Nomogram for predicting 90-day mortality in patients with Acinetobacter baumannii-caused hospital-acquired and ventilator-associated pneumonia in the respiratory intensive care unit.

OBJECTIVE: We built a prediction model of mortality risk in patients the with Acinetobacter baumannii (AB)-caused hospital-acquired (HAP) and ventilator-associated pneumonia (VAP). METHODS: In this retrospective study, 164 patients with AB lower respiratory tract infection were admitted to the respiratory intensive care unit (RICU) from January 2019 to August 2021 (29 with HAP, 135 with VAP) and grouped randomly into a training cohort (n = 115) and a validation cohort (n = 49). Least absolute shrinkage and selection operator regression and multivariate Cox regression were used to identify risk factors of 90-day mortality. We built a nomogram prediction model and evaluated model discrimination and calibration using the area under the receiver operating characteristic curve (AUC) and calibration curves, respectively. RESULTS: Four predictors (days in intensive care unit, infection with carbapenem-resistant AB, days of carbapenem use within 90 days of isolating AB, and septic shock) were used to build the nomogram. The AUC of the two groups was 0.922 and 0.823, respectively. The predictive model was well-calibrated; decision curve analysis showed the proposed nomogram would obtain a net benefit with threshold probability between 1% and 100%. CONCLUSIONS: The nomogram model showed good performance, making it useful in managing patients with AB-caused HAP and VAP.

Incidence of and risk factors for post-intensive care syndrome among Chinese respiratory intensive care unit patients: A cross-sectional, prospective study.

BACKGROUND: Patients transferred from the respiratory intensive care unit (ICU) can experience post-intensive care syndrome (PICS), which comprises cognitive, psychological, and physical disorders that seriously affect the quality of life. Therefore, it was necessary to explore the incidence of and the risk factors for PICS among respiratory ICU patients. OBJECTIVES: This study evaluated PICS among respiratory ICU patients and explored the risk factors for PICS. METHODS: This cross-sectional, prospective study was performed at one hospital in China. Using convenience sampling, 125 respiratory ICU patients from August 2018 to June 2019 were recruited for the study. The Mini-Mental State Examination, Confusion Assessment Method for the Intensive Care Unit, Hospital Anxiety and Depression Scale, Medical Research Council Scale, activities of daily living scale, Pittsburgh Sleep Quality Index, and the 14-item fatigue scale were used to comprehensively assess the patients' cognitive status, psychological status, and physiological status when entering the ICU and 2 weeks after leaving the ICU. Factors affecting PICS were measured using researcher-created questionnaires of patients' general information and disease-related information. RESULTS: Fifteen patients were lost to follow-up. Fifty-nine patients had PICS (incidence rate, 53.6%). Logistic regression showed that risk factors for PICS were age, invasive mechanical ventilation, noninvasive ventilator-assisted ventilation, and coronary heart disease (P < 0.05). CONCLUSION: The PICS incidence was high. Older age, longer invasive mechanical ventilation times, longer noninvasive ventilator times, and coronary heart disease were risk factors for PICS. ICU medical workers in China should pay more attention on PICS, know the risk factors, and implement preventive measures.

Assisted mobilisation in critical patients with COVID-19.

The therapeutic value of early physiotherapeutic treatment in critical respiratory settings has already been clearly outlined in the last fifteen years by several authors. However, there is still a controversial perception of mobilisation by healthcare professions. In-bed cycling has attracted increasing attention having been demonstrated as a feasible and safe intervention in critical settings. Patients with respiratory diseases are typically prone to fatigue and exertional dyspnoea, as we observe in COVID-19 pandemic; in fact, these patients manifest respiratory and motor damage that can even be associated with cognitive and mental limitations. COVID-19 is at risk of becoming a chronic disease if the clinical sequelae such as pulmonary fibrosis are confirmed as permanent outcomes by further analysis, particularly in those cases with overlapping pre-existent pulmonary alterations. In the present article, we propose a practical analysis of the effects of in-bed cycling, and further discuss its potential advantages if used in critical patients with COVID-19 in intensive care settings.

A survival analysis of patients with an acute exacerbation of chronic obstructive pulmonary disease discharged from the respiratory intensive care unit.

BACKGROUND: To analyse the survival of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after discharge from respiratory intensive care unit (RICU) and the adverse factors affecting patient's survival, so as to improve the follow-up work in the future. METHODS: A retrospective observational study was conducted in the RICU. Patient demographic and clinical data were collected before discharge. RESULTS: All patients were followed for 2 years after discharge. Living status was collected. The LogRank test was used to compare the survival distributions at 24 months, and the Kaplan-Meier curve was plotted. Multivariate Cox regression analysis was performed. A total of 159 patients were admitted to the RICU; 19 patients died in the hospital. The post-hospitalization mortality was 18.24% (29/159), 27.04% (43/159), and 37.11% (59/159), respectively, at 6, 12 and 24 months. Data from a total of 140 discharged patients were collected and analysed. Old age, no education, low BMI, bedridden status, comorbidity with bronchiectasis, and comorbidity with cancer were risk factors affecting the survival rate of patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) as analysed by the Log-Rank test. Multivariate Cox regression analysis showed that old age, no education, and low BMI were independent factors affecting patient survival. CONCLUSIONS: In China, there are many older patients who have no education, and it may be very important for patients with an acute exacerbation of COPD to have additional specialized health education after discharge.

Prevalence and development of chronic critical illness in acute patients admitted to a respiratory intensive care setting.

INTRODUCTION: Chronic Critical Illness (chronic CI) is a condition associated to patients surviving an episode of acute respiratory failure (ARF). The prevalence and the factors associated with the development of chronic CI in the population admitted to a Respiratory Intensive Care Unit (RICU) have not yet been clarified. METHODS: An observational prospective cohort study was undertaken at the RICU of the University Hospital of Modena (Italy). Patients mechanically ventilated with ARF in RICU were enrolled. Demographics, severity scores (APACHEII, SOFA, SAPSII), and clinical condition (septic shock, pneumonia, ARDS) were recorded on admission. Respiratory mechanics and inflammatory-metabolic blood parameters were measured both on admission and over the first week of stay. All variables were tested as predictors of chronic CI through univariate and multivariate analysis. RESULTS: Chronic CI occurred in 33 out of 100 patients observed. Higher APACHEII, the presence of septic shock, diaphragmatic dysfunction (DD) at sonography, multidrug-resistant (MDR) bacterial infection, the occurrence of a second infection during stay, and a C-reactive protein (CRP) serum level inceasing 7 days over admission were associated with chronic CI. Septic shock was the strongest predictor of chronic CI (AUC = 0.92 p < 0.0001). CONCLUSIONS: Chronic CI is frequent in patients admitted to RICU and mechanically ventilated due to ARF. Infection-related factors seem to play a major role as predictors of this syndrome.

Epidemiology and risk factors for nosocomial infection in the respiratory intensive care unit of a teaching hospital in China: A prospective surveillance during 2013 and 2015.

BACKGROUND: To determine the epidemiology and risk factors for nosocomial infection (NI) in the Respiratory Intensive Care Unit (RICU) of a teaching hospital in Northwest China. METHODS: An observational, prospective surveillance was conducted in the RICU from 2013 to 2015. The overall infection rate, distribution of infection sites, device-associated infections and pathogen in the RICU were investigated. Then, the logistic regression analysis was used to test the risk factors for RICU infection. RESULTS: In this study, 102 out of 1347 patients experienced NI. Among them, 87 were device-associated infection. The overall prevalence of NI was 7.57% with varied rates from 7.19 to 7.73% over the 3 years. The lower respiratory tract (43.1%), urinary tract (26.5%) and bloodstream (20.6%) infections accounted for the majority of infections. The device-associated infection rates of urinary catheter, central catheter and ventilator were 9.8, 7.4 and 7.4 per 1000 days, respectively.The most frequently isolated pathogens were Staphylococcus aureus (20.9%), Klebsiella pneumoniae (16.4%) and Pseudomonas aeruginosa (10.7%). Multivariate analysis showed that the categories D or E of Average Severity of Illness Score (ASIS), length of stay (10-30, 30-60, ≥60 days), immunosuppressive therapy and ventilator use are the independent risk factors for RICU infection with an adjusted odds ratio (OR) of 1.65 (95% CI: 1.15~2.37), 5.22 (95% CI: 2.63~10.38)), 2.32 (95% CI: 1.19~4.65), 8.93 (95% CI: 3.17~21.23), 31.25 (95% CI: 11.80~63.65)) and 2.70 (95% CI: 1.33~5.35), respectively. CONCLUSION: A relatively low and stable rate of NI was observed in our RICU through year 2013-2015. The ASIS-D、E, stay ≥10 days, immunosuppressive therapy and ventilator use are the independent risk factors for RICU infection.

A Prospective Study of Fungal Colonization and Invasive Fungal Disease in Long-Term Mechanically Ventilated Patients in a Respiratory Intensive Care Unit.

BACKGROUND: Long-term mechanical ventilation in an Intensive Care Unit (ICU) exposes the patient to fungal colonization and invasive fungal disease due to the presence of indwelling catheters, administration of broad-spectrum antibiotics, and intravenous corticosteroids. A study is hence required to study the risk factors and incidence of fungal infection in these patients. METHODS: A prospective observational study was carried out in the respiratory ICU of a tertiary care hospital for a period of approximately 1 year in which patients on mechanical ventilation (>7 days) were enrolled. Blood, urine, and endotracheal aspirate (ETA) of these patients were sent for fungal culture on day 1 and day 7 of mechanical ventilation. Fiberoptic bronchoscopy was done on day 7 and bronchoalveolar lavage along with transbronchial lung biopsy (TBLB) were sent for fungal culture. RESULTS: During 7 days of ventilation, there was a statistically significant increase in the proportion of culture-positive ETA and urine samples. Overall, Candida albicans emerged as the most common colonizer. Blood candidemia was seen in 10% of patients on day 7 of mechanical ventilation. Fungal invasion of the lung, as evidenced by fungal culture-positive TBLB specimens, was seen in 17% of patients. Diabetes was found to be a statistically significant risk factor for respiratory and urinary tract colonization as well as invasive fungal disease. CONCLUSION: Long-term mechanical ventilation (>7 days) is strongly associated with fungal colonization of the respiratory tract and urinary tract. Appropriate prophylactic antifungals may be given and infection control practices to be observed to ensure minimum colonization and therefore infection in such settings.

Rheumatoid arthritis associated pulmonary hypertension: Clinical challenges reflecting the diversity of pathophysiology.

The present article reports three clinical cases in order to elucidate the diversity of the pathophysiological mechanisms that underlie rheumatoid arthritis associated pulmonary hypertension. The condition's three major causes are: interstitial lung disease, vasculitis, and chronic thromboembolic disease, but it should be noted that the multiple pulmonary manifestations of rheumatoid arthritis, can all contribute to chronic lung disease or hypoxia. The first patient in this report suffered from moderate restriction due to fibrosis and was diagnosed with pulmonary hypertension during an episode of life threatening hypoxia. Early upfront combination therapy prevented intubation and reversed hypoxia to adequate levels. The second presented patient was a case of isolated pulmonary hypertension attributable to vasculopathy. The patient maintained normal lung volumes but low diffusion capacity and echocardiography dictated the need for right heart catheterization. Finally, the third patient presented severe functional limitation due to several manifestations of rheumatoid arthritis, but a past episode of acute pulmonary embolism was also reported although it had never been evaluated. Chronic thromboembolic disease was eventually proved to be one major cause of the patient's pulmonary hypertension. The importance of early identification of pulmonary hypertension in patients with rheumatoid arthritis is therefore emphasized, especially since multiple treatment options are available, symptoms can be treated, and right heart failure can be avoided.

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.

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.

Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units.

PURPOSE: The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit. PATIENTS AND METHODS: A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann-Whitney U-test. Kaplan-Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox's proportional hazards regression model was performed to identify risk factors for multivariate analysis. RESULTS: A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, P<0.05). Kaplan-Meier survival analysis showed that patients with CAP had a worse survival rate than patients without CAP (P<0.05). Clinical characteristics, including Acute Physiology and Chronic Health Evaluation II (APACHE II) score, C-reactive protein, and CAP, were found to be closely associated with survival of AECOPD individuals. Further multivariate Cox regression analysis confirmed that CAP and APACHE II were independent risk factors for inhospital mortality in critically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50-18.47, P<0.01 and APACHE II: hazard ratio, 1.20; 95% CI, 1.06-1.37, P<0.01). CONCLUSION: CAP may be an independent risk factor for higher inhospital mortality in critically ill AECOPD patients.

Extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted in an intensive care unit and respiratory intensive care unit.

BACKGROUND: Extensively drug-resistant Acinetobacter baumannii (XDRAB) is a great threat in intensive care units (ICUs). The aim of this study was to describe an XDRAB outbreak which was cross-transmitted in the ICU and respiratory intensive care unit (RICU) in a tertiary care hospital from January-March 2013. METHODS: Patient and environmental surveillances were performed. Isolates were tested for antimicrobial susceptibility. Genotypes were analyzed by multilocus sequence typing (MLST). A series of enhanced strategies were implemented to control the outbreak. RESULTS: A total of 11 patients were infected by XDRAB strains during this outbreak. Three patients in the ICU were found positive for XDRAB at the onset of the outbreak. Thereafter, infections were detected in 6 patients in the RICU, followed by reappearance of this strain in the ICU in 2 patients. All A baumannii strains isolated from patients and the environment were extensively drug resistant. MLST revealed them as ST368. After 3 rounds of environmental screening and cleaning, the laminar flow system connecting the ICU and RICU was found as the source of transmission. Successful control of this outbreak was achieved through multifaceted intervention measures. CONCLUSIONS: This study suggested the importance of thorough surveillance and disinfection of the environment, including concealed devices, in preventing the transmission of an outbreak.

Intelligence Care: A Nursing Care Strategy in Respiratory Intensive Care Unit.

BACKGROUND: Working in respiratory intensive care unit (RICU) is multidimensional that requires nurses with special attributes to involve with the accountability of the critically ill patients. OBJECTIVES: The aim of this study was to explore the appropriate nursing care strategy in the RICU in order to unify and coordinate the nursing care in special atmosphere of the RICU. MATERIALS AND METHODS: This conventional content analysis study was conducted on 23 health care providers working in the RICU of Sina and Shariati hospitals affiliated to Tehran university of medical sciences and the RICU of Baqiyatallah university of medical sciences from August 2012 to the end of July 2013. In addition to in-depth semistructured interviews, uninterrupted observations, field notes, logs, patient's reports and documents were used. Information saturation was determined as an interview termination criterion. RESULTS: Intelligence care emerged as a main theme, has a broad spectrum of categories and subcategories with bridges and barriers, including equality of bridges and barriers (contingency care, forced oriented task); bridges are more than barriers (human-center care, innovative care, cultural care, participatory care, feedback of nursing services, therapeutic-professional communication, specialized and independent care, and independent nurse practice), and barriers are higher than bridges (personalized care, neglecting to provide proper care, ineffectiveness of supportive caring wards, futility care, nurse burnout, and nonethical-nonprofessional communications). CONCLUSIONS: Intelligence care is a comprehensive strategy that in addition to recognizing barriers and bridges of nursing care, with predisposing and precipitating forces it can convert barriers to bridges.

Alterations in platelet count and mean platelet volume as predictors of patient outcome in the respiratory intensive care unit.

INTRODUCTION: Thrombocytopenia is associated with increased mortality in intensive care unit (ICU) patients. Mean platelet volume (MPV) reflects platelet function and activation. Elevated MPV is associated with poor outcomes and increased mortality rate in diseases that are commonly encountered in the respiratory ICU. METHODS: We retrospectively enrolled 95 patients who died in the ICU (dead group), 80 patients who improved and were transferred from the ICU (survived group), and 80 healthy individuals as controls. Laboratory parameters including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin, and complete blood count (CBC) were recorded within 24 h on admission and transfered from the ICU or died. White blood cell (WBC) count, hemoglobin (Hb), red cell distribution width, MPV, platelet distribution width (PDW), and platelet count (PC) were obtained from the CBC. RESULTS: Admission PC and MPV levels were not different in the survived and dead groups. But in the survived group, admission WBC, MPV and PDW levels decreased, while PC increased when compared with admission levels. In the dead group, admission MPV and PDW levels increased, while PC decreased with respect to admission levels. The admission mean PC of the dead group was 182 103, which was above the thrombocytopenia limit. The ratio of admission thrombocytopenia was 45.3% in the dead group, which was significantly higher than that of the survived group (13.8%) (P < 0.001) CONCLUSIONS: Increasing MPV and decreasing platelet count may alert intensivists to the worse course of disease in patients who had normal platelet counts at ICU admission. The development of thrombocytopenia may also be essential to assessing the outcome of ICU patients.

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 .

Differences in distribution and drug sensitivity of pathogens in lower respiratory tract infections between general wards and RICU.

BACKGROUND: Lower respiratory tract infections (LRTIs) are common among patients in hospitals worldwide, especially in patients over the age of 60. This study investigates the differences in distribution and drug sensitivity of pathogens in LRTIs. METHODS: The clinical and laboratory data of 4,762 LRTI patients in the general ward and respiratory intensive care unit (RICU) of Xiangya Hospital (Changsha) were retrospectively analyzed. RESULTS: The infection rate of Gram-negative bacteria was significantly higher than that of Gram-positive bacteria in both the general ward and RICU (P<0.05). The incidence of Gram-negative bacteria infection was significantly higher in the RICU than in the general ward (P<0.05), whereas the incidence of Gram-positive bacteria infection is less in the RICU than in the general ward (P<0.05). In the general ward, the incidence of Gram-negative bacteria infection significantly increased (P<0.05) over time, whereas the incidence of Gram-positive bacteria infection significantly decreased from 1996 to 2011 (P<0.05). In the RICU, the incidence of Gram-positive bacteria infection decreased, while Gram-negative bacteria infections increased without statistical significance (P>0.05). Staphylococcus pneumoniae and Staphylococcus aureus were found to be the predominant Gram-positive strains in the general ward (34.70-41.18%) and RICU (41.66-54.87%), respectively (P>0.05). Pseudomonas aeruginosa and Acinetobacter baumannii were the predominant gram negative strains in the general ward (19.17-21.09%) and RICU (29.60-33.88%), respectively (P>0.05). Streptococcus pneumoniae is sensitive to most antibiotics with a sensitivity of more than 70%. Staphylococcus aureus is highly sensitive to vancomycin (100%), linezolid (100%), chloramphenicol (74.36-82.19%), doxycycline (69.57-77.33%), and sulfamethoprim (67.83-72.46%); however, its sensitivity to other antibiotics is low and decreased each year. Sensitivity of Pseudomonas aeruginosa to most ß-lactam, aminoglycoside, and quinolone group antibiotics decreased each year. CONCLUSIONS: The distribution and drug sensitivity of LRTI pathogens exhibit a high divergence between the general ward and RICU. Streptococcus pneumoniae may not be the predominant pathogen in LRTIs in some areas of China.

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..

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

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.

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.