Effect of early off-bed mobility on diaphragm function in intensive care unit patients undergoing mechanical ventilation / 中华危重病急救医学

Objective:To explore the improvement of diaphragm function after early off-bed mobility intervention in intensive care unit (ICU) patients undergoing mechanical ventilation.Methods:A randomized controlled trial was conducted. A total of 147 adult patients undergoing mechanical ventilation admitted to ICU of Affiliated Hospital of Zunyi Medical University from October 2019 to March 2022 were enrolled. The patients were divided into control group and observation group by convenient sampling. Except for the different intervention programs of early mobility, other treatment and nursing of the patients in the two groups were carried out according to ICU routine. Progressive early activities were performed in the control group, while early off-bed mobility was performed in the observation group. The changes of diaphragm thickness at the end of inspiratory (DTei), diaphragm thickness at the end of expiratory (DTee) and diaphragm thickening fraction (DTF) before and 24, 48, 72 and 96 hours of intervention, and the duration of mechanical ventilation, length of ICU stay and 24-hour re-intubation rate after intervention were compared between the two groups.Results:Among the 147 patients, there were 4 cases of detachment in the control group and 5 cases of detachment in the observation group. Finally, 138 patients were enrolled, 69 cases in the control group and 69 cases in the observation group. There was no significant difference in gender, age, diagnosis of ICU, sedatives, muscle strength, ventilator model, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and DTei, DTee, DTF before intervention between the two groups. The DTei, DTee and DTF in both groups were increased gradually with the extension of intervention time, especially in the observation group [DTei (cm) at 24, 48, 72 and 96 hours of intervention in the observation group were 0.247±0.014, 0.275±0.016, 0.300±0.013 and 0.329±0.013, while in the control group were 0.242±0.015, 0.258±0.013, 0.269±0.014, and 0.290±0.017, effect of time: F = 993.825, P = 0.000, effect of intervention: F = 82.304, P = 0.000, interaction effect between intervention and time: F = 84.457, P = 0.000; DTee (cm) of the observation group were 0.213±0.014, 0.227±0.013, 0.243±0.016, 0.264±0.010, while in the control group were 0.213±0.016, 0.218±0.013, 0.224±0.013, 0.234±0.014, effect of time: F = 385.552, P = 0.000, effect of intervention: F = 28.161, P = 0.000, interaction effect between intervention and time: F = 45.012, P = 0.000; DTF of the observation group were (15.98±4.23)%, (21.35±4.67)%, (24.09±4.44)% and (25.24±3.74)%, while in the control group were (14.17±4.66)%, (18.11±3.92)%, (20.22±4.19)% and (20.98±4.12)%, effect of time: F = 161.552, P = 0.000, effect of intervention: F = 49.224, P = 0.000, interaction effect between intervention and time: F = -4.507, P = 0.000]. The duration of mechanical ventilation and length of ICU stay in the observation group were significantly shorter than those in the control group [duration of mechanical ventilation (hours): 112.68±12.25 vs. 135.32±22.10, length of ICU stay (days): 7.84±1.78 vs. 10.23±2.43, both P < 0.01]. However, there was no significant difference in 24-hour re-intubation rate between the observation group and the control group (0% vs. 2.90%, P > 0.05). Conclusions:Both early off-bed mobility and progressive early activities can prevent diaphragm weakness in ICU patients undergoing mechanical ventilation, and the effect of early off-bed mobility is better. Early off-bed mobility can significantly shorten the duration of mechanical ventilation and length of ICU stay, and it is safe and feasible.

Summary of the best evidence for maintaining lactation of very low birth weight infant mothers during separation / 中国实用护理杂志

Objective:To search, evaluate and integrate the best evidence for lactation maintenance of very low birth weight infant(VLBWI) mothers, and to provide evidence for lactation maintenance.Methods:Up to Date, BMJ best practice, Newborn Services Clinical Guidelines, ABM, NICE, OVID evidence-based database, NGC, Joanna Briggs Institute Library, Cochrane Library, Web of Science, PubMed, CNKI, CBM and Wanfang Data were retrieved by computer on the Maintenance of Mother′s Lactation in VLBWI: Guidelines, Systematic Evaluation, Expert Consensus/Opinions, Evidence Summary Literature screening, quality evaluation, evidence extraction and integration of documents which met the requirements.Results:A total of 10 articles were included, including 3 guidelines, 4 systematic reviews, 1 expert consensus and 2 expert opinions. A total of 41 evidences were summarized from 9 aspects, including lactation support, lactation initiation, lactation monitoring and the application of lactating agents.Conclusion:The evidence of lactation maintenance of VLBWI mothers is sufficient, which can provide a basis for medical staff to make clinical decisions.

Effect of early off-bed mobility on delirium in mechanical ventilated patients in intensive care unit: a prospective randomized controlled study / 中华危重病急救医学

Objective:To investigate the feasibility of early off-bed mobility in patients with mechanical ventilation and its effect on delirium and the duration of delirium in the intensive care unit (ICU).Methods:Adult patients who were admitted to ICU of the Affiliated Hospital of Zunyi Medical University from January 1st to December 31st 2020 for invasive mechanical ventilation and no early activity contraindication were selected. The patients were randomly divided into two groups. The experimental group conducted early off-bed mobility, such as using the shift machine off-bed sitting and walking aids to assist standing and walking, and the off-bed mobility is based on patient tolerance. The control group was given early bed activities, including conducting the joint range activity, limb movement, bed sitting, upper limb elastic belt movement, and lower limb cycling, once a day. Each joint moved 15-20 times, a total of 30 minutes. Both groups were treated with anti-infection, mechanical ventilation, analgesia and sedation, and nutrition therapy. After intervention, confusion assessment method for the ICU (CAM-ICU) was used to assess the onset and duration of delirium, physical restraint rate and duration of physical restraint, mechanical ventilation time, and the length of ICU stay.Results:After excluding patients who died or gave up treatment during the intervention period, 266 patients were included, with 133 patients in the experimental group and 133 patients in the control group. There were no significant differences in gender, age, diagnosis, degree of illness, sedative drugs between the two groups. The incidence of the delirium in intervention group was significantly lower than that in control group [26.3% (35/133) vs. 42.1% (56/133), χ 2 = 7.366, P = 0.007], the duration of delirium was shorter than that in control group (hours: 11.26±4.11 vs. 17.00±3.29, t = -4.157, P = 0.000), the rate of physical restraint was lower than that in control group [19.5% (26/133) vs. 45.1% (60/133), χ 2 = 19.864, P = 0.000], the duration of physical restraint was shorter than that in control group (hours: 9.71±4.07 vs. 13.55±7.40, t = -5.234, P = 0.000), the mechanical ventilation time and the length of ICU stay were shorter than those in control group [mechanical ventilation time (hours) : 106.23±42.25 vs. 133.10±41.88, t = -3.363, P = 0.001; length of ICU stay (days) : 8.35±6.21 vs. 13.25±9.98, t =-4.190, P = 0.000]. Conclusions:Early off-bed mobility can reduce physical restraint rate and the incidence of delirium, and thus can accelerate rehabilitation in critically ill patients. Early off-bed mobility is safe and effective for patients with mechanical ventilation in ICU.

Design and development of early warning systems for unplanned extubation in decision-making-based critical patients / 中国实用护理杂志

Objective:To develop early warning systems for unplanned extubation in critical patients to give the early warning and interference in order to reduce the risks of unexpected drawn tubes and guarantee the security of the patients.Methods:Took the model of risk warning system for unplanned extubation in critical patients as the core, obeyed the guide of the nursing intervention program, based on the information system of patients in ICU and relied on computer science technology to design the architecture for the interface layout, the partitions, the modular structure, the content and the function of the system. This warning system was designed from multiple angels and directions. This research retrospectively analyzed the 18 cases for unplanned extubation from January to December in 2016 using this system to verify its warning effectiveness.Results:The prototype of this warning system included login module, evaluation module, decision module, warning module, directive module and the module for canal fixed scheme. The system automatically determined the level of risk for critical patients to implement the layered pre-warning and screen the high-risk patients. Finally, individual nursing interfering method could be supplied. The detection rate of this warning system was 88.89% after retrospective analysis.Conclusion:The warning system for unplanned extubation patients is an automated, intellectualized and informationalized platform. It can effectively warn the high risk of the extubation patients and evade the risk of canal nursing.

Application effect of blending-learning model on clinical teaching for practice nursing students in ICU / 中国实用护理杂志

Objective@#To explore the application effect of blending-learning model on clinical teaching for practice nursing students in ICU.@*Methods@#Totally 165 nursing students who practiced in ICU from 2016 to 2017 were selected by convenient sampling.82 nursing students in the traditional teaching mode were used as the control group in 2016, while 83 nursing students in the blending-teaching model on the basis of the control group were used as the observation group in 2017.@*Results@#The aspects of theory and skill operation, clinical nursing comprehensive ability, teaching content, teaching method, language expression, interpersonal relationship, learning atmosphere, learning opportunity and overall evaluation in nursing students of the observation group were (83.89±7.01), (93.05±2.60) , (6.61±1.15), (3.64±0.68) , (3.85±0.77) , (3.76±0.73) , (3.84±0.91) , (3.68±0.78) , (3.74±0.81) , (3.73±0.66) points, which were higher than (69.93±10.28) , (87.94±3.11) , (5.51±1.53) , (2.79±0.84) , (2.69±0.63) , (2.39±0.52) , (2.01±0.70) , (2.43±0.57) , (2.50±0.55) , (2.46±0.55) points in the control group, the differences were significant (t=-14.235- -5.176, P<0.05) .There was no significant difference between the two groups in terms of sex, age, educational level, scores of entrance examination, teachers′ quality, teaching attitude, work atmosphere and organizational support (P>0.05).@*Conclusions@#The blending-teaching model is beneficial to improve the learning achievement, clinical nursing comprehensive ability and satisfaction in nursing students who practiced in ICU, and promote the continuous improvement of clinical teaching quality.

Application effect of blending-learning model on clinical teaching for practice nursing students in ICU / 中国实用护理杂志

Objective To explore the application effect of blending-learning model on clinical teaching for practice nursing students in ICU. Methods Totally 165 nursing students who practiced in ICU from 2016 to 2017 were selected by convenient sampling.82 nursing students in the traditional teaching mode were used as the control group in 2016, while 83 nursing students in the blending-teaching model on the basis of the control group were used as the observation group in 2017. Results The aspects of theory and skill operation, clinical nursing comprehensive ability, teaching content, teaching method, language expression, interpersonal relationship, learning atmosphere, learning opportunity and overall evaluation in nursing students of the observation group were (83.89±7.01),(93.05±2.60), (6.61± 1.15),(3.64±0.68),(3.85±0.77),(3.76±0.73),(3.84±0.91),(3.68±0.78),(3.74±0.81),(3.73±0.66)points, which were higher than(69.93 ± 10.28),(87.94 ± 3.11),(5.51 ± 1.53),(2.79 ± 0.84),(2.69 ± 0.63),(2.39 ± 0.52),(2.01 ± 0.70),(2.43 ± 0.57),(2.50 ± 0.55),(2.46 ± 0.55)points in the control group, the differences were significant(t =-14.235--5.176,P ＜0.05).There was no significant difference between the two groups in terms of sex, age, educational level, scores of entrance examination, teachers′quality, teaching attitude, work atmosphere and organizational support (P>0.05). Conclusions The blending-teaching model is beneficial to improve the learning achievement, clinical nursing comprehensive ability and satisfaction in nursing students who practiced in ICU, and promote the continuous improvement of clinical teaching quality.

Effect of progressive early bed exercise on blood flow in lower limb of patients on mechanical ventilation in intensive care unit / 中华危重病急救医学

Objective To investigate the effect of progressive early bed physical activity on blood flow in lower limb of patients on mechanical ventilation in intensive care unit (ICU). Methods Adult patients with mechanical ventilation ≥ 72 hours admitted to ICU of the Affiliated Hospital of Zunyi Medical University from February 22nd to November 30th, 2016 were enrolled. The patients were randomly divided into experimental group and control group by random number table method. Patients in the two groups were given the same basic treatment, including antibiotics, analgesia and sedation, mechanical ventilation, nutritional support, and routine ICU activities such as maintaining functional position of limbs and raising of bed head. On the basis of those, the experimental group was given early bed physical activity with gradual enhancement of grades Ⅰ-Ⅲ according to the nerve, circulation and respiration situations, such as passive/active exercise of the bicycle, straight leg lifting exercise, etc. The exercise intensity was evaluated with target heart rate, and the exercise was performed for 15-30 minutes at a time, twice a day. The control group was given intermittent pneumatic compression (IPC), 30 minutes in each time, twice a day. Mean blood flow and blood volume were measured before and immediately, 5, 10 and 15 minutes after intervention on the 3rd day. Heart rate and blood pressure were measured at 5 minutes before intervention, during 5 minutes, and 5, 10, 15, 30 minutes after intervention on the 3rd day. Results 214 adult patients were selected, after excluding the patients who died during the intervention or gave up treatment, 160 patients were included in the data analysis, with 81 in the experimental group and 79 in the control group. The mean blood flow velocity and blood volume were increased in both groups, and the mean blood flow velocity and blood flow volume in the experimental group were significantly increased and lasted longer than those in the control group [mean blood flow velocity (mm/s) of the experimental group were 11.92±1.06, 18.19±0.17, 17.24±0.14, 15.48±0.12, 12.68±0.16, and that of the control group were 12.01±1.41, 15.65±0.18, 12.91±0.14, 12.13±0.12, 11.59±0.16, respectively, the time effect was F = 1 043.101, P = 0.000, the intervention effect was F = 151.001, P = 0.000, and the interaction effect between intervention and time was F = 224.830, P = 0.001; the blood volume (mL/min) of the experimental group were 3.39±0.96, 5.59±0.11, 5.16±0.12, 4.19±0.10. 3.35±0.09, and that of the control group were 3.28±0.82, 4.04±0.11, 3.40±0.12, 3.02±0.10, 3.00±0.10, respectively, the time effect was F = 680.405, P = 0.000, the intervention effect was F = 125.359, P = 0.000, and the interaction effect between intervention and time was F = 79.631, P = 0.012]. The heart rate and blood pressure of the two groups of patients in the course of intervention were increased first, then decreased and then slowly recovered to the change trend before intervention, but the index of the experimental group fluctuated greatly [heart rate (bpm) of the experimental group were 97.64±1.50, 113.91±1.36, 105.96±1.34, 98.52±1.48, 97.84±1.46, 97.54±1.48, and that of the control group were 97.03±1.57, 105.39±1.38, 96.76±1.35, 96.54±1.50, 97.22±1.48, 96.53±1.49, respectively, the time effect was F = 235.030, P = 0.000, the intervention effect was F = 39.473, P = 0.000, and the interaction effect between intervention and time was F = 3.494, P = 0.063; the systolic blood pressure (mmHg, 1 mmHg = 0.133 kPa) of the experimental group were 118.57±1.06, 133.05±1.01, 120.44±1.10, 117.78±1.07, 117.65±1.01, 118.14±1.00, and that of the control group were 118.10±1.08, 126.68±1.02, 118.23±1.11, 117.48±1.08, 118.04±1.03, 118.90±1.10, respectively, the time effect was F = 336.604, P = 0.000, the intervention effect was F = 26.350, P = 0.000, and the interaction effect between intervention and time was F = 0.948, P = 0.332; the diastolic blood pressure (mmHg) of the experimental group were 68.07±0.72, 72.79±0.73, 70.68±0.74, 69.30±0.72, 68.73±0.74, 67.80±0.73, and that of the control group were 68.51±0.73, 72.03±0.74, 70.05±0.75, 69.10±0.73, 68.41±0.75, 67.85±0.74, respectively, the time effect was F = 286.390, P = 0.000, the intervention effect was F = 4.812, P = 0.000, and the interactive effect between intervention and time was F = 0.055, P = 0.815]. Conclusions The effects of progressive early bed physical activity on the mean blood flow velocity and blood volume of lower limbs in ICU patients with mechanical ventilation are better than those of IPC. Although the fluctuation of heart rate and blood pressure is large, it does not cause any harm to the patients.

Analysis of risk factors of delirium in patients with mechanical ventilation in intensive care unit / 中华护理杂志

Objective To explore the risk factors and predict the risk of delirium in patients with mechanical ventilation in intensive care unit(ICU).Methods Data were collected from ICU patients hospitalized from June 2016 to June 2017.Logistic regression model was used to analyze the risk factors of delirium in ICU patients with mechanical ventilation,and the ROC curve was used to calculate the area and optimal cut-off value of the curve.Results This study included 398 patients with 163 cases of delirium,and the incidence of delirium was 41.0％.Logistic regression model showed that using physical restraint (OR=3.084),receiving sedation (OR=2.255),duration of mechanical ventilation(OR=1.146) and ICU length of stay(OR=1.111) were independent predictors of delirium.ROC curve showed that the area under the curve was 0.580,0.566,0.787,and 0.774,respectively,and the cut-off value for mechanical ventilation duration and ICU length was 7 days and 8 days,respectively.Conclusion The incidence of delirium in ICU patients with mechanical ventilation is still high.Physical restraint,sedation,mechanical ventilation time of duration more than 7 days and ICU length of stay greater than 8 days can cause ICU delirium.

Nursing preventive interventions of venous thromboembolism in ICU:a methodological systematic review / 中国实用护理杂志

Objective To systematically review the nursing preventive interventions and their effects on venous thromboembolism (VTE) in ICU patients. Methods We searched PubMed, Cochrane Library, EMBASE, SCI, CINAHL, Science Direct, BM, CNKI, WanFang and VIP, to collect the randomized controlled trials of nursing prophylaxis on VTE in ICU patients. Results 57 studies were included, meta-analysis provided that: the incidence rates of VTE and bleeding between Intermittent Pneumatic Compression Devices(IPC) group and low molecular weightheparin group in severe trauma patients had no statistical significance (P=0.14); comparing with graduated compression stockings (GCS) only group, the incidence rates of deep vein thrombosis(DVT) were lower in combination with IPC and GCS group (P=0.003);comparing with routine nursing group, the incidence rates of VTE were lower in IPC group and GCS group (P<0.01), the blood flow velocity and the average velocity of venous flow in lower limbs were increased in IPC group (P<0.01). The results of descriptive analysis show that early comprehensive nursing interventions and corresponding nursing interventions after risk assessment can reduce the incidence of VTE in ICU. Conclusion According to the present projects, using IPC, GCS, adopting early comprehensive nursing interventions and giving corresponding nursing interventions after DVT risk assessment are the effective interventions on ICU VTE.

Nursing preventive interventions of venous thromboembolism in ICU:a methodological systematic review / 中国实用护理杂志

Objective To systematically review the nursing preventive interventions and their effects on venous thromboembolism (VTE) in ICU patients. Methods We searched PubMed, Cochrane Library, EMBASE, SCI, CINAHL, Science Direct, BM, CNKI, WanFang and VIP, to collect the randomized controlled trials of nursing prophylaxis on VTE in ICU patients. Results 57 studies were included, meta-analysis provided that: the incidence rates of VTE and bleeding between Intermittent Pneumatic Compression Devices(IPC) group and low molecular weightheparin group in severe trauma patients had no statistical significance (P=0.14); comparing with graduated compression stockings (GCS) only group, the incidence rates of deep vein thrombosis(DVT) were lower in combination with IPC and GCS group (P=0.003);comparing with routine nursing group, the incidence rates of VTE were lower in IPC group and GCS group (P<0.01), the blood flow velocity and the average velocity of venous flow in lower limbs were increased in IPC group (P<0.01). The results of descriptive analysis show that early comprehensive nursing interventions and corresponding nursing interventions after risk assessment can reduce the incidence of VTE in ICU. Conclusion According to the present projects, using IPC, GCS, adopting early comprehensive nursing interventions and giving corresponding nursing interventions after DVT risk assessment are the effective interventions on ICU VTE.

Construction of nursing comprehensive experimental evaluation index system / 中国实用护理杂志

Objective To construct a comprehensive nursing content and experiment evaluation index weights for the nursing profession to provide objective and comprehensive evaluation criteria for nursing comprehensive experimental evaluation. Methods Literature search method and the Delphi method(Delphi)were used to explore indicators of evaluation and appraisal the analytic hierarchy process was adopted to calculate index weights and test its logical consistency. Results 28 experts were selected from 10 hospitals of five provinces such as Shanghai, Guangzhou, Chongqing, etc. Three round screening investigations' effective return-ratio Wag 93.9%、96.8%and 100.0%respectively.The authoritative coefficient was above 0.70.3 first-level tar-gets were established,14 second-level targets and the corresponding target connotations, all levels of target weight satisfied the logical uniformity request Conclusions The Delphi method and the analytic hierarchy process jointly determine the nursing comprehensive experimental evaluation index system to ensure the scien-title and reliable characteristic of the evaluation index system. It is able to comprehensively measure the overall quality and ability of students for the nursing profession and provide the basis for a comprehensive experimental evaluation.