ObjectiveTo observe the effect of different preoxygenation methods for emergency intubation in severe patients in intensive care unit (ICU). MethodsProspective randomized study was performed in the intensive care unit between June 2013 and January 2014. Forty patients were randomly divided into 4 groups:group A (control group, n=10), group B (bag-valve-mask preoxygenation group, n=10), group C (noninvasive ventilator-mask preoxygenation group, n=10), and group D (invasive ventilator-mask preoxygenation group, n=10). Standardized rapid sequence intubation was performed without preoxygenation in group A; preoxygenation was performed by using a bag-valve-mask rose pulse oxygen saturation (SpO2) to 90% before a rapid sequence intubation in group B; preoxygenation was performed by using noninvasive ventilator through a face mask rose SpO2 to 90% before a rapid sequence intubation in group C; and preoxygenation was performed by using invasive ventilator through a face mask rose SpO2 to 90% before a rapid sequence intubation in group D. We recorded the time when SpO2 was more than or equal to 90% in group B, C, and D, and arterial blood gases and complications were observed. ResultsThere was no significant difference in the basic indexes before preoxygenation among the four groups (P>0.05). The time of the patients in group D and C was significantly lower than that of group B. The arterial oxygen saturation (SaO2) and arterial oxygen partial pressure (PaO2) in the group C and D were higher than those in group B after preoxygenation (P<0.05). After intubation, SpO2 in group B, C and D was significantly higher than that in group A (P<0.05). At the same time, SpO2 in group C and D was higher than that in group B (P<0.05); PaO2 and SaO2 in group C and D were higher than in those in group A and B (P<0.05); SaO2 in group D was higher than that in group B (P<0.05). The incidence of abdominal distension in group D was significantly lower than that of group B and C (P<0.05). ConclusionFor emergency tracheal intubation in critically ill patients in the ICU, preoxygenation is more effective than the rapid sequence intubation without preoxygenation in improving oxygenation indicators. Invasive ventilator-mask preoxygenation efficacy and safety are superior to other methods.
Objective To verify the association between admission serum phosphate level and short-term (<30 days) mortality of severe pneumonia patients admitted to intensive care unit (ICU) / respiratory intensive care unit (RICU). Methods Severe pneumonia patients admitted to the ICU/RICU of Quanzhou First Hospital Affiliated to Fujian Medical University from November 2019 to September 2021 were included in the study. Serum phosphate was demonstrated as an independent risk factor for short-term mortality of severe pneumonia patients admitted to ICU/RICU by logical analysis and receiver operator characteristic (ROC) curve. The patients were further categorized by serum phosphate concentration to explore the relationship between serum phosphate level and short-term mortality. Results Comparison of baseline indicators at admission between the survival group (n=54) and the non survival group (n=46) revealed that there was significant difference in serum phosphate level [0.9 (0.8, 1.2) mmol/L vs. 1.2 (0.9, 1.5) mmol/L, P<0.05]. Logical analysis showed serum phosphate was an independent risk factor for short-term mortality. ROC curve showed that the prediction ability of serum phosphate was close to pneumonia severity index (PSI). After combining serum phosphate with PSI score, CURB65 score, and sequential organ failure score, the predictive ability of these scores for short-term mortality was improved. Compared with the normophosphatemia group, hyperphosphatemia was found be with significantly higher short-term mortality (85.7% vs. 47.3%, P<0.05), which is absent in hypophosphatemia (25.8%). Conclusions Serum phosphate at admission has a good predictive value on short-term mortality in severe pneumonia patients admitted to the ICU/RICU. Hyperphosphatemia at admission is associated with a higher risk of short-term death.
Peritoneal dialysis (PD) is widely used to treat acute kidney injury (AKI) in low-resource and higher income countries. This paper summarizes the key points and improvements of the 2020 International Society for Peritoneal Dialysis guidelines in five aspects of outcomes for AKI treatment, peritoneal access, dialysis solutions, prescription of dialysis with targets of solute clearance and complications, so as to provide references for AKI in clinical practice.
The monitoring of pregnant women is very important. It plays an important role in reducing fetal mortality, ensuring the safety of perinatal mother and fetus, preventing premature delivery and pregnancy accidents. At present, regular examination is the mainstream method for pregnant women's monitoring, but the means of examination out of hospital is scarce, and the equipment of hospital monitoring is expensive and the operation is complex. Using intelligent information technology (such as machine learning algorithm) can analyze the physiological signals of pregnant women, so as to realize the early detection and accident warning for mother and fetus, and achieve the purpose of high-quality monitoring out of hospital. However, at present, there are not enough public research reports related to the intelligent processing methods of out-of-hospital monitoring for pregnant women, so this paper takes the out-of-hospital monitoring for pregnant women as the research background, summarizes the public research reports of intelligent processing methods, analyzes the advantages and disadvantages of the existing research methods, points out the possible problems, and expounds the future development trend, which could provide reference for future related researches.
ObjectiveTo investigate the risk factors, prognostic factors and prognosis of Multidrug-Resistant Acinetobacter Baumannii (MDR-AB) infection of lower respiratory tract in Intensive Care Unit (ICU) of the Second Affiliated Hospital of Anhui Medical University. MethodsUsing retrospective analysis, we reviewed and compared clinical data of 77 AB infections in lower respiratory tract cases in ICU from January 2013 to March 2015. According to the resistance, patients were divided into a MDR-AB group and a NMDR-AB group. Then the risk factors, prognostic factors and prognosis of MDR-AB infection were analyzed. ResultsA total of 58 cases in the MDR-AB group, 19 cases in the NMDR-AB group were included. The result showed that, the MDR-AB infection in lower respiratory tract could significantly prolong the length of ICU stay (18.5±16.0 vs. 10.6±9.3 days, P<0.05) and increase the mortality (44.8% vs. 11.1%, P<0.01). Logistic regression analysis showed that the independent risk factors for MDR-AB infection in lower respiratory tract included Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score >15 (OR=0.138, 95%CI 0.03 to 0.625, P=0.01) and use of carbapenems (OR=0.066, 95%CI 0.012 to 0.0346, P=0.001). The independent prognostic factors included placement of drainage tube (OR=8.743, 95%CI 1.528 to 50.018, P=0.015) and use of vasoactive drugs (OR=12.227, 95%CI 2.817 to 53.074, P=0.001). ConclusionThe MDR-AB infection in lower respiratory tract can significantly prolong the length of ICU stay and increase the mortality. The Apache Ⅱ score >15 and use of carbapenems are the risk factors, and the placement of drainage tube and use of vasoactive drugs can increase the mortality of MDR-AB infection of lower respiratory tract in ICU.
目的 报道临床药师参与抗结核药物致结核性胸膜炎待诊患者多形红斑型药疹的临床药学实践的经验。 方法 1例结核性胸膜炎待诊患者在2011年11月3日出现皮疹后，临床药师根据患者的用药情况及病情变化，提供咨询意见，与临床医师共同制定不良反应的临床处理措施。 结果 推断为链霉素所致的多形红斑型药疹，积极处理后患者病情好转。 结论 临床药师参与药学监护，有利于处理药物不良反应。
Objective To observe the functional state of the optic nerve and discover the injury of visual pathway function in time under general ane sthesia. The flash visual evoked potential (F-VEP) was used to monitor visual function during orbital surgery. Methods A total of 252 out of 282 patients undergoing orbital surgery under general anesthesia were successfully monitored by F-VEP during the surgery. All patients were monitored by this method under the following conditions:consious state before operation, under general anaesthesia, during and after dissection of orbital tumor and at the end of operation. Results ①There was no significant difference of wave amplitude and latency under general anesthesia and consciousness condition. ②The amplitude and latency of F-VEP were normal in the orbital surgery withou toptic nerve injury. ③Pulling and oppression of optic nerve could cause temporary wave loss, but the wave recovered after removal of the pull and oppression. ④ The wave loss of F-VEP would occur immedicately when optic nerve was severe injured and its blood supply was deficient. Since the application of the visual function monitoring, 24 cases were treated in time during disturbance of visual function and no patient has unexpected visual loss during orbital surgery. Conclusion The intraoperative monitoring of F-VEP during orbital surgery can decrease the proportion of permanent visual loss caused by orbit al surgery, and help the surgical procedures go to function-anatomy stage from experience-anatomy stage. (Chin J Ocul Fundus Dis, 2001,17:260-263)
Objective To identify the predictors for readmission in the ICU among cardiac surgery patients. Methods We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016. Results The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%, P<0.001). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=1.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 to1.259, P<0.001), and the drainage on the day of surgery (OR=1.001, 95%CI1.001 to 1.002, P<0.001) were the independent risk factors for readmission to the cardiac surgery ICU. Conclusion The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient healthcare planning and resources allocation.