A prolonged observational study of tracheal tube displacements: Benchmarking an incidence <0.5-1% in a medical-surgical adult intensive care unit

Background and Aims:

Tracheal tubes are commonly used in intensive care unit (ICU) and lead to complications like displacements. The primary aim of the study was to evaluate if the rate of tracheal tube displacement benchmarked at <1% per patient and <0.5% per tracheal tube day, could be sustained over a prolonged period. The secondary aim was to document the patterns of all forms airway accident and to evaluate their consequences.

Subjects and Methods:

This was a prospective observational study of Intubated and ventilated patients in a General Medical-Surgical Adult ICU. The incidence of accidental extubation, self extubation, partial displacement and blockages of tracheal tubes were recorded.

Results:

The overall tracheal tube displacement rate was 61/10,112 (0.6%) per patient and 61/28,464 (0.22%) per tracheal tube day. There were 30 additional incidents of blockage, kinking or biting of the tracheal tube. Physiological consequences-69 were mild, 10 moderate, 12 major and one death. Of the 91 accidents, 30 were partly and 30 were completely preventable. 76 incidents involved an endotracheal tube (54 displaced, 12 blocked and 10 bitten-kinked) and 15 a tracheostomy tube (seven displaced and eight blocked). Accidents were more common in medical than surgical patients (medical = 48, cardiac surgical = 17 and other surgical/trauma = 26).

Conclusion:

Tracheal tube displacement rate in a mixed medical-surgical adult ICU was maintained below the pre-set benchmark of <1% per patient and <0.5% per intubated day over nearly a decade.     

对《中国乙型肝炎病毒母婴传播防治指南(2019年版)》中育龄妇女抗病毒治疗期间意外妊娠推荐意见的评价

最近,中华医学会感染病学分会发表了《中国乙型肝炎病毒母婴传播防治指南(2019年版)》 [1] (以下简称《指南》),以减少HBV的母婴传播。《指南》发表后,相关杂志刊登了学术讨论文章 [2-3] ,营造了学术争鸣环境,通过讨论,解决问题,提高学术水平。笔者就服用替诺福韦酯(TDF)、替比夫定(LdT)等抗病毒药物或使用干扰素期间意外妊娠等问题,提出个人的一些观点。     

Prospective Study of Unplanned Admission to the Intensive Care Unit after Total Hip Arthroplasty

The morbidity associated with elective total hip arthroplasty (THA) may result in intensive care unit (ICU) admission. A total of 175 consecutive THA patients were prospectively triaged to either an ICU bed or routine post-operative floor according to admission criteria based on a prior published study of 1259 THA patients. Primary end points were a reduction in unplanned ICU admission, as well as major complications. With our triage model, the rate of unplanned ICU admissions dropped from 7.1% to 2.2% (P = 0.013). The as-treated odds of unplanned admission pre- versus post-intervention were 3.2 (1.2, 10.6). The complication rate fell from 12.5% to 2%, and the mortality index decreased from 4.77 to 1.62. Triage according to selected risk factors affects a reduction in unplanned ICU admissions and major complications after THA.     

1 251例重复人工流产术后落实不同避孕方法的效果评价

目的：评价重复人工流产术后即时落实不同避孕方法的效果。方法：1 251例重复人工流产者接受流产后服务（PAC）,自愿选择并即时落实避孕方法,随访不同避孕方法的使用情况及不良反应等。结果：所有重复流产者接受PAC后均即时落实避孕措施,其中复方口服避孕药（COC）组随访12个月续用率达31.2%;宫内节育系统（IUS）组随访12个月有3例因有生育要求取出,其余均坚持使用,另外有19例、13例和17例分别于随访3、6、12个月自COC组转入;宫内节育器（IUD）组随访12个月有1例异位妊娠,6例因有生育要求取出,其余均坚持使用,另外有23例、31例和19例分别于随访3、6、12个月自COC组转入。随访中发现部分人群有阴道点滴出血、经量减少、经量增多、闭经、节育环下移和腰酸不适等不良反应,给予处理并充分解释后均继续坚持使用。结论：科学有效的PAC能有效避免重复流产,保护女性生殖健康。     

先天性白内障手术后计划外再手术原因及相关危险因素研究

目的　探讨先天性白内障手术后计划外再手术的原因及相关危险因素,为先天性白内障手术提供参考。方法　回顾性研究。收集2009年1月至2018年12月于青岛眼科医院就诊并行先天性白内障手术后计划外再次入院手术治疗的患者资料,分析患者再手术发生率、再手术时间以及发生原因等。结果　将白内障手术后计划外再手术36例（42眼）患者纳入本研究。计划外再手术占前三位的疾病分别为:后发性白内障(54.76%,23/42）、继发性青光眼(21.43%,9/42)、瞳孔闭锁（14.29%,6/42）;其他原因有人工晶状体异位（7.14%,3/42）、视网膜脱离（2.38%,1/42）。计划外再手术发生率在0～3个月龄组为13.29%,显著高于4～12个月龄组（3.82%）和>12个月龄组（1.96%）,组间差异有统计学意义（P=0.00）;低月龄（≤3个月）白内障手术、一期未植入人工晶状体与后发性白内障、继发性青光眼和瞳孔闭锁均高度相关（均为P＜0.05）。结论　后发性白内障、瞳孔闭锁和继发性青光眼为先天性白内障手术后计划外再手术的主要原因,低月龄（≤3个月）患者行白内障手术与计划外再手术高度相关。     

Are There Identifiable Risk Factors and Causes Associated with Unplanned Readmissions Following Total Knee Arthroplasty?

We conducted a retrospective review of 3218 primary total knee arthroplasties (TKA) performed over two years at an urban academic hospital network using clinical and administrative data. Increased length of stay (LOS) was associated with readmission (P < 0.001). Readmission was not associated with age (P = 0.100), gender (P = 0.608), body mass index (P = 0.329), or staged bilateral procedures (P = 0.420). The most common readmitting diagnoses were post-operative infection (22.5%), hematoma (10.1%), pulmonary embolus (7.9%) and deep vein thrombosis (5.6%). Of readmissions, 53.9% were for surgical reasons and 46.1% were for medical reasons. Certain interventions described in previous literature may be more successful in minimizing unplanned readmissions by focusing on patients with extended LOS, elevated infection risk and low socioeconomic status.     

导道滑脱风险跟踪评估监控流程的设计及应用

目的规范预防导管滑脱管理,降低非计划拔管发生率。方法制定导管滑脱风险评估监控表和导管滑脱风险跟踪评估监控流程,将导管滑脱风险评估监控表和跟踪评估监控流程应用于临床并进行动态管理。结果实施后高危拔管患者非计划拔管发生率显著低于实施前(P0.05)。结论实施导管滑脱风险跟踪评估监控流程,能降低非计划拔管发生率。     

Risk factor for 31-day unplanned readmission to hospital in patients with pulmonary tuberculosis in China

Objectives:To evaluate risk factors associated with 31-day unplanned readmission(s) for pulmonary tuberculosis (TB) in China.Methods:This retrospective study enrolled patients (age, >14 years) with pulmonary TB who experienced 31-day unplanned readmissions to a specialized hospital for TB between January 2018 and December 2019. For each confirmed readmission, 2 control subjects were randomly selected from among patients with pulmonary TB but did not experience an unplanned readmission within 31 days.Results:A total of 402 pulmonary TB patients (5.9%) experienced unplanned readmission within 31 days after discharge. In univariate analysis, readmission was associated with gender, age, insurance coverage, residing in a rural area, active smoking, chronic obstructive pulmonary disease (COPD), drug-induced hepatitis, and leaving hospital against medical advice. The final logistic regression model revealed that higher risks for unplanned readmissions were associated with male gender (odds ratio [OR] 1.44, [95% confidence interval (CI) : 1.06-1.95]), age >65 years (OR 2.94, 95%CI: 2.03-4.27), rural residence (OR 8.86, 95%CI: 6.61-11.87), active smoking (OR 2.15, 95% CI 1.37-3.40), COPD (OR 2.77, 95%CI: 1.59-4.81), and leaving hospital against physician advice (OR 4.11, 95%CI: 1.43-11.83). The median time to 31-day unplanned readmission was 24 days. Major reasons for unplanned readmission included fever, exacerbation of dyspnea, and hemoptysis.Conclusion:Unplanned readmission for pulmonary TB within 31 days of discharge was higher among older males residing in rural areas, active smokers, and those leaving hospital against medical advice.