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Risk factors and mortality rates of carbapenem-resistant Gram-negative bacterial infections in intensive care units

Journal of intensive Medicine 2024年第3期4卷 347-354页

作者： Tulay Orhan Kuloglu Gamze Kalin Unuvar Fatma Cevahir Aysegul Ulu Kilic Emine Alp Infection Control Committee Faculty of MedicineErciyes UniversityKayseriTurkey Department of Infectious Diseases Faculty of MedicineErciyes UniversityKayseriTurkey Programme of First and Emergency Aid Sakarya UniversitySakaryaTurkey Department of Infectious Diseases Faculty of MedicineYıldırım Beyazıt UniversityAnkaraTurkey

Background The prevalence of hospital-acquired infections caused by carbapenem-resistant gram-negative bacteria(CRGNB)is increasing *** risk factors have been associated with such *** present study aimed to identify risk factors and determine the mortality rates associated with CRGNB infections in intensive care *** This retrospective case-control study was conducted at Erciyes University Hospital(Kayseri,Turkey)between January 2017 and December *** and laboratory data were obtained from the Infection Control Committee data and record *** who had CRGNB infection 48–72 h after hospitalization were assigned to the case group,while those who were not infected with CRGNB during hospitalization formed the control *** factors,comorbidity,demographic data,and mortality rates were compared between the two *** Approximately 1449 patients(8.97%)were monitored during the active follow-up period;of those,1171 patients were included in this *** infection developed in 14 patients(70.00%)who had CRGNB colonization at admission;in 162(78.26%)were colonized during hospitalization,whereas 515(54.56%)were not *** was no significant difference in age,sex(male/female)or *** total length of hospital stay was statistically significantly longer(P=0.001)in the case group(median:24[interquartile range:3–378]days)than the control group(median:16[interquartile range:3–135]days).The rates of colonization at admission(25.5%;vs.10.6%,P=0.001)and mortality(64.4%vs.45.8%,P=0.001)were also significantly higher in the cases than in the control group,*** the univariate analysis,prolonged hospitalization,the time from intensive care unit admission to the development of infection,presence of CRGNB colonization at admission,transfer from other hospitals,previous antibiotic use,enteral nutrition,transfusion,hemodialysis,mechanical ventilation,tracheostomy,reintubation,central veno

关键词： Multidrug resistance Gram-negative bacteria Infection intensive care units

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Prediction of Th17/Treg cell balance on length of stay in intensive care units of patients with sepsis

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Journal of intensive Medicine 2024年第2期4卷 240-246页

作者： Yu Wu Guosheng Wu Minyu Li Yongqing Chang Miao Yu Yan Meng Xiaojian Wan Department of intensive care Medicine Changhai HospitalNaval Medical UniversityShanghaiChina Department of Anesthesiology Bethune International Peace HospitalShijiazhuangHebeiChina Department of Burns Changhai HospitalNaval Medical UniversityShanghaiChina Department of Special Needs Clinic Changhai HospitalNaval Medical UniversityShanghaiChina

Background Prolonged length of stay(LOS)of sepsis can drain a hospital's material and human *** study investigated the correlations between T helper type 17(Th17)and regulatory T(Treg)balance with LOS in *** A prospective clinical observational study was designed in Changhai Hospital affiliated to Naval Medical University in Shanghai,China,from January to October *** patients diagnosed with sepsis and who met the inclusion and exclusion criteria were recruited and whether the levels of cytokines,procalcitonin,subtypes,and biomarkers of T cells in the peripheral blood were *** analyzed the correlation between these and *** Sixty septic patients were classified into two groups according to whether their intensive care unit(ICU)stay exceeded 14 *** patients with LOS≥14 days were older([72.6±7.5]years vs.[63.3±10.4]years,P=0.015)and had higher Sequential Organ Failure Assessment(SOFA)(median[interquartile range]:6.5[5.0–11.0]vs.4.0[3.0–6.0],P=0.001)and higher Acute Physiology and Chronic Health Evaluation(APACHE)II scores(16.0[13.0–21.0]vs.8.5[7.0–14.0],P=0.001).There was no difference in other demographic characteristics and cytokines,interleukin-6,tumor necrosis factor-α,and interleukin-10 between the two *** Th17/Treg ratio of sepsis with LOScare for patients with sepsis.

关键词： Sepsis Th17/Treg Length of stay intensive care units

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Prevalence, risk factors, clinical course, and outcome of acute kidney injury in Chinese intensive care units： a prospective cohort study

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Chinese Medical Journal 2013年第23期126卷 4409-4416页

作者： WEN Ying JIANG Li XU Yuan QIAN Chuan-yun LI Shu-sheng QIN Tie-he CHEN Er-zhen LIN Jian-dong AI Yu- hang WU Da-wei WANG Yu-shan SUN Ren-hua HU Zhen-jie CAO Xiang-yuan ZHOU Fa-chun HE Zhen-yang ZHOU Li-hua AN You-zhong KANG Yan MA Xiao-chun YU Xiang-you ZHAO Ming-yan XI Xiu-ming DU Bin Department of Critical care Medicine Fuxing Hospital Capital Medical University Beijing 100038 China Department of Critical care Medicine Beijing Tongren HospitalCapital Medical University Beijing 100730 China Department of Emergency Medicine First Affiliated Hospital of Kunming Medical College Kunming Yunnan 650032 China Department of Critical care Medicine Tongji Hospital Tongji Medical College Huazhong University of Science & TechnologyWuhan Hubei 430030 China Department of Critical care Medicine Guangdong General HospitalGuangzhou Guangdong 510080 China Department of Emergency Medicine Ruijin Hospital Shanghai Jiao Tong University Shanghai 200025 China Department of Critical care Medicine First Affiliated Hospital ofFuiian Medical University Fuzhou Fujian 350005 China Department of Critical care Medicine Xiangya Hospital CentralSouth University Changsha Hunan 410008 China Department of Critical care Medicine Qilu Hospital Shandong University Jinan Shandong 250012 China Department of Emergency and Critical care Medicine The Second Hospital of Jilin University Changchun Jilin 130041 China Department of Critical care Medicine Zhejiang Provincial People's Hospital Hangzhou Zhejiang 310014 China Department of Critical care Medicine Hebei Medical University Fourth Hospital Shijiazhuang Hebei 050011 China Department of Critical care Medicine Affiliated Hospital of Ningxia Medical University Yinchuan Ningxia 750004 China Department of Critical care Medicine First Affiliated Hospital Chongqing Medical University Chongqing 400016 China Department of Critical care Medicine Hainan Provincial People's Hospital Haikou Hainan 570311 China Department of Critical care Medicine Affiliated Hospital of Inner Mongolia Medical College Huhhot Inner Mongolia 010050 China Department of Critical care Medicine Peking University People's Hospital Beijing 100044 China Department of Critical care Medicine West China Hospital Sichuan University Chengdu Sichuan 61004

Background Acute kidney injury （AKI） has been recognized as a major healthcare problem affecting millions of patients ***,epidemiologic data concerning AKI in China are still *** objectives of this study were to characterize AKI defined by RIFLE criteria,assess the association with hospital mortality,and evaluate the impact of AKI in the context of other risk *** This prospective multicenter observational study enrolled 3,063 consecutive patients from 1 July 2009 to 31 August 2009 in 22 ICUs across China's *** excluded patients who were admitted for less than 24 hours （n=1623）,younger than 18 years （n=127）,receiving chronic hemodialysis （n=29）,receiving renal transplantation （n=1） and unknown reasons （n=28）.There were 1255 patients in the final *** was diagnosed and classified according to RIFLE *** There were 396 patients （31.6％） who had AKI,with RIFLE maximum class R,I,and F in 126 （10.0％）,91 （7.3％）,and 179 （14.3％） patients,*** function deteriorated in 206 patients （16.4％）.In comparison with non AKI patients,patients in the risk class on ICU admission were more likely to progress to the injury class （odds ratio （OR） 3.564,95％ confidence interval （CI） 1.706-7.443,P =0.001],while patients in the risk class （OR 5.215,95％ CI 2.798-9.719,P ＜0.001） and injury class （OR 13.316,95％ CI 7.507-23.622,P ＜0.001） had a significantly higher probability of deteriorating into failure *** adjusted hazard ratios for 90-day mortality were 1.884 for the risk group,3.401 for the injury group,and 5.306 for the failure *** The prevalence of AKI was high among critically ill patients in Chinese *** comparison with non-AKI patients,patients with RIFLE class R or class I on ICU admission were more susceptibility to progression to class I or class *** RIFLE criteria were robust and correlated well with clinical deterioration and mortality.

关键词： acute kidney injury intensive care units mortality prevalence risk factors

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High risk factors for pulmonary fungous infection in intensive care units of neurosurgery

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Frontiers of Medicine 2007年第3期1卷 299-303页

作者： ZHU Wenyu TAN Liping CHEN Xiangfeng HUANG Qiang LAN Qing Department of Neurosurgery Second Affiliated Hospital of Soochow UniversitySuzhou 215004China

By analyzing the high risk factors for pulmonary fungous infection in intensive care units of neurosurgery,the strategy of early diagnosis and treatment was *** to the domestic diagnostic standard on pulmonary fungous infection,clinical data on 58 patients with the infection in our department were *** hundred and seventeen strains of fungi were separated from the 58 *** was the most frequent type,accounting for 92.3%of the *** such as the severity of primary diseases,long-time coma,long-term use of broad-spectrum antibiotic,abuse of glucocorticoid,the open airway,and some invasive intubations,may be regarded as high risk factors for pulmonary fungous *** showed good clinical effects on the treatment of fungous *** eliminate these high risk factors,early diagnosis and the use of prophylactic antifungal agents can help reduce the incidence of pulmonary fungous infection.

关键词： intensive care units lung diseases,fungal infection neurosurgery

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Effects of parental involvement in infant care in neonatal intensive care units:a meta-analysis

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Frontiers of Nursing 2018年第3期5卷 207-215页

作者： Ting-Ting Liu Meng-Jie Lei Yu-Feng Li Ya-Qian Liu Li-Na Meng Chang-De Jin School of Nursing Tianjin University of Traditional Chinese Medicine

Objective： This meta-analysis aimed to examine the effects of parental involvement in infant care in neonatal intensive care units （NlCUs）. Methods： PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI）, Wanfang database, and VIP database were searched till November 2017. Randomized controlled trials （RCTs） and controlled clinical trials （CCTs） examining the effect of parental involvement in the NICU were considered for inclusion. Resulls： We included 10 studies （three RCTs, seven CCTs） with a total of 1,851 participants. The meta-analysis demonstrated that there were no statistically significant differences on nosocomial infection between two groups （risk ratio [RR] = 0.90, 95% CI 0.63-1.30, P = 0.58）. Compared with no parental involvement groups, parental involvement groups showed more weight gain （mean difference [MD] = 1.47, 95% CI 0.65-2.29, P 〈 0.05）, higher breast-feeding rate （RR = 1.38, 95% CI 1.25-1.53, P 〈 0.05）, lower readmission rate （RR = 0.35, 95% CI 0.15-0.80, P 〈 0.05）, and higher satisfaction rate （RR = 1.09, 95% CI 1.02-1.16, P 〈 0.05）.Conclusions： Parentaiinvolvement in the NICU interventions could not increase the rate of nosocomial infection of neonates, but could improve their weight gain, breast-feeding and parental satisfaction and decrease their readmission. However, since the conclusion of this meta-analysis was drawn based on the limited number of high-quality RCTs, more hioh-quality studies should be conducted in the future to confirm its positive intervention effects.

关键词： family integrated care intensive care units neonatal infant newbom meta-analysis

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Clinical decision making on the use of physical restraint in intensive care units

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International Journal of Nursing Sciences 2014年第4期1卷 446-450页

作者： Xinqian Li Tonks NFawcett Department of Nursing The First Affiliated Hospital of Dalian Medical UniversityNo.222 Zhongshan RoadXigang DistrictDalianLiaoning Province 116001China Student Learning(Nurse Education)Nursing Studies The School of Health in Social ScienceThe University of EdinburghEdinburghUnited Kingdom

Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients'safety and to prevent unexpected ***,existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales,the negative physical and emotional effects on patients,but the lack of perceived *** paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by *** reviewing the literature,intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent ***,it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical *** that,such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be ***,despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint,it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.

关键词： Clinical decision-making intensive care units Intuition Heuristics Physical restraint

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Predicting intensive care unit-acquired weakness:A multilayer perceptron neural network approach

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World Journal of Clinical Cases 2024年第12期12卷 2023-2030页

作者： Carlos Martin Ardila Daniel González-Arroyave Mateo Zuluaga-Gómez Department of Basic Sciences University of AntioquiaMedellín 52-59Colombia Department of Surgery Pontificia Universidad BolivarianaMedellín 0057Colombia Department of Emergency Universidad Pontificia BolivarianaMedellín 0057Colombia

In this editorial,we comment on the article by Wang and Long,published in a recent issue of the World Journal of Clinical *** article addresses the challenge of predicting intensive care unit-acquired weakness(ICUAW),a neuromuscular disorder affecting critically ill patients,by employing a novel processing strategy based on repeated machine *** editorial presents a dataset comprising clinical,demographic,and laboratory variables from intensive care unit(ICU)patients and employs a multilayer perceptron neural network model to predict *** authors also performed a feature importance analysis to identify the most relevant risk factors for *** editorial contributes to the growing body of literature on predictive modeling in critical care,offering insights into the potential of machine learning approaches to improve patient outcomes and guide clinical decision-making in the ICU setting.

关键词： intensive care units intensive care unit-acquired weakness Risk factors Machine learning Computer neural network

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Severe dengue in the intensive care unit

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Journal of intensive Medicine 2024年第1期4卷 16-33页

作者： Alexandre Mestre Tejo Debora Toshie Hamasaki Letícia Mattos Menezes Yeh-Li Ho intensive care Unit Department of Intensive Medicine of the Cancer Institute of the State of São PauloHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil Transfusion Medicine and Cell Therapy Department A.C.Camargo Cancer CenterSão PauloBrazil intensive care Unit of Infectious Disease Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil

Dengue fever is considered the most prolific vector-borne disease in the world,with its transmission rate increasing more than eight times in the last two *** most cases present mild to moderate symptoms,5%of patients can develop severe *** the mechanisms are yet not fully comprehended,immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients:increased vascular permeability that may shock and thrombocytopenia,and coagulopathy that can induce *** risk factors of severe disease include previous infection by a different serotype,specific genotypes associated with more efficient replication,certain genetic polymorphisms,and comorbidities such as diabetes,obesity,and cardiovascular *** World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce *** review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.

关键词： Severe dengue intensive care units Shock Pathogenesis Diagnosis Management

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Gastrointestinal manifestations of critical ill heatstroke patients and their associations with outcomes:A multicentre,retrospective,observational study

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World Journal of Gastroenterology 2024年第4期30卷 346-366页

作者： Yu-Cong Wang Xin-Yang Jin Zheng Lei Xiao-Jiao Liu Yu Liu Bang-Guo Zhang Jian Gong Lie-Tao Wang Lv-Yuan Shi Ding-Yuan Wan Xin Fu Lu-Ping Wang Ai-Jia Ma Yi-Song Cheng Jing Yang Min He Xiao-Dong Jin Yan Kang Bo Wang Zhong-Wei Zhang Qin Wu Department of Critical care Medicine West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina School of Pharmacy Macao University of Science and TechnologyMacao 999078China Department of Critical care Medicine The First People's Hospital of Ziyang CityZiyang 641399Sichuan ProvinceChina Department of Critical care Medicine The First People's Hospital of Guanghan CityChengdu 618399Sichuan ProvinceChina Department of Critical care Medicine Lezhi County Traditional Chinese Medicine HospitalChengdu 641599Sichuan ProvinceChina Department of Critical care Medicine Chengdu Qingbaijiang District People's HospitalChengdu 610399Sichuan ProvinceChina Department of Critical care Medicine Ziyang People's HospitalChengdu 641399Sichuan ProvinceChina

BACKGROUND Extreme heat exposure is a growing health problem,and the effects of heat on the gastrointestinal(GI)tract is *** study aimed to assess the incidence of GI symptoms associated with heatstroke and its impact on *** To assess the incidence of GI symptoms associated with heatstroke and its impact on *** Patients admitted to the intensive care unit(ICU)due to heatstroke were included from 83 *** history,laboratory results,and clinically relevant outcomes were recorded at ICU admission and daily until up to day 15,ICU discharge,or *** symptoms,including nausea/vomiting,diarrhoea,flatulence,and bloody stools,were *** characteristics of patients with heatstroke concomitant with GI symptoms were *** regression analyses were performed to determine significant predictors of GI *** A total of 713 patients were included in the final analysis,of whom 132(18.5%)patients had at least one GI symptom during their ICU stay,while 26(3.6%)suffered from more than one *** with GI symptoms had a significantly higher ICU stay compared with those *** mortality of patients who had two or more GI symptoms simultaneously was significantly higher than that in those with one GI *** logistic regression analysis revealed that older patients with a lower GCS score on admission were more likely to experience GI *** The GI manifestations of heatstroke are common and appear to impact clinically relevant hospitalization outcomes.

关键词： Extreme heat Flatulence Sunstroke intensive care units Diarrhea

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Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU:A User-Centered Design for Rapid Prototyping

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Chinese Medical Sciences Journal 2024年第2期39卷 91-101页

作者： Miao Zheng Yong-Hui Zhang Ying Cao Chang-Lin Yin Li-Hua Wang Department of Outpatient First Affiliated Hospital of Army Medical UniversityChongqing 400038China Department of Critical care Medicine First Affiliated Hospital of Army Medical UniversityChongqing 400038China Administration Office First Affiliated Hospital of Army Medical UniversityChongqing 400038China

Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)*** study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with *** Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of *** The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing *** decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence *** decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge ***-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to *** DA was drafted into a web-based phototype using the elements of *** platform could guide users in their preparation of decision-making through a sequential four-step process:identifying

关键词： decision aids renal replacement therapy intensive care units shared decision-making user-centered design surrogate

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