ObjectiveTo analyze epidemic characteristics of multidrug-resistant organism (MDRO) in Neurosurgical Intensive Care Unit (NSICU), and to analyze the status of infection and colonization, in order to provide reference for constituting intervention measures. MethodsPatients who stayed in NSICU during January 2014 to April 2015 were actively monitored for the MDRO situation. ResultsA total of 218 MDRO pathogens were isolated from 159 patients, and 42 cases were healthcare-associated infections (HAI) among 159 patients. The Acinetobacter baumannii was the most common one in the isolated acinetobacter. Colonization rate was positively correlated with the incidence of HAI. From January to December, there was a significantly increase in the colonization rate, but not in the incidence of HAI. ConclusionThe main MDRO situation is colonization in NSICU. The obvious seasonal variation makes the HAI risk at different levels. So it is necessary that full-time and part-time HAI control staff be on alert, issue timely risk warning, and strengthen risk management. The Acinetobacter baumannii has become the number one target for HAI prevention and control in NSICU, so their apparent seasonal distribution is worthy of more attention, and strict implementation of HAI prevention and control measures should be carried out.
ObjectiveTo explore the preventive role of maintaining constant pressure of the endotracheal catheter cuff on ventilator-associated pneumonia (VAP). MethodsFrom January to December 2015, 96 patients of type Ⅱ respiratory failure were selected as the trial group who underwent intubation and mechanical ventilation more than 48 hours in the Intensive Care Unit (ICU). We used pressure gauges to measure the endotracheal catheter cuff pressure regularly and maintained a constant pressure in addition to the application of artificial airway cluster management. We recorded the initial pressure value which was estimated by pinching with finger and set initial pressure to 30 cm H2O (1 cm H2O=0.098 kPa). We measured endotracheal catheter cuff pressure and recorded it during different intervals. We reviewed 88 patients with the same disease as the control group who only accepted artificial airway cluster management between January and December 2014. Mechanical ventilation time, VAP occurrence time, ICU admission time, the incidence of VAP were recorded and analyzed for both the two groups of patients. ResultsIn the trial group, the initial pressure of endotracheal catheter cuff which was estimated by pinching with finger showed that only 11.46% of pressure was between 25 and 30 cm H2O and 82.29% of the pressure was higher than 30 cm H2O. We collected endotracheal catheter cuff pressure values during different interval time by using pressure gauges to maintain a constant management. The ratio at the pressure between 25 and 30 cm H2O was respectively 41.32%, 43.75%, 64.20%, 76.54%, 91.13%, and 91.85%. ICU admission time, mechanical ventilation time in patients of the trial group decreased more, compared with the control group, and the differences were statistically significant (t=4.171, P<0.001; t=4.061, P<0.001). The VAP occurrence time in patients of the trial group was later than the control group (t=2.247, P<0.001). ConclusionThe endotracheal catheter cuff pressure estimated by pinching with finger has errors. We recommend using pressure gauges to detect pressure every four hours, which utilizes minimal time to maintain effective pressure. The method of artificial airway of cluster management combined with the pattern of maintaining constant endotracheal catheter cuff pressure can shorten ICU admission time, mechanical ventilation time and delay the occurrence of VAP.
ObjectiveTo evaluate the efficacy and safety of pirfenidone in patients with idiopathic pulmonary fibrosis. MethodsPubMed, Cochrane Library, CNKI, CBM, Wanfang, and VIP databases were searched for randomized controlled trials of pirfenidone as interventions for the treatment of idiopathic pulmonary fibrosis. According to the Cochrane system evaluation method, the methodological quality of included studies was evaluated and the effective data were extracted. The meta-analysis was performed with RevMan 5.2 software. ResultsSix studies were included with 1727 patients in total. Compared with placebo groups, pirfenidon could improve the changing rate of vital capacity at the end of the treatment[WMD=0.06, 95% CI (0.01, 0.12), Z=2.48, P=0.01; heterogeneity inspection χ2=1.03, P=0.31]. Pirfenidon could not improve the changing rate of lowest SpO2 in 6-minute walking test[WMD=0.82, 95% CI (-1.35, 2.98), Z=0.74, P=0.46; heterogeneity inspection χ2=8.90, P=0.003] and could not reduce the mortality[RR=0.62, 95% CI (0.37, 1.03), Z=1.85, P=0.06; heterogeneity inspection χ2=3.05, P=0.55]. The incidences of photosensitivity, dizziness, nausea, abdominal discomfort, joint pain, fatigue in pirfenidone group were more frequent than those in placebo group. ConclusionsBecause of lack of enough eligible studies and defects in design and reporting data in the studies, this meta-analysis can not evaluate pirfenidone's long-term efficacy and safety. Hence, the existed clinical evidences can't support pirfenidone to be the treatment of IPF medication.