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 ...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.展开更多
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 Ma...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.展开更多
The predictive value of the initial procalcitonin(PCT)level was explored in the perioperative peniod of citically ill cancer patients.Background:It is quite important to predict infections in patients in the intensive...The predictive value of the initial procalcitonin(PCT)level was explored in the perioperative peniod of citically ill cancer patients.Background:It is quite important to predict infections in patients in the intensive care unit (ICU).Cancer surgery is characterized by large trauma,long duration,and wide operation scope;and there are many inflammatory factors in the tumor.Common manifestations of systermic inflammatory response syndrome(SIRS)。such as fever,elevated white blood cells,and elevated infammatory indicators,frequently occur in patients during the penioperative period as a result of the above factors.These factors are diverse and complex;additionally,advanced cancer and the trauma of major surgery are important factors that influence PCT blood levels.Because all of the aforementioned factors make it dificult to distinguish the postoperative inflammatory response fom the true infection in clinical practice,conventional methods cannot prediet disease sevenity or disease course.Methods:A total of 53 patients with endotracheal intubation admitted to the ICU of Tianjin Medical University Cancer Institute and Hospital from January 2020 to May 2020,were retrospectively selected.According to the patient source,35 cases were assigned to ORIG(Operating Room to ICU Group),and 18 cases were assigned to General Ward to ICU group(GWO).At the ICU admission,the patient's age,sex,surgical site of tumor,reason for ICU and other data were recorded to form a database;PCT,B-type natiuretic peptide(BNP),high sensitivity toponin I(hsTni),serumn creatinine(Cr),serum cystatin C(Cys-c)and other laboratory indicators were detected;scores of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)and sequential organ failure assessment(SOFA)were marked 24 h after ICU admission;Proportion of Antibiotics,Time Antibiotic Application,and Time Indicators(Ventilator support Time,Endotracheal Intubation Time,ICU Stay Time)were recorded during the period from ICU admission to ICU discharge.Results:APAHCE Ⅱ score and SOFA score increased significantly in the GWIG,compared with the ORIG,and the differences were statistically significant(P<0.01);the GWIG had a significantly longer Time Antibiotic Application than the ORIG,and the difference was statistically significant(P<0.01);in tems of blood indicators,the PCT,BNP,and hsTNi levels were elevated in the GWIG compared with the ORIG,and the differences were statistically significant(p<0.01);no statistical differences were found in Cr and Cys-C levels(P>0.05).In terms of time indicators,the Ventilator support Time,Endotracheal Intubation Time,and ICU Stay Time were prolonged in the GWIG compared with the ORIG,and the differences were statistically significant(P<0.01).The PCT level was statistically signifcant(P<0.01)when correlated with the Ventilator Supporting Time and Endotracheal Intubation Time;however,the PCT level was negatively correlated with the ICU Stay Time,with a small r(correlation cofficient)value and no statistical significance(P>0.05)when correlated with the ICU Stay Time.Conclusion:The initial PCT level can predict the disease severity in critically ill cancer patients treated with mechanical ventilation during the perioperative period.展开更多
BACKGROUND Acid-base imbalance has been poorly described in patients with coronavirus disease 2019(COVID-19).Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution th...BACKGROUND Acid-base imbalance has been poorly described in patients with coronavirus disease 2019(COVID-19).Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution that may have been over-looked using traditional acid-base analysis techniques.In a cohort of critically ill COVID-19 patients,we looked for an association between metabolic acidosis surrogates and worse clinical outcomes,such as mortality,renal dialysis,and length of hospital stay.AIM To describe the acid-base disorders of critically ill COVID-19 patients using Stewart’s approach,associating its variables with poor outcomes.METHODS This study pertained to a retrospective cohort comprised of adult patients who experienced an intensive care unit stay exceeding 4 days and who were diagnosed with severe acute respiratory syndrome coronavirus 2 infection through a positive polymerase chain reaction analysis of a nasal swab and typical pulmonary involvement observed in chest computed tomography scan.Laboratory and clinical data were obtained from electronic records.Categorical variables were compared using Fisher’s exact test.Continuous data were presented as median and interquartile range.The Mann-Whitney U test was used for comparisons.RESULTS In total,211 patients were analyzed.The mortality rate was 13.7%.Overall,149 patients(70.6%)presented with alkalosis,28 patients(13.3%)had acidosis,and the remaining 34 patients(16.2%)had a normal arterial pondus hydrogenii.Of those presenting with acidosis,most had a low apparent strong ion difference(SID)(20 patients,9.5%).Within the group with alkalosis,128 patients(61.0%)had respiratory origin.The non-survivors were older,had more comorbidities,and had higher Charlson’s and simplified acute physiology score 3.We did not find severe acid-base imbalance in this population.The analyzed Stewart’s variables(effective SID,apparent SID,and strong ion gap and the effect of albumin,lactate,phosphorus,and chloride)were not different between the groups.CONCLUSION Alkalemia is prevalent in COVID-19 patients.Although we did not find an association between acid-base variables and mortality,the use of Stewart’s methodology may provide insights into this severe disease.展开更多
文摘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.
文摘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.
基金supported by the Oncology Translational Medicine Seed Fund Project of Tianjin Medical University Cancer Institute and Hospital(No.1910).
文摘The predictive value of the initial procalcitonin(PCT)level was explored in the perioperative peniod of citically ill cancer patients.Background:It is quite important to predict infections in patients in the intensive care unit (ICU).Cancer surgery is characterized by large trauma,long duration,and wide operation scope;and there are many inflammatory factors in the tumor.Common manifestations of systermic inflammatory response syndrome(SIRS)。such as fever,elevated white blood cells,and elevated infammatory indicators,frequently occur in patients during the penioperative period as a result of the above factors.These factors are diverse and complex;additionally,advanced cancer and the trauma of major surgery are important factors that influence PCT blood levels.Because all of the aforementioned factors make it dificult to distinguish the postoperative inflammatory response fom the true infection in clinical practice,conventional methods cannot prediet disease sevenity or disease course.Methods:A total of 53 patients with endotracheal intubation admitted to the ICU of Tianjin Medical University Cancer Institute and Hospital from January 2020 to May 2020,were retrospectively selected.According to the patient source,35 cases were assigned to ORIG(Operating Room to ICU Group),and 18 cases were assigned to General Ward to ICU group(GWO).At the ICU admission,the patient's age,sex,surgical site of tumor,reason for ICU and other data were recorded to form a database;PCT,B-type natiuretic peptide(BNP),high sensitivity toponin I(hsTni),serumn creatinine(Cr),serum cystatin C(Cys-c)and other laboratory indicators were detected;scores of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)and sequential organ failure assessment(SOFA)were marked 24 h after ICU admission;Proportion of Antibiotics,Time Antibiotic Application,and Time Indicators(Ventilator support Time,Endotracheal Intubation Time,ICU Stay Time)were recorded during the period from ICU admission to ICU discharge.Results:APAHCE Ⅱ score and SOFA score increased significantly in the GWIG,compared with the ORIG,and the differences were statistically significant(P<0.01);the GWIG had a significantly longer Time Antibiotic Application than the ORIG,and the difference was statistically significant(P<0.01);in tems of blood indicators,the PCT,BNP,and hsTNi levels were elevated in the GWIG compared with the ORIG,and the differences were statistically significant(p<0.01);no statistical differences were found in Cr and Cys-C levels(P>0.05).In terms of time indicators,the Ventilator support Time,Endotracheal Intubation Time,and ICU Stay Time were prolonged in the GWIG compared with the ORIG,and the differences were statistically significant(P<0.01).The PCT level was statistically signifcant(P<0.01)when correlated with the Ventilator Supporting Time and Endotracheal Intubation Time;however,the PCT level was negatively correlated with the ICU Stay Time,with a small r(correlation cofficient)value and no statistical significance(P>0.05)when correlated with the ICU Stay Time.Conclusion:The initial PCT level can predict the disease severity in critically ill cancer patients treated with mechanical ventilation during the perioperative period.
文摘BACKGROUND Acid-base imbalance has been poorly described in patients with coronavirus disease 2019(COVID-19).Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution that may have been over-looked using traditional acid-base analysis techniques.In a cohort of critically ill COVID-19 patients,we looked for an association between metabolic acidosis surrogates and worse clinical outcomes,such as mortality,renal dialysis,and length of hospital stay.AIM To describe the acid-base disorders of critically ill COVID-19 patients using Stewart’s approach,associating its variables with poor outcomes.METHODS This study pertained to a retrospective cohort comprised of adult patients who experienced an intensive care unit stay exceeding 4 days and who were diagnosed with severe acute respiratory syndrome coronavirus 2 infection through a positive polymerase chain reaction analysis of a nasal swab and typical pulmonary involvement observed in chest computed tomography scan.Laboratory and clinical data were obtained from electronic records.Categorical variables were compared using Fisher’s exact test.Continuous data were presented as median and interquartile range.The Mann-Whitney U test was used for comparisons.RESULTS In total,211 patients were analyzed.The mortality rate was 13.7%.Overall,149 patients(70.6%)presented with alkalosis,28 patients(13.3%)had acidosis,and the remaining 34 patients(16.2%)had a normal arterial pondus hydrogenii.Of those presenting with acidosis,most had a low apparent strong ion difference(SID)(20 patients,9.5%).Within the group with alkalosis,128 patients(61.0%)had respiratory origin.The non-survivors were older,had more comorbidities,and had higher Charlson’s and simplified acute physiology score 3.We did not find severe acid-base imbalance in this population.The analyzed Stewart’s variables(effective SID,apparent SID,and strong ion gap and the effect of albumin,lactate,phosphorus,and chloride)were not different between the groups.CONCLUSION Alkalemia is prevalent in COVID-19 patients.Although we did not find an association between acid-base variables and mortality,the use of Stewart’s methodology may provide insights into this severe disease.
