Application of fecal collection device in Intensive Care Unit Patients with fecal incontinence Receiving Extracorporeal Membrane Oxygenation: A Comparison Cohort Study.

Objective: The objective of this study was to assess the effectiveness of fecal collection devices in preventing incontinence-associated dermatitis (IAD) and reducing skin care time in ICU patients with fecal incontinence undergoing Extracorporeal Membrane Oxygenation (ECMO). Methods: A nonrandomized comparison cohort (quasi-experimental) study with pre-post comparison was carried out in a general intensive care unit. 85 bedridden patients receiving ECMO with fecal incontinence (FI) in a general intensive care unit between June 2017 and May 2022 participated in the study and separated into two groups according to the fecal collection device they received. 40 were assigned to the Control group (structured IAD preventive care protocol alone) and 45 to the Intervention group (structured IAD preventive care protocol plus application of fecal collection device). The status of IAD was assessed using the Incontinence Associated Dermatitis Intervention Tool (IAD-IT). Fecal consistency was evaluated via the Bristol Stool Scale. Outcome measures included the nursing time for skin care and the incidence of IAD, and bleeding complications between the two groups during the period. Results: Participants in the Intervention group had fewer IAD occurrences than participants in the Control group (13.33% vs. 52.50%, P < .05). The patients in the Intervention group significantly reduced skincare time (63.30±14.09 min in the Control group versus 28.44±2.04 min in the Intervention group, P < .01). There was 3 turning complications for bleeding in the Intervention group and 11 in the Control group and had a significant reduction in urning complications(3 vs.11, P = .022). Conclusions: Applying a fecal collection device may reduce skincare time and reduce occurrences of IAD and bleeding related to turning position for skin care in ICU patients with FI associated with diarrhea receiving ECMO Support.This study offers a more efficient way to use the fecal collection device in ECMO patients.Future research needs to focus on the perianal skin in ECMO patients regarding fecal collection devices connected to continuous low-negative-pressure suction devices.

Impact of Double-Machine Replacement Protocol at Start of Continuous Renal Replacement Therapy in Vasopressor-Dependent Patients: A Retrospective Cohort Study.

INTRODUCTION: When starting continuous renal replacement therapy (CRRT), vasopressor-dependent patients are at risk of hemodynamic instability. Thus far, only a few studies have analyzed the impact of CRRT circuit replacement for vasopressor-dependent patients. Hence, we compared the effect of double-machine replacement protocol (DMRP) with single-machine replacement protocol (SMRP) for CRRT circuit replacement in vasopressor-dependent patients. METHODS: The medical records of 96 vasopressor-dependent patients treated with CRRT in the general intensive care unit of the Shunde Hospital, Southern Medical University, between January 2017 and April 2018 were retrospectively analyzed. The major measures of the SMRP included returning the blood to the patient and sealing access catheter with heparin and starting a new CRRT machine with a slow blood pump, while DMRP involved simultaneous drawing and return of blood with two machines using a slow blood pump for circuit replacement. The primary outcome measures were changes in vasopressor dose and hemodynamic parameters, and the secondary outcome measure was the pause time difference between the two groups during the period. RESULTS: A total of 53 patients were treated with SMRP and 43 patients with DMRP. Heart rate was higher in the SMRP group as compared to the DMRP group (p < 0.05). There were no significant changes in central venous pressure, mean arterial pressure, and vasopressor dose in either group (p > 0.05). The patients in the DMRP group had a significant reduction in CRRT pause time (5.62 ± 0.69 min in DMRP group vs. 37.01 ± 8.72 min in SMRP group, p < 0.01). The DMRP group needed a lower volume of circuit purging and priming fluid related to CRRT circuit replacement (0 mL in DMRP group vs. 463 mL in SMRP group). CONCLUSIONS: Implementation of the DMRP for CRRT circuit replacement had a slight hemodynamic effect on vasopressor-dependent patients. It also reduced the pause time and volume of circuit purging and priming fluid related to CRRT circuit replacement compared with SMRP.