Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54;CI 95%: 0.39 - 0.74) were observed. Conclusion: The results indicate the benefits of care measures for children admitted to the PICU in terms of a reduction in adverse events and expansion of access.

Distribution and antibiotic resistance of pathogens isolated from ventilator-associated pneumonia patients in pediatric intensive care unit

BACKGROUND： With mechanical ventilation widely used in intensive care unit, the ventilator associated pneumonia （VAP） has become a common and serious complication in critically ill patients. Compared with adults, the incidence of VAP and the mortality are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, and increased use of artificial airway or mechanical ventilation. Hence it is of significance to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence and mortality of VAP in children.METHODS： From January 2008 to June 2010, 2758 children were treated in PICU of Wuhan Children＇s Hospital. Among them, 171 received mechanical ventilation over 48 hours in PICU, and 46 developed VAP. The distribution and drug-resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed. RESULTS：A total of 119 pathogenic microbial strains were isolated. Gram-negative bacilli （G-） were the most （65.55%）, followed by fungi （21.01%） and gram-positive cocci （G~, 13.45%）. Among them, the most common pathogens were Acinetobacter baummannii, Escherichia coli, Klebsiella pneumoniae, candida albicans and coagulase-negative staphylococci. Antibiotic susceptibility tests indicated that the multiple drug-resistances of G- and G＋to antibiotics were serious. Most of G- was sensitive to ciprofloxacin, amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. The susceptibility of G＋ to vancomycin, teicoplanin and linezolid were 100%. Fungi were almost sensitive to all the antifungal agents. The primary pathogens of VAP were G-, and their multiple drug-resistances were serious. CONCLUSION： In clinical practice we should choose the most sensitive drug for VAP according to pathogenic test.

Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit

With beta-lactam drugs and immunosuppressants widely used, the infection caused by Acinetobacter baumannfi （Ab） has become more and more serious with multidrug resistant Acinetobacter baumannfi （MDRAb） emerging and worsening rapidly. Compared with other patients, the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, prolonged hospitalization and invasive operations. Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children. A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb （NMDRAb） pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children＇s Hospital. Clinical data were analyzed with univariate and multivariate Logistic regression. In 176 clinical strains of Acinetobacter baumannfi isolated, there were 128 strains of MDRAb, accounting for 72.73%. Drug susceptibility tests showed that the resistance rates of 13-1actam antibiotics were more than 70% except for cefoperazone sulbactam. The rates to carbapenems were higher than 90%. They were significantly higher than those of NMDRAb. Amikacin, levofloxacin, ciprofloxacin and minocycline had the lowest drug-resistance rates （〈20%）. Multivariate Logistic regression revealed that ICU stay, the time of mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia. MDRAb is an important opportunistic pathogen to pneumonia in PICU, and its drug-resistance is severe. It increases significantly the mortality of patients. It is important to take the effective prevention measures for controlling it.

Psychological needs of parents of children with complicated congenital heart disease after admitting to pediatric intensive care unit: A questionnaire study

BACKGROUND Parents of children with complicated congenital heart disease(CHD)have different needs after surgery.Little literature reports the impact factors for psychological needs of parents of children with complicated CHD.AIM To investigate the status quo of the needs of parents of children after surgery for complex CHD,and analyze the influencing factors,in order to provide a theoretical basis for formulating corresponding nursing countermeasures.METHODS A modified Chinese version of the Critical Care Family Needs Inventory(MCCFNI)was used to select 200 parents of children with complex CHD after surgery within 72 h after admission to the intensive care unit in our hospital to conduct an online questionnaire survey.The aim was to understand the needs of parents in relation to the following five aspects:The support from medical staff,comfort of the parents themselves,the acquisition of information,their closeness to the children,and assurance of the child’s condition.RESULTS Parents of children with complex CHD had a higher degree of demand,especially in terms of condition assurance,acquisition of information,and closeness to the children.The age,education level,and residence of the parents were related to the five dimensions of the needs of parents of children with complex CHD who had undergone surgery.CONCLUSION In practice,nurses should formulate corresponding nursing strategies based on the different cultural and social backgrounds of parents of children after complex CHD surgery to meet their different needs,and improve satisfaction.These findings provide a theoretical basis for constructing a family participatory nursing model for children in the intensive care unit in the future.

The Clinical Effects of Psychological Nursing in the Pediatric Intensive Care Unit

Objective:To explore the effects of psychological nursing in the pediatric intensive care unit.Methods:110 cases of intensive care of children from January 2014 to January 2015 were selected and randomly divided into the observation group(n=55)and the control group(n=55).The children of the control group were given usual nursing care,the patients of the observation group were given psychological nursing.On two groups of patients before and after the intervention of the SAS scores and SDS scores、compliance、parents care quality satisfaction are compared.Results:Before intervention,the observation group of patients and the control group of patients with SAS scores and SDS scores difference no statistical significance(P>0.05),and after the intervention,the observation group patients'scores of SAS and SDS were significantly better than the control group,and the observation group below the control group(P<0.05).The observation group of compliance rate was 96.36%,and the control group of compliance rate was 69.09%,it below the observation(P<0.05).Parents care quality satisfaction of observation group was obviously better than that of control group with that difference is statistically significant(P<0.05).Conclusion:psychological nursing measures used in pediatric intensive care unit has certain feasibility and is worth popularizing clinically.

National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic

The coronavirus disease pandemic caught many pediatric hospitals unpreparedand has forced pediatric healthcare systems to scramble as they examine and planfor the optimal allocation of medical resources for the highest priority patients.There is limited data describing pediatric intensive care unit (PICU) preparednessand their health worker protections.AIMTo describe the current coronavirus disease 2019 (COVID-19) preparedness effortsamong a set of PICUs within a simulation-based network nationwide.METHODS A cross-sectional multi-center national survey of PICU medical director(s) fromchildren’s hospitals across the United States. The questionnaire was developedand reviewed by physicians with expertise in pediatric critical care, disasterreadiness, human factors, and survey development. Thirty-five children’shospitals were identified for recruitment through a long-established nationalresearch network. The questions focused on six themes: (1) PICU and medicaldirector demographics;(2) Pediatric patient flow during the pandemic;(3)Changes to the staffing models related to the pandemic;(4) Use of personalprotective equipment (PPE);(5) Changes in clinical practice and innovations;and(6) Current modalities of training including simulation.RESULTSWe report on survey responses from 22 of 35 PICUs (63%). The majority of PICUswere located within children’s hospitals (87%). All PICUs cared for pediatricpatients with COVID-19 at the time of the survey. The majority of PICUs (83.4%)witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicatedunits, and 74.6% pivoted to accept adult COVID-19 patients. All PICUsimplemented changes to their staffing models with the most common changesbeing changes in COVID-19 patient room assignment in 50% of surveyed PICUsand introducing remote patient monitoring in 36% of the PICU units. Ninety-fivepercent of PICUs conducted training for donning and doffing of enhanced PPE.Even 6 months into the pandemic, one-third of PICUs across the United Statesreported shortages in PPE. The most common training formats for PPE werehands-on training (73%) and video-based content (82%). The most commonconcerns related to COVID-19 practice were changes in clinical protocols andguidelines (50%). The majority of PICUs implemented significant changes in theirairway management (82%) and cardiac arrest management protocols in COVID-19patients (68%). Simulation-based training was the most commonly utilizedtraining modality (82%), whereas team training (73%) and team dynamics (77%)were the most common training objectives.CONCLUSIONSA substantial proportion of surveyed PICUs reported on large changes in theirpreparedness and training efforts before and during the pandemic. PICUsimplemented broad strategies including modifications to staffing, PPE usage,workflow, and clinical practice, while using simulation as the preferred trainingmodality. Further research is needed to advance the level of preparedness,support staff assuredness, and support deep learning about which preparednessactions were effective and what lessons are needed to improve PICU care andstaff protection for the next COVID-19 patient waves.

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.

Cumulative radiation exposure from diagnostic imaging in intensive care unit patients

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.

PICU机械通气治疗患儿谵妄发生情况及其影响因素分析

目的探讨儿科重症监护室(PICU)内接受机械通气(MV)治疗的患儿发生谵妄(PD)概率及其相关影响因素。方法回顾性分析2022年7月至2023年3月在医院PICU内接受MV治疗患儿的临床资料。结果149例患儿接受MV,中位年龄2.0(1.0~6.0)岁,男74例、女75例。其中年龄≤2岁患儿86例(57.7%),治疗期间反复气管插管患儿34例(22.8%)。149例患儿中有81例(54.4%)发生谵妄,与非谵妄组相比,谵妄组年龄较小,俯卧位通气比例较低,年龄≤2岁比例较高,PICU住院时间延长,PICU住院时间>14天比例较高,差异有统计学意义(P<0.05)。与非谵妄组相比,谵妄组MV首日氧合指数≤150 mmHg比例较高,MV总时间较长,MV总时间≤168 h比例较低,差异有统计学意义(P<0.05)。多因素logistic回归分析显示患儿PICU住院时间>14 d、MV首日氧合指数≤150 mmHg是MV患儿发生谵妄的独立危险因素(P<0.05),而MV总时间≤168 h是MV患儿发生谵妄的保护因素(P<0.05)。结论PICU内接受MV治疗的患儿谵妄发生率较高,与低氧性损伤密切相关。长时间的MV和PICU住院治疗也是导致谵妄发生的重要影响因素。

PICU护士谵妄管理行为意向及影响因素的质性研究

目的 以计划行为理论为框架,深入了解PICU护士谵妄管理行为意向及影响因素,为提高PICU谵妄管理质量提供参考。方法 采用目的抽样法对6所三级甲等医院的16名PICU护士进行半结构式访谈,根据Colaizzi七步分析法对访谈资料进行分析,提取主题。结果 共获得3个主题及8个亚主题,包括行为态度(正性态度,负性态度)、主观规范(自我感知压力增加,团队的影响)及知觉行为控制(谵妄认知及应对技能不足,缺乏相关制度与流程,工作负荷过重,缺乏谵妄管理能力培训)。结论 PICU护士对谵妄管理总体持积极态度,但影响因素较多。应提高护理人员对谵妄的认知,加强相关培训力度,建立多学科团队合作机制,以提高PICU谵妄管理质量。

PICU转科患儿照顾者准备度量表的编制及信效度检验

目的编制PICU转科患儿照顾者准备度量表,并检验其信效度。方法以Meleis过渡理论和Roy适应模式为理论依据,通过文献回顾、专家函询和预调查编制初始量表。采用便利抽样法,选取PICU转科患儿的397名照顾者作为调查对象,对量表进行项目分析和信效度检验。结果PICU转科患儿照顾者准备度量表包含5个维度共23个条目。探索性因子分析提取5个公因子,累积方差贡献率为69.294%;验证性因子分析结果显示,χ^(2)/df=1.998,GFI=0.891,CFI=0.964,IFI=0.916,TLI=0.901,RMSEA=0.060。量表总的Cronbach′sα系数为0.906,各维度的Cronbach′sα系数为0.835~0.963;分半信度为0.904。结论编制的PICU转科患儿照顾者准备度量表信效度良好,可用于评估PICU住院患儿恰当转科时机及照顾者准备程度。

PICU患儿肠内营养支持不耐受延长的现状及危险因素

目的:探究儿童重症监护室(PICU)肠内营养支持患儿不耐受延长现状及危险因素。方法:采用便利抽样法,选取2021年1月—2023年4月于我院收治的PICU肠内营养支持患儿240例作为研究对象。采用自制一般资料问卷调查患儿相关信息,统计患儿肠内营养不耐受持续时间,通过单因素分析、多因素Logistic回归分析筛选PICU肠内营养支持患儿肠内营养不耐受延长的危险因素。结果:PICU肠内营养支持患儿肠内营养不耐受持续时间为5~12(8.50±3.42)d,取8 d为平均水平,即肠内营养不耐受持续时间≤8 d为一般组(n=186),>8 d为延长组(n=54)。单因素分析结果显示,PICU肠内营养支持患儿肠内营养不耐受延长的影响因素有年龄、早产儿、出生体重、机械通气、肠内营养启动时间、腹内压、早期使用促胃动力药(P<0.05);多因素Logistic回归分析结果显示,PICU肠内营养支持患儿肠内营养不耐受延长的危险因素包括早产儿、出生体重、机械通气、肠内营养启动时间、腹内压。结论:PICU肠内营养支持患儿肠内营养不耐受风险较高,且其发生受多方面因素的影响,临床应加强对相关因素的监测管理,据此制订预防护理方案。

基于5G云边协同联合AI智慧医疗的PICU病房建设探索

传统的病房管理模式已经不能满足日益增长的医疗需求,需要联合多种科技手段提高医疗质量及服务水平。目前国内外的智慧医疗仍处于探索阶段,中山大学附属第三医院儿科重症监护室利用5G医疗专网融合监测、治疗、辅助等智能医疗终端,搭建了基于云边协同架构的儿童重症监护室(PICU)一体化平台,实现了从传统医疗模式向智慧医疗模式的转型,促进了医护信息对称,提高了工作效率,满足了患者的临床治疗及患者家属的心理情感需求,对于其他儿科重症监护室的智慧化建设具有启示作用。

PICU不同进食方式的患儿误吸发生现状及特征比较研究

目的:探索儿科重症监护室(pediatric intensive care unit,PICU)不同进食方式的患儿误吸发生现状并比较不同特征情况。方法:采用便利抽样法,选取2022年3月-12月医院PICU收治的224例患儿为研究对象。分为鼻胃管喂养、幽门后喂养和经口进食3种不同进食方式,观察3种不同进食方式的患儿误吸发生情况,并比较不同特征患儿的误吸发生情况。结果:鼻胃管喂养患儿误吸发生率为17.11%,幽门后喂养患儿误吸发生率为12.00%,经口进食患儿误吸发生率为9.18%。不同进食方式的患儿在意识障碍、机械通气、呕吐、胃潴留时误吸发生比较差异有统计学意义(P<0.05)。两两比较结果显示,鼻胃管喂养和幽门后喂养的患儿机械通气和意识障碍时误吸发生的比例比经口进食组高(P<0.001);鼻胃管喂养的患儿胃潴留时误吸发生的比例比经口进食组高(P<0.001);经口进食组患儿呕吐时误吸发生的比例高于幽门后喂养(P<0.05)。结论:PICU患儿鼻胃管喂养的误吸发生率处于较高水平,并且高于幽门后喂养和经口进食的方式。护理人员应该根据患儿不同进食方式和不同特征为预防其误吸提供及时和适当的早期干预措施。

某三甲医院PICU住院医师职业倦怠研究

目的研究儿科重症监护病房(pediatric intensive care unit,PICU)住院医师职业倦怠的现状,探索降低职业倦怠的方法。方法2019年1月—2021年12月,采用问卷调查法、统计学分析方法对上海某三甲医院PICU住院医师的职业倦怠进行分析。结果回收有效问卷71份。研究对象职业倦怠量表中“情绪衰竭”“玩世不恭”“个人成就感低”三个维度得分分别为(3.55±0.94)分、(2.45±1.10)分、(2.90±0.65)分,有77.5%的医师存在中度职业倦怠,21.1%的医师存在重度职业倦怠。职业倦怠的两个分量表(情绪衰竭、玩世不恭)与内在工作满意度、外在工作满意度、总体工作满意度差异有统计学意义(P<0.05)。学历、年龄、工作时间、收入与PICU住院医生职业倦怠得分的差异有统计学意义(P<0.05)。其中研究生学历者、每周工作时间≥50小时者“情绪衰竭”得分更高,年龄≥30岁者、年收入<10万元者“个人成就感低”得分更高。结论PICU住院医师职业倦怠水平高,职业倦怠与工作满意度呈负相关,学历、年龄、工作时间、收入可影响职业倦怠水平,应采取措施降低职业倦怠,稳定医疗队伍。

重症患儿PICU过渡期分离焦虑的研究进展

重症患儿从儿童重症监护病房(PICU)转出到普通病房的过渡期常常会产生心理障碍,其中分离焦虑是最常见的心理障碍之一。随着身心医学模式的发展,患者的身心健康越来越受到关注,重症患儿PICU过渡期分离焦虑也越来越受重视。本文从儿童分离焦虑的研究起源、重症患儿PICU过渡期分离焦虑概念、临床表现、产生原因及干预措施等方面进行综述,以期为重症患儿PICU过渡期分离焦虑的临床护理提供最新参考依据。

Clinical application of bedside fiber-optic bronchoscopy in mechanically ventilated children in a pediatric intensive care unit

Critically ill children often require mechanical ventilation on the pediatric intensive care unit （PICU） for indications such as severe pneumonia, atelectasis, airway abnormalities, and the presence of a foreign body in the airway. The correct management of the airway is a crucial determinant of a successful outcome. We performed fiber-optic bronchoscopy （FOB） 70 times for 51 mechanically ventilated children between June 2009 and December 2011, and present our results below.

俯卧位通气在PICU呼吸机相关性肺炎患儿中的应用效果

目的分析俯卧位通气在儿童重症监护室(PICU)呼吸机相关性肺炎患儿中的应用效果。方法120例研究对象选取温州医科大学附属第二医院2020年12月至2022年7月PICU收治的患儿,使用机械通气的时间前后顺序交替分为研究组(60例)和试验组(60例)。2~3 h对体位进行一次改变,对照组进行仰卧位、侧卧位交替体位,试验组进行仰卧位、侧卧位、俯卧位交替体位。检测比较两组并发症发生情况、肺功能、炎症因子水平及临床疗效。结果治疗后,试验组患儿最大通气量、第1秒用力呼气量、用力肺活量、最大呼气流量水平高于对照组,差异有统计学意义(P<0.05)。试验组转化生长因子-β1、白细胞介素-6、高迁移率族蛋白B1、肿瘤坏死因子-α水平低于对照组,差异有统计学意义(P<0.05)。试验组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。试验组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。结论PICU采用俯卧位通气后呼吸机相关性肺炎发生率降低,肺功能改善,炎症反应减轻,症状缓解。

PICU有创动脉血压监测患儿导管堵管发生相关因素及预测模型构建

目的:探讨儿科重症监护室(PICU)有创动脉血压监测患儿导管堵管发生相关因素,并构建预测模型。方法:选取北京大学第一医院2018年1月至2022年12月PICU患儿267例,均经桡动脉置管行有创动脉血压监测,根据有无导管堵管分为堵塞组与无堵塞组,收集两组临床资料,采用Lasso回归和logistic回归筛选PICU有创动脉血压监测患儿导管堵管发生的相关因素,构建Nomogram预测模型,采用校准曲线和受试者工作特征(ROC)曲线验证预测模型的预测价值。结果:单因素分析封管液、一次性穿刺成功、穿刺点渗血、导管留置时间、使用镇静镇痛药物、使用甘露醇、机械通气、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)是PICU有创动脉血压监测患儿导管堵管的影响因素(均P<0.05);Lasso回归分析选出8个预测因素为一次性穿刺成功、穿刺点渗血、导管留置时间、使用镇静镇痛药物、使用甘露醇、机械通气、PT、APTT;logistic回归分析,一次性穿刺成功、穿刺点渗血、导管留置时间、使用镇静镇痛药物、使用甘露醇、机械通气、PT、APTT是PICU有创动脉血压监测患儿导管堵管的相关影响因素(均P<0.05);据此构建Nomogram预测模型的一致性指数(C-index)为0.945,校准度为0.928,且拟合良好(χ^(2)=8.741,P=0.593);ROC曲线分析,该模型预测PICU有创动脉血压监测患儿导管堵管的AUC为0.926(95%CI:0.871~0.984)。结论:PICU有创动脉血压监测患儿导管堵管的相关因素包括一次性穿刺成功、穿刺点渗血、导管留置时间、使用镇静镇痛药物、使用甘露醇、机械通气、PT、APTT,由上述因素构建的预测模型具有可靠的预测价值。

新冠疫情前后PICU细菌变迁及耐药性变化研究

目的探讨新冠疫情发生前后儿童重症监护病房(PICU)临床分离病原菌的特点及其耐药性的变迁,为后疫情时期合理使用抗生素、减少细菌耐药提供依据。方法采用回顾性研究方法对2017年1月1日至2019年12月1日(新冠疫情前组)、2020年1月1日至2022年12月1日(新冠疫情后组)华中科技大学同济医学院附属同济医院PICU所有送检标本中分离出的病原菌及常见病原菌药敏结果进行统计学分析。结果2017~2022年近6年时间,该院PICU共分离出789株菌株,其中新冠疫情前组占比51.7%,新冠疫情后组占比48.3%,均以革兰阴性菌为主。新冠疫情后组中流感嗜血杆菌、鲍曼不动杆菌和肺炎链球菌占比均明显下降,铜绿假单胞菌占比较前上升,由4.4%升至10.5%,差异均具有统计学意义(均P<0.05)。在细菌耐药性方面,新冠疫情后组鲍曼不动杆菌对除氨曲南、替加环素外的多种药物的耐药率均下降(均P<0.05);铜绿假单胞菌在疫情前后对氨基糖苷类、大环内酯类、喹诺酮类等药物的耐药率差异无统计学意义(均P>0.05)。新冠疫情后金黄色葡萄球菌对头孢类药物的耐药率较前升高,对红霉素、克林霉素的耐药率较前下降(均P<0.05)。在常见的多重耐药细菌方面,除耐甲氧西林金黄色葡萄球菌(MRSA)外,常见多种多重耐药菌占比较前均呈下降趋势,其中耐碳青霉烯类鲍曼不动杆菌由68.4%下降至33.3%,差异具有统计学意义(P<0.01)。结论新冠疫情后PICU分离细菌谱及细菌耐药性较前发生了较大变化,流感嗜血杆菌、鲍曼不动杆菌和肺炎链球菌占比较前下降,铜绿假单胞菌占比较前上升。新冠疫情后常见多种多重耐药的菌株占比较前下降,而MRSA占比较前略有升高,需引起重视。