Improvement of the nutritional support management system for patients in intensive care units

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.

Prognostic impact of hypernatremia for septic shock patients in the intensive care unit

BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.

Global and Regional Surface Nitrogen Balances in Intensive Agricultural Production Systems for the Period 1970-2030

Global nitrogen (N) budgets for intensive agricultural systems were compiled for a 0.5 by 0.5 degree resolution. These budgets include N inputs (N fertilizer, animal manure, biological N fixation and atmospheric N deposition) and outputs (N removal from the field in harvested crops and grass and grass consumption by grazing animals, ammonia volatilization,denitrification and leaching). Data for the historical years 1970 and 1995 and a projection for 2030 were used to study changes in the recovery of N and the different loss terms for intensive agricultural systems. The results indicate that the overall system N recovery and fertilizer use efficiency slowly increased in the industrialized countries between 1970 and 1995, the values for developing countries have decreased in the same period. For the coming three decades our results indicate a rapid increase in both the industrialized and developing countries. High values of ＞ 80% for fertilizer use efficiency may be related to surface N balance deficits, implying a depletion of soil N and loss of soil fertility. The projected intensification in most developing countries will cause a gradual shift from deficits to surpluses in the coming decades.The projected fast growth of crop and livestock production, and intensification and associated increase in fertilizer inputs will cause a major increase in the surface N balance surplus in the coming three decades. This implies increasing losses of N compounds to air (ammonia, nitrous oxide and nitric oxide), and groundwater and surface water (nitrate).

Modeling Soil Organic Matter Dynamics Under Intensive Cropping Systems on the Huang-Huai-Hai Plain of China

A modified CQESTR model, a simple yet useful model frequently used for estimating carbon sequestration in agricultural soils, was developed and applied to evaluate the effects of intensive cropping on soil organic matter （SOM） dynamics and mineralization as well as to estimate carbon dioxide emission from agricultural soils at seven sites on the Huang-Huai-Hai Plain of China. The model was modified using site-specific parameters from short- and mid-term buried organic material experiments at four stages of biomass decomposition. The predicted SOM results were validated using independent data from seven long-term （10- to 20-year） soil fertility experiments in this region. Regression analysis on 1 151 pairs of predicted and measured SOM data had an r2 of 0.91 （P≤0.01）. Therefore, the modified model was able to predict the mineralization of crop residues, organic amendments, and native SOM. Linear regression also showed that SOM mineralization rate （MR） in the plow layer increased by 0.22% when annual crop yield increased by 1 t ha^-1 （P ≤ 0.01）, suggesting an improvement in SOM quality. Apparently, not only did the annual soil respiration efftux merely reflect the intensity of soil organism and plant metabolism, but also the SOM MR in the plow layer. These results suggested that the modified model was simple yet valuable in predicting SOM trends at a single agricultural field and could be a powerful tool for estimating C-storage potential and reconstructing C storage on the Huang-Huai-Hai Plain of China.

Allocation of patients with liver cirrhosis and organ failure to intensive care: Systematic review and a proposal for clinical practice

AIM: To propose an allocation system of patients with liver cirrhosis to intensive care unit(ICU), and developed a decision tool for clinical practice. METHODS: A systematic review of the literature was performed in Pub Med, MEDLINE and EMBASE databases. The search includes studies on hospitalized patients with cirrhosis and organ failure, or acute on chronic liver failure and/or intensive care therapy. RESULTS: The initial search identified 660 potentially relevant articles. Ultimately, five articles were selected; two cohort studies and three reviews were found eligible. The literature on this topic is scarce and no studies specifically address allocation of patients with liver cirrhosis to ICU. Throughout the literature, there is consensus that selection criteria for ICU admission should be developed and validated for this group of patients and multidisciplinary approach is mandatory. Based on current available data we developed an algorithm, to determine if a patient is candidate to intensive care if needed, based on three scoring systems: premorbid Child-Pugh Score, Model of End stage Liver Disease score and the liver specific Sequential Organ Failure Assessment score.CONCLUSION: There are no established systems for allocation of patients with liver cirrhosis to the ICU and no evidence-based recommendations can be made.

Discussion on the Index System of Intensive Land Use Evaluation in Development Area

The establishment of evaluation index system is the key to the evaluation of intensive land use.On the basis of expounding connotation,characteristics and the principle of establishing evaluation index system,and as for the problems existing in Evaluation Regulation(Trial)of Intensive Land Use in Development Area,regarding the evaluation index system of intensive land use in the development area,in the light of the connotation of intensive land use in development area,coupled with the practical situation of the land use in China's development area,after referring to the research achievements of domestic and abroad scholars,some suggestions are put forward in order to improve and perfect the evaluation index system of intensive land us in development area.

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

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.

Response of train-bridge system under intensive seismic excitation by random vibration method

Earthquake is a kind of sudden and destructive random excitation in nature.It is significant to determine the probability distribution characteristics of the corresponding dynamic indicators to ensure the safety and the stability of structures when the intensive seismic excitation,the intensity of which is larger than 7,acts in train-bridge system.Firstly,the motion equations of a two-dimensional train-bridge system under the vertical random excitation of track irregularity and the vertical seismic acceleration are established,where the train subsystem is composed of 8 mutually independent vehicle elements with 48 degrees of freedom,while the single-span simple supported bridge subsystem is composed of 102D beam elements with 20 degrees of freedom on beam and 2 large mass degrees of freedom at the support.Secondly,Monte Carlo method and pseudo excitation method are adopted to analyze the statistical parameters of the system.The power spectrum density of random excitation is used to define a series of non-stationary pseudo excitation in pseudo excitation method and the trigonometric series of random vibration history samples in Monte Carlo method,respectively solved by precise integral method and Newmark-βmethod through the inter-system iterative procedure.Finally,the results are compared with the case under the weak seismic excitation,and show that the samples of vertical acceleration response of bridge and the offload factor of train obeys the normal distribution.In a high probability,the intensive earthquakes pose a greater threat to the safety and stability of bridges and trains than the weak ones.

Shifts in Carbon Stocks through Soil Profiles Following Management Change in Intensive Agricultural Systems

Soil carbon content is an important ecosystem property, especially under the ongoing climate change. The stability of soil organic matter (SOM) is controlled by environmental and biological factors including anthropogenic-induced agricultural management change. However, understanding the effects of anthropogenic activities (e.g., intensive agricultural practices) on carbon stability of soil profiles remains a challenge. The objective of this study was to determine the changes in carbon stocks through soil profiles following agricultural management change from grain fields to greenhouse vegetable fields. The sampling sites were located in an intensive vegetable production area in northernChina. A total of 20 pairs of grain fields (GF) and adjacent vegetable fields (VF) within a distance of50 mwere selected. The results showed that soil organic carbon (SOC) storage increased by 10.6 mg C ha-1 in upper soil layers but decreased by 5.3 mg C hm2 indeeper soil layers due to large input of organic manure and chemical fertilizer following the conversion from GF to VF. Conversion to VF also led to increased dissolved organic carbon (DOC) and dissolved organic nitrogen (DON) concentrations. Extremely higher input of chemical N fertilizer in the VF led to the soil C:N ratio decreased by 2.02 times and the -N leached to deeper soils increased by 3.7 times compared to that in the GF. The pH value and microbial biomass carbon (MBC) content were lower in the VF than in the GF. These results indicate that excessive nitrogen application as fertilizers might lead to deeper soil carbon depletion. Reducing nitrogen addition in intensive agricultural systems is thus necessary to reduce soil carbon loss and to maintain a relatively sustainable soil system.

Early mobilization for mechanically ventilated patients in the intensive care unit:a systematic review and meta-analysis

Background: Early mobilization(EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta-analysis concerning whether EM could benefit the clinical outcomes of critically ill patients requiring mechanical ventilation(MV). The present systematic review aims to evaluate the effect of EM compared with immobilization for mechanically ventilated patients.Methods: A computerized literature search was performed in six databases for related articles from inception to June 2017. We included randomized controlled trials and controlled clinical trials and used the Physiotherapy Evidence Database scale to assess the quality of included studies. Primary outcomes were measures of muscle function, duration of MV, and incidence of mortality.Secondary outcomes were adverse effects and length of stay(LOS) in intensive care unit(ICU) and hospital.Results: Eight trials were included; of those, only one study without standard EM reported that the intervention was invalid to improve the outcomes. The result of meta-analysis indicated that EM shortened the duration of MV; however, it had no positive effect on mortality and LOS in ICU.Conclusions: This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.

Database Management System Construction for the Evaluation Results of Intensive Land Use in the Development Areas of Hunan Province

Using spatial data integration and database technology,analyzing and integrating the assessment results in all the development zones at different time in Hunan Province,the paper is intended to construct the database and managerial system for the assessment results of land use intensity in development zones,thus formulating"one map"of Hunan Development zones and realizing the integrated management and application of the assessment results in all the development zones at any time of Hunan above the provincial level.It has been proved that the system has good application effect and promising development in land management for land management departments and development zones.

Management of sepsis in a cirrhotic patient admitted to the intensive care unit:A systematic literature review

BACKGROUND Sepsis is a severe medical condition that occurs when the body's immune system overreacts to an infection,leading to life-threatening organ dysfunction.The"Third international consensus definitions for sepsis and septic shock(Sepsis-3)"defines sepsis as an increase in sequential organ failure assessment score of 2 points or more,with a mortality rate above 10%.Sepsis is a leading cause of intensive care unit(ICU)admissions,and patients with underlying conditions such as cirrhosis have a higher risk of poor outcomes.Therefore,it is critical to recognize and manage sepsis promptly by administering fluids,vasopressors,steroids,and antibiotics,and identifying and treating the source of infection.AIM To conduct a systematic review and meta-analysis of existing literature on the management of sepsis in cirrhotic patients admitted to the ICU and compare the management of sepsis between cirrhotic and non-cirrhotic patients in the ICU.METHODS This study is a systematic literature review that followed the PRISMA statement's standardized search method.The search for relevant studies was conducted across multiple databases,including PubMed,Embase,Base,and Cochrane,using predefined search terms.One reviewer conducted the initial search,and the eligibility criteria were applied to the titles and abstracts of the retrieved articles.The selected articles were then evaluated based on the research objectives to ensure relevance to the study's aims.RESULTS The study findings indicate that cirrhotic patients are more susceptible to infections,resulting in higher mortality rates ranging from 18%to 60%.Early identification of the infection source followed by timely administration of antibiotics,vasopressors,and corticosteroids has been shown to improve patient outcomes.Procalcitonin is a useful biomarker for diagnosing infections in cirrhotic patients.Moreover,presepsin and resistin have been found to be reliable markers of bacterial infection in patients with decompensated liver cirrhosis,with similar diagnostic performance compared to procalcitonin.CONCLUSION This review highlights the importance of early detection and management of infections in cirrhosis patients to reduce mortality.Therefore,early detection of infection using procalcitonin test and other biomarker as presepsin and resistin,associated with early management with antibiotics,fluids,vasopressors and low dose corticosteroids might reduce the mortality associated with sepsis in cirrhotic patients.

Monitoring of Respiratory Infections in the Intensive Area of Respiratory System Disease

Respiratory infections are the most frequent nosocomial infections after those urinaries and surgicals. We analysed respiratory infection incidences in patients treated with different kinds of respiratory assistance (non-invasive ventilation and invasive mechanical ventilation trough tracheostomy), studying 640 patients recovering in the intensive area of respiratory disease from 2010 to 2013. We had 113 cases of respiratory infections: 42.5% in patients of non-invasive ventilation group and 57.5% of patients treated with invasive ventilation with a statistically significant difference between the two groups. The patients treated with non-invasive ventilation showed a lower incidence of nosocomial respiratory infections. Prevention guidelines are important to reduce nosocomial infections frequency.

Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.

Mothers’experiences of neonatal intensive care:A systematic review and implications for clinical practice

BACKGROUND Preterm birth is on the rise worldwide.Neonatal intensive care units(NICUs)have enabled many critically ill newborns to survive.When a premature baby is admitted to the NICU,the mother–infant relationship may be interrupted,affecting the mother's mental health.AIM To examine the maternal emotions associated with having a child in the NICU and provide suggestions for clinical practice.METHODS MEDLINE,CINAHL,PsychARTICLES,and PsychINFO were searched for relevant articles between 2005 to 2019,and six qualitative articles were chosen that explored the experiences of mothers who had a preterm infant in the NICU.The thematic analysis method was used to identify the most common themes.RESULTS Four main themes of the experience of mothers who had a preterm infant in the NICU were identified:Negative emotional impacts on the mother,support,barriers to parenting,and establishment of a loving relationship.CONCLUSION NICU environment is not conducive to mother-child bonding,but we stipulate steps that health care professionals can take to reduce the negative emotional toll on mothers of NICU babies.

COVID-19 pandemic in the intensive care unit:Psychological implications and interventions,a systematic review

BACKGROUND The coronavirus disease 2019(COVID-19) pandemic produced changes in intensive care units(ICUs) in patient care and health organizations. The pandemic event increased patients’ risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff;this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties.AIM To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff.METHODS We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles,upon which we commented.RESULTS Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories.CONCLUSION As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.

Intensive Training for Stroke: Evidence of Safety from Meta-analysis and Systematic Reviews

[Objectives] To investigate the safety of intensive training for stroke recovery. [Methods] A systematic electronic search was conducted up to December 1 st , 2022, and the number of falls and fall-related injuries, as well as other adverse events, were extracted. Odds ratios (ORs) were calculated to assess the two intervention methods, and a 95% confidence interval (95% CI) was calculated for each of them to ensure the statistical accuracy of the results. The heterogeneity of the included studies was also tested. [Results] Five moderate to high quality studies comprising a total of 184 participants were included in this review. All five randomized controlled trials reported adverse events, including falls that did not result in injury, pain in the joints, back, muscle, or chest, and skin injuries such as cuts, bruises, and scrapes. The pooled analysis of these trials showed no statistically significant differences between the intensive training and control groups in terms of falls ( P =0.35) , pain ( P =0.07), or skin injuries ( P =0.90). [Conclusions] This review provides good evidence to suggest that intensive training is safe and feasible as a novel intervention during the stroke recovery.

Critical Soil Phosphorus Values for Yield Reduction in Intensive Agricultural Systems

Phosphorus(P)is an essential element for agricultural production.Over-fertilization during decades caused an accumulation of P in soils leading to eutrophication in regions characterized by intensive agriculture.These environmental concerns together with the non-renewability of P resources have led to a more sustainable P use.Knowledge about the P need of crops is essential for a sustainable agriculture thereby minimizing P losses to the environment without lowering the yield substantially.Therefore,in this study,critical soil P values for yield reduction(PCrit)were determined based on fertilizer trials conducted between 1970 and 1988 and more recent fertilizer trials(2016-2017).At rotational level a common PCrit value of 109 mg P/kg dry soil(in an ammonium lactate and acetate extract)was determined.Crop specific PCrit values were also determined for seven crops(potato,winter wheat,barley,rye,maize,sugar beet and temporary grassland).These critical values ranged from 59 mg P/kg dry soil to 164 mg P/kg dry soil with winter wheat the least and maize the most sensitive towards P deficiency.The diversity in PCrit values among crops can mainly be explained by the root intensity but also rooting depth,exudation of organic acids and phosphatases may influence the PCrit value.The soil pH also influenced the P availability significantly.Soils with a favorable pH had a significantly higher availability(i.e.,lower PCrit value)for all crops compared to soils with a suboptimal pH.Critical soil P values might help to set up new or to evaluate current soil P in target zones used for P fertilizer recommendations.

Effects of short-term intensive insulin therapy on systemic inflammatory response and stress response in patients with severe pneumonia

Objective:To study the effects of short-term intensive insulin therapy on systemic inflammatory response and stress response in patients with severe pneumonia.Methods:Patients with severe pneumonia who were treated in our hospital between March 2015 and October 2017 were chosen as the research subjects and randomly divided into the INS group who received short-term intensive insulin combined with routine therapy and the control group who received short-acting insulin combined with routine therapy. The levels of inflammatory factors and stress mediators in serum as well as the expression intensity of inflammatory molecules in peripheral blood were determined before treatment as well as 3 d and 7 d after treatment.Results:Compared with same group before treatment, serum IL-1β, IL-13, suPAR, sTREM1, sP-selectin, SF, 8-iso-PGF2α, AQP1 and AQP5 levels as well as peripheral blood NF-κB, COX2, RANTES, CD28 and CD80 expression intensity of both groups significantly decreased 3 days and 7 days after treatment, and serum IL-1β, IL-13, suPAR, sTREM1, sP-selectin, SF, 8-iso-PGF2α, AQP1 and AQP5 levels as well as peripheral blood NF-κB, COX2, RANTES, CD28 and CD80 expression intensity of INS group 3 d and 7 d after treatment were significantly lower than those of control group.Conclusion: Short-term intensive insulin therapy has inhibitory effect on the systemic inflammatory response and stress response in patients with severe pneumonia.

Epidemiological characteristics of traumatic spinal cord injuries in the intensive care unit from 2018 to 2023:a retrospective hospital-based study

BACKGROUND:The objective of this retrospective hospital-based study was to describe the epidemiological features of traumatic spinal cord injury(TSCI)in the intensive care unit(ICU)and assess the incidence and possible risk factors for venous thromboembolism(VTE)following TSCI.METHODS:We retrospectively reviewed the medical records of 370 patients with TSCI who were admitted between January 2018 and March 2023.The following parameters were collected:age,sex,body mass index,occupation,underlying diseases,smoking history,education level,etiology of injury,injury segments,American Spinal Injury Association(ASIA)Impairment Scale score,severity of injury,injury severity score(ISS),VTE risk score(Caprini score),treatment,VTE prophylaxis,ICU length of stay,length of hospital stay,concomitant injuries,and complications.Descriptive statistics were used to summarize the demographic and clinical characteristics of the study participants.Logistic regression analysis was used to determine the risk factors for VTE.RESULTS:The mean age of patients with TSCI was 55.5±13.4 years,with a male-to-female ratio of 6.5:1.The leading cause of TSCI was falls from height(46.5%),followed by traffic accidents(36.5%).The cervical spinal cord was the most affected segment,followed by the thoracolumbar region.Among all the patients,362(97.8%)had concomitant injuries.Complications were observed in 255 patients(68.9%)during hospitalization.The incidence rate of VTE was 25.1%.Logistic regression analysis revealed that age(OR=1.721,95%CI:1.207-2.454,P=0.003),mechanical ventilation(OR=3.427,95%CI:1.873-6.271,P<0.001),and non-use of chemical prophylaxis(OR=2.986,95%CI:1.749-5.099,P<0.001)were risk factors for VTE.CONCLUSION:Falls from height and traffic accidents were the main causes of TSCIs in the ICU,especially for male patients with cervical spinal cord injuries.VTE is a frequent complication in patients with TSCI in the ICU.Age,mechanical ventilation,and non-use of chemical prophylaxis were found to be independent risk factors for VTE following TSCI.