Development and validation of a nomogram for oral mucosal membrane pressure injuries in ICU patients: A prospective cohort study.

AIMS: Establishing a nomogram to estimate the probability of oral mucosal membrane pressure injury of endotracheal tube-intubated hospitalized patients in intensive care unit. DESIGN: Multicentre prospective cohort study. METHODS: Using Lasso regression and COX regression, variable selection was performed on demographic, clinical and laboratory data of 1037 ICU endotracheal tube-intubated hospitalized patients from West China Hospital, to construct a nomogram. External validation was conducted on 484 ICU endotracheal tube-intubated patients from People's Hospital of Zhongjiang County. RESULTS: Among 38 potential predictors, five variables emerged as independent predictors, integrated into the nomogram: administration of antibiotics, nutritional therapy duration, agitation, hypotension and albumin levels. CONCLUSIONS: We established a nomogram based on the hospital characteristics of ICU endotracheal tube-intubated patients, aiding in the prediction of the occurrence of oral mucosal membrane pressure injury. REPORTING METHOD: The study followed TRIPOD guidelines. RELEVANCE TO CLINICAL PRACTICE: The nomogram we developed can assist clinical worker in better identifying at-risk patients and risk factors. It enables the implementation of evidence-based nursing interventions in care to prevent the development of oral mucosal membrane pressure injury. TRIAL REGISTRATION: The study has been registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn) under registration number ChiCTR2200056615.

Radiation Exposure to Staff in Intensive Care Unit with Portable CT Scanner.

Background. Bedside radiological procedures pose a risk of radiation exposure to ICU staff. The perception of risk may increase the degree of caution among the health care staff and raise new barriers preventing patients from obtaining prompt care. Objective. The aim of this study was to estimate the annual cumulative radiation dose to individual ICU staff. Methods. In this prospective study, forty subjects were required to wear thermoluminescent dosimeter badges during their working hours. The badges were analyzed to determine the exposure after 3 months. Results. A total of 802 radiological procedures were completed at bedside during the study period. The estimated annual dosage to doctors and nurses on average was 0.99 mSv and 0.88 mSv (p < 0.001), respectively. Residents were subjected to the highest radiation exposure (1.04 mSv per year, p = 0.002). The radiation dose was correlated with day shift working hours (r = 0.426; p = 0.006) and length of service (r = -0.403; p < 0.01). Conclusions. With standard precautions, bedside radiological procedures-including portable CT scans-do not expose ICU staff to high dose of ionizing radiation. The level of radiation exposure is related to the daytime working hours and length of service.

[A study of the value of high frequency chest wall oscillation in patients with acute exacerbation of chronic obstructive pulmonary disease].

OBJECTIVE: To explore the safety and efficacy of high-frequency chest wall oscillation (HFCWO) in invasive mechanical ventilation patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: A prospective, randomized, controlled trial was conducted. Thirty-five AECOPD patients with invasive mechanical ventilation were included in the intensive care unit of West China Hospital of Sichuan University from February 2012 to February 2013. The patients were randomly allocated into a HFCWO (H) group and a control group using SAS 9.1 software . The control group received routine therapy, while the H group received HFCWO, along with routine therapy. Invasive mechanical ventilation time, noninvasive ventilation time, total mechanical ventilation time, ICU stay time, hospital stay time and pH, oxygen index (OI) during the first 7 days were collected. At the same time, heart rate, blood pressure, respiratory rate, SpO2 and peak airway pressure before, during and after HFCWO and ventilation alarm of the H group were collected. RESULTS: The total mechanical ventilation time of patients in the H group was significantly shorter than that of the control group [(10 ± 6) d and (15 ± 8) d, P < 0.05]. But there were no significant differences between the 2 groups in invasive mechanical ventilation time, noninvasive ventilation time, ICU stay and hospital stay time (P > 0.05). There were no significant differences between the 2 groups in pH and oxygen index during the first 7 days (P > 0.05). There were no change in heart rate, blood pressure, respiratory rate, SpO2 and peak airway pressure before, during and after HFCWO in the H group (P > 0.05). Severe ventilator alarm(level 3) occurred in 3.67% patients, but there was no significant correlation between ventilation alarm and patient prognosis. CONCLUSIONS: HFCWO is very safe and comfortable in ventilated patients with AECOPD. It reduces the total mechanical ventilation time, but cannot improve the prognosis.