Research progress of quiet time intervention in improving sleep quality of ICU patients / 中国实用护理杂志

Quiet time intervention is an effective strategy to improve the sleep quality of ICU patients.This paper reviews the concept and implementation of quiet time intervention, the evaluation index of improving ICU patients′ sleep quality, and the impact on ICU patients′ sleep quality, aiming to provide reference for clinical medical staff to provide better sleep intervention strategies for ICU patients.

The value of space glucose control in ICU stress hyperglycemia management / 中华急诊医学杂志

Objective@#To investigate the effect of space glucose control (SGC) on the quality of blood glucose management in ICU patients with stress hyperglycemia.@*Methods@#A prospective, cross-controlled, quasi-trial was conducted to observe patients with ICU-induced stress hyperglycemia between January 2018 and January 2019. Patients with conventional blood glucose management served as the control group, and SGC blood glucose management was used as the intervention group. The enrolled patients were interchanged between the two groups every 24 h, and the end point was 96 h. The differences in blood glucose management quality indicators between the two groups were compared, including the average blood glucose level, the highest and lowest blood glucose level, the average blood glucose monitoring interval, and the accumulated insulin dosage. SPSS 23.0 was used to analyze the data. The paired t test was used for the normal distributed data. Otherwise, two nonparametric correlation sample tests was used. A P<0.05 was considered statistically significant.@*Results@#A total of 41 patients enrolled in this study during the study period. The average blood glucose value in the intervention group was significantly lower than that in the control group [(8.60 ±1.42)mmol/L vs (10.02 ±1.49)mmol/L, P< 0.01]. The frequency of hyperglycemia was lower than that of the control group (16.59 ±8.56 vs 18.73 ±7.91, P=0.023). The frequency of blood glucose value in the target blood glucose range was significantly higher than that of the control group (53.07±19.11 vs 29.44±19.60, P< 0.01). However, the frequency of hypoglycemia, the frequency of blood glucose monitoring and the accumulated insulin dosage in the intervention group were higher than those in the control group [1 (0, 5) vs 0 (0, 2), P< 0 01; 1 36 ±0 23 vs 1 89 ±0 28, P< 0.01; and (139.61 ±77.06)U vs (107.49 ±64.41)U, P<0.01].@*Conclusions@#SGC can optimize the control of blood glucose in the target blood glucose range, but it can easily lead to mild hypoglycemia, and to a certain extent increases the workload of medical staff.

The value of space glucose control in ICU stress hyperglycemia management / 中华急诊医学杂志

Objective To investigate the effect of space glucose control (SGC) on the quality of blood glucose management in ICU patients with stress hyperglycemia.Methods A prospective,cross-controlled,quasi-trial was conducted to observe patients with ICU-induced stress hyperglycemia between January 2018 and January 2019.Patients with conventional blood glucose management served as the control group,and SGC blood glucose management was used as the intervention group.The enrolled patients were interchanged between the two groups every 24 h,and the end point was 96 h.The differences in blood glucose management quality indicators between the two groups were compared,including the average blood glucose level,the highest and lowest blood glucose level,the average blood glucose monitoring interval,and the accumulated insulin dosage.SPSS 23.0 was used to analyze the data.The paired t test was used for the normal distributed data.Otherwise,two nonparametric correlation sample tests was used.A P＜0.05 was considered statistically significant.Results A total of 41 patients enrolled in this study during the study period.The average blood glucose value in the intervention group was significantly lower than that in the control group [(8.60 ±l.42)mmol/L vs (10.02 ±1.49)mmol/L,P＜0.01].The frequency of hyperglycemia was lower than that of the control group (16.59 ±8.56 vs 18.73 ±7.91,P=0.023).The frequency of blood glucose value in the target blood glucose range was significantly higher than that of the control group (53.07±19.11 vs 29.44±19.60,P＜ 0.01).However,the frequency of hypoglycemia,the frequency of blood glucose monitoring and the accumulated insulin dosage in the intervention group were higher than those in the control group [1 (0,5) vs 0 (0,2),P＜ 0 01;1 36 ±0 23 vs 1 89 ±0 28,P＜ 0.01;and (139.61 ±77.06)U vs (107.49 ±64.41)U,P＜0.01].Conclusions SGC can optimize the control of blood glucose in the target blood glucose range,but it can easily lead to mild hypoglycemia,and to a certain extent increases the workload of medical staff.

Cholesterol levels: the prognostic significance in ICU patients

Background: Snakebite envenomation is an important public health problem faced by the tropical countries with India, the worst affected in terms of mortality and morbidity. In spite of increasing reports of other snake species causing envenomation, the existing research and management strategies including antivenom are still focused on the “Big Four” species- Russel’s viper, saw scaled viper, common krait and spectacled cobra. Pit vipers as a group are being increasingly reported to cause human bites from different parts of the country. Hence, we decided to study the clinico-epidemiology of pit viper bites.Methods: 30 cases of proven pit viper bites who attended our Department during the study period of 18 months were analysed for the epidemiological factors, clinical features and abnormalities in laboratory parameters.Results: Hump nosed pit viper (Hypnale hypnale) was responsible for all the thirty cases. 57% of cases were females. Mean age of victims was 41.8 years. 17 patients had exclusively local envenomation. Ten cases had coagulopathy along with local envenomation. Three patients developed acute kidney injury of whom three underwent dialysis. No mortality was observed in the study. Low fibrinogen levels were observed in all cases with coagulopathy and some had low levels of factor V (70%) and factor VIII (40%).Conclusions: Hump nosed viper bites were observed to be common in this part of the country. Significant envenomation can occur. Further epidemiologic studies involving more centres will be helpful in quantifying the true incidence of bites. Since no specific antivenom is available, further researches in this direction are warranted.

Investigation of the cognition, attitudes and clinical practice of ICU medical staff on the family meeting for ICU patients / 中国实用护理杂志

Objective To investigate the cognition, attitudes and clinical practice of ICU medical staff on the family meeting for ICU patients. Methods The study used questionnaire to investigate 428 ICU medical staff and SPSS software to analyze data. Results The cognition of medical staff on the family meeting was 25.4％(109/428). The attitudes of medical staff on the family meeting were positive. Only 38.17％(164/428)medical staff selected necessary or very necessary to carry out the family meeting and only 41.45％(177/428)medical staff would to participate in family meeting. Different professional, the highest record of formal schooling and ICU working life had different attitude scores(t=7.33,F=4.06,5.33, P<0.01 or 0.05);different professional titles and ICU working life had different aspiration attitude scores (F=4.79,6.94,P<0.05 or 0.01). The rate of family meeting in clinical work was only 8.18％ (35/428). Conclusion Medical staff has low level of cognition and attitudes about family meeting on ICU patients, and still many difficulties in clinical implementation.

Influencing factors of venous thromboembolism in hospitalized patients of intensive care unit / 中国实用护理杂志

Objective To analyze the influencing factors of venous thromboembolism (VTE) in intensive care units, and provide evidence for corresponding clinical decisions. Methods A case-control study was carried out:224 VTE patients admitted to the ICUs of tertiary hospitals in Kunshan from Nov. 2011 to Nov. 2016 were included in the case group, and 224 non-VTE patients admitted during the same period were randomly selected as the control. The patients' medical history, laboratory tests, prophylaxis and treatment of VTE, and other relevant data were retrieved. Logistic aggression analysis was utilized to identify the influencing factors of VTE in hospitalized critically ill patients. Results The univariate analysis showed that gender, age, hypertension, smoking, D-dimer, Caprini scaling, prophylaxis and treatment of VTE were associated with VTE. The multivariate analysis indicated that except hypertension, the other varieties were independent influencing factors of VTE in hospitalized critically ill patients:female ( OR=1.68, 95％CI:1.09-2.61, P=0.02), higher age(OR=1.03, 95％CI:1.01-1.04, P<0.01), smoking(OR=6.82, 95％CI:1.70-27.46, P=0.007), smoking(OR=6.82, 95％CI:1.70-27.46, P=0.007), D-dimer(OR=0.94, 95％CI:0.92-0.96, P<0.01), higher Caprini scaling(OR=1.80, 95％CI:1.33-2.44, P<0.01), prophylaxis and treatment of VTE(OR=0.34, 95％CI:0.15-0.79, P=0.01). Conclusions Those ICU patients who are female, elder, with smoking history, have higher test value of D-dimer should be screened and assessed for VTE, and those with higher Caprini scaling should be given closer attention, and receive corresponding prophylaxis and treatment to reduce the formation of VTE and its damage.

Application of minimally invasive tracheostomy with percutaneous horn expansion in ICU / 中国基层医药

Objective To analyze the clinical key points of minimally invasive tracheostomy with percutaneous horn expansion applicated in ICU,and to discuss the problems encountered in minimally invasive surgery and the solutions.Methods The clinical data of 25 patients of minimally invasive tracheostomy with percutaneous horn expansion in ICU were analyzed retrospectively.Results Twenty-one patients with minimally invasive tracheostomy with percutaneous horn expansion were successfully performed in 25 patients of ICU (no incision sputum,subcutaneous emphysema,pneumothorax and other complications),2 patients had more postoperative bleeding,2 patients were difficult to imbedding catheter,of which 1 case abandoned the catheter and received conventional tracheotomy.Conclusion Percutaneous horn expansion minimally invasive tracheostomy has the advantages of small incision,less injury,less operative time,less blood loss and low incidence of complications.However,ICU patients are in severe condition and easy to change.Adequate preoperative preparation,controlling the key steps in the operation can find a solution to the problme.

Prediction of Outcome in ICU Patients Using SAPS II Scoring-A Prospective Study.

Introduction: Since 1981, several severity scores have been proposed for ICU patients. The first ones were acute physiology and chronic health evaluation(APACHE, APACHEII),Simplified acute physiology score (SAPS); later, mortality probability model(MPM) and APACHE III were introduced. The SAPS II scoring system, have been used as a method for converting the score to a probability of hospital mortality.The present prospective study is designed to predict the ICU outcome in medical ICU patients. Objective of the Study: To predict the mortality and morbidity of the patients admitted in ICU for various emergencies using SAPS II scoring system and correlate it with the outcome of the patient on discharge. Materials and Methods: The study prospective type, data was obtained from the patients admitted to ICU ,SAPS II scoring was given and were followed up till they got discharged to assess the outcome .Results:45 patients were studied the total mortality was 26.6%. The SAPS II Scores of the patients and the number of deaths in the different groups are given in table below. The chi-square value was 23.04, df= 6with a p + 0.0007 and this study is well within the p value of 0.05, hence it is significant which means the higher the score the more is the risk of morbidity and mortality, when score is >50 there is increased risk of morbidity and mortality, when score is >50 there is increased risk of mortality. Conclusion:The present study imposes on the following conclusions -SAPS II scoring is useful in predicting the ICU outcome of patients admitted in the ICU even when the primary diagnosis is not specified.

Effects of APACHE II Score and Initial Nutritional Status on Prognosis of the Critically Ill Patients / 대한구급학회지

BACKGROUND: Malnutrition is common in hospitalized patients, especially in critically ill patients and affects their mortality and morbidity. However, the correlation between malnutrition and poor outcome is not fully understood. Our hypothesis is that the nutritional effect on the patient's prognosis would differ depending on the severity of the disease. METHODS: 3,758 patients admitted to the intensive care unit (ICU) were observed retrospectively. Patients were divided into well, moderate and severe groups, according to their nutritional status as assessed by their serum albumin level and total lymphocyte count (TLC). The severity of the disease was assessed by the Acute Physiologic and Chronic Health Evaluation (APACHE II score). All patients were followed clinically until discharge or death and ICU days, hospital days, ventilator days, and mortality rates were recorded. RESULTS: Depending on the definition used, the prevalence of hospital malnutrition is reported to be 68.3%. Hospital days, ICU days, as well as ventilator days of moderate and severe groups were longer than the well group. In patients exhibiting mild severity of disease, moderate and severe malnutrition groups have 3-5 times the mortality rate than the well group. CONCLUSIONS: Malnutrition affects the prognosis of patients who have an APACHE II score ranging from 4-29 points. Active nutritional support may be more effective for patients with a disease of mild severity.

Candiduria in catheterized intensive care unit patients : Emerging microbiological trends.

Objectives: Urinary tract infection (UTI) as a result of Candida spp. is becoming increasingly common in hospitalized setting. Clinicians face dilemma in differentiating colonization from true infection and whether to treat candiduria or not. The objective of the present study was to look into the significance of candiduria in catheterized patients admitted in the ICUs and perform microbiological characterization of yeasts to guide treatment protocols. Materials and Methods: One hundred consecutive isolates of Candida spp. from the urine sample of 70 catheterized patients admitted in the ICU were collected and stocked for further characterization. A proforma was maintained containing demographic and clinical details. Blood cultures were obtained from all these 70 patients and processed. Species identification of yeasts was done on VITEK. Results: Candiduria was more common at extremes of age. The mean duration of catheter days was 11.1 ± 6 days. Other associated risk factors such as diabetes mellitus and antibiotic usage were seen in 38% and 100% of our study group. Concomitant candidemia was seen in 4.3% of cases. Non-albicans Candida spp. (71.4%) emerged as the predominant pathogen causing nosocomial UTI. Conclusion: The present study reiterates the presence of candiduria in catheterized patients, especially in the presence of diabetes and antibiotic usage. Non-albicans Candida spp. are replacing Candida albicans as the predominant pathogen for nosocomial UTI. Hence, we believe that surveillance for nosocomial candiduria should be carried out in hospitalized patients.

Desafios na profilaxia do tromboembolismo venoso: abordagem do paciente crítico / Challenges in prevention venous thromboembolism: critical ill patient approach

JUSTIFICATIVA E OBJETIVOS: O tromboembolismo venoso (TEV), que inclui a trombose venosa profunda (TVP) e o tromboembolismo pulmonar (TEP) são complicações comuns em pacientes críticos. A ocorrência de TEV acarreta um substancial aumento da morbimortalidade dos pacientes internados em unidades de terapia intensiva (UTI). CONTEÚDO: A maioria dos pacientes críticos apresenta alto risco para ocorrência de complicações tromboembólicas, entretanto, a prevenção do TEV muitas vezes não é realizada de maneira adequada para este grupo de pacientes. A heparina de baixo peso molecular (HBPM) parece ser o método mais eficiente para a prevenção do TEV em pacientes de UTI. Entretanto, é patente a escassez de estudos voltados para esta população, cujas particularidades levam a recomendações específicas em relação ao diagnóstico e tratamento. CONCLUSÕES: Esta revisão faz uma análise do risco, discute os principais trabalhos publicados a respeito da profilaxia e sugere estratégias para a diminuição da ocorrência de TEV nos pacientes críticos.

BACKGROUND AND OBJECTIVES: Venous thromboembolism (VTE), with includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication in critically ill patients, resulting in high morbidity and mortality. CONTENTS: Most patients treated in intensive care units (ICU) face a high risk of thromboembolic complications. Despite these considerations, the prevention of VTE may not be as high a priority in ICU patients as it is in other high-risk patient groups. Low molecular weight heparin (LMWH) may be the optimal prophylaxis in most ICU patients, but there is a lack of sufficient data including the paucity of VTE consensus and guidelines documents pertaining to critically ill patients. CONCLUSIONS: This article reviews background, current options, and recommendations regarding VTE in intensive care population emphasizing special diagnostic and treatment considerations in the ICU setting.

Drug Resistance of Chryseobacterium meningosepticum / 中华医院感染学杂志

OBJECTIVE To compare and analyze the drug resistance of Chryseobacterium meningosepticum which producing metallo-?-lactamase(MBL) and extended-spectrum-?-lactamases(ESBLs) from ICU patients′ and non ICU patients′ specimens of sputa so as to guide the rational application of antibiotics.METHODS Identified the strains with VITEK 32,MBL and ESBLs were also screened by double disk synergy;the antimicrobial sensitivity of clinical isolates was tested by VITEK GNS143 and the antimicrobial sensitivity was added and tested by K-B method.RESULTS As a result the rate of producing MBL of C.meningosepticum was 49.0% from ICU patients′ specimens of sputa which was higher than the rate of 13.8% from non ICU patients′;the rate of producing ESBLs of C.meningosepticum was 37.2% from ICU patients′ specimens of sputa which was higher than the rate of 30.6% from non ICU patients′;the rate of drug resistance to AMP/SUB,TZP,CEP,CIP,and LEV from ICU patients′ was higher than that from non ICU patients.CONCLUSIONS Why the high resistance rate of C.mengingosepticum in ICU patients′ specimens of sputa might be due to the high producing ?-lactamases(MBL and ESBLs).

A Study About the Factors Concerned with Death of ICU patients by the APACHE III tool / 성인간호학회지

Using the APCHE III tool, this study was about the factors related to the death of ICU-patients. From 1999. 12. 1 to 2000. 9. 30, the 284 patients admitted to ICU at P university who were over 15 years of age were selected for the subjets. The data was analyzed through SPSS WIN program for frequency, percentile, x2-test, t-test and logistic regression. The results are summarized as follows: 1) Of the 284 patients, 88died. The mortality is 31.0 percent. The average APACHE III point was 48.62 +/- 32.32. The average point of non-survivors was higher than that of survivors. 2) There are the significant difference between APACHE III marks and mortality. The mortality rate were over 50 percent 60 points of the mark. When the marks were over 100 points, the mortality were over 90 percent. Below 40 points, the mortality was below 10 percent. Among the variables in the APACHE III, the most significant variables in explaining death were neurologic abnormalities, pulse, PaO2/ AaDO2, creatinine, sodium, glucose, chronic health state and age. According to the variables, the models explained the 42.43 percent of the variance in patient's death. In conclusion, the APACHE III tool can be used to predict the progress of ICU patients, and can also be used for the selection of patients for ICU admission/discharge criteria.

The causes and effects of airway incidents on Post-surgical ICU patients.

Objective : To identify the causes and effects of in airway incident reduction in the post-surgical ICU, Siriraj Hospital. CQI program was gradually implemented to reduce the incidence. Methods : Self-reported of airway incidents ( unplanned extubation, tube dislocation, tube obstruction, unrecognised disconnection etc.) from August 2000-January 2001 were used for data collection and analysis. CQI program was implemented gradually over six months. Results : Among 284 intubated patients in 524 patients admitted to post-surgical ICU, there were 24 episodes of airway incidents during 6 months, 15 episodes in the first trimester and 9 episodes in the second trimester. The incidents happened during afternoon shifts more than other shifts. Five patients experienced moderate cardiopulmonary events (hypoxemia or severe hypo or hypertension) and two resulted in death. Most (23 out of 24) episodes were considered preventable. The causes were; lack of manpower, insecure airways, lack of knowledge, inadequate communication and inadequate sedation. Conclusion : Airways incidents occurred for several different reasons and occasionally resulted in death. Most of the causes were preventable. The CQI program aimed to define preventable causes and improved the quality of care.

Midazolam Infusion for Sedation in the ICU Patients / 대한마취과학회지

Problems related to agitation in the ICU patients include cardiorespiratory instability, ina bility to cooperate with nursing care, failure to maintain op timal positioning in bed, dis- ruption of life sustaining tubes and catheters, and injuries to patients and hospital person- nel. Thus, the ability to provide safe, controllable, and reversible sedation can be important in the care of critically ill patients. Midazolam is a water soluble imidazobenzodiazepine with a rapid onset of ac tion and short elimination half life compared with diazepam or lorazepam. We evaluated the use of midazolam by continuous infusion for prolonged sedation of critically ill adult patients. The results were as follows ; 1) Midazolam infusion effectively controlled severe agitation in all patients. 2) No episodes of cardiovascular depression due to midazolam occur red during the study period. 3) In one patient, tolerance was developed 6 days after infusion. 4) Mean time to alertness was 2.23 hours. 5) In a renal failure patient, there was no significant prolongation of time to alertness. These results suggest that midazolam infusion provides safe, controllable, and reversible sedation in the care of critically ill patients.