呼吸支持治疗在新生儿重病监护病房的应用及影响因素分析

目的探讨新生儿重症监护病房(NICU)中新生儿窒息相关疾病患儿应用呼吸支持进行抢救的临床效果及影响因素分析。方法回顾性分析2006年1月至2010年12月NICU采用呼吸支持治疗321例患儿的临床资料,分析患儿的各项指标。结果早产儿占全部病例的55.45%,足月产儿占44.55%。极低体质量儿占51.71%,低体质量儿占33.96%,正常体质量儿占14.33%。患儿无创机械通气前后的治疗效果进行比较差异有统计学意义(P<0.05)。经χ2检验,不同疾病通过机械通气治疗效果,差异具有统计学意义(P<0.05);发病1 h～3 d、4～7 d和8～21 d的患儿治愈率比较,差异有统计学意义(P<0.05);极低体质量儿、低体质量儿和正常体质量的患儿治愈率比较,差异有统计学意义(P<0.05)。所有患儿发生呼吸机相关肺炎39例和肺不张27例。结论医护人员只有综合分析患儿的全面病情,配合正确使用机械通气就能够有效救治NICU的危重新生儿。     

儿童重症监护病房和新生儿重症监护病房死亡患儿父母心理干预研究进展

2016年,据世界卫生组织统计,全球每天约有1.5万名5岁以下儿童和3000名5~14岁儿童死亡;我国统计数据显示,每年约有20万名5岁以下儿童死亡[1]。研究[2]显示,50%~70%儿童的死亡地点在医院,尤其是医院的儿科重症监护病房[3]。这提示儿童重症监护病房(pediatric intensive care unit,PICU)和新生儿重症监护病房(neonatel intensive care unit,NICU)的医护人员在挽救危重患儿生命的同时也需对其死亡及死亡后其家庭成员的反应做出准备。     

新生儿重症监护病房护理人员疼痛知识培训的效果分析

目的探讨疼痛知识培训对新生儿重症监护病房(neonatal intensive care unit,NICU)护理人员疼痛管理知识和态度的影响。方法便利抽样选取某三级综合性教学医院的临床NICU护理人员42人,采用自身前后对照的研究设计,使用护理人员疼痛知识和态度(2008)中文版问卷(knowledge and attitudes survey regarding pain,KASRP)评价疼痛知识培训对护理人员疼痛管理知识和态度的影响。结果接受疼痛知识培训后,护理人员KASRP的平均得分从培训前的(16.88±3.05)分增加到(34.68±5.74)分,应用疼痛评估工具的频率显著增加,与培训前比较差异均有统计学意义(均P0.05)。结论疼痛知识培训能显著提高NICU护理人员的疼痛知识水平,改善对疼痛管理的认识,促进其对新生儿疼痛的管理,对及时评估、预防和降低新生儿疼痛具有积极的意义。     

早产儿操作性疼痛及白噪声的应用进展

呼吸治疗、静脉穿刺、足根采血等操作性疼痛会引起早产儿一系列的生理改变,导致呼吸暂停、喂养不耐受、低血糖等并发症的发生,还可能引起发育迟缓、儿童期注意力不能集中、自我调节能力差等长期功能障碍。白噪声是一种连续的嗡嗡声音,模拟母体内的、熟悉的声音环境,通过听觉诱发随机共振。白噪声干预或白噪声联合口服葡萄糖、非营养性吸吮等联合干预可有效缓解早产儿操作性疼痛,较药物干预有一定优势。早产儿又称未成熟儿(preterm infant),是指胎龄<37周的新生儿,其中胎龄<28周称为极早早产儿,34~37周的早产儿称为晚期早产儿[1]。研究显示,早产儿入住新生儿重症监护室达到平均21 d[2],在监护期间尤其容易受到操作性疼痛的影响[3],对早产儿大脑成熟和神经发育产生影响[4],还可能导致感知行为异常或神经功能损害等较严重影响[5]。临床治疗时考虑到药物镇痛带来的副作用,一般不给予药物进行镇痛。白噪声是来自外部环境的连续、单调的声音[6],以共振的形式抑制不安[7],作为一种安全、经济、简便的干预措施来缓解早产儿操作性疼痛。国外关于白噪音研究较为成熟,国内也逐渐兴起,本文旨在总结在早产儿操作性疼痛及白噪声的应用进展,为临床实施白噪声缓解早产儿操作性疼痛提供指导,现报道如下。     

儿童重症监护病房患儿静脉输液外渗原因和护理

探究护理儿童重症监护病房患儿静脉输液时发生外渗现象的原因,提出护理预防措施以及出现外渗现象后的处理方法。     

重症监护病房语言交流障碍患者疼痛评估的研究进展

疼痛评估是做好患者疼痛管理的第一步。本文综述了重症监护病房语言交流障碍患者5个疼痛评估量表的研究与应用,包括疼痛行为量表、疼痛干预计数法、成人非语言疼痛量表、非语言疼痛评估量表及重症监护疼痛观察量表;介绍了疼痛评估生理指标的意义,为我国医护工作者科学地评估该类患者的疼痛程度提供参考。     

新生儿重症监护病房噪声现况调查

目的:调查新生儿重症监护病房（NICU）噪声状况。方法:2020年12月1日—2020年12月10日使用噪音计对上海市某三级甲等儿童专科医院NICU有声设备噪声、病室内环境噪声和暖箱内部噪声进行测量。结果:NICU常用的心电监护仪报警音量为55.7～86.3 dB;微量注射泵报警音量为62.6～76.2 dB;洗手池噪声为52.8～82.2 dB;连接氧气接头的湿化瓶噪声为48.7～61.2dB;暖箱内部基础噪声为43.4～58.6 dB;设备移动时发出的噪声为47.4～85.3 dB;NICU白天暖箱内部噪声为46.4～97.6 dB;NICU病室内环境噪声为47.4～96.2 dB。结论:NICU内的环境、仪器设备和暖箱内部噪声均较大,不利于早产儿生长发育,需引起重视并重点改进。     

儿童重症监护病房病原菌分布及耐药性分析

目的 调查2008年武汉市儿童医院重症监护病房(PICU)病原菌的分布及耐药情况,为临床合理选用抗菌药物提供依据.方法 采用VITEK-32微生物全自动鉴定系统鉴定细菌菌种,以纸片扩散法进行药敏试验,按美国临床及实验室标准化协会(CLSI)2008年标准操作.结果 全年共分离细菌584株,其中革兰阴性杆菌68.15%,革兰阳性球菌21.58%,真菌10.27%.大肠埃希菌和肺炎克雷伯菌属超广谱β-内酰胺酶产生率分别为57.77%和58.62%.耐甲氧西林凝固酶阴性葡萄球菌检出率为75.00%.药敏结果显示,大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌对亚胺培南、美洛培南、环丙沙星、阿米卡星最敏感,其次为哌拉西林/他唑巴坦;鲍曼不动杆菌耐药性较低的抗生索依次为环丙沙星、阿米卡星、头孢哌酮/舒巴坦,对碳青霉烯类耐药率达50%以上;嗜麦芽窄食单胞菌对复方新诺明最敏感,其次为环丙沙星,对碳青霉烯类耐药率达100%;革兰阳性球菌对万古霉素、替考拉宁和利奈唑胺最敏感.结论 我院PICU优势病原菌为革兰阴性杆菌,以大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌为主.各类细菌对常用抗菌药物表现为高度多重耐药,临床应依据细菌病原学及耐药性资料合理选择抗菌药物.     

The effects of auditory interventions on pain and comfort in premature newborns in the neonatal intensive care unit; a randomised controlled trial

ObjectiveThis study investigated the effects of three auditory interventions; white noise, recorded mother's voice, and MiniMuffs, applied during a heel lance on pain and comfort in premature infants in the neonatal intensive care units.Design and methodsThis experimental, parallel, randomised controlled research was conducted in a state hospital tertiary-level neonatal intensive care unit. The sample comprised sixty-four premature infants with gestational ages of 31–36 weeks. The infants were randomly assigned to four groups: i) white noise, ii) recorded mother’s voice, iii) MiniMuffs, and iv) control. Pain and comfort of newborns were evaluated according to the Neonatal Infant Pain Scale (NIPS) and the COMFORTneo scale. Oxygen saturation, heart rate, and crying time were also measured.ResultsThe mean of oxygen saturation levels in the white noise, recorded mother's voice, and MiniMuffs group were higher than the control group. The heart rate, crying time, mean NIPS score, COMFORTneo score of the premature neonates in the white noise, recorded mother’s voice, and MiniMuffs groups were significantly lower than the control group (p < .001).ConclusionAuditory interventions used during heel lance reduce the pain and increase the comfort of the premature infants. White noise is extremely effective in preventing infants’s pain.     

Effects of intensive care unit noise on patients: a study on coronary artery bypass graft surgery patients

Aims and objectives. The aim of this study was to measure the noise levels in specific locations of an intensive care unit and determine the disturbance levels of patients owing to noise. Background. Studies have shown that hospital noise is a potential stressor for patients. Noise levels measured in the intensive care unit are mostly far beyond the recommended standards for hospitals, and generally measured around 60–70 dB (A). Although there are a few studies on noise levels in the intensive care unit, no study could be found that compares 24‐hour intensive care unit noise measurement data at several locations of intensive care unit. Methods. The study was conducted with 35 coronary artery bypass graft surgery patients. The intensive care unit noise level was measured by using Bruel & Kjaer 2144 Model Frequency Analyzer next to the bed of each patient. A patient's disturbance owing to the intensive care unit noise was questioned. Results. Noise levels ranged between 49 and 89 dB (A) with a mean of 65 dB (A). Peak noise levels were measured as high as 89 dB (A). The noise levels measured at different locations in the intensive care unit did not differ significantly. Noises created by other patients, those who were admitted from emergency room and operating room into intensive care unit, monitor alarms, conversations among staff were the most disturbing noise sources for patients. Conclusion. The patients who were located in the bed which was closer to the nurses' station were more affected by the intensive care unit noise than other patients. Having a previous intensive care unit experience also affected the patients’ disturbance levels owing to noise. Relevance to clinical practice. Nurses are in key positions where they can identify physical, psychological and social stressors that affect patients during their hospital stay. Staff education, planned nursing activities and proper design of intensive care unit may help combat this overlooked problem.     

Poisonings requiring admission to the pediatric intensive care unit: A 5-year review

Background. Poisonings represent a significant number of preventable admissions to the pediatric intensive care unit (PICU), but data about poisonings requiring PICU-level care are limited. Objectives. To identify the demographics of patients admitted with poisonings and characterize their clinical courses related to their poisoning. Methods. All poisonings over a 5-year period (2008–2012) at an academic medical center in New England were retrospectively reviewed using electronic medical records in an observational case series. Poisonings were identified using key search terms within an admissions database. Results. There were 273 admissions for poisonings, which represent 8% of total PICU admissions over this time period. The poisonings were unintentional in 148 (54%) cases and intentional in 125 (46%). The vast majority of poisonings occurred in patients either 3 years or below (N = 121, 44%) or 13 years or above (N = 124, 45%). Most (96%) admissions were for less than 48 h and 41% were for less than 24 h. Mean PICU length of stay was 1.2 + 0.7 days. A total of 468 substances were ingested in 54 different drug classes, with analgesics and antidepressants being the most common. Eighty-five (31%) poisonings were polypharmaceutical. The most commonly used therapies were naloxone, activated charcoal, and benzodiazepines. Twenty-seven patients (10%) received mechanical ventilation. There was one fatality, an adolescent with a polypharmacy overdose in a suicide attempt. Conclusion. Pediatric poisonings are a significant percentage of admissions to the PICU. The majority of poisonings are non-fatal, require supportive care, close monitoring, and some specific treatment. Drug classes causing poisonings have changed to a higher percentage of opioids in younger patients and atypical antidepressants in adolescents.     

Perceptions of parents on satisfaction with care in the pediatric intensive care unit: the EMPATHIC study

Purpose  To identify parental perceptions on pediatric intensive care-related satisfaction items within the framework of developing a Dutch pediatric intensive care unit (PICU) satisfaction instrument. Methods  Prospective cohort study in tertiary PICUs at seven university medical centers in The Netherlands. Participants  Parents of 1,042 children discharged from a PICU. Results  A 78-item questionnaire was sent to 1,042 parents and completed by 559 (54%). Seventeen satisfaction items were rated with mean scores <8.0 (1, completely unimportant, to 10, very important) with standard deviations ≥1.65, and thus considered of limited value. The empirical structure of the items was in agreement with the theoretically formulated domains: Information, Care and Cure, Organization, Parental Participation, and Professional Attitude. The Cronbach’s α of the domains ranged between 0.87 and 0.94. Conclusions  Parental perceptions on satisfaction with care measures were identified and prioritized. Reliabilities of the items and domains were of high level.     

儿童重症监护室病人呼吸机相关性肺炎Logistic回归分析

[目的]探讨儿童重症监护室(PICU)患儿呼吸机相关性肺炎(VAP)的发病情况和危险因素,为预防儿童VAP提供科学依据.[方法]对2007年1月-2008年12月在上海交通大学医学院附属儿童医学中心PICU应用机械通气超过48 h的患儿240例病史资料进行回顾性分析,先对可能的危险因素应用卡方检验进行单因素分析,筛选出有统计学意义的危险因素,再对主要危险因素采用多因素Binary Logistic回归分析.[结果]在240例患儿中有92例发生了VAP,发病率为38.3%;机械通气时间、留置胃管时间、存在原发肺部疾病、插管方式、再插管是引起VAP的危险因素,口腔护理为VAP保护因素.[结论]PICU患儿VAP发病率较高,机械通气时间、留置胃管时间、存在原发肺部疾病、插管方式、再插管和口腔护理为VAP影响因素;应针对VAP影响因素制定相应的护理干预措施.     

儿童重症监护治疗病房118例重症意外伤害儿童临床及预后分析

目的分析儿童重症监护治疗病房（PICU）重症意外伤害儿童临床及预后情况。 方法回顾性分析广东省佛山市妇幼保健院PICU 2012年1月至2018年10月收治的118例重症意外伤害儿童的一般情况、临床资料和预后情况。对118例患儿的性别、地域分布、来源、有无监护人员在场等资料的组间比较,对不同年龄组儿童重症意外伤害的发生率和种类的比较采用χ²检验。 结果共收治重症意外伤害患儿118例,占同期PICU收治患儿总数的9.60%。在患儿一般情况方面：性别比较差异有统计学意义（男孩72例vs女孩46例,χ²=11.46,P<0.05）;发生意外时有无监护人在场,二者比较差异有统计学意义（有人在场48例vs无人在场70例,χ²=8.20,P<0.05）。患儿的地域分布和来源差异无统计学意义（P均>0.05）。不同年龄组意外伤害的发生例数和发生率：婴儿组39例（33.05%）,幼儿组53例（44.92%）,学龄前儿童组19例（16.10%）,学龄期儿童组6例（5.08%）,青春期组1例（0.85%）。不同年龄组儿童重症意外伤害的发生率差异有统计学意义（χ²=104.72,P<0.05）,幼儿组的发生例数最多。意外伤害种类分别为气管异物41例（34.75%）、窒息22例（18.64%）、中毒18例（15.25%）、溺水14例（11.86%）、交通意外7例（5.93%）、消化道异物7例（5.93%）、烧烫伤3例（2.54%）以及其他6例（5.08%）。不同年龄组意外伤害种类比较,差异有统计学意义（χ²=102.92,P<0.05）。患儿平均住院时间9.48 d,平均住院花费9126元。死亡病例17例,死亡原因中溺水7例,窒息6例,中毒3例,其他1例。 结论重症意外伤害患儿中男孩多见,幼儿组发病例数最多。溺水、窒息是前两位的意外伤害死亡原因。应强化安全意识,注重安全教育,减少儿童意外伤害发生。     

Evaluation of pediatric intensive care scoring systems

There is no report analysing pediatric severity scoring systems in British Intensive Therapy Units (ICUs). Two previously reported pediatric severity scoring systems, the Admission Physiologic Stability Index (APSI) and the Organ System Failure (OSF) score were evaluated for 151 patients. The APSI was higher for children who died than for those who lived (p<0.001). This difference reflected the sharp distinction between the APSI for chilren who left intensive care within 24 h and those remaining in ICU longer than 24h (p<0.001). For children remaining in ICU longer than 24 h, there was a large overlap of APSI scores, and the APSI did not discriminate between children in the overlap region who lived and those who died (p=0.054). There was underscoring of neurological patients; the APSI did not differentiate neurological patients whole lived and those who died (p>0.10). The OSF also underscored neurological patients. Increasing number of organ systems failed was associated with increasing mortality. In contrast to previous reports, however, the mortality rate was unaffected by whether the total number of systems failed simultaneously or non-simultaneously. There is still a need for a comprehensive yet simple pediatric scoring system for comparing the efficacy and outcome of pediatric intensive care in different ICUs in different countries.     

Unplanned pediatric intensive care unit readmissions: A single-center experience

Purpose

The purpose of the study was to compare patients readmitted to the pediatric intensive care unit (PICU) unexpectedly within 48 hours (early), more than 48 hours from transfer (late), or not readmitted during the same hospitalization.

Materials and Methods

A retrospective study (2007-2009) was performed at a tertiary care pediatric academic hospital. Readmitted at-risk patients were grouped by timing of readmission, and a sample of nonreadmitted patients was randomly selected. Early readmissions were compared to late readmissions and to nonreadmissions.

Results

Of 3805 eligible patients, 3.9% had an unplanned PICU readmission with almost half occurring within 48 hours. Median times to readmission were 21.5 hours (early) and 7 days (late). Compared with late readmissions, early readmissions were more often admitted from and transferred to a surgical service, transferred on a weekend, and readmitted with the same primary diagnosis. Compared with nonreadmitted patients, independent risk factors for early readmission were admission source and respiratory support at PICU transfer. Readmitted patients had longer total PICU and hospital lengths of stay than nonreadmitted patients. Late readmissions had a higher mortality than early readmissions.

Conclusions

Patients requiring an unplanned PICU readmission had worse outcomes than those without a readmission. Future studies should focus on identifying modifiable risk factors for targeted interventions.     

The lived experience of parents of children admitted to the pediatric intensive care unit in Lebanon

Background

Family caregivers have a significant responsibility in the care of their child in the Pediatric Intensive Care Unit (PICU). Parents staying with their child in the PICU have particular needs that should be acknowledged and responded to by clinicians. Several studies have been conducted in the USA and Europe to try to understand the experience of family caregivers of children admitted to the Pediatric Intensive Care Unit. There are no such studies in Lebanon or the Middle East where the culture and support systems differ from other countries.

Objective

To understand the lived experience of Lebanese parents of children admitted to the PICU in a tertiary hospital in Beirut.

Design

Phenomenological study.

Methods

The study followed purposeful sampling in which 10 parents (mother or father) of children admitted to PICU were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironside (1998).

Results

A constitutive pattern “Journey into the unknown” which constitutes an overarching theme and four major themes with subthemes emerged from the data. These were: We are human beings with dignity “; “looking for a healthier environment”; Dependence on God and “The need to be in the loop” reveal the parents’ journey into the unknown.

Conclusion

This qualitative study adds to the knowledge that would help health care workers understand the experience of Lebanese parents with a child in PICU and to highlight the significance of this experience to them. The findings could be used to inform the development of a PICU parental satisfaction instrument for the sample group.     

Characteristics and immediate outcome of childhood meningitis treated in the pediatric intensive care unit

Objective To describe patient characteristics, use of technology and mortality in children with meningitis admitted to the pediatric intensive care unit (PICU).Design Retrospective cohort study.Setting Fifteen US PICUs.Patients All admissions with a diagnosis of meningitis between 1995 and 2000 in the Pediatric Intensive Care Unit Evaluations (PICUEs) database.Measurements and results Of 559 patients with meningitis, 58% were male. The median age was 19 months and the median length of PICU stay was 2 days. The crude PICU mortality rate was 7%. Three hundred thirty-four (60%) patients had bacterial meningitis. Non-survivors had significantly higher Pediatric Risk of Mortality (PRISM) III scores and also constituted a larger proportion of the patients with bacterial meningitis, coma and shock upon PICU admission. The use of invasive devices was higher among non-survivors, patients with bacterial meningitis or those who were in coma or shock upon PICU admission. There was significant variation in the use of intracranial pressure (ICP) monitors by coma status and by institution. In multivariate analysis, patients had 1.26 higher odds of mortality for each unit increase in PRISM III score (odds ratio 1.26, 95% confidence interval: 1.19–1.34), while adjusting for other variables.Conclusion In a large cohort of children admitted to the PICU with meningitis, severity of illness, particularly the presence of shock or coma, was significantly associated with both the higher use of invasive medical devices and higher mortality. There was significant variation in the use of ICP monitors among the various PICUs without statistical association with survival.Presented, in part, at the 14^th Pediatric Critical Care Colloquium, San Diego, CA, USA, October 2002