Comprehensive Intensive Care Unit Research Articles

Study of perioperative safety of laparoscopic pancreaticoduodenectomy in elderly patients

To investigate the safety of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients and the related risk factors admitted to the intensive care unit (ICU) after LPD. The perioperative data of patients who underwent LPD in Tianjin Medical University General Hospital from February 2017 to June 2023 were retrospectively collected, including basic data, preoperative laboratory indicators, intraoperative and postoperative indicators, pathological results (tumor size, lymph node dissection and pathological type), postoperative complications, ICU postoperative management and prognosis. The patients were divided into the elderly group (≥ 65 years) and the non-elderly group (< 65 years) according to age. Perioperative data between two groups were compared. Kaplan-Meier survival curve was drawn to analyze the survival rate of the elderly group and the non-elderly group, and the pancreatic head carcinoma group and other type of tumors group after LPD. Logistic regression was used to analyze the risk factors of ICU stay (length of ICU stay > 1 day) after LPD in elderly patients. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of this risk factor for ICU stay after LPD in elderly patients. A total of 160 patients were enrolled, including 57 cases in the elderly group (17 cases of vascular reconstruction) and 103 cases in the non-elderly group (40 cases of vascular reconstruction). All patients underwent R0 resection and were transferred to the comprehensive ICU for treatment. The follow-up time of patients with malignant tumors was 43 (6, 72) months. The elderly group had significantly longer surgery time, postoperative hospital stay and oral feeding time than the non-elderly group, and the incidence of delayed gastric emptying (DGE) was significantly higher than that in the non-elderly group. There were no significant differences in intraoperative blood transfusion rate, intraoperative blood loss, pathological results, short-term and severe postoperative complications, reoperation rate and 90-day mortality between the two groups. In patients with vascular resection reconstruction, the intraoperative blood loss in the elderly group was significantly higher than that in the non-elderly group, and the operation time and postoperative hospital stay were significantly longer. During ICU, the acute physiology and chronic health evaluation II [APACHE II: 12 (9, 14) vs. 8 (7, 10)], sequential organ failure assessment [SOFA: 6 (4, 8) vs. 3 (2, 5)] within 24 hours after admission to ICU were significantly increased in the elderly group (both P < 0.05), the time of mechanical ventilation [hours: 12 (10, 15) vs. 9 (5, 13)] and the length of ICU stay [days: 2 (1, 2) vs. 1 (1, 1)] were significantly increased in the elderly group (both P < 0.05), and the proportion of multi-disciplinary team (MDT) was also significantly increased in the elderly group (33.3% vs. 17.4%, P < 0.05), there were no significant differences in the levels of hemoglobin (Hb), albumin, and blood lactic acid between the two groups. Logistic regression analysis showed that the APACHE II score was an independent risk factor for ICU stay after LPD in elderly patients (β = 1.737, P = 0.028). ROC curve showed that the prediction performance was the best when the APACHE II score was 13, with the sensitivity of 72.41% and the specificity of 96.43%, and the area under the ROC curve (AUC) of 0.884. The Kaplan-Meier survival curve showed that there were no significant difference in median survival time (months: 24.1 vs. 24.7) and 5-year survival rate (19.01% vs. 19.02%) between the elderly group (52 cases) and the non-elderly group (92 cases) among the 144 patients with malignant tumors (both P > 0.05). The median survival time in the pancreatic head carcinoma group was significantly shorter than that in the other tumors group (63 cases; months: 20.2 vs. 40.1, P < 0.05), 5-year survival rate was significantly lower than that in the other tumors group (21.98% vs. 30.91%, P < 0.05). LPD is a safe and feasible treatment for elderly patients. APACHE II score has a certain predictive value for ICU stay after LPD in elderly patients.

Investigation on the current situation of the development of intensive care units in Inner Mongolia Autonomous Region in 2022

Investigation on the current situation of the development of intensive care units in Inner Mongolia Autonomous Region in 2022

Health Care–Associated Infection in Elderly Patients With Cerebrovascular Disease in Intensive Care Units: A Retrospective Cohort Study in Taizhou, China

Cerebrovascular diseases are associated with high incidence of healthcare-associated infections (HAIs) and poor prognosis in elderly patients. This study aimed to investigate the incidence and clinical characteristics of HAIs in elderly patients with cerebrovascular disease in Intensive Care Unit (ICU) METHODS: Patients admitted with cerebrovascular disease patients aged≥65 years were included. The clinical data of the patients were retrospectively analyzed to determine the risk factors, infection type, distribution, and pathogenic characteristics of HAIs in the context of cerebrovascular diseases. Out of 381 ICU inpatients monitored, 79 (20.73%) developed HAIs. Risk analysis revealed number of ventilator days as significant risk factors for HAIs in elderly patients with cerebrovascular diseases in the comprehensive ICU. In the HAIs group, 56 patients (70.89%) had respiratory tract infection (RTI). Sixty-five patients (82.28%) were infected with gram-negative bacteria (GNB), and 42 (53.16%) with multi-drug resistant organism (MDRO). The length of hospitalization days, ventilator days, and overall hospitalization costs were higher in the HAIs group than in the non-HAIs group (p<0.05), but there was no significant difference between groups in the treatment outcome of patients. Patients with MDRO infection had longer duration and higher cost of hospitalization than those infected with non-MDRO (p<0.05), but there was no significant difference between the groups in the treatment outcome of patients. HAIs occurred mostly due to RTI and GNB infection. The hospitalization cost and duration, as well as the length of ventilator days, were higher for cerebrovascular patients with HAIs than for non-HAIs patients.

Status and Risk Factors in Patients Requiring Unplanned Intensive Care Unit Readmission Within 48 Hours: A Retrospective Propensity-Matched Study in China.

This study investigated the current status and related risk factors of 48-hour unplanned return to the intensive care unit (ICU) to reduce the return rate and improve the quality of critical care management. Data were collected from 2365 patients discharged from the comprehensive ICU. Multivariate and 1:1 propensity score matching analyses were performed. Forty patients (1.69%) had unplanned readmission to the ICU within 48 hours after transfer. The primary reason for return was respiratory failure (16 patients, 40%). Furthermore, respiratory failure (odds ratio [OR] = 5.994, p = 0.02) and the number of organ failures (OR = 5.679, p = 0.006) were independent risk factors for unplanned ICU readmission. Receiver operating characteristic curves were drawn for the predictive value of the number of organ injuries during a patient's unplanned transfer to the ICU (area under the curve [AUC] = 0.744, sensitivity = 60%, specificity = 77.5%). The reason for patient transfer and the number of organ injuries during the process were independent risk factors for patients who were critically ill. The number of organs damaged had a predictive value on whether the patient would return to the ICU within 48 hours.

Management of helicopter medical transport in 36 patients with critical cardiac disease

To summarize the management experience of helicopter medical transport in patients with critical heart disease, so as to provide reference for transport of patients with critical heart disease under the background of major natural disasters. The clinical and transport data of 36 critically ill cardiac patients in Fuwai Central China Cardiovascular Hospital from 16:30 on July 21 to 19:30 on July 22, 2021 due to historically rare heavy rainstorms were collected. All 36 critically ill cardiac patients were transported by helicopter. The safe transportation was implemented under the measures of quickly forming a transport leadership and coordination group, clarifying responsibilities and division of labor, doing a good job in the pretreatment of the patient's condition, pipeline assessment and mechanical circulation support (MCS) equipment, simulating and practicing the transfer process, improving the safety of the transfer implementation process, and effectively handing over with the target hospital. The gender, age, disease type, MCS, transport and outcome of patients were collected. Thirty-six patients with cardiac critical illness were from adult extracardiac intensive care unit (ICU), adult cardiac care unit (CCU), children's CCU, comprehensive ICU and department of neurology. There were 24 males and 12 females; age (50.93±20.86) years old. There were 12 patients using respirator, 7 patients needing MCS, 2 of whom needed both extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP), and 7 patients with post-cardiac surgery. The total distance of transportation of 36 patients was 1 638.4 km, the transit time was 10.5 hours, one way flight time of helicopter was about 8 minutes, and the average transport time per patient was about 17.5 minutes. The vital signs of 36 patients during transport were basically stable, without complications, and all of them reached the target hospital safely. Under the seamless connection of the rapid establishment of the transfer leadership coordination group, assessment of the patient's condition and pretreatment, the simulation of the transfer process, and the effective handover with the receiving hospital, the use of helicopter for medical transport for critically ill heart patients is feasible and safe, which can buy valuable time for saving patients' lives and further treatment.

Risk stratification of patients with acute respiratory distress syndrome complicated with sepsis using lactate trajectories

BackgroundNo consensus has been reached on an optimal blood lactate evaluation system although several approaches have been reported in the literature in recent years. A group-based trajectory modeling (GBTM) method could better stratify patients with acute respiratory distress syndrome (ARDS) complicated with sepsis in the intensive care unit (ICU).Patients and methods760 patients from the comprehensive ICU of Tianjin Medical University General Hospital with ARDS complicated with sepsis were eligible for analysis. Serial serum lactate levels were measured within 48 h of admission. In addition to the GBTM lactate groups, the initial lactate, peak lactate level, the area under the curve of serial lactate (lactate AUC), and lactate clearance were also considered for comparison. The short- and long-term outcomes were the 30- and 90-day mortality, respectively.ResultsThree lactate groups were identified based on GBTM, with group 3 exhibiting the worse short- [hazard ratio (HR) for 30-day mortality: 2.96, 95% confidence interval (CI) 1.79–4.87, P < 0.001] and long term (HR for 90-day mortality: 3.49, 95% CI 2.06–5.89, P < 0.001) outcomes followed by group 2 (HR for 30-day mortality: 2.05, 95% CI 1.48–2.84, P < 0.001 and HR for 90-day mortality: 1.99, 95% CI 1.48–2.67, P < 0.001). GBTM lactate groups exhibited significantly improved diagnostic performance of initial lactate + SOFA scores/APACHE II scores models. Based on the multivariable fractional polynomial interaction (MFPI) approach, GBTM lactate groups could better differentiate high-risk patients than the initial lactate groups in short- and long-term outcomes.ConclusionsTo the best of our knowledge, this is the first report that GBTM-based serial blood lactate evaluations significantly improve the diagnostic capacity of traditional critical care evaluation systems and bring many advantages over previously documented lactate evaluation systems.

A Retrospective Study of the Clinical Characteristics of Japanese Encephalitis in Adults.

This study aimed to explore the diagnostic points and treatment modes of the clinical characteristics of Japanese encephalitis (JE) in the middle-aged and elderly population. Six patients aged 47-72 who were diagnosed with JE at the Beijing Chaoyang Hospital Affiliated with the Capital Medical University between August 2018 and September 2019 were enrolled in the study. Their clinical manifestations, biochemical indicators, imaging data, diagnostic methods, and the evolution and outcomes of the treatments they underwent were retrospectively analyzed. (1) All six patients had severe clinical symptoms and poor prognoses that were more likely to be associated with other systemic diseases. (2) Lesions were most commonly distributed in the thalamus, basal ganglia, and midbrain. The appearance of hyperintensity in the corpus callosum, hippocampus, and subcortical white matter was more specific. The hyperperfusion metabolism in the lesion area in head computed tomography perfusion imaging indicated the state of inflammatory activity in the lesion. In cranial magnetic resonance imaging (MRI), T2 and fluid-attenuated inversion recovery (FLAIR) were more sensitive. (3) After a patient has been systematically treated in the intensive care unit (ICU), the patient gradually recovered and the level of consciousness improved (p < 0.05). In brain MRI-especially T2 and FLAIR-intracranial infection is often accompanied by abnormal signals in the thalamus, midbrain, hippocampus, and white matter hyperintensity (WMH), which is highly suggestive of JE. The positive detection of anti-JE virus immunoglobulin M antibodies in a patient's serum and/or cerebrospinal fluid can confirm the diagnosis of JE, and comprehensive ICU treatment (hormones combined with anti-inflammatory, antiviral, and mild hypothermic cerebral protection therapies) can improve the survival rate.

Predictive value of six critical illness scores for 28-day death risk in comprehensive and specialized intensive care unit patients based on MIMIC-IV database

To explore the basic characteristics of various types of intensive care unit (ICU) patients and the predictive value of six common disease severity scores in critically ill patients on the first day on the 28-day death risk. The general information, disease severity scores [acute physiology score III (APS III), Oxford acute disease severity (OASIS) score, Logistic organ dysfunction score (LODS), simplified acute physiology score II (SAPS II), systemic inflammatory response syndrome (SIRS) score and sequential organ failure assessment (SOFA) score], prognosis and other indicators of critically ill patients admitted from 2008 to 2019 were extracted from Medical Information Mart for Intensive Care-IV 2.0 (MIMIC-IV 2.0). The receiver operator characteristic curve (ROC curve) of six critical illness scores for 28-day death risk of patients in various ICU, and the area under the ROC curve (AUC) was calculated, the optimal Youden index was used to determine the cut-off value, and the AUC of various ICU was verified by Delong method. A total of 53 150 critically ill patients were enrolled, with medical ICU (MICU) accounted for the most (19.25%, n = 10 233), followed by cardiac vascular ICU (CVICU) with 17.78%(n = 9 450), and neurological ICU (NICU) accounted for the least (6.25%, n = 3 320). The patients in coronary care unit (CCU) were the oldest [years old: 71.79 (60.27, 82.33)]. The length of ICU stay in NICU was the longest [days: 2.84 (1.51, 5.49)] and accounted for the highest proportion of total length of hospital stay [63.51% (34.61%, 97.07%)]. The patients in comprehensive ICU had the shortest length of ICU stay [days: 1.75 (0.99, 3.05)]. The patients in CVICU had the lowest proportion of length of ICU stay to total length of hospital stay [27.69% (18.68%, 45.18%)]. The six scores within the first day of ICU admission in NICU patients were lower than those in the other ICU, while APS III, LODS, OASIS, and SOFA scores in MICU patients were higher than those in the other ICU. SAP II and SIRS scores were both the highest in CVICU, respectively. In terms of prognosis, MICU patients had the highest 28-day mortality (14.14%, 1 447/10 233), while CVICU patients had the lowest (2.88%, 272/9 450). ROC curve analysis of the predictive value of each score on the 28-day death risk of various ICU patients showed that, the predictive value of APS III, LODS, and SAPS II in comprehensive ICU were higher [AUC and 95% confidence interval (95%CI) were 0.84 (0.83-0.85), 0.82 (0.81-0.84), and 0.83 (0.82-0.84), respectively]. The predictive value of OASIS, LODS, and SAPS II in surgical ICU (SICU) were higher [AUC and 95%CI were 0.80 (0.79-0.82), 0.79 (0.78-0.81), and 0.79 (0.77-0.80), respectively]. The predictive value of APS III and SAPS II in MICU were higher [AUC and 95%CI were 0.84 (0.82-0.85) and 0.82 (0.81-0.83), respectively]. The predictive value of APS III and SAPS II in CCU were higher [AUC and 95%CI were 0.86 (0.85-0.88) and 0.85 (0.83-0.86), respectively]. The predictive value of LODS and SAPS II in trauma ICU (TICU) were higher [AUC and 95%CI were 0.83 (0.82-0.83) and 0.83 (0.82-0.84), respectively]. The predictive value of OASIS and SAPS II in NICU were higher [AUC and 95%CI were 0.83 (0.80-0.85) and 0.81 (0.78-0.83), respectively]. The predictive value of APS III, LODS, and SAPS II in CVICU were higher [AUC and 95%CI were 0.84 (0.83-0.85), 0.81 (0.80-0.82), and 0.78 (0.77-0.78), respectively]. For the patients in comprehensive ICU, MICU, CCU, and CVICU, APS III or SAPS II can be applied for predicting 28-day death risk. For the patients in SICU and NICU, OASIS or SAPS II can be applied to predict 28-day death risk. For the patients in TICU, SAPS II or LODS can be applied for predicting 28-day death risk. For CVICU patients, APS III or LODS can be applied to predict 28-day death risk.

Analysis on the operation status of subspecialty of critical care medicine of hospital affiliated to Guizhou Medical University in the past 5 years

Through retrospective analysis of the admission and treatment of patients in the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University over the past 5 years, it provides a basis for the construction of the subspecialty of intensive care medicine. Collect clinical data of patients admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from January 1, 2016 to December 31, 2020, including gender, age, first consultation department, intensive care unit (ICU) hospitalization time, ventilator use time, main diagnosis, acute physiology and chronic health evaluation II (APACHE II) when transferred into and out of ICU, treatment results, whether to give mechanical ventilation, whether to use a non-invasive ventilator to assist breathing, whether to die in 24 hours, rescue times and success rate, etc. Changes in the above indicators during the 5 years were analyzed. In the past 5 years, our hospital has treated 2 668 patients in the comprehensive ICU with severe neurological, severe circulation, and severe trauma as the main treatment area, including 1 648 males and 1 020 females; aged 6 months to 94 years old, the average age (53.49±19.03) years old. Neurosurgery (907 cases) was the most frequently diagnosed department, the top 3 diseases were cerebral hemorrhage (539 cases), septic shock (214 cases), and hypovolemic shock (200 cases); ICU hospitalization time was 126 (52, 253) hours, ventilator time was 65 (17, 145) hours, APACHE II scores were 23.29±8.12 and 12.99±6.37 when transferred into and out of ICU. The proportion of receiving mechanical ventilation was 92.94% (2 147/2 310), and 314 cases used non-invasive ventilators. 84 cases died within 24 hours (mortality was 3.15%). A total of 2 585 rescues were performed, and the rescue success rate was 92.84% (2 400/2 585). From 2016 to 2020, the 5-year cure rates were 65.92%, 65.83%, 61.53%, 65.64%, 69.06%, respectively, and the 5-year mortality were 13.13%, 14.29%, 18.89%, 16.69%, 13.38%, respectively. With the continuous expansion of critical care medicine, the establishment of classified subspecialties can focus on the admission of patients, so that treatment can be professionalized and standardized, improve the cure rate, and reduce mortality. At the same time, medical staff can focus on management and learning related expertise to master the disease, it is also more in-depth, which is helpful for doctors to improve themselves, and is conducive to the proficiency of related sub-specialties, and lays a good foundation for the development of the department.

Comprehensive Rehabilitation of Severe Tuberculous Meningitis: A Case Series

Tuberculous Meningitis (TBM) is a severely disabling condition that often leads to death. It requires the right intensive treatment to minimize disability, speed up recovery, and reduce the risk of death. Rehabilitation is one of the key components in managing TBM. Rehabilitation is expected to speed up recovery and prevent disabilities. The purpose of this case series was to highlight the effectiveness of a comprehensive rehabilitation program in severe TBM patients at Intensive Care Unit (ICU) settings. We present two cases of severe TBM that showed significant changes after the rehabilitation program started. Both patients were at GCS 111. Rehabilitation program was a therapist-based multimodal sensory stimulation in a comprehensive ICU setting with approximately 2 weeks duration. After 5 days of rehabilitation, the first patient’s consciousness began to improve. The second patient’s consciousness began to improve after 1 week of rehabilitation. After approximately 2 weeks, both of them were already at GCS 456 and then transferred to the High Care Unit (HCU). There were only minor disabilities as they were transferred. The rehabilitation program was adapted and continued at HCU. After 1 month, both of them got discharged to home. These cases highlight the importance of rehabilitation programs to be included in the management of TBM patients.

Impact of environmental cleaning on the colonization and infection rates of multidrug-resistant Acinetobacter baumannii in patients within the intensive care unit in a tertiary hospital

ObjectiveTo continuously evaluate the effect of environmental cleaning and hand hygiene compliance on the colonization and infection rates of multidrug-resistant Acinetobacter baumannii (MDR-AB) in the patients within an intensive care unit (ICU).MethodsEnvironmental cleaning on the high-touch clinical surfaces (HTCS) within a comprehensive ICU was evaluated through monitoring fluorescent marks when the overall compliance with hand hygiene during 2013–2014 was monitored. Meanwhile, samples from the HTCS and inpatients were collected and sent for bacterial culture and identification. The drug susceptibility testing was further implemented to monitor the prevalence of MDR-AB. The genetic relatedness of MDR-AB collected either from the HTCS or inpatients was analyzed by pulsed field gel electrophoresis (PFGE) when an outbreak was doubted.ResultsThe overall compliance with hand hygiene remained relatively stable during 2013–2014. Under this circumstance, the clearance rate of fluorescence marks on the environmental surfaces within ICUs significantly increased from 21.9 to 85.7%, and accordingly the colonization and infection rates of MDR-AB decreased from 16.5 to 6.6‰ and from 7.4 to 2.8‰, respectively, from the beginning to the end of 2013. However, during 2014, because of frequent change and movement of environmental services staff, the clearance rate of fluorescence marks decreased below 50.0%, and the overall colonization and infection rates of MDR-AB correspondingly increased from 9.1 to 11.1‰ and from 1.5 to 3.9‰, respectively. PFGE displayed a high genetic relatedness between the MDR-AB strains analyzed, indicating a dissemination of MDR-AB during the surveillance period.ConclusionFor the easily disseminated MDR-AB within ICUs, the clearance rate of fluorescence labeling on HTCS is negatively correlated with the hospital infection rate of MDR-AB. Such an invisible fluorescence labelling is an effective and convenient method to continuously monitor cleanness of medical environment within hospitals.

Social Network Analysis of Intensive Care Unit Health Care Professionals Measured by Wearable Sociometric Badges: Longitudinal Observational Study.

BackgroundUse of wearable sensor technology for studying human teamwork behavior is expected to generate a better understanding of the interprofessional interactions between health care professionals.ObjectiveWe used wearable sociometric sensor badges to study how intensive care unit (ICU) health care professionals interact and are socially connected.MethodsWe studied the face-to-face interaction data of 76 healthcare professionals in the ICU at Mie University Hospital collected over 4 weeks via wearable sensors.ResultsWe detail the spatiotemporal distributions of staff members’ inter- and intraprofessional active face-to-face interactions, thereby generating a comprehensive visualization of who met whom, when, where, and for how long in the ICU. Social network analysis of these active interactions, concomitant with centrality measurements, revealed that nurses constitute the core members of the network, while doctors remain in the periphery.ConclusionsOur social network analysis using the comprehensive ICU interaction data obtained by wearable sensors has revealed the leading roles played by nurses within the professional communication network.

Study on present status of ICU in county-level general hospitals of Henan Province

To investigate the present status of intensive care unit (ICU) in the county-level general hospitals of Henan Province and provide basis for improving the construction level and rational allocation of medical resources of ICU. According to The guidelines for the construction and management of critical care medicine (trial implementation) issued by National Health Commission (NHC) (hereinafter referred as the guidelines), a cross-sectional survey was conducted on the present status of ICU in 93 county-level general hospitals in Henan Province in 2018 by using a self-designed questionnaire concerning this topic. The survey included the basic information of ICU (establishment time, organization and management mode, development of special departments in ICU, construction of key disciplines), scale and staffing allocation and training, and the equipment and technology development situation in ICU. The basic aspects of ICU situation were as follows: firstly, the establishment time: the ICU of county-level general hospitals in Henan Province started relatively late. The survey showed that all the 93 hospitals had set up ICU, of which the earliest was the ICU of Xunxian People's Hospital in 1989, only 4 county-level general hospitals established their ICUs before 2000, and 34 before 2009. Secondly, the management mode: the proportion of ICU closely managed was accounting for 68.82% (64/93), while semi-open management was 18.28% (17/93), and 12.90% (12/93) hospitals still adopted the open management mode. Thirdly, development of specialized ICU and construction of key disciplines: comprehensive ICUs were founded in 86 hospitals, and the proportions of specialized ICUs such as neonatal ICU, emergency ICU and coronary heart disease care unit (CCU) were higher than other kinds of special department; the ICUs of 8 hospitals were the key discipline of Henan Provincial Health Commission, and the ICUs of 9 hospitals were the discipline of Municipal Health Commission. Scale and staffing of ICU: a total of 2 189 ICU beds were opened in 93 county-level general hospitals. The utilization rate reaching the targets of ICU beds and the compliance rate of ICU bed area per bed were relatively high, 76.34% and 80.64%, while the compliance rates of ICU doctors/ICU beds, ICU nurses/ICU beds were low, which were 8.60% and 7.52% respectively, indicating that the clinicians and nursing facilities were insufficient. There were 1 tertiary hospital, 76 secondary-A hospitals and 16 secondary-B hospitals in this survey. Compared with secondary-B hospitals in the total number of beds (sheets: 922.22±285.99 vs. 636.75±258.84) and ICU beds (sheets: 25.28±21.15 vs. 14.63±6.89), the secondary-A hospitals were significantly higher (all P < 0.01), and the rate of bed use compliance of secondary-A hospitals was significantly higher than that in secondary-B hospitals [81.6% (62/76) vs. 50.0% (8/16), P < 0.01]. In terms of staffing, the proportion of clinicians and nurses with elementary titles was the highest, the proportion of full-time senior professional titles was relatively low, the proportion of doctors with bachelor's degree was the highest, and that of nurses with junior college degree was the highest. In personnel training, the hospitals surveyed had sent the doctors and nurses mostly to participate in the continuing education and training of critical care medicine at or above the provincial level for 745 person-times and 1 156 person-times, and there were in the mean for 8 and 12 person-times in each hospital, respectively. In terms of equipment configuration and technology development of ICU, mostly the equipment in ICU of county-level general hospitals consisted of microinjection pump, monitor, infusion pump, invasive ventilator, expectorant machine, etc. but the overall equipment was insufficient. Although an extracorporeal membrane oxygenation (ECMO) equipment was introduced in one hospital, it had not been carried out clinically. All county-level general hospitals in Henan Province had set up ICUs, but there were gaps between the compliance rates of many indicators and the requirements of the guidelines, and the medical personnel and equipment were relatively insufficient. The ICUs of county-level general hospitals in Henan Province have developed rapidly in recent years, but there is still much room for improvement.

Investigation and analysis of the development status of critical care medicine in Xinjiang Uygur Autonomous Region in 2019

To comprehensively understand the basic construction of intensive care unit (ICU) in the secondary and tertiary hospitals in Xinjiang Uygur Autonomous Region, and to provide a theoretical basis for the development direction of critical care medicine and the rational allocation of medical resources in our region. On the March 14th, 2020, a cross-sectional survey of 147 ICU in 122 hospitals in Xinjiang Uygur Autonomous Region was conducted using an online questionnaire. The survey included 6 modules: the basic conditions of the hospital, ICU profile, ICU human resources status, equipment allocation, technology development, and ICU quality control. Among the 147 ICUs, there were 69 ICUs in tertiary hospital and 78 ICUs in secondary hospital. 75.51% (111/147) were comprehensive ICU and 24.49% (36/147) were specialized ICU. The total number of ICU beds was 1 818, accounted about 2.43% (1 818/74 912) of the total number of hospital beds. In ICU terms of human resourse, physicians/beds ratio was 0.54:1, and nurses/beds ratio was 1.55:1. Physicians/beds ratio in the secondary hospitals was 0.52:1, and nurses/beds was 1.45:1; physicians/beds ratio in the tertiary hospital was 0.56:1, and nurses/beds ratio was 1.79:1. The ICU management model was mainly closed management (82.99%, 122/147), and the proportion of closed management in tertiary hospitals was 88.41% (61/69), which was higher than that in secondary hospitals (78.21%, 61/78). In aspect of ICU equipment, the invasive ventilator/bed ratio, enteral nutrition infusion pump/bed ratio, and blood purifier/bed ratio in the tertiary hospitals were significantly higher than those in the secondary hospitals [0.70 (0.46, 1.00) vs. 0.45 (0.33, 0.67), 0.18 (0.00, 0.56) vs. 0.00 (0.00, 0.13), 0.08 (0.00, 0.13) vs. 0.00 (0.00, 0.10), respectively, all P < 0.01]. In the tertiary hospital, the chest sputum excretion device, blood gas analyzer, blood purification instrument, transport ventilator, fiber bronchoscope, enteral nutrition infusion pump, bedside ultrasound machine, continuous hemodynamics and oxygen metabolism monitor, electroencephalogram bispectral index monitor, bedside electroencephalography machine and extracorporeal membrane oxygenation (ECMO) were also superior to the secondary hospitals. ICU technologies, such as deep venipuncture, jejunal nutrition tube placement, percutaneous tracheotomy, invasive blood pressure monitoring, invasive hemodynamic monitoring, bedside ultrasound examination, continuous blood purification, fiber bronchoscopy, high frequency ventilation, intra-aortic balloon counterpulsation (IABP), and ECMO had also performed better than secondary hospitals. In the management of ICU medical quality control, in tertiary hospitals, the proportions of single or isolated room for patients with drug-resistant bacteria, 1-hour bundle and hemodynamic monitoring for patients with septic shock, routine prone position ventilation and lung recruitment for patients with acute respiratory distress syndrome (ARDS), common analgesic, and use of personal digital assistant (PDA) for pre-operation scan code by nurses and electronic medical record for routine rounds were significantly higher than those in secondary hospitals (91.30% vs. 85.90%, 68.12% vs. 48.72%, 85.51% vs. 70.51%, 28.99% vs. 12.82%, 85.51% vs. 61.54%, 76.81% vs. 61.54%, 71.01% vs. 29.49, 49.28% vs. 28.21%, respectively), and the differences were statistically significant (all P < 0.05). 89.74% (70/78) ICU in secondary hospitals and 89.86% (62/69) of tertiary hospitals used acute physiology and chronic health evaluation II (APACHE II) to evaluate the severity of critically ill patients; in terms of sequential organ failure assessment (SOFA), the difference between the secondary hospitals and the tertiary hospitals was not statistically significant (51.28% vs. 62.32%, χ2 = 1.814, P = 0.178). Although the ICU construction of the tertiary hospitals in Xinjiang Uygur Autonomous Region is more complete than secondary hospitals, there is a big gap between the requirements of the national guidelines and the developed regions in the east. The ICU's investment in human resource, equipment and supporting facilities allocation, promotion of suitable technology, and medical quality control management should be increased to promote the development of critical care medicine in Xinjiang Uygur Autonomous Region.

Effect of Smart Hand Hygiene Management System on hand hygiene compliance of Intensive Care Unit medical staff

Objective To explore the effect of Smart Hand Hygiene Management System on hand hygiene compliance of Intensive Care Unit (ICU) medical staff. Methods Using convenience sampling method, 106 medical staff in the comprehensive ICU of Tianjin First Central Hospital were selected as the research objects. By deploying Smart Hand Hygiene Management System, medical staff's hand hygiene before and after contacts with patients in the ward were collected automatically, and compliance was calculated. By engineering means, the first month (July, 2018) data collected after removing the system's prompting function was taken as the baseline level, and the month after the system's acousto-optic prompting function was added and working principle training (August, 2018) was taken as the intervening stage. Compare the hand hygiene compliance of selected medical staff before and after intervention. Results The hand hygiene compliance of medical staff was 85.62% after intervention, which was higher than 52.87% before intervention and the difference was statistically significant (P<0.01) . After intervention, the pre-operation compliance increased to 73.90%, and the post-operation compliance increased to 94.94%, which were all statistically different from those before intervention (P<0.01) . Conclusions The application of Smart Hand Hygiene Management System has a significant effect on improving the compliance of hand hygiene performance of medical staff, and the initiatives of performing hand hygiene of medical staff have been greatly improved. Key words: Intensive Care Unit; Hand hygiene; Compliance; Smart Hand Hygiene Management System

Integration of clinical pathway construction and hospital information system in intensive care unit is the core of digitalized hospital: experience of clinical pathway construction in Liuzhou Worker's Hospital from 2016 to 2018

To explore the effective strategies of clinical pathway construction in intensive care unit (ICU). From January 2016 to July 2018, 1 488 patients were discharged from ICU of Liuzhou Worker's Hospital of Guangxi Zhuang Autonomous Region. The pilot project of "postoperative monitoring of heart disease" with simpler route and less variation was selected first, and then the pilot project was promoted to "post-operative monitoring" after its success. The implementation of the clinical pathway was divided into three stages: the first stage, January 2016 to May 2017, for the pilot phase, a total of 87 patients were enrolled in the clinical pathway trial; the second stage, June 2017 to December 2017, surgical ICU "postoperative monitoring of heart disease" was put into the pathway 111 times; the third stage, January 2018 to July 2018, surgical ICU "postoperative monitoring of heart disease" was entered in the path 116 times; comprehensive ICU "postoperative care" was put into the path 96 times. After carefully analyzed the reasons and sum up the experience, internet+medical treatment (Liuzhou Worker's Hospital became the fifth deep partner of Tencent Inc in the internet+medical field, and carried out the plan and practice of "WeChat wisdom hospital 3.0" in 2017) was used, four aspects of connection, payment, security and ecological cooperation were upgraded, and the construction of 6 level of electronic medical record (EMR) was accelerated. At the same time, through diagnosis related groups system (DRGs), the concept of evidence-based medicine, quality management and continuous improvement as the leading factor, and combined with the construction status of hospital information system (HIS) and EMR system, step by step implementation and design of information management platform for clinical pathway were formulated. The completion rate of clinical pathway, average length of hospital stay, average cost, cure rate and improvement rate were the main observation parameters. In the first stage, none of the 87 patients who entered the clinical pathway completed the clinical pathway. In the second stage, the completion rate of surgical ICU clinical pathway was increased from 33.33% in June 2017 to 94.44% in December 2017, and up to 100% in October 2017, and the average completion rate from January to July 2018 was 94.00%. The completion rate of ICU clinical pathway was increased from 81.82% in January 2008 to 92.86% in July 2008. There was a significant difference in the overall clinical pathway completion rate from 2016 to 2018 (χ2 = 204.300, P = 0.000). After the effective implementation of clinical pathway in June 2017, the length of hospital stay of patients was significantly shortened as compared with that before implementation (days: 2.96±0.43 vs. 6.66±0.75, P < 0.01), and the daily cost was significantly reduced (Yuan: 3 550.92±755.51 vs. 6 171.48±377.29, P < 0.01). The average length of hospital stay was shortened by about 3.84 days (P < 0.01), and the average daily cost was reduced by about 2 108.39 Yuan (P < 0.01) after the implementation of clinical pathway by surgical ICU "postoperative monitoring of heart disease" as compared with those before implementation. The average length of hospital stay was shortened by about 2.98 days (P < 0.01) and the average daily cost was reduced by 5 094.13 Yuan (P < 0.01) after the implementation of clinical pathway by comprehensive ICU "post-operative monitoring" as compared with those before implementation. At the same time, the cure rate was increased from 1.16% (7/603) to 42.26% (105/227), and the improvement rate was decreased from 94.36% (569/603) to 52.86% (120/227, both P < 0.01) after the implementation of surgical ICU clinical pathway, but there was no significant difference in the cure rate or the improvement rate after the implementation of comprehensive ICU [2.77% (33/1 193) vs. 2.22% (2/90), 79.21% (945/1 193) vs. 97.78% (88/90), both P > 0.05]. Application of clinical pathway to control ICU quality and guide diagnosis and treatment, more refined diagnosis and treatment schemes including clinical guidelines, average length of stay, average cost of hospitalization, cost-efficiency ratio and so on were completed, which confirmed that the improvement of clinical pathway management strategy originated from clinical were needed. Informatization, intellectualization, standardization and effective control of medical cost of clinical pathway could improve medical quality and accurate management. The integration of ICU clinical pathway construction and HIS could promote the development of digital hospitals.

From Just Surviving, ICU Physicians Turn Focus to Survivorship

From Just Surviving, ICU Physicians Turn Focus to Survivorship

Analysis of risk factors for ventilator-associated pneumonia in comprehensive ICU and nursing strategy

Objective To investigate the risk factors and nursing strategy of ventilator-associated pneumonia (VAP) in intensive care unit (ICU),and provide reference for preventing and controlling VAP.Methods Totals of 168 cases with mechanical ventilation (MV) duration over 48 hours in ICU from Jan 2011 to Dec 2011 were studied.The clinical epidemiological characteristics and treatment process were recorded.The risk factors of VAP were analyzed by Logistic regression.Results Totally 60 VAP cases among 168 patients were collected,the incidence of VAP was 35.7％.The univariate analysis showed that enteral nutrition,mechanical ventilation type,tracheotomy,infections at other sites,the number of antibiotics,ventilator time and total hospital days and ICU days were important risk factors of VAP.Logistic regression analysis showed that mechanical ventilation type (OR =10.945,P ＜0.05),the number of antibiotics (OR =1.653,P ＜0.01) and ICU hospital days (OR =1.111,P ＜ 0.01) were independently associated with VAP.Conclusions Because of many risks factors,the patients in ICU are the high risk group of VAP.Specific measures should be taken to prevent the incidence of VAP,such as:reducing the duration of mechanical ventilation,ICU length of stay and invasive treatment Etc. Key words: Intensive care unit; Ventilator-associated pneumonia; Risk factors; Logistic regression analysis

Test-ordering strategy in the intensive care unit.

The objective of this study was to assess the effect of an intervention designed to reduce utilization of portable chest x-rays (CXRs) in the intensive care unit (ICU). In this prospective observational study, patients representing 2734 consecutive admissions over a 35-month period were studied. Data collected from the comprehensive ICU database included patient days, ventilator days, number of admissions to the unit, number of CXRs ordered, costs for CXR, Acute Physiology and Chronic Health Evaluation II (Apache II) scores, ICU length of stay (LOS), length of mechanical ventilation, inadvertent extubations from mechanical ventilation, and reintubation within 48 hours of planned extubation. There was a 22.5% reduction in the rate CXR utilization during the study period, resulting in a $109,968 cost savings, and these savings were not associated with any adverse clinical outcomes.