/24.Ages of the fatal were EICU 72 ± 17 years,SICU 56 ± 17 years,and MICU 63 ± 20 years,respectively.Age of the fatal in EICU was significantly older than that of the SICU (P ＜ 0.01) and the MICU (P ＜ 0.01).APACHE Ⅱscores were 33 ± 8 in EICU,34 ± 10 in SICU,29 ± 10 in MICU,respectively.The severity scores in EICU patients were higher than those in MICU patients and SICU patients (P =0.01 and 0.021).Lengths of stay were 2 days (1,46) in EICU,14 days (1,84) in SICU,12 days (1,77) in MICU,respectively.EICU hospitalization time was significantly shorter than that of SICU (P ＜ 0.01) and the MICU (P ＜ 0.01).Total costs of hospitalization were 9 777 yuan (400,164 126) yuan in EICU,100 628 yuan (13 639,964 783) yuan in SICU,119 463 yuan (5 650,590 903) yuan in MICU,and that in EICU was significantly less than the total cost of hospitalization in SICU (P ＜ 0.01) and in MICU (P ＜ 0.01).The opinion of patient families was proposed to give up treatment associated with 165 dead cases in EICU,18 death cases in SICU and 20 dead cases in MICU,and the rate of discontinuous treatment in EICU patients was significantly greater than that in SICU (P ＜ 0.01) and in MICU (P ＜ 0.01).There were no significant differences in invasive procedures,invasive hemodynamic monitoring,mechanical ventilation,blood purification and deep vein puncture among three groups.The 5 leading causes in EICU were severe sepsis,stroke,sudden cardiac arrest,acute myocardial infarction and advanced malignancy.Conclusions The death of patients were due to advanced age with severe disease,poor prognosis,and the request of patient family members to give up treatment.The 5 leading causes were severe sepsis,stroke,sudden cardiac arrest,acute myocardial infarction and advanced tumors suggesting the establishment of corresponding treatment scheme to be made and preparation of abundant medical resources to be ready.Timely communication with the patients' families and let them participate in end-stage treatment decisions was the best strategies to improve the successful rate of treating severe patients and use EICU resource effectively.
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Objective To analyze the characteristics of pathogenic microorganism infection and the bacterial drug resistance in emergency intensive care unit (EICU),and to provide the basis for rational use of antibacterials and effective control of infection.Methods A total of 1 516 samples of infected patients were collected from 214 infected patients who were diagnosed in 628 patients from January 2015 to December 2016 in EICU of the Central Hospital of Luoyang City.The specimens were subjected to etiological detection and drug sensitivity tests.The constituent ratio of samples,positive rate of etiological examination,the constituent ratio of pathogenic bacteria,the characteristics of pathogenic microorganism infection,the classification in different infection sites,the main bacteria in different infection sites and the bacterial drug resistance were analyzed.Results The positive rate of etiological examination was 14.31％ (217/1 516),there were 186 effective positive specimens after removing duplicate samples,including 123 gram negative bacteria (66.13％),34 fungi (18.28％) and 29 gram positive bacteria (15.59％).The lower respiratory tract,urinary tract and blood system were the most common sites of infection;there were 87 strains (46.77％),39 strains (20.97％) and 32 strains (17.20％) were detected.The proportion of community infection (90.32％,168/186) was significantly higher than that of nosocomial infection (9.68 ％,18/186) (x2 =80.778,P ＜ 0.05).There was difference in the main pathogenic bacteria in different infection sites between community infection and nosocomial infection,the proportion of Acinetobacter baumannii and Stenotrophomonas maltophilia in lower respiratory tract increased in the patients with nosocomial infection,the Enterococcus faecalis were detected in urinary tract infection in the patients with nosocomial infection.The Escherichia coli and Klebsiella pneumoniae have lower resistance to carbapenems,β-1actamase inhibitors,amikacin,cefoxitin and ceftazidime.The resistance rate of Pseudomonas aeruginosa to quinolone,ceftazidime,piperacillin and sulbactam,aminoglycosides and β-1actamase inhibitors was low.42.86％ Staphylococcus aureus were oxacillin-resistant Staphylococcus aureus.Conclusion EICU patients with infection,lower respiratory tract,urinary tract and blood system were the most common infection site.The proportion of community infection is higher than that of nosocomial infection.The ventilator-associated pneumonia,urethral catheter-related urinary tract infection and catheter-related blood infection are common nosocomial infections.There are differences in the pathogenic bacteria and bacterial drug resistance in different infection sites between community infection and nosocomial infection.The common pathogens should be taken into account in the empirical selection of antimicrobial agents.
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Objective To explore the strategies of diagnosis and treatment of severe multiple injuries in Emergency Intensive Care Unit (EICU).Methods The clinical data of 226 patients with severe multiple injuries were analyzed retrospectively.188 patients were treated by surgical operation,and 38 patients were not treated by surgical operation.Results Among these patients,46 patients (accounted for 20.3%)were with pulmonary infection and atelectasis,41 patients (accounting for 18.1%)were with multiple -organ dysfunction syndrome (MODS), 35 patients (accounted for 15.5%)were with acute respiratory distress syndrome (ARDS),and 19 patients (accounted for 8.4%)were with stress ulceration and bleeding.198 patients (accounted for 87.6%)were successfully rescued, and 28 patients (accounted for 12.3%)died.The main cause of death in the early stage was the serious craniocerebral injury,and the main cause of death in the later stage was the multiple -organ dysfunction.Conclusion EICU plays a very important role in comprehensive treatment of severe multiple injuries,and can obviously increase the success rate of treatment and cure of severe multiple injuries.
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Objective To explore the clinical risk factors of ventilator-associated fungal pneumonia (VAFP) in emergency intensive care unit.Methods One hundred and ninety-seven consecutive patients with 121 males and 76 females,aged from 17 to 98 years met the criteria of ventilator-associated pneumonia in emergency intensive care unit admitted from July 2009 to June 2014,were retrospectively evaluated.Those with mechanical ventilation less than 48 hours or treatment discontinued were excluded.Patients were divided into VAFP group and ventilator-associated non-fungal pneumonia group according to the results of fungal culture and microscopy.Univariate analysis was used to find out preliminary risk factors for VAFP,and then the ultimate independent risk factors were determined with multivariate stepwise logistic regression analysis.Results The occurrence of VAFP was 32.0 ％ (63 cases) out of 197 patients with ventilatorassociated pneumonia.In those 63 patients,there were 71 species found from fungus culture.Candida albicans counted for 33 (46.5％),Candida glabrata for 11 (15.5％),other Candida Albicans for 26 (36.6％).The preliminary univariate analysis showed that 19 factors were statistically significant,while multivariate stepwise logistic regression analysis revealed that acute physiology and chronic health evaluation Ⅱ score≥ 22,radiotherapy or chemotherapy,mechanical ventilation ≥14.11 days,use of antibiotics ≥14 days,use of glucocorticoid and other immuno-suppressants were independent predictors of VAFP,and the adjusted odds ratios with 95％ confidential intervals were 4.133 (2.831-6.033),2.977 (1.942-4.564),2.305 (1.439-3.736),1.988 (1.441-2.741),1.528 (1.337-1.746),respectively.Conclusion Higher APACHE Ⅱ score,radiotherapy or chemotherapy,prolonged use of mechanical ventilation,prolonged use of antibiotics,use of glucocorticoid and immunosuppressants are independent risk factors of VAFP.The incidence rate of VAFP may be reduced by improving patients' overall clinical setting,shortening the duration of mechanical ventilation and employment of antibiotics,and more strict guidelines to the application of glucocorticoid and immunosuppressants.
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Objective To observe the effects of using problem-based learning (PBL) and lecture-based learning (LBL) in clinical teaching in emergency intensive care unit (EICU).Methods Three hundred and twelve 5-year clinical medicine undergraduates from Xinjiang Medical University including 108 students in 2007 class and 204 students in 2008 class were enrolled. The students in each class were randomly divided into two groups, 54 students in each group in 2007 class and 102 students in each group in 2008 class. Randomized controlled trial was conducted; in the first half of a semester, the students in the two groups of each class were taught by PBL method and LBL method respectively. At the middle of the semester, written examination (WES), objective structure clinical examinations (OSCE) and self assessment questionnaire test were carried out to evaluate students' learning effect. In the second half of the semester, the teaching method in the two groups of each class was exchanged, and at the end of the semester, the same examinations were carried out, and the examination and questionnaire scores in the two groups of each class were compared.Results The results of comparisons of the WES and OSCE scores between two modes in each class showed that the scores of WES and OSCE of the PBL mode were obviously higher than those in the LBL mode (the first half of semester in 2007 class: WES: 23.20±3.33 vs. 22.78±4.41, OSCE: 27.60±6.44 vs. 25.45±6.35, in 2008 class: WES: 24.45±2.65 vs. 23.02±3.67, OSCE: 29.53±4.67 vs. 27.57±6.83, in the second half of the semester in 2007 class: WES: 24.60±3.67 vs. 23.46±2.57, OSCE: 28.50±4.78 vs. 28.01±5.78, in 2008 class: WES: 23.54±3.56 vs. 22.56±6.89, OSCE: 28.08±2.15 vs. 27.43±7.23,P < 0.05 orP < 0.01). The score results of self assessment questionnaires of students in two groups of 2007 class and 2008 class showed that the self learning ability, initiative, linking theory with practice, team power and attentiveness were significantly higher in the PBL teaching mode than those in the LBL teaching mode [the first half of the semester in 2007 class: self learning ability (score): 4.20±0.67 vs. 3.32±0.71, the initiative (score): 4.15±0.98 vs. 2.01±0.81, linking theory with practice (score): 4.09±0.65 vs. 3.52±0.89, team power (score): 4.43±0.56 vs. 3.08±0.43, attentiveness (score): 4.25±0.77 vs. 2.98±0.67; the second half of the semester in 2007 class: self learning ability (score): 4.23±0.77 vs. 2.11±0.98, the initiative (score): 4.59±0.85 vs. 3.20±0.73, linking theory with practice (score): 4.23±0.71 vs. 2.88±0.87, team power (score): 4.66±0.63 vs. 2.21±0.64, attentiveness (score): 4.21±0.73 vs. 2.28±0.43; the first half of the semester in 2008 class: self learning ability (score): 7.60±0.64 vs. 5.62±0.41, the initiative (score): 7.23±0.47 vs. 5.07±0.51, linking theory with practice (score): 7.04±0.67 vs. 4.56±0.59, team power (score): 7.33±0.55 vs. 5.06±0.47, attentiveness (score): 6.21±0.87 vs. 4.88±0.37; the second half of the semester in 2008 class: self learning ability (score): 7.03±0.71 vs. 5.11±0.48, the initiative (score): 7.89±0.57 vs. 5.20±0.33, linking theory with practice (score): 7.63±0.25 vs. 4.88±0.57, team power (score): 7.64±0.33 vs. 5.21±0.67, attentiveness (score): 7.01±0.89 vs. 6.01±0.90].Conclusion PBL method of teaching is worthwhile to be explored and spread extensively, especially in medicine, a scientific course involving much attention on practice, it embodies more importance.
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BACKGROUND:Catheter-related infection (CRI) of the central vein is a common cause of nosocomial infection. This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit (EICU) in order to provide the beneficial reference.METHODS:From January 2008 to December 2010, a total of 1363 patients were subjected to catheterization. In these patients, the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1363 patients using the central venous catheter. The peak rate of CRI was 10.79％, with an incidence of 3.05 episodes per 1000 catheter days. Of the 147 patients, 46.94％ had gram-negative bacilli, 40.14％ had gram-positive cocci, and 12.92％ had fungi. Unconditional logistic regression analysis suggests that multiple catheterization, femoral vein catheterization, the application of multicavity catheter, and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.
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Objective To investigate the characteristics of pathogens and risk factors of the catheterassociated infection (CAI) in emergency ICU (EICU) in order to design an appropriately therapeutic strategy for the future.Methods From January 2008 to December 2010,a total of 1363 patients were enrolled for this retrospective study.Blood sample taken from the vein with indwelling catheterization and the tips of catheters cut in 5 cm after withdrawn from the veins in 1363 patients were collected for bacterial culture.Results Of 1363 catheters,pathogens were found in 147 (10.79％) after venous catheterization.The daily occurrences of CAI were 3.05 ones per 1000 catheters.Of 147 cases of infection,46.94％ pathogens were gram-negative bacilli,40.14％ gram-positive cocci,and 12.92％ fungi.Unconditional Logistic regression analysis suggested that repeated catheterization,femoral vein catheterization,the application of multi-lumen catheter and long-term indwelling catheterization were the independent risk factors responsible for CAI.Conclusions The risk factors responsible for catheter related infections should be controlled to prevent the occurrence of nosocomial infection.
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Objective To investigate the epidemiology and features of severe poisoning.Methods A retrospective analysis of patients with severe poisoning admitted into the emergency intensive care unit of Peking Union Medical College Hospital from February 2008 to March 2010 was made.Results A total of 138 patients consisting of 45 males and 93 females were enrolled.The average age was 39.2 years.Committed suicide with toxic agents was the major cause of poisoning (76.8％ ),followed by alcoholism (8.7％ ) and misuse of medicine (5.8％).Of them,96.4％ patients were poisoned by swallowing poison agents,and 45.7％ patients were treated with gastric lavage and 15.2％ of patients with hemofiltration.Mortality was 3.62％.Conclusions Our study presents the current status of acute severe poisoning in the large general hospital.
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OBJECTIVE To analyze the etiological distribution and drug resistance characteristics of patients with respiratory failure and lung infection in EICU.METHODS The types of respiratory failure,the incidence condition of ventilator-associated pneumonia(VAP),the mortality rate,and the drug sensitivity of 129 pathogen strains which were isolated and cultured from the 110 cases with respiratory failure and pneumonia between Jan 2006 to Aug 2008 in EICU were analyzed.RESULTS Among the 110 patients,48 cases were died(the mortality rate of 43.6%).There were 28 cases(58.3%) of Ⅱ type respiratory failure,20 cases(41.7%) of Ⅰ type respiratory failure.Of 129 pathogens strains,there were 29 Gram-positive bacteria(22.5%) and 100 Gram-negative bacteria(77.5%).The major Gram-negative bacteria were Pseudomonas aeruginosa,Acinetobacter baumannii,and Klebsiella pneumoniae,and they showed generally higher multidrug resistance.Except minocycline,A.baumannii appeared strong multidrug resistance to the other 16 kinds of common antibiotics.The main Gram-positive bacteria were Staphyococcus haemolyticus,S.aureus and coagulase-negative staphylococci(CNS),and no evidence showed they resisted to vancomycin.CONCLUSIONS There are high mortality rate of patients with respiratory failure and lung infection if they suffered from compound infection.The main pathogens of the lung infection are Gram-negative bactiera,such as P.aeruginosa,A.baumanniiand K.pneumoniae in order,with high multidrug resistance.The main Gram-positive bacteria show no evidence resist to vancomycin.
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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 explore the nursing intervention of lower respiratory airway bacteria(LRAB) isolated from patients with mechanical ventilation.METHODS A total of 72 stains of LRAB were isolated from mechanical ventilation patient and nursing intervention were analyzed.RESULTS The major pathogenic bacteria were Pseudomonas aeruginosa(22.3%),Acinetobacter baumannii(18.1%),Staphylococcus aureus(16.7%).CONCLUSIONS To control infection effectively,effective sterizing measures must be carried out,especially attention to EICU management,sterilizing of the breathing circuit and management of artificial respiratory airway.
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OBJECTIVE To explore the clinical and etiological characteristics in patients with ventilator-associated pneumonia(VAP) in emergency intensive care unit(EICU),and improve the prevention and treatment level of VAP.METHODS To analyze the clinical information of 54 patients with VAP,and to compare the clinical information with the incidence rate of VAP.Bacterial culture of airway secretion and drug sensitive test were used to analyze etiology.RESULTS Totally 148 patients were enrolled in this study,of which 54 were diagnosed as VAP.The incidence rate of VAP group was 36.5%.Respirator used time of VAP group was obviously longer than that of non VAP one.Antibiotic prophylaxis could not lower the incidence rate.A total of 59 pathogen strains were isolated by bacteria culture.The major pathogenic bacteria in VAP were Pseudomonas aeruginosa(22.0%),Acinetobacter baumannii(16.9%),Staphylococcus aureus(15.3%),Escherichia coli(10.1%),and Klebsiella pneumonia(10.1%).CONCLUSIONS VAP is one of the significant reasons for failed mechanical ventilation treatment.To prevent and treat VAP should pay attention to disinfection and aseptic manipulation,and make the rational use of antimicrobial agents.
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OBJECTIVE To investigate the profile of pathogen of infection in emergency intensive care unit(EICU). METHODS Pathogen of infection in EICU of our hospital from Jan to Apr 2005 were retrospectively investigated. RESULTS A total of 25 species from 119 pathogen strains were isolated from 45 cases. Among them, nonfermenters Gram-negative bacilli had great advantage, about 42.9% (51/119). Pseudomonas aerugionosa was the most one , counted for 16.8%. 65.9% of isolates were from sputum, 9.2%from blood. 81.4%(35/43) of cases were caused by multi-bacterial infection. CONCLUSIONS The pathogen of infection in EICU is mainly P. aeruginosa. The isolates are multi-resistant to biotics.