ICU Department Research Articles

The Application Effect Analysis of Nurse's Equipment Management Standardized in ICU Equipment Management

Objective: To assess the application effect analysis of nurse's equipment management standardized in ICU equipment management. Method: This study included 56 related medical staffs who are working in ICU department and they used the medical equipment in their working. the data of 2018 was defined as control group, that the medical equipment was receive common management methods in 2018. In intervention group, we collected related data in 2019, that the medical equipment was receive nurse's equipment management standardized in this year, the intervention contrasts Standardize management, set up instrument management team, formulate instrument management system, instrument maintenance and repair system, instrument training system, and regularly organize study and training for all staff in the ward. We evaluated the differences between the two groups in terms of instrument repair rate, instrument maintenance cost, nursing staff's mastery of instrument and equipment skills, instrument maintenance quality, instrument and equipment maintenance rate, and instrument management mode satisfaction. Result: In terms of the frequency and cost of instrument and equipment maintenance, the frequency and cost of maintenance are both higher than the standard management, and the results are statistically significant. In the survey results of instrument and equipment standard management, except maintenance efficiency, the other data are statistically significant. The p value of nursing staff's satisfaction with instrument and equipment skills, instrument maintenance quality, instrument and equipment maintenance, the p-value instrument management mode was all less than 0.005, the difference was statistically significant. Conclusion: Standardized management of ICU equipment can reduce equipment failure rate and maintenance cost.

The Efficacy of low: Dose ketamine for prevention of intraoperative nausea and vomiting during caesarean section under spinal anaesthesia: A comparative study

Background: Intraoperative nausea and vomiting affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about intraoperative nausea and vomiting (IONV) and several in parturient and cesarean. However, it needs more attention. Ketamine is a potential drug in this procedure. Objective: The main objective of the study was to evaluate the efficacy of low-dose ketamine for prevention of intraoperative nausea and vomiting in caesarean section under spinal anaesthesia. Methods: This comparative study was conducted in Department of Anaesthesiology and ICU in Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh during the period from January 2019 to December 2019. In total 120 patients were randomly allocated into two equal groups: the ketamine group; in which 0.5 mg/kg was infused intravenously in 20 min and the placebo group; in which normal saline was infused. The two groups were given subarachnoid block with local anaesthetic hyperbaric 0.5% bupivacaine and intrathecal fentanyl. Results: The incidence of intraoperative nausea was 20% and episodes were 38 in total in the ketamine group compared with 38.33% and episodes were 76 in total in the placebo group, which was statistically significant (P value 0.176). Both vomiting episodes and number of patients who required rescue anti-emetics in the ketamine group compared with placebo one (3.33% vs 6.67% and 2 vs 5 respectively) were not statistically significant P values 0.682 and 0.593. Conclusion: In our study, we found the satisfactory efficacy and better compliance from the patient’s front. Ketamine may be used without hesitation for prevention of intraoperative nausea and vomiting in caesarean section under spinal anaesthesia.

Life threatening opioid withdrawal syndrome due to inadvertent naltrexone administration and lifesaving result by clonidine.

Sir, Administration of an opioid antagonist like naltrexone in a nonabstinent opioid user results in sudden onset of the withdrawal symptoms. We report a case who took tablet naltrexone in conjunction with heroin and suffered a life-threatening experience who did not improve with usual symptomatic medications initially, but later improved dramatically with tablet clonidine. A 36-year-old male presented to the Psychiatry Outpatient Department with complaints of severe agitation, projectile vomiting, diarrhea, cramping, pain abdomen, and sweating for 2 h. A history revealed that he was a chronic opioid abuser, started with chasing heroin initially followed by intravenous (IV) abuse in a dependence pattern for the last 7 years. There was no history of other substance abuse. Eight hours after his last intake of heroin, he consumed 100 mg naltrexone orally, followed by the onset of above symptoms within a gap of 15–20 min. There was no history of psychiatric illness, fever, head injury, or seizures, prior to the development of the symptoms. On examination, he was conscious but irritable. Glasgow Coma Scale (GCS) was 13/15. His pulse was 100/min, heart rate 120/min, respiratory rate 26/min; pupils were bilaterally dilated and sluggishly reactive to light. Blood pressure (BP) was 116/80 mmHg; oxygen saturation, blood glucose, and temperature were normal. The Clinical Opiate Withdrawal Scale (COWS) score was 37, indicating severe withdrawal. He was agitated and uncooperative and had no thought or perceptual abnormality. He was admitted in intensive care unit and symptomatic treatment was initiated. Injection furosemide 40 mg IV was added for diuresis. His agitation persisted and sensorium deteriorated gradually. In a span of 2 h, GCS came down to 8, and fall of oxygen saturation and BP were noted. Routine blood examination and computed tomography scan brain were within normal limits, except reactivity to the hepatitis C virus. Electrocardiogram (ECG) was suggestive of dysrhythmia. After 24 h, vitals were normal, but there was persistence in the withdrawal symptoms. Hence, clonidine 0.1 mg tablet was added on BD basis. The next day, improvement was evident by a decrease in size of pupils, no autonomic hyperactivity, improved urine output, decrease in frequency of loose stools, improvement in consciousness, normal ECG, and decrease score in COWS. Before administering naltrexone, the patient should be opioid free for a minimum period of 7–10 days, to prevent abrupt sign and symptoms of withdrawal as reported in the past.[123] Clonidine is an agonist at α-2 adrenergic autoreceptors and acts to reduce central and peripheral sympathetic activity and catecholamine concentration associated with opioid withdrawal. The advantages of clonidine are that it is not a controlled substance, has little risk of abuse, and can reduce the delay between stopping opioids and starting naltrexone.[45] It is possible that it was the combined effect of all regular drugs and clonidine that worked, but as improvement was not seen before administration of clonidine, it is also possible that clonidine had a greater contribution to the treatment. Hence, we conclude that it is worthwhile to give a trial of clonidine, which is an effective choice for this type of case. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgments The authors would like to thank the consultants of Department of Psychiatry and residents of Department of Anaesthesiology and ICU, Silchar Medical College and Hospital, for their tremendous support in managing the case.

A comparative study of DECAF score and modified DECAF score in predicting hospital mortality rates in acute exacerbation of chronic obstructive pulmonary disease

Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common and lead to catastrophic events. Accurate prognostic tool for patients with exacerbation who required hospital admission is needed to predict the risk of in-hospital mortality and help physicians to select the appropriate level of care. Aim The aim was to compare the ability of conventional DECAF (dyspnea, eosinopenia, consolidation, acidemia, frequency of hospital admission) and modified DECAF scores to expect the in-hospital mortality rate. Patients and methods A prospective, observational study was carried out on 100 patients with AECOPD admitted at the respiratory ICU and chest department. All patients were subjected to complete medical history taking, chest examination, dyspnea assessment by extended modified Medical Research Council Dyspnea, complete blood count, chest radiograph, ECG, and arterial blood gas analysis. Both conventional DECAF score [(D) dyspnea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) atrial fibrillation] and modified DECAF score [(D) dyspnea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) frequency of hospital admission] were calculated. In-hospital mortality was recorded. Results Nine (9%) patients died during their hospital stay. The modified DECAF score showed a good prediction of in-hospital mortality (area under the receiver operating characteristic curve=0.95) and was higher in accuracy than the original DECAF score (area under the receiver operating characteristic curve=0.92). Both were (sensitive 100%) but the modified DECAF was more specific (specificity=86.81) than the DECAF score (specificity=80.22). Conclusion Both the conventional DECAF score and the modified DECAF score are practical and can be calculated easily using simple questions and routine investigations available during the initial admission. Both were good predictors of mortality and the requirement of invasive mechanical ventilation. The modified DECAF was superior in predicting in-hospital mortality in AECOPD than the original score.

Comparison of ICU outcome of mechanically ventilated gbs patients receiving intravenous immunuglobulin or plasma exchange in a neuro-icu of Bangladesh

Introduction: Intravenous immunoglobulin (IVIG) and plasma exchanges (PLEX) are the standard therapy for Guillain-Barré syndrome (GBS) patients. Objectives/Aims: The aim of the study was to compare ICU outcome of mechanically ventilated (MV) GBS patients treated with IVIG and PLEX. Methods: This prospective cohort study was conducted in the ICU of Department of Critical Care at National Institute of Neurosciences & Hospital, Dhaka, Bangladesh from January 2017 to December 2018 for a period of 1 year. All GBS patients under MV treated with either IVIG or plasma exchange were selected as study population who were divided into group A with IVIG (0.4 g/kg/day for 5 days) and group B with PLEX- 5 sessions for 10 days in every alternate day. The outcome variables were duration of MV, need for tracheostomy and duration of ICU stay. The follow up was done at 6 months. Results: Seventy-four patients (58 in group A and 16 in group B) were enrolled. The mean age was 30.31±15.47 years in Group A and 30.88±12.09 years in Group B, with a male predominance (78.4%). Electrophysiological study reavled acute inflammatory demyelinating polyradiculoneuropathy (AIDP) in 19 (25.7%) patients, acute motor axonal neuropathy (AMAN) in 46 (62.2%) patients, acute motor-sensory axonal neuropathy (AMSAN) was 3 (4.1%). The mean length of ICU stay was 23.66±19.18 days and 60.12 ±38.79 days in Group A and Group respectively (p = 0.02). The mean duration of MV was 21.12±16.55 days and 51.12 ±35.31 days in Group A and Group respectively (P=.04) and the need for tracheostomy (p=.001) was less in Group A than Group B. Conclusion: This study revealed a significant difference for the duration of MV and ICU stay in IVIG group compared to PLEX.

High values of procalcitonin in non-septic patients with thermal and airway burns

Purpose – Combined airway burns with cutaneous burns is a further negative prognostic factor in burn patients. In this study we tried to identify the most relevant negative prognostic factors at admission in a relatively homogeneous population. Methods – In this study, ten young patients who suffered from skin and airway burns following a fire in a club, admitted to our ICU department, were included. At the intake, ABSI and APACHE II scores were calculated, and a series of biomarkers were also collected. The correlation and associations between gravity scores and biomarkers was then calculated using the Spearman correlation and Chi square tests. Results – Based on data analysis, we found very high values of ABSI 8.9 ± 1.4 and APACHE II 25.4 ± 2.79 scores, procalcitonin (46.16 ± 68.18 ng/ml), white blood cells (41.26 ± 15.66 × 103/mm3), hematocrit (51.6 ± 7.31 %), and low corrected albumin values (22.08 ± 4.66 g/l). The statistical analysis revealed a good correlation between gravity scores and values of PCT and low albumin levels (p< 0.05). The mortality was also associated with the need for vasopressor support from the beginning (p < 0.05). Conclusions – Adverse prognostic factors that we have identified in this group of young patients with skin burns and airway include: increased values of the severity scores and PCT, low values of corrected albumin and vasopressor support necessary at admission.

Clonal dissemination of KPC-2-producing Klebsiella pneumoniae ST11 and ST48 clone among multiple departments in a tertiary teaching hospital in Jiangsu Province, China.

The world-wide prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a threat to the public health. The objective of this study was to determine the epidemiological and molecular patterns of KPC-producing Klebsiella pneumoniae (K. pneumoniae) clinical isolates. In this study, a total of 82 non-duplicated CRKP isolates were analyzed for the prevalence of resistant determinants including carbapenemase, extended spectrum β-lactamase (ESBLs), and AmpC as well as integrons and cassette regions by polymerase chain reaction (PCR) and DNA sequencing. The genetic relatedness was investigated by pulsed field gel electrophoresis (PFGE) and multi-locus sequencing typing (MLST). Overall, bla KPC-2 (n=75) was the predominant carbapenemase gene, followed by high prevalence of bla SHV (92.7%) and bla CTX-M (90.2%). PFGE and MLST analysis revealed that 65 out of 68 KPC-2-producing CRKP belonged to the ST11 clone and were distributed mainly in the department of neurology ICU. Moreover, first report on clonal dissemination of KPC-2-producing CRKP ST48 clone and NDM-5-producing CRKP ST337 clone was also identified. Class I integron were detected in 17 (20.7%) of 82 isolates with aadA2 being the most common cassette. And a novel cassette array of integron, aac(6')-II-bla CARB/PSE-1 was identified. All in all, KPC-2-producing CRKP ST11 and ST48 clone were widely disseminated in multiple departments of our hospital, which triggers the need for active surveillance and implementation of infection control measures.

Analytical review of 10-year work of intensive care unit of Moscow’s Municipal Clinical Hospital No. 52

The intensive care unit for nephrological patients is the first such intensive care unit in the Russian Federation and is unique in its specificity. The main task of the ICU department No. 2 is to provide an intensive care complex aimed at restoring and maintaining the vital functions of organs and systems in patients with kidney diseases of various origins, as well as in patients after kidney allotransplantation. The department is equipped with the most advanced equipment for the treatment of multi-organ pathology, including therapeutic plasma exchange, therapeutic plasmapheresis and double cascade plasma filtration.

Pseudomeningocele From Brachial Plexus Root Avulsion

We report a case of a 42-year-old male involved in a motor vehicle accident. Initial MRI revealed T2 hypo-intensity of the anterior cord at the C6 level of the cervical spine which raised significant discussions within the neurosurgical, radiology and ICU departments at our institution. After careful review of images and patient’s clinical examination we suspected root avulsion of the brachial plexus. Subsequent MRI brachial plexus showed a large axillary pseudomeningocele originating from the C5-T2 nerve roots. Our team concluded the patient suffered a complete brachial plexus injury from right lateral hyperflexion as extrapolated from his injuries. The aim of this report is to highlight the uncommon condition and report of key clinical findings and management strategies.

Outcome of Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients in a Tertiary Care Hospital

Background: In Bangladesh eclampsia and severe preeclampsia or toxemia (PET) are the leading cause of perinatal morbidity and mortality. Its management is challenging for the obstetrician and anesthesiologist. Still now general anesthesia is commonly practiced for emergency LUCS in developing countries, but the outcome of spinal anesthesia is better than GA. Recently in developed countries like the UK and United States, spinal anesthesia is also accepted as a safer anesthetic technique.
 Objective: The objective of our study was to establish spinal anesthesia as a preferable method to reduce maternal and neonatal morbidity and mortality during emergency LUCS in severe PET and eclampsia patients.
 Materials and Methods: The study was done in the Department of Anesthesiology and ICU of Enam Medical College & Hospital, Savar, Dhaka during the period from January 2016 to December 2017. Total 62 cases of severe PET and eclampsia patients were selected by subarachnoid block for emergency LUCS. Each patient was given magsulph as prophylactic or maintenance dose and judiciously preloaded by crystalloid fluid. Thiopental sodium 50−100 mg was given to those who had convulsion during SAB. About 2−2.5 mL (10−12.5 mg) 0.5% bupivacaine heavy was used by 25−27 G spinocaine in L3−4 or L4−5 space. After the establishment of the desired block, LUCS was performed. Meticulous monitoring was done and all events were recorded and problems were effectively managed.
 Results: Our study shows higher maternal (96.6%) and neonatal (95.17%) success rate. Almost all patients were eclamptic (74.19%), primi (59.67%), term pregnancy (64.51%), aged between 21–30 years (43.54%) and rest of them had preeclampsia (25.80%), multigravida (40.32%), preterm (35.48%), aged <20 years (25.80%) and aged >30 years (30. 64%). Thiopental sodium was given in 9.65% cases for controlling convulsion during LUCS. Remarkable complications were hypotension (33.87%) with highly significant p value (0.000) and bradycardia (27.41%).
 Conclusion: With close monitoring of perioperative events, spinal anesthesia may be given as a safe alternative technique in severe preeclampsia and eclapmsia rather than GA or epidural even in cases of altered consciousness or restless in presence of an expert and skilled anesthesiologist and thereby perioperative maternal and neonatal morbidity and mortality will be reduced.
 J Enam Med Col 2019; 9(3): 170-176

Prospective Evaluation of Vacuum-Assisted therapy in patient with abdominal sepsis

Purpose of the study. Improve treatment results of patients with abdominal sepsis, due to the diffuse acute secondary peritonitis, by choosing of the optimal method of laparostomy.
 Materials and methods. The analysis of treatment of 35 patients with common secondary peritonitis and abdominal sepsis accompanied by septic shock with score of the Mannheim Peritonitis Index 29, which were treated by laparostomy, during the period from 2014 to 2019, was performed. The patients were divided into 2 groups. The treatment group consists of 17 patients who were treated by negative pressure therapy (NPT) – a technique of vacuum-assisted closure of theabdominalcavity(VAC) withanegativepressure levels from 50 to 125 mm Hg in the continuous or intermittent modes. The control group consists of 18 patients, who were treated by laparostomy with planned abdominal sanations, with intervals between sanations of 24, 36, 48 hours, depending on the degree of development of peritonitis and the condition of the patient (as needed).
 Results. The average length of hospital stay in ICU department was 11,3 days in treatment group
 (from 5,2 to 16,4 days), compared with the control group 22,9 days (from 3,4 to 47,4 days). The number of relaparotomies during which the replacing or removing of VAC-bandages was performed at the end of NTP was 3,8 (from 1 to 4) in the treatment group and 6,8 (from 3 to 11) in the control group. Adequate source control of abdominal sepsis was achieved in all operated patients of the treatment group, and in the control group only in 7 patients (38,9%). The overall mortality rate in both groups was 20%. In the treatment group, which were treated by applying NTP 2 patients were died (11,8%) while in the control group this count was 27,8% (7 patients).
 Conclusion. The experience of applying NTP and VAC-bandages in the complex treatment of abdominal sepsis, with values of the SOFA 3, shows better results in comparison with other methods of open abdomen, reducing the length of stay in the ICU by 2 times, the mortality rate is 3 times and this allows to complete treatment with final closure of the abdominal cavity more than in 50% of patients.

Epidemiology and outcomes of in-hospital acute burn-patients in Togo: A retrospective analysis

BackgroundBurn epidemiologic data are limited in sub-Saharan Africa. This study was aimed at filling the gap in the real-time data about burns in Togo by assessing sociodemographic, clinical and outcome characteristics, causes and severity of burns of hospitalized patients for prevention programs. MethodologyThis retrospective study analysed the medical folders of patients admitted to the ICU department of Sylvanus Olympio Teaching Hospital (SOTH) in Lomé for an acute burn injury during 7 years (January 2007–December 2013). We collected sociodemographic parameters, causes, and mechanisms of burns; the time between burns injury and admission to the Surgical Emergency Department (SED), pre-hospital care, pre-existing medical conditions, and treatments. Burned total body surface area (TBSA), anatomical sites and depth of burns, treatment and outcomes were assessed by EPI INFO 3.5.3 (ATLANTA CDC 2003). ResultsBurns represented 2.1% of all admissions to the SED. Of the 1,843 burn patients, 497 (26.9%) were admitted to the ICU department, and 1,346 (73%) were treated as outpatients. The analysis included the complete folders of 211 patients. The patients’ mean age was 14.9 years (4 months-94 years). The male to female ratio was 1.67. Children numbered 129 (61.1%) and adults 82 (38.9%).Burns were caused by hot liquids in 74.4% of children and in 13.4% of adults (p = 0.003), and by flames in 73.2% of adults and 19.4% of children (p = 0.001). The mean burned TBSA was 26.5% (range 3%–95%). Mean Abbreviated Burn Severity Score was 4 (range 2–11) for children and 6 (range 3–13) for adults.Medical treatments were fluid resuscitation, close or open wound dressing. Surgical treatments included escharotomy in 28 (13.3%) patients, skin grafts in 23 (11%), local flaps in 3 (1.4%), and fingers or limbs amputations in 9 (4%). Mean hospital stay was 21 (range 1–99) days. The overall burn-related mortality rate was 24.6%. ConclusionsIn Togo, over the 2007–2013 period, children were most affected in house-related accidents, whereas adults had most fire burns with extended burned TBSA and associated injuries. Only few patients had surgery and in delayed planning.This study has identified the essential requirements to enhance burn care management and provided an outline for further epidemiologic studies.

Analysis of incidence and risk factors of septic cardiomyopathy

Objective To investigate the incidence and risk factors of septic cardiomyopathy, and to provide evidence for the diagnosis, treatment and prevention of septic cardiomyopathy. Methods Totally 208 patients with septic or septic shock (≥18 years old) were admitted to ICU Department of The First Hospital of Jilin University from January 2015 to August 2017. The clinical data of all patients were retrospectively analyzed, and the baseline data and clinical outcomes were compared between the septic cardiomyopathy group (39 cases) and non-septic cardiomyopathy group (169 cases). Multiple Logistic regression analysis was used to analyze the risk factors of septic cardiomyopathy. Results (1) The incidence of septic cardiomyopathy in patients with septic or septic shock was about 18.8%. (2) There was no significant difference in baseline body weight, atrial fibrillation, hypertension, diabetes, malignant tumor, maximum body temperature, blood leukocyte, C-reactive protein(CRP), procalcitonin(PCT), positive blood culture, in-hospital mortality and 30-day mortality between the two groups (all P>0.05). Age (P=0.01), sex (P=0.02), history of heart failure (P=0.03), history of coronary heart disease (P=0.01), platelet at ICU admission (P=0.01), lactic acid at ICU admission (P=0.02), vasoactive drugs (P=0.03), APACHE Ⅱ score (P=0.03), SOFA score (P=0.01), and ICU length of hospital stay (P=0.03) were significantly different between the two groups. (3) Patients with a history of heart failure (OR=1.55, 95%CI:0.73-1.66; P=0.01), a history of coronary heart disease (OR=1.18, 95%CI: 1.03-1.66; P=0.03), and lactic acid at ICU admission > 4.0 mmol/L (OR=1.10, 95%CI: 1.00-1.30; P=0.04) were independent risk factors for the incidence of septic cardiomyopathy. Conclusion Septic cardiomyopathy has a relatively high incidence in patients with septic or septic shock. Patients with a history of heart failure, a history of coronary heart disease and lactic acid at ICU admission > 4.0 mmol/L are independent risk factors for the incidence of septic cardiomyopathy. Key words: Septic cardiomyopathy; Morbidity; Risk factors; Sepsis; Septic shock

PRESCRIPTION PATTERN OF DIURETICS IN A TERTIARY CARE HOSPITAL

Diuretics are drugs that increase the rate of urine flow; clinically useful diuretics also increase the rate of excretion of Na+ (natriuresis) and an accompanying anion, usually Cl. Diuretics are a mainstay of therapy for a wide variety of diseases ranging from hypertension to the nephrotic syndrome.
 Objective: To study the prescribing patterns of diuretics in General Medicine and ICU. To assess the drug-drug interaction of diuretics. To study the route of administration of diureics. 
 Materials and methods: A prospective observational study was conducted over a period of six months at general medicine and ICU department of Basaveshwara Medical College and Hospital and Research Centre, Chitradurga.a otal of 100 in-patients are included as study subject.
 Results: Mostly prescribed diuretic in this study were furosemide (52.9%), followed by mannitol (28.1%), spironolactone (11.57%), torsemide (5.79%), amiloride (0.82%) and hydrochlorothiazide (0.82%). Out of 100 prescriptions 84.4% of diuretics prescribed in intravenous route, 15.6% of diuretics prescribed in oral route. Out of 100 prescriptions total 89 drug interactions with diuretics are found. In that 2.3% major interactions and 67.4% moderate interactions and 30.3% minor interactions are found.
 Conclusion: Prescription monitoring helped to reduce the diuretic usage errors with respect to dose and drug-drug interaction with other prescribed drugs to provide better patient care.
 Keywords: prescribing pattern, drug-drug intraction, diuretics

Gender disparity in ICU staffing in Argentina

PurposeGender disparities in healthcare are striking, notwithstanding an increase in female students and physicians. Underrepresentation of women in leadership positions is well-documented; however, information from low and middle-income countries (LMICs) is still sparse. The Argentinian Society of Intensive Care Medicine (SATI) aimed to characterize the gender composition in Argentine ICUs. Methods and resultsBetween 8/1/2018 and 1/1/2019, 131 questionnaires were submitted to ICU Department Chairs of SATI research networks. Gender distribution of the different staffing levels, board certification and hospital characteristics were recorded.One-hundred and four were completed, including 2186 physicians; 44% were female. Female participation decreased with highest responsibility: only 23% of Department Chairs were female (P = .002 vs. the rest of the staffing categories, adjusted for multiple comparisons). Residents exhibited the highest proportion of female physicians (47%). Board certification was similar for both sexes (62.3% vs. 62.2%, P = .97). Female/male distribution in public and private hospitals was 47%/53% and 40/60% (P < .01), respectively. ConclusionOur data provide evidence of an important gender gap in ICU management in a LMIC. Women were poorly represented in the leadership positions, although qualifications were similar to men. Moreover, female physicians worked more frequently in the public health subsector, usually underfinanced in LMICs—a surrogate of a gender pay gap.

Application of detail nursing in enteral nutrition in patients with severe craniocerebral injury

Objective To analyze the effect of detail nursing in enteral nutrition in patients with severe craniocerebral injury. Methods A total of 96 patients with severe craniocerebral injury admitted to ICU department were divided into 2 groups of 48 cases according to the Stochastic numerical table method. Both groups were treated with enteral nutrition. During the treatment, the control group was given routine care, and the observation group was given detailed nursing, and the two groups were compared. Results The incidence of abdominal distension, constipation and diarrhea in the observation group was 4.17% (2/48) and 2.08% (1/48) lower than 16.67% (8/48) and 16.67% (8/48) in the control group, the difference was statistically significant (χ2=4.019, 4.414, P<0.05). The Glasgow Coma Scale (GCS) score was 9.45±1.42, which was significantly higher than 7.19±1.36 of the control group (t=7.963, P<0.05). Compared with the control group, the serum total protein (62.67±3.69) g/L, serum albumin (35.56±2.08) g/L, and peripheral lymphocyte count (1.68±0.15)×109 were significantly higher than (59.15±3.55) g/L, (31.62±2.17) g/L, (1.49±0.26)×109 in the control group (t=4.763, 9.081, 4.385, P<0.05). Conclusion During the period of enteral nutrition therapy for patients with severe craniocerebral injury, detailed nursing is helpful to reduce the related complications, improve the degree of illness, and improve the nutritional status of the body. Key words: Severe craniocerebral injury; Enteral nutrition therapy; Detail nursing; Nutritional status; Complications

TEG in the monitoring of coagulation changes in patients with sepsis and the clinical significance.

Application values of thromboelastography (TEG) in dynamic monitoring of coagulation parameters of sepsis patients were investigated. Eighty-one patients with sepsis who were admitted to the ICU department of the General Hospital of Ningxia Medical University from April 1, 2015 to December 31, 2015 were collected. Clinical data of the patients were collected. Data were compared using 5 grouping methods: i) the 81 patients were divided into the sepsis group (n=45) and sepsis shock group (n=36); ii) patients were divided into two groups: group A (APACHE II score ≤13, n=51); group B (APACHE II score >13, n=30); iii) according to Disseminated Intravascular Coagulation Diagnosis Integral System (CDSS), patients were divided into non-disseminated intravascular coagulation (DIC) group (CDSS <7 points) and DIC group (CDSS ≥7 points); TEG indexes were compared between the two groups; iv) correlation between TEG indexes and Sequential Organ Failure Assessment (SOFA) scores was analyzed; v) patients were divided into survival group and non-survival group and correlations between TEG indicators and prognosis were analyzed. At 6 h after ICU entry, compared with sepsis group, R value and K time were significantly increased, LY30 was also increased, while MA value, coagulation index (CI), and α angle were significantly decreased in the septic shock group (P<0.05). At 6 h after ICU entry, compared with sepsis group, R value and K time were significantly increased, while MA value, CI, and α angle were significantly decreased in the septic shock group (P<0.05). Compared with the non-DIC group, the DIC group had prolonged K time, decreased α angle, increased R value, and decreased CI and MA value (P<0.05). With increase of SOFA scores, R value and K value increased significantly, and α angle, MA value, and CI decreased significantly (P<0.05). According to TEG, platelet function and fibrinogen function of DIC patients were significantly reduced, and the body showed hypocoagulability.

Is Stylet Use During Intubation Associated with Post Intubation Complications

Objective: The basic objective is to evaluate the impacts of placing stylet during tracheal intubation on the post-operative pharyngeal pain in anesthetized patients. Methodology: This randomized control trail was conducted in the department of Anesthesia and ICU, Ch. Pervaiz Ellahi Institute of Cardiology and Nishter Hospital Multan from May 2017 to December 2018. All these patients were divided into two groups group S (stylet group) and group C (control group) by lottery method. All the data was entered and analyzed by the computer software SPSS version 23.2. Results: A total number of 100% (n=386) patients were included in this study, both genders. Gender distribution showed that there were more males than females i.e. 56.2% (n=217) and 43.8% (n=169) respectively. The main outcome variables of this study were pharyngeal pain, airway maintenance and sore throat. It was also noted that group (S) showed easy airway maintenance in 95.9% (n=185) patients. It was observed that, in group (S), 63.2% (n=122) patients were complained from sore throat and 67.4% (n=130) were complained about pharyngeal pain. While on the other hand, in group (C), only 8.3% (n=16) patients were complained about sore throat and 11.4% (n=22) were complained about pharyngeal pain Conclusion: Use of stylet during endotracheal intubation decreases the incidences multiple attempts and make the airway maintenance easy for the anesthetist but on the other side it have complications like sore throat and post intubation pharyngeal pain than those patients in which stylet was not usede. Keywords: Pharyngeal pain, Tracheal Intubation, Stylet, Post-operative. DOI : 10.7176/JMPB/53-05 Publication date :March 31 st 2019

Research on constructing ICU nursing sensitivity quality index system based on evidence-based and "three-dimensional quality structure" model

Objective To use the three-dimensional quality model as a theoretical basis, based on multiple evidence-based evidence, to construct ICU nursing sensitivity quality indicators, and to provide reference for the evaluation and monitoring of ICU department nursing safety quality. Methods Evidence-based and Delphi methods were used to complete 3 rounds of inquiry among 27 experts to obtain consensus opinions of experts and to determine nursing quality indicators. Results Of the 30 articles included, 17 were ⅢA, 10 were ⅣA, 2 were ⅤA, and 1 was ⅤB. According to the three-dimensional structure theory model, the included indicators were sorted out and a total of 12 items were obtained. The effective recovery rate of 3 rounds of questionnaires was 96.6%, 100.0%, and 96.4%. The authoritative coefficients were 0.899, 0.895, and 0.909, and the coordination coefficients of the first, second, and third indexes were 0.340, 0.379, and 0.403, respectively,with significance (P<0.01). The final ICU nursing sensitivity quality indicator consists of 3 first-level indicators, 15 second-level indicators and 69 third-level indicators. The selection of indicators at all levels gradually converges. Conclusions The established ICU nursing sensitivity quality index accords with the principle of scientificity and practicality, and can be used for ICU department nursing quality assessment. Key words: Evidence-based method; Intensive care units; Three-dimensional quality structure; Quality index of nursing sensitivity; Delphi method

The impact of the national action plan on the epidemiology of antibiotic resistance among 352,238 isolates in a teaching hospital in China from 2015 to 2018

BackgroundWe sought to understand the epidemiology and characteristics of antimicrobial resistance (AMR) and the impact of the National Action Plan (NAP) on AMR. This information will be critical to develop interventions and strengthen antibiotic stewardship in hospital settings in China.MethodsCross-sectional data collection from the hospital information management system from 1 January 2015 to 30 August 2018. Variables included patient age, sex, diagnosis, hospital department and antibiotic sensitivity test. T-test for two samples method was applied to compare the results before and after NAP implementation. Multivariate analysis with binary logistic regression was conducted to examine the associations of risk factors for antimicrobial resistance.ResultsIn total there were 352,238 isolates in the final analysis after excluding contamination strains and isolates with incomplete information. More than 50% of patients were > 66 years old. 62% were male. 40% of the total samples were sputum. Among the total sample, the total resistance rate was 42% among all isolates. The rate of resistance to all antibiotics declined by 5.3% (95% CI 4.96–5.64%, p < 0.0001) and culture positivity rate declined by 9.8% (95% CI 9.22–10.34%, p < 0.0001) after NAP. Logistical regression showed that the NAP had effect with an adjusted odds ratio of 0.76 (95% CI 0.71–0.81, p = 0.002). Being male, age > 65 years, ICU department, diagnosed with certain diseases were more likely to be associated with antimicrobial resistance.ConclusionsAntibiotic resistance rates were high in this teaching hospital. However, the introduction of the China NAP since 2016 followed by hospital policy emphasis was associated with a declining AMR trend. Policies will need to incorporate antimicrobial stewardship with a focus on certain departments, with infection control practices and with increases in vaccination coverage among elderly.