Objective To investigate the effect of a real-time compliance dashboard to help reduce ventilator-associated pneumonia ( VAP) with ventilator bundle. Methods 240 patients who were admitted into the intensive care unit ( ICU) of Shougang Hospital of Peking University and had received mechanical ventilation ( MV) for over 48 hours, between January 2010 and November 2011, were studied prospectively. The patients were divided into two groups by random number table, ie. a dashboard group ( n = 120) with implementation of a real-time compliance dashboard to help reduce VAP with ventilator bundle, and a control group ( n=120) with implementation of usually routine order to help reduce VAP with ventilator bundle. The success rate of ventilator bundle implementation, incidence of VAP, duration of MV, duration within ICU, mortality within 28 days, cost within ICU were compared between two groups. Results Compared with the control group, the success rate of ventilator bundle implementation obviously increased ( 81.6% vs. 52.5%) , incidence of VAP ( 14. 5/1000 days of MV vs. 36.2 /1000 days of MV) , duration of MV [ 5( 4,7) days vs. 8( 6,11) days] , duration within ICU [ 8( 6,12) days vs. 13( 8,16) days] , mortality of 28 days ( 12.6% vs. 28.6% ) , and cost within ICU ( 36,437 vs. 58,942) in the dashboard group obviously reduced ( Plt;0.05) . Conclusions Implementation of a real time compliance dashboard to help reduce VAP with ventilator bundle can obviously improve medical personnel compliance and reduce incidence of VAP, duration of MV, duration within ICU, mortality and cost in ICU than those of routine medical order to help reduce VAP with ventilator bundle.
目的 探讨危重症手足口病的集束化综合救护的护理方案。 方法 通过比较儿科使用集束化综合护理方案后1年（2009年5月－2010年4月）的26例危重症手足口病并发症的发生率，确定预防危重症手足口病的集束化综合护理方案的有效性。 结果 使用集束化综合护理方案后，26例患儿均治愈出院，其中仅3例有后遗症。 结论 集束化综合护理救治作为主动预防措施比传统的被动预防更有针对性和有效。
【摘要】 目的 总结2例特重烧伤患者在ICU的救治经验和体会，旨在进一步提高特重烧伤患者的救治水平。 方法 回顾分析2009年6月2例重症烧伤患者的诊治经过程和临床资料。 结果 1例患者病情好转，转出ICU继续治疗，1例患者伤后37 d因消化道出血死亡。 结论 特重烧伤患者的治疗需要整体计划和多科协作。【Abstract】 Objective To summarize the experiences of the management of two patients with severe burn, so as to improve the treatment of severe burn patients. Method Treating processes and clinical data of two patients with severe burn in June 2009 were analyzed retrospectively. Result After prompt treatments, one patient died of severe bleeding in the digestive tract 37 days after the burn and the other patient recovered and left ICU for further treatment. Conclusion Bundle treatment and multi-subject cooperation are important for treating patients with severe burn.
【摘要】 目的 探讨甲型H1N1流感危重症患者的抢救疗效。 方法 2009年10月－2010年1月，对我院ICU收治5例甲型H1N1流感危重症患者采用集束化治疗方案进行救治，并就患者的器官功能变化进行评价。 结果 5例患者平均住院天数为（11.8±5.59）d，4 例存活，1例死亡。存活患者在治疗过程中急性生理和既往健康 （APACHE）Ⅱ、多器官功能障碍综合征评分（MODS）、全身性感染相关的器官衰竭评分 （SOFA）总体呈逐渐下降趋势。死亡者APACHEⅡ、SOFA评分均呈逐渐升高趋势。 结论 对甲型H1N1流感危重症患者采取集束化救治疗效良好。【Abstract】 Objective To explore the effect of bundle therapy on severe patients with influenza A (H1N1). Methods Bundle therapy were used in 5 severe patients with influenza A from October 2009 to January 2010. The patients’ organ dysfunction were observed for. Results The average in-hospital duration was (11.80±5.59) days. Four patients survived and one died with the survival ratio of 80%. Acute physiology and chronic health evaluation (APACHE) II score, Multiple organ dysfunction syndrome (MODS) score and sepsis-related organ failure assessment (SOFA) score gradually decreased in 4 survived patients, while gradually increased in the died patient. Conclusion Bundle therapy is effective on patients with severe influenza A.
ObjectiveTo explore the preventive role of maintaining constant pressure of the endotracheal catheter cuff on ventilator-associated pneumonia (VAP). MethodsFrom January to December 2015, 96 patients of type Ⅱ respiratory failure were selected as the trial group who underwent intubation and mechanical ventilation more than 48 hours in the Intensive Care Unit (ICU). We used pressure gauges to measure the endotracheal catheter cuff pressure regularly and maintained a constant pressure in addition to the application of artificial airway cluster management. We recorded the initial pressure value which was estimated by pinching with finger and set initial pressure to 30 cm H2O (1 cm H2O=0.098 kPa). We measured endotracheal catheter cuff pressure and recorded it during different intervals. We reviewed 88 patients with the same disease as the control group who only accepted artificial airway cluster management between January and December 2014. Mechanical ventilation time, VAP occurrence time, ICU admission time, the incidence of VAP were recorded and analyzed for both the two groups of patients. ResultsIn the trial group, the initial pressure of endotracheal catheter cuff which was estimated by pinching with finger showed that only 11.46% of pressure was between 25 and 30 cm H2O and 82.29% of the pressure was higher than 30 cm H2O. We collected endotracheal catheter cuff pressure values during different interval time by using pressure gauges to maintain a constant management. The ratio at the pressure between 25 and 30 cm H2O was respectively 41.32%, 43.75%, 64.20%, 76.54%, 91.13%, and 91.85%. ICU admission time, mechanical ventilation time in patients of the trial group decreased more, compared with the control group, and the differences were statistically significant (t=4.171, P<0.001; t=4.061, P<0.001). The VAP occurrence time in patients of the trial group was later than the control group (t=2.247, P<0.001). ConclusionThe endotracheal catheter cuff pressure estimated by pinching with finger has errors. We recommend using pressure gauges to detect pressure every four hours, which utilizes minimal time to maintain effective pressure. The method of artificial airway of cluster management combined with the pattern of maintaining constant endotracheal catheter cuff pressure can shorten ICU admission time, mechanical ventilation time and delay the occurrence of VAP.
ObjectiveTo research on the influence of cluster management on the nutritional intervention for nasopharynx cancer patients undergoing intensity modulated radiation therapy (IMRT), in order to discuss effective and feasible nutrition management method. MethodEighty-three nasopharynx cancer patients undergoing IMRT between June 2013 and December 2014 were selected as the study subjects. They were divided into two groups randomly. Regular health education and nutritional guidance were carried out for the 41 patients in the control group, while nutritional risk screening (NRS)-2002 nutrition screening, nutrition assessment and nutritional intervention were carried out for the 42 patients in the intervention group. Nutrition risk, nutritional status and side-reaction were recorded and evaluated for both groups of patients. ResultsAfter treatment, NRS-2002 score of the intervention group was lower than the control group (P<0.05). Body weight, constitutional index, skinfold thickness of triceps brachii muscle, mid-arm circumference and mid-arm muscle circumference of the intervention group were better than the control group (P<0.05). Total serum protein, serum albumin, serum transferrin were better and the rate of levelⅢ-Ⅳ radiation-induced oral mucositis was lower in the intervention group than that in the control group (P<0.05). ConclusionsThe application of cluster management model in nutritional intervention is a way to promote patients' rehabilitation, which can effectively improve the whole body situation of nasopharynx cancer patients, and reduce malnutrition rate and side-reaction.
ObjectiveTo investigate the correlation between compliance of clinical respiratory bundle and duration of mechanical ventilation. MethodsThe data of patients who admitted to intensive care unit (ICU)of Cancer Hospital Chinese Academy of Medical Sciences between June 2013 and December 2014 were retrospectively reviewed and analyzed.The patients with respiratory insufficiency who ventilated more than 48 hours were included into the study. ResultsFifty-five patients were enrolled into the final analysis.There were 43 males and 12 females with a mean age of 63.47±12.49 years.The mean sequential organ failure assessment (SOFA)score was 2.8±2.2,and the mean simplified acute physiology score 3 (SAPS3)was 51±14 on ICU admission.The mean duration of mechanical ventilation of all 55 patients was 7.3±5.5 days.The compliance of low tidal volume strategy was 23.6%(13/55).No significant difference was found on duration of mechanical ventilation between the patients who was compliant with low tidal volume strategy and the patients who was not compliant (7.31±7.02 days vs. 7.31±5.07 day,P=0.444).A negative correlation between compliance of protocolized sedation strategy and duration of mechanical ventilation was found by Bivariate spearman correlation analysis (r2=0.312,P<0.001).A negative correlation between compliance of spontaneous awakening trial strategy and duration of mechanical ventilation (r2=0.337,P<0.001)and a negative correlation between compliance of spontaneous breathing trial strategy and duration of mechanical ventilation (r2=0.280,P<0.001)were also found by Bivariate spearman correlation analysis.Multiple linear regression analysis showed that only spontaneous awakening trial strategy was correlated with duration of mechanical ventilation(B=-0.623,P<0.001). ConclusionThe more compliance with clinical respiratory bundle,especially with spontaneous awakening trial strategy,the shorter of duration of mechanical ventilation.The effect of low tidal volume strategy on the duration of mechanical ventilation needs further studies.
ObjectiveTo explore the effect of the cluster intervention in new nurses in the Department of Neurosurgery in occupation training, so as to provide reference for the clinical training of new nurses. MethodsEight nurses who entered the Department of Neurosurgery in January 2013 were set as control group and the 8 new nurses entering in January 2014 as the observation group. The control group was adopted the traditional training methods, while the observation group underwent used extra cluster intervention. The differences in the results of theory, technology, operation and the 360-degree evaluation between the two groups were analyzed at the end of year. ResultsIn the observation group, the median theory examination score was 91.50, median operation assessment grades was 95.00, which were higher than those in the control group (82.00 and 83.00). The average scores of 360-degree evaluation in the observation group were higher than those in the control group with a significant difference (P < 0.01). ConclusionsIntensive intervention should be used for new nurses' training. It helps to improve the training effect and new nurses' ability.