Objective To identify the predictors for readmission in the ICU among cardiac surgery patients. Methods We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016. Results The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%, P<0.001). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=1.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 to1.259, P<0.001), and the drainage on the day of surgery (OR=1.001, 95%CI1.001 to 1.002, P<0.001) were the independent risk factors for readmission to the cardiac surgery ICU. Conclusion The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient healthcare planning and resources allocation.
ObjectiveTo analyze the trend of disease spectrum and main diagnosis and therapeutic technologies in respiratory intensive care unit (RICU) in recent years, and find out the trend of change of patient’s characteristics and commonly used interventions in order to provide evidence for planning discipline development and improving personnel training program.MethodsPatients information and main diagnosis and therapeutic technologies of 1503 inpatients in RICU of Shenzhen People's Hospital from January, 2017 to December, 2020 were collected. The changes of disease spectrum and diagnosis and treatment technologies in different years were compared and analyzed.ResultsAmong all the patients, 66.3% were directly admitted into RICU, 12.1% were transferred from respiratory department, and 21.6% were transferred from other departments. The proportion of patients with non-respiratory diseases as principal diagnosis had an increasing trend, from 18.8% in 2017 to 37.3% in 2020 (P<0.05). The diseases with most obvious increasing trend were sepsis, nervous system diseases, circulatory system diseases and extra-pulmonary malignancies (P<0.05). The use of respiratory related diagnosis and therapeutic technologies was gradually increasing, meanwhile, the use of non-traditional respiratory related technologies, especially continuous renal replacement therapy, was also increasing. There was no significant difference in fatality rate among different years (P>0.05).ConclusionsThe number of patients with extra-pulmonary diseases and the use of non-traditional respiratory related diagnosis and therapeutic technologies in RICU were increasing. The development of RICU and the allocation of technical personnel needed to be improved accordingly.
Objective To analyze risk factors for prolonged stay in intensive care unit (ICU) after cardiac valvular surgery. Methods Between January 2005 and May 2005, five hundred and seven consecutive patients undergone cardiac valvular surgery were divided into two groups based on if their length of ICU stay more than 5 days (prolonged stay in ICU was defined as 5 days or more). Group Ⅰ: 75 patients required prolonged ICU stay. Group Ⅱ: 432 patients did not require prolonged ICU stay. Univariate and multivariate analysis (logistic regression) were used to identify the risk factors. Results Seventyfive patients required prolonged ICU stay. Univariate risk factors showed that age, the proportion of previous heart surgery, smoking history and repeat cardiopulmonary bypass (CPB) support, cardiothoracicratio, the CPB time and aortic crossclamping time of group Ⅰ were higher or longer than those of group Ⅱ. The heart function, left ventricular ejection fraction (LVEF), pulmonary function of group Ⅰwere worse than those of group Ⅱ(Plt;0.05, 0.01). Logistic regression identified that preoperative age≥65 years (OR=4.399), LVEF≤0.50(OR=2.788),cardiothoracic ratio≥0.68(OR=2.411), maximal voluntary ventilation observed value/predicted value %lt;71%(OR=4.872), previous heart surgery (OR=3.241) and repeat CPB support during surgery (OR=18.656) were final risk factors for prolonged ICU stay. Conclusion Prolonged ICU stay after cardiac valvular surgery can be predicted through age, LVEF, cardiothoracic ratio, maximal voluntary ventilation, previous heart surgery and repeat CPB support during surgery. The patients with these risk factors need more preoperative care and postoperative care to reduce mortality, morbidity and avoid prolonged ICU stay after cardiac valvular surgery.
Objective To discuss the effect of monitoring-training-planning (MTP) intervention model on the prevention and control of catheter–associated urinary tract infection (CAUTI) in Intensive Care Unit (ICU). Methods Patients with indwelling catheter from departments with ICU (ICU, ICU of the Department of Neurosurgery, ICU of the Department of Neurologic Medicine) between 2014 and 2015 were included in this study. Based on the inclusion criteria, target monitoring indicators were set in accordance with Hospital Infection Monitoring Norms. A total of 493 patients with indwelling catheters from January to December 2014 were subjected to target surveillance, and were used as baseline for the study. A total of 529 patients with indwelling catheters from January to December 2015 were treated with MTP intervention. The occurrence of indwelling catheter–associated urinary tract infections in the intensive care unit was compared before and after intervention. Results The incidence of indwelling catheter-associated urinary tract infections before and after MTP intervention were different, and the difference was statistically significant (P<0.05). Conclusion MTP intervention model can effectively prevent and reduce indwelling catheter-associated urinary tract infections in ICU.
ObjectiveTo evaluate the effect of bundle strategies on the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), in order to effectively prevent and control the severe situation of multiple drug-resistant bacteria in ICU.MethodsWe selected patients who admitted into the ICU from January 2016 to December 2017 as study subjects, and monitored 6 types of MDROs. Basic information was surveyed and collected from January to December 2016 (before intervention), while bundle strategies on MDROs were implemented from January to December 2017 (after intervention), including issusing isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, implementing hand hygiene, etc. Then we compared the MDRO detection rate, nosocomial infection rate, MDRO nosocomial infection rate, and compliance rates of interventions between the two periods.ResultsThe MDRO detection rate before intervention was 77.10%, and that after intervention was 49.12%, the difference between the two periods was statistically significant (χ2=69.834, P<0.001). The nosocomial infection rate of ICU decreased from 23.51% before intervention to 15.23% after intervention, the MDRO nosocomial infection rate decreased from 13.70% before intervention to 5.84% after intervention, and the differences between the two periods were statistically significant (χ2=8.594, P=0.003; χ2=13.722, P<0.001). The compliance rates of doctor’s isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, and hand hygiene, as well as the correct rate of hand hygiene after intervention (92.12%, 93.55%, 81.77%, 84.24%, 82.90%, 77.39%, and 96.37%) were significantly higher than those before intervention (31.94%, 52.00%, 23.43%, 48.18%, 67.16%, 59.46%, and 88.64%), and the differences were all statistically significant (P<0.001).ConclusionThe implementation of the above bundle strategies on the prevention and control of MDROs can decrease the MDRO detection rate and MDRO nosocomial infection rate.
ObjevtiveThe morbidity of intensive care unit-acquired swallowing disorder (ICU-ASD) was clarified through meta-analysis by synthesizing previous evidence, in order to provide an evidence-based basis for early identification and intervention of ICU-ASD. Methods A computerized search of PubMed, Embase, Web of Science, The Cochrane Library, CHINAL, China Knowledge Network, Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal Database was conducted to retrieve the relevant literature on the morbidity of ICU-ASD published in China and abroad from the database establiment to December 2022. Considering the quality of the included literature, the Chinese database excluded master's theses and non-core journals. Meta-analysis of morbidity was performed using Stata 12.0. Results A total of 19 papers, including 4291 patients, were included. Meta-analysis showed that the overall morbidity of ICU-ASD was 36% [95% confidential interval (CI) 26% - 46%; I2=97.62%, P<0.01]. Subgroup analyses showed that the morbidity of ICU-ASD in Asian, European, South American, and North American was 39% (95%CI 28% - 50%), 23% (95%CI 8% - 44%), 52% (95%CI 46% - 57%), and 39% (95%CI 20% - 61%), respectively; and that the morbidity of male and female ICU-ASD was 36% (95%CI 24% - 48%) and 33% (95%CI 22% - 45%), respectively; the morbidity of ICU-ASD was 41% (95%CI 30% - 52%) and 31% (95%CI 18% - 44%) in the patients with and without hypertension, respectively; the morbidity of ICU-ASD was 58% (95%CI 42% - 73%) and 51% (95%CI 36% - 66%) in the patients with and without respiratory disease respectively; the morbidity of ICU-ASD in the patients with and without diabetes mellitus was 37% (95%CI 24% - 51%) and 39% (95%CI 28% - 51%), respectively; the morbidity of ICU-ASD in the patients with and without renal disease was 40% (95%CI 23% - 59%) and 35% (95%CI 24% - 46%), respectively; the morbidity of ICU-ASD in the patients with intubation caliber ≤7.5 mm and >7.5 mm was 31% (95%CI 19% - 45%) and 37% (95%CI 22% - 54%), respectively; the morbidity of ICU-ASD in the patients with and without heart failure was 58% (95%CI 30% - 84%) and 36% (95%CI 23% - 51%), respectively; and the morbidity of ICU-ASD in patients with and without arrhythmia was 36% (95%CI 11% - 65%) and 31% (95%CI 21% - 42%), respectively; the morbidity of ICU-ASD in the patients with and without neurologic disease was 48% (95%CI 24% - 72%) and 34% (95%CI 15% - 57%), respectively. Begg's test P<0.05, Egger's test P<0.05, suggesting publication bias in the study, and the cut-and-patch method corrected for an overall incidence result of 27% (95%CI 18% - 36%). Conclusions Meta-analysis reveals an overall morbidity of 36% for ICU-ASD and 27% for the cut-and-patch correction. Subgroup analysis reveals that the morbidity of ICU-ASD is significantly higher in patients with hypertension, heart failure, and neurological disorders than in patients without these disorders. Current evidence suggests that the prevalence of ICU-ASD is high and needs to be taken seriously. Timely screening and assessment of swallowing disorders is recommended for intensive care unit patients, especially those with hypertension, heart failure, and neurological disorders.
呼吸机相关肺炎( VAP) 是指应用机械通气治疗后48 h和停用机械通气拔除人工气道48 h 内发生的肺实质的感染性炎症。VAP 是机械通气治疗中常见的严重并发症。其发生率为9% ～70% [ 1] , 病死率高达20% ～71% [ 2, 3 ] 。依据其发生的时间可分为早发性VAP 和晚发性VAP。早发性VAP: 即气管插管或人工气道建立lt; 5 d 发生者, 约占VAP的1/2, 主要由插管时即定植于呼吸道内的病原体如肺炎链球菌、甲氧西林敏感金黄色葡萄球菌、流感嗜血杆菌等引起。晚发性VAP: 即气管插管或人工气道建立gt;5 d 发生者, 常由肠道革兰阴性细菌如肠杆菌科、不动杆菌属和假单胞菌属细菌所致。采取有效措施预防VAP 的发生, 对于降低病死率, 减少住院时间和医疗费用, 节约医疗资源具有重要的意义。按照随机对照临床试验中的预防措施可总分为非药物性措施与药物性措施。
Objective To verify the association between admission serum phosphate level and short-term (<30 days) mortality of severe pneumonia patients admitted to intensive care unit (ICU) / respiratory intensive care unit (RICU). Methods Severe pneumonia patients admitted to the ICU/RICU of Quanzhou First Hospital Affiliated to Fujian Medical University from November 2019 to September 2021 were included in the study. Serum phosphate was demonstrated as an independent risk factor for short-term mortality of severe pneumonia patients admitted to ICU/RICU by logical analysis and receiver operator characteristic (ROC) curve. The patients were further categorized by serum phosphate concentration to explore the relationship between serum phosphate level and short-term mortality. Results Comparison of baseline indicators at admission between the survival group (n=54) and the non survival group (n=46) revealed that there was significant difference in serum phosphate level [0.9 (0.8, 1.2) mmol/L vs. 1.2 (0.9, 1.5) mmol/L, P<0.05]. Logical analysis showed serum phosphate was an independent risk factor for short-term mortality. ROC curve showed that the prediction ability of serum phosphate was close to pneumonia severity index (PSI). After combining serum phosphate with PSI score, CURB65 score, and sequential organ failure score, the predictive ability of these scores for short-term mortality was improved. Compared with the normophosphatemia group, hyperphosphatemia was found be with significantly higher short-term mortality (85.7% vs. 47.3%, P<0.05), which is absent in hypophosphatemia (25.8%). Conclusions Serum phosphate at admission has a good predictive value on short-term mortality in severe pneumonia patients admitted to the ICU/RICU. Hyperphosphatemia at admission is associated with a higher risk of short-term death.