Objective To evaluate systematically the effectiveness and safety of procalcitonin ( PCT) -guided therapy in comparison with standard therapy in patients with suspected or confirmed severe bacterial infections in intensive care unit ( ICU) . Methods Five randomized controlled trials ( 927 patients) were included for statistical analysis by the cochrane collaboration′s RevMan5. 0 software. Results PCT-guided therapy was associated with a significant reduction in duration of antibiotic therapy [ MD =- 2. 01, 95% CI ( - 2. 37, - 1. 64) , P lt;0. 00001] , but the mortality [ OR =1. 11, 95% CI ( 0. 83, 1. 49) ,P =0. 47] and length of ICU stay[ MD = 0. 49, 95% CI( - 1. 44, 2. 42) , P = 0. 62] were not significantly different. Conclusions An algorithmbased on serial PCT measurements would allow a more judicious use of antibiotics than currently traditional treatment of patients with severe infections in ICU. It can reduce the use of antibiotics and appears to be safe.
ObjectiveTo evaluate the effect of bundle strategies on the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), in order to effectively prevent and control the severe situation of multiple drug-resistant bacteria in ICU.MethodsWe selected patients who admitted into the ICU from January 2016 to December 2017 as study subjects, and monitored 6 types of MDROs. Basic information was surveyed and collected from January to December 2016 (before intervention), while bundle strategies on MDROs were implemented from January to December 2017 (after intervention), including issusing isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, implementing hand hygiene, etc. Then we compared the MDRO detection rate, nosocomial infection rate, MDRO nosocomial infection rate, and compliance rates of interventions between the two periods.ResultsThe MDRO detection rate before intervention was 77.10%, and that after intervention was 49.12%, the difference between the two periods was statistically significant (χ2=69.834, P<0.001). The nosocomial infection rate of ICU decreased from 23.51% before intervention to 15.23% after intervention, the MDRO nosocomial infection rate decreased from 13.70% before intervention to 5.84% after intervention, and the differences between the two periods were statistically significant (χ2=8.594, P=0.003; χ2=13.722, P<0.001). The compliance rates of doctor’s isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, and hand hygiene, as well as the correct rate of hand hygiene after intervention (92.12%, 93.55%, 81.77%, 84.24%, 82.90%, 77.39%, and 96.37%) were significantly higher than those before intervention (31.94%, 52.00%, 23.43%, 48.18%, 67.16%, 59.46%, and 88.64%), and the differences were all statistically significant (P<0.001).ConclusionThe implementation of the above bundle strategies on the prevention and control of MDROs can decrease the MDRO detection rate and MDRO nosocomial infection rate.
Multidrug-resistant bacterial infection is one of the important causes of death in intensive care unit (ICU) patients, which can significantly increase the length of hospital stay and treatment costs for ICU patients. At present, domestic scholars have paid less attention to hospital-acquired multidrug-resistant bacterial infection in ICU patients. This article summarizes the clinical manifestations, risk factors, and prevention and control measures of hospital-acquired multidrug-resistant bacterial infection in ICU patients, aiming to improve the understanding of medical staff on the situation of hospital-acquired multidrug-resistant bacterial infection in ICU and promote the development of hospital infection prevention and control.
ObjectivesTo assess the efficacy of non-drug interventions on improving sleep quality in ICU patients by network meta-analysis.MethodsThe Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on non-drug interventions on improving sleep quality in ICU patients from inception to December, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, network meta-analysis was performed by using the Stata 13.0 software.ResultsA total of 12 RCTs, involving 1 223 patients and 9 non-pharmacological interventions (music therapy, comprehensive nursing intervention, TCM emotions, music therapy+TCM emotions, Chinese medicine pillow therapy, ear acupressure, eye mask+earplugs+music, eye mask+earplugs, regular care) were included. The results of Pittsburgh sleep quality index (PSQI) showed that eye mask+earplugs, eye masks, and comprehensive nursing interventions were superior to conventional care in improving sleep quality in ICU patients, and the rankings were: eye mask+earplugs>eye mask>comprehensive nursing intervention, music therapy+TCM emotional>Chinese medicine emotional>music therapy>general care. The results of Richards-Campbell sleep scale (RCSQ) showed that eye mask+earplugs+music, Chinese medicine pillow therapy, and auricular pressure beans were superior to conventional care, and the rankings were: eye mask+earplugs+music>Chinese medicine pillow therapy>music therapy>ear acupressure beans>general care.ConclusionsThe evidence shows that in improving the sleep quality of ICU patients, eye mask + earplug, eye mask, comprehensive nursing intervention, music therapy + TCM emotional characteristics may all be effective intervention methods. It is suggested that more non-drug interventions should be carried out in the future for enhancing the sleep quality of ICU patients.
ObjectiveTo survey the current situation of post-intensive care syndrome (PICS) among patients in respiratory intensive careunit (RICU), and explore the effect factors of PICS.MethodsBy convenience sampling, 125 patients in the RICU of Peking University First Hospital were recruited in the study. The patients were tested for PICS using Mini-mental State Examination (MMSE), Confusion Assessment Method for the ICU (CAM-ICU), Hospital Anxiety and Depression Scale (HADS), Medical Research Council (MRC), Activities of Daily Living (ADL), Pittsburg Sleep Quality Index (PSQI), Fatigue Scale-14 (FS-14), including three aspects of cognition, psychology and physiology. The effect factors of PICS were measured through researcher-created Questionnaire on Patients’ General Information and Questionnaire on Disease-Related Information.ResultsIn this study, the actual effective sample size was 110 cases, among which 59 cases developed PICS, with an incidence of 53.6%. Logistic regression showed that effect factors of PICS were age, invasive mechanical ventilation time, noninvasive ventilator assisted ventilation time and coronary atherosclerotic heart disease (P< 0.05).ConclusionsThe incidence of PICS in RICU patients is 53.6%, which is at a high level. Advanced age, long duration of invasive mechanical ventilation, long duration of non-invasive ventilator assisted ventilation, and coronary atherosclerotic heart disease are the risk factors of PICS. Medical and nursing staff should pay more attention to PICS, intervene in the risk factors of the patient, and take targeted measures to prevent the occurrence of PICS.
ObjevtiveThe morbidity of intensive care unit-acquired swallowing disorder (ICU-ASD) was clarified through meta-analysis by synthesizing previous evidence, in order to provide an evidence-based basis for early identification and intervention of ICU-ASD. Methods A computerized search of PubMed, Embase, Web of Science, The Cochrane Library, CHINAL, China Knowledge Network, Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal Database was conducted to retrieve the relevant literature on the morbidity of ICU-ASD published in China and abroad from the database establiment to December 2022. Considering the quality of the included literature, the Chinese database excluded master's theses and non-core journals. Meta-analysis of morbidity was performed using Stata 12.0. Results A total of 19 papers, including 4291 patients, were included. Meta-analysis showed that the overall morbidity of ICU-ASD was 36% [95% confidential interval (CI) 26% - 46%; I2=97.62%, P<0.01]. Subgroup analyses showed that the morbidity of ICU-ASD in Asian, European, South American, and North American was 39% (95%CI 28% - 50%), 23% (95%CI 8% - 44%), 52% (95%CI 46% - 57%), and 39% (95%CI 20% - 61%), respectively; and that the morbidity of male and female ICU-ASD was 36% (95%CI 24% - 48%) and 33% (95%CI 22% - 45%), respectively; the morbidity of ICU-ASD was 41% (95%CI 30% - 52%) and 31% (95%CI 18% - 44%) in the patients with and without hypertension, respectively; the morbidity of ICU-ASD was 58% (95%CI 42% - 73%) and 51% (95%CI 36% - 66%) in the patients with and without respiratory disease respectively; the morbidity of ICU-ASD in the patients with and without diabetes mellitus was 37% (95%CI 24% - 51%) and 39% (95%CI 28% - 51%), respectively; the morbidity of ICU-ASD in the patients with and without renal disease was 40% (95%CI 23% - 59%) and 35% (95%CI 24% - 46%), respectively; the morbidity of ICU-ASD in the patients with intubation caliber ≤7.5 mm and >7.5 mm was 31% (95%CI 19% - 45%) and 37% (95%CI 22% - 54%), respectively; the morbidity of ICU-ASD in the patients with and without heart failure was 58% (95%CI 30% - 84%) and 36% (95%CI 23% - 51%), respectively; and the morbidity of ICU-ASD in patients with and without arrhythmia was 36% (95%CI 11% - 65%) and 31% (95%CI 21% - 42%), respectively; the morbidity of ICU-ASD in the patients with and without neurologic disease was 48% (95%CI 24% - 72%) and 34% (95%CI 15% - 57%), respectively. Begg's test P<0.05, Egger's test P<0.05, suggesting publication bias in the study, and the cut-and-patch method corrected for an overall incidence result of 27% (95%CI 18% - 36%). Conclusions Meta-analysis reveals an overall morbidity of 36% for ICU-ASD and 27% for the cut-and-patch correction. Subgroup analysis reveals that the morbidity of ICU-ASD is significantly higher in patients with hypertension, heart failure, and neurological disorders than in patients without these disorders. Current evidence suggests that the prevalence of ICU-ASD is high and needs to be taken seriously. Timely screening and assessment of swallowing disorders is recommended for intensive care unit patients, especially those with hypertension, heart failure, and neurological disorders.
ObjectiveTo observe the effect of target monitoring on the patients with ventilator-associated pneumonia (VAP) in intensive care unit (ICU), analyze the risk factors and take effective measures to reduce the VAP occurrence. MethodsTarget monitoring was performed on patients with ventilator in ICU from January to July 2013 (observation group), and they were compared with those patients accepting general comprehensive monitoring in ICU from January to July 2012 (control group). The incidence of VAP was compared between the two groups. ResultsThe incidence of VAP in the observation group and the control group was 21.73‰ and 53.33‰, respectively. There was a significant difference between the observation group and the control group (P<0.05). ConclusionFor patients undergoing mechanical ventilation, target monitoring can control the risk factors and incidence of VAP, adjust the interference in time, and improve the curing rate.
Objective To investigate the drug resistance and homogeneous analysis of Acinetobacter baumanii in emergency intensive care unit ( EICU) . Methods Four multidrug-resistant Acinetobacter baumannii ( MDR-Ab) strains isolated fromnosocomial inpatients fromJuly 25 to September 7 in 2009 were collected and tested for drug sensitivity and MIC determination as well. The A. baumannii isolates were typed with pulsed-field gel electrophoresis ( PFGE) to determine whether they derived fromthe same clone.Results Four isolates from nosocomial inpatients were resistant to multiple antibiotics including carbapenem. The PFGE types identified from four isolates were A and B. The A. baumannii isolates did not derived from the same clone. Conclusion The prevalence of nosocomial infection is not due to transmission of the same strains among different individuals in EICU.
Objective To explore the type and frequency of oral care practice in intensive care units (ICUs) in Mainland China, and to provide evidence and suggestions for improving oral care practice. Methods Three survey methods, including mailing questionnaires to ICUs of Grade 3A hospitals, consulting experts in this field and visiting accessible ICUs, were used to survey current oral care practice in Mainland China. Results A total of 184 questionnaires were given to the subjects, of which 79 effective ones were collected, and the response rate was 42.93%. All 79 respondents considered oral care very unimportant, and 98.7% of the ICUs performed oral care in different ways. Currently, the cotton ball wipe-off method was the most frequently used for oral care (62.5%), with an average (9.1± 5.1) min per time, twice or three times daily. The mouthwashes often used were saline (76.1%), solutions containing sodium bicarbonate (22.8%), furacilin (13.9%), and hydrogen dioxide (13.9%). Conclusion The oral care practice for the critically-ill patients in ICUs of China is unsatisfactory, although it is perceived as an important item in nursing care. More evidence–based training should be given and it is necessary to establish a national oral care guideline for critically-ill patients.
Objective To investigate the species distribution and antibiotic resistance of pathogens fromcatheter-related bloodstream infections ( CRBSI) in intensive care unit( ICU) , to provide evidence for the guidance of clinical rational administration.Methods A retrospective analysis was performed to review the microbiological and susceptibility test data of all CRBSI patients in ICU from January 2009 to December 2011. The patterns of antibiotic resistance among the top seven bacteria were compared. Results 67 cases of CRBSI were detected with 81 strains, including 40 Gram-positive ( G+ ) bacteria( 49.4% ) , 38 Gram-negative( G- ) bacteria ( 46.9% ) , and 3 fungi ( 3.7% ) . The main pathogens causing CRBSI were coagulase negative Staphylococci ( 27 strains, 33.3%) , Acinetobacter baumannii ( 12 strains, 14.8% ) , Klebsiella pneumoniae( 9 strains, 11. 1% ) , Staphylococcus aureus ( 8 strains, 9. 9% ) , Pseudomonas aeruginosa ( 7 strains, 8. 6% ) , Escherichia coli ( 6 strains, 7.4% ) , suggesting that Staphylococcus epidermidis was predominant pathogenic G+ bacteria, and Acinetobacter baumannii was predominant G- bacteria. The antibiotic resistance tests demonstrated that isolated G- bacillus was highly sensitive to carbopenem, while vancomycin-resistant G+ bacteria were not found. Conclusions Within the latest 3 years, the predominant pathogens of CRBSI in ICU are Staphylococcus epidermidis and Acinetobacter baumannii. Acinetobacter baumannii exhibited high drug resistance to all antibiotics.