Objective To provide evidence for clinical practice by analyzing the factors associated with bloodstream infection in ICU patients through retrospective case-control study. Methods Using self-made data collection form, 133 cases of blood sample record from HIS system during May 2013 to December 2015 at Peking Union Medical College Hospital ICU ward were collected. In this study, 54 patients with positive blood culture results were allocated to the case group while 79 patients with negative results were in the control group. Baseline characteristics, which included sex, age and chronic diseases, were almost the same between both groups. Binary Logistic regression analysis was used to identify factors related to blood infection. Results During May 2013 to December 2015, there were 54 blood infectious cases, among which 19 cases with positive gram bacteria accounted for 35.2%(19/54), 57.4%(31/54) of gram-negative bacilli and 7.4%(4/54) of fungal infection. Logistic regression analysis revealed that blood filtration treatment (OR=7.691), pulmonary infection (OR=7.682), ICU (OR=1.115), Acute Physiology and Chronic Health Evaluation (APACHEⅡ) scores(OR=1.096), procalcitonin (OR=1.065) were risk factors of bloodstream infection for ICU patients, while albumin (OR=0.763) was a protective factor. Conclusions Blood filtration treatment, pulmonary infection, hospital length of stay, APACHEⅡand procalcitonin are factors associated with bloodstream infection in ICU patients. Clinical procedures in ICU should mainly focus on improvement of prevention awareness, strict aseptic technology, professional quality of nursing staff. Besides, guarantee of patients′nutrition, effective treatment of primary diseases, and shortened hospital length of stay are also important to reduce the infection and improve quality of life of these patients.

A comprehensive literature on the utility of ultrasound guidance for artery catheterization were searched. The research of the literature was divided to three parts:evaluation of radial artery, the process of puncture and the application progress. Ultrasound is a useful adjunct to arterial catheter insertion and increase the rate of success. During the process of ultrasound guidance, evaluation of radial artery, preparation, the way of poke and the direction of the needle were recommended.

Objective To compare the consistency between interstitial fluid glucose and arterial blood glucose in septic shock patients with different tissue perfusion levels.Methods A prospective investigative study was conducted. Sixty-one septic shock patients with ages above 18 years old admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from April 2013 to December 2013 were enrolled. The real-time continuous glucose monitoring system (RTCGMS) and arterial blood gas analyzer were used to measure the patients' interstitial fluid glucose and arterial blood glucose, and according to the criteria of International Organization for Standardization (ISO) and the median of relative absolute difference (Median RAD), the consistency between interstitial fluid glucose and arterial blood glucose was calculated. Based on the lactate (Lac) level and pulse oxygen perfusion index (PI), the septic shock patients were divided into groups with different degrees of tissue perfusion, the consistency between the interstitial fluid glucose and arterial blood glucose among septic shock patients with different degrees of tissue perfusion was compared by using Bootstrap re-sampling technique.Results Negative correlation existed between PI and Lac (r= -0.272,P < 0.001), which showed the opposite change tendency of organism tissue perfusion. In patients with Lac > 8 mmol/L, their consistency between interstitial fluid glucose and arterial blood glucose was better than that in those with Lac > 2-4 mmol/L, and the 95% credibility intervals (CI) of ISO standardized deviation value was 0.026-38.710 (P < 0.05). In patients with PI ≤ 0.7%, their consistency between interstitial fluid glucose and arterial blood glucose was better than that in those with PI > 0.7%-1.4%, the 95%CI of median RAD difference value was 0.002-0.076, and the 95%CI of ISO standardized deviation value was -27.000 to -0.583 (allP < 0.05); in patients with PI > 3.0%, their consistency between interstitial fluid glucose and arterial glucose was better than that in those with PI ≤ 0.7%, PI > 0.7%-1.4% and PI > 1.4%-3.0%, and the 95%CI of ISO standardized deviation values were 3.322-28.302, 11.988-40.265 and 5.170-33.333 respectively (allP < 0.05).Conclusions When septic shock patients were under low tissue perfusion (Lac > 8 mmol/L or PI ≤ 0.7%), the worse the tissue perfusion, the better the consistency between interstitial fluid glucose and arterial blood glucose; when septic shock patients were under normal local tissue perfusion (PI > 3.0%), the better the local tissue perfusion, the better the consistency between interstitial fluid glucose and arterial blood glucose.

Objective:To summarize the nursing care measures of a patient after spinal orthopedic surgery for spinal muscular atrophy type Ⅱ.Methods:The patient was provided with a goal-directed pulmonary rehabilitation nursing program during ICU resuscitation by exercise pulmonary function, monitor difficult airway extubation and alleviating anxiety.Results:The patient postoperative pulmonary function recovered well, the difficult airway was extubated smoothly and the anxiety was relieved. The patient was discharged from the hospital on the 17th day after the operation.Conclusions:Goal-directed pulmonary care can help promote pulmonary rehabilitation and improve the quality of patient survival after orthopedic surgery for spinal muscular atrophy typeⅡ.

Objective? To explore the application of three-way connection in air bag pressure monitoring in patients with artificial airway. Methods? Totally 85 patients who received artificial airway formechanical ventilation in the 4th People＇s Hospital of Shenyang from August 2016 to July 2017 were selected and randomized into two groups in whichminimum hermetically sealed pressure (MOP) was used in the air bag to seal the airway. The artificial airway balloon for the observation group (n=43) was connected to a balloon pressure meter by three-way connection to monitor the pressure in the balloon, while the artificial airway balloon for the observation group (n=42) was connected to a balloon pressure meter by direct connection to monitor the pressure in the balloon. The changes of balloon pressure (△P=MOP-monitoring pressure) at 4, 8, 24 and 48 h post air inflation were monitored in both groups. The incidence of regurgitation and aspiration, airway mucosal injury and pulmonary infection were observed in the two groups. Results? There was no statistically significant difference in △P between the two groups at 4 h post air inflation[△P 4 h: (3.76±1.47) vs. (3.82±1.36) cmH2O; (P＞0.05)]. The△P 8, 24 and 48 h of the observation group were lower than those of the control group, and there was statistically significant difference between the two groups [△P 8 h: (5.76±2.58) vs. (7.29±2.42) cmH2O; △P 24 h: (6.32±3.08) vs. (9.38±3.32) cmH2O; △P 48 h: (8.79±5.26) vs. (15.32±5.87) cmH2O; (P＜0.01)]. The incidence rate of regurgitation and aspiration in the observation group was 9.3%, lower than that in the control group, which was 11.9%, and there was statistically significant difference between the two groups (P＜0.05); there was no statistically significant difference in the incidence rate of airway mucosal injury and pulmonary infection between the two groups (P＞ 0.05). Conclusions? The use of three-way connection can reduce air leakage of the artificial airway balloon and reduce the incidence rate of regurgitation and aspiration effectively.

Objective:To evaluate quality of clinical practice guidelines and expert consensus on early activities of ICU adult patients issued at home and abroad, so as to provide reference for the standardized construction of the early activity program for ICU adult patients in China.Methods:Clinical practice guidelines and expert consensus on early activities for ICU adult patients published at home and abroad on clinical practice guide websites, rehabilitation professional related websites and various databases were searched by computer system. The retrieval time was from the establishment of databases to July 31, 2020. Two researchers applied Clinical Guidelines Research and Evaluation SystemⅡ and the Joanna Briggs Institute (JBI) Evidence-based Health Care Center in Australia to evaluate guidelines and expert consensus on the standards of article quality evaluation, respectively.Results:Finally, a total of 8 clinical practice guidelines and 12 expert consensuses were included. The overall quality evaluation of the guideline was grade B for 7 articles and grade C for 1 article. Expert consensus could be included in the study after quality evaluation, and the authenticity was high. Recommendations on early activities for ICU adult patients involved six aspects, such as safety and feasibility of early activities, preparation and monitoring indicators of early activities, start indicators of early activities, suspension indicators of early activities, intensity and time of early activities and prognostic measurement indicators.Conclusions:The overall quality of the clinical practice guidelines and expert consensus for early activities for ICU adult patients is average, and the rigor, clarity, applicability and independence of guidelines need to be improved. Domestic scholars should pay attention to the formulation and application of clinical practice guidelines, learn from foreign high-quality evidence for localized practice and guide development of critical illness rehabilitation field in China.

Objective:To construct the nursing scheme for facial pressure injury of patients with prone position ventilation (PPV) based on surface, skin inspection, keep moving, incontinence/moisture, nutrition (SSKIN) cluster scheme, so as to provide guidance for clinical nursing practice.Methods:Under the guidance of SSKIN cluster scheme, the existing research evidence was summarized and the nursing scheme of facial pressure injury in patients with PPV was preliminarily constructed. From August to September 2021, a total of 19 nursing experts were selected for two rounds of Delphi expert consultation, and the items of scheme were modified according to the expert opinions.Results:In the two rounds of expert letter inquiries, 19 questionnaires were distributed and 19 valid questionnaires were recovered. The effective recovery rate was 100.00% and the expert authority coefficient were all 0.85. The Kendall's harmony coefficients of the importance and operability of the items in the second round of expert letters were 0.48 and 0.41 respectively (all P<0.01) . Finally, the nursing scheme for PPV patients with facial pressure injury was formed, including 5 frameworks, namely skin evaluation, support surface, body position change, moisture treatment and nutritional support, with a total of 27 items. Conclusions:The nursing scheme of PPV patients with facial pressure injury based on SSKIN cluster scheme constructed in this study has scientific, feasible and strong clinical practical value, which can provide guidance for clinical nursing practice.

Objective:To explore the effect of nursing team leader rotation in ICU nursing team, so as to provide reference for optimizing the allocation of nursing human resources, promoting the cooperation of nursing team and improving the quality of nursing care.Methods:The ICU nursing team leader rotation was implemented from October 2018 to June 2019, semi-structured interview method was used to understand the feeling and experience of medical staff in the department on team cooperation, workflow, nursing quality and other aspects after the implementation of the rotation, so as to evaluate the effectiveness.Results:According to the results of interviewing, by implementing the nursing team leader after rotation, most staff feel the improvement of care team, as well as the enthusiasm of learn and work. The new leader′ ability is got promoted, former leader feeled working pressure eased, some medical workers think that nursing quality was not affected, and there performance appraisal was reduced in an acceptable range.Conclusion:The implementation of the nursing team leader rotation may be able to improve teamwork, work enthusiasm,and the ability of overall leader team, alleviate the workload, future studies could evaluate its specific effect by quantitative indicators, and discusses the impact on the quality of care and patient outcomes, to further explore the feasibility and effectiveness of the system.

Objective To investigate the application and effect evaluation of combined warming and humidification device in patients with artificial airway in high altitude area. Methods The convenient sampling method was used to select 225 hospitalized patients in the Department of Critical Care Medicine of the People′s Hospital of Tibet Autonomous Region from January to June 2018. According to the order of admission time, they were divided into two groups: observation group (125 cases) and control group (100 cases). The observation group was humidified by artificial nose, while the control group was humidified by heating and humidifying device. The phlegm properties and scab formation were observed in the two groups. The ambient temperature, humidity and airway temperature were measured at 3:00, 9:00, 15:00 and 21:00 every day. The average values of four measurements were taken. The levels of CO2 partial pressure and oxygen partial pressure were recorded by blood gas analysis. χ2was used to compare the differences between the 2 groups. Results There was no difference in sputum properties between the two groups before humidification. The incidence of grade II and grade III mucous phlegm in the observation group was 46, 48 and 65 on the first, second and third day after humidification, while that in the control group was 13, 9 and 10 respectively. The difference between the two groups was statistically significant (χ2=16.266, 25.387, 44.100, P<0.01). On the 2nd and 3rd day, the oxygen partial pressure levels of the observation group were (92.62 ± 5.73), (91.34 ± 4.82) mmHg, and those of the control group were (96.17 ± 3.60), (95.53 ± 2.96) mmHg, respectively. The difference between the two groups was statistically significant (t=5.697, 8.045, P<0.01). The sputum scab formation and airway temperature in the observation group were 41 cases and(29.89±1.95)℃ respectively after 3 days of humidification, 7 cases and(34.79±1.82)℃respectively in the control group. The difference between the two groups was statistically significant (χ2= 22.035, t =- 26.031, P < 0.01). Conclusion The combination of heating and humidifying device can effectively improve the sputum properties, reduce the formation of sputum scab, effectively improve the level of carbon dioxide, without increasing the workload.

Objective To explore the nursing effect of modified prone position and traditional prone position in the skin protection of patients with prone position in ICU. Methods A total of 60 ICU patients with prone position treatment were selected in June 2014 to May 2015. According to the digital method the patients were randomly divided into the control group and the experimental group with 30 cases in each.The control group adopted traditional way of prone position with the head and chest pad pushed up. used by patients not pad up way of improvement of prone position. The incidence of skin pressure injury and the incidence of stress in the two groups were compared. Results The incidence of skin pressure injury was 20.0％(6/30) in the experimental group and 66.7％(20/30) in the control group, and the difference was statistically significant (χ2=13.30, P < 0.05). Conclusions Modified prone position has obvious advantages in reducing the incidence of skin pressure ulcer and is suitable for patients with clinical prone position.