ObjectiveTo explore the effectiveness of lung ultrasound-guided pulmonary rehabilitation training in ICU patients on mechanical ventilation.MethodsPatients on mechanical ventilation admitted to the ICU of a tertiary A-level hospital in Hefei city from July 2022 to December 2023 were selected and randomly divided into a control group and an experimental group using a random number table method. The control group received conventional pulmonary rehabilitation training, while the experimental group underwent lung ultrasound-guided pulmonary rehabilitation training. The differences in lung ultrasound scores, oxygenation index, diaphragm function, weaning success rate, and mechanical ventilation time were compared between the two groups on the 1st, 3rd, 5th, and 7th days of intervention.ResultsThe study was completed with 48 cases in the experimental group and 46 cases in the control group. Repeated measures ANOVA showed statistically significant intergroup effects, time effects, and interaction effects on lung ultrasound scores, oxygenation index, diaphragm mobility, and diaphragm thickness variability rate (P<0.05). The weaning success rate was higher in the experimental group than in the control group, and the mechanical ventilation time was shorter, with statistically significant differences (P<0.05).ConclusionsThe lung ultrasound-guided pulmonary rehabilitation training program can effectively improve the pulmonary status, oxygenation, and diaphragm function of ICU patients on mechanical ventilation, increase the success rate of weaning, shorten the mechanical ventilation time, and accelerate patient recovery.
Objective To retrospectively analyze the clinical characteristics of different lactate trajectories in sepsis patients receiving mechanical ventilation (MV) and to investigate their associations with acute kidney injury (AKI) and in-hospital death risk, aiming to provide references for early renal protection in critically ill sepsis patients. Methods Data from sepsis patients receiving MV were extracted from the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) database. The daily mean lactate values over the first 10 days were calculated. The latent class trajectory model (LCTM) was used to identify lactate trajectories over time and group the patients accordingly. AKI was the primary outcome measure, while in-hospital death was the secondary outcome measure. Logistic regression and Cox regression analyses were used to explore the associations between different lactate trajectories and these outcomes. Kaplan-Meier curves were drawn to compare in-hospital death risks among different lactate trajectory groups. Results A total of 2 062 MV-treated sepsis patients were included. After LCTM analysis, 1 396 patients were classified into the low lactate trajectory group, 451 into the moderate lactate trajectory group, and 215 into the high lactate trajectory group. After adjusting for confounding factors, the high lactate trajectory group was associated with an increased risk of AKI and in-hospital death (P<0.05). Conclusions In sepsis patients receiving MV, those with high lactate trajectories have a higher risk of AKI. Lactate trajectory changes can serve as an early assessment indicator for AKI and mortality risk in critically ill sepsis patients.
ObjectiveTo explore the psychological pressure in Intensive Care Unit (ICU) nurses and the sources of their pressure. MethodWe investigated the ICU nurses in West China Hospital with a self-designed psychological pressure questionnaire from March to September 2013. ResultsThe total stress level of ICU nurses was 2.89±0.86. The top five sources were low salaries and welfare benefits (3.37±0.61), high frequency of night work (3.31±0.88), wide need of knowledge (3.22±0.41), heavy workload (3.20±0.80) and chronic fatigue syndrome (3.19±0.75). ConclusionsGreat psychological pressure exists in ICU nurses. We urgently need effective approaches to relieve the stress of ICU nurses in order to improve the efficiency and quality of nursing service.
ObjectiveTo investigate the causes of ventilator-associated pneumonia (VAP) in patients with tumor in Intensive Care Unit (ICU), and take effective intervention measures to reduce the incidence of VAP. MethodsThe targeted monitoring was conducted for the ICU patients who underwent the mechanical ventilation for over 48 hours from January 2013 to December 2014. Then the conventional nursing measures where adopted in 2013 without any field intervention measure implemented. While the prevention and control method was conducted in 2014 and the causes of VAP was valued and anyzed. ResultsAfter adopting intervention measures, the thousand-day rate of VAP decreased from 8.71‰ before the interventions to 2.30‰ after the interventions. The utilization rate of ventilators increased from 63% to 72% after the interventions were taken in 2014. The constituent ratio of the multidrug-resistant bacteria among the isolated pathogens in each year presented a downward trend. ConclusionVAP is common in ICU patients. It is necessary to reach preventive measures and designated position and ventilator management so as to prevent the occurrence of new nosocomial infection.
ObjectiveTo discuss the demands for nursing knowledge among family caregivers for elderly people, in order to provide a basis for nurses to provide effective education for these people. MethodsBetween May and June 2012, a questionnaire which contained the condition of demands for nursing knowledge and the burden of care was used to investigate 1 600 family caregivers for the elderly people. ResultsThe caregivers had a demand for nursing knowledge, which may include the knowledge on medicine, disease and caregiving. The demand for knowledge was correlated with relationship between the caregivers and care recipients, health condition of the caregivers and care burden. ConclusionThe demands for nursing knowledge are higher in those who have spouse and high burden of care, without disease and symptom; we should pay more attention on them and take measures to reduce their burden of care.
Aiming at the shortcomings in the theory and practice of integrated elderly care and medical services in China, using the methods of literature analysis and comparative analysis, we summarize four typical models of integrated elderly care and medical services, namely, the American commercial pension model, the British national tax financing system pension model, the Japanese national security transformation, and the German long-term care insurance system, and compare the four models systematically from the aspects of system overview, service principle, operation mode, financing supervision, etc. The enlightenment for the policy and practice development of integrated elderly care and medical services in China is obtained: firstly, the service concept should be innovated; secondly, it is important to improve the relevant legal protection and supporting measures; thirdly, the refinement of the integrated elderly care and medical service projects are supposed to be promoted; fourthly, a multi-party linkage mechanism ought to be establishd; and fifthly, community endowment model should be advocated.
ObjectiveTo investigate the incidence of nosocomial infection and device-related infection in the Intensive Care Unit (ICU), analyze its related risk factors, and search for effective measures to prevent and control nosocomial infection. MethodsBy prospective objective monitoring method, we surveyed 294 patients hospitalized in the ICU for at least 48 hours between January and December 2012. The doctor in charge filled in relevant information of the patients to complete the questionnaires, and hospital infection management staff was responsible for tracking, judging, and statistical analysis. ResultsIn the 294 patients, 61 had hospital infections, and there were 78 cases. The hospital infection rate was 20.75%, and the case infection rate was 26.53%. The day incidence of patient infection was 16.01‰, and day infection rate was 20.47‰ for infection cases. After average severity of illness score adjustment, the day case infection rate was 7.48%, ventilator associated pneumonia (VAP) infection rate was 27.27‰, central venous catheter associated bloodstream infection rate was 6.58‰, and catheter associated urinary tract infection rate was 3.15‰. ConclusionICU has a high risk of hospital infection. In the device related infections, VAP infection rate is the highest. Continuous improvement can be achieved through monitoring and discovering problems, strengthening hospital infection management training for the medical personnel of the hospital, close communication between doctors and hospital infection management staff, and strict implementation of hospital infection management measures.
ObjectiveTo explore the application of different digestive system management strategies in the perioperative period of thoracolumbar fracture.MethodsThe clinical data of the patients with thoracolumbar fractures and pedicle screw fixation in Affiliated Hospital of Southwest Medical University from January 2016 to January 2018 were retrospectively analyzed. According to different perioperative management strategies of the digestive system, they were divided into two groups. Patients with careful management strategy were included in the observation group, and patients with routine management were included in the control group. The baseline conditions, the abnormalities of digestive tract function at admission and before and after surgery, the postoperative first feeding time, exhaust time, defecation time, the incidence of other postoperative complications except digestive tract complication, length of stay and patient satisfaction were compared between the two groups. At 6 months after surgery, the fracture healing, loosening or fracture of internal plants were compared between the two groups.ResultA total of 121 patients were included in the study, including 67 cases in the observation group and 54 cases in the control group. There was no significant differences in the baseline conditions between the two groups (P>0.05). There were no significant differences between the two groups in the incidences of digestive system dysfunction at admission (P>0.05). The incidences of digestive system dysfunction in the observation group before and after surgery were lower than those in the control group (29.9% vs. 53.7%, P<0.05; 35.8% vs. 61.1%, P<0.05). The first eating time [(3.7±1.1) vs. (6.7±2.6) h], exhaust time [(7.8±2.3) vs. (13.6±4.2) h], defecation time [(26.7±8.1) vs. (40.9±11.2) h] and length of stay [(6.5±2.4) vs. (9.0±2.7) d] in the observation group were shorter than those in the control group (P<0.005), and the patients’ satisfaction was better than that of the control group (8.3±1.1 vs. 7.6±1.3; t=−3.208, P=0.002). There was no statistically significant difference in the incidence of postoperative complications except digestive tract complication, and the fracture healing rate, the incidence of nail-rod breakage at6 months after surgery between the two groups (P>0.05). No internal plant loosening was found in the two groups of patients within 6 months after surgery.ConclusionThe application of the careful digestive system management strategy in patients with thoracolumbar fractures can help reduce the incidence of perioperative gastrointestinal dysfunction, promote the recovery of perioperative gastrointestinal function, shorten the length of hospital stay, and improve patient satisfaction.
ObjectiveTo investigate the effects of total parenteral nutrition in neonatal patients and study the nursing methods for these neonates. MethodsWe retrospectively analyzed the clinical data of 70 neonatal patients who accepted total parenteral nutrition in our hospital from October 2010 to October 2011. Physiological indexes were compared before and after total parenteral nutrition. ResultsSignificant improvements in the nutritional status of all children were observed. All patients achieved good efficacy and effective care. ConclusionTotal parenteral nutrition support for critically ill newborns is of great significance, and good caring also plays an important role.
ObjectiveTo deeply discuss the home care experience of parents of children with epilepsy, analyzed the current status of care ability and the real influencing factors, and provide a basis to improve their care ability.MethodsDescriptive research was used to conduct in-depth interviews with parents of 14 children with epilepsy who were admitted to the Children's Hospital of Zhengzhou University from December 2019 to January 2020, and data analysis was performed by using the generic analysis method.ResultsThe home care experience of parents of children with epilepsy includes four themes: weak nursing ability, physical and mental fatigue, weak support system, and expectation of medical professional support.ConclusionMedical staffs should combine the needs of parents of children with epilepsy and the influencing factors of care ability to carry out health education guidance of online and offline epilepsy knowledge and care skills to improve their care ability.