Research progress in cognition, attitude and willingness for organ donation among ICU staff in China / 器官移植

In recent years, organ donation and transplantation have entered a stage of steady development in China. Nevertheless, the shortage of transplant organs and the contradiction between supply and demand of organs are still the bottlenecks to achieve the strategy of "self-sufficiency in organ transplantation" advocated by the World Health Organization (WHO). The key reasons for donor loss described in the "critical pathway of organ donation" defined by the WHO include the identification and referral of potential donors and the maintenance and repair of organs. Smooth development, high efficiency and high-quality development of organ donation cannot be achieved without the support of intensive care medicine, which are highly associated with the cognition, recognition and participation of intensive care unit(ICU) staff. In this article, research progress in ICU staff’s cognition, attitude and willingness for organ donation were reviewed and relevant influencing factors were discussed, aiming to offer targeted suggestions on how to resolve these difficulties.

Validation of Malay Language Translated Questionnaire on Adult Intensive Care Unit Nurses’ Perception and Involvement in End-of-life Care

@#Introduction: The study’s objective was to validate a Malay language translated questionnaire on end-of-life care to be used among nurses practicing in critical care areas. Methods: The English language questionnaire underwent forward and backward translations by four experts. The translated Malay language questionnaire was pilot tested on 30 subjects and revised accordingly. The validation of the revised questionnaire was carried out on 250 nurses. The reliability of the translated questionnaire was checked. Cronbach alpha value of at least 0.70 suggests adequate internal consistency. The validity of the questionnaire was explored using Confirmatory Factor Analysis (CFA) and model fit tests were run to achieve fit test specific cut off values. The CFAs were run repeatedly with iterative item reductions until acceptable goodness of fit for the model was achieved. Results: All domains of the translated questionnaire showed reasonable to excellent reliability (Cronbach Alpha 0.687 to 0.922). Multiple CFAs were run and 13 out of 46 items were excluded, and the final model fit improved substantially with the indices were within the acceptable threshold of good or reasonably fit, cut off values are in brackets [Chi-Square statistics 1.635 (≤ 2.0), Root Mean Square Error of Approximation 0.050 (< 0.05), Standardised Root Mean Square Residual 0.059 (≤ 0.08), Comparative Fit Index 0.911 (0.90-0.94), Tucker Lewis Index 0.900 (0.90-0.94), Akaike Information Criteria 13024, Bayesian Information Criteria 13334]. Conclusion: The psychometric properties of the final model indicated the Malay language translated questionnaire is reliable and valid to investigate nurses’ perspective and involvement in end-of-life care.

Attaching importance to mechanical perfusion of donor liver and promoting high-quality development of liver transplantation / 器官移植

With the increasing quantity of organ donors and the continual expansion of the definition of extended criteria donor (ECD) livers, the quality of donor liver has become a prominent issue affecting the high-quality development of liver transplantation, which is also the study focus in related fields. Resolving the shortage of organs to the maximal extent and promoting the high-quality development of organ transplantation lead the development direction of organ donation and transplantation in China. In recent years, the application of mechanical perfusion (MP) for the perfusion, preservation, evaluation and repair of donor liver has become a hot topic to improve the quality of liver transplantation within the international community. In this article, according to different conditions of the application of ECD livers in liver transplantation at home and abroad in combination with the research progress on MP in the international community and relevant research experience of our center, the feasibility of establishing an organ intensive care unit (ICU) with integrated organ protection techniques was discussed, aiming to promote the high-quality development of organ transplantation in China and further expand the technical connotation of the "Chinese model" of organ donation and transplantation.

Clinical characteristics of 34 COVID-19 patients admitted to intensive care unit in Hangzhou, China / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Objective: This study summarizes and compares clinical and laboratory characteristics of 34 patients admitted to the intensive care unit (ICU) for complications from coronavirus disease 2019 (COVID-19) at the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China from Jan. 22 to Mar. 5, 2020. Methods: A total of 34 patients were divided into two groups, including those who required noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) with additional extracorporeal membrane oxygenation (ECMO) in 11 patients. Clinical features of COVID-19 patients were described and the parameters of clinical characteristics between the two groups were compared. Results: The rates of the acute cardiac and kidney complications were higher in IMV cases than those in NIV cases. Most patients had lymphocytopenia on admission, with lymphocyte levels dropping progressively on the following days, and the more severe lymphopenia developed in the IMV group. In both groups, T lymphocyte counts were below typical lower limit norms compared to B lymphocytes. On admission, both groups had higher than expected amounts of plasma interleukin-6 (IL-6), which over time declined more in NIV patients. The prothrombin time was increased and the levels of platelet, hemoglobin, blood urea nitrogen (BUN), D-dimer, lactate dehydrogenase (LDH), and IL-6 were higher in IMV cases compared with NIV cases during hospitalization Conclusions: Data showed that the rates of complications, dynamics of lymphocytopenia, and changes in levels of platelet, hemoglobin, BUN, D-dimer, LDH and IL-6, and prothrombin time in these ICU patients were significantly different between IMV and NIV cases.

Clinical characteristics of 34 COVID-19 patients admitted to intensive care unit in Hangzhou, China / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#This study summarizes and compares clinical and laboratory characteristics of 34 patients admitted to the intensive care unit (ICU) for complications from coronavirus disease 2019 (COVID-19) at the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China from Jan. 22 to Mar. 5, 2020.@*METHODS@#A total of 34 patients were divided into two groups, including those who required noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) with additional extracorporeal membrane oxygenation (ECMO) in 11 patients. Clinical features of COVID-19 patients were described and the parameters of clinical characteristics between the two groups were compared.@*RESULTS@#The rates of the acute cardiac and kidney complications were higher in IMV cases than those in NIV cases. Most patients had lymphocytopenia on admission, with lymphocyte levels dropping progressively on the following days, and the more severe lymphopenia developed in the IMV group. In both groups, T lymphocyte counts were below typical lower limit norms compared to B lymphocytes. On admission, both groups had higher than expected amounts of plasma interleukin-6 (IL-6), which over time declined more in NIV patients. The prothrombin time was increased and the levels of platelet, hemoglobin, blood urea nitrogen (BUN), D-dimer, lactate dehydrogenase (LDH), and IL-6 were higher in IMV cases compared with NIV cases during hospitalization.@*CONCLUSIONS@#Data showed that the rates of complications, dynamics of lymphocytopenia, and changes in levels of platelet, hemoglobin, BUN, D-dimer, LDH and IL-6, and prothrombin time in these ICU patients were significantly different between IMV and NIV cases.

Key strategies of ICU in promoting organ donation: a relay for life / 器官移植

Organ transplantation is an effective treatment for end-stage organ failure. However, organ shortage has always been a common problem faced by countries around the world. The recognition and active participation of intensive care unit (ICU) medical staff in organ donation contributes to promoting the development of organ donation, thereby alleviating the shortage of donor organ. In this article, the key strategies of ICU donor management to promote organ donation and the key strategies of ICU medical staff management to promote organ donation were summarized, aiming to provide reference for organ donation practitioners (especially ICU medical staff) and jointly facilitate the professional development of organ donation.

Intubation Performed In The Emergency Department Is Associated With Increased Pulmonary Complications

Ventilator Associated Pneumonia (VAP) is among the most common hospital acquired infections. Trauma patients are known to have a unique predisposition to the development of pneumonia. At our urban level 1 trauma center, we noticed variability in the incidence of aspiration and pneumonia among intubated patients with similar levels of injury severity. In an attempt to discern why, we hypothesized that location of intubation was a risk factor for development of in-hospital complications. We performed a retrospective cohort study over a 6 month period using adult patients admitted to our trauma service. Intubations performed were reported from four different locations: Emergency Department (ED), operating room (OR), intensive care unit (ICU) and the surgical floor. Data obtained included location of intubation, age, Acute Injury Score (AIS), days on a ventilator, incidence of pulmonary infection, incidence of aspiration, intubation difficulty, ICU length of stay (ICU-LOS), hospital length of stay (HLOS), and survival. One way analysis of variance (ANOVA) was then performed. Our study included 96 enrolled patients consisting of 13 women and 83 men with a mean age of 49.5. Patients intubated in the ED, in comparison to patients intubated on the surgical floor, ICU or OR, were noted to have a statically significant increase in ventilator days (10.9 days), ICU length of stay (12.1 days), HLOS (18.8 days). Additionally, incidence of pulmonary infection (63.9%) and incidence of aspiration (37.7%) were noted to be increased with no statistically significant change in survival. In conclusion, trauma patients requiring emergent intubation in the ED are uniquely predisposed towards development of pneumonia and inhospital morbidity. These patients should be aggressively managed with strategies aimed at VAPprevention.

72-Hour Clinical Pulmonary Infection Score May Have Prognostic Value Among Trauma Patients With Ventilator Associated Pneumonia

Background: Ventilator-associated pneumonia (VAP) is a common, serious nosocomial infection; reduction of morbidity and mortality is achieved by prompt diagnosis and early initiation of appropriate empiric antimicrobial therapy. While Clinical Pulmonary Infection Score (CPIS) on the day of VAPdiagnosis has not been proven a consistently effective device, we postulate the CPIS 72 hours after VAPdiagnosis may serve as a clinical prognostic indicator. The purpose of this study is to assess the potential value of CPIS in trauma patients with VAP. Methods:We performed a retrospective chart review of 50 intubated trauma patients with VAPadmitted to the intensive care unit (ICU) of an urban level-I trauma center from January-December 2013. Patients were consecutively identied via trauma registry, and data were abstracted on demographics; injury severity score (ISS); vital signs; laboratory values; microbiological cultures; ventilator settings; antibiotic therapy; time of VAP diagnosis; outcomes; and survival to discharge. We calculated modied CPIS at initial diagnosis and 72-hours post-diagnosis. Incomplete records were excluded from analysis. Results: Forty-nine patients, 25 females and 24 males, with mean age of 66.1±5.2 years were analyzed. Overall mortality was 18.4% (n=9); mean ISS was 18.3±1.2; mean length of stay (LOS) was 20.7±3 days; mean ICU-LOS was 16.7±3.1 days; mean ventilator days was 15±3.2; mean day-1 CPIS was 5.8±0.5; and mean day-3 CPIS was 4.9±0.6. Multidrug resistant organisms (MDROs) were identied in 26 patients and associated with higher 72-hour CPIS (5.8±0.9 vs 3.7±0.7, p=0.025). 72-hour CPIS <6 was signicantly associated with shorter LOS (16.8±3.1 vs 27.3±5.2 d), shorter ICU-LOS (12.4±2.9 vs 24.1±5.6 d), shorter duration of mechanical ventilation (10.8±3 vs 22.1±5.9 d), and earlier VAPdiagnoses (hospital day 4.4±0.6 vs 7.1±1.4, p<0.001). Conclusions:Initial CPIS calculations after VAPdiagnosis have no clinical value. While not associated with survival to discharge, CPIS calculated 72 hours after VAPdiagnosis may be used as a prognostic indicator for MDROs and improved short-term outcomes for trauma patients.

Preeclampsia y eclampsia en el período gravídico y puerperal en pacientes ingresadas en cuidados intensivos / Preeclampsia and Eclampsia in the Gravid and Puerperal Period in Patients Admitted To Intensive Care

Introducción: La preeclampsia produce proteinuria, edema e hipertensión arterial. La eclampsia aparece luego de la preeclampsia o de forma aguda con convulsiones. Ambos estados suelen producirse hacia el final de la gestación, durante o después del parto. Objetivo: Caracterizar a gestantes o puérperas con preeclampsia-eclampsia, ingresadas en la unidad de cuidados intensivos. Método: Estudio descriptivo, prospectivo y longitudinal, que incluyó 38 pacientes a las que se les realizó examen físico completo, exámenes complementarios de utilidad para su diagnóstico y el índice APACHE II. Resultados: Predominaron las puérperas con preeclampsia y las edades entre 21 a 35 años. Los factores de riesgo más frecuentes encontrados: las edades extremas, antecedentes personales y la nuliparidad. Con una estadía entre 4 y 5 días de ambos grupos, con 100 por ciento de egresos vivos. Conclusiones: Con una estrategia de seguimiento precoz en gestantes y puérperas con riesgo, se puede llegar al diagnóstico de formas graves e incipientes de preeclampsia(AU)

Introduction: Preeclampsia produces proteinuria, edema and arterial hypertension. Eclampsia appears after preeclampsia or acute with seizures. Both states usually occur towards the end of pregnancy, during or after delivery. Objective: To characterize pregnant or puerperal women with preeclampsia-eclampsia, admitted to the Intensive Care Unit. Methods: A descriptive, prospective and longitudinal study was concluded, in 38 patients who underwent a complete physical examination, complementary tests useful for their diagnosis and APACHE II index. Results: Puerperal pre-eclampsia predominated. The ages between 21 to 35 years prevailed. The most frequent risk factors found were advanced ages, personal history and nulliparity. The stay ranged between 4 and 5 days in both groups, with 100 percent of live hospital discharges. Conclusions: The early diagnosis of severe and initial forms of preeclampsia is possible with a strategy of early follow-up in pregnant and puerperal women at risks(AU)

Prevalence of prolonged corrected QT interval and its impact on outcomes in patients admitted in medical intensive care unit

Background: The long QT syndrome (LQTS) is a disorder of myocardial repolarization characterized by a prolonged QT interval on the electrocardiogram (ECG). Hence the present study was aimed to determine prevalence of QT prolongation of the ECG and to assess its impact on outcomes in patients admitted in medical ICU of Noor Hospital of IIMSR Medical College, Badnapur, Jalna, Maharashtra, India.Methods: This prospective observational study was carried out during the period of October 2016 to March 2018, for assessment of prevalence of prolonged QTc at admission and its impact on outcomes in medical ICU. QTc calculated by bazett’s formula of >440 ms for males and >460 ms for females was considered as prolonged. Details of illness, clinical observations and laboratory parameters were also monitored.Results: The total 150 patients were studied and there was a high prevalence (32%) of prolonged QTc at admission to the ICU which reduced to 20.5% on day 3. Patients with prolonged QTc were found to be at high risk for adverse outcomes and their ICU and hospital stay was more.Conclusions: The study concluded that prolonged QTc is common in authors’ medical ICU at admission (32%). Patients with QTc prolongation were at higher risk for adverse outcomes and their ICU and hospital stay was more.

Quality of Life in Critically Ill Patients: A Systematic Review.

Objective: This paper aims to present a comprehensive literature review of Quality of Life (QOL) in patients who are suffering from serious medical illness as evidenced by receiving treatment in the intensive care setting. By examining the instruments used to measure QOL, as well as the factors that influence it, this review will explore the relevance of QOL to patient care and management. Data Sources: From Medline and other online resources, over 467 articles were identified, of which 73 articles were selected for inclusion in this review by three independent reviewers. The reviewers reached a consensus using pre-defined selection criteria. Study Selection Criteria: Articles had to: 1) be written in English or have an available published English translation, 2) be published in a peer-reviewed journal, 3) study adult humans, 4) focus on serious medical illnesses, such as sepsis and MI (myocardial infarction), rather than focusing exclusively on terminal illnesses (any study design was accepted), and 5) use at least one QOL measure. Data Extraction: The study selection process yielded 73 articles. Research methodology and key findings were derived from the full text and tables of the selected studies. Data Synthesis: QOL is very poor in gravely ill medical patients and continues to decline with further deterioration of medical status. A model that incorporates QOL and the severity of the medical illness, in addition to the patient’s wishes, might have the potential to improve overall QOL for patients and their families and guide end-of-life decisions. Conclusions: A formal assessment of the patient's QOL and final wishes could assist the patient, their loved ones, and the treating physician in making critical decisions about how to improve QOL through comfort/palliative care.

Strategizing quality implementation in intensive care unit: a statistically-sound, novel approach using Delphi technique.

Background: Ascendancy of Intensive Care Medicine in the realm of healthcare has made Continuous Quality Improvement (CQI) in Intensive Care Units (ICUs) most imperative for hospital administrators worldwide. Perspicuous identification of all clinical and non-clinical drivers warranting contemplation is the most arduous step in achieving the same. This study avers the effectiveness of a statistically-sound, novel approach using Delphi technique in identifying various drivers to be prioritized for strategizing CQI in the postoperative ICU of a premier tertiary care hospital in Asia. Methods: Three rounds of Delphi survey were initially planned. Mean Rank Scores (MRS) was used to rank the opinions in this study. Results: Statistically validated consensus was reached among expert participants on five drivers that should galvanize hospital administration vis-à-vis strategizing quality implementation in the post-operative ICU. Foremost among these was adequate staff that is tantamount to desirable staff-patient ratio (MRS: 9.4), and regular medical audit for sustainable quality in healthcare delivery (MRS: 9.1). Experts further concurred that communication skills of ICU staff (MRS: 8.9), continuous medical education and training of these staff (MRS: 7.6) along with perspicuous ‘Standard Operating Procedures’ (MRS: 7.1) were other points to be considered. Conclusions: With regard to the process of planning, identification of correct drivers holds the crux in strategizing quality implementation in any setup. Implementing change management is equally imperative. This approach can be used to realize both of these.

Contribuciones de la Psicología al manejo interdisciplinario del paciente en Unidad de Cuidados Intensivos (UCI)

Introducción: Las UCI son altamente estresantes para los pacientes, los familiares y los miembros del equipo de salud. Los temores, la soledad y la pérdida de autonomía son condiciones frecuentes que confrontan a los actores de estas unidades con la vulnerabilidad, el sufrimiento y la muerte. Objetivos: Presentar y argumentar las razones por las que la participación del psicólogo resulta pertinente, relevante e indispensable en el trabajo interdisciplinario dentro de las UCI. Metodología: La evidencia empírica se obtuvo de artículos científicos extraídos de bases de datos especializadas. Resultados: Estar en una UCI es una experiencia altamente estresante y potencialmente traumática, pues los pacientes se enfrentan a situaciones que comprometen la vida y se confrontan con la muerte. Conclusiones: La evidencia sobre la participación del psicólogo en las UCI es escasa. El psicólogo, como estudioso del comportamiento, puede contribuir de manera activa en la evaluación y el manejo del paciente crítico, de su familia y de los miembros del equipo de salud.

Introduction: Intensive Care Units are highly stressful for patients, family and the healthcare team. Fear, loneliness and loss of autonomy are common conditions that confront UCI actors with vulnerability, suffering and death. Objectives: to present and argue the reasons why the psychologist's participation is relevant, important and indispensable in the interdisciplinary work of the ICU. Methodology: the empirical evidence was obtained from scientific articles extracted from specialized databases. Results: Be in the ICU is highly stressful and potentially traumatic because patients are faced with life threatening situations and confronted with death. Conclusions: Evidence on the involvement of psychologists in the ICU is low. The psychologist, as a behavior researcher, can contribute actively in the assessment and handling of critically ill patients, their families and members of the healthcare team.

Caracterización de la morbilidad materna severa en una Unidad de Cuidados Intensivos / Characterization of the severe mother morbility in an Intensive Care Unit

Introducción: el ingreso en cuidados intensivos, es un marcador de morbilidad materna extremadamente grave e importante instrumento para reducir la morbi-mortalidad en pacientes obstétricas complicadas. Objetivos: caracterizar la morbilidad materna en cuidados intensivos relacionada con las causas de ingreso...

Introduction: the admission in the intensive care unit is a marker of extremely severe maternal mortality and an important tool to reduce the morbidity and mortality in obstetric patients with complications. Objectives: to characterize the maternal morbidity in an intensive care unit related to the admission causes. Methods: a retrospective study was conducted in 212 mothers admitted in the intensive care unit (icu) of the enrique cabrera: hospital, habana, 2008-2009. data wer4 collected from medical records, the admission diagnosis was taken as the dependent variable. for qualitative variables authors used percentages and chi²-test and for the quantitative ones the t-test, using the statistic spss-11.5 system...

Influence factors on prognosis of the patients with capillary leak syndrome / 中华急诊医学杂志

Objective To discuss influence factors on prognosis of the patients with capillary leak syndrome (CLS) in ICU.Methods The clinical data of 191 patients with CLS in ICU were reviewed,and the patients were divided into three groups according to prognosis:death group ( n =37),cured group ( n =132) and non-healed group (n =22).The clinical data of death group were compared with those of cured group at admission,during the course of CLS and before discharging from hospital.Results Compared with the cured group,the central venous pressure and serum albumin decreased ( P ＜ 0.01 ) ; anion gap,triglycerides,pressure adjusted heart rate (PAHR) and oxygenation index were lower ( P ＜ 0.01 or P ＜ 0.05) ; serum glucose and SIRS score increased ( P ＜ 0.01 ) in death group.There was higher rate of poor renal function at admission in death group than that in other groups ( P ＜ 0.01 ).There were more many patients treated with intravenous administration of hydroxyethyl starch,ulinastatin and continuous blood filtration therapy in cured group than those in other groups ( P ＜ 0.05).Conclusions The factors influencing the outcomes of the patients with CLS were hypovolemia,severe hypoproteinemia,interior milieu disorder,malnutrition,hypoxemia,renal injury and severe systemic inflammatory response.The outcomes of patients with CLS in ICU could be improved by using hydroxyethyl starch,ulinastatin and continuous blood filtration therapy.

Function of ICU to supervise patients after comprehensive correction of facial skeletal contouring / 中华医学美学美容杂志

Objective To investigate the function and necessity of ICU to supervise and cure the patients after comprehensive correction of facial skeletal contouring. Methods 178 patients were examined carefully and perfectly before operation to obviate taboo. After comprehensive correction of facial skeletal contouring operation, all the patients were transferred into ICU in order to be supervised and cured comprehensively. Results 26 (14. 61 %) patients had hypoxemia ( SPO2 ≤90 %),11(6. 18 %)kaliopenia (K+≤3. 5 mmol/L) and 18 (10. 11 %) hypertension. 21 patients appeared arhythmia. Among these 21 arhythmia patients, 15 (8.43 %) patients had pyknocardia (HR≥100/min), 3 (1. 69 %) atrial premature beat, 1 (0.56 %) fibrillation atrial, 2 (1. 12 %) premature ventricular contraction, 1 (0. 56 %) Ⅱ degree atrioventricular block. 8 patients had respiratory tract obstruction. 2 (1. 12 %) had hemorrhea of mandible and 1 transfused 600 ml blood. 17 (9. 55 %) patients had restlessness. 65 patients had nausea and vomitting. All patients in ICU having postoperative complications had been deal with corresponding management. There were no respiratory failure,hemorrhagic shock, cardiac arrest after operation in 178 patients. Conclusions ICU can offer timely, continuous, and systemic supervision and cure to patients after comprehensive correction of facial skeletal contouring,and reduce the postoperative emergency rate.

Prevalent strains of pathogens with antibiotic resistance isolated from patients with ventilator-associated pneumonia in pediatric intensive care unit / 中华急诊医学杂志

Objective To study the pathogenic bacteria strains with drug-resistance prevailing in patients with ventilator-associated pneumonia(VAP)in Pediatric Intensive Care Unit(PICU)in order to provide a reasonable guidance to the clinical use of suitable antibiotics.Method A retrospective clinical study in 46 patients with VAP was carried out in PICU of Wuhan Children's Hospital between January 2008 and June 2010.The prevalent strains of the pathogenic bacteria with drug-resistance isolated from lower respiratory tract by aspiration were analyzed.Results In total,119 pathogenic microbial strains were isolated including Gram-negative bacilli(G-,65.55%),fungi(21.01%)and Gram-positive cocci(G+,13.45%).Among pathogens,the most common pathogenic strains were Acinetobacter baummannii, Escherichia coli,Klebsiella pneumoniae,candida albicans and coagulase-negative staphylococci.Antibiotic susceptibility tests indicated that the situation of the multiple drug-resistances to antibiotics found in G- and G+ Was serious. Most of G- were sensitive to ciprofloxacin, amikacin, imipenem, meropenem,cefoperazone-sulbaetam and piperacillin-tazobactam.The G+ cocci were 100% susceptibility to vancomycin, teicoplanin and linezolid.Fungi were almost sensitive to all the anti-funaus agents. Conclusions The oredominant oathogens of VAP were G- bacilli,and their multiple drug-resistances to antibiotics were the serious problems.The monitoring of the drugresistance should be emphasized, and the option of antibiotics should depend on the antibiotic sensitivity test.

As dimensões do cuidado da enfermeira na unidade de terapia intensiva / The dimensions of nursing care in the intensive care unit

Esta pesquisa teve como objetivo desvelar os significados do que é o "cuidado" para enfermeiras que trabalham em Unidade de Terapia Intensiva de um hospital particular do Paraná. Desenvolveu-se, pois, uma pesquisa empírica de cunho qualitativo com base na perspectiva fenomenológico-existencial. O cenário em que o estudo se desenvolveu foi o Hospital São Lucas da Faculdade Assis Gurgacz - FAG na cidade de Cascavel (PR) e teve, como colaboradoras, seis enfermeiras da Unidade de Terapia Intensiva. Os depoimentos foram coletados a partir de uma entrevista semi-estruturada, analisados à luz da fenomenologia. A análise dos depoimentos foi baseada na proposta fenomenológica empírica de Amedeo Giorgi, que segue quatro passos: apreender o significado dentro da estrutura global por meio da leitura atenta do conteúdo total, expresso de forma a identificarem-se atributos ou elementos presentes; identificar as unidades de significado dentro da perspectiva da pesquisadora por meio da releitura do texto e transformar as expressões do sujeito em linguagem de pesquisa, para que sejam discriminadas afirmações significativas; refletir intuitivamente para captar aquilo que é significativo nas unidades, tendo sempre a questão norteadora como orientação e por fim, sintetizar todas as unidades pela análise de modo a realizar uma análise compreensiva das descrições. Desse modo, dos discursos emergiram seis categorias: Dimensão do mundo do cuidado, O Cuidar como Encontro com a Finitude, o Estar-Com a Família no Mundo do Cuidado, Cuidar como Trabalho em Equipe, A humanização do cuidado e, Criando a Visibilidade do Cuidado pela Enfermeira da UTI. A abordagem fenomenológica permitiu estar no mundo do cuidar da UTI e perceber que o cotidiano é repleto de complexas e infinitas possibilidades, cujo sentido é dado por quem o vivencia, permitindo uma compreensão dos significados do cuidar para o contexto da enfermagem. Conclui-se que o cuidar em UTI é uma atividade complexa que envolve o gerenciamento e a administração de serviços, bem como a formação continuada, a sistematização de procedimentos e convívio com a dimensão técnica e a tecnologia. Isto gera ambiguidades para o enfermeiro, pois este se depara com um distanciamento do cuidado direto ao paciente, bem como com os ideais trazidos da sua formação. Além disso, o cuidar implica em enfrentar a finitude, em estar-com a família e em trabalho em equipe. Por fim, percebeu-se a necessidade de se discutir a humanização do cuidado e de se refletir sobre a identidade do enfermeiro.

The aim of this research was to uncover the meanings of what is "care" for nurses working in the intensive care unit of a private hospital in Paraná. An empirical research based on qualitative existential-phenomenological perspective was developed. The scenario in which the study was carried out was São Lucas Hospital from Faculdade Assis Gurgacz - FAG and had, as cooperators, six nurses from the Intensive Care Unit of that hospital. The testimonies were collected through a semistructured interview and analyzed based on phenomenology. The phenomenological approach allowed us to be in the world of the ICU care, and realize that daily life is full of complex and endless possibilities, which meaning is given by the person who experiences, allowing an understanding of the meanings of caring in nursing context. The statements relied on the model proposed by the empirical phenomenology of Amedeo Giorgi, which follows four steps: understand the meaning within the overall structure by carefully reading the entire contents expressed in order to identify attributes or elements; identify units of meaning within the perspective of the researcher by rereading the text and changing the expressions of the subject to research language so that significant statements are described; think intuitively to express what is significant in the units, taking the research question as guidance, and finally synthesize all units through comprehensive analysis of the descriptions. Six categories rose from the speeches: World dimension of care; care as a joint with finitude; being with family in the world of caring; care as a teamwork; the humanization of care and, creating visibility of care by ICU nurses. It is concluded that ICU care is a complex activity which involves from management and administration services and continuing education to systemizing procedures as well as coping with technical dimension and technology. These create ambiguities for the nurse, who is faced with a distancing from the patient care and the relation of the ideals brought from training. In addition, caring means facing the finitude, being with family and also teamwork. Finally, the humanization of care and the reflection on the identity of the nurse are needed.

Antibiotic Resistance Analysis in Nosocomial Infections with Acinetobacter baumannii from Lower Respiratory Tract in ICU / 中华医院感染学杂志

OBJECTIVE To investigate antibiotic resistance in nosocomial infections with Acinetobacter baumannii from lower respiratory tract in the intensive care unit(ICU) and guide clinically rational use of drug.METHODS Antibiotics susceptibility tests in 109 clinical isolates of A.baumannii from lower respiratiory tract were performed by K-B disk diffusion method.The results were judged according to CLSI 2007.As controls,standard strain was used simultaneously.RESULTS The sensitivity rate to cefoperazone/sulbactam was the highest,arriving at 77.1% and followed by imipenem(57.8%) and meropenem(54.9%).The other antibiotics were below 50.0%,generally.The serious cross-resistance phenomenon was in present.Pan-resistant strains had been detected.CONCLUSIONS The drug-resistant status in nosocomial infections with A.baumannii from lower respiratory tract in ICU is very serious.We should continue to strengthen the monitoring of the antibiotic resistance and prevent the outbreak epidemics of drug resistant strains in ICU.

Nosocomial Infections with Pseudomonas aeruginosa in ICU:Clinical Distribution and Drug Resistance / 中华医院感染学杂志

OBJECTIVE To investigate flora distribution and drug resistance status of nosocomial infections with Pseudomonas aeruginosa (PAE) in intensive care unit (ICU) and to provide the scientific reference for clinically reasonable use of antibiotics. METHODS PAE was isolated,cultured and identified according to the National Clinical Laboratory Operation Rules. The antibiotic susceptibility test was performed by K-B method and the results were read according to CLSI 2004-2006. RESULTS Among 254 PAE strains,the isolating rate in the lower respiratory tract samples was the highest (rriving 59.4%). Then the isolating rate in the wound and soft tissue infection samples was 13.8%. The drug-resistance supervision in vitro accounted for 17.3% and 19.7%,respectively,of PAE were resistant to imipenem and meropenem in ICU. The drug resistance rate to aztreonam,trimethoprim-sulfamethoxazole,ciprofloxacin,levofloxacin,gentamicin,cefotaxime,cefepime and piperacillin was all over 60.0%. CONCLUSIONS PAE in ICU is the mostly multi-resistant strain. We should strengthen its monitoring and controlling.