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Improving pressure ulcer care in intensive care units:Evaluating the impact of bundled care and silver nanoparticle dressings

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World Journal of Clinical Cases 2024年第19期12卷 3873-3881页

作者： Hong Yu Department of intensive care Unit The First People's Hospital of ZiyangZiyang 641300Sichuan ProvinceChina

BACKGROUND Pressure ulcer(PU)are prevalent among critically ill trauma patients,posing substantial *** care strategies and silver nanoparticle dressings offer potential solutions,yet their combined effectiveness and impact on patient satisfaction remain insufficiently *** To assess the impact of bundled care along with silver nanoparticle dressing on PUs management and family satisfaction in critically ill trauma *** A total of 98 critically ill trauma patients with PUs in intensive care unit(ICU)were included in this *** were randomly assigned to either the control group(conventional care with silver nanoparticle dressing,n=49)or the intervention group(bundled care with silver nanoparticle dressing,n=49).The PU Scale for Healing(PUSH)tool was used to monitor changes in status of pressure injuries over *** were conducted at various time points:Baseline(day 0)and subsequent assessments on day 3,day 6,day 9,and day *** satisfaction was assessed using the Family Satisfaction ICU 24 *** No significant differences in baseline characteristics were observed between the two *** the intervention group,there were significant reductions in total PUSH scores over the assessment ***,surface area,exudate,and tissue type parameters all showed significant improvements compared to the control *** satisfaction with care and decision-making was notably higher in the intervention *** family satisfaction was significantly better in the intervention *** Bundled care in combination with silver nanoparticle dressings effectively alleviated PUs and enhances family satisfaction in critically ill trauma *** approach holds promise for improving PUs management in the ICU,benefiting both patients and their families.

关键词： Pressure ulcers Silver nanoparticle dressings Bundled care Pressure ulcer scale for healing tool Family satisfaction

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Adverse events related to physical restraint use in intensive care units: A review of the literature

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Journal of intensive Medicine 2024年第3期4卷 318-325页

作者： Sebastian Berger Pascale Grzonka Simon A.Amacher Sabina Hunziker Anja I.Frei Raoul Sutter Clinic for intensive care Department of Acute MedicineUniversity Hospital BaselBaselSwitzerland Medical Communication and Psychosomatic Medicine University Hospital BaselBaselSwitzerland Medical faculty University of BaselBaselSwitzerland Department of Clinical Research University of BaselBaselSwitzerland

Physical restraints are widely used and accepted as protective measures during treatment in intensive care unit (ICU). This review of the literature summarizes the adverse events and outcomes associated with physical restraint use, and the risk factors associated with their use during treatment in the ICU. The PubMed, Scopus, and Google Scholar databases were screened using predefined search terms to identify studies pertaining to adverse events and/or outcomes associated with physical restraint use, and the factors associated with their use in adult patients admitted to the ICU. A total of 24 articles (including 6126 patients) that were published between 2006 and 2022 were identified. The described adverse events associated with physical restraint use included skin injuries, subsequent delirium, neurofunctional impairment, and a higher rate of post-traumatic stress disorder. Subsequent delirium was the most frequent adverse event to be reported. No alternative measures to physical restraints were discussed, and only one study reported a standardized protocol for their use. Although physical restraint use has been reported to be associated with adverse events (including neurofunctional impairment) in the literature, the available evidence is limited. Although causality cannot be confirmed, a definite association appears to exist. Our findings suggest that it is essential to improve awareness regarding their adverse impact and optimize approaches for their detection, management, and prevention using protocols or checklists.

关键词： Physical restraint intensive care unit Delirium Complication Adverse event

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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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Risk Factors for Mortality in Acute Kidney Injury in intensive care units in Togo

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Open Journal of Nephrology 2024年第1期14卷 37-47页

作者： Eyram Makafui Yoan Yawo Amekoudi Kossi Akomola Sabi Marcel David Keoula Badomta Dolaama Sarakawabalo Assenouwe Tabana Mouzou Department of Nephrology Kara University Hospital University of Kara Kara Togo Department of Nephrology and Haemodialysis Sylvanus Olympio University Hospital University of Lome Lomé Togo Department of Anaesthesia and intensive care University Hospital of Kara University of Kara Kara Togo

Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.

关键词： AKI intensive care Unit Dialysis Epidemiology Togo

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Management of early mobilization in intensive care units:a multicenter cross-sectional study

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Frontiers of Nursing 2018年第4期5卷 291-299页

作者： Yan-Ping Zhu Li-Xia Xia Guo-Hong Li intensive care units Zhongda Hospital Southeast University Department of Nursing Jiangsu Provincial Hospital Department of Nursing Zhongda HospitalSoutheast University

Objective: The aim of this study was to assess the management of early mobilization(EM) in Chinese intensive care units(ICUs).Methods: This survey used a cross-sectional, observational design. A total of 65 tertiary and secondary hospitals were enrolled by convenience sampling and investigated using self-designed ***: We identified 69 ICUs in Jiangsu, China(response rate: 94.2%). 74.2%(1,004/1,353) of the nurses and nursing managers from 65 ICUs reported mobility practice. For the mobility level, 98.1%(1,327) reported use of in-bed exercise, 5.7%(77) sitting on a side of bed, 21.7%(294) transfer to chair, and 2.4%(33) walking. The most frequently reported barriers to early mobility were unplanned extubation, nursing resource, and absence of physical therapist. Nurses’ educational backgrounds, nursing experience, the lack of nursing resources, absence of physician, and the weakness of patient were the factors that influenced ICU early rehabilitation(P<0.01).Conclusions: Although implementation rates for EM in critically ill patients are high, the activity level is generally poor in most of the involved ICUs.

关键词： early mobilization critical care critically ill patients management clinical practice

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A National Multicenter Survey on Management of Pain, Agitation, and Delirium in intensive care units in China

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Chinese Medical Journal 2017年第10期130卷 1182-1188页

作者： Jing Wang Zhi-Yong Peng Wen-Hal Zhou Bo Hu Xin Rao Jian-Guo Li Department of intensive care Unit Zhongnan Hospital of Wuhan University Wuhan Hubei 430071 China Department of Clinical Medicine City College Wuhan universLty of Science and TechnoLogy Wuhan Hubei 430083 China

Background： The management of pain, agitation, and deliriunl （PAD） in intensive care Unit （ICU） is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving： yet relatively little intbrmation is available in China. This study aimed to investigate the practice of PAD in ICUs in China. Methods： A multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016. The questionnaire focused on the assessment and naanagement of PAD by the clinicians in ICUs. The practice of PAD was compared among the lbur regions of China （North, Southeast, Northwest, and Southwest）. The data were expressed as percentage and fi＇equency. The Chi-square test, Fisher＇s exact test, and line-row Chi-square test were used. Results： Of the 1011 valid questionnaire lbrms, the response rtite was 80.37%. The clinicians came from 704 hospitals across 158 cities of China. The rate of PAD assessment was 75.77%, 90.21%, and 66.77%, respectively. The rates of PAD scores were 45.8%, 68.94%, and 34.03%, respectively. The visual analog scale, Richmond agitation-sedation scale, and conlktsion assessment method lbr the ICU were the first choices of scales for PAl） assessment. Fentanyl, midazolam, and dexmedetomidine were the first choices of agents for analgesic, sedation, and delirium treatment. While choosing analgesics and sedatives, the clinicians put the pharmacological characteristics of drugs in the first place （66.07% and 76.36%）. Daily interruption for sedation was carried out by 67.26% clinicians. Most of the clinicians （87.24%） used analgesics while using sedatives. Of the 738 （73%） clinicians titrating the sedatives oil the basis of the proposed target sedation level, 268 （26.61%） clinicians just depended on their clinical experience. Totally, 519 （51.34%） clinicians never used other nondrug strategies tbr PAD. The working time of clinicians was

关键词： Agitation Delirium: intensive care Unit Pain Sedation

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Extensive Variability in Vasoactive Agent Therapy： A Nationwide Survey in Chinese intensive care units

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Chinese Medical Journal 2015年第8期128卷 1014-1020页

作者： Xian-Bo Pei Peng-Lin Ma Jian-Guo Li Zhao-Hui Du Qing Zhou Zhang-Hong Lu Luo Yun Bo Hu Department of Anesthesia and Critical care Intensive Care Unit Emergency Medicine Study Center Zhongnan Hospital Wuhan University Wuhan Hubei 430071 China HOPE School of Nursing Wuhan University Wuhan Hubei 430071 China Department of Critical care Medicine 309th Hospital of Chinese People's Liberation Army Beijing 100091 China

Background： Inconsistencies in the use of the vasoactive agent therapy to treat shock are found in previous studies. A descriptive study was proposed to investigate current use of vasoactive agents for patients with shock in Chinese intensive care settings. Methods： A nationwide survey of physicians was conducted from August 17 to December 30, 2012. Physicians were asked to complete a questionnaire which focused on the selection of vasoactive agents, management in the use ofvasopressor/inotropic therapy, monitoring protocols when using these agents, and demographic characteristics. Results： The response rate was 65.1% with physicians returning 586 valid questionnaires. Norepinephrine was the first choice of a vasopressor used to treat septic shock by 70.8% of respondents; 73.4% of respondents favored dopamine for hypovolemic shock： and 68.3% of respondents preferred dopamine for cardiogenic shock. Dobutamine was selected by 84.1%, 64.5%, and 60.6% , of respondents for septic, hypovolemic, and cardiogenic shock, respectively. Vasodilator agents were prescribed by physicians in the management of cardiogenic shock （67.1%） rather than for septic （32.3%） and hypovolemic shock （6.5%）. A significant number of physicians working in teaching hospitals were using vasoactive agents in an appropriate manner when compared to physicians in nonteaching hospitals. Conclusions： Vasoactive agent use for treatment of shock is inconsistent according to self-report by Chinese intensive care physicians： however, the variation in use depends upon the form of shock being treated and the type of hospital： thus, corresponding educational programs about vasoactive agent use for shock management should be considered.

关键词： Shock Survey Variability Vasoactive Agent Therapy

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Antibiotic stewardship programmes in intensive care units:Why,how,and where are they leading us

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World Journal of Critical care Medicine 2015年第1期4卷 13-28页

作者： Yu-Zhi Zhang Suveer Singh Departments of intensive care and Respiratory Medicine Chelsea and Westminster Hospital

Antibiotic usage and increasing antimicrobial resistance(AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units(ICU). Antibiotic stewardship programmes(ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies"through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial(RCT), 22 observational and 11 case series], 29(85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin(PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop(de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core

关键词： Antibiotic stewardship programme intensive care Antimicrobial resistance Antibacterial resistance Antibiotic resistance

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The WHO near miss criteria are appropriate for admission of critically ill pregnant women to intensive care units in China

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Chinese Medical Journal 2013年第5期126卷 895-898页

作者： WANG Yong-qing GE Qing-gang WANG Jing NIU Ji-hong HUANG Chao ZHAO Yang-yu Department of Obstetrics and Gynecology Peking University Third Hospital Beijing 100191 China intensive care Unit Peking University Third Hospital Beijing 100191 China Department of Obstetrics and Gynecology Maternal and ChildHealth Hospital of Haidian District Beijing 100080 China

Background Evaluation of the severity of the pregnant women with suitable admission to the intensive care Unit （ICU） is very important for obstetricians. By now there are no criteria for critically ill obstetric patients admitted to the ICU. In this article, we investigated the admission criteria of critically ill patients admitted to the ICU in order to provide a referral basis of reasonable use of the ICU. Methods A retrospective analysis of critically ill pregnant women admitted to the ICU in Perking University Third Hospital in China in the last 6 years （from January 2006 to December 2011） was performed, using acute physiology and chronic health evaluation II （APACHE-II）, Marshall and WHO near miss criteria to assess the severity of illness of patients. Results There were 101 critically ill pregnant patients admitted to the ICU. Among them, 25.7% women were complicated with internal or surgical diseases, and 23.8% women were patients of postpartum hemorrhage and 23.8% women were patients of pregnancy-induced hypertension. Sixty-nine cases （68.3%） were administrated with adjunct respiration with a respirator. Sixteen cases （15.8%） required 1-2 types of vasoactive drugs. Fifty-five cases （54.5%） required a hemodynamic monitoring. Seventy-three cases （72.3%） had multiple organ dysfunctions （MODS）. The average duration in ICU was （7.5＋3.0） days. A total of 12.9%, 23.8% and 74.3% of women were diagnosed as critically ill according to the APACHE-II, Marshall and WHO near miss criteria, respectively. The rate was significantly different according to the three criteria （P〈0.01）. Conclusions The WHO near miss criteria can correctly reflect the severity of illness of pregnant women, and the WHO near miss criteria are appropriate for admission of critically ill pregnant women to ICU in China.

关键词： pregnancy intensive care unit severity of illness APACHE-II Marshall score WHO near miss

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Factors associated with low adherence to head-of-bed elevation during mechanical ventilation in Chinese intensive care units

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Chinese Medical Journal 2013年第5期126卷 834-838页

作者： LIU Jing-tao SONG Hai-jing WANG Yu KANG Yan JIANG Li LIN Si-han DU Bin MA Peng-lin Department of Critical care Medicine 309th Hospital of Chinese Peoples' Liberation Army Beijing 100091 China Department of Emergency Medicine 306th Hospital of ChinesePeoples' Liberation Army Beijing 100101 China Department of Critical care Medicine West China Hospital WestChina School of Medicine Sichuan University Chengdu 610041Sichuan 610041 China Department of Critical care Medicine Fuxing Hospital CapitalMedical University Beijing 100045 China Department of Epidemiology and Bio-Statistics School of PublicHealth Peking University Health Science Centre Beijing 100191China Medical intensive care Unit Peking Union Medical CollegeHospital Beijing 100730 China

Background Elevating the head of bed （HOB） 30°-45° has been widely supported as a means of ventilator associated pneumonia （VAP） prevention. However, it was poorly adhered in clinical practice. This observational study aimed to investigate the factors impeding this simple practice at the bedside. Methods This prospective study was conducted in 33 Chinese academic hospital intensive care units （ICUs）. HOB angle was measured four times daily at 5-7 hour intervals. The predefined HOB elevation goal was an angle ≥30°. Results The overall rate of achieving the HOB goal was 27.8% of the 8647 measurements in 314 patients during 2842 ventilation days. The HOB goal of ≥3 times/d was consistently achieved only in 15.9% of the cases. Almost 60% of patients had at least one 24 hours period during which the HOB goal was never documented. This low rate of protocol compliance was not associated with acute physiology and chronic health evaluation （APACHE） II score or dependence on vasopressors. In a survey, ＂nurse workload＂ was identified as the most important factor for non-compliance with the HOB goal. In addition, the rates of compliance were significantly different （P 〈0.001） between physicians self-reporting that they either did or did not know the Institutes of Healthcare Improvement （IHI） ventilator bundle. Conclusions Low adherence to a HOB angle of ≥30° was found in this nationwide survey. Nursing workload and lack of knowledge on VAP prevention were important barriers to changin.q this practice.

关键词： head of bed elevation clinical compliance ventilator associated pneumonia

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