Objective To investigate the efficacy and safety of citrate anticoagulation for continuous renal placement therapy (CRRT) in patients at high risk of bleeding. Methods Forty-seven patients who needed to CRRT and were admitted into the department of critical care medicine from January 2015 to October 2016 were enrolled in this study. According to the patient′s actual condition, they were divided into citrate groups (24 cases) and saline group (23 cases). Patients in saline group were given saline wash. The efficacy and safety were compared between the two groups. The filter lifetime, after treatment the activated partial thromboplastin time (APTT), hemoglobin (Hb), blood gas indexes were compared between the two groups. Results The citrate group used 76 filters while the 0.9% sodium chloride group used 87 filters. The average filter lifetime in citrate group was (22.4 ± 12.7) h which was longer than (8.6±3.3) h in 0.9%sodium chloride group (t=9.79, P<0.01). The incidence of coagulation in extracorporeal circulation was 3.9%(3/76) which was lower than 16.1%(14/87) in 0.9%sodium chloride group(χ2=5.20, P<0.05). Conclusions Regional citrate anticoagulation is a safe and effective option for CRRT in patients at high risk of bleeding.

This paper summarized nursing care in intra-hospital transfer of 13 critically ill patients with extracorporeal membrane oxygenation. The key points to guarantee safety of critically ill patients were establishing a well-trained professional team and developing standardized procedures,and applying checklist for ECMO Transfer. The key points in nursing were assessment and pretreatment,homogenized nursing during transfer and effective handover after transfer. As a result,six cases of avian influenza patients successfully completed CT ex-amination,five cases of lung re-transplant patients and two cases of lung transplant patients were successfully trans-ferred to the operating room.

This paper retrospectively analyzed nursing care of 20 critically ill patients with human infections of avian influenza A(H7N9) virus treated by oxygen therapy.According to the severity of hypoxia in patients admitted to the hospital,individualized oxygen therapy strategy was selected,such as humidified high flow nasal cannula or mechanical ventilation.Oxygen therapy strategy was adjusted in a timely manner according to patients' condition,such as prone position ventilation and extracorporeal membrane oxygenation.As a resuh,15 cases were transferred to the general ward when the virus associated test was negative,and 5 cases died.

Objective To investigate the effects of analgesia and sedation scheme on ICU delirium among patients with cardiac surgery. Methods A total of 235 patients undergoing mechanical ventilation were enrolled via simple random number sampling method from January to December,2016, and divided into the experimental group(117 cases)and the control group(118 cases).The experimental group received analgesia and sedation scheme designed by our department,and the control group received routine sedation protocol. The incidence of ICU delirium, the dosages of drugs, duration of mechanical ventilation, length of ICU stay were recorded. Results The compliance rate of shallow sedation in the experimental group was 87.17% (102/117), which was lower than 57.62% (68/118) in the control group with statistical difference(χ2=25.642,P<0.05).The incidence of ICU delirium in the experimental group was 17.09% (20/117), which was lower than 34.75% (41/118) in the control group with statistical difference (χ2=9.524, P<0.05). The dosages of sedation drugs were: dexmedetomidine, (269.46 ± 32.47) μg,disoprofol,(286.84±81.96)mg,the duration of mechanical ventilation was(14.31±1.43)h,the length of ICU stay was(16.02±1.25)h.Those data were all lower than those of the control group[(507.29±58.27) μg,(575.63±95.74)mg,(20.45±2.29)h,(22.82±2.45)h]with statistical difference(t=-5.529--4.371, P<0.05). Conclusion Analgesia and sedation scheme was worthy of popularization and application.

Objective? To explore the effects of enteral nutrition program based on intensive ultrasound monitoring gastric residual on patients receiving lung transplantation. Methods? Totally 100 patients who received lung transplantation in a Class Ⅲ Grade A hospital between January and December 2016 were selected and divided into the treatment group (n=50) and the control group (n=50) according to the random number table. Patients in the treatment group received enteral nutrition based on intensive ultrasound monitoring gastric residual, while patients in the control group received conventional enteral nutrition. The indicators of enteral nutrition application and complications were observed in both groups. Results? The gastric residual of the treatment group was (130.32±40.44) ml; the nutrition interruption rate was 6%; the time for achieving the target feed volume was (3.47±0.62) d, lower than those of the control group (t/χ2=-2.341, 8.575, 2.193;P＜ 0.05), which were (198.13±40.25) ml, 28% and (5.59±0.71) d. The dripping speed of the treatment group was (87.00±10.59) ml/h, higher than that of the control group (t=6.121, P＜0.05). The incidence rate of aspiration of the treatment group was 4%, and there was no statistically significant difference compared with that of the control group (χ2=0.298; P＞0.05), which was 6%. The incidence rates of enteral nutrition reflux, diarrhea and reintubation rates of the treatment group were 10%, 10% and 8%, respectively, lower than those of the control group (33%,26%,24%) (χ2=6.250, 4.336, 4.762; P＜ 0.05) . Conclusions? The enteral nutrition program based on intensive ultrasound monitoring gastric residual conforms to target-oriented nursing care for patients receiving lung transplantation, which helps to achieve the target feed volume more quickly and ameliorate enteral nutrition-related complications.

Objective? To investigate the effect and safety of high-flow nasal cannula (HFNC) oxygen therapy for patients after extubation in lung transplantation. Methods? A retrospective study was conducted on 60 hospitalized patients with lung transplant during January 2017 to December 2017 in Wuxi People＇s Hospital. According to the different methods of respiratory support prescribed after extubation, the patients were divided into two groups: observation group (n=28, via HFNC) and control group (n=32, via nasal oxygen tube) . The two groups were compared in terms of the clinical indicators including their blood gas analysis(oxygenation index, lactic acid, partial pressure of carbon dioxide) , viscosity of sputum and comfort, etc. Results? Six hours after extubation and before transferring to other departments, the observation group＇s oxygenation index was(263.70±48.97)and(273.22±43.26)mmHg, which were statistically different from those of the control group with (217.83±77.30)and(229.08±68.64)mmHg respectively (P＜ 0.05). Before transferring to other departments, the partial pressure of carbon dioxide in the observation group was (37.04±8.56)mmHg, lower than the control group with (42.43±6.14)mmHg with a statistical difference (P＜0.05); the viscosity of sputum in the obseration group was lower than the control group with statistical difference (P＜0.05); the patients＇ comfort in the observation group achieved (7.72±1.06)points, higher than the control group＇s (4.39±0.82)points with statistical difference (P＜ 0.05). Conclusions? HFNC oxygen therapy for the patients after extubation in lung transplantation has good effects, is safe and reliable, and can be widely applied in clinical practice.

Objective To explore the impact of medication self-management module on medication compliance of patients after lung transplantation.Methods Totals of 48 patients were divided into experimental group ( n=24 ) and control group ( n =24 ) .The control group received conventional treatment and nursing care.The experimental group received medication self-management module on the basis of conventional treatment and nursing care.Results Compared the two groups after 12 months, medication compliance of experimental group was 87.50%, and that of control group was 79.17%, significant difference was found between two groups (χ2 =8.641,P<0.05).Blood drug concentration and 6MWT of experimental group was (10.78 ± 2.61)ng/L and (324.15 ±23.91) m,respectively, higher than that in control group (8.64 ±2.03) ng/L and (291.58 ±20.84) m, and the differences between the two groups were statistically significant ( t=8.143,7.852, respectively;P<0.05).Conclusions Medication self-management module can solve the patient’ s medication problem and improve the compliance of lung transplant patients,so it is suitable for clinical application.

Objective To verify the effects of critical-care pain observation tool ( CPOT) on pain assessment after lung transplantation. Methods 2 critical care nurses applied CPOT scale for pain assessment of 42 cases hospitalized in ICU after lung transplantation who would have pain assessment. The whole investigation were divided into 3 stages and 2 points of each stage ( rest before turning over and the simulation of turning over) with total 6 measuring point (T1-T6). The first stage was patients with general anesthesia ( no awareness) , the second stage ( patients with sanity and applied artificial respirator through oral trachea cannula, the third stage ( patients got off oral trachea cannula and ventilator paused ) . The measurement point was 1 min, recording patient′s value of CPOT from T1 to T6. The second stage was used digital scoring method. Results For 3 stages, the measurement points of turning over for CPOT value was higher than that of rest measurement point before turning over; 2 critical patients had high uniformity for CPOT score;in stage 2, patient′s CPOT score had high uniformity with NRS score. Conclusions CPOT is a effective way to assess pain for mechanically ventilated patients after lung transplantation.

Objective To summarize the experiences of postoperative care of 7 patients with lung transplantation patients receiving high flow nasal cannulae oxygen therapy. Methods The key points to ensure the success of operation were oxygen therapy waiting for lung transplantation,sequential treatment after tracheal intubation, assisted by fiberoptic bronchoscopy, nasal high flow oxygen therapy failed to switch to non-invasive treatment or re intubation. Results All 7 patients got through the intensive care period successful. Conclusions High flow nasal cannulae can improve the comfort and compliance of lung transplant patients,and easy to operate.

Objective To summarize current status of multidrug-resistant organism (MDRO) infection in lung transplant recipients and analyze the risk factors of MDRO infection. Methods Clinical data of 321 lung transplant recipients were retrospectively analyzed. According to the incidence of postoperative MDRO infection, they were divided into the MDRO group (n=122) and non-MDRO infection group (n=199). The incidence of MDRO infection in lung transplant recipients was summarized. The risk factors of MDRO infection in lung transplant recipients were analyzed by logistic regression model. The dose-response relationship between MDRO infection and time of ventilator use was determined by restricted cubic spline model. Results Among 321 lung transplant recipients, 122 cases developed MDRO infection, with an infection rate of 38.0%. Two hundred and twenty-nine strains of pathogenic bacteria were detected in the MDRO infection group, mainly Gram-negative bacteria (92.6%), and the top three strains were carbapenem-resistant acinetobacter baumannii (46.3%), carbapenem-resistant pseudomonas aeruginosa (22.3%) and carbapenem-resistant klebsiella pneumoniae (14.8%), respectively. MDRO infection mainly consisted of lower respiratory tract infection (61.5%), followed by ventilator-associated pneumonia (26.2%). Univariate analysis showed that the risk factors of MDRO infection in lung transplant recipients were single-lung transplantation, long-time postoperative use of extracorporeal membrane oxygenation (ECMO), long operation time, long-time urinary catheterization, long-time central venous catheterization and long-time ventilator use (all P < 0.05). Multivariate logistic regression analysis indicated that single-lung transplantation and long-time ventilator use were the independent risk factors for MDRO infection in lung transplant recipients (both P < 0.05). Results of restricted cubic spline model analysis showed that the risk of infection continued to increase with the prolongation of ventilator use time within 20 d. After 20 d, prolonging the time of ventilator use failed to increase the risk of infection, showing a plateau effect. Conclusions The MDRO infection rate tends to decline in lung transplant recipients year by year. Single-lung transplantation and long-time ventilator use are the independent risk factors for MDRO infection in lung transplant recipients.