Effect of a 1-Piece Drainable Pouch on Incontinence-Associated Dermatitis in Intensive Care Unit Patients With Fecal Incontinence: A Comparison Cohort Study.

PURPOSE: The purpose of this study was to compare the effect of a 1-piece drainable pouch to standard care on occurrences of incontinence-associated dermatitis (IAD) in intensive care unit (ICU) patients with fecal incontinence (FI). DESIGN: Nonrandomized comparison cohort (quasi-experimental) study. METHODS: Sixty-two bedridden patients with FI and indwelling urinary catheters in the ICU of the Shunde Hospital, Southern Medical University, Foshan, China, participated in the study. Thirty-one were assigned to the control group (standard IAD preventive care alone) and 31 to the intervention group (standard IAD preventive care plus application of a 1-piece drainable pouch). Stool consistency was evaluated via the Bristol Stool Scale. Trained nurses assessed the status of IAD using the Incontinence-Associated Dermatitis Intervention Tool. The incidence of IAD and the perianal skin status were investigated over a 7-day period. RESULTS: Participants in the experimental group had fewer IAD occurrences than participants in the control group (12.9% vs 41.9%, P < .05). Occurrences of IAD in the perianal were also significantly lower in the experimental group than in the control group (χ = 7.884, P < .05). CONCLUSION: Applying a 1-piece drainable pouch may reduce occurrences of IAD in ICU patients with FI compared with the patients receiving standard IAD preventive care.

[Septic pulmonary embolism in intravenous drug users].

OBJECTIVE: To analyze the characteristics of septic pulmonary embolism (SPE) in intravenous drug users. METHODS: The clinical manifestations, radiographic findings, bacteriology, echocardiography and outcome of intravenous drug users were analyzed retrospectively. RESULTS: Twenty-two patients were identified with SPE between January of 1994 and December of 2006. Presenting symptoms included fever (22/22), dyspnea (20/22), pleuritic chest pain (10/22), cough (18/22), and hemoptysis (8/22). Chest radiographic features included nodular (15/22) and focal (12/22) infiltrates, wedge-shaped lesions (5/22), cysts (18/22), cavities (11/22), and pleural lesions (11/22). Peripheral or subpleural zones were most commonly affected (20/22). CT was more helpful and revealed multiple air cysts or nodules peripherally, often with cavitation. Staphylococcus aureus was the aetiological pathogen in all patients. Tricuspid valve vegetations were detected in all patients. Aside from antimicrobial therapy, the management included mechanical ventilation, control of shock and tube thoracostomy. Most patients recovered from their illness. CONCLUSIONS: SPE manifests with variable and often nonspecific clinical and radiographic features. The diagnosis is usually suggested by the presence of a predisposing factor, fever, and radiographic findings of multiple, peripheral or subpleural air cysts, or nodules with or without caritation. With early diagnosis, appropriate antimicrobial therapy, and control of the infectious source, resolution of the illness can be expected for most patients.