ObjectiveTo explore the effect of closed-loop group nursing model on the makeshift intensive care unit (ICU) in a hospital specialized for coronavirus disease 2019 (COVID-19).MethodsSeveral fever wards had been shifted into ICUs and ran by the first medical team from Sichuan Province from January 30th to March 19th, 2020. Closed-loop group nursing model was utilized. The nursing model activated the nurses in management by empowerment and nursing group establishment. To ensure standard of care, measures were carried out in this model, namely, improving the physical work environment, nurse training, optimizing composition of nursing manpower, fine and standardized management of medical resources, “double-chain” medical supply system, “3S” management on first aid kit, protecting patient safety and dignity, and developing emergency nursing workforce deployment plan.ResultsThe implementation of closed-loop group nursing model showed good results in treating severe to critically ill COVID-19 patients regardless of shortages in nursing workforce and facilities. The rescue work was carried out successfully in the makeshift ICUs. All the nurses showed great teamwork and were really involved in the management of the wards. ConclusionsAs the current ICUs were not adequate for the increasing number of critically ill patients during the epidemic, it was unavoidable to transform other wards into ICUs. Closed-loop group nursing model was utilized to break the hierarchy. As a result, all nurses were empowered to participate in nursing management and their potential was fully inspired. Furthermore, this working model presented a clear working framework in multidisciplinary teamwork in a limited time, which also provided patients with dignity and safety.
ObjectiveTo analyze the perdictive value of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) for malnutrition or postoperative complications in children with critical congenital heart disease (CHD).MethodsA total of 875 children with critical CHD who were hospitalized in West China Hospital, Sichuan University form August 2019 to February 2021, including 442 males and 433 females with a median age of 30 (12, 48) months, were assessed by STAMP in Health Information System. Clinical data of postoperative complications were collected.Results(1) Based on World Health Organization Z-score as gold standard, 24.5% had malnutrition risk, and 34.3% were diagnosed with malnutrition. According to STAMP, the children were with medium malnutrition risk of 37.9% and high malnutrition risk of 62.1%. There was a statistical difference of incidence rate of malnutrition and detection rate of STAMP malnutrition risk in gender, age, ICU stay or length of mechanical ventilation (P<0.05); (2) with the optimal cut-off point of 5.5 in STAMP for malnutrition, the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) were 68.3%, 84.3%, 48.1%, 88.3% and 0.82, respectively; (3) 12.0% of the children were with postoperative complications; (4) with the optimal cut-off point of 5.5 in STAMP for postoperative complications, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 83.8%, 73.1%, 18.8%, 99.1% and 0.85, respectively.ConclusionChildren with critical CHD have a higher incidence of malnutrition risk and postoperative complications. STAMP has a good perdictive value for malnutrition or postoperative complications, however, the sensitivity and specificity of STAMP are affected by the gold standard or the cut-off point.
Objective To analyze the relationship between preoperative anemia and postoperative infection and death in children with acyanotic congenital heart disease (CHD) after elective cardiac surgery. Methods Medical records and follow-up data of 3 859 children with acyanotic CHD who underwent elective cardiac surgery in our hospital from 2011 to 2018 were retrospectively collected, including 2 081 males and 1 778 females with a median age of 32.2 (13.7, 61.5) months. The relationship between preoperative anemia and postoperative infection and death within 90 days was analyzed by univariate and multivariate regression analyses. Results Preoperative anemia was found in 325 (8.4%) patients. There were 716 (18.6%) patients of postoperative infection, including 281 (7.3%) patients of confirmed infection and 435 (11.3%) patients of suspected infection. Forty-six (1.2%) patients died within 90 days after the operation. Univariate analysis showed that age, infection history within 3 months before admission, degree of pulmonary hypertension, the risk adjustment in congenital heart surgery-1 (RACHS-1) score, cardiopulmonary bypass (CPB), disease diagnosis, chromosome abnormality, preoperative left ventricular ejection fraction (LVEF)<55% and preoperative anemia were associated with postoperative infection. Age, degree of pulmonary hypertension, RACHS-1 score, CPB, disease diagnosis and preoperative LVEF<55% were associated with postoperative death within 90 days. Logistic regression analysis showed that preoperative anemia was significantly associated with confirmed postoperative infection [OR=1.82, 95%CI (1.18, 2.82), P=0.007], suspected infection [OR=1.60, 95%CI (1.11, 2.30), P=0.012] and total infection [OR=1.64, 95%CI (1.20, 2.24), P=0.002]. The results of modified Poisson regression analysis showed that there was no significant association between preoperative anemia and death within 90 days after the surgery [RR=1.59, 95%CI (0.69, 3.69), P=0.276]. Conclusion Preoperative anemia may be a risk factor for infection after elective cardiac surgery in children with acyanotic congenital heart disease.
ObjectiveTo provide recommendations for the management of intensive care unit patients without novel coronavirus disease 2019 (COVID-19).MethodsWe set up a focus group urgently and identified five key clinical issues through discussion. Total 23 databases or websites including PubMed, National Guideline Clearing-House, Chinese Center for Disease Control and Prevention and so on were searched from construction of the library until February 28, 2020. After group discussion and collecting information, we used GRADE system to classify the evidence and give recommendations. Then we apply the recommendations to manage pediatric intensive care unit in the department of critical care medicine in our hospital. ResultsWe searched 13 321 articles and finally identified 21 liteteratures. We discussed twice, and five recommendations were proposed: (1) Patients should wear medical surgical masks; (2) Family members are not allowed to visit the ward and video visitation are used; (3) It doesn’t need to increase the frequency of environmental disinfection; (4) We should provide proper health education about the disease to non-medical staff (workers, cleaners); (5) Medical staff do not need wear protective clothing. We used these recommendations in intensive care unit management for 35 days and there was no novel coronavirus infection in patients, medical staff or non-medical staff. ConclusionThe use of evidence-based medicine for emergency recommendation is helpful for the scientific and efficient management of wards, and is also suitable for the management of general intensive care units in emergent public health events.