Risk factors for intensive care unit delirium after cardiac operation / 中华危重病急救医学

Objective? ?To?analyze?the?risk?factors?of?delirium?in?patients?in?cardiac?surgery?intensive?care?unit?(CSICU).? Methods? A?prospective?observational?study?was?performed.?Patients?admitted?to?CSICU?of?Fujian?Medical?University?Union?Hospital?from?March?to?August?in?2017?were?enrolled.?The?combination?of?the?Richmond?agitation?sedation?scale?(RASS)?and?the?ICU-confusion?assessment?method?(CAM-ICU)?were?used?to?evaluate?delirium.?The?patient?was?assessed?on?the?second?day?after?CSICU?admission,?twice?a?day,?the?evaluation?was?stopped,?and?the?follow-up??observation?was?terminated?after?the?patient?was?discharged?from?CSICU.?The?patients?were?divided?into?two?groups?according?to?whether?delirium?occurred?in?CSICU.?The?general?and?clinical?treatment?data?(including?condition,?operation,?anesthesia?and?CSICU?treatment)?of?the?two?groups?were?compared.?The?related?factors?of?delirium?were?identified?by?univariate?analysis?and?multifactor?Logistic?regression?analysis.? Results? A?total?of?318?cases?were?included?in?this?study.?Among?them,?93?cases?had?delirium?and?the?incidence?of?delirium?was?29.2%.?It?was?shown?by?univariate?analysis?that?age,?history?of?hypertension,?type?of?surgery,?surgical?procedure,?American?Society?of?Anesthesiologists?(ASA)?anesthesia?classification,?usage?of?propofol,?plasma?transfusion,?red?blood?cells,?platelet?transfusion,?blood?loss,?operative?time,?cardiopulmonary?bypass?(CPB)?time,?myocardial?block?time,?acute?physiology?and?chronic?health?evaluation?Ⅱ?(APACHEⅡ),?duration?of?mechanical?ventilation,?the?length?of?intensive?care?unit?(ICU)?stay,?postoperative?usage?of?diazepam,?midazolam,?fentanyl,?morphine,?chlorpromazine,?etc.?which?were?related?to?delirium,?and?occupation?? (on-the-job?or?self-employed),?medical?insurance?(city?or?provincial?medical?insurance),?education?(primary?to?junior?high?school,?high?school?or?above)?could?reduce?the?risk?of?delirium.?Colinearity?diagnosis?was?performed?on?variables?with?statistically?significant?differences,?and?variables?with?variance?expansion?factor?(VIF)?<?3?were?included?in?multivariate?Logistic?regression?analysis.?The?results?showed?that?age,?education?level,?type?of?surgery,?ASA?classification,?CPB?time,?APACHEⅡ,?ICU?mechanical?ventilation?time,?and?post?operation?usage?of?midazolam?were?independently?related?to?delirium?[age:?odds?ratio?(OR)?=?1.625,?95%?confidence?interval?(95%CI)?=?1.303-2.026;?education?level:?OR?=?0.293,?95%CI =?0.171-0.504;?type?of?surgery:?OR?=?2.194,?95%CI =?1.052-4.576;?ASA?classification:?OR?=?1.916,?95%CI =?1.032-3.559;?CPB?time:?OR =?2.125,?95%CI =?1.105-4.088;?APACHEⅡ:?OR =?2.091,?95%CI =?1.005-4.349;?ICU?mechanical?ventilation?time:?OR =?1.943,?95%CI?=?1.269-2.975;?midazolam:?OR =?2.653,?95%CI =?1.328-5.299;?all?P?<?0.05],?among?which,?high?education?level?has?a?good?protective?effect?on?delirium.? Conclusions? Age,?type?of?surgery,?ASA?classification,?CPB?time,?APACHEⅡ,?ICU?mechanical?ventilation?time,?post?operation?usage?of?midazolam?were?independent?risk?factors?for?delirium,?and?high?education?level?had?a?good?protective?effect.?Among?them,?the?educational?level,?CPB?time,?duration?of?mechanical?ventilation,?and?midazolam?are?intervention?factors.?In?clinical?treatment,?not?only?the?risk?factors?should?be?identified,?but?also?intervention?should?be?taken?to?prevent?the?occurrence?of?delirium.

Reliability and validity of Chinese version of Intensive Care Unit Environment Stressor Questionnaire / 中华护理杂志

Objective To translate the English vcrsion of Intensive Care Unit Environment Stressor Questionnaire (ESQ) into Chinese,and test the reliability and validity of the Chinese version of Intensive Care Unit Environment Stressor Questionnaire (ESQ-C).Methods The ESQ-C was translated from the ESQ and back-translated,Delphi tcchnique was used to conduct cultural adaption.The reliability and validity of ESQ-C were tested in 313 cardiac surgery ICU patients.Results The ESQ-C contained 42 items.Eight factors that explained 51.803％ of the variance were extracted after exploratory factor analysis.The Cronbach's α coefficient of the questionnaire was 0.851,the odd-even split-half reliability was 0.888.Conclusion ESQ-C was proved to be valid and reliable.It's a valuablc tool to assess the environment stressors of ICU patients in China.

Prospective study on central line-associated bloodstream infection among critically ill children in 2012-2015 / 中国感染控制杂志

Objective To evaluate the incidence of central line-associated bloodstream infection(CLABSI) among critically ill children, and provide basis for making preventive and control measures.Methods Prospective surveillance was performed to monitor CLABSI among children (including neonates) with central lines in 7 children's intensive care units(ICUs) from January 2012 to December 2015.Results Of 37 712 hospitalized patients, the overall length of hospital stay were 268 531 days, the overall central line-day was 57 639, utilization rate of central line was 21.46%;126 patients had CLABSI, CLABSI rate per 1 000 central line-days was 2.19, there was no significant difference in the CLABSI rate among each year(P>0.05);CLABSI rate in the third quarter was higher than that in other quarters(all P<0.05,compared with the first quarter,RR[95%CI]=1.98[1.20, 3.29]);CLABSI rates were different among different types of ICUs, surgical neonatal ICU (SNICU)(6.12/1 000 central line-days) was higher than other types of ICUs (all P<0.05, compared with pediatric ICUs[PICUs], RR[95%CI]=3.02[1.51-6.04]).126 patients with CLABSI were isolated 139 strains of pathogenic bacteria, the main pathogens were Klebsiella pneumoniae (20.86%) and Staphylococcus epidermidis (15.83%).Conclusion Critically ill children in SNICU are high risk population of CLABSI infection, intensified intervention measures should be developed for the department , so as to reduce CLABSI effectively.

Prevalence of healthcare-associated infection in a children's hospital in Guangzhou in 2014 / 中国感染控制杂志

Objective To investigate the prevalence of healthcare-associated infection(HAI)in a children's spe-cialty hospital in Guangzhou in 2014.Methods A cross-sectional survey was undertaken to investigate the preva-lence of HAI among all hospitalized patients on September 17,2014.Results A total of 997 patients were investiga-ted,30 patients developed 32 times of HAI,HAI rate and HAI case rate were 3.01% and 3.21% respectively. The main infection sites were upper respiratory tract(n= 11,34.38% );the departments with higher HAI prevalence rates were intensive care unit(ICU,3 .99% )and pediatric internal medicine department(3 .60% );the rate of etio-logical examination in patients with HAI accounted for 93 .33% ,a total of 24 strains of pathogens were isolated,6 of which were virus (25 . 00% ),6 were fungi (25 . 00% ),11 were bacteria (45 . 83% ),and 1 was Chlamydia (4.17% ). The main bacteria were Staphylococcusaureus (n= 3,27.27% )and Staphylococcusepidermidis (n= 3, 27.27% );a total of 451 (45.24% )patients received antimicrobial agents on the investigation day,67.41% of whom received therapeutic use of antimicrobial agents,19.73% received prophylactic use,and 12.86% received both therapeutic and prophylactic use;mono-drug application accounted for 82 .26% ,the percentage of bacterial de-tection among patients with therapeutic antimicrobial use (including combination of therapeutic and prophylactic use)was 82.60% .Conclusion Management of key departments and key sites of HAI should be strengthened in children's specialty hospital,antimicrobial agents should be used rationally,so as to protect the safety of children.

Discussion about the effects of using PlCC for low birth weight infant during the course of parenteral nutrition / 中国实用护理杂志

Objective Study of peripherally inserted central catheter (PICC) for low birth weight infant parenteral nutrition effect. Methods A total of 100 low birth weight infants were selected, and then divided into the study group and the control group with 50 cases in each group according to random number table method. The study group used PICC for intravenous nutrition support treatment, the control group using external support for the treatment of indwelling needle for nutrition week vein. Comparing the two groups of one-time success rate of catheterization, average operation time, indwelling time, incidence of complications and nutritional support before and after the treatment, the children of weight. Results The one-time success rate of catheterization between the two groups had no significant difference (P >0.05). The operation time and the indwelling time in the study group was(30.65±9.87) d, (23.47±6.38) d respectively, while in the control group was (3.26±1.09) d, (4.15±1.52) d respectively, the difference was significant between the two groups (t=19.054 and 20.829, P 0.05). Conclusions Parenteral nutritional support by PICC for low birth weight infant is a more ideal way with longer indwelling time and fewer complications.

Targeted monitoring of nosocomial infections in a neonatal intensive care unit / 现代临床护理

Objective To explore the incidence of nosocomial infection in a neonatal intensive care unit(NICU) so as to come out with scientific and effective measures for infection control. Method Real-time monitoring system was used for investigating nosocomial infection of ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central-line associated bloodstream infection (CLABSI) in NICU. Results Among 2 836 patients, 28 patients were infected, with the rate of 0.99%and the case-time infection rate of 1.09%. The nosocomial infection manifested to be blood infection with the rate of 35.48%, and 10%of main pathogens were gram-negative bacteria. Conclusions Targeted monitoring in NICU can make the nosocomial infection information acquired timely, objectively and accurately. The strict and intensified prevention and control program should be adopted to reduce the neonatal nosocomial infection.