Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyz...Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.展开更多
BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modi...BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.展开更多
Objective:To compare the characteristics of patients between adverse event(AE)group and non-AE group,and to assess the causes,preventability,and severity of AE.Methods:A retrospective triple-phase medical record study...Objective:To compare the characteristics of patients between adverse event(AE)group and non-AE group,and to assess the causes,preventability,and severity of AE.Methods:A retrospective triple-phase medical record study was conducted at a Spanish tertiary hospital.Data was collected over a 6-month period,including all patients with an unplanned intensive care admission.Demographic characteristics,APACHE栻,length of ICU stay,mortality were compare between AE and non-AE group causes,preventability and severity were analyzed in AE cases.Results:597 Patients were included in the study.The overall incidence of AEs was 17.3%(n=103),of which 83.5%were considered preventable.Mortality within the AE group was higher than in the non-AE group(23.3%vs.13.6%),making it 1.7 times more frequent in the AE group(95%CI:1.143-2.071).The primary cause of AE was associated with surgical procedures(43.7%).Of the AEs,18.4%were classified as mild,58.3%as moderate,and 23.3%as severe.Conclusions:The incidence of unplanned intensive care admissions due to AE is high and potentially preventable.This is concerning given the high mortality observed in patients admitted to the intensive care unit because of an AE,although direct causality cannot always be established.The findings emphasize the importance of patient safety and underscore the need for improved quality and management of care resources.They also indicate where efforts should be directed to enhance care risk management.展开更多
BACKGROUND Acute kidney injury(AKI)is one of the most common acute pancreatitis(AP)-associated complications that has a significant effect on AP,but the factors affecting the AP patients’survival rate remains unclear...BACKGROUND Acute kidney injury(AKI)is one of the most common acute pancreatitis(AP)-associated complications that has a significant effect on AP,but the factors affecting the AP patients’survival rate remains unclear.AIM To assess the influences of AKI on the survival rate in AP patients.METHODS A total of 139 AP patients were included in this retrospective study.Patients were divided into AKI group(n=72)and non-AKI group(n=67)according to the occurrence of AKI.Data were collected from medical records of hospitalized patients.Then,these data were compared between the two groups and further analysis was performed.RESULTS AKI is more likely to occur in male AP patients(P=0.009).AP patients in AKI group exhibited a significantly higher acute physiologic assessment and chronic health evaluation II score,higher Sequential Organ Failure Assessment score,lower Glasgow Coma Scale score,and higher demand for mechanical ventilation,infusion of vasopressors,and renal replacement therapy than AP patients in non-AKI group(P<0.01,P<0.01,P=0.01,P=0.001,P<0.01,P<0.01,respectively).Significant differences were noted in dose of norepinephrine and adrenaline,duration of mechanical ventilation,maximum and mean values of intra-peritoneal pressure(IPP),maximum and mean values of procalcitonin,maximum and mean serum levels of creatinine,minimum platelet count,and length of hospitalization.Among AP patients with AKI,the survival rate of surgical intensive care unit and in-hospital were only 23%and 21%of the corresponding rates in AP patients without AKI,respectively.The factors that influenced the AP patients’survival rate included body mass index(BMI),mean values of IPP,minimum platelet count,and hospital day,of which mean values of IPP showed the greatest impact.CONCLUSION AP patients with AKI had a lower survival rate and worse relevant clinical outcomes than AP patients without AKI,which necessitates further attention to AP patients with AKI in surgical intensive care unit.展开更多
Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit(ICU) patients.Methods: The study used a qualitative descriptive...Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit(ICU) patients.Methods: The study used a qualitative descriptive design. Relevant samples depending on organ system involvement from 100 ICU patients were collected and processed.Identification and speciation of the isolates was conducted by the biochemical tests.Antifungal susceptibility testing was carried out as per CLSI-M27-A3 document.Results: Ninety Candida isolates were isolated from the different clinical samples: urine(43.3%), tracheal aspirate(31.1%), urinary catheter(12.2%), endotracheal tube(7.8%),abdominal drains(3.3%), sputum(2.2%). The incidence of candidiasis caused by nonalbicans Candida(NAC) species(63.3%) was higher than Candida albicans(36.7%).The various NAC species were isolated as: Candida tropicalis(41.1%), Candida glabrata(10%), Candida parapsilosis(6.7%), Candida krusei(3.3%) and Candida kefyr(2.2%). The overall isolation rate of Candida species from samples was 53.3%. Antifungal susceptibility indicated that 37.8% and 7.8% of the Candida isolates were resistant to fluconazole and amphotericin B, respectively.Conclusions: Predominance of NAC species in ICU patients along with the increasing resistance being recorded to fluconazole which has a major bearing on the morbidity and management of these patients and needs to be further worked upon.展开更多
The introduction of new treatments for cancer and advances in the intensive care of critically ill cancer patients has improved the prognosis and survival. In recent years, the classical intensive care unit(ICU) admis...The introduction of new treatments for cancer and advances in the intensive care of critically ill cancer patients has improved the prognosis and survival. In recent years, the classical intensive care unit(ICU) admission comorbidity criteria used for this group of patients have been discouraged since the risk factors for death that have been studied, mainly the number and severity of organic failures, allow us to understand the determinants of the prognosis inside the ICU. However, the availability of intensive care resources is dissimilar by country, and these differences are known to alter the indications for admission to critical care setting. Three to five days of ICU management is warranted before making a final decision(ICU trial) to consider keep down intensive management of critically ill cancer patients. Nowadays, taking into account only the diagnosis of cancer to consider ICU admission of patients who need full-supporting management is no longer justified.展开更多
AIM:To quantify cumulative effective dose of intensive care unit(ICU)patients attributable to diagnostic imaging.METHODS:This was a prospective,interdisciplinary study conducted in the ICU of a large tertiary referral...AIM:To quantify cumulative effective dose of intensive care unit(ICU)patients attributable to diagnostic imaging.METHODS:This was a prospective,interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center.Demographic and clinical data including age,gender,date of ICU admission,primary reason for ICU admission,APACHE Ⅱ score,length of stay,number of days intubated,date of death or discharge,and re-admission data was collected on all patients admitted over a 1-year period.The overall radiation exposure was quantified by the cumulative effective radiation dose(CED)in millisieverts(mS v)and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board.Pediatric patients were selected for subgroupanalysis.RESULTS:A total of 2737 studies were performedin 421 patients.The total CED was 1704 m Sv with a median CED of 1.5 mS v(IQR 0.04-6.6 mS v).Total CED in pediatric patients was 74.6 mS v with a median CED of 0.07 mS v(IQR 0.01-4.7 mS v).Chest radiography was the most commonly performed examination accounting for 83% of all studies but only 2.7% of total CED.Computed tomography(CT)accounted for 16% of all studies performed and contributed 97% of total CED.Trauma patients received a statistically significant higher dose [median CED 7.7 mS v(IQR 3.5-13.8 mS v)] than medical [median CED 1.4 m Sv(IQR 0.05-5.4 m Sv)] and surgical [median CED 1.6 mS v(IQR 0.04-7.5 mS v)] patients.Length of stay in ICU [OR = 1.12(95%CI:1.079-1.157)] was identified as an independent predictor of receiving a CED greater than 15 mS v.CONCLUSION:Trauma patients and patients with extended ICU admission times are at increased risk of higher CEDs.CED should be minimized where feasible,especially in young patients.展开更多
BACKGROUND Ammonia is a normal constituent of body fluids and is found mainly through the formation of urea in the liver.Blood levels of ammonia must remain low as even slightly elevated concentrations(hyperammonemia)...BACKGROUND Ammonia is a normal constituent of body fluids and is found mainly through the formation of urea in the liver.Blood levels of ammonia must remain low as even slightly elevated concentrations(hyperammonemia)are toxic to the central nervous system.AIM To examine the relationship between the incidence of non-hepatic hyperammonemia(NHH)and the prognosis of patients who were admitted to the intensive care unit(ICU).METHODS This is a prospective,observational and single-center study.A total of 364 patients who were admitted to the ICU from November 2019 to February 2020 were initially enrolled.Changes in the levels of blood ammonia at the time of ICU admission and after ICU admission were continuously monitored.In addition,factors influencing the prognosis of NHH patients were analyzed.RESULTS A total of 204 patients who met the inclusion criteria were enrolled in this study,including 155 NHH patients and 44 severe-NHH patients.The incidence of NHH and severe-NHH was 75.98% and 21.57%,respectively.Patients with severe-NHH exhibited longer length of ICU stay and higher Acute Physiologic Assessment and Chronic Health Evaluation and Sequential Organ Failure Assessment scores compared to those with mild-NHH and non-NHH.Glasgow Coma Scale scores of patients with severe-NHH were than those of non-NHH patients.In addition,the mean and initial levels of ammonia in the blood might be helpful in predicting the prognosis of NHH.CONCLUSION High blood ammonia level is frequent among NHH patients admitted to the ICU,which is related to the clinical characteristics of patients.Furthermore,the level of blood ammonia may be helpful for prognosis prediction.展开更多
BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)readmission.AIM To identify the incidence,causes,and outcomes of ICU readmission af...BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)readmission.AIM To identify the incidence,causes,and outcomes of ICU readmission after LDLT.METHODS A retrospective cohort study was conducted on patients who underwent LDLT.The collected data included patient demographics,preoperative characteristics,intraoperative details;postoperative stay,complications,causes of ICU readmission,and outcomes.Patients were divided into two groups according to ICU readmission after hospital discharge.Risk factors for ICU readmission were identified in univariate and multivariate analyses.RESULTS The present study included 299 patients.Thirty-one(10.4%)patients were readmitted to the ICU after discharge.Patients who were readmitted to the ICU were older in age(53.0±5.1 vs 49.4±8.8,P=0.001)and had a significantly higher percentage of women(29%vs 13.4%,P=0.032),diabetics(41.9%vs 24.6%,P=0.039),hypertensives(22.6%vs 6.3%,P=0.006),and renal(6.5%vs 0%,P=0.010)patients as well as a significantly longer initial ICU stay(6 vs 4 d,respectively,P<0.001).Logistic regression analysis revealed that significant independent risk factors for ICU readmission included recipient age(OR=1.048,95%CI=1.005-1.094,P=0.030)and length of initial hospital stay(OR=0.836,95%CI=0.789-0.885,P<0.001).CONCLUSION The identification of high-risk patients(older age and shorter initial hospital stay)before ICU discharge may help provide optimal care and tailor follow-up to reduce the rate of ICU readmission.展开更多
BACKGROUND Intensive care unit(ICU)patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making.Those data are vit...BACKGROUND Intensive care unit(ICU)patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making.Those data are vital in the assistance of these patients,being already used by several scoring systems.In this context,machine learning approaches have been used for medical predictions based on clinical data,which includes patient outcomes.AIM To develop a binary classifier for the outcome of death in ICU patients based on clinical and laboratory parameters,a set formed by 1087 instances and 50 variables from ICU patients admitted to the emergency department was obtained in the“WiDS(Women in Data Science)Datathon 2020:ICU Mortality Prediction”dataset.METHODS For categorical variables,frequencies and risk ratios were calculated.Numerical variables were computed as means and standard deviations and Mann-Whitney U tests were performed.We then divided the data into a training(80%)and test(20%)set.The training set was used to train a predictive model based on the Random Forest algorithm and the test set was used to evaluate the predictive effectiveness of the model.RESULTS A statistically significant association was identified between need for intubation,as well predominant systemic cardiovascular involvement,and hospital death.A number of the numerical variables analyzed(for instance Glasgow Coma Score punctuations,mean arterial pressure,temperature,pH,and lactate,creatinine,albumin and bilirubin values)were also significantly associated with death outcome.The proposed binary Random Forest classifier obtained on the test set(n=218)had an accuracy of 80.28%,sensitivity of 81.82%,specificity of 79.43%,positive predictive value of 73.26%,negative predictive value of 84.85%,F1 score of 0.74,and area under the curve score of 0.85.The predictive variables of the greatest importance were the maximum and minimum lactate values,adding up to a predictive importance of 15.54%.CONCLUSION We demonstrated the efficacy of a Random Forest machine learning algorithm for handling clinical and laboratory data from patients under intensive monitoring.Therefore,we endorse the emerging notion that machine learning has great potential to provide us support to critically question existing methodologies,allowing improvements that reduce mortality.展开更多
Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. R...Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses展开更多
Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try ...Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit (ICU) after coronary artery bypass graft surgery (CABG) . Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital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
Hepatic encephalopathy(HE)is one of the main complications of cirrhosis,characterized by a wide spectrum of neuropsychiatric alterations that lead to an increase in mortality,morbidity and recurrent hospitalizations.D...Hepatic encephalopathy(HE)is one of the main complications of cirrhosis,characterized by a wide spectrum of neuropsychiatric alterations that lead to an increase in mortality,morbidity and recurrent hospitalizations.Due to the central role in HE pathogenesis of ammonia and other neurotoxins primarily produced by the gut microbiota,the main therapeutic approaches for the treatment of HE are based on the modulation of the gut microbiota.Rifaximin is a non-absorbable broad-spectrum antibiotic,that is effective against ammonia-producing grampositive,gram-negative,and anaerobic species,approved for the treatment of HE in secondary prophylaxis.The chronic administration of rifaximin in this setting is associated with a lower risk of HE recurrence and mortality,while the role of rifaximin for the treatment of an overt-HE episode in inpatients is still unclear.Limited data exist about the coadministration of rifaximin and broad-spectrum antibiotics commonly used to treat concomitant infections,as patients receiving or recently treated with antibiotics were frequently excluded from clinical trials.In this editorial we comment on the article by Ward et al published in the recent issue of the World Journal of Hepatology.It is a single center,retrospective,quasiexperimental,pharmacist-driven protocol,with the aim to evaluate the feasibility and safety of rifaximin discontinuation in critically ill patients with HE and chronic liver disease receiving broad-spectrum antibiotic therapies in intensive care units.The study revealed no differences between the protocol and control group in terms of primary outcome(days alive and free of delirium and coma to day 14)and secondary outcomes which include:Intensive care mortality,intensive care length of stay,intravenous vasopressor requirement changes and adverse effects rate.Therefore,rifaximin discontinuation during broad-spectrum antibiotic therapy does not appear to negatively impact the clinical status of critically ill liver patients,with a similar safety profile and significant cost savings,as compared to the coadministration of rifaximin and broad-spectrum antibiotics.In agreement with Ward et al,a recently published double-blind,randomized controlled trial provided additional evidence to support the feasibility of withholding rifaximin during broad-spectrum antibiotic therapy in critically ill cirrhotic patients.However,given the limitations of these studies,further multicentric and prospective clinical trials,enrolling a larger sample of non-critically ill patients,are needed to better establish the role of rifaximin in this setting.展开更多
[Objectives]This study aimed to investigate the incidence and risk factors associated with SSD in patients following cardiac surgery.[Methods]A total of 378 patients who underwent cardiac surgery in Taihe Hospital wer...[Objectives]This study aimed to investigate the incidence and risk factors associated with SSD in patients following cardiac surgery.[Methods]A total of 378 patients who underwent cardiac surgery in Taihe Hospital were recruited and screened.Diagnosis of delirium was made using evaluation methods and DSM-5 criteria.SSD was defined as the presence of one or more core features of delirium without meeting the full diagnostic criteria.Statistical analysis included independent samples t-test for group comparisons and binary logistic regression analysis to identify independent risk factors for SSD after cardiac surgery.[Results]Among the 378 subjects,112(29.63%)had SSD,28(7.41%)had delirium,and the remaining 238 patients(62.96%)did not present with delirium.Univariate analysis revealed that age,APACHE II score,duration of aortic clamping,length of ICU stay,duration of sedation use,and daily sleep time were significant risk factors for the occurrence of SSD(P<0.05).Logistic regression analysis identified age>70 years old,APACHE II score>20 points,length of ICU stay>5 d,and duration of sedation use>24 h as independent risk factors for SSD after cardiac surgery(P<0.05).A functional model was fitted based on the analysis results of the binary logistic regression model,yielding the equation logit P=1.472X_(1)+2.213X_(2)+3.028X_(3)+1.306X_(4).[Conclusions]Comprehensive clinical assessment is crucial for patients undergoing cardiac surgery,and appropriate preventive measures should be taken for patients with identified risk factors.Close monitoring of the patient s consciousness should be implemented postoperatively,and timely interventions should be conducted.Further research should focus on model validation and optimization.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
Objectives:To study the related factors of acute kidney injury(AKI)in intensive care unit(ICU)patients.Methods:The clinical data of 879 patients in the intensive care unit were retrospectively analyzed.AKI patients we...Objectives:To study the related factors of acute kidney injury(AKI)in intensive care unit(ICU)patients.Methods:The clinical data of 879 patients in the intensive care unit were retrospectively analyzed.AKI patients were selected according to the AKI clinical diagnostic criteria,the causal analysis was performed,the indicators of AKI patients were tested,and the urine volume and the time of admission to the ICU were recorded.Finally,logistic regression analysis was used to analyze the risk factors that affect the prognosis.Results:Among the 879 patients in the intensive care unit,96 patients(10.9%)met the KDIGO-AKI diagnostic criteria,of which 29(30.31%)died and 49(51.04%)required renal replacement therapy.As the age and stage of AKI patients increase,the mortality rate also increases.The pathology constituted 46 septic patients(47.92%)and 50 non-septic patients(52.08%).Patients with septic AKI have longer ICU and hospital stay than patients with non-septic AKI(t=2.291,0.023;t=2.082,0.041),and the rate of renal replacement therapy is higher(χ2=4.091,P=0.042).Logistic regression analysis shows that old age,low urine volume,shock,acidosis,stage 3 of AKI,intake of blood pressure drugs,infections,and the need for renal replacement therapy are relevant factors that affect AKI.Conclusions:In the intensive care unit,the incidence and mortality of AKI are very high;the treatment of AKI is related to many factors;early detection and treatment is very crucial to reduce the mortality of AKI.展开更多
文摘Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.
基金Supported by Research Project of Zhejiang Provincial Department of Education,No.Y202045115.
文摘BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.
文摘Objective:To compare the characteristics of patients between adverse event(AE)group and non-AE group,and to assess the causes,preventability,and severity of AE.Methods:A retrospective triple-phase medical record study was conducted at a Spanish tertiary hospital.Data was collected over a 6-month period,including all patients with an unplanned intensive care admission.Demographic characteristics,APACHE栻,length of ICU stay,mortality were compare between AE and non-AE group causes,preventability and severity were analyzed in AE cases.Results:597 Patients were included in the study.The overall incidence of AEs was 17.3%(n=103),of which 83.5%were considered preventable.Mortality within the AE group was higher than in the non-AE group(23.3%vs.13.6%),making it 1.7 times more frequent in the AE group(95%CI:1.143-2.071).The primary cause of AE was associated with surgical procedures(43.7%).Of the AEs,18.4%were classified as mild,58.3%as moderate,and 23.3%as severe.Conclusions:The incidence of unplanned intensive care admissions due to AE is high and potentially preventable.This is concerning given the high mortality observed in patients admitted to the intensive care unit because of an AE,although direct causality cannot always be established.The findings emphasize the importance of patient safety and underscore the need for improved quality and management of care resources.They also indicate where efforts should be directed to enhance care risk management.
基金Supported by the Scientific Research Project of Heilongjiang Health and Family Planning Commission,No.2018086 and No.2018392.
文摘BACKGROUND Acute kidney injury(AKI)is one of the most common acute pancreatitis(AP)-associated complications that has a significant effect on AP,but the factors affecting the AP patients’survival rate remains unclear.AIM To assess the influences of AKI on the survival rate in AP patients.METHODS A total of 139 AP patients were included in this retrospective study.Patients were divided into AKI group(n=72)and non-AKI group(n=67)according to the occurrence of AKI.Data were collected from medical records of hospitalized patients.Then,these data were compared between the two groups and further analysis was performed.RESULTS AKI is more likely to occur in male AP patients(P=0.009).AP patients in AKI group exhibited a significantly higher acute physiologic assessment and chronic health evaluation II score,higher Sequential Organ Failure Assessment score,lower Glasgow Coma Scale score,and higher demand for mechanical ventilation,infusion of vasopressors,and renal replacement therapy than AP patients in non-AKI group(P<0.01,P<0.01,P=0.01,P=0.001,P<0.01,P<0.01,respectively).Significant differences were noted in dose of norepinephrine and adrenaline,duration of mechanical ventilation,maximum and mean values of intra-peritoneal pressure(IPP),maximum and mean values of procalcitonin,maximum and mean serum levels of creatinine,minimum platelet count,and length of hospitalization.Among AP patients with AKI,the survival rate of surgical intensive care unit and in-hospital were only 23%and 21%of the corresponding rates in AP patients without AKI,respectively.The factors that influenced the AP patients’survival rate included body mass index(BMI),mean values of IPP,minimum platelet count,and hospital day,of which mean values of IPP showed the greatest impact.CONCLUSION AP patients with AKI had a lower survival rate and worse relevant clinical outcomes than AP patients without AKI,which necessitates further attention to AP patients with AKI in surgical intensive care unit.
基金Supported by the University Grants Commission(UGC),Government of India,New Delhi-110002,India[Grant:Rs.908100/-and Grant number:F.31-260/2005(SR)]
文摘Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit(ICU) patients.Methods: The study used a qualitative descriptive design. Relevant samples depending on organ system involvement from 100 ICU patients were collected and processed.Identification and speciation of the isolates was conducted by the biochemical tests.Antifungal susceptibility testing was carried out as per CLSI-M27-A3 document.Results: Ninety Candida isolates were isolated from the different clinical samples: urine(43.3%), tracheal aspirate(31.1%), urinary catheter(12.2%), endotracheal tube(7.8%),abdominal drains(3.3%), sputum(2.2%). The incidence of candidiasis caused by nonalbicans Candida(NAC) species(63.3%) was higher than Candida albicans(36.7%).The various NAC species were isolated as: Candida tropicalis(41.1%), Candida glabrata(10%), Candida parapsilosis(6.7%), Candida krusei(3.3%) and Candida kefyr(2.2%). The overall isolation rate of Candida species from samples was 53.3%. Antifungal susceptibility indicated that 37.8% and 7.8% of the Candida isolates were resistant to fluconazole and amphotericin B, respectively.Conclusions: Predominance of NAC species in ICU patients along with the increasing resistance being recorded to fluconazole which has a major bearing on the morbidity and management of these patients and needs to be further worked upon.
文摘The introduction of new treatments for cancer and advances in the intensive care of critically ill cancer patients has improved the prognosis and survival. In recent years, the classical intensive care unit(ICU) admission comorbidity criteria used for this group of patients have been discouraged since the risk factors for death that have been studied, mainly the number and severity of organic failures, allow us to understand the determinants of the prognosis inside the ICU. However, the availability of intensive care resources is dissimilar by country, and these differences are known to alter the indications for admission to critical care setting. Three to five days of ICU management is warranted before making a final decision(ICU trial) to consider keep down intensive management of critically ill cancer patients. Nowadays, taking into account only the diagnosis of cancer to consider ICU admission of patients who need full-supporting management is no longer justified.
文摘AIM:To quantify cumulative effective dose of intensive care unit(ICU)patients attributable to diagnostic imaging.METHODS:This was a prospective,interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center.Demographic and clinical data including age,gender,date of ICU admission,primary reason for ICU admission,APACHE Ⅱ score,length of stay,number of days intubated,date of death or discharge,and re-admission data was collected on all patients admitted over a 1-year period.The overall radiation exposure was quantified by the cumulative effective radiation dose(CED)in millisieverts(mS v)and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board.Pediatric patients were selected for subgroupanalysis.RESULTS:A total of 2737 studies were performedin 421 patients.The total CED was 1704 m Sv with a median CED of 1.5 mS v(IQR 0.04-6.6 mS v).Total CED in pediatric patients was 74.6 mS v with a median CED of 0.07 mS v(IQR 0.01-4.7 mS v).Chest radiography was the most commonly performed examination accounting for 83% of all studies but only 2.7% of total CED.Computed tomography(CT)accounted for 16% of all studies performed and contributed 97% of total CED.Trauma patients received a statistically significant higher dose [median CED 7.7 mS v(IQR 3.5-13.8 mS v)] than medical [median CED 1.4 m Sv(IQR 0.05-5.4 m Sv)] and surgical [median CED 1.6 mS v(IQR 0.04-7.5 mS v)] patients.Length of stay in ICU [OR = 1.12(95%CI:1.079-1.157)] was identified as an independent predictor of receiving a CED greater than 15 mS v.CONCLUSION:Trauma patients and patients with extended ICU admission times are at increased risk of higher CEDs.CED should be minimized where feasible,especially in young patients.
基金Supported by Scientific research project of Heilongjiang Health and Family Planning Commission,No.2019045.
文摘BACKGROUND Ammonia is a normal constituent of body fluids and is found mainly through the formation of urea in the liver.Blood levels of ammonia must remain low as even slightly elevated concentrations(hyperammonemia)are toxic to the central nervous system.AIM To examine the relationship between the incidence of non-hepatic hyperammonemia(NHH)and the prognosis of patients who were admitted to the intensive care unit(ICU).METHODS This is a prospective,observational and single-center study.A total of 364 patients who were admitted to the ICU from November 2019 to February 2020 were initially enrolled.Changes in the levels of blood ammonia at the time of ICU admission and after ICU admission were continuously monitored.In addition,factors influencing the prognosis of NHH patients were analyzed.RESULTS A total of 204 patients who met the inclusion criteria were enrolled in this study,including 155 NHH patients and 44 severe-NHH patients.The incidence of NHH and severe-NHH was 75.98% and 21.57%,respectively.Patients with severe-NHH exhibited longer length of ICU stay and higher Acute Physiologic Assessment and Chronic Health Evaluation and Sequential Organ Failure Assessment scores compared to those with mild-NHH and non-NHH.Glasgow Coma Scale scores of patients with severe-NHH were than those of non-NHH patients.In addition,the mean and initial levels of ammonia in the blood might be helpful in predicting the prognosis of NHH.CONCLUSION High blood ammonia level is frequent among NHH patients admitted to the ICU,which is related to the clinical characteristics of patients.Furthermore,the level of blood ammonia may be helpful for prognosis prediction.
文摘BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)readmission.AIM To identify the incidence,causes,and outcomes of ICU readmission after LDLT.METHODS A retrospective cohort study was conducted on patients who underwent LDLT.The collected data included patient demographics,preoperative characteristics,intraoperative details;postoperative stay,complications,causes of ICU readmission,and outcomes.Patients were divided into two groups according to ICU readmission after hospital discharge.Risk factors for ICU readmission were identified in univariate and multivariate analyses.RESULTS The present study included 299 patients.Thirty-one(10.4%)patients were readmitted to the ICU after discharge.Patients who were readmitted to the ICU were older in age(53.0±5.1 vs 49.4±8.8,P=0.001)and had a significantly higher percentage of women(29%vs 13.4%,P=0.032),diabetics(41.9%vs 24.6%,P=0.039),hypertensives(22.6%vs 6.3%,P=0.006),and renal(6.5%vs 0%,P=0.010)patients as well as a significantly longer initial ICU stay(6 vs 4 d,respectively,P<0.001).Logistic regression analysis revealed that significant independent risk factors for ICU readmission included recipient age(OR=1.048,95%CI=1.005-1.094,P=0.030)and length of initial hospital stay(OR=0.836,95%CI=0.789-0.885,P<0.001).CONCLUSION The identification of high-risk patients(older age and shorter initial hospital stay)before ICU discharge may help provide optimal care and tailor follow-up to reduce the rate of ICU readmission.
文摘BACKGROUND Intensive care unit(ICU)patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making.Those data are vital in the assistance of these patients,being already used by several scoring systems.In this context,machine learning approaches have been used for medical predictions based on clinical data,which includes patient outcomes.AIM To develop a binary classifier for the outcome of death in ICU patients based on clinical and laboratory parameters,a set formed by 1087 instances and 50 variables from ICU patients admitted to the emergency department was obtained in the“WiDS(Women in Data Science)Datathon 2020:ICU Mortality Prediction”dataset.METHODS For categorical variables,frequencies and risk ratios were calculated.Numerical variables were computed as means and standard deviations and Mann-Whitney U tests were performed.We then divided the data into a training(80%)and test(20%)set.The training set was used to train a predictive model based on the Random Forest algorithm and the test set was used to evaluate the predictive effectiveness of the model.RESULTS A statistically significant association was identified between need for intubation,as well predominant systemic cardiovascular involvement,and hospital death.A number of the numerical variables analyzed(for instance Glasgow Coma Score punctuations,mean arterial pressure,temperature,pH,and lactate,creatinine,albumin and bilirubin values)were also significantly associated with death outcome.The proposed binary Random Forest classifier obtained on the test set(n=218)had an accuracy of 80.28%,sensitivity of 81.82%,specificity of 79.43%,positive predictive value of 73.26%,negative predictive value of 84.85%,F1 score of 0.74,and area under the curve score of 0.85.The predictive variables of the greatest importance were the maximum and minimum lactate values,adding up to a predictive importance of 15.54%.CONCLUSION We demonstrated the efficacy of a Random Forest machine learning algorithm for handling clinical and laboratory data from patients under intensive monitoring.Therefore,we endorse the emerging notion that machine learning has great potential to provide us support to critically question existing methodologies,allowing improvements that reduce mortality.
文摘Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses
文摘Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit (ICU) after coronary artery bypass graft surgery (CABG) . Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital
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Hepatic encephalopathy(HE)is one of the main complications of cirrhosis,characterized by a wide spectrum of neuropsychiatric alterations that lead to an increase in mortality,morbidity and recurrent hospitalizations.Due to the central role in HE pathogenesis of ammonia and other neurotoxins primarily produced by the gut microbiota,the main therapeutic approaches for the treatment of HE are based on the modulation of the gut microbiota.Rifaximin is a non-absorbable broad-spectrum antibiotic,that is effective against ammonia-producing grampositive,gram-negative,and anaerobic species,approved for the treatment of HE in secondary prophylaxis.The chronic administration of rifaximin in this setting is associated with a lower risk of HE recurrence and mortality,while the role of rifaximin for the treatment of an overt-HE episode in inpatients is still unclear.Limited data exist about the coadministration of rifaximin and broad-spectrum antibiotics commonly used to treat concomitant infections,as patients receiving or recently treated with antibiotics were frequently excluded from clinical trials.In this editorial we comment on the article by Ward et al published in the recent issue of the World Journal of Hepatology.It is a single center,retrospective,quasiexperimental,pharmacist-driven protocol,with the aim to evaluate the feasibility and safety of rifaximin discontinuation in critically ill patients with HE and chronic liver disease receiving broad-spectrum antibiotic therapies in intensive care units.The study revealed no differences between the protocol and control group in terms of primary outcome(days alive and free of delirium and coma to day 14)and secondary outcomes which include:Intensive care mortality,intensive care length of stay,intravenous vasopressor requirement changes and adverse effects rate.Therefore,rifaximin discontinuation during broad-spectrum antibiotic therapy does not appear to negatively impact the clinical status of critically ill liver patients,with a similar safety profile and significant cost savings,as compared to the coadministration of rifaximin and broad-spectrum antibiotics.In agreement with Ward et al,a recently published double-blind,randomized controlled trial provided additional evidence to support the feasibility of withholding rifaximin during broad-spectrum antibiotic therapy in critically ill cirrhotic patients.However,given the limitations of these studies,further multicentric and prospective clinical trials,enrolling a larger sample of non-critically ill patients,are needed to better establish the role of rifaximin in this setting.
基金Supported by Philosophy and Social Science Research Project of Hubei Education Department in 2022(22D092)Guiding Scientific Research Project of Shiyan Science and Technology Bureau in 2022(22Y34).
文摘[Objectives]This study aimed to investigate the incidence and risk factors associated with SSD in patients following cardiac surgery.[Methods]A total of 378 patients who underwent cardiac surgery in Taihe Hospital were recruited and screened.Diagnosis of delirium was made using evaluation methods and DSM-5 criteria.SSD was defined as the presence of one or more core features of delirium without meeting the full diagnostic criteria.Statistical analysis included independent samples t-test for group comparisons and binary logistic regression analysis to identify independent risk factors for SSD after cardiac surgery.[Results]Among the 378 subjects,112(29.63%)had SSD,28(7.41%)had delirium,and the remaining 238 patients(62.96%)did not present with delirium.Univariate analysis revealed that age,APACHE II score,duration of aortic clamping,length of ICU stay,duration of sedation use,and daily sleep time were significant risk factors for the occurrence of SSD(P<0.05).Logistic regression analysis identified age>70 years old,APACHE II score>20 points,length of ICU stay>5 d,and duration of sedation use>24 h as independent risk factors for SSD after cardiac surgery(P<0.05).A functional model was fitted based on the analysis results of the binary logistic regression model,yielding the equation logit P=1.472X_(1)+2.213X_(2)+3.028X_(3)+1.306X_(4).[Conclusions]Comprehensive clinical assessment is crucial for patients undergoing cardiac surgery,and appropriate preventive measures should be taken for patients with identified risk factors.Close monitoring of the patient s consciousness should be implemented postoperatively,and timely interventions should be conducted.Further research should focus on model validation and optimization.
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Objectives:To study the related factors of acute kidney injury(AKI)in intensive care unit(ICU)patients.Methods:The clinical data of 879 patients in the intensive care unit were retrospectively analyzed.AKI patients were selected according to the AKI clinical diagnostic criteria,the causal analysis was performed,the indicators of AKI patients were tested,and the urine volume and the time of admission to the ICU were recorded.Finally,logistic regression analysis was used to analyze the risk factors that affect the prognosis.Results:Among the 879 patients in the intensive care unit,96 patients(10.9%)met the KDIGO-AKI diagnostic criteria,of which 29(30.31%)died and 49(51.04%)required renal replacement therapy.As the age and stage of AKI patients increase,the mortality rate also increases.The pathology constituted 46 septic patients(47.92%)and 50 non-septic patients(52.08%).Patients with septic AKI have longer ICU and hospital stay than patients with non-septic AKI(t=2.291,0.023;t=2.082,0.041),and the rate of renal replacement therapy is higher(χ2=4.091,P=0.042).Logistic regression analysis shows that old age,low urine volume,shock,acidosis,stage 3 of AKI,intake of blood pressure drugs,infections,and the need for renal replacement therapy are relevant factors that affect AKI.Conclusions:In the intensive care unit,the incidence and mortality of AKI are very high;the treatment of AKI is related to many factors;early detection and treatment is very crucial to reduce the mortality of AKI.
