Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran

Background and objective

Pressure ulcer (PU) is one of the important and frequent complications of hospitalization, associated with high treatment costs. The present study was conducted to determine the incidence of PU and its direct treatment costs for patients in intensive care unit (ICU) in Iran.

神经外科重症监护病房常见病原菌的分布与耐药性研究

目的调查珠江医院神经外科重症监护病房(ICU)病原菌的分布与耐药情况,分析ICU院内感染的发生原因,探讨防治对策。方法应用法国VITEKⅡ全自动细菌鉴定仪鉴定病原菌,用纸片扩散法检测药敏结果。结果神经外科ICU菌群主要以革兰阴性杆菌(71.6%)为主,鲍曼不动杆菌占16.7%,大肠埃希菌占15.7%,铜绿假单胞菌占13.7%,肺炎克雷伯菌占13.7%等。但葡萄球菌、粪肠球菌等阳性球菌(28.4%)也有增加的趋势。亚胺培南和头孢哌酮/舒巴坦仍保持最高抗菌活性,细菌的耐药率分别为15.3%和30.6%。结论我院神经外科ICU感染主要病原菌是革兰阴性杆菌,对常用抗菌药物耐药性较高,但革兰阳性球菌所占比例呈增高趋势。控制第二、三代头孢菌素以及制酸剂(质子泵抑制剂)的预防性用药,减少耐药菌株的产生,有针对性地使用抗生素是控制危重病人感染的有效措施。     

早期胰岛素强化序贯治疗在ICU中的临床应用

本文通过复习相关文献资料，就早期胰岛素强化序贯治疗在ICU病人治疗中应用的几个主要方面进行扼要的综述，以利临床医生的参考。     

ICU重型颅脑外伤并发肺部感染临床分析与对策

目的:研究该院ICU病房重型颅脑外伤患者院内肺部感染原因及病原菌特点,探讨预防及控制感染的措施。方法:对该院1999年5月~2004年12月的245例ICU重型颅脑外伤患者肺部感染危险因素及病原菌调查分析。结果:院内感染率为31.8%,引起肺部感染有显著意义的危险因素有高龄、住院时间过长、呼吸机应用、气管切开、休克、基础病等;肺部感染以G-杆菌为主,占64.7%,依次为阴沟杆菌、铜绿假单孢菌、不动杆菌、嗜麦芽黄单胞菌、大肠埃希菌,G+球菌占14.1%,真菌占21.2%。结论:针对危险因素,采取有效措施降低感染率;为有效控制感染,必须合理选择抗生素,重视交叉感染。     

Diabetic and nondiabetic hyperglycemia in the ICU

Hyperglycemia is a common feature in critically ill patients, whether they are diabetic or not, and it is associated with unfavorable outcome. The more severe the underlying disease, the more important the hyperglycemia appears to be although, we still cannot define whether hyperglycemia is just a marker of the severity of the acute illness or rather an active contributor to poor outcome. The review of the literature on this subject published from 2001 up today conveys a massive amount of information the interpretation of which is equivocal, due to the heterogeneity of patients (nondiabetic vs. diabetic, medical intensive care unit (ICU) pts vs. surgical ICU pts) and of interventions (dose and modality of insulin infusion).The association between high glucose level and mortality is strong in critically ill patients without a previous history of diabetes. Admission hyperglycemia seems to be an independent risk factor of in-hospital mortality in patients both with and without diabetes in cardiac, cardiothoracic and neurosurgical ICUs. No data are still available on general surgical ICU patients.Tight control of blood glucose levels has been demonstrated to improve outcome in both diabetic and nondiabetic critically ill patients. In surgical ICUs, tight glucose control improves mortality and reduces morbidity only among patients admitted in ICU for more than 5 days, while outcome is not improved in patients who stay in ICU for less than 3 days.However, it is not yet understood if such favorable effect is secondary to glucose control itself or if insulin plays a part, by means of its nonglucose, anabolic effects. More randomized controlled trials are needed, addressing specific issues—such as the optimal target glucose concentration and the most effective insulin regimen—especially in the general surgical patient.     

多元文化护理在ICU的应用

针对ICU特殊的医疗环境和病人对多元化的迫切需要，总结在ICU应用多元化护理的具体护理对策。指出依据病人不同的化背景和需要，通过改善ICU的化环境（传统化、现代化、饮食化）、居住环境、语言环境，可缓解多元化冲击，提高ICU的护理质量和护士素质。     

气管切开病人在ICU期间的健康教育

气管切开是保持呼吸通畅的一种急诊手术,病人在ICU(重症监护)期间,如能加强相关卫生知识的宣传教育工作,对疾病的治疗及预后,都将起到一定作用.     

综合ICU中低年资护士培训方法探讨

目的探讨为综合ICU培养合格的护理人员的方法。方法根据ICU护士应具备的素质及低年资护士的特点,采用定期集中培训、一对一带教、参加护理查房等方法,对基础理论和基本技能进行强化,重点加强了ICU专科护理知识地训练。结果通过客观考核和主观考核,效果良好。结论经过为期12个月两个时段较规范的岗位培训,低年资护士能较好的适应ICU工作。     

重症监护病房中呼吸机相关肺炎的病原学和耐药性特征

目的探讨重症监护病房（ICU）中呼吸机相关肺炎（VAP）的流行病学、病原菌分布、耐药性特征。方法对广州市3所三级甲等医院ICU发生VAP的53例患者进行前瞻性研究，对病原菌进行细菌鉴定和耐药性分析。结果VAP平均发病时间为机械通气后7．8d。97株病原菌中革兰阴性细菌58株（59．8％），革兰阳性细菌23株（23．7％），真菌16株（16．5％）。最常见病原菌分别为铜绿假单胞菌16株（16．5％），金黄色葡萄球菌13株（13．4％），嗜麦芽窄食单胞菌8株（8．2％），肺炎克雷伯菌8株（8．2％），白色念珠菌8株（8．2％）。耐甲氧西林金黄色葡萄球菌（MRSA）检出率为100．0％；未发现耐万古霉素金黄色葡萄球菌；VAP病原菌存在严重的多重耐药性。结论ICU中VAP的病原菌构成以革兰氏阴性杆菌为主且呈现多重耐药现象，适当的经验性抗菌治疗应以病原学和耐药性的监测结果为依据。     

Association of obesity with illness severity in hospitalized patients with COVID-19: A retrospective cohort study

BackgroundAlthough recent studies have shown an association between obesity and adverse coronavirus disease 2019 (COVID-19) patient outcomes, there is a paucity in large studies focusing on hospitalized patients. We aimed to analyze outcomes associated with obesity in a large cohort of hospitalized COVID-19 patients.MethodsWe performed a retrospective study at a tertiary care health system of adult patients with COVID-19 who were admitted between March 1 and April 30, 2020. Patients were stratified by body mass index (BMI) into obese (BMI ≥ 30 kg/m 2) and non-obese (BMI < 30 kg/m 2) cohorts. Primary outcomes were mortality, intensive care unit (ICU) admission, intubation, and 30-day readmission.ResultsA total of 1983 patients were included of whom 1031 (51.9%) had obesity and 952 (48.9%) did not have obesity. Patients with obesity were younger (P < 0.001), more likely to be female (P < 0.001) and African American (P < 0.001) compared to patients without obesity. Multivariable logistic models adjusting for differences in age, sex, race, medical comorbidities, and treatment modalities revealed no difference in 60-day mortality and 30-day readmission between obese and non-obese groups. In these models, patients with obesity had increased odds of ICU admission (adjusted OR, 1.37; 95% CI, 1.07?1.76; P = 0.012) and intubation (adjusted OR, 1.37; 95% CI, 1.04?1.80; P = 0.026).ConclusionsObesity in patients with COVID-19 is independently associated with increased risk for ICU admission and intubation. Recognizing that obesity impacts morbidity in this manner is crucial for appropriate management of COVID-19 patients.