ObjectiveTo analyze the risk factors for the prolonged time of intensive care unit (ICU) stay after isolated heart valve replacement. MethodWe retrospectively analyzed the clinical data of 400 patients underwent heart valve replacement surgery in our hospital in 2013 year. There were 208 males and 192 females with a mean age of 50.5±11.1 years ranging from 11-85 years. We divided them into an A group with the time of ICU stay shorter than 48 hours and a B group with the time of ICU stay longer than 48 hours. We recorded the demographic characteristics, preoperative data, intraoperative data and postoperative data and analyzed those data with univariate and multivariate methods. ResultThere was a statictical difference in the demographic characteristics, preoperative data, intraoperative data and postoperative data between the 2 groups (P < 0.05). The logistic result showed that if we didn't consider the postoperative factors the prolonged time of ICU stay statistically related with age over 70 year(OR 2.024, 95%CI 1.182-3.466, P < 0.05), the cardiac grade of New York Heart Association at Ⅲ-Ⅳ(OR 3.295, 95% CI 1.030-10.544, P < 0.05), preoperative hemoglobin concentration less than 120 g/l (OR 0.500, 95%CI 0.263-0.950, P < 0.05), and the cardiopulmonary bypass time more than 180 min (OR 2.486, 95%CI 1.006-6.143, P < 0.05). If we considered the postoperitive factors, the prolonged time of ICU stay statistically linked to the cardiopulmonary bypass time longer than 180 min (OR 3.295, 95% CI 1.030-10.544, P < 0.05), the postoperative blood glucose more than 10 mmol/l (OR 2.954, 95%CI 1.334-6.543, P < 0.05), and the pulling out trachea canula 24 hours after operation (OR 6.742, 95% CI 3.005-15.124, P < 0.05). ConclusionThe prolonged time of ICU stay after valve replacement surgery is associated with a number of risk factors before, during and after heart valve replacement surgery. Targeting the risk factors, especially the postoperitive risk factors, can be effective to shorten the ICU residence time.
Objective To explore the nurses’ cognition of busyness in intensive care unit (ICU), summarize the main busy scenes, and provide strategies for solving problems of busyness. Methods Nurses in three ICU departments of Shanghai Oriental Hospital were selected by purpose sampling method from September 2020 to January 2021. Face-to-face semi-structured in-depth interviews were conducted with nurses. The interview data were analyzed and thematically refined using the method of Colaizzi data analysis. Results A total of 10 nurses were interviewed, including 8 general nurses and 2 head nurses, all of whom were women. The cognition of busyness covered three elements: explosively increased workload, time pressure, and overwhelming information from multiple sources. Busy scenes included four themes: large amount of patients, critical conditions of patients, unstable conditions of patients, and frequent service transfer among different medical divisions. Conclusions According to the three elements of nurses’ cognition of busyness and scenes of it, nursing managers can put forward corresponding solutions. This can retain or attract more nurses to work in ICU and provide better services for patients.
ObjectiveTo systematically review the efficacy of ICU diaries on psychological outcomes, cognition and health-related quality of life in both patients and their relatives. MethodsThe PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, CNKI, WanFang Data and VIP database were electronically searched to collect trails related to the objective from inception to August 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 17 studies involving 2 093 patients and 786 relatives were included. The results of meta-analysis showed that compared with the control group, ICU diaries could improve patients’ post-traumatic stress disorder (PTSD) (RR=0.64, 95%CI 0.50 to 0.83, P<0.01), depression (RR=0.65, 95%CI 0.48 to 0.89, P<0.01) and quality of life (MD=7.78, 95%CI 4.37 to 11.18, P<0.01) significantly. However, there were no significant differences in patients’ anxiety, memory and relatives’ psychological outcomes. ConclusionCurrent evidence shows that the use of ICU diaries can reduce the incidence rate of patients’ PTSD, depression and improve their quality of life, but other effects are unclear. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.