Factores asociados a mortalidad en pacientes críticos con COVID-19 en un centro universitario de Paraguay / Factors associated with mortality in critical patients with COVID-19 in an university center in Paraguay

INTRODUCCIÓN: La pandemia por COVID-19 es un problema de salud mundial. Habitualmente cursa con sintomatología leve y 5% de los afectados evoluciona a cuadros graves que requieren de cuidados intensivos. OBJETIVO: Determinar el perfil clínico, la mortalidad y factores asociados a la misma en pacientes con COVID-19 ingresados al Departamento de Cuidados Intensivos de Adultos, del Hospital de Clínicas de la Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Paraguay, entre agosto de 2020 a agosto de 2021. PACIENTES Y MÉTODO: Se realizó un estudio observacional analítico de corte transverso. Los datos se obtuvieron a partir de las historias clínicas de los pacientes. RESULTADOS: Se incluyeron 214 pacientes críticos entre 21 y 85 años de edad (mediana 54 años), 57,9% del sexo masculino, 85% provenientes del Departamento Central y Asunción. La mortalidad global fue de 38,3%. Se asociaron significativamente con la mortalidad una edad ≥ 60 años, las comorbilidades (diabetes mellitus, cardiopatía, enfermedad renal crónica), los índices de gravedad (APACHE II, SOFA, inicial), procalcitonina elevada, utilización de vasopresor, asistencia respiratoria mecánica y utilización del decúbito prono; así como la presencia de SDRA y el requerimiento de depuración extrarenal. En el análisis multivariado (por regresión logística) los factores de riesgo de mortalidad independientes fueron: la edad mayor de 60 años, la utilización de noradrenalina y depuración extra-renal durante la hospitalización. CONCLUSIÓN: Nuestra mortalidad es similar a la reportada internacionalmente. Los factores de riesgo de mortalidad identificados muestran una población con mayores posibilidades de un desenlace desfavorable.

BACKGROUND: The COVID-19 pandemic is a world health issue. Generally, it is with mild and around 5% evolves to a severe disease that requires intensive care. AIM: To determine the clinical profile, mortality and associated factors in COVID-19 patients admitted at the Adult Intensive Care Department at the Hospital de Clinicas, between August 2020 and August 2021. METHODS: Cross-section observational analytic study. Data was obtained from clinical charts. RESULTS: 214 patients were included, with an average age of 54 years, 57.9% male. Overall mortality was 38.3%. Factors associated significantly with mortality were: ≥60 years of age, comorbidity (diabetes mellitus, heart disease, chronic renal disease), severity index (APACHE II, initial SOFA), high procalcitonin, use of vasopressor, mechanical respiratory assistance and prone decubitus; as well as the presence of acute respiratory distress syndrome and hemodialysis. Multi varied analysis identified as mortality risk factors: ≥60 years of age, noradrenaline use and hemodialysis. CONCLUSION: Mortality rate is similar to that reported worldwide. Mortality risk factors identified show a population with higher possibilities for unfavorable outcome.

Calidad del sueño y factores que lo alteran en los pacientes críticos en la uti en una institución privada de córdoba 2022 / Sleep quality and factors that alter it in critical patients in the icu in a private institution in Córdoba 2022

Los pacientes que están hospitalizados tienen un desequilibrio en de sus necesidades, más si hablamos de los pacientes que se encuentran en una unidad de terapia intensiva donde el movimiento es dinámico segundo a segundo debido a la inestabilidad hemodinámica de cada paciente. Una vez que se haya estabilizado la salud del paciente orientado, aparece la dificultad de poder dormir, por diversos factores que rodean al paciente ya sea intrínsecos, lo que siente la misma persona o ambientales propiamente de la terapia. Objetivo: determinar la calidad del sueño y los factores que lo alteran los pacientes orientados críticos en la Unidad de Terapia Intensiva. Metodología: estudio descriptivo y transversal, como instrumento se utilizó el cuestionario de Richard Campbell que correspondía 5 preguntas sobre la calidad del sueño y la 6ta pregunta que corresponde al Cuestionario de Freedman sobre los factores que impide obtener un sueño óptimo. Resultado: Se realizó 40 entrevistas a los pacientes orientados de la unidad intensiva de diferentes edades, sexo y patología. Conclusión: El sueño en los pacientes orientados en la unidad de terapia intensiva dio una mala calidad de sueño, es decir un sueño superficial con despertares intermitentes. Los pacientes que tuvieron más dificultad para conciliar el sueño son lo que sufrieron enfermedades respiratorias y oncológicas en los cuales influyo los factores intrínsecos la ansiedad y el extrínseco la postura corporal y el ruido[AU]

The patients who are hospitalized have an imbalance in all their needs, more so if we talk about patients who are in an intensive care unit where movement is dynamic second by second due to the hemodynamic instability of each patient. Once the health of the oriented patient has stabilized, the deficit of being able to sleep appears, due to various factors that surround the patient, whether intrinsic, what the person feels, or the environment of the therapy itself. Objective: to determine the quality of sleep and the factors that alter it in critically oriented patients in the Intensive Care Unit.Methodology: descriptive and cross-sectional study, the Richard Campbell questionnaire was used as an instrument, corresponding to 5 questions on sleep quality and the 6th question corresponding to the Freedman Question-naire on the factors that prevent optimal sleep. Result: 40 interviews were con-ducted with oriented patients from the intensive unit of different ages, sex and pathology. Conclusion: The sleep in the patients oriented in the intensive care unit gave a poor quality of sleep, that is, a superficial sleep with intermittent awakenings. The patients who had more difficulty falling asleep are those who suffered respiratory and oncological diseases in which the intrinsic factors influ-ence anxiety and the extrinsic body posture and noise[AU]

Progress and Prospect in Intensive Care and Treatment of Patients with Solid Tumors / 肿瘤防治研究

The incidence of cancer has remained high in recent years, and anti-tumor treatment methods are emerging. Cancer treatment has undergone significant changes, and the survival rate of patients with cancer has significantly improved. Various types of new anti-tumor treatments may not only treat and control tumor growth but also place patients in critical situations that require treatment by intensive care medical personnel. Patients with cancer are in critical condition mainly due to three reasons: severe cases caused by cancer diseases themselves, complications during the perioperative period, and accompanying diseases and hospital acquired diseases. In the new situation, we should consider patient characteristics, such as abnormal metabolism, abnormal coagulation system, and abnormal immune mechanism, to save them from serious illness. We need to comprehensively evaluate patients with cancer, emphasize the role of the Intensive Care Unit (ICU) treatment platform, and promote the treatment concept of planned transfer to ICU, to improve the success rate and efficiency of treatment. After transferring the patient out of the ICU, the planned follow-up anti-tumor treatment can still be continued as the endpoint of ICU treatment for critically ill patients with cancer. In the future, efforts will be devoted to establishing a discipline and talent echelon with distinctive characteristics of oncology critical care medicine and treating "the critical illness of cancer and the cancer of critical illness".

Research progress on risk prediction models for incontinence-associated dermatitis in critically ill patients / 中华护理杂志

Incontinence-associated dermatitis is one of the common complications in critically ill patients.This paper reviews the research progress of risk prediction models for incontinence-associated dermatitis in critically ill patients,introduces and compares the characteristics and application effects of different risk prediction models.The purpose is to provide ideas for constructing a localized risk prediction model and provide evidence for medical staff to identify risk factors of incontinence-associated dermatitis at an early stage and take preventive measures.

Utilidad de la plasmaféresis terapéutica en pacientes críticos con disfunción orgánica / Usefulness of therapeutic plasmapheresis in critical patients with organ dysfunction

Introducción: La aféresis terapéutica es el procedimiento que separa y remueve el plasma de la sangre total, con el objetivo de eliminar componentes considerados responsables patógenos de una enfermedad o de sus manifestaciones clínicas Objetivos: Analizar los aspectos generales de la aplicación de la técnica de plasmaféresis como alternativa de tratamiento en pacientes críticos con disfunción orgánica. Métodos: Se realizó una investigación bibliográfica-documental acerca del tema. Se consultaron fundamentalmente las bases de datos de SciELO y Pubmed de los últimos diez años. Análisis y síntesis de la información: Se describen los aspectos de la plasmaféresis, desde sus criterios de indicación; así como la aplicación del procedimiento en los pacientes con disfunción orgánica y sus resultados en la evolución del paciente. Conclusiones: Con la utilización de la plasmaféresis se encontró mejoría de los parámetros clínicos y de laboratorio en la mayoría de los pacientes en disfunción orgánica al egreso de la unidad de cuidados intensivos(AU)

Introduction: Therapeutic apheresis is the procedure that separates and removes plasma from whole blood, thus eliminating components considered pathogenic of a disease or its clinical manifestations. Objectives: To analyze the general aspects of de application of the plasmapheresis technique as an alternative treatment in oncohematological patients wish organic dysfunction. Methods: A bibliographic- documentary investigation was carried out on de subject The Scielo and Pubmed data bases were consulted. Analysis and synthesis of information: The technical aspects of plasmapheresis are described, based on its indication criteria, as well as the application of de technique in patients with organic dysfunction and its results in the evolution of the patient. Conclusions: With the use of the plasmapheresis technique improvement in clinical and laboratory parameters was found in the majority of organ dysfunction patients upon discharge from the intensive care unit(AU)

Caracterización de pacientes geriátricos con ventilación mecánica invasiva en cuidados intensivos / Characterization and evolution of the geriatric patient with invasive mechanical ventilation in intensive care unit

Introducción: La ventilación mecánica invasiva en pacientes geriátricos ingresados en las unidades de cuidados intensivos, es frecuente y tiene una letalidad elevada. Objetivos: Caracterizar a los pacientes geriátricos con ventilación mecánica invasiva y su evolución en la unidad de cuidados intensivos. Métodos: Se realizó un estudio descriptivo, en 149 pacientes geriátricos ingresados en la sala de cuidados intensivos. Las variables estudiadas fueron: edad, sexo, antecedentes patológicos personales, índices APACHE II y SOFA, perfil diagnóstico, diagnóstico al ingreso, aplicación de traqueostomía, tiempo de ventilación mecánica, estado al egreso y complicaciones. Se emplearon como medidas las frecuencias porcentajes; se evaluó la posible asociación entre las variables. Resultados: Predominó la edad de 70 a 79 años (44,9 por ciento) y el sexo masculino (53,7 por ciento). La mortalidad fue de 40,9 por ciento y se asoció a: valores elevados de los índices APACHE II y SOFA, pacientes quirúrgicos y tiempo de ventilación mecánica mayor de 7 días. Las complicaciones más frecuentes fueron: el síndrome de disfunción múltiple de órganos (23,4 por ciento), la neumonía asociada a la ventilación (22,8 por ciento) y la insuficiencia renal aguda (22,1 por ciento). Conclusiones: Los pacientes se caracterizan por el predomino del sexo masculino, edad menor de 80 años y presencia de enfermedades crónicas; el diagnóstico al ingreso más relevante, es el posoperatorio de afecciones quirúrgicas urgentes; la mortalidad se asociada al sexo femenino, al perfil quirúrgico, la gravedad de la enfermedad y el tiempo de ventilación mecánica. Las complicaciones se relacionan con la sepsis(AU)

Introduction: Invasive mechanical ventilation in geriatric patients admitted to intensive care units, is frequent and has a high lethality. Objectives: To characterize geriatric patients with invasive mechanical ventilation and their evolution in the intensive care unit. Methods: A descriptive study was carried out in 149 geriatric patients admitted to the intensive care unit. The variables studied were: age, sex, personal pathological history, APACHE II and SOFA indices, diagnostic profile, diagnosis on admission, application of tracheostomy, time of mechanical ventilation, status at discharge and complications. Percentage and frequencies were used as measurements; the possible association between the variables was evaluated. Results: The age of 70 to 79 years (44.9 percent) and the male sex (53,7 percent) predominated. Mortality was 40,9 percent and was associated with: elevated APACHE II and SOFA indices, surgical patients, and mechanical ventilation time greater than 7 days. The most frequent complications were: multiple organ dysfunction syndrome (23,4 percent), ventilator-associated pneumonia (22,8 percent) and acute renal failure (22,1 percent). Conclusions: The characteristics were: age less than 80 years, most were male sex, history of chronic diseases and in the diagnosis at admission, urgent surgical conditions. Mortality was associated with female sex, surgical profile, severity of the disease, and time on mechanical ventilation. Complications were related to sepsis (AU)

Una mirada hacia las unidades decuidados intermedios / A look at the intermediate care units

Introducción: Las unidades de cuidados intermedios constituyen parte de los procesos de atención progresivo. Brindan asistencia continua a pacientes potencialmente graves, además ofrecen vigilancia y tratamiento en un nivel menor que las unidades de cuidados intensivos, pero superior a las salas de hospitalización convencionales. Objetivo: Motivar a los profesionales del nivel de atención secundaria a valorar las ventajas de la unidades de cuidados intermedios y fomentar su aplicación. Métodos: Se realizó una revisión bibliográfica minuciosa de 80 artículos publicados en español e inglés sin limitación de la fechas de publicación, en las bases de datos: PubMed, Latindex y Medline. Se utilizó la palabra clave Unidades de Cuidados Intermedios. Se aplicaron métodos de síntesis de la información y análisis crítico para crear un artículo de revisión y opinión. Resultados: De los artículos revisados 28 se incluyeron en el presente trabajo. Discusión: Entre las ventajas de hacer uso de unidades de cuidados intermedios están, disminución de costos, adecuada distribución de los recursos, reducción de las transferencias a prestadores externos, elevación de la calidad asistencial y disminución de ingresos en las unidades de cuidados intensivos. Varios países latinoamericanos carecen de unidades de cuidados intermedios, incrementándose los costos hospitalarios y afectándose la atención del paciente potencialmente grave. Conclusiones: Las unidades de cuidados intermedios representan un eslabón en la actividad asistencial del paciente potencialmente grave de gran importancia, con numerosas ventajas que impactan sobre los costos y calidad en la atención hospitalaria.

Sedoanalgesia con midazolam-ketamina en el paciente crítico ventilado mecánicamente / Sedoanalgesia with midazolam-ketamine in the mechanically ventilated critically ill patient

La sedoanalgesia en pacientes bajo ventilación mecánica artificial se recomienda para lograr una mejor satisfacción del paciente y prevenir complicaciones. El objetivo de este trabajo fue realizar una revisión bibliográfica sobre la acción sedoanalgésica de la combinación de midazolam-morfina comparado con midazolam-ketamina en pacientes críticos tratados con ventilación mecánica artificial. Se realizó una búsqueda manual y digital en diferentes bases de datos como Scielo, IBECS, MEDLINE, Google Scholar, Cochrane y Wh, con los descriptores en inglés siguientes: sedation, midazolam-ketamine, midazolam-morfina AND mechanical ventilation AND crtical illness [MeSH Terms]. Se encontró un total de 60 artículos, todos realizados en seres humanos, 32 en los últimos 5 años, pero solo 16 a texto completo. De ellos, 7 eran revisiones sistemáticas sobre el tema y solo 4 ensayos clínicos. Ninguno utilizó la asociación midazolam-ketamina para la sedación. En la revisión realizada no se encontró ningún artículo que informara sobre las ventajas de la asociación midazolam-ketamina en la sedación del paciente crítico ventilado mecánicamente, lo que le confiere novedad a la investigación(AU)

The sedoanalgesia is recommended for patients under artificial mechanical ventilation in order to achieve better patient satisfaction and to prevent complications. The objective of this work was to carry out a literature review about the sedoanalgesic effect to the combination of midazolam-morphine compared with comidazolam-ketamine in critically ill patients treated with artificial mechanical ventilation. A manual and digital search was carried out in different databases such as Scielo, IBECS, MEDLINE, Google Scholar, Cochrane, and Wh, using the following descriptors in English: sedation, midazolam-ketamine, midazolam-morphine, AND mechanical ventilation AND critical illness (MeSH terms). We found 60 articles, all of which reported human-related cases, 32 in the last 5 years, but only 16 at full text. Out of these, seven were systematic reviews about the subject and only four, clinical trials. We did not find any articles in the review that reported about the advantages of the association midazolam-ketamine in sedation of mechanically ventilated critically ill patients, a fact that confers novelty to the investigation.

Application of the transfer statement in inhouse transfer of critical patients / 中华医院管理杂志

Objective To evaluate the use of transfer statements in inhouse transport of critical patients.Methods By means of continuous enrollment,123 critical patients were enrolled as a control group for conventional transport,and 111 such patients were enrolled as an observation group for transport using the transfer statement.Then the incidence of adverse events,transport during and nurse-nurse collaboration level of the two groups were compared.Results In the control group,its incidence of adverse events was 13.8%,the mean transport during was(19.5 ± 8.4)minutes,and the mean score for nurse-nurse collaboration level was ( 101.87 ± 7.13 ).In the observation group,its incidence of adverse events was 5.4%,the mean transport during was(13.5 ± 5.4)minutes,and the mean score for nurse-nurse collaboration level was(106.15 ± 8.86).Implementing the transfer statement has cut back the incidence of adverse events (P<0.05)and the transport duration significantly(t=3.833,P<0.01),while improving the level of nurse-nurse cooperation significantly(t= -4.261,P<0.05).Conclusions The transfer statement can increase the safety of patient transport,promote organization and coordination of nurses,and improve the efficiency of transport.

Preventive Use of Proton Pump Inhibitors in Critical Patients / 中国药师

Proton pump inhibitors ( PPI) have been widely used in clinics because of strong and lasting inhibiting effect on gastric acid secretion. Because of the higher incidence of stress ulcer and more drug combination used in critical patients, the use of PPI is more important. It has been proved that PPI used in critical patients may increase the incidence of serious adverse events, such as clos-tridium difficile associated diarrhea and pneumonia, so the rational use of PPI is more important in critical patients, especially for the preventive use. The preventive use of PPI including the prevention of drug-related upper gastrointestinal damage and stress ulcer in crit-ical patients was reviewed in the paper in order to provide reference for the rational drug use.

Preventive Use of Proton Pump Inhibitors in Critical Patients / 中国药师

Proton pump inhibitors ( PPI) have been widely used in clinics because of strong and lasting inhibiting effect on gastric acid secretion. Because of the higher incidence of stress ulcer and more drug combination used in critical patients, the use of PPI is more important. It has been proved that PPI used in critical patients may increase the incidence of serious adverse events, such as clos-tridium difficile associated diarrhea and pneumonia, so the rational use of PPI is more important in critical patients, especially for the preventive use. The preventive use of PPI including the prevention of drug-related upper gastrointestinal damage and stress ulcer in crit-ical patients was reviewed in the paper in order to provide reference for the rational drug use.

Shortening Transfer Time of Critical Inpatients from Ward to Intensive Care Unit:Based on Six Sigma / 中国康复理论与实践

Objective To shorten the transfer time of critical inpatients from wards to intensive care unit (ICU). Methods From Novem-ber to December, 2015, 30 critical inpatients transferred from wards to ICU were investigated, and analyzed with Six Sigma DMAIC five-step method. There were 7 main processes and 22 sub-processes refined in transfer procedure, as well as the key quality points and the factors influencing the safety of transferring. Some improvement advice were recommended, including multifunctional transfer cart, Check-list before Transfer to Intensive Care Unit for Critical Patients, setting up transport group, training for young nurses and application of SBAR communication. Other 30 critical inpatients transferred from wards to ICU, from May to June, 2016, after the series of control pro-grams, were investigated. Results After improvement, the total transfer time from wards to ICU decreased (t=15.052, P<0.001), without the increase of human power and unsafety issues. The rescue success rate increased from 91.67%to 98.01%. Conclusion The process transfer-ring patient from wards to ICU has been reengineered based on Six Sigma DMAIC management, that reduces the time and improve the res-cue success rate.

Condition of clinical handover for critical patients：a literature review / 中国实用护理杂志

The clinical handover, which is associated with the observation of the changes in patients′ status and the implementation of nursing process, plays a vital role in critical care. Also, the quality of clinical hand-over has a far-reaching impact on patient safety due to the complicate condition of critical patients. Over the past few years, lots of studies have focused on the many aspects of clinical handover such as the contents of clinical handover, the standard procedure of clinical handover so as to reduce the risks associated with the unsystematic clinical handover.

Development and the reliability and validity test of observation table with influencing factors for catheter-associated urinary tract infections in critical patients / 中国实用护理杂志

Objective To develop a observation table with influencing factors for catheter-associated urinary tract infections in critical patients and verify its reliability and validity. Methods Literature review, brainstorming method, expert interview and group discussion were performed to identify items of the form. By convenience sampling method, totally 130 severe patients with urinary catheter were investigated by this scale. This form was evaluated by item analysis, exploratory factor analysis and reliability and validity test. Results The observation table with influencing factors for Catheter-associated Urinary Tract Infections in critical patients consisted of five dimensions and 26 items. The cumulative contribution of variance was 73.752%, the Cronbach′s alpha coefficient was 0.869 and the Spearman-Brown split-half coefficient was 0.828. Regarding to the construct validity, the correlation coefficient between the each factor and total observation table was 0.652~0.873, the correlation coefficient between the factors was 0.311~0.823. All the difference of correlation coefficients were statistically significant (P<0.01). Conclusions The observation table with influencing factors for Catheter-associated Urinary Tract Infections in critical patients has been proved to be reliable and valid. It can be used as a valid tool to assess influencing factors for Catheter-associated Urinary Tract Infections in critical patients.

Design and application of special gowns for critical patients / 现代临床护理

Objective To explore the effect of newly-designed gowns for critical patients. Methods Two hundred critical patients hospitalized for more than 3 days in the intensive care unit of our hospital during February 2013 to February 2015 were divided into the control group and observation group equally according to their odd or even registration number. The control group wore conventional dresses for patients (including a shirt and a pant) and the patients in the latter group were newly-designed gowns. The two groups were compared in terms of comfort, nursing manpower, nursing stuff and security. Result The observation group was significantly superior to the control group in terms of comfort, nursing manpower, nursing stuff and security (P<0.05). Conclusions The newly-designed gowns for critical patients can improve the comfort degree and save nursing manpower and stuff. It allows convenience in treatment and nursing.

Study on performance evaluation indicators of central venous pressure measuring system for critical patients in clinical trials / 中国实用护理杂志

Objective We aimed to study the performance evaluation indicators of central venous pressure (CVP) measuring system for ICU patients in clinical trials and discuss its impact factors.Methods Ac-cording to the performance evaluation indicators of CVP measuring system based on the Delphi method,a form was created to evaluate the continuous CVP monitoring of 197 ICU patients and then the data were collected.A comparative analysis was performed to verify the factors affecting the performance of CVP measuring system.Results The performance of CVP measuring system was affected by the number of threeway switches,vasoactive drugs and positive end-expiratory pressure,the statistical value was 8.577,-6.773and 3.244.There were no statistically significant differences with respect to performance evaluation indicators of CVP measuring system among the patients with different body positions.Conclusions The performance evaluation indicators of CVP measuring sys-tem proves to be feasible and practical by clinical empirical research.Their influencing factors were dis-cussed and they offer a valuable reference for the determination of the performance of CVP measuring sys-tem in clinical practice.

Terapia ocupacional y paciente crítico / Occupational therapy and critical ill patients

El presente estudio fue realizado en la Unidad de Pacientes Críticos adultos, del Hospital Clínico de la Pontificia Universidad Católica de Chile (UPC-HCPUC), durante el año 2012, donde se exploraron las características del paciente crítico, para obtener un perfil de salud global durante su estadía en la UPC, con el fin de determinar si sería posible realizar una intervención desde la Terapia Ocupacional que fuese un aporte a esta unidad.Se realizó un estudio prospectivo, observacional en la UPC médico quirúrgica durante 25 días. Los resultados obtenidos permitieron caracterizar al paciente crítico de esta unidad, como un sujeto con alta probabilidad de presentar compromiso de conciencia, edema en mano, limitación de rango de movimiento articular (ROM) en muñeca y dedos, y carencia de estímulos que evoquen su realidad previa a la hospitalización. Finalmente, a partir del análisis del perfil del paciente crítico de la UPC HCPUC y del contexto al que se encuentra expuesto, se concluye que la intervención temprana de Terapia Ocupacional podría disminuir y prevenir la aparición de algunos signos asociados al paciente crítico, comprobándose la hipótesis, que dadas las características de este paciente, sería posible realizar una intervención desde la Terapia Ocupacional.

This study was conducted in The Unit Critics adult patients, Clinical Hospital of the Catholic University of Chile (UPC HCPUC), in 2012, where the characteristics of critical patients were explored to obtain a profile of global health while in the UPC, in order to determine whether it would be possible to make an intervention from occupational therapy to be a contribution to this unit.A prospective, observational study in medical UPC-surgery for 25 days. The results allowed to characterize critical patients of this unit, as a subject with high probability of impairment of consciousness, edema in hand, limitation of joint range of motion (ROM) in the wrist and fingers, and lack of stimuli that evoke your reality prior to hospitalization.Finally, from the analysis of the profile of critical patient - HCPUC UPC and the context to which it is exposed, it is concluded that early intervention occupational therapy could reduce and prevent the appearance of certain signs associated with critical patient, checking hypothesized that given the characteristics of this patient, it would be an intervention from Occupational Therapy.

Clinical significance of determination of serum procalcitonin and CRP related indexes in ICU patients / 国际检验医学杂志

Objective To explore the value of serum procalcitonin detection in judging whether severe patients complicate with infection.Methods 188 patients in the intensive care unit (ICU)were collected and divided into the infection and non-infection groups.The serum procalcitonin(PCT),C-reactive protein(CRP),total number of white blood cells(WBC)and neutrophile cell ratio were simultaneously monitored;41 cases in the infection group dynamically monitored PCT and related indicators for continuous 1-6 d and the statistical analysis was conducted.Results The age,PCT and CRP had statistically significant differences between the infection group(112 cases)and non-infection group(76 cases).Except the correlation of PCT and CRP in the infection group showing statistical significance,the comparison of the other indicators had no statistical differences.In the infectors,the PCT value comparison between on 1 d and 2 d in the hospital discharge group(32 cases)and the death group (9 cases)showed P >0.05,the PCT value comparison between on 3-6 d showed P <0.05.Conclusion Serum PCT is an effective indicator to judge whether se-vere infected patient has infection and is significantly superior to the traditional inflammatory indicators.Dynamically monitoring the PCT level in the critical patients has a certain value to judge the control situation of infection.

Application research of parenteral nutrition with high branched-chain amino acid content for criti-cally ill patients in general ICU / 临床外科杂志

Objective To research the effects of parenteral nutrition(PN)with high branchedchain amino acid(BCAA)content for critically ill patients in general ICU.Methods A total of60 patientsfrom the general ICU were randomly divided into the control group(30 cases)and treatment group(30 cases).The control group was given PN with balanced amino acids,while the treatment group received PNwith high content of BCAA.Therapeutic outcomes and the blood parameters were measured betweengroups.Results Total protein (TP),albumin (ALB),prealbumin (PA),arm muscle circumference(AMC)and arm circumference(MAC)of the treatment group increased significantly(P <0.05).In thecontrol group,the change of TP,ALB and PA after 7 days was statistically significant(P <0.05).Compared to the control group,the improvement of parameters in the treatment group was more obvious.Conclusion For patients in general ICU,parenteral nutrition with high BCAA content is able to provide effective nutritional support without relative sideeffects.

Rational Treatment Course of Omeprazole for Critical Patients / 中国药师

Objective: To study the rational treatment course of proton pump inhibitor omeprazole for critical patients in order to improve the prognosis and reduce the hospital stay and treatment expense. Methods:Totally 180 critical patients with APACHEⅡ>10 and mechanical ventilation >48 hours in ICU were selected and randomly divided into 3 groups treated by omeprazole for 1 day, 3 days and 5 days , respectively. The incidence rate of stress ulcer, gastrointestinal hemorrhage and ventilator-associated pneumonia ( VAP) in the three groups was studied, and the ICU stay and expense were also investigated. Results:The incidence rate of stress ul-cer and gastrointestinal hemorrhage in the group with treatment course of 3 days and 5 days were significantly lower than those in the group with 1 day treatment(P<0. 05). The incidence rate of VAP with 3-days treatment was the lowest, compared with 1 day and 5 days treatment, the different was satatistically significant(P<0. 05). The ICU hospitalization time and treatment expense were also significantly different among the three groups, and that in 3-days, group was the lowest(P<0. 05). Conclusion:The 3-day treatment is the most reasonable, which can not only prevent stress ulcer and gastrointestinal bleeding in critical patients, but also reduce the in-cidence of VAP with lowered hospital stay and expense.