Objective To evaluate the effects of different bedside elevation angles on ventilator-associated pneumonia and pressure sores in critically ill patients with mechanical ventilation.Methods The randomized controlled trials of raising the angle of the bed at the Cochrane Library,JBI,PubMed,Embase, Ovid,CMB,VIP,CNKI and Wanfang database on ventilator-associated pneumonia and pressure sores in critically ill patients with mechanical ventilation were retrieved. Meta-analysis was performed on the included literatures after including literature review,evaluation and extraction by 3 researchers.Results A total of 6 literatures were included involving 518 patients. The overall quality of the included literature was medium The results of meta-analysis showed that the incidence rate of VAP in patients with bedside elevation angles >30° was significantly lower than that in patients with bedside elevation angles ≤30° (OR=0.42,P=0.02). There was no significant difference in the risk of pressure sore (OR=0.85,P=0.55). There was no significant difference in the increase of death outcome (OR=0.86,P=0.52).Conclusions In the clinic,it is appropriate to raise the head of a bed more than 30°without any contraindication,but further attention should be paid to the durability of raising the head of a bed more than 30°and the medical staffs' compliance.

Objective To compare the effect of modified seldinger technique under the guidance of ultrasound for PICC inserttion with the traditional method of PICC catheterization(14 G needle insertion of PICC)in elderly patients with Alzheimer’s disease.Methods 60 patients with AD were divided into observation group applying PICC insertion with US and MST and con-trol group with traditional method of PICC catheterization with 30 patients in each group.The suc-cess rates of the only one puncture,catheter indwelling time and the incidence of complications dur-ing catheter indwelling were compared between the two groups.Results There were 22 patients with 7 to 12 months catheter indwelling time and 8 patients with more than 12 months in observa-tion group.There was 1 patient for 1 to 3 months catheter indwelling time,11 patients for 4 to 6 months,7 patients for 7 to 12 months and 1 patient for more than 12 months in control group.Ac-cording to the results,the difference was statistically significant(P <0.05).The successful rate of the only one puncture in observation group was 96.7% while only 53.3% in control group.So the difference was statistically significant(P <0.05).The incidence of complications during catheter indwelling was 6.7% in observation group and 50% in control group.Thus,the difference was statistically significant(P <0.05).Conclusion The PICC catheterization with modified seldinger technique under the guidance of vascular ultrasound has higher successful rate and less incidence of complications.So it is worthy of widely application.

Objective To investigate the effect of different airway humidification methods on off-line of artificial airway.Methods A total of 80 ICU patients with off-line of artificial airway were randomly divided into two groups.A total of 40 odd numbered cases were as control group,given conventional T tube airway humidification.Another 40 even numbered cases were as observation group,given therapeutic equipment for airway humidification.The effects of two airway humidification methods on the viscosity of sputum and the incidence of lower respiratory tract infection were compared.Results The sputum viscosity of the observation group was significantly better than that of the control group (P ＜ 0.05).The incidence of respiratory tract infection in the observation group was significantly lower than that in the control group (P ＜ 0.05).The nursing satisfaction was much higher than that of the ordinary T tube (P ＜ 0.05).Conclusion Airway humidification with therapeutic equipment has better effect on airway humidification than that of ordinary T tube.

Objective To compare the effect of modified seldinger technique under the guidance of ultrasound for PICC inserttion with the traditional method of PICC catheterization(14 G needle insertion of PICC)in elderly patients with Alzheimer’s disease.Methods 60 patients with AD were divided into observation group applying PICC insertion with US and MST and con-trol group with traditional method of PICC catheterization with 30 patients in each group.The suc-cess rates of the only one puncture,catheter indwelling time and the incidence of complications dur-ing catheter indwelling were compared between the two groups.Results There were 22 patients with 7 to 12 months catheter indwelling time and 8 patients with more than 12 months in observa-tion group.There was 1 patient for 1 to 3 months catheter indwelling time,11 patients for 4 to 6 months,7 patients for 7 to 12 months and 1 patient for more than 12 months in control group.Ac-cording to the results,the difference was statistically significant(P <0.05).The successful rate of the only one puncture in observation group was 96.7% while only 53.3% in control group.So the difference was statistically significant(P <0.05).The incidence of complications during catheter indwelling was 6.7% in observation group and 50% in control group.Thus,the difference was statistically significant(P <0.05).Conclusion The PICC catheterization with modified seldinger technique under the guidance of vascular ultrasound has higher successful rate and less incidence of complications.So it is worthy of widely application.

Objective To investigate the effect of different airway humidification methods on off-line of artificial airway.Methods A total of 80 ICU patients with off-line of artificial airway were randomly divided into two groups.A total of 40 odd numbered cases were as control group,given conventional T tube airway humidification.Another 40 even numbered cases were as observation group,given therapeutic equipment for airway humidification.The effects of two airway humidification methods on the viscosity of sputum and the incidence of lower respiratory tract infection were compared.Results The sputum viscosity of the observation group was significantly better than that of the control group (P ＜ 0.05).The incidence of respiratory tract infection in the observation group was significantly lower than that in the control group (P ＜ 0.05).The nursing satisfaction was much higher than that of the ordinary T tube (P ＜ 0.05).Conclusion Airway humidification with therapeutic equipment has better effect on airway humidification than that of ordinary T tube.

Objective? To review systematically the influence of different lying positions on monitoring of central venous pressure (CVP)in patients with mechanical ventilation. Methods? Relevant articles published publicly from database establishment date to June, 30th, 2018 in PubMed, Cochrane Library, Embase, Web of Science, CBM, Chinese Academic Journal Full-text Database(CJFD), Wanfang and VIP Database were searched on computer. Two researchers independently screened and extracted the literature. RevMan 5.3 software was used for meta-analysis of the included studies. Results? Nine literatures were included, including 380 subjects. Meta-analysis showed that there were significant statistical differences in CVP values between 30 degree semi-recumbent position and supine position (WMD=-0.70, 95%CI:-1.15--0.24, P=0.003), and between 45 degree semi-recumbent position and supine position (WMD=-1.34, 95%CI:-1.82--0.86, P＜0.001), and between 60 degree semi-recumbent position and supine position (WMD=-2.96, 95%CI:-3.91--2.00, P＜0.001). Conclusions? There are differences between the CVP measurements in the 30°, 45°, 60° hemi-recumbent position and the supine position. To ensure the accuracy of the CVP measurement values in mechanical ventilation patients, we should take the supine position for measurement.