Cigarette smoking and risk of pressure ulcer in adult intensive care unit patients

The objective of this study was to assess relationship between smoking, some other risk factors and ulcers development in intensive care unit. This prospective cohort study was performed in two university‐affiliated hospitals. The sample consisted of adult male patients who were admitted to medical–surgical intensive care units. All eligible patients were grouped according to their cigarette smoking status as smoker and non‐smoker. The final sample included 160 smokers and 192 non‐smokers. Pressure ulcer occurred in 62 smoker patients and 28 of non‐smoker who showed significant difference. Also number of pack‐year of cigarettes smoking showed significant association with ulcer development. Ulcer stage was significantly different between the two groups. Besides of smoking, age, length of stay, faecal incontinency, diabetes mellitus, anaemia and trauma were significantly associated with pressure ulcers. Our study showed significant association between smoking and development of pressure ulcers.     

ICU患者压疮发生危险因素分析

目的：探讨导致ICU患者压疮发生的危险因素。方法：采用自行设计的“ICU患者压疮风险因素调查表”记录735例ICU患者的患病情况、主要治疗情况等资料。结果：性别、糖尿病、脑卒中、入ICU时间、是否持续进行动脉血压监测、水肿、平均动脉压、乳酸Lac、心率、Apachell评分是ICU患者发生压疮的影响因素。结论：ICU患者压疮发生是多因素共同参与的病理生理过程,护理人员应充分认识各种危险因素对ICU患者发生压疮的影响,对存在或可能存在危险因素的ICU患者实施重点防护以减少压疮的发生。     

ICU医院获得性肺炎危险因素分析及护理

目的:通过研究呼吸重症监护病房(RICU)医院获得性肺炎(HAP)的发病危险因素,为制定护理措施提供科学依据。方法:采用回顾性研究方法对2008年1月至2009年12月某"三甲"医院RICU收治2天以上的192例患者的病历记录进行查阅。结果:192例患者中,发生HAP者52例(27.1%),未发生HAP者140例(72.9%);多因素Logistic回归分析显示,RICU医院获得性肺炎发生的独立危险因素有:高龄、APACHEⅡ评分15、机械通气、联合使用2种以上抗生素。结论:RICU医院获得性肺炎的发生是多种因素共同作用的结果,应针对不同的影响因素及时实施全面护理干预。     

Negative pressure pulmonary oedema in the medical intensive care unit

Objective Negative pressure pulmonary oedema (NPPE) occurring in the medical intensive care unit (MICU) is an uncommon, probably under-diagnosed, but life-threatening condition.Design Retrospective data collection.Setting Medical intensive care unit in a 1,500–bedded tertiary care hospital.Patients and participants Five patients were diagnosed between January 1998 and January 2002.Interventions None.Measurements and results Five patients were diagnosed to have NPPE from different aetiologies. These were acute epiglottitis, post-stenting of right bronchus intermedius stenosis, strangulation, compression from a goitre and one patient developed diffuse alveolar haemorrhage after biting the endotracheal tube during recovery from anaesthesia. All patients responded rapidly to supplemental oxygen, positive pressure ventilation and correction of underlying aetiologies. Pulmonary oedema resolved rapidly.Conclusions There is a large spectrum of aetiologies causing NPPE in the medical intensive care unit.     

监护病房中高血钠并发症发生的危险因素及预后分析

目的：确定高血钠对危重患者病死率的影响及发生高血钠并发症的危险因素。方法：P用急性生理功能与慢性健康状况评分Ⅱ（APACHEⅡ）评分系统对入科诊断及疾病严重程度不同的患者进行合理分层,并在患者基础疾病严重程度和年龄基本一致的情况下比较和分析有高血钠患者和无高血钠患者的病死率,同时用单因素X^2检验和多因素logistic回归分析筛选和判定发生高血钠的危险因素。结果：高血钠并发症在监护患者中有较高的发生率（16.55%)。在相同条件下,高血钠患者比非高血钠患者病死率列高。高血钠并发症的发生主要与患者有不同程度的意识障碍或昏迷、多尿、高热、基础疾病较严重、经口饮水受限及使用脱水剂不当等因素显著相关。结论：高血钠是监护病室常见并发症,且对疾病转归有不利影响,应重视并针对其危险因素加以预防。     

Candida infections in the intensive care unit: epidemiology,risk factors and therapeutic strategies

This article reviews the epidemiology, predisposing risk factors and outcome of systemic Candida spp. infections in the intensive care unit setting. Incidence of systemic Candida infections in patients requiring intensive care has increased substantially in recent years; while diagnosis of serious Candida infection may be difficult, the clinical conditions which predispose patients to these infections are now better understood and effective antifungal therapies are becoming increasingly available. Severe fungal infections are generally associated with poor outcomes in these patients. Patients at highest risk for Candida infection may be potential candidates for early, presumptive therapy. In this article we review antifungal treatment, including the use of polyenes, azoles and echinocandines, and the role of prophylaxis.     

重症医学科呼吸机相关性肺炎的发生及其危险因素分析

目的探讨重症医学科呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的发生及其危险因素,以便更好地指导临床工作。方法采用查阅病例的方式,回顾性分析158例在重症医学科住院行机械通气患者的临床资料,分析患者VAP的发生及其危险因素。结果机械通气时间、留置胃管是重症医学科患者VAP发生的主要危险因素(P0.01)。结论每天评估患者停止机械通气的可能性,尽早停止机械通气;保持口咽清洁,减少细菌定植;加强环境清洁和空气消毒管理;做好气管切开的护理;提高护理操作技术水平对降低VAP的发生具有重要的作用。     

肿瘤外科ICU室上性心律失常的发生率及危险因素分析

目的 探讨肿瘤外科ICU室上性心律失常(SVAs)的发生率及危险因素.方法 回顾分析我院ICU 2008年11月至2009年10月间收治570例患者的临床资料,对SVAs可能的影响因素进行单因素和多因素Logistic分析.结果 13例有心房颤动病史的患者被除外,入选557例.SVAs发生率为12.93%(72/557).多因素分析显示年龄(OR=1.066,95%CI:I.034～1.099,P＜0.001)、冠心病病史(OR=2.644,95%CI:1.459～4.790,P＜0.05)、转入时确诊为脓毒症(OR=2.374,95%CI:1.098～5.135,P＜0.05)和胸部外科手术操作(OR=2.322,95%CI:1.061～5.084,P＜0.05)是SVAs发生的独立危险因素.SVAs患者与非SVAs组住ICU时间[2(1～77)、3(1～40)d,Z=-3.505,P＜0.001]和APACHEⅡ评分[9(0～37)、11(3～38)分,Z=-3.332,P=0.001],差异有统计学意义.SVAs组死亡9例(12.5%),非SVAs组死亡19例(3.9%),病死率差异有统计学意义(x2=9.673,P=0.002).结论 肿瘤外科ICU患者术后SVAs的发生率较高,年龄、冠心病病史、转入ICU时确诊有脓毒症和胸部外科手术操作是术后SVAs发生的独立危险因素.SVAs增加患者住ICU时间,是反映患者病情严重性的一种标志.

Abstract：

Objective To evaluate the incidence and to investigate risk factors of supraventricular arrhythmia (SVAs) in postoperative cancer patients in intensive care unit ( ICU ). Methods Data of 570 patients consecutively admitted to oncologic surgical ICU of Cancer Hospital of Chinese Academy of Medical Sciences from Nov. 2008 to Oct. 2009 were retrospectively collected. Univariate and multivariate logistic analysis were conducted for potential factors that influenced SAVs. Results Thirteen patients with a history of atrial fibrillation (AF) were excluded and 557 patients were eligible for the study. SVAs occurred in 72 patients ( 12. 93% ). Multivariate analysis showed four independent predictors of SVAs including age ( OR = 1. 066,95%CI: 1. 034 - 1. 099,P ＜0. 001 ) ,a history of coronary heart diseases ( OR = 2. 644,95% CI: 1. 459 - 4. 790,P ＜ 0. 05), sepsis ( OR = 2. 374,95% CI: 1. 098 - 5. 135, P ＜ 0. 05 ) and intra-thoracic procedure ( OR =2. 322,95 % CI: 1.061 - 5.084, P ＜ 0. 05 ) . ICU length of stay, severity ( APACHE Ⅱ scores in SVAs patients) were significantly greater in patients who were not affected by SVAs ( ICU stay: [2 ( 1 ～ 77 )]vs [3 ( 1 ～ 40 )]days,P ＜ 0. 001; APACHE Ⅱ score: [9 (0 ～ 37 )] vs [11 (3 ～ 38 )], P = 0. 001 ). Nine cases died in SVAs patients ( 12. 5% ) and 19 died in the non-SVAs patients (3.9%), with significant difference between the two groups( x2 = 9. 673, P = 0. 002). Conclusion In oncologic surgical ICU, the incidence of SVAs is high. Age,history of coronary heart diseases, sepsis and intra-thoracic procedure were independent rsik factors of SVAs. SVAs prolong ICU length of stay. SVAs is a marker of critical illness severity.     

Risk factors and prevention among patients with hospital-acquired and pre-existing pressure ulcers in an acute care hospital

Aims and objectives.  This study aimed to describe and identify risk factors associated with hospital‐acquired pressure ulcers among adults in an acute care hospital compared with patients with pre‐existing pressure ulcers present on admission. A further aim was to identify the preventive measures performed with both groups respectively. Background.  Pressure ulcers occur most often in older and immobile persons with severe acute illness and neurological deficits. However, few studies have addressed risk factors that are associated with hospital‐acquired pressure ulcers compared with patients with pre‐existing pressure ulcers. Design.  A point prevalence study with a cross‐sectional survey design was conducted at a Swedish university hospital. Method.  Data on 535 patients were recorded using a modified version of the protocol developed and tested by the European Pressure Ulcer Advisory Panel, including the Braden scale for risk assessment. Results.  The prevalence of pressure ulcers was 27% (95% confidence interval, 23–31%). Higher age and a total Braden score below 17 were significantly associated with the presence of pressure ulcers. Among individual risk factors higher age, limited activity level and friction and shear while seated or lying down were associated with hospital‐acquired pressure ulcers, whereas only higher age and friction and shear were associated with the presence of pressure ulcers in the overall sample. There was an overall sparse use of preventive measures to relieve pressure. Conclusion.  The findings of the present study revealed that pressure ulcers and the insufficient use of preventive measure to relieve pressure is still a problem in acute care settings. A continued focus must be placed on staff training in identifying patients at risk for pressure ulcers development. Relevance to clinical practice.  Increasing the ability to identify patients who are at risk for pressure ulcer development can assist in preventing unnecessary complications and suffering as well as reduce costs.