Objective To establish a severe sepsis/septic shock prognosis prediction model based on randomize forest law (RF model), and to evaluate the prognostic value of this model for patients with severe sepsis/septic shock. Methods 497 patients with severe sepsis/septic shock admitted to intensive care unit (ICU) of Zhejiang Hospital from September 2013 to May 2017 were enrolled. The basic data, vital signs and symptoms, biochemical indexes and blood routine indexes on the 1st, 3rd, 5th day and prognosis were collected. According to the 28-day prognosis, the patients were divided into death group and survival group, and the specific indicators about the prognosis of severe sepsis/septic shock were screened. A RF model was constructed by using the specificity indicators. The assessment effectiveness of RF model, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) were evaluated by receiver operating characteristic (ROC) curve analysis. Results In 497 cases of severe sepsis/septic shock, 201 cases died, 28-day mortality was 40.4%. ① According to the index difference of death group and survival group, 19 specific parameters of the RF model were selected, which included the age; 24-hour urine output, urea nitrogen (BUN), serum creatinine (SCr), platelet count (PLT) on the 1st day; heart rate (HR), mean arterial pressure (MAP), cyanosis and clammy skin on the 3rd day; temperature, HR, MAP, 24-hour urine output, PLT, fever, cyanosis, dyspneic, clammy skin, piebald on the 5th day. ② ROC curve analysis showed that the area under the ROC curve (AUC) of RF model predicting 28-day mortality was higher than that of SOFA and APACHE Ⅱ score on the 1st, 3rd, 5th day (AUC: 0.836 vs. 0.643, 0.554, 0.766 and 0.590, 0.670, 0.758). The sensitivity of RF model to predict the 28-day mortality was 86.1%, the specificity was 77.0%, the accuracy was 80.7%. Conclusion The evaluation model based on random forest can effectively predict the death risk of 28-day in patients with severe sepsis/septic shock, and its predictive efficiency is better than that of the SOFA and APACHE Ⅱ score.

The paper introduced the necessary of nurse-leaded management in the sedation and analgesia. It introduced nursing involved management including music therapy,daily sedation interruption, cluster analgesia sedation care,procedural sedation and analgesia nursing management and aim-leaded sedation nursing management. Besides,this paper put forward on the deficiencies with the prospect so as to provide references to improve the nurse-leaded management in the sedation and analgesia management.

Deep venous thrombosis (DVT) is an acute critical disease with high clinical incidence and easy to be misdiagnosed and missed. Not early assessment and effective prevention, it is very easy to lead to the occurrence of post thrombotic syndrome and pulmonary embolism, with high mortality and a serious threat to the life safety of the patients. The early and effective individual assessment of the DVT risk assessment tool is the basis for risk stratification and appropriate preventive measures. It is the key to reduce the incidence of DVT, misdiagnosis rate, missed diagnosis rate, incidence of complications and mortality. This paper is to review the research progress of individual DVT risk assessment tools at home and abroad, with a view to the same kind. The development of the research can be used for reference.

Nurses can assess the risk of pulmonary embolism (PE) in patients quickly and accurately with a PE risk assessment tool. PE risk assessment tools are widely used in clinical practice. This article reviews the development, diagnostic thresholds, applicable populations and assessment effects of PE risk assessment tools, summarizes and analyzes the existing problems of assessment tools and future research directions, in order to provide a basis for modifying PE risk assessment tools and expanding its scope of clinical application.

A series of complications occur in the patients with mechanical ventilation in ICU because of long immobility and sedation, which influences the prognosis and the quality of life of the patients severely. The article introduces the significance of early mobility for mechanical ventilation patients in ICU. It also introduces five aspects including the necessity of early mobility, the time of early mobility, the way of early mobility, the leader of early mobility and the positive effect of early mobility on the patients' health outcome. The nursing research progress of early mobility applied in mechanical ventilation patients is summarized in this article. Besides, this article prospects the deficiencies.