Status of COPD patients with deep venous thrombosis in RICU / 西安交通大学学报(医学版)

Objective To analyze the incidence and related risk factors of chronic obstructive pulmonary disease (COPD) patients with deep venous thrombosis (DVT) in the respiratory intensive care unit (RICU).Methods We recruited 204 patients from RICU of our hospital between January 2015 and December 2015.The basic clinical data of the patients were also collected.Bedside venous ultrasonography of double lower limbs was taken 24-48 hours after admission.The patients were divided into DVT group and non-DVT group.The clinical data of the two groups were analyzed and compared using Chi-square test or t test,Logistic regression analysis was used to analyze risk factors,and ROC curve analysis was used to identify the disease.Results Among the 204 patients,39 were identified with DVT,with the overall incidence rate of 19.1％.D-dimer in DVT group was significantly higher than that in non-DVT group (P＜0.001).The two groups did not significantly differ in age,sex,smoking history,underlying diseases,or other laboratory test results.The area under the ROC curve of D-dimer was 0.787,and the cut off value was 1.985 mg/L (sensitivity of 0.641,specificity of 0.817).Conclusion D-dimer is closely associated with increased incidence of DVT in COPD patients.

Distribution and change in antimicrobial resistance of bacteria from sputum of patients in respiratory intensive care unit / 中国感染控制杂志

Objective To investigate the distribution and antimicrobial resistance of bacteria isolated from sputum of patients in respiratory intensive care unit (RICU).Methods Non-repetitive bacteria isolated from sputum specimens of 557 hospitalized patients in RICU of a tertiary first-class hospital between January 2013 and December 2015 were collected,antimicrobial resistance of bacteria was analyzed.Results A total of 1 131 bacterial strains were isolated,212 (18.8 ％) were gram-positive bacteria and 919 (81.2 ％) were gram-negative bacteria.The top five species were Acinetobacter baumannii (30.2 ％),Pseudomonas aeruginosa (21.1 ％),Staphylococcus aureus (18.2％),Klebsiella pneumoniae (9.8％),and Serratia marcescens (8.3％).In 2013-2015,isolation rate of Staphylococcus aureus and non-fermentative bacteria showed no obvious changing tendency,but isolation rate of Enterobacteriaceae strains had increasing tendency.Antimicrobial susceptibility testing results showed that Acinetobacter baumannii and Pseudomonas aeruginosa exhibited high resistance rates to imipenem,levofloxacin,and gentamicin (all ＞ 60％),resistance rate of Pseudomonas aeruginosa to ceftazidime showed a downward trend (from 59.4％ to 37.5％);isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) was 96.1％,susceptibility to tigecycline,vancomycin,linezolid,compound sulfamethoxazole,quinupristin/dalfopristin were almost 100％;resistance rates of Enterobacteriaceae strains to sulfonamide decreased from 55.6％ to 14.3 ％,but resistance rates to ceftazidime,cefotaxime,imipenem,levofloxacin,and gentamicin were all ＞60％.Conclusion The major bacteria isolated from sputum of patients in RICU are Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus,antimicrobial resistance of isolated bacteria is serious.

The study of infection situation and antibacterial resistence of Pseudomonas aeruginosa in patients with lower respiratory tract infection in respiratory intensive care unit / 国际检验医学杂志

Objective To investigate the infection situation of Pseudomonas aeruginosa (PA) in patients with the lower respira‐tory tract infection in the department of respiratory intensive care units (RICU ) in recent five years ,and to analyze the changing trend of antibacterial resistence ,in order to guide rational selection of antimicrobial agents .Methods Strains of bacteria were isola‐ted and identified from sputum specimen of patients in the department of RICU and common ward from Jul .2008 to Jul .2013 .The situations of PA infection and antibacterial resistence were analyzed ,and differences of infection rates of PA and antibacterial resis‐tence were compared between RICU and common ward .Results 517 strains of bacteria were detected from sputum specimens of patients in the department of RICU from 2008 to 2013 ,including 141 strains of PA (accounted for 27 .3% ) ,and ticarcilli/clavulanic acid(61 .0% ) was with the highest rate of resistance among 14 drugs and colistin B(9 .2% ) was with the lowest rate of resistance . 378 strains of bacterias were detected from sputum specimens of patients in common wards ,including 125 strians of PA(accounted for 33 .1% ) ,and ticarcilli/clavulanic acid(28 .0% ) was with the highest rates of resistance and colistin B (4 .0% ) was with the low‐est rate of resistance .Conclusion In recent 5 years ,PA might be one of the main pathogenic bacterias of respiratory tract infections in the depatment of RICU in this hospital ,and antibiotic resistance may increse gradually .The antibiotic resistance in the depatment of RICU may be higher than that in cionmon wards .Clinical effective measures should be taken to prevent nosocomial infection ,and rational use of antibiotics should be taken to reduce the emergence of resistant strains .

Influence of different routes of nutrition on the respiratory muscle strength and outcome of elderly patients in respiratory intensive care unit / 中华临床营养杂志

Objective To compare the influences of different routes of nutrition on the outcome and respiratory muscle strength of elderly patients in respiratory intensive care unit (RICU). Methods Totally 147 elderly patients in RICU were equally randomized into combined nutrition group ( combinination of parenteral nutrition and enteral nutrition), total enteral nutrition (EN) group, and total parenteral nutrition (PN) group. The changes of energy metabolism, respiratory muscle strength, and short-term outcome were observed or determined.Results Plasma albumin (ALB), hemoglobin (Hb), creatinine (Cr) levels, and nitrogen balance significantly increased in all group 7 days later ( all P ＜ 0. 01 ), while blood urea nitrogen (BUN) significantly decreased ( P ＜0.01 ). The increase of ALB, Hb, Cr levels, and nitrogen balance were significantly more remarkable than that in EN group and PN group (P＜0.05 or P＜0.01). The decrease of BUN level in the combined nutrition group was significantly more remarkable than that in EN group ( P ＜ 0. 05 ). After nutritional support, the maximum inspiratory pressure in the combined nutrition group (P =0. 021 ) and EN group (P = 0. 011 ) became significantly higher, and occlusion pressure at 0.1 second inspiration level in the combined nutrition group became significantly lower ( P =0. 025). The incidences of infectious and non-infectious complications in PN group were significantly higher than those in EN group (P = 0. 002 and 0. 017, respectively) and combined nutrition group ( P = 0. 005 and 0. 004, respectively). Gastric retention was more common in EN group than that in PN group ( P = 0. 035). The weaning time,length of RICU stay, length of hospital stay and 20-day-mortality were significantly decreased in the combined nutrition group than those in the other two groups ( all P ＜ 0. 05 ). Conclusion The effectiveness of the combined application of PN and EN is superior to PN or EN alone in improving nutritional status and respiratory muscle strength as well as in improving the short-term outcome in elderly patients in RICU..

Associated Risk Factors and Drug Resistance of Infected Patients in RICU / 中华医院感染学杂志

OBJECTIVE To investigate the associated risk factors for the infected patients in respiratory intensive care unit(RICU) and to study the resistance of isolates.METHODS To study the bacterial spectrum and drug resistance test of all the patients with hospital acquired infection from Jan to Dec 2005.Identification and antimicrobial susceptibility were determined with the methods of API and K-B,respectively.RESULTS A total of 265 strains were isolated from 117 patients,the rate of isolation of Gram-negatives was the highest(74.3%),the species were predominated by Pseudomonas aeruginosa,Acinetobacter baumannii and Klebsiella pneumoniae,the rates of isolates were 28.68%,23.02% and 5.66%,respectively.The predominated species of Gram-positives was Staphylococcus aureus.Gram-negative bacilli were susceptible to imipenem and meropenem,there were not vancomycin-resistant strains.CONCLUSIONS It is important to realize the associated risk factors of infected patients in RICU and to promote the rational use of antimicrobial agents.

Prevention and Treatment of Ventilator-associated Pneumonia:Their Characteristics / 中华医院感染学杂志

50.0% and increased year by year,the rate of aminoglycoside resistance

A Clinical Survey of Pediatric espiratory Intensive Care (1985)-The fifth report / 대한마취과학회지

A clinical survey was performed on 342 patients under the age of 15 years who were admitted to the respiratory intensive care unit(RICU) between January and December, 1985. The results were as follows 1) The total number of RICU patients in 1985 was 610, and 342(56.1%) were pediatric patients. 2) The ratio of male to female was 55%(188 cases) to 45%(154 cases). 3) The most prevalent age group was 1 to 5 years of age, 145 cases(42.4%). 4) Of the 342 patients, 308 were chest surgery patients(90.1%), 30 were pediatric surgery (8.8%), 2 were neurosurgery, one was a general surgery and one was a plastic surgery patient. 5) The mortality rate was 3.5%(12 cases) which was significantly decreased from the 1984 rate of 5.9% Neonates experienced the highest mortality rate(l0.5%), but this decreased with aging. 6) The mortality rate according to procedure was 2.6%(8 cases) in chest surgery, 10%(3 cases) in pediatric surgery, and 100%(1 case) in general surgery and increased as the length of ventilatory support time increased. 7) The duration of ventilatory support was 57.93 hrs in chest surgery, 68.86 hrs in pediatric surgery and 59.75 hrs on average. Ventilatory support of 12~24 hrs was required in 115 (33.6%) cases. 8) The types of ventilators used were Bourns(132 cases, 38.6%), Bennet MA-1 (47 cases, 13.7%), Roche (45 cases, 13.2%), Bear-Cub(40 cases, 11.7%), etc. 9) The two major causes of death were low cardiac output syndrome(5 cases) in chest surgery and sepsis (2 cases) in pediatric surgery.