干预措施对ICU医院感染发病率的影响

目的 评价实施预防与控制干预措施对ICU医院感染发病率的影响。方法 采用前瞻性监测的方法 ,对本院2013年7月1日~2014年6月30日收住ICU的395例患者进行目标性监测。2014年1月开始实施预防与控制干预措施,将2013年7月1日~12月31日184例ICU患者目标性监测结果作为干预前,2014年1月1日~2014年6月30日211例ICU患者目标性监测结果作为干预后。比较干预前、后ICU医院感染发病率的变化。结果 干预前、后:ICU例次医院感染发病率由12.50%下降至6.16%,两者比较,差异具有统计学意义(χ2=4.77,P<0.05),调整例次感染发病率由3.75%下降至1.91%,次日感染发病率由19.67‰下降至12.54‰,呼吸机相关肺炎(VAP)感染发病率由12.18‰下降至8.25‰,血管导管相关血流感染(CRBSI)发病率由5.81‰下降至0‰,泌尿道插管相关泌尿道感染(CAUTI)发病率由3.48‰下降至3.12‰。结论 持续开展ICU医院感染目标性监测,有针对性的制定ICU医院感染预防与控制干预措施并实施,能有效的降低ICU医院感染发病率。     

预见性护理对预防ICU危重症患者导管相关性感染的效果分析

目的探析预见性护理对预防ICU危重症患者导管相关性感染的效果。方法选取2018年1月~2019年6月在ICU接受治疗的50例危重症患者进行研究,随机分为对照组与观察组。对照组给予常规护理,观察组给予预见性护理,对两组导管相关性感染发生率、置管时间、住院时间及护理满意度进行统计对比。结果观察组导管相关性感染发生率为4.00%,对照组为16.00%,观察组显著低于对照组(P<0.05)。观察组置管时间、住院时间均显著短于对照组(P<0.05)。观察组护理满意度为96.00%,对照组为80.00%,观察组显著高于对照组(P<0.05)。结论ICU危重症患者应用预见性护理后,可显著减少导管相关性感染的发生,加快患者康复,提高患者护理满意度。     

Understanding new nurses’ learning experiences in intensive care

ObjectivesRecruitment and retention of nurses in intensive care units (ICU) has been challenging over the last few years. Rising demand is now exacerbated by the ongoing Covid-19 pandemic. Transition to ICU from other clinical areas is stressful resulting in significant nurse retention issues. This study therefore aimed to illuminate and explore new nurses’ learning experiences in one large intensive care unit in the United Kingdom.Methodology/MethodsExploratory qualitative case study utilising two data collection methods: one to one interview with six new ICU nurses and focus groups with six senior/clinical education ICU nurses.SettingA large major trauma centre in London with over ninety ICU beds.FindingsFindings indicate that ICU is a challenging learning environment for new nurses due to the large number of skills which must be developed in a short period of time. Forming supportive social relationships proved important in helping new ICU nurses learn and adapt to this complex clinical environment. The high-risk culture of ICU makes it harder to learn particularly for internationally educated nurses. Frequently changing shift patterns also impacts learning.ConclusionSenior ICU nurses should be aware of the issues affecting new nurses and where possible alleviate the stress of working in this challenging environment. They should also consider individual circumstances whilst maintaining high quality education. Social support should be facilitated where possible and new nurses need to be aware of the realities of ICU work.     

Should Flexible Bronchoscopy be Routinely Performed in Aspiration Pneumonitis: Non Liquet

How to cite this article: Sehgal IS, Dhooria S, Agarwal R. Should Flexible Bronchoscopy be Routinely Performed in Aspiration Pneumonitis: Non Liquet. Indian J Crit Care Med 2021;25(2):113–114.     

Video Laryngoscopy-guided Nasal Intubation: One More Bullet in Our Rifle

How to cite this article: Cittadini A, Marsigli F, Sica A, Santonastaso DP, Russo E, Gamberini E, et al. Video Laryngoscopy-guided Nasal Intubation: One More Bullet in Our Rifle. Indian J Crit Care Med 2021;25(3):351.     

Clinical course and outcomes of critically ill patients with COVID-19 infection: a systematic review

ObjectivesCoronavirus disease 19 (COVID-19) is a major cause of hospital admission and represents a challenge for patient management during intensive care unit (ICU) stay. We aimed to describe the clinical course and outcomes of COVID-19 pneumonia in critically ill patients.MethodsWe performed a systematic search of peer-reviewed publications in MEDLINE, EMBASE and the Cochrane Library up to 15th August 2020. Preprints and reports were also included if they met the inclusion criteria. Study eligibility criteria were full-text prospective, retrospective or registry-based publications describing outcomes in patients admitted to the ICU for COVID-19, using a validated test. Participants were critically ill patients admitted in the ICU with COVID-19 infection.ResultsFrom 32 articles included, a total of 69 093 patients were admitted to the ICU and were evaluated. Most patients included in the studies were male (76 165/128 168, 59%, 26 studies) and the mean patient age was 56 (95%CI 48.5–59.8) years. Studies described high ICU mortality (21 145/65 383, 32.3%, 15 studies). The median length of ICU stay was 9.0 (95%CI 6.5–11.2) days, described in five studies. More than half the patients admitted to the ICU required mechanical ventilation (31 213/53 465, 58%, 23 studies) and among them mortality was very high (27 972/47 632, 59%, six studies). The duration of mechanical ventilation was 8.4 (95%CI 1.6–13.7) days. The main interventions described were the use of non-invasive ventilation, extracorporeal membrane oxygenation, renal replacement therapy and vasopressors.ConclusionsThis systematic review, including approximately 69 000 ICU patients, demonstrates that COVID-19 infection in critically ill patients is associated with great need for life-sustaining interventions, high mortality, and prolonged length of ICU stay.     

湖北省某医院ICU护士对身体约束知信行现况调查及影响因素分析

目的 调查湖北省某三甲医院ICU护士对患者身体约束知信行的现况并分析其影响因素。方法 采用便利抽样法,选取重症医学科的115名护士为研究对象,采用身体约束知信行问卷调查护士对患者实施身体约束的知识、态度和行为现状,并分析影响因素。结果 ICU护士身体约束知识得分为(66.74±8.54)分,态度得分为(21.02±4.54)分,行为得分为(52.0±6.18)分。参加过身体约束理论学习培训的护士,在身体约束知识、态度、行为方面得分均高于未参加培训的护士(t=0.346,P=0.002;t=3.038,P=0.003;t=2.744,P=0.007),参加过身体约束体验活动的护士,身体约束行为维度得分高于未参加者(t=2.047,P=0.043),内心为负性体验的护士约束态度维度得分高于内心正性体验的护士(t=-2.977,P=0.004)。护士的身体约束知识得分同约束态度、约束行为得分呈正相关(r=0.460,P＜0.001;r=0.322,P＜0.001),约束态度与约束行为呈正相关(r=0.579,P<0.001)。结论 ICU护士身体约束知识、态度、行为水平有待提高。理论学习培训、参加身体约束体验活动、改善身体约束情感体验可以提高护士身体约束知信行水平,管理者可以从知识培训、树立正确态度、制定规范引导良好实践行为维度着手逐渐改善身体约束行为实践。     

成人ICU病人住院期间睡眠状况的纵向调查及特点分析

目的:了解重症监护室(ICU)病人住院期间的睡眠状况及不同阶段的特点。方法:采用方便抽样法选择85例成人ICU病人进行睡眠状况的评估与记录,选择首次(T1)、住院中期(T2)、出院前1 d(T3)数据进行分析。结果:共收集430份睡眠质量评分,单因素重复测量方差分析结果显示,ICU住院病人在T1~T3阶段理查兹-坎贝尔睡眠量表得分分别为(58.33±18.27)分,(61.45±12.71)分及(58.67±15.51)分,差异无统计学意义(P>0.05)。但两两比较发现,T2阶段比T3阶段睡眠得分高(2.78±1.23)分,差异有统计学意义(P<0.05)。各阶段护士评估时长均高于病人自评时长,差异均具有统计学意义(P<0.05)。病人认为影响夜间睡眠状况的主要为环境、心理、生理病理、医源性刺激等因素。结论:ICU病人在住院期间睡眠质量处于中等水平,住院中期睡眠质量最好。在不同阶段影响病人睡眠的主要因素不同,应加强对医护人员的睡眠相关知识及管理能力的培训,促进行为修正,采取相应干预措施,制定睡眠管理方案。     

ICU患者双上肢握力及髋关节屈曲拉力水平及其影响因素

目的调查ICU患者双上肢握力及髋关节屈曲拉力及其主要影响因素。 方法选取2019年4月至7月青海省人民医院77例ICU患者为研究对象,男性55例,女性22例,平均年龄（56.09±18.44）岁。收集患者一般病例资料（包括一般社会学资料,入住ICU后,出ICU前及出ICU时评价指标）,测量其在入住ICU时和出ICU时双上肢握力及髋关节屈曲拉力。 结果患者入住ICU时及出ICU时,上肢握力分别为（22.14±10.91）kg、（23.22±12.01）kg,差异有统计学意义（t=2.490,P=0.015）;髋关节屈曲拉力分别为（9.99±6.23）kg、（11.14±7.87）kg,差异有统计学意义（t=4.605,P＜0.001）。患者出ICU时,ADL评分较入住ICU时有显著改善,差异有统计学意义（Z=4.401,P＜0.001）,患者营养不良比例、红细胞、血红蛋白较入住ICU时有显著性下降,差异有统计学意义（χ²=65.07,t=5.208,t=2.688,P＜0.05）,其余化验指标均无显著性改变（P＞0.05）。患者上肢握力与年龄（r=-0.540）、性别（r=-0.415）、婚姻状况（r=-0.512）、住ICU天数（r=-0.304）、机械通气天数（r=-0.246）、人工气道天数呈显著性负相关（r=-0.224）,与ADL评分（r=0.316）呈显著正相关;髋关节屈曲拉力与性别（r=-0.452）、营养状态（r=-0.334）呈显著负相关。 结论ICU患者上肢握力及髋关节屈曲拉力呈现较低水平,随着疾病恢复逐渐增强。对于高龄、女性、有吸烟史、有饮酒史及已婚的患者在住ICU期间要更加关注其肌肉健康状态,患者住ICU期间要根据病情尽早拔除人工气道、缩短机械通气的时间,同时要加强患者的营养,为预防ICU患者肌肉衰减做好预防工作。     

一例胆总管腺癌终末期患者在ICU的安宁疗护实践A case of palliative care practice on an patient with end-stage common bile duct adenocarcinoma in ICU 周林,曹梅利,周岚

目的 总结及分享一例终末期患者在ICU安宁疗护实践的经验方法。方法 运用安宁疗护专科理念、知识、技能,帮助患者解决疼痛、呼吸困难、食欲不振等躯体不适症状;抓取重要时机与患者共情,觉察患者决策态度的改变;根据患者个体情况选择以家庭会议方式帮助患者及家属直面治疗进展不佳事实,签署放弃临终抢救相关知情同意书;通过对临死觉知的探讨帮助患者正视人生终点,与死亡和解。结果 患者对死亡释然,放下负担,转回病房,亲人陪伴下安静离世。 结论 ICU的特殊性导致安宁疗护实践的开展难度增加,专科护士在实践中应根据个体化特征选择合适的方法动态评估与开导,为终末期患者提供身、心、社和灵全方面照护,提高ICU患者的死亡质量,促进ICU安宁照护措施的实施及专科发展。