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Objective:The evidence on the use of bedside ultrasound to assess muscle mass in critically ill adults was retrieved and screened, and the best evidence was summarized.Methods:A computer search was conducted for relevant literature on ultrasound measurement of muscle mass in critically ill adults in domestic and foreign databases such as BMJ Best Clinical Practice, UpToDate, PubMed, CNKI, and guide website and professional association website. The search time limit was from the establishment of the database to August 30, 2023. Literature quality was evaluated by four researchers trained in systematic evidence-based courses according to literature type.Results:A total of 15 literatures were included, including 2 guideline, 4 expert consensus, 5 systematic reviews and 4 randomized controlled studies. A total of 22 pieces of evidence were summarized, including 6 aspects: position and patient preparation, feasibility of implementation by nursing staff, selection of probe and matters needing attention, muscle positioning, evaluation of muscle structure by ultrasound and the guiding significance of ultrasound evaluation of muscle mass.Conclusions:The best evidence summary of bedside ultrasound assessment of muscle mass in critically ill adults summarized in this study is scientific and systematic, and provides evidence-based basis for establishing standardized ultrasound assessment procedures in clinic.
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【Objective】 To investigate the feasibility of allogeneic platelet-rich plasma (PRP) for the treatment of skin injury around enterostomy. 【Methods】 The treatment process by PRP of 2 patients with skin injury around enterostomy was analyzed, and the PRP for each patient was tested with platelet count, bacteria and 5 growth factors. The clinical efficacy of enteral nutrition support therapy combined with allogeneic PRP was explored through analyzing treatment key points and literature review. 【Results】 After cleaning the skin around enterostomy, the patients were treated with PRP once daily for 5 days, adjusted to once every other day, and cure was achieved at 15 and 18 days, respectively. 【Conclusion】 Allogeneic PRP is a safe and effective treatment to promote skin injury around enterostomy regeneration in a short time, which can provide a new perspective for clinical.
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Objective:To investigate the prognosis and influencing factors in critically ill surgical patients of different feeding intolerance trajectories.Methods:The retrospective cohort study was conducted. The clinical data of 354 critically ill surgical patients who were admitted to 69 medical centers in the Chinese Critical Care Nutrition Trials Group -NEED database from March 2018 to July 2019 were selected. There were 247 males and 107 females, aged 58(46,68)years. According to the trajectory model of feeding intolerance change, 354 patients were divided into 3 categories as feeding intolerance, decreased feeding intolerance, continuous feeding intolerance, including 164, 49, 141 cases respectively. Observation indicators: (1) general situations of patients of different feeding intolerance trajectories; (2) treatment of patients of different feeding intolerance trajectories; (3) survival of patients of different feeding intolerance trajectories; (4) analysis of pro-gnostic factors in critically ill surgical patients. Measurement data of normal distribution were expressed as Mean± SD, and one-way analysis of variance was used for comparison between groups. Measurement data of skewed distribution were expressed as M( Q1, Q3), and Kruskal-Wallis rank sum test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and chi-square test was used for comparison between groups. Ordinal data were compared using the Kruskal-Wallis rank sum test. Bonferroni correction was used for pairwise comparison. Group-based trajectory model was constructed according to Traj plug-in in Stata17.0 statistical software, and the optimal trajectory model was evaluated by Bayesian information criterion and average posterior probability parameter. The Kaplan-Meier method was used to draw the survival curve and calculate the survival rate, and Log-Rank test was used for survival analyses. Univariate and multivariate analyses were conducted using the COX proportional hazard regression model. Results:(1) General situations of patients of different feeding intolerance trajectories. Of 354 critically ill surgical patients, 257 cases underwent enteral nutrition and 97 cases underwent enteral plus parenteral nutrition. The acute physiological and chronic health score (APACHEII) was 17(13,21), and the sequential organ failure score (SOFA) was 6(5,8). The modified Critical Illness Nutritional risk score (mNUTRIC) was 4 (2,5), the number of complications was 2(1,3). There were 293, 55 and 6 patients with grade Ⅰ, grade Ⅱ and grade Ⅲ acute gastrointestinal injury (AGI), and there were 224, 17 and 61 patients who were treated with mechanical ventilation, continuous renal replacement therapy and vasoactive drugs, respectively. The incidence of feeding intolerance in 354 patients increased first and then decreased, reaching a peak of 25.42%(90/354) on the third day and 53.67%(190/354) within 7 days. Of 354 critically ill surgical patients, cases with no feeding intolerance, decreased feeding intolerance, continuous feeding intolerance had the APACHE Ⅱ as 16(12,20), 17(14,25), 18(13,22), mNUTRIC as 3(2,5), 4(3,6), 4(3,5), the number of complications as 2(1,2), 2(2,3), 2(2,3). There were 152, 27, 114 cases with grade Ⅰ AGI, 12, 22, 27 cases with grade Ⅱ-Ⅲ AGI, 95, 39, 90 cases with mechanical ventilation. There were significant differences in the above indicators among the three groups ( H=6.14, 13.11, 28.05, χ2=37.96, 7.65, P< 0.05). Further analysis showed that compared with patients with no feeding intolerance, patients with decreased feeding intolerance and continuous feeding intolerance had the higher number of complications and grade of AGI ( Z=60.32, 54.69, χ2=39.72, 9.52, P<0.05), patients with decreased feeding intolerance had the higher mNUTRIC scores and ratio of mechanical ventilation ( Z=53.41, χ2=7.59, P<0.05). (2) Treatment of patients of different feeding intolerance trajectories. Cases with prokinetic drugs use and post-pyloric feeding were 36, 13 of patients with no feeding intolerance, 25 and 10 of patients with decreased feeding intolerance, 46 and 19 of patients with continuous feeding intolerance, respectively, showing significant differences in the above indicators among the three groups ( χ2=15.76, 6.20, P<0.05). Further analysis showed that compared with patients with no feeding intolerance, patients with decreased feeding intolerance had higher ratio of prokinetic drugs use and ratio of post-pyloric feeding ( χ2=15.60, 6.10, P<0.05). (3) Survival of patients of different feeding intolerance trajectories. The 28-day overall survival rates of patients with no feeding intolerance, decreased feeding intolerance, and continued feeding intolerance were 96.96%, 95.92%, and 87.94%, respectively, showing a significant difference ( χ2=10.39, P<0.05). Further analysis showed a significant difference between patents with no feeding intolerance and patients with continuous feeding intolerance ( χ2=9.19, P<0.05). (4) Analysis of prognostic factors in critically ill surgical patients. Multivariate analysis showed that continuous feeding intolerance was an independent risk factor for 28-day death in critically ill surgical patients ( hazard ratio=3.92, 95% confidence interval as 1.43-10.79, P<0.05). Conclusion:For surgical critically ill patients, patients with continuous feeding intolerance have a higher 28-day mortality than patients with no feeding intolerance, and the continuous feeding intolerance is an independent risk factor for 28-day death in critically ill surgical patients.
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Objective:To investigate the stability of fat emulsions after the preparation of parenteral nutrient solution under different storage conditions.Methods:Standardized parenteral nutrient solution was used to prepare a total of 24 bags of nutrient solution with the same formula, except for that Group A (12 bags) contains 20% of medium and long chain fat emulsion (C6-24) while Group B contains 20% of C8-24. The preparations were stored under 2-8℃, 23-25℃, and 35-37℃ and were examined at 24h, 48h and 72h after preparation. The appearance, average size of fat particles, pH value of nutrient solution, and lipid peroxidation were investigated.Results:After storage at 4℃, 25℃ and 36℃ for 24h, 48h and 72h respectively, both groups of preparations showed no obvious change in appearance. There was no significant difference in pH ( P>0.05) nor lipid peroxidation ( P>0.05). Conclusion:Both kinds of fat emulsion are stable in terms of pH value, fat particle size and lipid peroxidation, and can be used for patients receiving intravenous nutrition support.
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Objective:Analysis of influencing factors of enteral nutrition interruption in critically ill patients in general surgery department and its impact on prognosis.Methods:A total of 91 cases of critically ill patients in general surgery department were selected who were admitted to the general surgery of General Hospital of Eastern Theater Command of the Chinese People′s Liberation Army in Nanjing from June 2021 to March 2022 by convenient sampling method, demographic and enteral nutrition interruption data were collected,and patients were divided into enteral nutrition interruption group and enteral nutrition uninterrupted group to investigate the analysis of the factors of affecting enteral nutrition interruption and its impact on prognosis by Logistic regression analysis.Results:There were 59 cases in the enteral nutrition interruption group and 32 cases in the enteral nutrition uninterrupted group. There were statistically significant differences in gender, analgesic and sedatives, Gastro-kinetic agent and feeding intolerance between both groups ( χ2 values were 4.51-9.97, all P<0.05). Logistic regression analysis results showed that gender ( OR=4.566, 95%CI 1.332-15.657, P<0.05), analgesic and sedatives ( OR=3.437, 95%CI 1.112-10.621, P<0.05), and feeding intolerance ( OR=4.116, 95%CI 1.257-13.479, P<0.05) were the factors of enteral nutrition interruption. There were statistically significant differences between the two groups in the number of days of enteral nutrition up to goal in 3 days, 3-7 days and 7 days, albumin,length of stay in intensive care unit, total length of stay and hospitalization expenses between both groups ( Z values were -2.80 - -0.73, all P<0.05). Conclusions:Female, analgesic and sedatives and feeding intolerance are the risk factors of enteral nutrition interruption in critically ill patients in general surgery department, and enteral nutrition interruption has an adverse impact on the prognosis.Medical staff should avoid excessive use of analgesic and sedatives, and do well in feeding tolerance management to reduce the occurrence of enteral nutrition interruption.
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Objective:To explore the effects of 30° and 45° angles on the time and comfort of mechanical ventilation and extubation for patients undergoing abdominal surgery.Methods:A total of 64 patients who underwent oral tracheal intubation at SICU in the General Surgery Center of the Critical Care Medical Center of our hospital from January 2018 to November 2018 were selected. A total of 64 patients were randomly divided into group A and group B by random number table method, of which there were 31 people in group A and 33 people in group B. During the experiment, 1 people in group A and 3 people in group B experienced dyspnea during the withdrawal process and terminated treatment. Finally, 30 patients in group A and 30 patients in group B were selected. The bedside angle during group A treatment was 30°, and the bedside angle during group B treatment was 45°. The bedside angle card was used by both groups to measure the height of the bedside during the weaning. The two groups of patients were compared during the weaning period (improved Visual Analogue Scale score), weaning to extubation time, aspiration rate, intubation time, pressure ulcer rate, pulmonary function and hemodynamic changes after extubation.Results:Patients with ventilator to extubation time, during the machine during oxygenation index, pulled machine comfort score in group A were 117.50 (45.25, 189.00) min, (348.20±59.72) mmHg(1 mmHg=0.133 kPa), 1.00 (1.00, 2.00) points, group B were respectively 30.00 (13.50, 42.75) min, (314.60±67.13) mmHg and 3.00 (2.00, 3.00) points, two groups comparing the difference was statistically significant ( Z values was -2.411, -4.806, t value was 2.048, P<0.05 or 0.01). Conclusion:Lifting the bedside 30° during mechanical ventilation withdrawal in patients with abdominal surgery can shorten the time from patient withdrawal to extubation, improve the patient's oxygenation index, and improve the comfort during patient withdrawal. It can be used as an early patient for abdominal surgery. One of the auxiliary intervention measures for withdrawal.
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Objective:To offer experience for preventing thrombosis-related complications in patients receiving extracorporeal membrane oxygenation (ECMO).Methods:A case of mural thrombosis occurred in a patient with acute respiratory distress syndrome (ARDS) during ECMO therapy. The key points for nursing included: intensive monitoring of the ECMO parameters, repeated assessment of the thrombosis and appropriate preventive measures, adequate nutritional support, active mobilization and rehabilitation, and psychological care.Results:No severe thrombosis-related complication occurred during hospitalization and the patient was discharged 62 days after admission.Conclusion:Mural thrombosis related complication could be well prevented with active and individualized nursing.
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Objective To explore the correlation of stage early upright mobilization in critical patients and enteral nutrition- related tolerance. Methods A total of 50 critically patients with continuous enteral nutrition who admitted in ICU from October 2016 to July 2017 were randomized into two groups;the control group (receiving routine functional exercise in bed) and the observation group (stage early upright mobilization)25 cases in each group,the correlation of nutrition-related tolerance,the length of target feeding time and incidence of catheter related adverse events were compared. Results There was no statistically significant difference in the incidence of reflux of stomach,aspiration,diarrhea and catheter related adverse events in this two group patients during enteral nutrition(P>0.05),while the times of interrupting enteral nutrition in the observation group(0)was lower than that of the control group (20.83%,5/24),with a statistically significant difference(χ2=4.922,P=0.035).The length of target feeding time was shortened, (3.04 ± 0.66) d in the control group, (3.57 ± 0.83) d in the observation group,with a statistically significant difference(t=2.409,P=0.025). Conclusions Stage early upright mobilization in critical patients is safe and feasible,it can improve the feeding tolerance and shorten the length of target feeding time to promote the early recovery of the patient's disease.
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Objective To observe the clinical outcomes and safety of continuous negative pressure irrigation (NPI) and endoscopic necrosectomy(ED) for treating infected pancreatic necrosis(IPN). Methods A retrospective review of the data of 163 severe acute pancreatitis(SAP) patients with IPN who were treated by four-step drainage from January 2012 to December 2013 at the SAP therapy center of Nanjing General Hospital was performed. All patients were divided into 7 groups including PCD alone, PCD+NPI, PCD+NPI+ED, PCD+ON, PCD +NPI +ON, PCD +ED +ON and PCD +NPI +ED +ON group based on the drainage strategy of percutaneous catheter drainage(PCD),NPI, ED and open necrosectomy(ON), and the feasibility and safety were analyzed. Results All the patients underwent PCD therapy. Each patient underwent a median of 3 drainage procedures and the median total drainage duration was 11 days. No significant procedure-related complication was observed. Around 40% of the patients recovered after receiving PCD alone. Thirty-four patients(20.9%) underwent ON. The mean hospitalization duration was 38 days and the mean ICU stay was 19 days. There were 25 cases with new-onset organ functional failure,26 patients with sepsis,32 patients with gastric and intestinal fistula,34 patients with intra-abdominal bleeding,8 patients with portal vein thrombosis and 3 patients with gastric outlet obstruction. 28 patients(17.2%) died. Conclusions This four-step approach is effective in treating IPN when compared with other step-up strategies. NPI and ED could offer distinct clinical efficacy without adding no extra risk to patients.
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Objective: To construct the management model for intravenous drug use based on index system in a hospital.Methods: A three-level organizational framework was established, the KPI assessment method was used to set control index and observational index respectively for outpatients and inpatients.The completion of the clinical department indicators were monitored and analyzed with the help of the hospital information systems, and regulated by pharmacy and management tools.Results: After the application of the hospital intravenous drug use management model, the qualification rate of intravenous medication orders was improved in December 2015 (89%) when compared with that in December 2014 (68%), and the difference was statistically significant(P＜0.05).The indices of intravenous drug use of inpatients and outpatients in 2015 were significantly improved when compared with those in 2014.Conclusion: The hospital intravenous drug use management model based on index system construction can effectively reduce unnecessary intravenous medication and promote the rationality of intravenous medication.
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This report summarized the nursing experience of caring for twice skin grafts in a patient with enteroatmospheric fistula after trauma.Keys to nursing success including:monitoring vital signs closely to prevent septic shock,blocking enteroatmospheric fistula (EAF) and sucking overflowed intestinal juice timely,promoting the protection of the graft on abdominal wall wounds,strengthing drainage and lavage with the application of abdominal double cannula to control abdominal infection,early nutrion support with parenteral nutrition in combination with trophic enteral nutrition to improve intestinal immune function,and attaching importance to post-traumatic stress disorder.Timely blocking of EAF is the bases of skin graft healing.
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Objective: To evaluate the self-developed intelligent assist order system for parenteral nutrition on the control of concentration exceeding standard of positive ions.Methods: The special comments, pharmacist audit and information control were used to intervene the concentration exceeding standard of positive ions in parenteral nutrition orders and the effect of the three intervention methods were evaluated.Results: For the intervention of concentration exceeding standard of positive ions in parenteral nutrition orders, the information control was better than the special comments and pharmacists audit.Conclusion: The intelligent assist order system for parenteral nutrition can solve the problem of concentration exceeding standard and promote the rational application of parenteral nutrition in hospitals.
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Objective Cancer-related fatigue (CRF) is a key in the management of cancer patients' clinic syptoms.This article investigated the status quo of nurses' knowledge and attitude towards CFR.Methods THe method of cross-sectional survey and questionnaire was used to investigate the knowledge and attitude towards CRF among nurses from related departments of three Grade III hospitals in Nanjing.Results 142 nurses answered the questionnaire.The average correct rate was 76.25%, among which nurses from the oncology department had better congition rate than nurses from other medical and surgical departments (84.3%, 75.98%, 79.57%) , representing significant difference (P<0.05).64.79% of the nurses found the relatives of cancer patients and nurses often fail to understand cancer patients;complaint of fatigue, 76.76% of nurses assumed there is lack of communication in fatigue between patients and medical staff.94.36% of nurses agreed medical institutions should strengthen the management of CRF.Conclusion At present, the clinical nurses have inadequate knowledge about CRF, which should be enhanced in future work.
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Objective There is no quantization scheme for the early ambulation in patients with gastrointestinal tumor after operation of enhanced recovery .The aim of this study was to explore a suitable objective method of postoperative ambulation for gastro -intestinal tumor patients . Methods Sixty six gastrointestinal tumor postoperative patients were randomly assigned to two groups :ex-perimental group ( 33 cases ) and control group ( 33 cases ) .Enhanced recovery was adopted in the both groups afterthe operation . Wireless smart bracelets ( fitbit flex) were used in the experimental group , and the ambulation of patients was monitored by the hand of synchronous real time computer digital panel .At the same time, the patients was supervised for positive ambulation . Traditional quantitative methods of electronic pedometer were used in the control group.The postoperative ambulation , effect and compliance were compared between the two groups . Results Postoperative ambula-tion steps in the experimental group were increased compared with the control group on the days 1, 2, and 3postoperative, and the data were (208.70 ±45.76) vs (144.36 ±47.68), (560.73 ±148.67) vs (407.00 ±85.92), and (894.70 ±91.68) vs (674.00 ±73.06) steps (P<0.05).The first time of early ambulation, flatus, ca-tharsis, and compliance of ambulation showed significant difference in the two groups (P<0.05). Conclusion Wireless intelligent monitoring bracelet is objective and effective for monitoring and quantifying postoperative ambulation .It is superior to the traditional quantitative methods , and can improve the effect and compliance of the ambulation .Moreover , it can promote postoperative recovery in patient with enhanced recovery surgery .
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Objective To investigate the management of retroperitoneal infected necrotic tissues in pelvic cavity in patients with severe acute pancreatitis (SAP).Methods The clinical data of 5 patients with SAP complicated with retroperitoneal infected necrotic tissue in the pelvic carvity who were admitted to the General Hospital of Nanjing Military Area from December 2009 to February 2012 were retrospectively analyzed.Systemic comprehensive treatement combined with local management were applied to all the patients.Results Systemic comprehensive treatment:all the 5 patients were treated by enteral nutrition,3 by mechanical ventilation and 3 by continuous blood purification.All the retroperitoneal infected necrotic tissues in the pelvic carvity were treated by computed tomography (CT)-guided percutaneous catheter drainage,and then the patients were converted to open surgery for further drainage.Four patients had complication of infected pancreatic necrosis bleeding,and they were treated by arterial embolism and (or) sandwich therapy.Local management:5 patients with retroperitoneal infected necrotic tissues received CT-guided percutaneous catheter drainage via buttocks.The average time of puncturation after illness was 38.4 days,and the average CT density of infected necrotic tissue was 24.4 Hu (20-28 Hu).Catheterization was successfully done in the open surgery for all the 5 patients,and the average time of abdominal drainage was 21 days.The body temperature and white blood cell count were decreased after puncturation.The average duration of intensive care unite stay,the average time of hospital stay and the average cost of hospitalization were (47 ± 20 )days,(88 ±34 )days and (186 342 ± 15 467 )yuan.All the patients were followed up till May 2012,no recurrece of the retroperitoneal infected necrotic tissue was detected.Conclusion CT-guided percutaneous catheter drainage via buttocks is effective for the treatment of retroperitoneal infected necrotic tissue in the pelvic cavity in SAP patients.
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Objective To discuss the frequency of ventilator pipe replacement in ICU ward for reducing the frequency of VAP occurrence caused by bacterial colonization in ventilator-line. Methods 30 patients hospitalized to ICU ward from Janurary,2008 to June, 2009 who had mechanical-ventilation above 48h were randomly divided into group A, B and C with 30 patients in each group, then bacteria culture and strain analysis were employed for the pipeline sample of ventilator inspiratory side at the time point to be use and used mechanical ventilation for 1 day, 3 days and 7 days. Results There was no bacteria grew after ventilator-line sterilization, and positive ratio of bacterial culture in 1d, 3d and 7d were 46.66%,53.33% and 100.00%, respectively. Conclusions The frequency of ventilator pipe replacement should be shortened in patients with abdominal infection, to replace every 3 days is suitable in ICU where infectious patients gathered.
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This paper summarizes the systematic management of artificial airway for 36 postoperative patients with laryngeal cancers. A full-time nurse is responsible for the systematic artificial airway management to implement respiratory care,endotracheal tube care,infection prevention and control,nutritional support and health education. As a result,the incidence of fever,frequent cough,and bloody sputum was 2.12%. Pharyngeal fistula and pulmonary infection occurred in one patient,respectively. All the patients recovered well after intensive care. It is suggested that systematic artificial airway management can effectively reduce complications,improve the quality of nursing and increase patient satisfaction.
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This paper summarizes the experiences of nursing care of five patients with stoma after small bowel allotransplantation. The nursing care focused on observation of the survival,motility,secretion and other functions of early transplanted bowel,preparation and cooperation for colonoscopy,stoma care during enteral nutritional support,observation of the digestion,absorption and rejection of transplanted bowels. The five patients survived after operations. The stoma of transplanted bowels was ruddy and had a good circulation without complications such as rupture of skin around stoma. The patients gradually restored the normal diet by mouth.
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Objective:To investigate the knowledge of hand-cleaning in student nurses,cultivate their awareness of washing hands,improve their submitting of washing hands and standardize their washing procedure,so as to reduce the hospital-acquired infection via hands.Methods: A self-designed questionnaire on hand-cleaning-related knowledge was used to survey 100 student nurses in their clinical practice in our hospital.Results:In the 100 questionnaires,some student nurses have poor-mastering of the signs of hand-cleaning,and have indefinite concepts of the time,position and frequency of hand-cleaning.The most frequently forgotten part of hands cleaning is finger(42%),the second is wrist(29%).Lots of student nurses(92%) mistakingly thought that washing hands with warm water was much better.Conclusion:The student nurses had relatively poor knowledge on hand-cleaning,much more attention should be paid on the education of this aspect by nursing department,in order to improve self-protection and control of hospital-acquired infection effectively.
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Objective: To investigate the absorption of EVA and PVC infusion sets to insulin.Methods: Two infusion sets of EVA and PVC were used to contain insulin which was mixed with TNA and preserved at 4℃ and 25℃ for o,8,24 and 48 h,respectively.The content of insulin was observeed for changes.Results: The content of insulin mixed with TNA in EVA bags was obviously higher than in PVC bags preserved at 25℃ for 48h(P