Observations on the Application of Nursing Risk Management in the Care of Critically Ill Patients in the Respiratory Unit

Objechive:Investigate the effectiveness of mursing risk management in the care of cntically ill patients in the respiratory umit.Methods:Among the cntically ill respiratory patients admitted to our hospital between May 2019 and April 2020,78 patients were randomly selected and divided into an observation group and a control group,each consisting of 39 patients.In the observation group.a mursing nisk management model was implemented,i.e,patients'clinical symptoms were observed at any time to monitor their treatment satisfaction and the effectiveness of their care and routine care was implemented for the control group.Results:The heart rate,respiratory rate,and pH of patients in the observation group were more stable than those in the control group,and their respiratory status was better,with differences in data.There was also sigmifcant statistical significance(P<0.05).The incidence of patient-provider disputes,unplanned extubation,and uplammed events were lower in the observation group conpared to the control group,and their data difference was satistically siguificant(P-0.05).The treatment satisfaction as well as the total effective rate of patients in the observation group was also much higher than that of the contol group,and there was also a statistically sigmificant difference in the data(P<0.05).Conclusion:The musing nisk management model has a significant therapeutic effect in the care of cnitically ill respiratory patients.Therefore,it is worth popularizing to use in the clinical mursing of respiratory cnitical patients.

The Impact of Rate of Feeding Advancement after Early Initiation of Enteral Nutrition in Critically Ill, Underweight Patients: A Single-Center Retrospective Chart Review

Background: The optimal rate of feeding advancement after initiation of early enteral nutrition (EEN) for underweight, critically ill patients is unknown. Methods: We conducted a retrospective chart review in intensive care unit (ICU) patients with a body mass index (BMI) < 20.0 kg/m2. Patients were categorized into Group R, which reached the energy target within 3 days of EEN initiation, and Group S, which reached the energy target 4 or more days after EEN initiation. Results: A total of 65 patients with a median age of 73 years were included in the study. No significant differences were observed between the two groups for all-cause mortality, ICU-free days, or length of hospital stay. Ventilator-free days (VFDs) were significantly fewer in Group R than in Group S (18.0 [0.0 - 22.0] vs. 21.0 [16.3 - 24.8] days;P = 0.046). A significantly higher number of patients requiring mechanical ventilation (MV) at hospital discharge were observed in Group R than in Group S (29% vs. 8%;P = 0.030). Multivariable analyses with adjustment for confounders found that days required to reach target energy intake after EEN initiation were significantly and independently associated with the requirement for MV at hospital discharge, but not with VFDs. Conclusion: A slow rate of feeding advancement after initiation of EEN in critically ill patients having a BMI of <20.0 kg/m2 might be associated with a reduced requirement for MV at hospital discharge. These results require confirmation in a large multicenter trial of underweight, critically ill patients.

Modified B-ultrasound method for measurement of antral section only to assess gastric function and guide enteral nutrition in critically ill patients

AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patients. METHODS First,30 healthy volunteers were selected. The modified B-ultrasound method and the traditional B-ultrasound method were applied to assess gastric function. The correlation of indices of gastric function between the two groups was analyzed statistically. In addition,64 critically ill patients were selected,and the modified B-ultrasound method and the gastric juice withdrawal method were applied to guide the implementation of EN. Daily caloric value,the time required to achieve complete EN,ICU stay,hospitalization time,and serum prealbumin and albumin levels were recorded and compared between the two groups. Kaplan-Meier survival curve was used to compare the complications of EN between the two groups. RESULTS In healthy subjects,there was a good correlation among gastric emptying time,antral contraction frequency andantral motility index between the two groups(r = 0.57,0.61 and 0.54,respectively). The study on critically ill patients also revealed that a better effect of EN was achieved in the modified B-ultrasound method group,in which patients had shorter ICU stay and hospitalization time and higher levels of serum prealbumin and albumin. The Kaplan-Meier survival analysis revealed that the improved B-ultrasound method was associated with significantly fewer EN complications(P = 0.031).CONCLUSION The modified B-ultrasound method can provide a good real-time assessment of gastric function and has a better effect than the traditional method in guiding EN in critically ill patients.

Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency

BACKGROUND:This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.METHODS:The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed.The data of 321 patients with no acute respiratory insufficiency as controls were also collected.Clinical variables of the first 24 hours after admission to intensive care unit were collected,including age,sex,comorbid disease,type of surgery,admission type,presence of shock,presence of acute kidney injury,presence of acute lung injury/acute respiratory distress syndrome,acute physiologic and chronic health evaluation(APACHE Ⅱ) score,sepsis-related organ failure assessment(SOFA),and PaO_2/FiO_2 ratio.Duration of mechanical ventilation,length of intensive care unit stay,intensive care unit death,length of hospitalization,hospital death and one-year survival were calculated.RESULTS:The incidence of acute respiratory insufficiency was 37.2%(190/321).Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases(P=0.001),surgeryrelated infection(P=0.004),hypo-volemic shock(P<0.001),and emergency surgery(P=0.018),were independent risk factors of postoperative acute respiratory insufficiency.Compared with the patients without acute respiratory insufficiency,the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay(P<0.001),a prolonged length of hospitalization(P=0.006),increased intensive care unit mortality(P=0.001),and hospital mortality(P<0.001).Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency(P=0.029,RR:8.522,95%CI:1.243-58.437,B=2.143,SE=0.982,Wald=4.758).Compared with the patients without acute respiratory insufficiency,those with acute respiratory insufficiency had a shortened one-year survival rate(78.7%vs.97.1%,P<0.001).CONCLUSION:A history of chronic obstructive pulmonary diseases,surgery-related infection,hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency.Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency.Compared with patients without acute respiratory insufficiency,those with acute respiratory insufficiency had adverse shortterm outcome and a decreased one-year survival rate.

Effect of fiber supplementation on the microbiota in critically ill patients

AIM:To determine tolerance to fiber supplementation of semi-elemental tube feeds in critically ill patients and measure its effect on colonic microbiota and fermentation.METHODS:Thirteen intensive care unit patients receiving jejunal feeding with a semi-elemental diet for predominantly necrotizing pancreatitis were studied.The study was divided into 2 parts:first,short-term (3-9 d)clinical tolerance and colonic fermentation as assessed by fecal short chain fatty acid(SCFA)concentrations and breath hydrogen and methane was measured in response to progressive fiber supplementation increasing from 4 g tid up to normal requirement levels of 8 g tid;second,4 patients with diarrhea were studied for 2-5 wk with maximal supplementation to additionally assess its influence on fecal microbiota quantitated by quantitative polymerase chain reaction (qPCR)of microbial 16S rRNA genes and Human Intestinal Tract Chip(HITChip)microarray analysis.Nearly all patients were receiving antibiotics(10/13)and acid suppressants(11/13)at some stage during the studies.RESULTS:In group 1,tolerance to progressive fiber supplementation was good with breath hydrogen and methane evidence(P=0.008 and P<0.0001,respectively)of increased fermentation with no exacerbation of abdominal symptoms and resolution of diarrhea in 2 of 4 patients.In group 2 before supplementation,fecal microbiota mass and their metabolites,SCFA,were dramatically lower in patients compared to healthy volunteers.From qPCR and HITChip analyses we calculated that there was a 97%reduction in the predominant potential butyrate producers and starch degraders.Following 2-5 wk of fiber supplementation there was a significant increase in fecal SCFA(acetate 28.4±4.1μmol/g to 42.5±3.1μmol/g dry weight,P=0.01;propionate 1.6±0.5 vs 6.22±1.1,P=0.006 and butyrate 2.5±0.6 vs 5.9±1.1,P=0.04)and microbial counts of specific butyrate producers,with resolution of diarrhea in 3 of 4 patients.CONCLUSION:Conventional management of critically ill patients,which includes the use of elemental diets and broad-spectrum antibiotics,was associated with gross suppression of the colonic microbiota and their production of essential colonic fuels,i.e.,SCFA.Our investigations show that fiber supplementation of the feeds has the potential to improve microbiota mass and function,thereby reducing the risks of diarrhea due to dysbiosis.

Mechanisms underlying feed intolerance in the critically ill: Implications for treatment

Malnutrition is associated with poor outcomes in critically ill patients. Although nutritional support is yet to be proven to improve mortality in non-malnourished critically ill patients, early enteral feeding is considered best practice. However, enteral feeding is often limited by delayed gastric emptying. The best method to clinically identify delayed gastric emptying and feed intolerance is unclear. Gastric residual volume (GRV) measured at the bedside is widely used as a surrogate marker for gastric emptying, but the value of GRV measurement has recently been disputed. While the mechanisms underlying delayed gastric emptying require further investigation, recent research has given a better appreciation of the pathophysiology. A number of pharmacological strategies are available to improve the success of feeding. Recent data suggest a combination of intravenous metoclopramide and erythromycin to be the most successful treatment, but novel drug therapies should be explored. Simpler methods to access the duodenum and more distal small bowel for feed delivery are also under investigation. This review summarises current understanding of the factors responsible for, and mechanisms underlying feed intolerance in critical illness, together with the evidence for current practices. Areas requiring further research are also highlighted.

Clinical features and risk factors of severely and critically ill patients with COVID-19

BACKGROUND As of June 1,2020,over 370000 coronavirus disease 2019(COVID-19)deaths have been reported to the World Health Organization.However,the risk factors for patients with moderate-to-severe or severe-to-critical COVID-19 remain unclear.AIM To explore the characteristics and predictive markers of severely and critically ill patients with COVID-19.METHODS A retrospective study was conducted at the B11 Zhongfaxincheng campus and E1-3 Guanggu campus of Tongji Hospital affiliated with Huazhong University of Science and Technology in Wuhan.Patients with COVID-19 admitted from 1st February 2020 to 8th March 2020 were enrolled and categorized into 3 groups:The moderate group,severe group and critically ill group.Epidemiological data,demographic data,clinical symptoms and outcomes,complications,laboratory tests and radiographic examinations were collected retrospectively from the hospital information system and then compared between groups.RESULTS A total of 126 patients were enrolled.There were 59 in the moderate group,49 in the severe group,and 18 in the critically ill group.Multivariate logistic regression analysis showed that age[odd ratio(OR)=1.055,95%(confidence interval)CI:1.099-1.104],elevated neutrophil-to-lymphocyte ratios(OR=4.019,95%CI:1.045-15.467)and elevated high-sensitivity cardiac troponin I(OR=10.126,95%CI:1.088-94.247)were high-risk factors.CONCLUSION The following indicators can help clinicians identify patients with severe COVID-19 at an early stage:age,an elevated neutrophil-to-lymphocyte ratio and high sensitivity cardiac troponin I.

基于Caprini风险评估量表构建重症监护病房患者深静脉血栓形成的预测模型

目的 基于Caprini风险评估量表构建重症监护病房患者深静脉血栓形成的预测模型。方法 收集2020年1月至2022年12月362例重症患者的临床资料,根据是否发生深静脉血栓,分为深静脉血栓组和对照组。比较两组患者临床特征和Caprini风险评估量表评分差异,分析深静脉血栓形成的相关危险因素并构建预测模型。结果 两组患者糖尿病、Caprini风险评估量表评分和外科手术率比较,差异有统计学意义(P<0.05)。多因素Logistics回归分析显示,糖尿病、外科手术和Caprini评分≥5是重症患者并发深静脉血栓的独立危险因素(P<0.05)。将训练集和验证集数据代入构建的预测模型,训练集ROC曲线下面积为0.768,验证集ROC曲线下面积为0.870,验证集里对模型进行拟合优度检验(χ^(2)=4.856,P=0.773),可信度较好。结论 基于Caprini风险评估量表构建的预测模型对重症监护病房患者深静脉血栓形成具有较好的预测价值和可信度。

Proximal gastric motility in critically ill patients with type 2 diabetes mellitus

AIM: To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with long- standing type 2 diabetes mellitus. METHODS: Proximal gastric motility was assessed (using a barostat) in 10 critically ill patients with type 2 diabetes mellitus (59 ± 3 years) during two 60-min duodenal infusions of Ensure? (1 and 2 kcal/min), in random order, separated by 2 h fasting. Data were compared with 15 non-diabetic critically ill patients (48 ± 5 years) and 10 healthy volunteers (28 ± 3 years). RESULTS: Baseline proximal gastric volumes were similar between the three groups. In diabetic patients, proximal gastric relaxation during 1 kcal/min nutrient infusion was similar to non-diabetic patients and healthy controls. In contrast, relaxation during 2 kcal/ min infusion was initially reduced in diabetic patients (P < 0.05) but increased to a level similar to healthy humans, unlike non-diabetic patients where relaxation was impaired throughout the infusion. Duodenal nutrient stimulation reduced the fundic wave frequency in a dose-dependent fashion in both the critically ill diabetic patients and healthy subjects, but not in critically ill patients without diabetes. Fundic wave frequency in diabetic patients and healthy subjects was greater than in non-diabetic patients. CONCLUSION: In patients with diabetes mellitus, proximal gastric motility is less disturbed than non- diabetic patients during critical illness, suggesting that these patients may not be at greater risk of delayed gastric emptying.

Intensive care unit-acquired weakness and mechanical ventilation:A reciprocal relationship

Intensive care unit-acquired weakness(ICU-AW;ICD-10 Code:G72.81)is a syndrome of generalized weakness described as clinically detectable weakness in critically ill patients with no other credible cause.The risk factors for ICU-AW include hyperglycemia,parenteral nutrition,vasoactive drugs,neuromuscular blocking agents,corticosteroids,sedatives,some antibiotics,immobilization,the disease severity,septicemia and systemic inflammatory response syndrome,multiorgan failure,prolonged mechanical ventilation(MV),high lactate levels,older age,female sex,and pre-existing systemic morbidities.There is a definite association between the duration of ICU stay and MV with ICU-AW.However,the interpretation that these are modifiable risk factors influencing ICU-AW,appears to be flawed,because the relationship between longer ICU stays and MV with ICU-AW is reciprocal and cannot yield clinically meaningful strategies for the prevention of ICU-AW.Prevention strategies must be based on other risk factors.Large multicentric randomized controlled trials as well as meta-analysis of such studies can be a more useful approach towards determining the influence of these risk factors on the occurrence of ICU-AW in different populations.

Prevalence of polymyxin-induced nephrotoxicity and its predictors in critically ill adult patients:A meta-analysis

BACKGROUND Polymyxin-induced nephrotoxicity is a major safety concern in clinical practice due to long-term adverse outcomes and high mortality.AIM To conducted a systematic review and meta-analysis of the prevalence and potential predictors of polymyxin-induced nephrotoxicity in adult intensive care unit(ICU)patients.METHODS PubMed,EMBASE,the Cochrane Library and Reference Citation Analysis database were searched for relevant studies from inception through May 30,2022.The pooled prevalence of polymyxin-induced nephrotoxicity and pooled risk ratios of associated factors were analysed using a random-effects or fixed-effects model by Stata SE ver.12.1.Additionally,subgroup analyses and meta-regression were conducted to assess heterogeneity.RESULTS A total of 89 studies involving 12234 critically ill adult patients were included in the meta-analysis.The overall pooled incidence of polymyxin-induced nephrotoxicity was 34.8%.The pooled prevalence of colistin-induced nephrotoxicity was not higher than that of polymyxin B(PMB)-induced nephrotoxicity.The subgroup analyses showed that nephrotoxicity was significantly associated with dosing interval,nephrotoxicity criteria,age,publication year,study quality and sample size,which were confirmed in the univariable meta-regression analysis.Nephrotoxicity was significantly increased when the total daily dose was divided into 2 doses but not 3 or 4 doses.Furthermore,older age,the presence of sepsis or septic shock,hypoalbuminemia,and concomitant vancomycin or vasopressor use were independent risk factors for polymyxin-induced nephrotoxicity,while an elevated baseline glomerular filtration rate was a protective factor against colistin-induced nephrotoxicity.CONCLUSION Our findings indicated that the incidence of polymyxin-induced nephrotoxicity among ICU patients was high.It emphasizes the importance of additional efforts to manage ICU patients receiving polymyxins to decrease the risk of adverse outcomes.

High-risk factors for delirium in severely ill patients and the application of emotional nursing combined with pain nursing

BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Patients with delirium in the intensive care unit(ICU)are often missed or misdiagnosed and do not receive adequate attention.AIM To analyze the risk factors for delirium in ICU patients and explore the applica-tion of emotional nursing with pain nursing in the management of delirium.METHODS General data of 301 critically ill patients were retrospectively collected,including histories(cardiovascular and cerebrovascular diseases,hypertension,smoking,alcoholism,and diabetes),age,sex,diagnosis,whether surgery was performed,and patient origin(emergency/clinic).Additionally,the duration of sedation,Richmond Agitation Sedation Scale score,combined emotional and pain care,ven-tilator use duration,vasoactive drug use,drainage tube retention,ICU stay du-ration,C-reactive protein,procalcitonin,white blood cell count,body tempe-rature,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission.Patients were assessed for delirium according to confusion assessment method for the ICU,and univariate and multivariate logistic regre-ssion analyses were performed to identify the risk factors for delirium in the patients.RESULTS Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients.The results showed that 16 risk factors were closely related to delirium,including combined emotional and pain care,history of diabetes,and patient origin.Multivariate logistic regression analysis revealed that no combined emotional and pain care,history of diabetes,emergency source,surgery,long stay in the ICU,smoking history,and high APACHE II score were independent risk factors for de-lirium in ICU patients.CONCLUSION Patients with diabetes and/or smoking history,postoperative patients,patients with a high APACHE II score,and those with emergency ICU admission need emotional and pain care,flexible visiting modes,and early intervention to reduce delirium incidence.

Nursing Experience of Early Application of Nasoenteric Tube for Enteral Nutrition in Critically Ill ICU Patients

Objective:To investigate the effective nursing measures of early application of nasoenteric tube for enteral nutrition in critically ill patients in ICU,and to summarize the nursing experience.Methods:The study was carried out in June 2023–November 2023.62 samples of ICU critically ill patients were selected,all of whom used enteral nutrition by mesenteric tube and were grouped into an observation group(n=31)and a control group(n=31)by using the numerical table randomization method.The patients in the control group were basic nursing interventions,and the patients in the observation group were comprehensive quality care,comparing the nutritional indexes,complication rates,and nursing satisfaction between the two groups.Results:All nutritional indicators of the observation group were higher than those of the control group after nursing intervention(P<0.05);the complication rate of the observation group was lower than that of the control group(P<0.05);the nursing satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:Comprehensive quality nursing care during the early application of a gastroenteric tube for enteral nutrition in critically ill patients in the ICU can improve nutritional indexes,reduce the incidence of complications and improve nursing satisfaction.

Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a Surgical Intensive Care Unit

Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam- ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results： According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group （P〈0.05）. The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores （P〈0.05）. Conclusions： The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of decompression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.

Antioxidant enriched enteral nutrition and oxidative stress after major gastrointestinal tract surgery

AIM: To investigate the effects of an enteral supple-ment containing antioxidants on circulating levels of antioxidants and indicators of oxidative stress after major gastrointestinal surgery.METHODS: Twenty-one patients undergoing major upper gastrointestinal tract surgery were randomised in a single centre, open label study on the effect of postoperative enteral nutrition supplementedwith antioxidants. The effect on circulating levels of antioxidants and indicators of oxidative stress, such as F2-isoprostane, was studied. RESULTS: The antioxidant enteral supplement showed no adverse effects and was well tolerated. After surgery a decrease in the circulating levels of antioxidant parameters was observed. Only selenium and glutamine levels were restored to pre-operative values one week after surgery. F2-isoprostane increased in the first three postoperative days only in the antioxidant supplemented group. Lipopolysaccharide binding protein (LBP) levels decreased faster in the antioxidant group after surgery.CONCLUSION: Despite lower antioxidant levels there was no increase in the circulating markers of oxidative stress on the first day after major abdominal surgery. The rise in F2-isoprostane in patients receiving the antioxidant supplement may be related to the conversion of antioxidants to oxidants which raises questions on antioxidant supplementation. Module AOX restored the postoperative decrease in selenium levels. The rapid decrease in LBP levels in the antioxidant group suggests a possible protective effect on gut wall integrity. Further studies are needed on the role of oxidative stress on outcome and the use of antioxidants in patients undergoing major abdominal surgery.

Misconceptions and truths for feeding patients in the intensive care unit: Case studies with practical nursing solutions

The Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient published in May 2009 (joint guidelines between the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) have advanced our clinical practice for the nutritional management of critically ill patients. In the current article, we will review how to implement these guidelines using a case study model. Two mechanically ventilated and tube fed patients are discussed, one with pneumonia and the second with severe acute pancreatitis. We address the questions of the feeding timing, method of administration, and management of its complications for these two patients.

Application and Reliability of Caprini Thrombus Risk Assessment Scale in Risk Assessment of Venous Thromboembolism in Acute and Severe Uygur Patients

Background: To explore the application and reliability of Caprini thromboembolism risk assessment scale in the risk assessment of venous thromboembolism in acute and severe uygur patients. Methods: 160 cases of acute and severe Uighur patients with venous thrombo embolism (VTE) that were treated in our hospital from December 2017 to December 2018 were selected as the research group. 160 cases of acute and severe uygur patients without VTE admitted to our hospital in the same period were selected as the control group. Caprini thrombus risk assessment scale and Padua thrombus risk assessment scale were used to evaluate in both groups. The general data of the two groups were compared. The results of the two groups were consistent using Caprini and Padua blood clot risk assessment scales. Clinical efficacy of two different thrombosis risk assessment scales in risk assessment of VTE. Results: Group and control group in the gender distribution, backlog of red blood cells and platelet count have no significant difference (P > 0.05), the team average age, average hospitalization days were significantly less than control group (P P P 2 = 6.956, P P (P P > 0.05). Conclusion: The sensitivity, negative predictive value and positive predictive value of Caprini thrombosis risk assessment scale in VTE risk assessment of acute and severe uygur patients are very prominent, and the clinical efficacy is better, which is worthy of application.

老年危重症患者发生再喂养综合征的危险因素回归方程的构建及干预措施分析

目的构建老年危重症患者发生再喂养综合征(RFS)的危险因素回归方程,并分析相应的干预措施。方法回顾性分析2021年1月—2023年3月重症监护室(ICU)收治的154例老年危重症患者的临床资料,根据RFS发生情况分为RFS组51例和非RFS组103例。采用Logistic回归模型分析影响发生RFS的因素;采用受试者工作特征(ROC)曲线分析预测因子对RFS的预测价值;构建并验证相关Logistic回归方程,拟定相关护理干预内容。结果老年危重症患者发生RFS与急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、营养风险筛查2002(NRS2002)评分、有创机械通气、喂养前禁食时间、D-二聚体水平、营养摄入方式和喂养前血磷、血钾、血镁水平有相关性(P<0.05)。Logistic回归分析显示,APACHEⅡ评分、NRS2002评分、营养摄入方式和喂养前血磷、血钾水平均为影响老年危重症患者发生RFS的独立危险因素(P<0.05)。ROC曲线结果显示,APACHEⅡ评分、NRS2002评分、营养摄入方式和喂养前血磷、血钾水平和联合预测因子预测老年危重症患者发生RFS的曲线下面积(AUC)分别为0.754、0.723、0.707、0.783、0.774和0.859(P<0.05)。发生RFS的Logistic回归方程为L=0.085×APACHEⅡ评分-0.337×NRS 2002评分+0.537×营养摄入方式-0.776×喂养前血磷水平-0.207×喂养前血钾水平+0.942。该方程预测价值良好,可根据方程拟定针对性的护理干预措施。结论危险因素回归方程可用于老年危重症患者RFS发生风险的临床预测,临床可根据回归方程制订相关护理干预措施,预防RFS的发生。

ICU患者再喂养综合征风险预测模型的研究进展

再喂养综合征(refeeding syndrome,RFS)在重症患者中发生率较高,严重影响患者的康复和预后。通过对再喂养综合征的风险因素和风险预测模型进行综述,发现其风险因素包括患者相关因素、治疗相关因素和疾病相关因素三个方面;风险预测模型包括风险分层模型、风险评分模型和Logistic回归模型。预防RFS的发生重点在于早期评估,但目前尚缺乏预测效能良好的RFS风险预测模型。关注营养和血清学指标等多方面因素对RFS的预防有着重要意义,未来需开展前瞻性、多中心研究,以构建预测效能良好的ICU患者RFS风险预测模型,为RFS高危人群的早期评估和早期干预提供参考。

经口气管插管患者口腔黏膜压力性损伤风险预测模型的构建及验证

目的构建并验证经口气管插管患者发生口腔黏膜压力性损伤的风险预测模型。方法纳入2022年12月至2023年7月浙江省某三级甲等医院ICU的400例经口气管插管患者为模型训练集,2023年8-10月的152例为模型外部验证集。采用logistic回归筛选口腔黏膜压力性损伤的预测变量。绘制受试者工作特征曲线下面积、校准曲线和临床决策曲线来评估预测模型的预测性能。采用Bootstrap法对模型进行内部验证。结果logistic回归结果显示,年龄、躁动-镇静程度量表评分、急性生理与慢性健康评分Ⅱ、血清白蛋白水平、气管插管操作者、气管导管固定方式和人工气道留置时间是口腔黏膜压力性损伤的影响因素(P<0.05)。训练集和验证集的受试者工作特征曲线下面积分别为0.913(95%CI:0.873~0.954)和0.956(95%CI:0.922~0.981);Hosmer-Lemeshow检验结果表明,模型预测值与实际值吻合较好,模型校准度较好(χ^(2)=1.702,P=0.427)。Bootstrap法重抽样结果显示,受试者工作特征曲线下面积为0.908(95%CI:0.852~1.105),灵敏度为94.9%,特异度为60.8%,准确率为83.7%。结论本研究构建的风险预测模型具有较好的区分度、校准度和临床应用价值,可为精准识别经口气管插管患者口腔黏膜压力性损伤高风险人群提供参考依据。