Delirium Assessment in Intensive Care Unit: A Need for Higher Regard!

How to cite this article: Govil D, Pal D. Delirium Assessment in Intensive Care Unit: A Need for Higher Regard! Indian J Crit Care Med 2022;26(6):661–662.     

Communication with Patients on Mechanical Ventilation: A Review of Existing Technologies

How to cite this article: Anand A, Nair RR, Kodamanchili S, Panda R, Bhardwaj KK, Gowthaman TB. Communication with Patients on Mechanical Ventilation: A Review of Existing Technologies. Indian J Crit Care Med 2022;26(6):756–757.     

2016~2018年某院ICU 医院感染目标性监测及干预

目的 分析我院ICU医院感染现状,为医院感染管理提供依据。方法 制定ICU医院感染目标性监测方案,采用前瞻性监测方法对我院2016~2018年ICU患者进行目标性监测,每季度根据监测结果进行实时干预。结果 通过监测及干预,连续三年ICU医院感染发病率、医院感染例次发病率、日感染发病率、调整医院感染发病率、调整医院感染例次发病率以及调整日感染发病率均呈逐年下降趋势（P＜0.05）。神经系统和呼吸系统疾病类ICU住院患者的医院感染发病率分别为10.83%、3.31%。ICU医院感染部位以呼吸道为主,占70.67%。呼吸机、导尿管、中心静脉导管的使用率分别为33.90%、71.92%、22.73%,三管相关发病率分别为10.00‰、1.49‰、1.81‰。呼吸机使用率与VAP发病率有相关性（r=1.00,P＜0.001）。医院感染前3位病原菌分别为肺炎克雷伯菌（占30.23%）、鲍曼不动杆菌（占23.26%）、铜绿假单胞菌（占10.47%）。结论 持续开展ICU医院感染目标性监测,有利于针对高危因素及薄弱环节及时采取干预措施,从而有效降低医院感染发病率。神经系统疾病类和呼吸系统疾病类患者是院感防控关注的重点人群,器械相关性感染（特别是VAP）、多重耐药菌感染是干预的重点环节。     

Shortening ventilatory support with a protocol based on daily extubation screening and noninvasive ventilation in selected patients

BACKGROUND:

Prolonged invasive mechanical ventilation and reintubation are associated with adverse outcomes and increased mortality. Daily screening to identify patients able to breathe without support is recommended to reduce the length of mechanical ventilation. Noninvasive positive-pressure ventilation has been proposed as a technique to shorten the time that patients remain on invasive ventilation.

METHODS:

We conducted a before-and-after study to evaluate the efficacy of an intervention that combined daily screening with the use of noninvasive ventilation immediately after extubation in selected patients. The population consisted of patients who had been intubated for at least 2 days.

RESULTS:

The baseline characteristics were similar between the groups. The intervention group had a lower length of invasive ventilation (6 [4;9] vs. 7 [4;11.5] days, p = 0.04) and total (invasive plus noninvasive) ventilator support (7 [4;11] vs. 9 [6;8], p = 0.01). Similar reintubation rates within 72 hours were observed for both groups. In addition, a lower ICU mortality was found in the intervention group (10.8% vs. 24.3%, p = 0.03), with a higher cumulative survival probability at 60 days (p = 0.05). Multivariate analysis showed that the intervention was an independent factor associated with survival (RR: 2.77; CI 1.14-6.65; p = 0.03), whereas the opposite was found for reintubation at 72 hours (RR: 0.27; CI 0.11-0.65; p = 0.01).

CONCLUSION:

The intervention reduced the length of invasive ventilation and total ventilatory support without increasing the risk of reintubation and was identified as an independent factor associated with survival.     

护士工作满意度对其抬高机械通气患者床头依从性影响的应用

目的:分析重症监护病房(ICU)护士团队工作满意度状况;探讨其对护士抬高机械通气患者床头依从性的影响。方法:采用工作满意度量表分析ICU护士的工作满意度现状;使用自制检查表单,检查ICU护士抬高无禁忌症有创机械通气患者床头执行情况,计算床头抬高依从性;应用SPSS 17.0对数据进行统计分析。结果:ICU护士对团体内团结,自己是团体中的一员和能不违背自己良心做事满意度最高;而对于报酬、晋升机会和上级领导对待自己的方式及工作条件为最不满意项;内在满意度维度与依从性呈正相关(r=0.716,P=0.000),外在满意度维度与依从性呈正相关(r=0.678,P=0.002),一般满意度与依从性正相关(r=0.481,P=0.001),整体工作满意度越高的护士,其抬高机械通气患者床头依从性越高(r=0.755,P=0.000)。结论:工作满意度越高的护士,其床头抬高的依从性就越高。