Table of Content

10 December 2024, Volume 5 Issue 12 Previous Issue    Next Issue

Research Paper

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The development of a risk prediction model for stress hyperglycemia in patients with acute exacerbation of chronic obstructive pulmonary disease XIE Yun, LUO Li, WANG Haiyan 2024, 5 (12):  1061-1067.  doi: 10.3761/j.issn.2096-7446.2024.12.001 Abstract ( )   PDF (1178KB) ( )   Save Objective To explore the influencing factors of stress hyperglycemia in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）,and to construct a risk prediction nomogram model. Methods A retrospective study was conducted among 444 AECOPD patients in the emergency intensive care of a tertiary class A hospital in Urumqi from March 2021 to March 2023,and the independent risk factors of stress hyperglycemia in AECOPD patients were explored through univariate analysis and Logistic regression analysis. A risk prediction model was established and incorporated into the nomogram. The prediction performance of the model was tested using the receiver operating characteristic curve（ROC）,and the Hosmer-Lemeshow test was used to determine the goodness of fit of the model. Results The incidence of stress hyperglycemia in AECOPD patients was 24.5%. Logistic regression analysis showed that age,smoking,history of cerebrovascular disease,mechanical ventilation,Acute Physiology and Chronic Health EvaluationⅡ score at admission,coefficient of variation of blood glucose and C-reactive protein were independent influencing factors for stress hyperglycemia in AECOPD patients（P<0.05）. The individual nomogram prediction model was established based on Logistic regression. The area under the receiver operating characteristic curve was 0.823（95%CI：0.780~0.865）,the Hosmer-Lemeshow test P=0.354,the best cutoff value was 0.514,the sensitivity was 0.872,and the specificity was 0.642. The Bootstrap method was used for internal validation,and the C-index was 0.817,indicating that the model had a good prediction effect. Conclusion The prediction model constructed in this study has a good prediction effect,which can provide a reference for effectively evaluating the risk of stress hyperglycemia in patients with AECOPD. References | Related Articles | Metrics

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A qualitative study on experience of family members of critically ill patients participating in ECMO treatment decision-making YANG Xiangying, TANG Amao, LIN Yao, DAI Weiying, ZHANG Qian, ZENG Xiaokang, NING Li 2024, 5 (12):  1068-1073.  doi: 10.3761/j.issn.2096-7446.2024.12.002 Abstract ( )   PDF (1042KB) ( )   Save Objective To understand the experience of family members of critically ill patients participating in ECMO treatment decision making and related factors that may affect the efficiency of decision making. Methods Descriptive qualitative research method was used to conduct semi-structured interviews with 19 family members of critically ill patients who met the inclusion criteria in the ICU of a tertiary Grade A hospital in Zhejiang Province from November 2021 to June 2022. Content analysis method was used to analyze the interview data. Results 5 themes and 10 subthemes emerged：① tough choices：the dilemma in the emergency situation,the guilt and remorse after giving up;②rationalization of decision-making：ethics and morality guide decision-making,expected outcome influences decision making,and previous decision making experience promotes decision making;③decision-making methods：independent decision-making,group decision-making,decision making based on patient preferences;④ influencing factors of decision making：information and communication,social support. Conclusion It is a very difficult process for family members of critically ill patients to participate in ECMO treatment decision-making. Medical staff should pay attention to the psychological changes of family members in decision-making process,provide timely emotional support,information support and multi-directional social support,and assist them in efficient decision-making on the premise of respecting the treatment wishes of decision-makers. References | Related Articles | Metrics

Special Planning—Neonatal Nursing Care

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Construction and application of standardized operation scheme of oral feeding for neonates with Pierre Robin syndrome ZHOU Lianjuan, YUAN Tianming, ZHU Haihong, YE Fang, WU Liyuan, SHEN Qingqing, WANG Ling, SHEN Yafang, ZHU Jihua 2024, 5 (12):  1074-1080.  doi: 10.3761/j.issn.2096-7446.2024.12.003 Abstract ( )   PDF (1277KB) ( )   Save Objective To establish a standardized operation scheme of oral feeding for neonates with Pierre Robin syndrome and to explore its application effects. Methods Based on the best evidence and expert group discussion,the oral feeding operation scheme of Pierre Robin syndrome was established.From April to June 2023,15 experts from 8 regions,including Beijing,Shanghai and Hangzhou,were invited to conduct 2 rounds of Delphi expert consultation to modify the operation scheme and clarify the final scheme. A total of 21 neonates with Pierre Robin syndrome admitted from September to December 2023 in four tertiary hospitals in Hangzhou City and Changsha City were selected as the experimental group,and 25 neonates with Pierre Robin syndrome admitted from May to August 2023 were selected as the control group. On the basis of routine nursing,the experimental group was given the standardized operation scheme of oral feeding,and the control group was given the routine nursing. The differences of transition time,feeding efficiency,feeding effectiveness,milk intake ratio,length of hospital stay and incidence of adverse events were compared between the two groups. Results The effective recovery rates were 93.75% and 100%,respectively. The expert authority coefficient of the two rounds was 0.91. After the second round of expert correspondence,the coefficient of variation of importance and operability of each item was 0~0.185 and 0~0.241,and the Kendall harmony coefficient was 0.168 and 0.205,respectively（P<0.05）. The standardized operation scheme of oral feeding for neonates with Pierre Robin syndrome included 4 first-level items,13 second-level items and 22 third-level items. In the application process of this protocol,46 children were finally included,including 21 in the experimental group and 25 in the control group. The differences between the two groups were statistically significant in terms of feeding transition time,feeding efficiency,feeding effectiveness,ratio of milk intake,length of hospital stay and incidence of adverse events（P<0.05）. Conclusion The process of constructing the standardized operation scheme of oral feeding for newborns with Pierre Robin syndrome is scientific,practical and has obvious specialty features,which can promote the standardized development of feeding technology for newborns with Pierre Robin syndrome. References | Related Articles | Metrics

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Development and psychometric tests of the Palliative Care Quality Assessment Scale in the neonatal intensive care setting WANG Caoyuan, REN Yimei, CHEN Fangyuan 2024, 5 (12):  1081-1087.  doi: 10.3761/j.issn.2096-7446.2024.12.004 Abstract ( )   PDF (1116KB) ( )   Save Objective To develop the Neonatal Intensive Care Unit-Palliative Care Quality Assessment Scale（NICU-PCQAS） and evaluate its reliability and validity,with the aim of providing an appropriate tool for assessing the quality of palliative care in NICU infants. Methods Guided by the conceptual model of a good death in the NICU,and referring to the Adult Quality of Dying and Death Questionnaire,the initial item pool was constructed through literature review and semi-structured interviews. The draft of the NICU-PCQAS was developed using a Delphi methodology and pre-investigation. Convenient sampling was used to investigate and evaluate the quality of palliative care of 344 neonates in 3 general hospitals,9 maternal and child health hospitals,and 6 children‘s hospitals in Jiangsu Province,Zhejiang Province,and Sichuan Province from July 2021 to July 2023. The data were then analyzed for item analysis,testing of reliability and validity. Results A 5-domain,20-item NICU-PCQAS was developed. Exploratory factor analysis identified five factors accounting for 76.35% of the variance. Confirmatory factor analysis showed a good fit（χ2/df=1.25,RMR=0.03,IFI=0.99,CFI=0.99,RMSEA=0.03）. The I-CVI ranged from 0.78 to 1.00,and the S-CVI was 0.97. The Cronbach‘s α was 0.92,and the Spearman-Brown coefficient was 0.75. Domain-specific Cronbach‘s α ranged from 0.86 to 0.93,and Spearman-Brown coefficients ranged from 0.87 to 0.92. Conclusion The NICU-PCQAS is reliable and valid,suitable for assessing the quality of palliative care in NICU infants,and supports the development of palliative care in NICUs. References | Related Articles | Metrics

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Nursing care of an extremely low birth weight preterm infant with bronchopulmonary dysplasia undergoing transoral blind jejunal tube placement CHEN Jinxiu, CHENG Yuchao, WANG Shan, LI Changyan, YU Genzhen, YI Junli 2024, 5 (12):  1088-1090.  doi: 10.3761/j.issn.2096-7446.2024.12.005 Abstract ( )   PDF (589KB) ( )   Save To summarize the nursing experience of an extremely low birth weight preterm infant combined with bronchopulmonary dysplasia who suffered from repeated cardiac arrest due to gastroesophageal reflux and received transoral blind placement of jejunal tube to maintain enteral nutrition. Nursing points included prevention of aspiration risk and refined airway management,nursing during blind jejunal tube placement,proper fixation of the catheter and strengthening observation and treatment,improving the feeding and maintenance methods to ensure the smoothness of the catheter. After careful perioperative care of jejunal tube placement,the child‘s vital signs gradually stabilized,and gradually changed to oral feeding,with good weight gain and no adverse reactions,and he was discharged after 131 d of hospitalization. References | Related Articles | Metrics

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Design and application of biomimetic ectopic development position assistance management package for premature infants SHANG Zhenru, LUO Feixiang, SHEN Fei, ZHU Haihong, ZHU Jihua, LING Yun 2024, 5 (12):  1091-1095.  doi: 10.3761/j.issn.2096-7446.2024.12.006 Abstract ( )   PDF (1054KB) ( )   Save Objective To design a biomimetic ectopic development position assistance management package and evaluate its application. Methods The biomimetic ectopic development position assistance management package consists of three parts：2-in-1 warm and anti-jumping blanket,wrapped bottom cushion,and supportive and fixed belt. Using the method of quasi-experimental study,94 preterm infants admitted to a Grade 3 A children‘s hospital in Hangzhou from July 2022 to May 2023 were selected as the study objects. Forty-seven preterm infants admitted from July to November 2022 were included in the control group,and 47 preterm infants admitted from January to May 2023 were included in the experimental group. The experimental group used the biomimetic ectopic development position assistance management package for positional support;the control group used the traditional "bird‘s nest" for positional care. The length of 24-hour physiological flexion and poor posture in different positions,the effectiveness and comfort of position maintenance,the number of startle reflexes,the length of sleep,and the growth and development of preterm infants at 4 weeks after birth were compared between the two groups. Results In the experimental group,the length of physiological flexion was significantly greater than that of the control group in the supine position and the left and right lateral positions,the length of poor posture was significantly less than that of the control group,and the effectiveness of position maintenance and comfort were significantly higher than that of the control group,and the differences were statistically significant（P<0.05）. The number of 24-h startle reflexes in the experimental group was significantly less than that of the control group（P<0.05）. The length of 24h sleep,and the body weight gain of the experimental group in the second to the fourth week were significantly higher than those of the control group（P<0.05）. Conclusion The biomimetic ectopic development position assistance management package helps preterm infants maintain physiologic flexion,improve comfort,which can effectively promote preterm growth and development. References | Related Articles | Metrics

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Best evidence summary for prevention of pressure injury related to noninvasive ventilation in neonates SUN Xing, LI Kehua, LIU Beibei, TIAN Yingying, XU Wei 2024, 5 (12):  1096-1103.  doi: 10.3761/j.issn.2096-7446.2024.12.007 Abstract ( )   PDF (1307KB) ( )   Save Objective To comprehensively search,evaluate and summarize the best evidences on the prevention of pressure injury related to noninvasive ventilation in neonates. Methods The clinical decisions,recommended practices,guidelines,evidence summaries,expert consensuses,and systematic evaluations on the prevention of pressure injury related to noninvasive ventilation of neonates in domestic and foreign databases and related professional websites were searched by computer. The retrieval time was from the establishment of database to July 31,2023. Results A total of 9 literature were included,including 1 clinical decision,3 guidelines,2 evidence summaries and 3 expert consensuses. A total of 21 pieces of best evidences were summarized from 6 aspects,including risk assessment,nutrition management,keeping skin clean and appropriate temperature and humidity,proper use of dressing,proper use of noninvasive ventilation equipment,multidisciplinary team and educational training. Conclusion This study summarized the best evidences for the prevention of pressure injury related to noninvasive ventilation in neonates. It is suggested that medical staff can select the best evidences according to the clinical situation and individualized differences of infants to reduce the incidence of pressure injuries related to noninvasive ventilation and improve the overall quality of nursing care and family satisfaction. References | Related Articles | Metrics

Emergency Care Research

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Analysis of related risk factors for group thunderstorm asthma in Hohhot LI Weiwei, BAI Yiping, WEN Feng, LIU Dan, GUO Yanrong 2024, 5 (12):  1103-1107.  doi: 10.3761/j.issn.2096-7446.2024.12.008 Abstract ( )   PDF (738KB) ( )   Save Objective To describe the clinical characteristics of group thunderstorm asthma and analyze the risk factors for the severity of thunderstorm asthma. Methods A total of 244 patients with thunderstorm asthma in Inner Mongolia Autonomous Region on September 2,2023 were investigated to describe the clinical characteristics and treatment methods of thunderstorm asthma. Univariate and multivariate logistic regression were used to analyze the risk factors for the severity of thunderstorm asthma. Results The number of thunderstorm asthma patients was 244,the peak period of thunderstorm asthma outbreak was within 1-4 hours after the thunderstorm. The patient's symptoms were mainly wheezing and shortness of breath. The effective treatments were inhaled short-acting β 2 receptor agonists and inhaled corticosteroids. Multivariate logistic regression analysis showed that age,allergy history,bronchial asthma and allergic rhinitis were risk factors for the severity of thunderstorm asthma. Conclusion The severity of thunderstorm asthma is related to age,history of allergy,history of bronchial asthma,and history of allergic rhinitis. Relevant preventive measures against risk factors are recommended to reduce the risk of severe asthma. References | Related Articles | Metrics

Critical Care Research

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Nursing care of a patient with acute respiratory distress syndrome undergoing extracorporeal carbon dioxide removal therapy GUO Lihua, GAO Chunhua, LIN Yan, QIAO Wenbo, ZHOU Feifei, CHU Junqing 2024, 5 (12):  1108-1110.  doi: 10.3761/j.issn.2096-7446.2024.12.009 Abstract ( )   PDF (525KB) ( )   Save To summarize the nursing care of a patient with acute respiratory distress syndrome who received extracorporeal carbon dioxide removal. Nursing points：nursing during prone position ventilation,dynamic adjustment of lung protective ventilation strategy,coordination and management of nitric oxide therapy,balancing the risk of bleeding and thrombosis,goal-oriented sedation and analgesia,and progressive early rehabilitation exercise. The patient went offline successfully on the 110th day and was transferred to a rehabilitation hospital for further treatment on the 120th day. References | Related Articles | Metrics

Quality and Safety

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Application and effectiveness of information quality management plan for the whole process of pre-hospital emergency blood transfusion WANG Min, BAO Jianli, CHENG Cong, FAN Fangzhi, ZHANG Jian 2024, 5 (12):  1111-1115.  doi: 10.3761/j.issn.2096-7446.2024.12.010 Abstract ( )   PDF (816KB) ( )   Save Objective To develop and explore the application effects of information quality management plan for the whole process of pre-hospital emergency blood transfusion. Methods A multidisciplinary research team was established,our hospital used radio frequency identification（RFID） technology,low temperature storage technology and Internet of Things technology to jointly construct an information quality management plan for the whole process of pre-hospital emergency blood transfusion,to carry out the whole process information management and traceability of the implementation process of pre-hospital emergency blood transfusion,and conduct dynamic regulation and evaluation. We selected and compared the data before the application of prehospital emergency blood transfusion whole process information quality management plan（January 2020 to December 2021） and after the application（January 2022 to December 2023）,to evaluate the effect of this plan in pre-hospital emergency blood transfusion. Results After the implementation of the information quality management plan for the whole process of pre-hospital emergency blood transfusion,the waiting time for emergency blood decreased from 53.28 minutes to 19.70 minutes（P<0.001）,the blood collection time decreased from 15.08 minutes to 8.76 minutes（P<0.001）, the average hospital stay decreased from 15.80 days to 9.68 days（P<0.001）,the rescue success rate increased from 91.5% to 99%（P<0.05）,and the incidence of complications decreased from 9.4% to 1% （P<0.05）,the rate of blood waste decreased from 39.6% to 0（P<0.001）. Conclusion The information quality management plan for the whole process of pre-hospital emergency blood transfusion can significantly shorten the time of blood use,improve the treatment efficiency,and ensure the safety of blood use in pre-hospital emergency patients. References | Related Articles | Metrics

Evidence Synthesis Research

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Summary of the best evidence for non-pharmacological anticoagulant interventions for preventing clotting of extracorporeal circuits during CRRT XIE Peipei, FU Peirong, LIU Yingying, LIN Tingyu, SHENG Zhonghua, DU Chen, ZHANG Zhirong 2024, 5 (12):  1116-1122.  doi: 10.3761/j.issn.2096-7446.2024.12.011 Abstract ( )   PDF (1041KB) ( )   Save Objective To search and obtain the best evidence for non-pharmacological anticoagulant intervention for preventing clotting of extracorporeal circuits during CRRT. Methods We searched databases （UpToDate,PubMed,Cochrane Library,CNKI,Wanfang database,etc） to collect relevant clinical evidences related to non-pharmacological anticoagulant intervention for preventing clotting of extracorporeal circuits during CRRT. The retrieval time was from the establishment of the database to July 31,2023. Two investigators independently screened the literature,evaluated the quality of the literatures,extracted and integrated the evidence. Results A total of 16 articles were included in this study,including 4 guidelines,6 systematic reviews,3 expert consensuses,and 3 expert opinions. A total of 23 best evidences were summarized from 5 aspects,including team factors,vascular access factors,machine factors,operation-related factors,and patient factors. Conclusion This study summarizes the best evidence of non-pharmacological anticoagulant intervention for preventing clotting of extracorporeal circuits during CRRT,and provides evidence-based basis for standardizing nurses‘ CRRT nursing behavior for critically ill patients,and further improves the sufficiency of CRRT for critically ill patients. References | Related Articles | Metrics

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The impact of nurse-led programmatic weaning protocol on mechanical ventilation outcomes in ICU patients：a systematic review BASANG Kangzhuo, SUN Jianhua, LUO Hongbo, LI Zunzhu, LUOSANG Danzeng, JING Jie, ZHAO Mingxi, XIE Lingli, JIANG Miao 2024, 5 (12):  1123-1129.  doi: 10.3761/j.issn.2096-7446.2024.12.012 Abstract ( )   PDF (1494KB) ( )   Save Objective To evaluate the effectiveness and safety of nurse-led programmatic weaning protocol on mechanical ventilation outcomes in Intensive Care Unit,so as to provide reference for early standardized weaning of mechanical ventilation. Methods PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure,WanFang Database,China Biomedical Literature Database,and VIP Database were retrieved. The search deadline was from database establishment to August 5,2023. Two researchers independently selected literature,extracted data,and evaluated the quality of the literature. RevMan 5.3 was used for meta-analysis. Results 9 randomized controlled trials were included. Meta-analysis showed that nurse-led programmatic ventilator weaning protocol could shorten mechanical ventilation time [MD=-37.05,95%CI（-57.93,-16.16）,P=0.005] and reduce ICU hospitalization time[MD=-5.58,95%CI（-9.91,-1.24）,P=0.010],with statistically significant differences. However,there was no statistically significant difference in patient mortality[OR=0.99,95%CI（0.70,1.42）,P=0.9]. Conclusion The nurse-led programmatic ventilator weaning protocol is safe and effective,which helps to shorten mechanical ventilation time,reduce ICU hospitalization time,and provides evidence for the nursing practice of mechanical ventilation for ICU patients. References | Related Articles | Metrics

Review

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A scoping review of ICU medical equipment alarm management strategies and effectiveness GUO Zhiting, TANG Jiaying, ZHANG Yuping, Gyumin Han, Chitchanok Benjasirisan, Atembeshu Miranda Fondem, Aline Aparecida Monroe, JIN Jingfen 2024, 5 (12):  1130-1137.  doi: 10.3761/j.issn.2096-7446.2024.12.013 Abstract ( )   PDF (1035KB) ( )   Save Objective To conduct a scoping review of ICU medical equipment alarm management strategies and their effectiveness to provide reference for optimize medical equipment alarm management. Methods Using the Arksey and O‘Malley framework,studies related to ICU alarm management were retrieved from databases including CNKI,VIP,WanFang,PubMed,Web of Science,Embase and EBSCO. The search period covered the database establishment up to June 30,2024. The included literature was screened,and the alarm management strategies were categorized. Results 30 studies were included,the intervention strategies focused on nurse-led multidisciplinary collaboration,alarm management bundle,nurse training and education,and optimization of alarm management procedures. After the intervention,the number of alarms decreased by 11.2% to 88.5%,alarms duration was shortened,nurses‘ knowledge and skills in alarm management improved,and nurse alarm fatigue outcome varied. Conclusion Effective alarm management can greatly improve ICU alarm quality. Optimizing it requires strengthening ICU nurses‘ leadership and standardizing team collaboration. The main goal remains patient safety,with consideration for reducing alarm fatigue among nurses. References | Related Articles | Metrics

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Research progress on risk factors of extubation failure and clinical application of risk prediction model in patients with severe neurological diseases WANG Haiyan, QI Xuefeng, YAO Meiqi, LAN Meijuan 2024, 5 (12):  1138-1142.  doi: 10.3761/j.issn.2096-7446.2024.12.014 Abstract ( )   PDF (770KB) ( )   Save The failure of the extubation failure means that the patient cannot maintain the autonomous breathing after leaving the ventilator,and the ventilator needs to be re-connected. Due to the particularity of the disease,patients have a greater risk of extubation failure in breathing support treatment. This article summarizes the risk factors of neurological critically ill patients‘ extubation failure,and the study of the predictive model of the extubation failure,which provides technical support for clinical medical staff for targeted prevention of risk factors and accurate prediction of extubation failure risk. References | Related Articles | Metrics

Technology Innovation

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The design of polygonal E-type elastic adhesive tape and its application in the fixation of central venous catheters HE Pei, ZHANG Bingxia, DU Juan, KAN Tianyan 2024, 5 (12):  1143-1146.  doi: 10.3761/j.issn.2096-7446.2024.12.015 Abstract ( )   PDF (683KB) ( )   Save Objective To design polygonal E-shaped elastic wide tape,and evaluate its application effects. Methods The polygonal E-shaped tape was made based on a 25 cm × 2.5 cm elastic wide tape. We selected any long edge,cut a triangular notch towards the center of the tape every 1 cm,and continued to cut from the triangle‘s vertex inward to 1 cm,to form the polygonal E-shaped tape. Convenience sampling was employed to select 280 patients who underwent central venous catheterization in the intensive care unit of a tertiary Grade A comprehensive hospital in Yinchuan city from July 2020 to July 2022 as the subjects. Using a random number table,they were divided into experimental and control groups,with 140 cases each. Both groups underwent standard catheter maintenance procedures. The experimental group was fixed with butterfly clips,edgeless transparent film and polygonal E-shaped elastic wide tape,while the control group was directly fixed with butterfly clips and edged transparent film. Catheter displacement,catheter slippage,local infections,film rolling,and catheter-related bloodstream infections were observed in the both groups. Results Catheter displacement（χ2=7.578,P=0.006）,catheter slippage（χ2=4.632,P=0.031）,local infections（χ2=6.637,P=0.010）,and film rolling（χ2=73.736,P<0.001） were all lower in the experimental group than those in the control group,with statistically significant differences（P<0.05）. There was no statistically significant difference in catheter-related bloodstream infections between the two groups（P>0.05）. Cost-effectiveness analysis showed that the fixation method in the experimental group was cost-effective with good outcomes. Conclusion The use of butterfly clips,edgeless transparent film and polygonal E-shaped elastic wide tap to fix central venous catheters can reduce catheter displacement,catheter slippage,local infection,and film rolling occurrence rates. Furthermore,its cost was lower. References | Related Articles | Metrics