The ratio of parasternal intercostal muscle-thickening fraction-to-diaphragm thickening fraction for predicting weaning failure.

BACKGROUND: Diaphragm dysfunction is associated with weaning outcomes in mechanical ventilation patients, in the case of diaphragm dysfunction, the accessory respiratory muscles would be recruited. The main purpose of this study is to explore the performance of parasternal intercostal muscle thickening fraction in relation to diaphragmatic thickening fraction ratio (TFic1/TFdi2) for predicting weaning outcomes, and compare its accuracy with D-RSBI in predicting weaning failure. MATERIALS AND METHODS: We prospectively enrolled consecutive patients from 7/2022-5/2023. We measured TFic, TFdi, and diaphragmatic excursion (DE3) by ultrasound and calculated the TFic/TFdi ratio and diaphragmatic rapid shallow breathing index (D-RSBI4). Receiver-operator characteristic (ROC5) curves evaluated the accuracy of the TFic/TFdi ratio and D-RSBI in predicting weaning failure. RESULTS: 161 were included in the final analysis, 114 patients (70.8%) were successfully weaned from mechanical ventilation. The TFic/TFdi ratio (AUROC = 0.887 (95% CI: 0.821-0.953)) was superior to the D-RSBI (AUROC = 0.875 (95% CI: 0.807-0.944)) for predicting weaning failure. CONCLUSIONS: The TFic/TFdi ratio predicted weaning failure with high accuracy and outperformed the D-RSBI.

[Analysis of death risk factors for nosocomial infection patients in an ICU: a retrospective review of 864 patients from 2009 to 2015].

OBJECTIVE: To investigate the mortality risk factors of nosocomial infection patients in intensive care unit (ICU), and to guide clinicians to take effective control measures. METHODS: A retrospectively cohort study was conducted. The relevant information of patients with nosocomial infection treated in ICU of Hengshui Harrison International Peace Hospital Affiliated to Hebei Medical University from June 2009 to December 2015 was analyzed. The patients who admitted to ICU again, with length of ICU stay less than 48 hours, without first etiology of screening within 48 hours of ICU admission, or without complete pathogenic information were excluded. The gender, age, diagnosis, length of ICU stay, invasive operation, nutritional status, acute physiology and chronic health evaluation II (APACHEII) score, sequential organ failure assessment (SOFA) score, distribution and drug resistance of the pathogens, and procalcitonin (PCT) levels at 7 days after nosocomial infection were recorded. The risk factors leading to death in patients with nosocomial infection were analyzed by logistic regression, and the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of all risk factors on the outcome of patients with nosocomial infection. RESULTS: In 864 enrolled patients with male of 54.75% and mean age of (63.50±15.80) years, 732 (84.72%) patients survived and 132 (15.28%) died. Compared with survivors, the non-survivors had higher age (years: 65.47±15.32 vs. 58.15±13.27), incidence of urgent trachea intubation (32.58% vs. 22.81%), deep venous catheterization (83.33% vs. 63.25%), and multiple drug-resistant infection (65.91% vs. 33.20%), longer length of ICU stay (days: 13.56±4.29 vs. 10.29±4.32) and duration of coma (days: 7.36±2.46 vs. 5.48±2.14), lower albumin (g/L: 23.64±8.47 vs. 26.36±12.84), higher APACHEII score (19.28±5.16 vs. 17.56±5.62), SOFA score (8.55±1.34 vs. 6.43±2.65), and PCT (µg/L: 3.06±1.36 vs. 2.53±0.87, all P < 0.05). There was no significant difference in gender and urinary tract catheterization between survivors and non-survivors (both P > 0.05). The low respiratory tract was the most common site of infection followed by urinary tract and bloodstream in both groups. It was shown by logistic regression analysis that prolonged ICU stay [odds ratio (OR) = 2.039, 95% confidence interval (95%CI) = 1.231-3.473, P = 0.002], APACHEII score (OR = 1.683, 95%CI = 1.002-9.376, P = 0.000), SOFA score (OR = 2.060, 95%CI = 1.208 -14.309, P = 0.041), PCT (OR = 2.090, 95%CI = 1.706-13.098, P = 0.004), and multi-drug resistant pathogens infection (OR = 5.245, 95%CI = 2.213-35.098, P = 0.027) were independent risk factors for ICU mortality in patients with nosocomial infection. The area under ROC curve (AUC) of length of ICU stay, APACHEII score, SOFA score, and PCT level for predicting death of nosocomial infection patients was 0.854, 0.738, 0.786, and 0.849, respectively, the best cut-off value was 16.50 days, 22.45, 6.37 and 3.38 µg/L, respectively, the sensitivity was 83.6%, 90.0%, 81.1%, and 89.6%, and the specificity was 70.3%, 75.6%, 71.3%, and 85.4%, respectively. CONCLUSIONS: Prolonged ICU stay, nosocomial infection with secondary sepsis and multiple organ dysfunction syndrome were the leading causes of death for nosocomial infection patients in ICU. Prolonged ICU stay, APACHE II score, SOFA score, and PCT level could effectively predict death risks for nosocomial infection patients.

[Observation of the use of percutaneous tracheostomy tube for closed drainage of pneumothorax in intensive care unit].

OBJECTIVE: To explore the effect of the transcutaneous tracheostomy tube in patients with pneumothorax and its clinical value. METHODS: A prospective randomized controlled trial was conducted. Thirty-two patients with pneumothorax admitted to Department of Critical Care Medicine of Harrison International Peace Hospital of Hebei Medical University from June 2010 to June 2014 were enrolled. The patients were divided into control group and observation group, with 16 cases in each group. Beside the treatment for primary disease, the patients in control group received thoracic close drainage with traditional silica gel tube as performed by thoracic surgeons, and those in observation group received thoracic close drainage with transcutaneous tracheostomy tube by intensive care doctors. The curative effect and complications of the two groups were observed. RESULTS: Compared with control group, the time from diagnosis to operation (minutes:8.00 ± 1.36 vs. 23.06 ± 3.83, t=14.790, P=0.000) and the operation time were significantly shortened (days:5.37 ± 1.02 vs. 7.31 ± 1.70, t=7.286, P=0.000), the frequency of drainage tube replacement (times: 0.18 ± 0.40 vs. 3.87 ± 1.14, t=12.128, P=0.000) and the times of repeated chest radiography (times:1.12 ± 0.34 vs. 2.93 ± 0.77, t=8.589, P=0.000) in observation group were significantly reduced, the length of hospital day was significantly shortened (days:8.30 ± 1.37 vs. 24.56 ± 5.62, t=17.289, P=0.000), the rates of dislocation of drainage tube (0 vs. 3 cases), obstruction of the tube (0 vs. 5 cases), and subcutaneous emphysema (3 vs. 16 cases) were reduced obviously, but there was no difference in incidence of incision infection (1 vs. 3 cases) and infection of thoracic cavity (0 vs. 2 cases). CONCLUSIONS: The usage of transcutaneous tracheostomy tube in patients with pneumothorax is safe and simple. Doctors in ICU can independently do this procedure, and its effect is positive.

[A prospective randomized controlled trial on effect of norvancomycin tube sealing for prevention of central venous catheter-related infection in critical patients].

OBJECTIVE: To evaluate the clinical value of tube-sealing with norvancomycin and heparin saline mixture for prevention of central venous catheter-related infection (CRI). METHODS: A prospective randomized controlled trial was performed. 120 patients who were admitted to department of critical care medicine from January 2012 to January 2014 were included, with their subclavian vein catheterization installation time longer than 48 hours, age over 18 years and younger than 80 years, and acute physiology and chronic health evaluation II (APACHE II) score reaching 10-29. The patients were divided into two groups using a random number table, and finally 116 patients were enrolled. Norvancomycin and heparin saline mixture were used for tube sealing in the intervention group (n=56), while only heparin saline was used in the control group (n=60). The incidence of CRI, catheter correlated spectrum of pathogens, adverse events, mortality, hospital day, catheter retention time, and hospital costs were compared between two groups. RESULTS: (1) There was no significant difference in the incidence of CRI between intervention group and control group [7.14% (4/56) vs. 8.33% (5/60), χ(2)=0.058, P=1.000]. There was no catheter pathogenic colonization in the intervention group, but there were 2 cases of catheter pathogenic colonization in control group. (2) A total of 7 pathogens were found in two groups. Three cases with pathogenic bacteria was found in the intervention group, with 1 case of Pseudomonas aeruginosa, 1 case Acinetobacter baumannii, and 1 case fungi. Staphylococcus aureus, Staphylococcus epidermidis, fungi, and Acinetobacter baumannii was found in the control group, with 1 case of each. There was no significantly statistical difference between two groups (all P>0.05), but there was a decreasing trend of Gram-positive cocci infection in the intervention group. (3) There was no significant difference in the catheter thrombosis, local bleeding or hematoma, catheter dislocation and other adverse events between intervention group and control group [21.43% (12/56) vs. 23.33% (14/60), χ(2)=0.060, P=0.806]. (4) There were no significant differences in mortality [7.14% (4/56) vs. 8.33% (5/60), χ(2)=0.058, P=1.000], hospital day (35.9±15.2 days vs. 34.1±16.3 days, t=16.330, P=0.620), catheter retention time (25.0±4.5 days vs. 24.5±5.1 days, t=26.427, P=2.560) and cost of hospitalization (10 thousand Yuan: 3.42±1.22 vs. 3.72±1.30, t=13.215, P=1.560) between intervention group and control group. CONCLUSIONS: For patients with central venous catheter, application norvancomycin with heparin saline mixture for tube sealing did not reduce the incidence of CRI, the incidence of adverse events and mortality, does not reduce hospitalization time, catheter retention time and hospital costs, but may reduce the catheter colonization and infection of Gram-positive bacteria.

[Pre-hospital systematic treatment for patients with severe acute organophosphorus pesticide poisoning].

OBJECTIVE: To evaluate the feasibility, safety and effectiveness of on-spot systematic treatment for the patients with severe acute organophosphorus pesticide poisoning (SAOPP). METHODS: Two hundred and twenty-three SAOPP patients were divided into two groups: pre-hospital treatment group (116 patients), in which rescue equipment and drugs were carried to the spot for the treatment of the patients; hospital treatment group (107 patients), in which the patients received emergency treatment after reaching the hospital. The pre-hospital group was sub-divided into group A and group B. In group A, gastric lavage was performed with aid of automatic lavage instrument, and in group B lavage was done by using suspending bucket. Antidotes including pralidoxime chloride and atropine were used simultaneously based on the patients' conditions. Cholinesterase (ChE) activity was dynamically monitored. When the symptoms disappeared, the length of atropinization, the total dosage of atropine and pralidoxime chloride, the recovery time of ChE, the mortality, hospital days, and the incidence of complications were analyzed. RESULTS: The therapeutic effect in pre-hospital group was better than that in in-patient group in terms of disappearance of the symptoms, length of atropinization, recovery time of ChE, the total dosage of atropine and pralidoxime chloride, hospital days, and the mortality rate in group A was markedly lower than in-patient group(P<0.05 or P<0.01). The incidence of respiratory failure, heart injury, brain injury, and atropine poisoning were also lower in pre-hospital group compared with in-patient group (all P<0.01). However, there were no significant differences in intermediate syndrome, relapse, liver injury (all P>0.05). On the other hand, there were no significant differences in mortality rate and hospital days between two subgroups of pre-hospital treatment group(P>0.05). CONCLUSION: Pre-hospital systematic treatment for SAOPP patients, due to its good effects, should be recommended as a safe and effective treatment strategy.