Objective To identify the predictors for readmission in the ICU among cardiac surgery patients. Methods We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016. Results The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%, P<0.001). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=1.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 to1.259, P<0.001), and the drainage on the day of surgery (OR=1.001, 95%CI1.001 to 1.002, P<0.001) were the independent risk factors for readmission to the cardiac surgery ICU. Conclusion The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient healthcare planning and resources allocation.
Objective To retrospectively analyze the clinical features of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU), so as to improve the level of clinical diagnosis and treatment. Methods A total of 81 patients diagnosed as IPA from March, 2017 to March, 2022 in the ICU of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China were selected as infection group. A total of 81 non-IPA patients with pulmonary infection and Aspergillus negative sputum culture were selected as the control group. The host factors, Acute Physiology and Chronic Health Assessment Ⅱ score at admission, underlying diseases, clinical symptoms and signs, relevant laboratory test results, and lung CT findings were compared between the two groups. Univariate analysis and multivariate conditional logistic regression analysis were used to identify the risk factors for the occurrence of pulmonary aspergillosis in IPA patients in ICU. At the same time, the types of aspergillus in the IPA group and the outcomes of the two groups at 28 days after ICU admission were analyzed. Results Of the 81 IPA patients, 4 were proven diagnosed and 77 were putative diagnosed. IPA patients were mainly infected with Aspergillus fumigatus and Aspergillus flavus. Symptoms and signs such as fever, cough and expectoration, dyspnea and pulmonary rales occurred in both groups. The level of procalcitonin in IPA group was higher than that in non-IPA group, and the difference was statistically significant (P=0.016). The positive rate of serum galactomannan antigen test (GM test) in the IPA group was higher than that in the non-IPA group, and the differences was statistically significant (P=0.000). The incidence of pulmonary imaging cavities in IPA group was higher than that in non-IPA group, and the difference was statistically significant (P=0.022). Univariate analysis showed that central venous catheterization, septic shock, complete parenteral nutrition, chronic obstructive pulmonary disease, and immunosuppression were risk factors for IPA (P<0.05); Multivariate conditional logistic regression analysis showed that complete parenteral nutrition, chronic obstructive pulmonary disease, and immunosuppression were independent risk factors for IPA (P<0.05). The 28-day fatality rate in IPA group was higher than that in non-IPA group (55.6% vs. 34.6%, P=0.007). Conclusions IPA patients have no specific clinical symptoms and signs, and are mainly infected with Aspergillus fumigatus and Aspergillus flavus; GM test has guiding significance for the diagnosis of IPA. Serum GM test and pulmonary imaging have cavity findings that are helpful for the diagnosis of IPA. Patients with a history of chronic obstructive pulmonary disease, immunosuppression, or complete parenteral nutrition need to be on high alert for the possibility of IPA during ICU stay.
Objective To explore the effect of “net bottom” management in the control of device-associated infections (DAIs) in elderly patients by setting infection monitoring doctors and nurses in the emergency intensive care unit (EICU). Methods Elderly patients who aged≥60 years old admitted to the EICU of the First People’s Hospital of Lianyungang between April 2018 and March 2021 were selected as the research subjects. A “net bottom” management mode was established and implemented for the purpose of infection prevention and control, taking medical and other departments as the coordination and management subjects, and infection monitoring doctors and nurses as the core. The effectiveness of the management intervention was evaluated by comparing the incidences of DAIs in elderly patients, the compliance rates of medical staff in hand hygiene, and the consumption of hand sanitizer per bed day in EICU among the primary stage (from April 2018 to March 2019), intermediate stage (from April 2019 to March 2020), and later stage (from April 2020 to March 2021). Results During the primary stage, intermediate stage, and later stage, there were 540, 497, and 507 elderly inpatients in EICU monitored, respectively, and the incidences of nosocomial infections were 7.22% (39/540), 5.84% (29/497), and 4.14% (21/507), respectively, showing a decreasing trend (χ2trend=4.557, P=0.033). The incidences of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections decreased from 4.82‰, 2.53‰, and 0.95‰, respectively in the primary stage, to 0.51‰, 1.01‰, and 0.53‰, respectively in the later stage, among which the difference in the incidence of ventilator-associated pneumonia was statistically significant (P<0.05). The hand hygiene compliance rate of EICU medical staff increased from 70.39% to 86.67% (P<0.05), and the consumption of hand sanitizer per bed day increased from 33.70 mL to 67.27 mL. The quarterly hand hygiene compliance rate was positively correlated with the quarterly consumption of hand sanitizer per bed day (rs=0.846, P=0.001), and negatively correlated with the quarterly incidence of nosocomial infections (rs=–0.769, P=0.003). Conclusion The “net bottom” management by setting up infection monitoring doctors and nurses in the EICU and multi-department collaboration can reduce the incidence of DAIs in elderly patients in EICU, which plays a positive role in promoting the hospital infection management and improving the quality of hospital infection management.
Objective To systematically assess the risk factors for the occurrence of multidrug-resistant organism (MDRO) infections in general intensive care units (ICU). Methods A computerized search was conducted to identify literature on the risk factors for MDRO infection in ICUs in the Chinese Biomedical Literature Service system, CNKI, Wanfang, VIP, PubMed, Web of Science, Cochrane Library, and Embase databases from January 1, 2012, to June 1, 2024. The literature meeting the inclusion and exclusion criteria was subjected to two-person data extraction and quality evaluation, and then meta-analysis was conducted by using Revman5.4 software. Results A total of 25 articles were included, with a cumulative total of 19 280 patients, including 3 945 patients with MDRO infection (20.5%). Twenty-four risk factors were analyzed, and the difference between 19 of them was statistically significant (P<0.050). The risk factors for MDRO infection included: (1) three general factors: length of hospital stay, ICU length of stay, and APACHE Ⅱ score; (2) seven invasive operation-related factors: mechanical ventilation, duration of mechanical ventilation, fiberoptic bronchoscopy, arterial intubation , length of venous catheterization, ureteral intubation, and urinary catheter retention; (3) four antibiotic-related factors: use of antimicrobials prior to ICU admission, concomitant antimicrobials, antimicrobial species, and duration of antimicrobials use; (4) five factors related to the underlying diseases: hypoproteinemia, pulmonary diseases, combined underlying diseases, number of combined underlying diseases, and mixed infections. Conclusions The current research evidence suggests that multiple factors are associated with the occurrence of MDRO infections in patients in general ICU, which may provide a basis for early screening of patients at risk for MDRO infections by ICU healthcare professionals.
Objective To investigate the predictive value of the prognostic nutritional index (PNI) for 28-day all-cause mortality in patients with chronic obstructive pulmonary disease (COPD) in intensive care unit (ICU). Methods The relationship between PNI and short-term mortality in COPD patients was analysed using COX proportional hazards and restricted cubic spline (RCS) models. Receiver operating characteristic (ROC) curves were plotted and area under the ROC curve (AUC) was calculated to assess the predictive performance of PNI. The optimal cut-off value for PNI was determined using the Youden index, and the data were divided into a low PNI group and a high PNI group. Kaplan-Meier curves were then constructed and the log-rank test was used to assess differences in survival between the two groups. Results A total of 980 COPD patients were included in the study. Multivariable COX regression analysis showed that PNI was an independent factor influencing short-term mortality in the severe COPD patients (HR=0.972, 95%CI 0.948 - 0.995, P=0.019). RCS curve results showed a non-linear relationship between PNI and short-term mortality in the severe COPD patients (P for non-linear=0.032), with the risk of death gradually decreasing as PNI increased. The ROC curve indicated that PNI had some predictive power, comparable to that of SOFA score [(AUCPNI=0.693) vs. (AUCSOFA=0.672)]. Kaplan-Meier curve analysis showed a significant difference in survival time between the low (≤38.3) PNI group and the high (>38.3) PNI group (P<0.05). Conclusions PNI has a certain predictive role for short-term all-cause mortality in patients with severe COPD. Patients with low PNI at ICU admission have a higher risk of short-term mortality.
Objective To investigate the correlation between monocyte-lymphocyte ratio (MLR) and intensive care unit (ICU) results in ICU hospitalized patients. Methods Clinical data were extracted from Medical Information Mart for Intensive Care Ⅲ database, which contained health data of more than 50000 patients. The main result was 30-day mortality, and the secondary result was 90-day mortality. The Cox proportional hazards model was used to reveal the association between MLR and ICU results. Multivariable analyses were used to control for confounders. Results A total of 7295 ICU patients were included. For the 30-day mortality, the hazard ratio (HR) and 95% confidence interval (CI) of the second (0.23≤MLR<0.47) and the third (MLR≥0.47) groups were 1.28 (1.01, 1.61) and 2.70 (2.20, 3.31), respectively, compared to the first group (MLR<0.23). The HR and 95%CI of the third group were still significant after being adjusted by the two different models [2.26 (1.84, 2.77), adjusted by model 1; 2.05 (1.67, 2.52), adjusted by model 2]. A similar trend was observed in the 90-day mortality. Patients with a history of coronary and stroke of the third group had a significant higher 30-day mortality risk [HR and 95%CI were 3.28 (1.99, 5.40) and 3.20 (1.56, 6.56), respectively]. Conclusion MLR is a promising clinical biomarker, which has certain predictive value for the 30-day and 90-day mortality of patients in ICU.
ObjectiveTo analyze targeted surveillance results of nosocomial infection in Neurosurgical Intensive Care Unit (ICU) and investigate the characteristics of nosocomial infection, in order to provide reference for constituting the intervention measures. MethodsWe monitored the incidence of nosocomial infection, the application and catheter-related infection of invasive operation, and the situation of multiple resistant bacteria screening and drug resistance characteristics of each patient who stayed more than two days in neurosurgical ICU during January to December 2013. ResultsThere were a total of 1 178 patients, and the total ICU stay was 4 144 days. The nosocomial infection rate was 4.92%, and the day incidence of nosocomial infection was 13.75‰. The nosocomial infection rate was significantly higher in January and between July and December compared with other months. Ventilator utilization rate was 9.75%; ventilator-associated pneumonia incidence density was 14.85 per 1 000 catheter-days; central line utilization rate was 28.40%; central line-associated bloodstream infection incidence density was 0.85 per 1 000 catheter-days; urinary catheter utilization rate was 97.90%; and the incidence density of catheter-associated urinary tract infection was 0.25 per 1 000 catheter-days. ConclusionThe nosocomial infection rate has an obvious seasonal characteristic in neurosurgical intensive care unit, so it is necessary to make sure that the hospital infection control full-time and part-time staff should be on alert, issue timely risk warning, and strengthen the risk management of hospital infection.
Objective To compare the bacterial spectrums of respiratory intensive care unit (RICU) patients derived from traditional bacterial culture and loop-mediated isothermal amplification (LAMP) assay. To analyze the relationship between clinical factors and clinical outcome of patients. Methods Data of patients in RICU with lower respiratory tract infection from October 2018 to December 2020 was collected. The bacterial spectrums obtained by traditional culture method and LAMP-based method were compared. Clinical factors were divided into two categories and taken into analysis of variance for assessing their relevance with clinical outcomes. Those with significances in analysis of variance were taken into binary logistic regression. Results A total of 117 patients were included. The ratio of patients with positive bacterial culture results was 39.13% (n=115), and that with positive LAMP assay results was 72.65% (n=117). The ratios of patients with at least two positive results for culture and LAMP were 8.70% (n=115) and 36.75% (n=117), respectively. According to chi-squared test, mechanical ventilation (χ2=5.260, P=0.022), and patients with two or more bacteria positive for LAMP assay (χ2=8.227, P=0.004) were related to higher risk of death. Mechanical ventilation and patients with two bacteria positive for LAMP assay were included in binary logistic regression. The odds ratio for death was 4.789 in patients with two or more bacteria positive by LAMP assay (95% confidence interval 1.198 - 19.144, P=0.027). Conclusions LAMP-based method is helpful in detecting more bacteria from respiratory tract specimens of RICU patients, which will be a contributor to precision medicine. Patients with at least two bacteria positive based on LAMP assay have higher risk of death.
ObjectiveTo investigate the protein intake of patients in the general surgery intensive care unit (ICU) and to analyze the factors, both hindering and facilitating, that affecting protein intake from the perspective of healthcare professionals. MethodsA mixed-methods approach was used in this study, including a quantitative study and a qualitative study. The quantitative study was use to assess the protein intake in the ICU patients. The qualitative study was used to analyze the perspectives of healthcare professionals via semi-structured interviews. In the quantitative study, 32 variables were analyzed, and the sample size was estimated to be 10 times the number of study variables. The qualitative study employed the maximum difference sampling strategy, with the sample size determined by data saturation. The multiple linear regression was used to identify the risk factors affecting protein intake achievement, with a significance level of α=0.05. ResultsThe quantitative study included 459 patients, with a protein intake of (0.739±0.552) g/(kg·d). Of the patients, 90 (19.6%) had a protein intake of 1.2–2.0 g/(kg·d), 11 (2.3%) had 2.0 g/(kg·d) or more, and 358 (78.0%) had less 1.2 g/(kg·d). The multiple linear regression analysis identified several risk factors influencing protein intake attainment, including male, higher body mass index, elevated blood glucose levels upon ICU admission, early initiation of enteral nutrition (≤48 h), nasoenteric tube placement, and the only use of enteral nutrition feedings. In the qualitative study, three key themes relevant protein intake attainment were identified from the interviews: inadequate infrastructure, healthcare workers’ factors, and patient-related factors. ConclusionsThe findings of this study suggest a substantial gap between the protein intake of general surgical ICU patients and the guideline-recommended intake. The study highlights patient groups at risk for inadequate protein intake based on identified risk factors. Future efforts should focus on improving the efficiency of protein supplementation, enhancing the nutritional status of patients, standardizing protein supplementation protocols, and increasing education for both healthcare workers and patients.
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.