ICU临床信息管理系统的研究

目的 以危重病人的临床过程为主线，利用全过程、全方位的管理信息流，建立ICU临床信息数据库，为治疗、护理、教学和科研提供科学依据和指南。方法 借助计算机专业技术力量，对ICU临床信息的收集、归类、储存、分析、统计和输出进行科学和系统的研究。结果 开发出ICU个体、整体临床信息的管理软件。结论 建立了ICU电子化工作和业务流程规范，为实现医院临床医疗信息网络化创造条件；提高了业务水平，减少了ICU护士护理文件书写记录的手工作业，提高了工作效率和护理质量。     

ICU护士长的职权与管理技巧

在医院的组织系统中，护士长是最基层的管理者，其位置及作用至关重要。尤其ICU是危重病人、先进医疗设备和急救技术知识密集的地方。因此，在病房管理，危重病人的抢救方面，要学会应用一定的管理技巧。下面就我院ICU十多年来的管理经验总结如下。     

ICU病人营养支持护理与临床应用

目的：通过营养管理、营养支持、保障危重病人的细胞和脏器功能。方法：采用经周围置入中心导管（PICC）输注营养液。结果：避免中心静脉置管并发症。对很多危重病人获得抢救机会得以康复。结论：临床营养支持的实施，提高了多种特殊肠道疾病的治愈率。     

香港医院ICU的组织管理与发展现状

1999年我参加了香港举办的“国际危重症护理研讨会” ,在港期间我参观考察了威尔斯亲王医院、依丽莎白医院、玛丽医院等六所医院的ＩＣＵ。同时 ,有幸结识了香港危重病护士学会执行委员会主席陈永强先生。陈先生是香港威尔斯亲王医院ＩＣＵ的专科护士 ,同时兼任香港中文大学、英国和澳大利亚ＩＣＵ课程文凭的讲师 ,对ＩＣＵ专科护理有很深的研究 ,由此被我院聘为重症护理协作指导顾问。近年来 ,陈先生先后两次在我院举办的北京军区重症监护学习班上进行专题讲学 ,我也多次与陈先生就ＩＣＵ护理专业进行交流与探讨。 2 0 0 0年我被吸收为香港…     

ICU危重病人转运的护理体会

危重病人原则上是不宜搬动。但有时为明确病情，或者转运到条件更好的医疗机构，转运势必难免。现将一点护理体会报告如下。     

60例ICU科危重病人镇静治疗的临床分析

对ICU科收治的60例危重病人采用镇静治疗的临床资料进行回顾性分析,观察其治疗效果。危重病人在接受治疗后取得了良好的治疗效果,仅有6例诱发并发症,治疗无效死亡1例;患者在进行镇静治疗后,SAS、SDS、HAMD评分均较治疗前显著降低(P0.05);患者满意度较治疗前显著提高,差异具有统计学意义(P0.05)。ICU科危重病患接受镇静治疗后取得了良好的临床治疗效果,其中治疗过程中的用药选择及护理手段均会影响患者的情绪,干扰治疗结果,因此,必须提高患者临床护理效果,进而提高治疗效果,降低并发症的发生率。     

综合医院ICU病人心理状况分析及对策

采用症状自评量表（ＳＣＬ－９０）对初入院的４４例危重病人进行问卷测评，根据测评结果对ＩＣＵ的２４例病人在积极治疗同时，进行针对性的心理护理（观察组）１４天后，进行２次测评，并与入ＣＣ产ＲＣＵ的２０例病人进行对照（对照组）。结果显示：心理护理前观察组，对照组各因子分均高于国内常模（Ｐ〈０．００１），观察组行心理两周后，除躯体化，忧郁，僬 虑巩怖因子分外，其余因子分与国内常模无差异（Ｐ〉０．０５），对     

国内外ICU建设与研究进展

目的：研究国内外ICU建设与发展规律，以便建设我国标准的ICU。方法：通过近10年发表的大量文献进行丹析整理综合。结果：国内外ICU发展仍在完善之中，但国外发达国家ICU无论建设和救治经验已趋成熟，我国近20年ICU从数量上发展是惊人的，约有20％能达到国外ICU水平。结论：ICU是国内外大中医院发展的一个趋势，降低急危重病人死亡率，提高了医疗质量，代表了一个医院的规模和水平。在我国同档次的医院应建立统一标准的ICU。     

大震后内科ICU病人多次转运的安全管理

5月12日14时28分四川汶川发生里氏8．0级的特大地震，我院也遭受严重破坏。由于强烈的余震不断，加之唐家山堰塞湖溃坝的危险，为保证病人安全，内科ICU进行了多达9次的转运，因病人病情危重，大多数须进行机械通气、连续性肾脏替代治疗（CRRT）等维持生命，治疗、护理较复杂，转运风险极大。现将9次的转运体会总结如下，以供同行参考。     

ICU的建立与发展

ICU（重症监护拳）是一支以危重病医学为专科、专门从事危重病救治的专业化队伍的临床基地，它集中了最先进的医疗监护设备，能对所接收的危重病人进行连续严密的监护和及时有效的抢救。对于ICU的病人来说，护理对其预后起着决定性的作用。     

护理风险管理在ICU的应用

[目的]在ICU护理质量管理中运用护理风险管理,以提高ICU护理质量.[方法]通过对护理风险的识别、衡量和评价、处理、效果评价4个阶段的护理风险管理,采取一系列有效的防范措施.[结果]护理风险管理提高了ICU护士的风险意识和业务水平,减少了护理差错和纠纷的发生.[结论]护理风险管理在ICU的应用降低了护理风险的发生,确保了护理安全.     

Multicentric study of monitoring alarms in the adult intensive care unit (ICU): a descriptive analysis

OBJECTIVES: To assess the relevance of current monitoring alarms as a warning system in the adult ICU. DESIGN: Prospective, observational study. SETTINGS: Two university hospital, and three general hospital, ICUs. PATIENTS: Hundred thirty-one patients, ventilated at admission, from different shifts (morning, evening, night) combined with different stages of stay, early (0-3 days), intermediate (4-6 days) and late (> 6 days). INTERVENTIONS: Experienced nurses were asked to record the patient's characteristics and, for each alarm event, the reason, type and consequence. MEASUREMENTS AND MAIN RESULTS: The mean age of the patients included was 59.8 +/- 16.4 and SAPS1 was 15.9 +/- 7.4. We recorded 1971 h of care. The shift distribution was 78 mornings, 85 evenings and 83 nights; the stage distribution was 88 early, 78 intermediate and 80 late. There were 3188 alarms, an average of one alarm every 37 min: 23.7% were due to staff manipulation, 17.5% to technical problems and 58.8% to the patients. Alarms originated from ventilators (37.8%), cardiovascular monitors (32.7%), pulse oximeters (14.9%) and capnography (13.5%). Of the alarms, 25.8% had a consequence such as sensor repositioning, suction, modification of the therapy (drug or ventilation). Only 5.9% of the alarms led to a physician's being called. The positive predictive value of an alarm was 27% and its negative predictive value was 99%. The sensitivity was 97% and the specificity 58%. CONCLUSIONS: The study confirms that the level of monitoring in ICUs generates a great number of false-positive alarms.     

The implementation of a bowel management protocol in an adult intensive care unit

Aim: A study to explore the impact of implementing a bowel management protocol in a tertiary referral intensive care unit (ICU) in the West of Scotland. Methods: A three phase study was implemented. Phase 1 – a baseline audit reviewing 26 patients' medical notes and a baseline focus group reviewing the multidisciplinary team's (MDT's) opinions with regard to bowel care management in the ICU. Phase 2 – the implementation of a protocol, updated bowel care chart and education sessions for members of the MDT. Phase 3 – an end of study audit reviewing 27 patients' notes after the implementation of phase 2. Additionally, a further focus group examined the MDT's experiences of the protocol in clinical practice. Results and Findings: During the phase 1 data collection period, it was evident that there was a haphazard approach to bowel care in the ICU, resulting in poor bowel care documentation and a high incidence of constipation and diarrhoea days. After the interventions of phase 2, bowel care documentation days increased by 13% (p = 0·0003), constipation incidence decreased by 20·7% (p = 0·13) and diarrhoea days reduced by 15·2% (p = 0·18). Conclusion: Although further evaluation is planned, the protocol implemented in this particular study appears to be a useful tool for the delivery of bowel care in the ICU. Relevance to Clinical Practice: Ensuring appropriate and timely bowel care in the ICU has major implications for the critically ill patients.     

Apheresis and COVID-19 in intensive care unit (ICU)

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, and on March 2020 the World Health Organization (WHO) declared it as pandemic, causing a public health crisis. Symptoms of COVID-19 are variable, ranging from mild symptoms like fever, cough, and fatigue to severe illness. Elderly patients and those with comorbidities like cardiovascular disease, diabetes, chronic respiratory disease, or cancer are more likely to develop severe forms of the disease. Asymptomatic infections have been well documented. Accumulating evidence suggests that the severity of COVID-19 is due to high levels of circulating inflammatory mediators including cytokines and chemokines leading to cytokine storm syndrome (CSS). Patients are admitted in ICU with severe respiratory failure, but can also develop acute renal failure and multi organ failure. Advances in science and technology have permitted the development of more sophisticated therapies such as extracorporeal organ support (ECOS) therapies that includes renal replacement therapies (RRTs), venoarterial (VA) or veno-venous (VV) extracorporeal membrane Oxygenation (ECMO), extracorporeal CO2 removal (ECCO2R), liver support systems, hemoperfusion, and various blood purification devices, for the treatment of ARDS and septic shock.     

The evolution of intensive care unit performance assessment

Intensive care units (ICUs) share the problems experienced by the health care system at large. Various approaches to define and manage the quality of care patients receive in the ICU have been proposed. Performance measurement involves the collection of data to evaluate an ICU's performance against itself (over time), other ICUs, or other appropriate benchmarks. Successful performance assessment requires the quantification of relevant indexes of performance. Although these indexes are increasingly being developed, it will be some time before widely recognized, validated systems are available.     

层级管理结合APN排班在重症监护病房中的应用

为改变传统的排班方式,有效地使用有限的护理人力资源,提高护理工作效率及护理质量,将层级管理与APN排班结合用于重症监护病房(ICU)护理管理,以探讨更合理、科学的护理管理模式.     

Delirium in the intensive care unit: a review

Aim:  The aim of this paper was to review the current discourse in relation to intensive care unit (ICU) delirium. In particular, it will discuss the predisposing and contributory factors associated with delirium's development as well as effects of delirium on patients, staff and family members.
Background:  Critically ill patients are at greater risk of developing delirium and, with an ageing population and increased patient acuity permitted by medical advances, delirium is a growing problem in the ICU. However, there is a universal consensus that the definition of ICU delirium needs improvement to aid its recognition and to ensure both hypoalert-hypoactive and hyperalert-hyperactive variants are easily and readily identified.
Relevance to clinical practice:  The effects of ICU delirium have cost implications to the National Health Service in terms of prolonged ventilation and length of hospital stay. The causes of delirium can be readily classified as either predisposing or precipitating factors, which are organic in nature and commonly reversible. However, contributory factors also exist to exacerbate delirium and having an awareness of all these factors promises to aid prevention and expedite treatment. This will avoid or limit the host of adverse physiological and psychological consequences that delirium can provoke and directly enhance both patient and staff safety.
Conclusions:  Routine screening of all patients in the ICU for the presence of delirium is crucial to its successful management. Nurses are on the front line to detect, manage and even prevent delirium.     

急诊重症监护病房患者发生ICU综合征的影响因素分析与防护对策

目的调查分析急诊重症监护病房(EICU)患者发生ICU综合征的影响因素与防护对策。方法选取2017年2月至2019年2月我院收治的EICU患者183例,其中41例发生ICU综合征。采用单因素和多因素logistic回归分析影响EICU患者发生ICU综合征的危险因素。结果APACHE II评分、高血压或脑梗死史、ICU环境压力源量表评分、使用机械通气是EICU患者发生ICU综合征的独立危险因素(P<0.05),家属或社会支持、术前综合宣教是EICU患者发生ICU综合征的保护因素(P<0.05)。结论EICU患者发生ICU综合征与人口学资料、治疗情况及环境状况等诸多因素相关,医护人员需重视病情评估,联合多学科全面诊断治疗,密切关注物理、人文、治疗环境对患者心理状况产生的效果,从而避免ICU综合征发生,降低病死率。     

Emotional consequences of intensive care unit delirium and delusional memories after intensive care unit admission: a systematic review

Purpose

The aim of this study was to review literature exploring the emotional consequences of delirium and delusional memories in intensive care unit patients.

Methods

A systematic review was performed using PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO.

Results

Fourteen articles were eligible for this review. Five of them assessed delirium during intensive care unit admission, and the remainder assessed delusional memories during or after admission. No association was found for delirium and adverse emotional outcome. Data regarding delusional memories and emotional outcome were heterogenic. Some studies presented worse scores on posttraumatic stress disorder screening tools in patients with delusional memories, whereas other studies found better scores in patients with delirium or delusional memories.

Conclusions

Based on current literature, no relationship could be shown for delirium and emotional outcome. Regarding delusional memories and adverse emotional outcome, results were in contradiction.