Objective: To analyze the accuracy of serum prealbumin levels in predicting the prognosis of patients with critical respiratory illness. Methods: Fifty patients with critical respiratory illness admitted to our hospit...Objective: To analyze the accuracy of serum prealbumin levels in predicting the prognosis of patients with critical respiratory illness. Methods: Fifty patients with critical respiratory illness admitted to our hospital from October 2022 to September 2023 were selected and divided into an observation group and a control group after condition assessment, with 25 cases in each group. The results of cholinesterase (ChE), prealbumin (PALB), albumin (ALB), aspartate aminotransferase (AST), total protein (TP), and forced expiratory volume (FEV1)/Predicted (Pred) of the two groups were measured. Results: The ChE levels of the observation group were lower than those of the control group, while the PALB and ALB levels of the observation group were higher than those of the control group (P < 0.05). The AST, TP, and FEV1 /Pred levels of the observation group were higher than those in the control group (P < 0.05). Conclusion: Serum PALB levels can be used as the main indicator for prognosis in critically ill respiratory patients.展开更多
Sleep is a complex process influenced by biological and environmental factors.Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo.Slee...Sleep is a complex process influenced by biological and environmental factors.Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo.Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment.This review will outline the predisposing and precipitating factors for sleep disturbance,categorised into patient,environmental and treatment-related factors.The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed.While polysomnography remains the gold-standard,its use in the critical care setting still presents many barriers.Other methodologies are needed to better understand the pathophysiology,epidemiology and treatment of sleep disturbance in this population.Subjective outcome measures,including the Richards-Campbell Sleep Questionnaire,are still required for trials involving a greater number of patients and provide valuable insight into patients’experiences of disturbed sleep.Finally,sleep optimisation strategies are reviewed,including intervention bundles,ambient noise and light reduction,quiet time,and the use of ear plugs and eye masks.While drugs to improve sleep are frequently prescribed to patients in the ICU,evidence supporting their effectiveness is lacking.展开更多
Objective:To investigate the predictive value of controlling nutritional status(CONUT)score for progression to chronic critical illness sepsis in elderly patients,and to construct a predictive model based on CONUT sco...Objective:To investigate the predictive value of controlling nutritional status(CONUT)score for progression to chronic critical illness sepsis in elderly patients,and to construct a predictive model based on CONUT score histogram.Methods:739 elderly patients with sepsis admitted from January 2020 to December 2022 were selected as the study objects,and were divided into chronic critical illness group(n=188)and non-chronic critical illness group(n=551)according to whether chronic critical illness disease occurred.Clinical data of the patients were collected and compared.The predictive value of CONUT score,PNI and NLR in the progression of senile sepsis to chronic severe disease was compared,and the optimal threshold value was determined,which was used to convert the numerical variables into binary variables.Through univariate analysis and multivariate Logistic regression analysis,the risk factors affecting the progression of elderly sepsis patients to chronic critical illness disease were screened out,and the prediction model was built based on the nomogram.The efficacy and clinical utility of the prediction model were evaluated by the area under the ROC curve(AUC),calibration curve and decision curve analysis(DCA).Results:The best cut-off value for CONUT score in predicting elderly sepsis progressing to chronic critical illness was 4 points.The predictive performance of CONUT score(AUC=0.739)was better than that of PNI(AUC=0.609)and NLR(AUC=0.582)in elderly sepsis progressing to chronic critical illness(CONUT score vs PNI:Z=5.960,P<0.001;CONUT score vs NLR:Z=6.119,P<0.001).Univariate analysis showed that age,CCI score,SOFA score,sepsis shock,serum Lac,CONUT score,mechanical ventilation(MV),and continuous renal replacement therapy(CRRT)treatment were related to elderly sepsis progressing to chronic critical illness(P<0.05).Multivariate logistic regression analysis showed that CONUT score≥4 points,age≥75 years,CCI score≥3 points,SOFA score>5 points,sepsis shock,and serum Lac≥4 mmol/L were independent risk factors for elderly sepsis progressing to chronic critical illness(P<0.05).The nomogram showed that CONUT score had the greatest contribution value in predicting elderly sepsis progressing to chronic critical illness.Based on this,the nomogram prediction model had an AUC of 0.846[95%CI(0.812~0.879)],with a sensitivity of 75.5%and specificity of 81.3%,indicating good predictive performance.The calibration curve was close to the ideal curve,and the DCA threshold had clinical utility advantages when ranging from 0.1 to 0.9.Conclusion:The nomographic prediction model based on CONUT score can effectively predict the risk probability of senile sepsis progressing to chronic critical illness,helpful for clinicians to identify the high risk group of chronic and severe senile sepsis,which is helpful for clinicians to identify high-risk populations of elderly sepsis with chronic critical illness.展开更多
Critically ill patients are a vulnerable group at high risk of developing secondary infections.High disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity mak...Critically ill patients are a vulnerable group at high risk of developing secondary infections.High disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections,including cytomegalovirus(CMV).CMV seroconversion has been reported in up to 33%of ICU patients,but its impact on patient outcomes remains a matter of debate.Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/acquired immuno deficiency syndrome,the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous.Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement.Hence,a better understanding of the symptomatology,diagnostics,and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.展开更多
Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of ...Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of 77 critically ill children and 33 non-diabetic healthy children (controls) who were admitted between 07/2015 and 05/2016. Patient data, clinical information, and blood samples were collected on admission, alongside a large number of laboratory parameters that were routinely assessed. Critically ill patients were divided into sepsis and non-sepsis/systemic inflammatory response syndrome (SIRS). Serum GLUT4 was measured using western blotting and enzyme-linked immunosorbent assays. Insulin resistance indexes, clinical data, laboratory parameters, and inflammatory cytokines were assessed. Results: GLUT4 serum levels were higher in critically ill children than in healthy children (90.5 vs. 30.3 μg/L, P 0.05). Compared to healthy children, hyperglycemic patients (n = 48) had elevated GLUT4 serum levels (30.3 vs. 103.7 g/L, P Conclusions: GLUT4 serum levels might be significantly increased in critically ill children compared with healthy children, particularly those in septic shock. Serum GLUT4 could predict disease severity.展开更多
Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs ...Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.展开更多
AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, ne...AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.展开更多
Alcohol is the most commonly used and abused drug in the world, and alcohol use disorders pose a tremendousburden to healthcare systems around the world. The lifetime prevalence of alcohol abuse in the United States i...Alcohol is the most commonly used and abused drug in the world, and alcohol use disorders pose a tremendousburden to healthcare systems around the world. The lifetime prevalence of alcohol abuse in the United States is estimated to be around 18%, and the economic consequences of these disorders are staggering. Studies on hospitalized patients demonstrate that about one in four patients admitted to critical care units will have alcohol-related issues, and unhealthy alcohol consumption is responsible for numerous clinical problems encountered in intensive care unit(ICU) settings. Patients with alcohol use disorders are not only predisposed to developing withdrawal syndromes and other conditions that often require intensive care, they also experience a considerably higher rate of complications, longer ICU and hospital length of stay, greater resource utilization, and significantly increased mortality compared to similar critically ill patients who do not abuse alcohol. Specific disorders seen in the critical care setting that are impacted by alcohol abuse include delirium, pneumonia, acute respiratory distress syndrome, sepsis, gastrointestinal hemorrhage, trauma, and burn injuries. Despite the substantial burden of alcoholinduced disease in these settings, critical care providers often fail to identify individuals with alcohol use disorders, which can have significant implications for this vulnerable population and delay important clinical interventions.展开更多
Widespread implementation of electronic health records has led to the increased use of artificial intelligence(AI)and computer modeling in clinical medicine.The early recognition and treatment of critical illness are ...Widespread implementation of electronic health records has led to the increased use of artificial intelligence(AI)and computer modeling in clinical medicine.The early recognition and treatment of critical illness are central to good outcomes but are made difficult by,among other things,the complexity of the environment and the often non-specific nature of the clinical presentation.Increasingly,AI applications are being proposed as decision supports for busy or distracted clinicians,to address this challenge.Data driven“associative”AI models are built from retrospective data registries with missing data and imprecise timing.Associative AI models lack transparency,often ignore causal mechanisms,and,while potentially useful in improved prognostication,have thus far had limited clinical applicability.To be clinically useful,AI tools need to provide bedside clinicians with actionable knowledge.Explicitly addressing causal mechanisms not only increases validity and replicability of the model,but also adds transparency and helps gain trust from the bedside clinicians for real world use of AI models in teaching and patient care.展开更多
Critical illness polyneuropathy and critical illness myopathy are frequent complications of severe illness that involve sensorimotor axons and skeletal muscles,respectively.Clinically,they manifest as limb and respira...Critical illness polyneuropathy and critical illness myopathy are frequent complications of severe illness that involve sensorimotor axons and skeletal muscles,respectively.Clinically,they manifest as limb and respiratory muscle weakness.Critical illness polyneuropathy/myopathy in isolation or combination increases intensive care unit morbidity via the inability or difficulty in weaning these patients off mechanical ventilation.Many patients continue to suffer from decreased exercise capacity and compromised quality of life for months to years after the acute event.Substantial progress has been made lately in the understanding of the pathophysiology of critical illness polyneuropathy and myopathy.Clinical and ancillary test results should be carefully interpreted to differentiate critical illness polyneuropathy/myopathy from similar weaknesses in this patient population.The present review is aimed at providing the latest knowledge concerning the pathophysiology of critical illness polyneuropathy/myopathy along with relevant clinical,diagnostic,differentiating,and treatment information for this debilitating neurological disease.展开更多
Critical illness is a sudden traumatising lived experience that affects the sufferer and their family throwing them into a crisis situation [1,2]. It is disruptive and alienating. Critically ill patients emerging from...Critical illness is a sudden traumatising lived experience that affects the sufferer and their family throwing them into a crisis situation [1,2]. It is disruptive and alienating. Critically ill patients emerging from unconsciousness often suffer from confusion that could be momentary or lasting. There is an increasing number of critical illness survivors in intensive care units (ICU)1 with numerous life changing ongoing physiological and psychological sequelae from critical illness and ICU hospitalization, with inadequate ongoing treatment for ICU survivors. Medicalised accounts of critical illness fail to recognise the significant impact on the person, their embodied sense of self and their ability to move on with their life after they leave hospital. The main purpose of this study was to explore the experience of critically ill patients in ICU and beyond. This phenomenological study describes what it was like for twelve people to experience critical illness in ICU and in the months after discharge. The finding was that critical illness is an acute life threatening event with long lasting effects which translate into temporal and biographical disruption, imprisonment by the ICU and its therapies and being trapped in an alien body that is plagued by uncertainty and long lasting conditions arising from the critical illness and the ICU therapies. Critical illness survivors are left in a state of limbo characterised by a struggle to reclaim their precritical illness ICU identity and uncertainty about their future. Hence an overarching theme of being in limbo under which three major themes of 1) disrupttion, 2) imprisonment and 3) being trapped were generated from the study.展开更多
The glucocorticoid receptor(GCR)and the mineralocorticoid receptor(MR)are members of the steroid receptor superfamily of hormone-dependent transcription factors.The receptors are structurally and functionally related....The glucocorticoid receptor(GCR)and the mineralocorticoid receptor(MR)are members of the steroid receptor superfamily of hormone-dependent transcription factors.The receptors are structurally and functionally related.They are localized in the cytosol and translocate into the nucleus after ligand binding.GCRs and MRs can be co-expressed within the same cell,and it is believed that the balance in GCR and MR expression is crucial for homeostasis and plays a key role in normal adaptation.In critical illness,the hypothalamic-pituitary-adrenal axis is activated,and as a consequence,serum cortisol concentrations are high.However,a number of patients exhibit relatively low cortisol levels for the degree of illness severity.Glucocorticoid(GC)actions are facilitated by GCR,whose dysfunction leads to GC tissue resistance.The MR is unique in this family in that it binds to both aldosterone and cortisol.Endogenous GCs play a critical role in controlling inflammatory responses in critical illness.Intracellular GC concentrations can differ greatly from blood levels due to the action of the two 11β-hydroxysteroid dehydrogenase isozymes,type 1 and type 2.11β-hydroxysteroid dehydrogenases interconvert endogenous active cortisol and intrinsically inert cortisone.The degree of expression of the two isozymes has the potential to dramatically influence local GC availability within cells and tissues.In this review,we will explore the clinical studies that aimed to elucidate the role of MR and GCR expression in the inflammatory response seen in critical illness.展开更多
BACKGROUND Critical time intervention(CTI)is an evidence-based model of practice that is time-limited and aims to provide support for most susceptible individuals during a transition period.AIM To examine the signific...BACKGROUND Critical time intervention(CTI)is an evidence-based model of practice that is time-limited and aims to provide support for most susceptible individuals during a transition period.AIM To examine the significance of fostering the mental health of diabetes patients through CTI using the scoping review methodology.METHODS As part of the scoping review process,we followed the guidelines established by the Joanna Briggs Institute.The search databases were Google Scholar,PubMed,Scopus,PsycINFO,Reference Citation Analysis(https://www.referencecitation-analysis.com/),and Cochrane Library.From these databases,77 articles were retrieved with the aid of carefully selected search terms.However,19 studies were selected after two reviewers appraised the full texts to ensure that they are all eligible for inclusion,while 54 papers were excluded.RESULTS This study revealed that diabetic patients who had experienced homelessness were at higher risk of being diagnosed with mental illness and that social support services are impactful in the management of the comorbidity of diabetes and mental health problems.In addition,this review reveals that CTI is impactful in enhancing the mental health of homeless patients during the transitional period from the hospital through social support services.CONCLUSION CTI is a promising intervention for alleviating mental health symptoms in homeless patients.Empirical studies are needed across the globe,involving both hospitalized and community-based patients,to determine how clinically effectively CTI is in managing the mental health of diabetics.展开更多
BACKGROUND Rifaximin is frequently administered to critically ill patients with liver disease and hepatic encephalopathy,but patients currently or recently treated with antibiotics were frequently excluded from studie...BACKGROUND Rifaximin is frequently administered to critically ill patients with liver disease and hepatic encephalopathy,but patients currently or recently treated with antibiotics were frequently excluded from studies of rifaximin efficacy.Due to overlapping spectrums of activity,combination therapy with broad-spectrum antibiotics and rifaximin may be unnecessary.A pharmacist-driven protocol was piloted to reduce potentially overlapping therapy in critically ill patients with liver disease.It was hypothesized that withholding rifaximin during broad-spectrum antibiotic therapy would be safe and reduce healthcare costs.AIM To determine the clinical,safety,and financial impact of discontinuing rifaximin during broad-spectrum antibiotic therapy in critically ill liver patients.METHODS This was a single-center,quasi-experimental,pre-post study based on a pilot pharmacist-driven protocol.Patients in the protocol group were prospectively identified via the medical intensive care unit(ICU)(MICU)protocol to have rifaximin withheld during broad-spectrum antibiotic treatment.These were compared to a historical cohort who received combination therapy with broadspectrum antibiotics and rifaximin.All data were collected retrospectively.The primary outcome was days alive and free of delirium and coma(DAFD)to 14 d.Safety outcomes included MICU length of stay,48-h change in vasopressor dose,and ICU mortality.Secondary outcomes characterized rifaximin cost savings and protocol adherence.Multivariable analysis was utilized to evaluate the association between group assignment and the primary outcome while controlling for potential confounding factors.RESULTS Each group included 32 patients.The median number of delirium-and coma-free days was similar in the control and protocol groups[3 interquartile range(IQR 0,8)vs 2(IQR 0,9.5),P=0.93].In multivariable analysis,group assignment was not associated with a reduced ratio of days alive and free of delirium or coma at 14 d.The protocol resulted in a reduced median duration of rifaximin use during broad-spectrum antibiotic therapy[6 d control(IQR 3,9.5)vs 1 d protocol(IQR 0,1);P<0.001].Rates of other secondary clinical and safety outcomes were similar including ICU mortality and 48-h change in vasopressor requirements.Overall adherence to the protocol was 91.4%.The median estimated total cost of rifaximin therapy per patient was reduced from$758.40(IQR$379.20,$1200.80)to$126.40(IQR$0,$126.40),P<0.01.CONCLUSION The novel pharmacist-driven protocol for rifaximin discontinuation was associated with significant cost savings and no differences in safety outcomes including DAFD.展开更多
BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity.Early diagnosis and specific treatment may improve outcomes.Lack of specific clinical signs or tests make the...BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity.Early diagnosis and specific treatment may improve outcomes.Lack of specific clinical signs or tests make the diagnosis challenging.AIM To assess the efficacy of cerebrospinal fluid(CSF)lactate in diagnosing meningitis in critically ill patients.METHODS A prospective,observational cohort study was carried out in a neuro-medical intensive care unit(ICU)over a 22 mo period.Adult patients,with suspected meningitis admitted in ICU,were serially recruited.Patients who refused consent,those with peripheral sensorineural deficit,or with any contraindication to lumber puncture were excluded.CSF cytology,bio-chemistry,lactates,culture and polymerase chain reaction based meningo-encephalitis panel were evaluated.Patients were divided in two groups based on clinical diagnosis of meningitis.The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests.RESULTS Seventy-one patients were included and 23 were diagnosed with meningitis.The mean values of CSF total leucocyte count(TLC),proteins and lactates were significantly higher in meningitis group.There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel.CSF lactate(>2.72 mmol/L)showed good accuracy in diagnosing meningitis with an area under the curve of 0.81(95% confidence interval:0.69-0.93),sensitivity of 82.6%,and specificity 72.9%.These values were comparable to those of CSF TLC and protein.Twelve patients with bacterial meningitis had significantly higher CSF lactate(8.9±4.7 mmol/L)than those with non-bacterial meningitis(4.2±3.8 mmol/L),P=0.006.CONCLUSION CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients.CSF lactate(>2.72 mmol/L)showed good accuracy,sensitivity,and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.展开更多
The intensive care unit(ICU)is a complex setting by nature,and some have described it as bizarre due to its numerous sirens that sound when anything is dangerous,constant activity,equipment,bright lights,and high fata...The intensive care unit(ICU)is a complex setting by nature,and some have described it as bizarre due to its numerous sirens that sound when anything is dangerous,constant activity,equipment,bright lights,and high fatality rate.The demands placed on nurses to care for critically ill patients in this environment frequently prevent nurses and other health‑care professionals from acknowledging the feelings of patient’s relatives or family caregivers,resulting in a hostile environment from the patient’s relative’s perspective.When a patient’s family enters the ICU,they feel that hospital administrators do little to nothing to alleviate their discomfort and fear.Despite research demonstrating the importance of providing a homely environment for patients’families,In Nigeria ICU is still far behind how a conventional ICU environment should be structured to accommodate patient’s relations in the unit.The goal of this study was to look at the patient’s relative’s perspective on providing care for a critically ill patient in an ICU,with a focus on the unit’s complexity and overall experience.Based on the findings of this study,we recommend that hospital administrators ensure that the environment of the upcoming ICU is designed to meet the needs of patient’s relatives by addressing identified environmental concerns,like caring neglect,by providing a friendly and stress‑free environment.展开更多
Objective:This paper aims to investigate the value of individualized care for critically ill patients receiving continuous blood purification therapy.Methods:89 cases of critically ill patients who were treated from J...Objective:This paper aims to investigate the value of individualized care for critically ill patients receiving continuous blood purification therapy.Methods:89 cases of critically ill patients who were treated from June 2021 to June 2023 were randomly divided into groups,with individualized care in group A and routine care in group B.The differences in clinical indicators,purification effect,quality of life,and complications of blood purification were compared between the groups.Results:Heart rate,respiration,body temperature,and other indicators in group A were better than those in group B,P<0.05.C-reactive protein(CRP),β2-microglobulin(β2-MG),blood urea nitrogen(BUN),and phosphorus(P)in group A were lower than those in group B,P<0.05.Group A had higher quality of life than Group B,P<0.05.The complication rate of blood purification in Group A was lower than that in Group B,P<0.05.Conclusion:During continuous blood purification in critically ill patients,individualized nursing intervention can enhance the effect of blood purification,improve the physiological indicators of patients,and reduce the complications of blood purification,which is highly effective and feasible.展开更多
Objective:To investigate the effect of using peripheral medium-length catheters in critically ill patients undergoing hepatobiliary surgery.Methods:A retrospective analysis of the nursing experience and effect of usin...Objective:To investigate the effect of using peripheral medium-length catheters in critically ill patients undergoing hepatobiliary surgery.Methods:A retrospective analysis of the nursing experience and effect of using medium-length catheters for infusion in 102 critically ill patients undergoing hepatobiliary surgery from March 2021 to April 2022 was conducted.Results:All 102 patients had successful catheter placement with no catheter-associated infections,blockage,decannulation,or breakage.However,four cases had blood oozing from the puncture site,but it resolved after changing the dressing.Conclusion:Medium-length catheters are superior to traditional infusion tools in terms of benefit;thus,they deserve to be widely promoted in clinical practice.展开更多
文摘Objective: To analyze the accuracy of serum prealbumin levels in predicting the prognosis of patients with critical respiratory illness. Methods: Fifty patients with critical respiratory illness admitted to our hospital from October 2022 to September 2023 were selected and divided into an observation group and a control group after condition assessment, with 25 cases in each group. The results of cholinesterase (ChE), prealbumin (PALB), albumin (ALB), aspartate aminotransferase (AST), total protein (TP), and forced expiratory volume (FEV1)/Predicted (Pred) of the two groups were measured. Results: The ChE levels of the observation group were lower than those of the control group, while the PALB and ALB levels of the observation group were higher than those of the control group (P < 0.05). The AST, TP, and FEV1 /Pred levels of the observation group were higher than those in the control group (P < 0.05). Conclusion: Serum PALB levels can be used as the main indicator for prognosis in critically ill respiratory patients.
基金supported through an Australian Government Research Training Program Scholarship
文摘Sleep is a complex process influenced by biological and environmental factors.Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo.Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment.This review will outline the predisposing and precipitating factors for sleep disturbance,categorised into patient,environmental and treatment-related factors.The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed.While polysomnography remains the gold-standard,its use in the critical care setting still presents many barriers.Other methodologies are needed to better understand the pathophysiology,epidemiology and treatment of sleep disturbance in this population.Subjective outcome measures,including the Richards-Campbell Sleep Questionnaire,are still required for trials involving a greater number of patients and provide valuable insight into patients’experiences of disturbed sleep.Finally,sleep optimisation strategies are reviewed,including intervention bundles,ambient noise and light reduction,quiet time,and the use of ear plugs and eye masks.While drugs to improve sleep are frequently prescribed to patients in the ICU,evidence supporting their effectiveness is lacking.
基金Natural Science Foundation of Hainan Provincial(No.819MS128)。
文摘Objective:To investigate the predictive value of controlling nutritional status(CONUT)score for progression to chronic critical illness sepsis in elderly patients,and to construct a predictive model based on CONUT score histogram.Methods:739 elderly patients with sepsis admitted from January 2020 to December 2022 were selected as the study objects,and were divided into chronic critical illness group(n=188)and non-chronic critical illness group(n=551)according to whether chronic critical illness disease occurred.Clinical data of the patients were collected and compared.The predictive value of CONUT score,PNI and NLR in the progression of senile sepsis to chronic severe disease was compared,and the optimal threshold value was determined,which was used to convert the numerical variables into binary variables.Through univariate analysis and multivariate Logistic regression analysis,the risk factors affecting the progression of elderly sepsis patients to chronic critical illness disease were screened out,and the prediction model was built based on the nomogram.The efficacy and clinical utility of the prediction model were evaluated by the area under the ROC curve(AUC),calibration curve and decision curve analysis(DCA).Results:The best cut-off value for CONUT score in predicting elderly sepsis progressing to chronic critical illness was 4 points.The predictive performance of CONUT score(AUC=0.739)was better than that of PNI(AUC=0.609)and NLR(AUC=0.582)in elderly sepsis progressing to chronic critical illness(CONUT score vs PNI:Z=5.960,P<0.001;CONUT score vs NLR:Z=6.119,P<0.001).Univariate analysis showed that age,CCI score,SOFA score,sepsis shock,serum Lac,CONUT score,mechanical ventilation(MV),and continuous renal replacement therapy(CRRT)treatment were related to elderly sepsis progressing to chronic critical illness(P<0.05).Multivariate logistic regression analysis showed that CONUT score≥4 points,age≥75 years,CCI score≥3 points,SOFA score>5 points,sepsis shock,and serum Lac≥4 mmol/L were independent risk factors for elderly sepsis progressing to chronic critical illness(P<0.05).The nomogram showed that CONUT score had the greatest contribution value in predicting elderly sepsis progressing to chronic critical illness.Based on this,the nomogram prediction model had an AUC of 0.846[95%CI(0.812~0.879)],with a sensitivity of 75.5%and specificity of 81.3%,indicating good predictive performance.The calibration curve was close to the ideal curve,and the DCA threshold had clinical utility advantages when ranging from 0.1 to 0.9.Conclusion:The nomographic prediction model based on CONUT score can effectively predict the risk probability of senile sepsis progressing to chronic critical illness,helpful for clinicians to identify the high risk group of chronic and severe senile sepsis,which is helpful for clinicians to identify high-risk populations of elderly sepsis with chronic critical illness.
文摘Critically ill patients are a vulnerable group at high risk of developing secondary infections.High disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections,including cytomegalovirus(CMV).CMV seroconversion has been reported in up to 33%of ICU patients,but its impact on patient outcomes remains a matter of debate.Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/acquired immuno deficiency syndrome,the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous.Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement.Hence,a better understanding of the symptomatology,diagnostics,and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.
文摘Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of 77 critically ill children and 33 non-diabetic healthy children (controls) who were admitted between 07/2015 and 05/2016. Patient data, clinical information, and blood samples were collected on admission, alongside a large number of laboratory parameters that were routinely assessed. Critically ill patients were divided into sepsis and non-sepsis/systemic inflammatory response syndrome (SIRS). Serum GLUT4 was measured using western blotting and enzyme-linked immunosorbent assays. Insulin resistance indexes, clinical data, laboratory parameters, and inflammatory cytokines were assessed. Results: GLUT4 serum levels were higher in critically ill children than in healthy children (90.5 vs. 30.3 μg/L, P 0.05). Compared to healthy children, hyperglycemic patients (n = 48) had elevated GLUT4 serum levels (30.3 vs. 103.7 g/L, P Conclusions: GLUT4 serum levels might be significantly increased in critically ill children compared with healthy children, particularly those in septic shock. Serum GLUT4 could predict disease severity.
文摘Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.
文摘AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.
基金Ashish J Mehta is supported by a Career Development Award(1IK2CX000643)from the Department of Veterans Affairs(Clinical Science Research and Development)
文摘Alcohol is the most commonly used and abused drug in the world, and alcohol use disorders pose a tremendousburden to healthcare systems around the world. The lifetime prevalence of alcohol abuse in the United States is estimated to be around 18%, and the economic consequences of these disorders are staggering. Studies on hospitalized patients demonstrate that about one in four patients admitted to critical care units will have alcohol-related issues, and unhealthy alcohol consumption is responsible for numerous clinical problems encountered in intensive care unit(ICU) settings. Patients with alcohol use disorders are not only predisposed to developing withdrawal syndromes and other conditions that often require intensive care, they also experience a considerably higher rate of complications, longer ICU and hospital length of stay, greater resource utilization, and significantly increased mortality compared to similar critically ill patients who do not abuse alcohol. Specific disorders seen in the critical care setting that are impacted by alcohol abuse include delirium, pneumonia, acute respiratory distress syndrome, sepsis, gastrointestinal hemorrhage, trauma, and burn injuries. Despite the substantial burden of alcoholinduced disease in these settings, critical care providers often fail to identify individuals with alcohol use disorders, which can have significant implications for this vulnerable population and delay important clinical interventions.
文摘Widespread implementation of electronic health records has led to the increased use of artificial intelligence(AI)and computer modeling in clinical medicine.The early recognition and treatment of critical illness are central to good outcomes but are made difficult by,among other things,the complexity of the environment and the often non-specific nature of the clinical presentation.Increasingly,AI applications are being proposed as decision supports for busy or distracted clinicians,to address this challenge.Data driven“associative”AI models are built from retrospective data registries with missing data and imprecise timing.Associative AI models lack transparency,often ignore causal mechanisms,and,while potentially useful in improved prognostication,have thus far had limited clinical applicability.To be clinically useful,AI tools need to provide bedside clinicians with actionable knowledge.Explicitly addressing causal mechanisms not only increases validity and replicability of the model,but also adds transparency and helps gain trust from the bedside clinicians for real world use of AI models in teaching and patient care.
基金supported by grants from China Scholarship Council,No.2008102056the National Natural Science Foundation of China,No.81241147
文摘Critical illness polyneuropathy and critical illness myopathy are frequent complications of severe illness that involve sensorimotor axons and skeletal muscles,respectively.Clinically,they manifest as limb and respiratory muscle weakness.Critical illness polyneuropathy/myopathy in isolation or combination increases intensive care unit morbidity via the inability or difficulty in weaning these patients off mechanical ventilation.Many patients continue to suffer from decreased exercise capacity and compromised quality of life for months to years after the acute event.Substantial progress has been made lately in the understanding of the pathophysiology of critical illness polyneuropathy and myopathy.Clinical and ancillary test results should be carefully interpreted to differentiate critical illness polyneuropathy/myopathy from similar weaknesses in this patient population.The present review is aimed at providing the latest knowledge concerning the pathophysiology of critical illness polyneuropathy/myopathy along with relevant clinical,diagnostic,differentiating,and treatment information for this debilitating neurological disease.
文摘Critical illness is a sudden traumatising lived experience that affects the sufferer and their family throwing them into a crisis situation [1,2]. It is disruptive and alienating. Critically ill patients emerging from unconsciousness often suffer from confusion that could be momentary or lasting. There is an increasing number of critical illness survivors in intensive care units (ICU)1 with numerous life changing ongoing physiological and psychological sequelae from critical illness and ICU hospitalization, with inadequate ongoing treatment for ICU survivors. Medicalised accounts of critical illness fail to recognise the significant impact on the person, their embodied sense of self and their ability to move on with their life after they leave hospital. The main purpose of this study was to explore the experience of critically ill patients in ICU and beyond. This phenomenological study describes what it was like for twelve people to experience critical illness in ICU and in the months after discharge. The finding was that critical illness is an acute life threatening event with long lasting effects which translate into temporal and biographical disruption, imprisonment by the ICU and its therapies and being trapped in an alien body that is plagued by uncertainty and long lasting conditions arising from the critical illness and the ICU therapies. Critical illness survivors are left in a state of limbo characterised by a struggle to reclaim their precritical illness ICU identity and uncertainty about their future. Hence an overarching theme of being in limbo under which three major themes of 1) disrupttion, 2) imprisonment and 3) being trapped were generated from the study.
文摘The glucocorticoid receptor(GCR)and the mineralocorticoid receptor(MR)are members of the steroid receptor superfamily of hormone-dependent transcription factors.The receptors are structurally and functionally related.They are localized in the cytosol and translocate into the nucleus after ligand binding.GCRs and MRs can be co-expressed within the same cell,and it is believed that the balance in GCR and MR expression is crucial for homeostasis and plays a key role in normal adaptation.In critical illness,the hypothalamic-pituitary-adrenal axis is activated,and as a consequence,serum cortisol concentrations are high.However,a number of patients exhibit relatively low cortisol levels for the degree of illness severity.Glucocorticoid(GC)actions are facilitated by GCR,whose dysfunction leads to GC tissue resistance.The MR is unique in this family in that it binds to both aldosterone and cortisol.Endogenous GCs play a critical role in controlling inflammatory responses in critical illness.Intracellular GC concentrations can differ greatly from blood levels due to the action of the two 11β-hydroxysteroid dehydrogenase isozymes,type 1 and type 2.11β-hydroxysteroid dehydrogenases interconvert endogenous active cortisol and intrinsically inert cortisone.The degree of expression of the two isozymes has the potential to dramatically influence local GC availability within cells and tissues.In this review,we will explore the clinical studies that aimed to elucidate the role of MR and GCR expression in the inflammatory response seen in critical illness.
文摘BACKGROUND Critical time intervention(CTI)is an evidence-based model of practice that is time-limited and aims to provide support for most susceptible individuals during a transition period.AIM To examine the significance of fostering the mental health of diabetes patients through CTI using the scoping review methodology.METHODS As part of the scoping review process,we followed the guidelines established by the Joanna Briggs Institute.The search databases were Google Scholar,PubMed,Scopus,PsycINFO,Reference Citation Analysis(https://www.referencecitation-analysis.com/),and Cochrane Library.From these databases,77 articles were retrieved with the aid of carefully selected search terms.However,19 studies were selected after two reviewers appraised the full texts to ensure that they are all eligible for inclusion,while 54 papers were excluded.RESULTS This study revealed that diabetic patients who had experienced homelessness were at higher risk of being diagnosed with mental illness and that social support services are impactful in the management of the comorbidity of diabetes and mental health problems.In addition,this review reveals that CTI is impactful in enhancing the mental health of homeless patients during the transitional period from the hospital through social support services.CONCLUSION CTI is a promising intervention for alleviating mental health symptoms in homeless patients.Empirical studies are needed across the globe,involving both hospitalized and community-based patients,to determine how clinically effectively CTI is in managing the mental health of diabetics.
文摘BACKGROUND Rifaximin is frequently administered to critically ill patients with liver disease and hepatic encephalopathy,but patients currently or recently treated with antibiotics were frequently excluded from studies of rifaximin efficacy.Due to overlapping spectrums of activity,combination therapy with broad-spectrum antibiotics and rifaximin may be unnecessary.A pharmacist-driven protocol was piloted to reduce potentially overlapping therapy in critically ill patients with liver disease.It was hypothesized that withholding rifaximin during broad-spectrum antibiotic therapy would be safe and reduce healthcare costs.AIM To determine the clinical,safety,and financial impact of discontinuing rifaximin during broad-spectrum antibiotic therapy in critically ill liver patients.METHODS This was a single-center,quasi-experimental,pre-post study based on a pilot pharmacist-driven protocol.Patients in the protocol group were prospectively identified via the medical intensive care unit(ICU)(MICU)protocol to have rifaximin withheld during broad-spectrum antibiotic treatment.These were compared to a historical cohort who received combination therapy with broadspectrum antibiotics and rifaximin.All data were collected retrospectively.The primary outcome was days alive and free of delirium and coma(DAFD)to 14 d.Safety outcomes included MICU length of stay,48-h change in vasopressor dose,and ICU mortality.Secondary outcomes characterized rifaximin cost savings and protocol adherence.Multivariable analysis was utilized to evaluate the association between group assignment and the primary outcome while controlling for potential confounding factors.RESULTS Each group included 32 patients.The median number of delirium-and coma-free days was similar in the control and protocol groups[3 interquartile range(IQR 0,8)vs 2(IQR 0,9.5),P=0.93].In multivariable analysis,group assignment was not associated with a reduced ratio of days alive and free of delirium or coma at 14 d.The protocol resulted in a reduced median duration of rifaximin use during broad-spectrum antibiotic therapy[6 d control(IQR 3,9.5)vs 1 d protocol(IQR 0,1);P<0.001].Rates of other secondary clinical and safety outcomes were similar including ICU mortality and 48-h change in vasopressor requirements.Overall adherence to the protocol was 91.4%.The median estimated total cost of rifaximin therapy per patient was reduced from$758.40(IQR$379.20,$1200.80)to$126.40(IQR$0,$126.40),P<0.01.CONCLUSION The novel pharmacist-driven protocol for rifaximin discontinuation was associated with significant cost savings and no differences in safety outcomes including DAFD.
文摘BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity.Early diagnosis and specific treatment may improve outcomes.Lack of specific clinical signs or tests make the diagnosis challenging.AIM To assess the efficacy of cerebrospinal fluid(CSF)lactate in diagnosing meningitis in critically ill patients.METHODS A prospective,observational cohort study was carried out in a neuro-medical intensive care unit(ICU)over a 22 mo period.Adult patients,with suspected meningitis admitted in ICU,were serially recruited.Patients who refused consent,those with peripheral sensorineural deficit,or with any contraindication to lumber puncture were excluded.CSF cytology,bio-chemistry,lactates,culture and polymerase chain reaction based meningo-encephalitis panel were evaluated.Patients were divided in two groups based on clinical diagnosis of meningitis.The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests.RESULTS Seventy-one patients were included and 23 were diagnosed with meningitis.The mean values of CSF total leucocyte count(TLC),proteins and lactates were significantly higher in meningitis group.There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel.CSF lactate(>2.72 mmol/L)showed good accuracy in diagnosing meningitis with an area under the curve of 0.81(95% confidence interval:0.69-0.93),sensitivity of 82.6%,and specificity 72.9%.These values were comparable to those of CSF TLC and protein.Twelve patients with bacterial meningitis had significantly higher CSF lactate(8.9±4.7 mmol/L)than those with non-bacterial meningitis(4.2±3.8 mmol/L),P=0.006.CONCLUSION CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients.CSF lactate(>2.72 mmol/L)showed good accuracy,sensitivity,and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.
文摘The intensive care unit(ICU)is a complex setting by nature,and some have described it as bizarre due to its numerous sirens that sound when anything is dangerous,constant activity,equipment,bright lights,and high fatality rate.The demands placed on nurses to care for critically ill patients in this environment frequently prevent nurses and other health‑care professionals from acknowledging the feelings of patient’s relatives or family caregivers,resulting in a hostile environment from the patient’s relative’s perspective.When a patient’s family enters the ICU,they feel that hospital administrators do little to nothing to alleviate their discomfort and fear.Despite research demonstrating the importance of providing a homely environment for patients’families,In Nigeria ICU is still far behind how a conventional ICU environment should be structured to accommodate patient’s relations in the unit.The goal of this study was to look at the patient’s relative’s perspective on providing care for a critically ill patient in an ICU,with a focus on the unit’s complexity and overall experience.Based on the findings of this study,we recommend that hospital administrators ensure that the environment of the upcoming ICU is designed to meet the needs of patient’s relatives by addressing identified environmental concerns,like caring neglect,by providing a friendly and stress‑free environment.
文摘Objective:This paper aims to investigate the value of individualized care for critically ill patients receiving continuous blood purification therapy.Methods:89 cases of critically ill patients who were treated from June 2021 to June 2023 were randomly divided into groups,with individualized care in group A and routine care in group B.The differences in clinical indicators,purification effect,quality of life,and complications of blood purification were compared between the groups.Results:Heart rate,respiration,body temperature,and other indicators in group A were better than those in group B,P<0.05.C-reactive protein(CRP),β2-microglobulin(β2-MG),blood urea nitrogen(BUN),and phosphorus(P)in group A were lower than those in group B,P<0.05.Group A had higher quality of life than Group B,P<0.05.The complication rate of blood purification in Group A was lower than that in Group B,P<0.05.Conclusion:During continuous blood purification in critically ill patients,individualized nursing intervention can enhance the effect of blood purification,improve the physiological indicators of patients,and reduce the complications of blood purification,which is highly effective and feasible.
文摘Objective:To investigate the effect of using peripheral medium-length catheters in critically ill patients undergoing hepatobiliary surgery.Methods:A retrospective analysis of the nursing experience and effect of using medium-length catheters for infusion in 102 critically ill patients undergoing hepatobiliary surgery from March 2021 to April 2022 was conducted.Results:All 102 patients had successful catheter placement with no catheter-associated infections,blockage,decannulation,or breakage.However,four cases had blood oozing from the puncture site,but it resolved after changing the dressing.Conclusion:Medium-length catheters are superior to traditional infusion tools in terms of benefit;thus,they deserve to be widely promoted in clinical practice.
