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Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a surgical intensive care unit

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Chinese Nursing Research 2015年第2期2卷 78-83页

作者： Xin-Ran Wang Bin-Ru Han General surgical intensive care unit Xuanwu HospitalCapital Medical University

Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam- ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results： According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group （P〈0.05）. The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores （P〈0.05）. Conclusions： The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of decompression measures during the treatment of the patients, are hel

关键词： Critically ill patients Pressure sores Risk factors Shock care

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Tigecycline Use in surgical intensive care unit for the Treatment of Complicated Intra-Abdominal Infections: A Real-World Study

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International Journal of Clinical Medicine 2021年第1期12卷 1-6页

作者： Yao Nie Fei Pei Luhao Wang Xiang Si Xiangdong Guan Department of surgical intensive care unit The First Affiliated Hospital of Sun Yat-sen University Guangzhou China

OBJECTIVES: To describe real-world use of tigecycline in cIAIs patients. METHODS: A retrospective, observational study enrolled cIAIs patients hospitalized in The First Affiliated Hospital, Sun Yat-sen University from January 1, 2013 to June 30, 2017 was conducted. Patients’ data were collected and matched based on age, gender, and Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score according to receiving first-line, later-line, or no tigecycline during hospitalization. RESULTS: Data were collected for 52 patients. 82.6% were male. Mean age was 57.8 years and APACHE II score was 14.8. The incidence of both extended-spectrum beta-lactamase producing and carbapenem-resistant pathogens was high on initial culture;however, few patients received first-line tigecycline. No significant difference in mortality rate was identified among first-line, later-line and no tigecycline users. Of surviving patients, shorter hospital length of stay was observed for patients receiving first- vs later-line or no tigecycline, respectively. ICU length-of-stay was shorter in patients receiving first- vs later-line or no tigecycline. CONCLUSIONS: First-line tigecycline use was rare in our surgical intensive care unit. Resistant organisms were commonly cultured from initial specimens. Although these results are limited by small patient numbers and single center, our results suggest that early tigecycline use may have significant benefits with similar mortality. Further research is warranted to demonstrate the values of early tigecycline use in cIAIs patients.

关键词： Tigecycline Complicated Intra-Abdominal Infection Multidrug-Resistant

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Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg:Only the gut knows

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1470-1473页

作者： Thibault Vieille Melissa Crotet Celia Turco Paul Monasterolo Hadrien Winiszewski Gael Piton Medical intensive care unit Besancon University HospitalBesancon 25000France intensive care unit Vesoul HospitalVesoul 70000France Department of Digestive surgical Oncology-Liver Transplantation unit Besancon University HospitalBesancon 25000France Inserm UMRS-938 Centre de Recherche Saint-Antoine(CRSA)Sorbonne UniversitéParis 10041NY212France intensive care unit Nord Franche Comte HospitalTrevenans 90400France

We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.

关键词： Acute pancreatitis Abdominal compartment syndrome Decompressive laparotomy Mesenteric ischemia Intra-abdominal pressure Abdominal perfusion pressure

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A Bibliometric Study on The Application of Progressive Muscle Relaxation Training in The Nursing Field in China

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Journal of Clinical and Nursing Research 2024年第4期8卷 14-21页

作者： Chengwen Shi Feifan Zhao Yingshuo Wang Chengxuan Liu Aiyu Mao Siqi Ji Ruixiao Lu surgical intensive care unit Peking University People’s HospitalBeijing 100000China

Objective:To systematically analyze the research status and application of progressive muscle relaxation training(PMRT)in the nursing field in China,and provide a reference basis for scientific research in this field.Methods:The bibliometric method was adopted in“progressive muscle relaxation training”or“PMRT,”and“nursing.”The established database was included in the China National Knowledge Infrastructure(CNKI)and the Wanfang Medical Network.The relevant articles in the Chinese Science and Technology Periodical Database(VIP)were analyzed.Results:A total of 169 literatures were included.The journals,years,and regions of literature publication were uneven,mainly originating from the eastern region(43.19%),and listed the application of progressive muscle relaxation training in the field of nursing in China.Intervention literature information was mainly dominated by experimental studies(97%).Conclusion:The related research and application of progressive muscle relaxation training in nursing in China is increasing,but there is a lack of objective evaluation of outcome indicators and a short intervention period.Further research should be conducted in the future to effectively guide the development of PMRT in the field of nursing in China.

关键词： Progressive muscle relaxation training Nursing practice Bibliometrics

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A case report of chylous ascites after cardiac surgery

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Emergency and Critical care Medicine 2024年第1期4卷 42-45页

作者： Shuaishuai Yuan Pailing Xie Xiantao Liu Peijun Li The University of Hong Kong-Shenzhen Hospital Cardiovascular Medicine Center Cardiac intensive care unit ShenzhenGuangdongChina.

Background:Chylous ascites(CA),an emulsion rich in triglycerides,is a rare type of ascites,especially after cardiac surgery.Also,there are few reports of the occurrence of CA after mitral valve replacement,aortic valve replacement,tricuspid valvuloplasty,and coronary artery bypass grafting.Case presentation:We report the case of a 53-year-old man who underwent surgery for a diagnosis of mitral incompetence,aortic incompetence,tricuspid incompetence,and coronary atherosclerotic heart disease.Fifteen days after surgery,3000 mL of milky-yellow ascites appeared in the abdominal cavity,diagnosed as CA by laboratory examination.The ascites gradually disappeared after being drained,and the patients improved.The curative was objective,but the exact cause is not clear.Conclusion:Although CA is rare,it may occur during the surgical intervention in cardiac surgery.

关键词： Cardiac intensive care unit Cardiac valve replacement Case report Chylous ascites Coronary artery bypass graft Department of cardiac surgery

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Red blood cell distribution width levels predict prolonged hospital stay for infants after cardiopulmonary bypass surgery

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South China Journal of Cardiology 2024年第2期 89-98页

作者：廖秋凤刘琦李思敏钟杏 Department of Cardiac surgical intensive care unit Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University

Background Thered cell distribution width(RDW) is a parameter that reflects the heterogeneity of red blood cell volume and size, and it is commonly used in the diagnosis of anemia in patients. RDW may serve as a predictor of the postoperative prognosis of surgical patients in the intensive care unit. This study evaluated the predictive capability of RDW for outcomes in infants after cardiopulmonary bypass surgery. Methods A retrospective cohort study was conducted at Guangdong Provincial People's Hospital enrolling infants(≤1 year) who underwent cardiac surgery between January 2019 and April 2019. The infants were divided into two groups based on their preoperative RDW levels(<14.5% and ≥14.5%). The primary outcome measured was the prolonged hospital stay post-operation. The association between RDW levels and prolonged hospital length of stay was evaluated using multivariate Logistic regression, presenting the adjusted odds ratio with a 95% confidence interval(CI). Additionally, interaction and subgroup analyses were performed to assess the consistency of these correlations. Results A total of 186 infants were included in the study. After adjusting for potential confounders, multivariate logistic regression models demonstrated a significant association between RDW and prolonged length of stay(LOS) in hospital when treated as a continuous variable(change per 1SD, OR: 1.50, 95% CI: 1.06-2.11, P=0.021). Categorizing RDW as a variable revealed that higher RDW levels(≥14.5%) were significantly associated with an increased risk of prolonged LOS compared to lower levels(<14.5%)(OR: 9.72, 95% CI: 2.87-32.91, P<0.001). Receiver operating curves(ROC) analysis showed that RDW levels exhibited relatively higher diagnostic value for predicting prolonged LOS(AUC=0.697, 95% CI: 0.617-0.776,P<0.05). Stratified analyses further showed that depending on the variable testing, an association between higher RDW levels and prolonged hospital length of stay in different subgroups was observed.Conclusions Elevated RDW levels in infants

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Early Postoperative Deaths in the surgical intensive care unit of CHU-Kara

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Open Journal of Internal Medicine 2023年第1期13卷 32-50页

作者： Essohanam Tabana Mouzou Sarakawabalo Assenouwe Pikabalo Tchetike Eyram Yoan Makafui Amekoudi Tchaa Hodabalo Towoezim Department of Anesthesia and intensive care at CHU-Kara Kara Togo Anesthesia Resuscitation Service at CHU-Sylvanus Olympio in Lomé Lomé Togo Medical Resuscitation and Nephrology Department of CHU-Kara Kara Togo Trauma Service CHU-Kara Kara Togo

Aim: Review of early postoperative deaths in the surgical intensive care unit at CHU-Kara. Introduction: Surgery, one of the means of treatment of diseases, also presents risks for the patient, including early postoperative death linked to numerous risk factors. Methodology: This was a retrospective descriptive study conducted on the records of patients who died within 48 hours after surgery from November 1, 2019 to April 30, 2021. The study was conducted in the surgical intensive care unit and in the operating room. Results: Thirty-two early postoperative deaths or 2.22% out of 1442 operated with 30 deaths retained for the study. Male gender predominated (70%). The average age was 31.22 years. Farmers were more concerned (66.67%). The time to surgery was 1.6 days. ASA1 patients (40%) predominated followed by ASA IV (30%). 80% of patients were operated on as an emergency. Digestive pathologies 80% were more represented. General anaesthesia 86.66% was more practiced associating Propofol, Fentanyl, Ketamine and Atropine more frequently. The average duration of the procedures was 132.5 minutes. Intraoperative complications were associated with cardiac arrest and hemorrhage (33.34%). ASA class higher than 2, dirty surgery (46.67%), and delayed recovery (13.34%) were the incriminating risk factors. Death by hemodynamic shock and respiratory distress were the main causes 26.66%. Conclusion: Early postoperative mortality was high and involved all ages. Anesthesia and surgery, the low level of qualification of the intraoperative actors, the lesser intraoperative security;the association of anesthetic effects, the complexity of intraoperative lesions led to the increase of mortality. The combination of two or more factors was pejorative for the deaths.

关键词： Mortality Early Postoperative surgical Resuscitation CHU-Kara Togo

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Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

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World Journal of Transplantation 2024年第2期14卷 107-118页

作者： Sophia Hatzianastasiou Paraskevas Vlachos Georgios Stravopodis Dimitrios Elaiopoulos Afentra Koukousli Josef Papaparaskevas Themistoklis Chamogeorgakis Kyrillos Papadopoulos Theodora Soulele Despoina Chilidou Kyriaki Kolovou Aggeliki Gkouziouta Michail Bonios Stamatios Adamopoulos Stavros Dimopoulos Microbiology Department and Infection Control Office Onassis Cardiac Surgery CenterAthens 17674Greece Heart Transplantation unit Onassis Cardiac Surgery CenterAthens 17674Greece Cardiac Surgery intensive care unit Onassis Cardiac Surgery CenterAthens 17674Greece

BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms(MDROs),as a result of frequent hospital admissions and increased exposure to antimi-crobials and invasive procedures.AIM To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition,as well as the impact of MDRO acquisition on intensive care unit(ICU)and hospital length of stay,and on ICU mortality and 1-year mortality post heart transplantation.METHODS This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period(2013-2022)in a single transplantation center.Data was collected regarding MDROs commonly encountered in critical care.RESULTS Among the 98 transplanted patients(70%male),about a third(32%)acquired or already harbored MDROs upon transplantation(MDRO group),while two thirds did not(MDRO-free group).The prevalent MDROs were Acinetobacter baumannii(14%),Pseudomonas aeruginosa(12%)and Klebsiella pneumoniae(11%).Compared to MDRO-free patients,the MDRO group was characterized by higher body mass index(P=0.002),higher rates of renal failure(P=0.017),primary graft dysfunction(10%vs 4.5%,P=0.001),surgical re-exploration(34%vs 14%,P=0.017),mechanical circulatory support(47%vs 26%P=0.037)and renal replacement therapy(28%vs 9%,P=0.014),as well as longer extracorporeal circulation time(median 210 vs 161 min,P=0.003).The median length of stay was longer in the MDRO group,namely ICU stay was 16 vs 9 d in the MDRO-free group(P=0.001),and hospital stay was 38 vs 28 d(P=0.006),while 1-year mortality was higher(28%vs 7.6%,log-rank-χ2:7.34).CONCLUSION Following heart transplantation,a predominance of Gram-negative MDROs was noted.MDRO acquisition was associated with higher complication rates,prolonged ICU and total hospital stay,and higher post-transplantation mortality.

关键词： Heart transplantation Multi drug resistant organisms Transplantation complications Transplantation outcome

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Bioinspired Hemostatic Strategy via Pulse Ejections for Severe Bleeding Wounds

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Research 2024年第1期2023卷 281-299页

作者： Bitao Lu Enling Hu Weiwei Ding Wenyi Wang Ruiqi Xie Kun Yu Fei Lu Guangqian Lan Fangyin Dai State Key Laboratory of Silkworm Genome Biology College of SericultureTextile and Biomass SciencesSouthwest UniversityChongqing 400715China Chongqing Engineering Research Center of Biomaterial Fiber and Modern Textile Chongqing 400715China Division of Trauma and surgical intensive care unit Research Institute of General SurgeryJinling HospitalMedical School of Nanjing UniversityNanjing210002 Jiangsu ProvinceChina Department of Applied Biology and Chemical Technology The Hong Kong Polytechnic UniversityHong KongChina

Efficient hemostasis during emergency trauma with massive bleeding remains a critical challenge in prehospital settings.Thus,multiple hemostatic strategies are critical for treating large bleeding wounds.In this study,inspired by bombardier beetles to eject toxic spray for defense,a shape-memory aerogel with an aligned microchannel structure was proposed,employing thrombin-carrying microparticles loaded as a built-in engine to generate pulse ejections for enhanced drug permeation.Bioinspired aerogels,after contact with blood,can rapidly expand inside the wound,offering robust physical barrier blocking,sealing the bleeding wound,and generating a spontaneous local chemical reaction causing an explosivelike generation of CO_(2) microbubbles,which provide propulsion thrust to accelerate burst ejection from arrays of microchannels for deeper and faster drug diffusion.The ejection behavior,drug release kinetics,and permeation capacity were evaluated using a theoretical model and experimentally demonstrated.This novel aerogel showed remarkable hemostatic performance in severely bleeding wounds in a swine model and demonstrated good degradability and biocompatibility,displaying great potential for clinical application in humans.

关键词： wound sealing offering

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Cardiac rehabilitation after cardiac surgery:An important underutilized treatment strategy

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World Journal of Cardiology 2024年第2期16卷 67-72页

作者： Christos Kourek Stavros Dimopoulos Medical School of Athens National and Kapodistrian University of AthensAthens 15772Greece Cardiac Surgery intensive care unit Onassis Cardiac Surgery CenterAthens 17674Greece Clinical Ergospirometry Exercise&Rehabilitation Laboratory1st Critical Care Medicine DepartmentEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece

Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,surgical incision,duration of cardiopulmonary bypass,and mechanical ventilation that affects their quality of life.These complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality rates.Despite the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac surgery.Prehabilitation and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle strength.Early mobilization should be adjusted to each patient’s functional capacity with progressive exercise training,from passive mobilization to more active range of motion and resistance exercises.Cardiopulmonary exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise intensity.During the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac rehabilitation.By incorporating artificial intelligence,simulation,telemedicine and virtual cardiac rehabilitation,cardiac surgery patients may improve adherence and compliance,targeting to reduced hospital readmissions and decreased healthcare costs.

关键词： Cardiac rehabilitation Cardiac surgery Cardiopulmonary exercise testing Early mobilization Treatment Technology

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