Objective To explore the value of glycemic variability（GV） in predicting early enteral feeding intolerance（EFI） in critically ill patients，and provide a basis for precision nutrition management. Methods The 283 patients who initiated enteral nutrition in the ICU between June 2022 and June 2024 were enrolled. Patients were divided into a tolerance group and an intolerance group based on the occurrence of enteral feeding intolerance（EFI）. Data collected included general patient characteristics，laboratory parameters，clinical treatments，and blood glucose values，with glycemic variability（GV） calculated. Logistic regression and Cox proportional hazards regression analyses were used to identify independent risk factors for EFI，while receiver operating characteristic （ROC） curves was employed to evaluate the predictive efficacy of GV for EFI. Results Among the 283 patients，156 tolerated enteral feeding，while 127 developed EFI. The incidence of EFI was 44.87%，with primary manifestations of gastric retention（50.39%） and diarrhea（36.22%），mostly occurring between days 2 and 3 after nutrition initiation. Logistic and Cox regression indicated that pre-nutrition glucose standard deviation（GLUsd）（β=0.218，OR=1.244） and APACHE Ⅱ score（β=0.078，OR=1.081） were independent risk factors for EFI. ROC analysis showed that the AUCs for APACHE Ⅱ score and pre-nutrition GLUsd were 0.696 and 0.657，respectively，increasing to 0.723 when combined. Correspondingly，accuracy improved from 67.137% and 63.984% to 70.115%，with more balanced sensitivity and specificity. GV indicators during nutrition initiation did not show significant predictive value. Conclusion APACHE Ⅱ score and pre-nutrition GLUsd are both significant predictors of early enteral feeding intolerance，and their combination further enhances diagnostic efficacy. Clinically，the dual-dimensional assessment of metabolic stability and disease severity should be emphasized prior to nutrition support，in order to optimize nutritional management，reduce the incidence of EFI，and improve outcomes in critically ill patients.

Objective To explore predicament and needs of coping financial toxicity in heart failure patients and families based on the three-dimensional conceptual framework of financial hardship，in order to provide reference for identifying financial toxicity and developing intervention strategies. Methods From March to May 2024，21 heart failure families from a tertiary class A hospital in Shanghai were selected to participate in the semi-structured interview by the principle of maximum differentiation. NVivo Plus 12.2 software was used to manage the text data and Colaizzi 7-step analysis method was used for data analysis and topic extraction. Results 3 themes were condensed，including financial toxicity-related experience and the change of economic status during the treatment of heart failure，financial concerns and psychological pressure during the treatment of heart failure，behavioral coping strategies and adaptation in the treatment of heart failure. Conclusion Medical staff should concern to the plight and needs of heart failure patients in coping with financial toxicity，and increase psychological intervention，provide educational programs，conduct cost dialogues to help them better cope with financial toxicity.

Objective To construct a knowledge graph based intelligent Q&A system for ventilator alarm management in intensive care units，to improve healthcare professionals’ ability to recognize and handle ventilator alarms，and to enhance patient safety and treatment outcomes. Methods We integrated knowledge from various sources such as thesis，guidelines，standards，clinical practice cases，device user manuals，etc.，and developed the knowledge framework through expert interviews and expert meetings. We used a combination of automation and manual review to construct entities，extract and integrate knowledge，and input data into the Neo4j graph database as “entity-relationship-entity” ternary data for storage. And for the semantic understanding and parsing of natural language questions，the knowledge graph Cypher query statement was created，so that the knowledge graph has intelligent question and answer functions. The system usability scale was used to test the usability of the Q&A system. Results The constructed knowledge graph covered six fields，including ventilation mode，parameter settings，alarm types，alarm causes，treatment measures，and equipment maintenance，and contains 206 knowledge entities，15 kinds of inter-entity relationships，and 256 linkages of knowledge points，and a web-side intelligent Q&A system has been developed based on the knowledge graph. The mean score of the System Usability Scale was （76.44 ± 13.17）. Conclusion The knowledge graph based intelligent Q&A system for ventilator alarm management constructed in this study has certain scientific validity and usability. Through the visualization of knowledge system functions，intelligent question and answer，and personalized recommendation，it provides an auxiliary decision support tool for healthcare professionals to effectively identify and accurately deactivate the alarms，and improves the safety of clinical alarms.

Objective To design and develop an intelligent communication mode for mechanically ventilated patients in Intensive Care Unit（ICU） based on WeChat applet，and evaluate its usability. Methods On the basis of the current situation investigation and qualitative interviews，the first draft of the content of the intelligent communication model module was constructed，and expert consultation was conducted in December 2021. A multi-field team combined with WeChat applet to design and develop an intelligent communication model. From August 2022 to February 2023，103 patients and 103 nurses from a tertiary hospital in Beijing were selected using convenience sampling method，and a questionnaire adapted from the technology acceptance model was used to evaluate the usability of the intelligent communication mode. Results The small program mainly included five modules：communication，WeChat users，usage records，feedback and text size setting. The usability score of the 103 patients was（99.89±3.73） out of 105. The usability score of the 103 tested nurses was（169.35±4.65） out of 175.Conclusion The intelligent communication mode developed based on WeChat applet can meet the effective communication between ICU nurses and mechanically ventilated patients，and can be applied to clinical practice.

Objective To develop artificial airway resistance intelligent warning system to detect the secretions early for patients with mechanical ventilation，and explore its effect in improving the intervention rate of secretions and reducing the viscosity of artificial airway secretions. Methods In May 2022，we started to develop an artificial airway resistance intelligent early warning system based on Internet of Things technology to achieve closed-loop intelligent management of artificial airway secretion viscosity. From March to April 2023，it was applied in the Department of Internal intensive Care Medicine and the Department of Surgical Intensive Care Medicine of a tertiary class A hospital in Zhejiang Province. The intervention rate of artificial airway secretion and the viscosity rate of artificial airway secretion in patients with mechanical ventilation after the application of the system（March to April 2023） and before the application（March to April 2022） were compared. Results After the system application，the intervention rate of artificial airway secretion increased from 14.2% to 25.8%，and the viscosity rate of artificial airway secretion decreased from 45.3% to 24.5%，with statistical significance（P<0.05）. Conclusion The application of intelligent early warning system of artificial airway resistance based on Internet of Things technology can improve the intervention rate of artificial airway secretion and reduce the viscosity of secretion.

Objective To construct a geriatric emergency clinic based on smart technology and explore the practice effectiveness. Methods From January to December 2023，the Emergency Medicine Clinic of a tertiary class A hospital of Zhejiang Province was selected as a pilot unit using convenience sampling method to explore the construction and practice of geriatric emergency clinic based on intelligent technology. The period from 1 November 2023 to 30 November 2023 before application was the control group；the period from 1 December 2023 to 31 December 2023 after application was the experimental group，and 548 and 768 geriatric emergency clinic patients were included，respectively. The effect of the construction of the smart geriatric emergency room was analysed by comparing the waiting time，the initial blood sampling time，the average time of patient transfer to resuscitation room，and patient satisfaction between the two groups. Results After the implementation of the intelligent geriatric emergency clinic，the mean waiting time was shortened，it was 11.00（6.00，18.00） minutes in the experimental group and 12.00（5.25，24.00） minutes in the control group，and the difference between the two groups was statistically significant（Z=-0.194，P<0.05）. The time for the first blood collection was 8.00（5.00，15.00） minutes in the experimental group and 8.00（5.00，16.00） minutes in the control group，and there was no statistically significant difference（Z=-0.945，P>0.05）. The time taken to transfer patients from the clinic to the resuscitation room for treatment was reduced，and was 99.00（45.00，132.00） minutes in the experimental group and 101.50（57.50，159.00） minutes in the control group，the difference was not statistically significant between the two groups （Z=-0.441，P>0.05）. The level of patient satisfaction increased 92.69% to 98.23%（Z=-2.830，P<0.05）. Conclusion The construction of the smart geriatric clinic can improve the work efficiency and medical satisfaction of geriatric patients.

Objective To explore the impact of an interactive information system on the outcomes of severe trauma patients within the “1-hour trauma emergency circle”. Methods Based on the “1-hour trauma emergency circle”，a real-time，accurate，and shared information interaction system was constructed. Using convenience sampling，138 severely injured patients admitted to a tertiary class A hospital in Zhengzhou from January 1to December 31，2023，were selected as the experimental group，the information interaction model was applied. 100 severely injured patients admitted from January 1，to December 31，2022，were selected as the control group，the conventional rescue model was applied. The key time indicators，24-hour survival rate，emergency surgery rate，incidence of adverse events，and emergency bypass rate were compared between the two groups. Results The pre-hospital response time，in-hospital warning time，definitive treatment time，emergency stay time，and emergency visit to surgery time in the experimental group were lower than those in the control group，and the differences were statistically significant（P<0.05）. Compared with the control group，the 24-hour survival rate（98.56% vs. 92.00%），emergency surgery rate（41.30% vs. 27.00%），adverse event rate（3.62% vs. 11.00%），and emergency bypass rate（13.00% vs. 1.00%） were significantly improved in the experimental group（P<0.05）. Conclusion The application of information interaction system in the “1-hour trauma emergency circle” can significantly shorten the time of patient treatment，reduce the incidence of medical adverse events，and improve the success rate of treatment.

Objective To construct the “one-click call” treatment platform for people in advanced age and evaluate its application effect. Methods The platform includes two ports，the medical terminal and the user terminal. The research team established health records for the oldest old and entered them into the doctor-nurse database. Medical terminal can automatically obtain health records when users dialed 120 or used wechat mini program. The pre-hospital scheduling time，pre-hospital response time，patient satisfaction and medical staff satisfaction using the platform from January 1 to December 31，2023 were collected from the medical terminal，and compared with the pre-hospital emergency data from January 1 to November 30，2022，to evaluate the application effect of the platform. Results By December 31，2023，health records of 11 000 people in advanced age had been established，and 7 700 of them had used the platform. The pre-hospital scheduling time was（28.25±6.27） s，which was significantly shorter than the traditional pre-hospital scheduling time（58.43±11.27） s，and the difference was statistically significant（t=200.532，P<0.001）. The pre-hospital response time was（9.26±1.93） min，which was shorter than the traditional pre-hospital response time（10.98±2.41） min，and the difference was statistically significant（t=47.785，P<0.001）. In addition，7 577 patients（98.40%） were satisfied with the platform，and no complaints or adverse events occurred. A total of 114 medical staff（98.28%） showed a high degree of satisfaction with the platform. Conclusion The "one-click call" treatment platform for the people in advanced age can shorten the pre-hospital scheduling time and response time，and improve the satisfaction of patients and medical staff，which has certain reference and promotion value.

To summarize the nursing experience of a patient with acute limb ischemia due to acute right iliac artery thrombosis after lung transplantation. In view of the problems of complex conditions，circulation instability and poor activity endurance of patients，early warning of acute limb ischemia after lung transplantation was adopted，interventional postoperative care was balanced with anticoagulation mechanism，first aid for arrhythmia was quickly started，diversified rehabilitation training was implemented，intestinal function recovery was promoted. After the treatment and meticulous care of the multidisciplinary team，the patient was transferred from the intensive care unit to the general ward 42 days after lung transplantation. After 2 months of follow-up，he was in good condition.

To summarize the nursing experience of a child with refractory mycoplasma pneumoniae pneumonia complicated by right ventricular thrombosis and pulmonary embolism. Due to the atypical clinical manifestations，critical condition，and nursing challenges such as high risk of bleeding during thrombolysis and potential thrombus dislodgement，the following strategies were implemented，including early risk stratification assessment for pulmonary embolism，formulation of a precise thrombolytic regimen，dynamic monitoring of thrombolytic efficacy，and timely detection of re-embolism symptoms. After 23 days of treatment and specialized care，the patient stabilized and was discharged. Follow-up at one month showed favorable recovery.

To summarize the nursing experience of a patient with severe pelvic and abdominal abscess caused by fallopian tube and ovarian inflammation. In view of the patient’s acute onset，severe pelvic and abdominal infection，poor nutritional status，and slow recovery of gastrointestinal function，a multidisciplinary nursing team was established after admission to the ward to formulate a detailed nursing plan. And early identification of severe disease，timely fluid resuscitation and use of antimicrobial drugs，refined nursing to control infection，comprehensive phased nutritional support，stepwise quantitative activities and traditional Chinese medicine assisted treatment were implemented to improve patient recovery. The patient was successfully discharged from the hospital after 40 days of careful treatment and nursing.

To summarize the postoperative nursing experience of a patient with silicosis complicating chronic thromboembolic pulmonary hypertension. Nursing points included：care of pulmonary ischemia-reperfusion injury after pulmonary endarterectomy，reduction of residual pulmonary hypertension to prevent pulmonary hypertension crisis， early implementation of prone ventilation by ultrasound assessment of pulmonary function，formulation of personalized volume management with vigilance for pulmonary edema，and formation of a multidisciplinary team to implement ICU transitional rehabilitation nursing. After active treatment and anticipatory care，the patient was successfully extubated and transferred out of the ICU.

To summarize the nursing experience of ABO incompatible liver transplantation in a child with biliary atresia complicated with pulmonary infection. In view of the severe pulmonary infection before surgery，ABO-incompatible liver transplantation was prone to acute rejection，complex vascular complications and infection risk，we adopted multidisciplinary collaboration to construct whole chain management mode，control lung infection actively，and strengthen respiratory function training，and reduced blood group antibody level actively and gave good predictive nursing. Early sequential anticoagulant therapy and being alert to vascular complications，high-efficient sequential weaning therapy and nasal high-flow humidified oxygen therapy nursing were implemented. We alleviated the negative emotion of the child through the medical counseling program for children. After 39 days of treatment and nursing，the child was discharged smoothly.

Objective The study aims to establish a neuro-monitoring and nursing plan during the low perfusion period in emergency cardiac arrest patients based on appropriate use criteria，to address the problem of brain injury after autonomous circulation recovery. This plan provides guidance for clinical nurses on neurological management during low perfusion period in cardiopulmonary resuscitation patients. Methods This study established a multidisciplinary team to develop a neuro-monitoring and nursing plan for emergency cardiac arrest patients during the low perfusion period based on the AHA and ILCOR guidelines. A total of 68 patients in the experimental group were resuscitated according to the plan，while the control group followed the traditional cardiopulmonary resuscitation protocol. Results There was no statistically significant difference between the two groups in terms of patient age，gender，cause of cardiac arrest，and outcomes. The neurological function assessment in survivors of the experimental group was significantly better than that of the control group（P=0.017）. In patients who achieved ROSC in the experimental group，the changes in end-tidal CO2 and cerebral oxygen saturation were consistent with domestic and foreign studies，but due to the limited sample size，there is no statistically significant difference between the two groups. Conclusion The neuro-monitoring and nursing plan during the low perfusion period in emergency cardiac arrest patients holds promise for improving neurological outcomes after cardiopulmonary resuscitation. However，there are operational complexities and technical challenges during its implementation.

Objective To gain a deeper understanding of the current management needs for device related pressure injuries（DRPI）in emergency and critically ill patients among emergency nurses，and to provide reference for the construction of DRPI prevention and management plans for emergency critically ill patients. Methods A questionnaire was used to investigate the emergency nurses’ management needs of DRPI among emergency critically ill patients. Convenience sampling was used to select 155 nurses from the emergency system of one provincial-level hospital in Henan Province and two tertiary grade A hospitals in Zhengzhou City for a questionnaire survey to analyze the management needs of emergency nurses. Results A total of 155 questionnaires were collected. The demand for DRPI management among emergency nurses for emergency critically ill patients reached 100%，with a medium-to-high demand accounted for 74.19%. There were mainly three aspects，including improving the systematic understanding of DRPI，enhancing the precise management ability of DRPI，and optimizing the DRPI workflow. Conclusion Nursing managers should develop and implement scientifically reasonable DRPI training and management plans based on the actual management needs of emergency nurses，enhance their DRPI management capabilities，and improve patient outcomes.

Objective To explore the latent profile and influencing factors of the flourishing of intensive care unit（ICU） nurses，and to provide a basis for improving the level of happiness among ICU nurses. Methods A questionnaire survey was conducted on 243 ICU nurses in Jiangsu Province using general information questionnaires，the Flourishing Scale，the Fatigue Scale，and the Professional Quality of Life Scale from November to December of 2023. The categories of ICU nurses’ flourishing were analyzed through latent profile analysis，and the influencing factors of different latent profiles were explored through single-factor analysis and binary logistic regression analysis. Results The flourishing state of the nurses can be categorized into two latent profiles，including the low flourishing level-low interest group（45.7%） and the high flourishing level-balanced group（54.3%）. Binary logistic regression analysis showed that average daily sleep time，fatigue，and empathy fatigue were influencing factors of latent profiles（all P<0.05）. Conclusion There is heterogeneity in the flourishing state among ICU nurses. Nursing managers should adopt targeted strategies based on the distinct flourishing characteristics of ICU nurses，with a particular focus on those who exhibit sleep disorders，fatigue，and empathy fatigue to improve their level of happiness，thereby ensuring the quality of nursing services.

Objective To explore the source of moral emotion in ICU nurses，analyze the influence of moral emotion on life and clinical work，and provide evidence for the formulation of moral emotion intervention strategies in ICU nurses. Methods A descriptive phenomenological study was used to conduct semi-structured interviews with 13 ICU nurses from a tertiary Grade A hospital in Shandong Province in June 2024 by objective sampling method. The data were analyzed by Colaizzi 7-step method. Results A total of 4 themes and 9 sub-themes were extracted，including the concealing of moral emotions，the sources of positive moral emotions（harmony of department atmosphere，application of the“HAVENS” humanistic care，recognition of professional values，life satisfaction and expectation），and the sources of negative moral emotions （overload of pressure burden，fear of environmental adaptation，expectation and disappointment），the influence of moral emotions on nurses（the influence of positive moral emotion experience on nurses，the influence of negative moral emotion experience on nurses）. Conclusion The positive and negative moral emotional experience of ICU nurses can not only promote the professional development of nurses，but also cause self-denial，anxiety，fear，helplessness and job burnout，which seriously affects the physical and mental health of nurses and is not conducive to the improvement of nursing quality. Nursing managers should focus on the influence of moral emotion on ICU nurses’ work and life，and formulate corresponding intervention measures to improve nurses’ moral emotion experience and improve nursing quality.

Objective To systematically integrate the qualitative studies on the influencing factors of palliative care implemented by ICU medical staff. Methods PubMed，Web of Science，Cochrane Library，Embase，CINAHL，CNKI，Wanfang Database，VIP，and CBM were searched for qualitative studies on the influencing factors of palliative care implemented by ICU medical staff from inception to September 1，2024. Two investigators independently screened articles and extracted data. The Qualitative Research Quality Assessment Tool（2016 Edition） of the Centre for Evidence-Based Health Care at the Joanna Briggs Institute in Australia was used to evaluate the quality of the literature. The results were integrated by a pooled integration approach. Results A total of 14 articles were included，and 53 research results were extracted，and the similar results were summarized into 9 new categories. Three results were integrated，including the promoting factors of ICU medical staff to implement palliative care，the hindrance factors of ICU medical staff to implement palliative care，and the external environmental factors. Conclusion The implementation of palliative care by ICU medical staff is affected by many factors，and hospital managers should build a good internal support system，strengthen the training and support of medical staff，overcome external obstacles，establish and improve the palliative care management system and mechanism，and provide better palliative care services for ICU patients.

Objective To evaluate and summarize the best evidence for the assessment and management of perioperative spinal cord ischemia（SCI） in patients with thoracic endovascular aortic repair（TEVAR）. Methods The databases at home and abroad and relevant professional websites were systematically searched for clinical decision-making，guidelines，expert consensus，evidence summaries，and original studies on the assessment and management of perioperative SCI in patients with TEVAR. The retrieval time limit was from January 1，2014 to May 23，2024. Two researchers performed quality assessment，data extraction，evidence grading and summarization of the included literature. Results A total of 15 studies were included，including one clinical decision，five guidelines，six expert consensuses，two systematic reviews，and one cohort study. Twenty-seven recommendations were summarized in seven areas，including multidisciplinary team，assessment of risk factors，intraoperative spinal cord protection，assessment of spinal cord ischemia，postoperative cluster measures，cerebrospinal fluid puncture and drainage，and rehabilitation. Conclusion This study comprehensively and scientifically summarizes the best evidence for the assessment and management of spinal cord ischemia after TEVAR，provides an evidence-based basis for clinical healthcare professionals to target the application of evidence.

Objective To retrieve and evaluate the relevant literature on conservative oxygen therapy for critically ill adults，summarize the best evidence，and provide references for clinical practice. Methods We developed a literature search strategy following the "6S" evidence model to retrieve computer decision support systems，guideline websites，and professional society websites，as well as Chinese and English databases，with a search timeframe from the establishment of the databases to April 22，2024. Literature that met the inclusion and exclusion criteria was selected，and two researchers independently conducted quality assessment and extracted and summarized evidence based on professional judgment. Results A total of 17 articles were included，including 4 guidelines，2 evidence summaries，and 11 systematic reviews. 22 pieces of evidence were extracted into 9 categories：oxygenation targets，contraindications，initiation timing，assessment，monitoring，discontinuation timing，precautions，quality control，and bene-fits of conservative oxygen therapy. Conclusion This study summarizes the best evidence for conservative oxygen therapy nursing in adult critically ill patients，which is instructive for medical staff to formulate reasonable oxygen therapy plans，standardize clinical oxygen therapy nursing，and ensure patient oxygen safety. When applying the evidence，it is still necessary to comprehensively judge based on the patients’ specific condition.

Objective Based on the three-dimensional quality structure model，a scoping review of the names，contents，and frequencies of ICU nursing quality evaluation indicators at home and abroad were conducted to provide reference for the construction of evaluation indicators of ICU nursing quality which is suitable for Chinese environment. Methods Based on the research framework proposed by Arksey and O`Malley，we searched PubMed，Embase，Web of science，Cochrane，China Knowledge Network，Wanfang database，from the establishment of the database to April 15，2024. Data selection and graphing was done by two researchers，using qualitative content analysis methods to qualitatively summarize the extracted contents. Results 18 articles were finally included. Most of the included studies used the Donabedian model（55.56%） as the theoretical framework. The basic method to form the indicators was mostly based on the literature review（72.22%），and then Delphi expert correspondence（88.89%），ultimately resulting in 3 first-level indicators，15 second-level indicators，and 115 third-level indicators，with a cumulative frequency of 784. Conclusion Evaluation indicators of ICU nursing quality have developed in the direction of evidence-based，scientific and professionalization，but there are still differences with the foreign index system，so it is necessary to further strengthen the quantity and quality of structural quality inputs，focusing on basic nursing care and nursing operations in process quality，while emphasizing the “patient-centered” outcome quality. In the future，we need to build a new type of high-quality，operable，and localized evaluation indicators for ICU nursing quality.

Return to work is an important indicator that patients have recovered and successfully integrated into society. Failure to return to work promptly will cause serious adverse effects on physical and mental recovery and social function of patients after aortic dissection. This paper reviews the influencing factors and interventions for postoperative patients with aortic dissection to return to work，aiming to provide references for clinical staff to formulate and implement scientific vocational rehabilitation programs to facilitate the patients to return to work and rebuild their social roles as soon as possible.