Is routine extubation overnight safe in cardiac surgery patients?

Objectives

Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.

Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran

Background and objective

Pressure ulcer (PU) is one of the important and frequent complications of hospitalization, associated with high treatment costs. The present study was conducted to determine the incidence of PU and its direct treatment costs for patients in intensive care unit (ICU) in Iran.

神经外科重症监护病房常见病原菌的分布与耐药性研究

目的调查珠江医院神经外科重症监护病房(ICU)病原菌的分布与耐药情况,分析ICU院内感染的发生原因,探讨防治对策。方法应用法国VITEKⅡ全自动细菌鉴定仪鉴定病原菌,用纸片扩散法检测药敏结果。结果神经外科ICU菌群主要以革兰阴性杆菌(71.6%)为主,鲍曼不动杆菌占16.7%,大肠埃希菌占15.7%,铜绿假单胞菌占13.7%,肺炎克雷伯菌占13.7%等。但葡萄球菌、粪肠球菌等阳性球菌(28.4%)也有增加的趋势。亚胺培南和头孢哌酮/舒巴坦仍保持最高抗菌活性,细菌的耐药率分别为15.3%和30.6%。结论我院神经外科ICU感染主要病原菌是革兰阴性杆菌,对常用抗菌药物耐药性较高,但革兰阳性球菌所占比例呈增高趋势。控制第二、三代头孢菌素以及制酸剂(质子泵抑制剂)的预防性用药,减少耐药菌株的产生,有针对性地使用抗生素是控制危重病人感染的有效措施。     

早期胰岛素强化序贯治疗在ICU中的临床应用

本文通过复习相关文献资料，就早期胰岛素强化序贯治疗在ICU病人治疗中应用的几个主要方面进行扼要的综述，以利临床医生的参考。     

ICU镇静研究和应用的近况

对病人实施适度镇静已成为ICU不可缺少的一部分。镇静可减轻机体的应激反应,消除病人焦虑,增加对机械 通气的耐受,有利于护理等。本文主要阐述成人ICU镇静的镇静深度评分系统,药物的选择,使用方法等。     

ICU重型颅脑外伤并发肺部感染临床分析与对策

目的:研究该院ICU病房重型颅脑外伤患者院内肺部感染原因及病原菌特点,探讨预防及控制感染的措施。方法:对该院1999年5月~2004年12月的245例ICU重型颅脑外伤患者肺部感染危险因素及病原菌调查分析。结果:院内感染率为31.8%,引起肺部感染有显著意义的危险因素有高龄、住院时间过长、呼吸机应用、气管切开、休克、基础病等;肺部感染以G-杆菌为主,占64.7%,依次为阴沟杆菌、铜绿假单孢菌、不动杆菌、嗜麦芽黄单胞菌、大肠埃希菌,G+球菌占14.1%,真菌占21.2%。结论:针对危险因素,采取有效措施降低感染率;为有效控制感染,必须合理选择抗生素,重视交叉感染。     

Diabetic and nondiabetic hyperglycemia in the ICU

Hyperglycemia is a common feature in critically ill patients, whether they are diabetic or not, and it is associated with unfavorable outcome. The more severe the underlying disease, the more important the hyperglycemia appears to be although, we still cannot define whether hyperglycemia is just a marker of the severity of the acute illness or rather an active contributor to poor outcome. The review of the literature on this subject published from 2001 up today conveys a massive amount of information the interpretation of which is equivocal, due to the heterogeneity of patients (nondiabetic vs. diabetic, medical intensive care unit (ICU) pts vs. surgical ICU pts) and of interventions (dose and modality of insulin infusion).The association between high glucose level and mortality is strong in critically ill patients without a previous history of diabetes. Admission hyperglycemia seems to be an independent risk factor of in-hospital mortality in patients both with and without diabetes in cardiac, cardiothoracic and neurosurgical ICUs. No data are still available on general surgical ICU patients.Tight control of blood glucose levels has been demonstrated to improve outcome in both diabetic and nondiabetic critically ill patients. In surgical ICUs, tight glucose control improves mortality and reduces morbidity only among patients admitted in ICU for more than 5 days, while outcome is not improved in patients who stay in ICU for less than 3 days.However, it is not yet understood if such favorable effect is secondary to glucose control itself or if insulin plays a part, by means of its nonglucose, anabolic effects. More randomized controlled trials are needed, addressing specific issues—such as the optimal target glucose concentration and the most effective insulin regimen—especially in the general surgical patient.     

多元文化护理在ICU的应用

针对ICU特殊的医疗环境和病人对多元化的迫切需要，总结在ICU应用多元化护理的具体护理对策。指出依据病人不同的化背景和需要，通过改善ICU的化环境（传统化、现代化、饮食化）、居住环境、语言环境，可缓解多元化冲击，提高ICU的护理质量和护士素质。     

人文关怀护理在ICU的应用

人文关怀是对人、人类社会的生存和发展、命运和前途的关心,是对人性和人权的尊重和保护,是对人独立思想和人格的容许与提倡。我们针对重症监护病房(IntensiveCareUnit,ICU)自身的特点,根据患者的病情和需求,从ICU病房的设置、布局,护士服务意识入手,注重人性化护理服务,加强患者的病情宣教,完善与家属沟通技巧,加速患者顺利康复,促进我院现代化护理服务向深层次发展。     

气管切开病人在ICU期间的健康教育

气管切开是保持呼吸通畅的一种急诊手术,病人在ICU(重症监护)期间,如能加强相关卫生知识的宣传教育工作,对疾病的治疗及预后,都将起到一定作用.