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Effects of strengthening prospective nursing practice on sleep quality,anxiety,and depression of awake patients in intensive care unit

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World Journal of Psychiatry 2024年第5期14卷 735-741页

作者： Fei Lin Lei Liu Department of intensive care unit Dushu Lake Hospital Affiliated to Soochow UniversitySuzhou 215000Jiangsu ProvinceChina

BACKGROUND The intensive care unit(ICU)is a specialized hospital department.Awake patients in the ICU frequently encounter adverse psychological states,such as anxiety and fear,often accompanied by poor sleep quality.This situation has garnered significant attention within the medical community.AIM To investigate the impact of prospective nursing intervention strategies on the sleep quality and negative emotional state of conscious ICU patients.METHODS One hundred and twenty ICU awake patients admitted to our hospital were selected and randomly divided into control(n=60)and observation(n=60)groups.Patients in the control group were cared for using the conventional nursing model,while patients in the observation group were cared for using the prospective nursing model.Sleep improvement was assessed using the International Standardized Sleep Efficiency Formula and Pittsburgh Sleep Quality Index(PSQI).The PSQI,Generalized Anxiety Disorder 7-item(GAD-7)scale,Self-Depression Scale(SDS),and satisfaction before and after treatment were used to assess the negative emotional states of patients under the two care models.RESULTS Patient satisfaction in the observation group was significantly higher than in the control group.The GAD-7 and SDS scores in the observation group were significantly lower than those in the control group,and the total effective rate of sleep improvement in the observation group was significantly higher than in the control group.After treatment,the PSQI scores of the two groups significantly decreased(P<0.05).The decrease in the observation group was more significan than that in the control group,and the difference between the two groups was statistically significant.CONCLUSION Prospective nursing interventions can improve sleep quality and psychological levels and significantly affect conscious patients in the ICU,which is worthy of clinical application.

关键词： Prospective nursing intensive care unit Sobriety Mental health sleep quality Anxiety and depression

intensive care unit-acquired weakness: Recent insights

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Journal of intensive Medicine 2024年第1期4卷 73-80页

作者： Juan Chen Man Huang Department of General intensive care unit The Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou 310009ZhejiangChina

intensive care unit-acquired weakness(ICU-AW)is a common complication in critically ill patients and is associated with a variety of adverse outcomes.These include the need for prolonged mechanical ventilation and ICU stay;higher ICU,in-hospital,and 1-year mortality;and increased in-hospital costs.ICU-AW is associated with multiple risk factors including age,underlying disease,severity of illness,organ failure,sepsis,immobilization,receipt of mechanical ventilation,and other factors related to critical care.The pathological mechanism of ICUAW remains unclear and may be considerably varied.This review aimed to evaluate recent insights into ICU-AW from several aspects including risk factors,pathophysiology,diagnosis,and treatment strategies;this provides new perspectives for future research.

关键词： intensive care unit-acquired weakness Muscle weakness Muscle atrophy Risk factor Mechanism Treatment

Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

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World Journal of Clinical Cases 2024年第7期12卷 1235-1242页

作者： Ling Wang Deng-Yan Long intensive care unit People's Hospital of Qiandongnan Miao and Dong Autonomous PrefectureKaili 556000Guizhou ProvinceChina

BACKGROUND intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.

关键词： intensive care unit-acquired weakness Risk factors Machine learning Prevention Strategies

Extracorporeal membrane oxygenation as a bridging therapy for patients with thiamine deficiency-induced pulmonary arterial hypertension

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World Journal of Emergency Medicine 2024年第2期15卷 147-149页

作者： Fangfang Qiu Weixing Dai Tengyue Huang Min Li Department of intensive care unit the Fourth Affiliated Hospital of Zhejiang University School of MedicineYiwu 322000China Department of intensive care unit the Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou 310009China

Thiamine deficiency is characterized by a deficiency of thiamine(vitamin B1),lactic acidosis,pulmonary arterial hypertension(PAH),right-sided heart failure,and peripheral nerve damage.Thiamine deficiency is easily misdiagnosed and missed during clinical practice and is associated with death in severe cases.[1,2]Here we reported a patient who was admitted to the hospital with severe metabolic acidosis and pulmonary hypertension and finally diagnosed with thiamine deficiency by detecting plasma vitamin B1 levels.Since clinically obvious thiamine deficiency is rare,and cases of thiamine deficiency requiring extracorporeal membrane oxygenation(ECMO)treatment are rarer,we believe that our case will be helpful for emergency clinicians.

关键词： vitamin hypertension arterial

Prediction of mechanical ventilation outcome by early abdominal-visceral-blood-flow-and-function score in critically ill patients after cardiopulmonary bypass in the ICU: A prospective observational study

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Journal of intensive Medicine 2024年第1期4卷 101-107页

作者： Chaofu Yue Longxiang Su Jun Wang Na Cui Yuankai Zhou Wei Cheng Bo Tang Xi Rui Huaiwu He Yun Long Department of intensive care unit Peking Union Medical College HospitalBeijingChina Department of intensive care unit Qujing First People’s HospitalQujingYunnanChina Department of intensive care unit Shiyan People’s Hospital of Bao’an DistrictShenzhenGuangdongChina

Background:Abdominal organs are important organs that sense and respond to ischemia and hypoxia,but there are few evaluation methods.We use ultrasonography to evaluate abdominal organ function and blood flow in patients with mechanical ventilation(MV)after cardiopulmonary bypass and to obtain a semiquantitative score for abdominal organ function and blood flow.Methods:Patients with cardiopulmonary bypass in the Critical care Department of Peking Union Medical College Hospital in China from March to July 2021 were enrolled in this prospective observational study.The correlation of the abdominal-visceral-blood-flow-and-function score(AVBFS)with the duration of MV,number of days spent in the intensive care unit(ICU),acute physiology and chronic health evaluation II(APACHE-II),sequential organ failure assessment(SOFA),lactate,epinephrine,and norepinephrine use was analyzed,and the results were used to assess the predictive value of the receiver operating characteristic curve(ROC)regression analysis score for the duration of MV.Results:Of the 92 patients who underwent cardiopulmonary bypass,41 were finally included.The AVBFS were significantly correlated with the duration of MV,number of days spent in the ICU,APACHE-II score,SOFA score,and norepinephrine use time.The AVBFS in a group of patients using ventilators≥36 h were significantly higher than those obtained for a group of patients using ventilators<36 h(P<0.05).The evaluation results for the AVBFS at 0-12 h after ICU admission were as follows:area under the ROC curve(AUC)=0.876(95%confidence interval[CI]:0.767 to 0.984),cut-off value=2.5,specificity=0.842,and sensitivity=0.773.Conclusions:Abdominal visceral organ function and blood perfusion can be used to evaluate gastrointestinal function.It is related to early and late extubation after cardiac surgery.

关键词： Ultrasonic evaluation Abdominal-visceral-blood-flow-and-function score(AVBFS) Gastrointestinal dysfunction Mechanical ventilation Cardiopulmonary bypass

A Retrospective Analysis of Intoxicated Patients Admitted to the intensive care unit: A Single-Institution Assessment in the Post-Pandemic Period

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Journal of Biosciences and Medicines 2024年第3期12卷 159-167页

作者： Müge Arikan Abdullah Yeşilkaya Büşra Nur Taşdelen İbrahim Özyiğit Department of anesthesia and intensive care Faculty of Medicine Karabuk University Karabuk Turkey

Background: The aim of this study was to evaluate the clinical and epidemiological characteristics of patients with acute intoxication admitted to the intensive care unit (ICU). Material and Methods: An observational retrospective study was conducted on intoxicated patients who admitted to ICU between January 2022 and January 2024. Data were collected from the patients medical records. The demographic characteristics, causes of intoxications, clinical parameters, the mean stay in the ICU, treatment modalities and prognosis were recorded. Results: A total of 2875 critically ill patients were admitted during the study period, and 109 (3.79%) of them were acute intoxications. Their mean of ages was 38.09 ± 12.29. The female-to-male ratio was 1.37/1. Drugs were found to be the primary cause (62.39%) of intoxications, and analgesics, antidepressants, and antibiotics were the most frequent agents. Suicidal attempts were present in 66 patients, most of them were female (62.13%) and between 17 - 24 years (40.91%). The other common causes of intoxications were carbon monoxide (CO) (22.02%), methyl/ethyl alcohol (8.26%) and mushroom (5.50%). The mean stay in the ICU was 2.69 ± 0.89 days. Mechanical ventilation was applied to 10 of our patients. Renal replacement therapy was required in 6 patients. Despite all treatments, 6 of our patients died, and we found the mortality rate to be 5.50%. Conclusion: Intoxications were more frequent in young female patients and drugs were the most common cause with suicidal intent. Unfortunately, CO poisoning continues to be a very important problem in our city. These findings provided significant information about the characteristics of intoxications in Karabuk.

关键词： Intoxication intensive care unit Suicidal Mortality

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 decades.While most cases present mild to moderate symptoms,5%of patients can develop severe disease.Although 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 hemorrhage.The 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 disease.The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality.This 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

Predictive performance of the variation rate of the driving pressure on the outcome of invasive mechanical ventilation in patients with acute respiratory distress syndrome

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Chinese Journal of Traumatology 2024年第2期27卷 107-113页

作者： Hui-Dan Jing Jun-Ying Tian Wei Li Bing-Ling He Hong-Chao Li Fu-Xia Jian Cui Shang Feng Shen Department of intensive care unit The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550004China Department of intensive care unit Army Medical Center of PLAChongqing400042China College of Foreign Languges Chongqing Medical UniversityChongqing400016China

Purpose:To assess the value of the driving pressure variation rate(ΔP%)in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.Methods:In this case-control study,a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled.Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days.Outcome measures including driving pressure,PaO2:FiO2,and positive end-expiratory pressure,etc.were assessed every 24 h from day 0 to day 14 until successful weaning was achieved.The measurement data of non-normal distribution were presented as median(Q1,Q3),and the differences between groups were compared by Wilcoxon rank sum test.And categorical data use the Chi-square test or Fisher's exact test to compare.The predictive value ofΔP%in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.Results:Of the total 35 patients included in the study,17 were successful vs.18 failed in weaning from a ventilator after 14 days of mechanical ventilation.The cut-off values of the medianΔP%measured by Operator 1 vs.Operator 2 in the first 4 days were≥4.17%and 4.55%,respectively(p<0.001),with the area under curve of 0.804(sensitivity of 88.2%,specificity of 64.7%)and 0.770(sensitivity of 88.2%,specificity of 64.7%),respectively.There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group(8(6,13)vs.12(7.5,17.3),p=0.043).The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group(0.2‰vs.2.3‰,p=0.001).There was a significant difference noted between these 2 groups in the 28-day mortality(11.8%vs.66.7%,

关键词： Driving pressure Driving pressure variation rate Acute respiratory distress syndrome Mechanical ventilation

Calcitonin gene-related peptide inhibits neuronal apoptosis in heatstroke rats via PKA/p-CREB pathway

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Chinese Journal of Traumatology 2024年第1期27卷 18-26页

作者： Jie Zhu Ya-Hong Chen Jing-Jing Ji Cheng-Xiang Lu Zhi-Feng Liu Department of Pediatric General Hospital of Southern Theater Command of PLAGuangzhou510010China Department of Medical intensive care unit General Hospital of Southern Theater Command of PLAGuangzhou510010China Department of intensive care unit Zhongshan Hospital Xiamen UniversityXiamenFujian province361004China

Purpose:The incidence of heatstroke(HS)is not particularly high;however,once it occurs,the consequences are serious.It is reported that calcitonin gene-related peptide(CGRP)is protective against brain injury in HS rats,but detailed molecular mechanisms need to be further investigated.In this study,we further explored whether CGRP inhibited neuronal apoptosis in HS rats via protein kinase A(PKA)/p-cAMP response element-binding protein(p-CREB)pathway.Methods:We established a HS rat model in a pre-warmed artificial climate chamber with a temperature of(35.5±0.5)℃and a relative humidity of 60%±5%.Heatstress was stopped once core body temperature reaches above 41℃.A total of 25 rats were randomly divided into 5 groups with 5 animals each:control group,HS group,HS+CGRP group,HS+CGRP antagonist(CGRP8-37)group,and HS+CGRP+PKA/p-CREB pathway blocker(H89)group.A bolus injection of CGRP was administered to each rat in HS+CGRP group,CGRP8-37(antagonist of CGRP)in HS+CGRP8-37 group,and CGRP with H89 in HS+CGRP+H89 group.Electroencephalograms were recorded and the serum concentration of S100B,neuron-specific enolase(NSE),neuron apoptosis,activated caspase-3 and CGRP expression,as well as pathological morphology of brain tissue were detected at 2 h,6 h,and 24 h after HSin vivo.The expression of PKA,p-CREB,and Bcl-2 in rat neurons were also detected at 2 h after HSin vitro.Exogenous CGRP,CGRP8-37,or H89 were used to determine whether CGRP plays a protective role in brain injury via PKA/p-CREB pathway.The unpairedt-test was used between the 2 samples,and the mean±SD was used for multiple samples.Double-tailedp<0.05 was considered statistically significant.Results:Electroencephalogram showed significant alteration ofθ(54.50±11.51vs.31.30±8.71,F=6.790,p=0.005)andαwave(16.60±3.21vs.35.40±11.28,F=4.549,p=0.020)in HS group compared to the control group 2 h after HS.The results of triphosphate gap terminal labeling(TUNEL)showed that the neuronal apoptosis of HS rats was increased in the cortex(9.67±3.16vs.1.80±1.10,F=11.002,p=0.001)and

关键词： Heatstroke Calcitonin gene-related peptide Brain injury Apoptosis