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Objective@#To describes and compare the effect of humidity heat exchanger and ultrasound on artificial airway patients in a hospital at high altitude.@*Methods@#The patients with artificial airway admitted to the People's Hospital of Tibet Autonomous Region from August to December 2017 were divided into two groups according to the time of admission. A total of 125 patients in the humid heat exchanger group were humidified by the humid heat exchanger during the offline process. In the ultrasonic humidification group, 106 patients underwent airway humidification with an ultrasonic humidifier during weaning. After 24, 48 and 72 hours offline, sputum viscosity, eschar formation, airway temperature, PaO2 and PaCO2 were investigated.@*Results@#Before humidification, 1 day after humidification, 2 days after humidification and 3 days after humidification, the proportion of first degree sputum in the ultrasonic humidification group was 77.36% (82/106), 80.19% (85/106), 95.28% (101/106) and 99.06% (105/106), respectively. In the heat-moisture exchange group, 99.20% (124/125), 99.20% (124/125), 95.20% (119/125), 72.80% (94/125), respectively. There were differences between the two groups before, 1 day and 3 days after humidification. There was statistical significance (χ2= 28.35, 24.06, 28.75, P < 0.01). There was no significant difference in PaCO2 between the two groups (P > 0.05). PaO 2 in the two and three days after humidification was (92.62 ± 5.76), (91.34 ± 4.85) mmHg, which was lower than that in the ultrasonic humidification group (97.38 ± 5.55), (99.16 ± 5.43) mmHg. There were significant differences between the two groups (t= 6.367, 11.558, P < 0.01). There were significant differences between the two groups (t=6.367, 11.558, P < 0.01).@*Conclusions@#The rate of eschar formation was higher in the wet heat exchanger group, and the frequency of sputum suction was higher in the ultrasonic wetting group.
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Objective To describes and compare the effect of humidity heat exchanger and ultrasound on artificial airway patients in a hospital at high altitude. Methods The patients with artificial airway admitted to the People's Hospital of Tibet Autonomous Region from August to December 2017 were divided into two groups according to the time of admission. A total of 125 patients in the humid heat exchanger group were humidified by the humid heat exchanger during the offline process. In the ultrasonic humidification group, 106 patients underwent airway humidification with an ultrasonic humidifier during weaning. After 24, 48 and 72 hours offline, sputum viscosity, eschar formation, airway temperature, PaO2 and PaCO2 were investigated. Results Before humidification , 1 day after humidification, 2 days after humidification and 3 days after humidification, the proportion of first degree sputum in the ultrasonic humidification group was 77.36% (82/106), 80.19% (85/106), 95.28% (101/106) and 99.06% (105/106), respectively. In the heat-moisture exchange group, 99.20% (124/125), 99.20% (124/125), 95.20% (119/125), 72.80% (94/125), respectively. There were differences between the two groups before, 1 day and 3 days after humidification. There was statistical significance (χ2=28.35, 24.06, 28.75, P<0.01). There was no significant difference in PaCO2 between the two groups (P>0.05). PaO 2 in the two and three days after humidification was (92.62 ± 5.76), (91.34 ± 4.85) mmHg, which was lower than that in the ultrasonic humidification group (97.38 ± 5.55), (99.16 ± 5.43) mmHg. There were significant differences between the two groups (t = 6.367, 11.558, P < 0.01). There were significant differences between the two groups (t=6.367, 11.558, P < 0.01). Conclusions The rate of eschar formation was higher in the wet heat exchanger group, and the frequency of sputum suction was higher in the ultrasonic wetting group.
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Objective@#To evaluate the feasibility of ICU nurse-performed lung ultrasound in screening the reason of dyspnea in ICU patients, and to explore the effect on nursing decisions.@*Methods@#ICU nurses trained on lung ultrasound with 16 hours performed point-of-care lung ultrasound in patient with acute respiratory failure to assess the condition of the patient′s lungs and screen for pleural effusion, atelectasis/lung consolidation. Etc; Repeated examinations by ICU physicians accredited by the International Critical Ultrasound Alliance to evaluate the accuracy of ICU nurse interpretation.@*Results@#A total of 510 lung ultrasonographic examinations were performed in 51 patients. Compared with physicians, ICU nurses correctly interpreted 472 ultrasound signs, accounting for 92.53%. ICU nurses found that the sensitivity of the pleural effusion was 86.7%, the specificity was 95.2%, and the diagnostic accuracy rate was 90.2%, and Youden index was 81.9%. The ultrasonography revealed a sensitivity of 92.1% for atelectic/pulmonary consolidation and a specificity of 92.3.%, the diagnostic accuracy rate was 92.2% and Youden index was 84.4%.@*Conclusion@#ICU nurses who have undergone standardized training can correctly interpret lung ultrasound signs and have good diagnostic value for screening of pleural effusions and atelectasis/lung consolidation; they provide the basis for optimization of chest physiotherapy programs.
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Objective To explore the nursing effect of modified prone position and traditional prone position in the skin protection of patients with prone position in ICU. Methods A total of 60 ICU patients with prone position treatment were selected in June 2014 to May 2015. According to the digital method the patients were randomly divided into the control group and the experimental group with 30 cases in each.The control group adopted traditional way of prone position with the head and chest pad pushed up. used by patients not pad up way of improvement of prone position. The incidence of skin pressure injury and the incidence of stress in the two groups were compared. Results The incidence of skin pressure injury was 20.0％(6/30) in the experimental group and 66.7％(20/30) in the control group, and the difference was statistically significant (χ2=13.30, P < 0.05). Conclusions Modified prone position has obvious advantages in reducing the incidence of skin pressure ulcer and is suitable for patients with clinical prone position.
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Objective To investigate the current status of application of the Confusion assessment method for the Intensive Care Unit (Cam-ICU),and to explore its influencing factors.Methods A total of 300 patients admitted to were enrolled.The researchers and nurses used Cam-ICU to assess patients' delirium,respectively,and the differences in deliriun assessment were analyzed.Results For delirium assessment,the Kappa value was 0.546 between the researchers and nurses.The consensus rate was 17.6％ for hypoactive delirium,and 77.8％ for hyperactive delirium in 44 delirium patients.Logistic regression analysis showed that APACHE Ⅱ score,RASS score and delirium type were influencing factors of accurate assessment of delirium.Conclusion The consistence of assessment of delirium by ICU nurses is generally good,but the accuracy of assessment of hypoactive delirium is the worst.
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Objective To compare the consistency between interstitial fluid glucose and arterial blood glucose in septic shock patients with different tissue perfusion levels.Methods A prospective investigative study was conducted. Sixty-one septic shock patients with ages above 18 years old admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from April 2013 to December 2013 were enrolled. The real-time continuous glucose monitoring system (RTCGMS) and arterial blood gas analyzer were used to measure the patients' interstitial fluid glucose and arterial blood glucose, and according to the criteria of International Organization for Standardization (ISO) and the median of relative absolute difference (Median RAD), the consistency between interstitial fluid glucose and arterial blood glucose was calculated. Based on the lactate (Lac) level and pulse oxygen perfusion index (PI), the septic shock patients were divided into groups with different degrees of tissue perfusion, the consistency between the interstitial fluid glucose and arterial blood glucose among septic shock patients with different degrees of tissue perfusion was compared by using Bootstrap re-sampling technique.Results Negative correlation existed between PI and Lac (r= -0.272,P 8 mmol/L, their consistency between interstitial fluid glucose and arterial blood glucose was better than that in those with Lac > 2-4 mmol/L, and the 95% credibility intervals (CI) of ISO standardized deviation value was 0.026-38.710 (P 0.7%-1.4%, the 95%CI of median RAD difference value was 0.002-0.076, and the 95%CI of ISO standardized deviation value was -27.000 to -0.583 (allP 3.0%, their consistency between interstitial fluid glucose and arterial glucose was better than that in those with PI ≤ 0.7%, PI > 0.7%-1.4% and PI > 1.4%-3.0%, and the 95%CI of ISO standardized deviation values were 3.322-28.302, 11.988-40.265 and 5.170-33.333 respectively (allP 8 mmol/L or PI ≤ 0.7%), the worse the tissue perfusion, the better the consistency between interstitial fluid glucose and arterial blood glucose; when septic shock patients were under normal local tissue perfusion (PI > 3.0%), the better the local tissue perfusion, the better the consistency between interstitial fluid glucose and arterial blood glucose.
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Objectives To implement the guideline-based clinical practice program for identification and manage-ment of dysphagia in stroke patients,and to create a good evidence-based practice culture,and to improve the quality of clinical care. Methods In this study,we use the Iowa model of evidence-based practice as a guide, reference guide issued by RNAO to implement the corresponding implementation strategy tool,and gradually apply the program to the pilot ward. Results The implementation of the program had a positive impact on the patient level (quality of life,satisfaction and hospitalization),the nurse level(satisfaction and knowledge),and the level of eachau-ditcriteria. Conclusion It is possible to improve the clinical nursing quality by adapting the high quality guide-lines for the identification and management of dysphagia in foreign countries and this study can provide reference for the research of future guideline implementation.
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Objective To provide evidence for clinical practice by analyzing the factors associated with bloodstream infection in ICU patients through retrospective case-control study. Methods Using self-made data collection form, 133 cases of blood sample record from HIS system during May 2013 to December 2015 at Peking Union Medical College Hospital ICU ward were collected. In this study, 54 patients with positive blood culture results were allocated to the case group while 79 patients with negative results were in the control group. Baseline characteristics, which included sex, age and chronic diseases, were almost the same between both groups. Binary Logistic regression analysis was used to identify factors related to blood infection. Results During May 2013 to December 2015, there were 54 blood infectious cases, among which 19 cases with positive gram bacteria accounted for 35.2%(19/54), 57.4%(31/54) of gram-negative bacilli and 7.4%(4/54) of fungal infection. Logistic regression analysis revealed that blood filtration treatment (OR=7.691), pulmonary infection (OR=7.682), ICU (OR=1.115), Acute Physiology and Chronic Health Evaluation (APACHEⅡ) scores(OR=1.096), procalcitonin (OR=1.065) were risk factors of bloodstream infection for ICU patients, while albumin (OR=0.763) was a protective factor. Conclusions Blood filtration treatment, pulmonary infection, hospital length of stay, APACHEⅡand procalcitonin are factors associated with bloodstream infection in ICU patients. Clinical procedures in ICU should mainly focus on improvement of prevention awareness, strict aseptic technology, professional quality of nursing staff. Besides, guarantee of patients′nutrition, effective treatment of primary diseases, and shortened hospital length of stay are also important to reduce the infection and improve quality of life of these patients.
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Objective To investigate doctors' and nurses' perceptions and implementation of delirium management in intensive care unit. Methods A total of 197 doctors and nurses in 2 general ICUs and 3 special ICUs at Peking Union Medical College Hospital finished a self-designed questionnaire of delirium management. Results There were 47 males and 150 females, 43 doctors and 154 nurses who participated in the survey.One hundred and twenty five participators were from general ICU and the others from special ICU. The ICU staff had a significant difference on the perceptions and implementation of delirium management(P< 0.001) including. Doctors and nurses scored lowest in"family engagement and empowerment"and"sleep management"with (4.620 ± 2.393) and (5.430 ± 2.153) respectively. There was a significant difference between nurses and doctors in the management of analgesia and sedation (P< 0.05). Doctors and nurses from different ICUs had significant discrepancy in the implementation of"delirium assessment"(P<0.05). Conclusions The ICU staff should improve the perceptions and the implementation of delirium management,especially in special ICUs. Delirium management should be included as a routine care in ICU to improve patients' outcome.
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A comprehensive literature on the utility of ultrasound guidance for artery catheterization were searched. The research of the literature was divided to three parts:evaluation of radial artery, the process of puncture and the application progress. Ultrasound is a useful adjunct to arterial catheter insertion and increase the rate of success. During the process of ultrasound guidance, evaluation of radial artery, preparation, the way of poke and the direction of the needle were recommended.
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BACKGROUND:Bisphosphonates that can increase bone density and inhibit bone resorption have been clinical y confirmed, but the structure of the bone matrix has been less studied. OBJECTIVE:To observe the effects of alendronate on bone structure and bone matrix metabolism, and then to investigate the control ing mechanism by which alendronate improves bone mass and increase bone intensity. METHODS:An ovariectomized rat model was prepared and intervened with alendronate as treatment group. Model and sham-surgery groups were set as controls. Alendronate effects on bone mineral density, bone metabolism, bone biomechanics, and bone structure were observed in bone loss rats using bone imaging, bone tissue pathology and biomechanical test and enzyme-linked immunosorbent assay. RESULTS AND CONCLUSION:Alendronate intervention could fight against bone loss as compared with model group at weeks 4, 8, and 12 after treatment (P<0.05). Compared with the model group, the expression of urinary deoxypyridinoline and serum carboxyterminal propeptide of type Ⅰ procol agen was decreased significantly after alendronate intervention (P<0.05);the maximal load, maximal pressure and modelus on the lumbar vertebrae and femur were increased as wel as ratio of urinary pyridinoline/deoxypyridinoline of type Ⅰ procol agen (P<0.05). These findings suggest that alendronate intervention can inhibit bone loss in rats induced by estrogen deficiency, increase biomechanical properties, improve bone matrix structure, and meanwhile, recover the Ⅰ col agen crosslinking component due to ovariectomy.
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BACKGROUND: Type Ⅰ collagen is a specific collagen secreted by in vitro cultured osteoblast, and the formed network is the basis of bone mineralization, which also reflects the ability of osteoblast bone formation. Studies have shown astragalus root increased osteoblast proliferation. However, the effect of astragalus root on improving type Ⅰ collagen expression of osteoblast remains poorly understood.OBJECTIVE: To evaluate the effect of astragalus root injection on the abilities of rat cranium-derived osteoblast proliferation and type Ⅰ collagen expression.METHODS: Rat osteoblast was cultured in vitro and divided into control group (MEM culture solution containing calf serum) and astragalus root groups (different concentrations). The effect on osteoblast proliferation was evaluated on days 1, 3, 5, 7, and 9 by MTT method. Moreover, the expression of type Ⅰ collagen protein was observed after 6 hours of treatment with astragalus root injection using in cell western-blot method. In addition, the gene expression of COLLal was investigated by real-time PCR method.RESULTS AND CONCLUSION: From days 3 to 9, the different concentrations of astragalus root injection improved osteoblast proliferation, respectively compared with control group (P ＜ 0.05), and this ascending trend peaked on day 7. Different concentretions of astragalus root injection improved COLLol mRNA expression, especially 15% astragalus root injection was the most effective. The type Ⅰ collagen protein expression of 15% and 10% astragalus root injection were significantly greater compared with the control group (P ＜ 0.05). Astragalus root injection improved in vitro cultured osteoblast proliferation and type Ⅰ collagen secretion in a certain dose-effect manner.