Objective: To summarize the best available evidence regarding diaphragmatic function training in mechanically ventilated patients and to establish a foundation for clinical practice.
Methods: Systematic searches were conducted in databases and official websites including UpToDate, the National Guideline Clearinghouse (NGC), the Registered Nurses' Association of Ontario (RNAO), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, PubMed, Web of Science, CNKI, Wanfang Data, VIP, and Yimaitong. The search period covered from the inception of each database to December 31, 2024. The types of evidence included guideline, clinical decision, expert consensus, systematic review, Meta-analysis, and randomized controlled trial (RCT). Two researchers conducted the literature search, study selection, quality assessment and evidence extraction and synthesis independently.
Results: A total of 16 articles were included, consisting of 1 guideline, 1 clinical decision, 2 expert consensuses, 4 systematic reviews, 3 Meta-analyses, and 5 RCTs. Nineteen pieces of evidence were ultimately categorized into 7 dimensions, including implementation team, intervention timing, training assessment, training methods, management of ICU-acquired weakness (ICU-AW), monitoring and safety, and outcome evaluation.
Conclusions: This summary of best evidence for diaphragmatic function training in mechanically ventilated patients is scientifically rigorous and comprehensive, offering a valuable reference for guiding clinical practice.
Objective: To search, evaluate, and summarize the best available evidence regarding enteral and parenteral nutrition support for adult patients with sepsis, in order to provide an evidence-based foundation for the nutritional management of these patients.
Methods: A systematic search was conducted in the following databases and resources for clinical guidelines, clinical decisions, evidence summaries, expert consensus statements, systematic reviews, randomized controlled trials (RCTs), and quasi-experimental studies related to enteral and parenteral nutrition in adult septic patients: the Cochrane Library, UpToDate, the JBI Evidence-Based Healthcare Center Database, BMJ Best Practice, official websites of professional societies including the American College of Critical Care Medicine, the American Society for Parenteral and Enteral Nutrition (ASPEN), the European Society of Intensive Care Medicine, the European Society for Parenteral and Enteral Nutrition (ESPEN), the Chinese Society of Critical Care Medicine, and the Chinese Society for Parenteral and Enteral Nutrition, ScienceDirect, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Chinese Medical Journal Full-text Database, Chinese Biomedical Literature Service System, Wanfang Data, China National Knowledge Infrastructure, the VIP Chinese Science and Technology Core Journal Database, Guidelines International Network, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, and Registered Nurses' Association of Ontario, and Medlive Guide. The search timeframe was from January 1, 2014, to June 30, 2024. Two researchers with evidence-based research backgrounds independently conducted the literature quality appraisal. Evidence was extracted and summarized from the included literature, incorporating expert opinion.
Results: After rigorous screening, 25 high-quality publications were included, comprising 5 clinical guidelines, 1 clinical decision, 2 evidence summaries, 5 expert consensus statements, 5 systematic reviews, 6 RCTs, and 1 quasi-experimental study. Focusing on key aspects of nutritional management (encompassing 7 major themes: nutritional screening and assessment, mode of nutritional support, timing of initiating nutritional support, energy and protein requirements, nutritional components, monitoring tolerance to nutritional support therapy, and complication prevention and management), 33 core recommendations were ultimately formulated and refined.
Conclusions: This study provides evidence-based recommendations for the enteral and parenteral nutrition management in adult patients with sepsis, aiming to enhance the effectiveness of nutritional support and improve patient clinical outcomes.
ICU-acquired weakness (ICU-AW), as a common complication in the intensive care unit (ICU), has received increasing attention from clinicians due to its potential to cause severe functional impairments in survivors. Early research primarily focused on the definition, diagnosis, pathophysiology, and risk factors of ICU-AW, while systematic studies on stepwise interventions aligned with disease progression remain scarce. Current guidelines merely advocate for early mobilization, without specifying the timing or content of interventions. This paper reviews relevant domestic and international studies to summarize the time-window-based pathogenesis and intervention measures of ICU-AW, aiming to identify time-window-based prevention and control strategies for ICU-AW and optimize the implementation pathway based on the characteristics of ICU resource allocation in China.
Severe frostbite, due to its complex pathological mechanism and high risk of amputation, not only has a profound impact on the physiological functions and mental health of patients, but also poses severe challenges to clinical diagnosis, treatment and nursing. The American Burn Association clinical practice guidelines on the treatment of severe frostbite were released in April 2023. The guideline, based on the PICO principle (i.e. population, intervention, comparison, outcomes of clinics) and existing evidence, provides evidence-based recommendations for the treatment of severe frostbite in adult patients. These recommendations cover four themes, including rapid rewarming, imaging examination, thrombolytic therapy and the use of lloprost. To draw lessons from and promote the application of this guideline, this article focuses on its interpretation, aiming to provide reference and assistance for domestic medical staff to understand and apply this guideline.
Tracheal intubation is a key technology for establishing an artificial airway during the resuscitation of critically ill patients. Its success directly impacts patient life safety and prognosis. Identification of difficult airway and improper selection of laryngoscope blades are important factors leading to intubation failure and complications. To optimize this process, medical staff at Guangdong Provincial Hospital of Chinese Medicine have designed an auxiliary tool for airway assessment and laryngoscope blade selection, and have obtained a National Utility Model Patent of China (patent number: ZL 2021 2 1187307.9). The device is mainly composed of two right-angled handles and a ruler. The width of the handle is based on the "3-3-2" airway assessment rule (LEMON rule), corresponding to the patient's three-finger and two-finger widths, respectively, and is used to measure mouth opening (three-finger handle), chin-hyoid distance (three-finger handle), hyoid-thyroid notch distance (two-finger handle) to preliminarily identify difficult airways. The ruler is used to accurately measure the distance from the earlobe to the corner of the mouth, providing an objective basis for selecting the appropriate laryngoscope blade length. This tool is designed to be simple and is intended to shorten intubation time and indirectly improve first-time intubation success rate. To verify the clinical application effect of the auxiliary tool for airway assessment and laryngoscope blade selection, 80 patients who required emergency endotracheal intubation admitted to the department of emergency and intensive care unit of Guangdong Provincial Hospital of Chinese Medicine from January to December 2023 were enrolled, and the tool was used for pre-intubation assessment (observation group); and 80 patients who received routine emergency tracheal intubation in 2022 were used as the control (control group). The results showed that 6 cases (7.5%) in observation group had difficulty in identifying difficult airways before intubation using the tool, and all were successfully intubated using fiberoptic bronchoscopes. The success rate of one-time intubation for the remaining 74 patients was 98.6% (73/74). The success rate of one-time intubation in the observation group was significantly higher than that in the control group [91.3% (73/80) vs. 73.8% (59/80), χ2 = 8.485, P = 0.004]. Although the incidence of complications such as tooth loss and oral bleeding in the observation group was lower than that in the control group, the differences were not statistically significant (tooth loss: 2.5% vs. 5.0%, χ 2 = 0.692, P = 0.405; oral bleeding: 6.3% vs. 15.0%, χ 2 = 3.224, P = 0.073). The results showed that the auxiliary tool can effectively identify difficult airways, guide the accurate selection of laryngoscope blades, and significantly improve the one-time endotracheal intubation success rate of critically ill patients.
Mechanical ventilation is an essential life-support therapy for critically ill patients. During ventilation, condensate water forms as a result of heating and humidification, posing risks such as ventilator-associated pneumonia (VAP), increased airway resistance, and even asphyxia. Clinicians often use inflated rubber or PVC gloves to secure the front end of the ventilator circuit. However, these methods are prone to loose tubing, instability, and water accumulation due to the tubing's low positioning. To address these issues, medical staff at the intensive care unit of the Affiliated Hospital of Hangzhou Normal University designed an inflatable ventilator tube fixation device, which has been granted a National Utility Model Patent of China (patent number: ZL 2022 2 1004655.2). The device comprises a support frame, mounting base, linkage structure, placement trough frame, and supporting balloon. The mounting base at the bottom of the support frame can be attached to a bed rail or guardrail, depending on patient needs. The support frame's height is adjustable via a sleeve and insertion rod, while the upper end connects to the linkage structure, allowing multi-angle adjustment and folding through the interlocking of slots and rods. The placement trough frame, welded from curved and circular rods, features a fixed cylinder at its central concavity that connects rotationally to a ring at the end of the linkage structure. The trough frame holds the supporting balloon, which is maintained in an inflated state with a draw rope and tensioner. The ring-shaped arc block and curved groove on the balloon's surface support and elevate the ventilator circuit, stabilizing the tubing and directing condensate toward a lower drainage position. This design is practical and user-friendly, ensuring secure fixation of the ventilator circuit during use. By maintaining elevation and preventing condensate accumulation and reflux, it effectively reduces ventilation-related complications, enhances medical safety, and lessens the workload of healthcare personnel, demonstrating strong potential for clinical adoption.
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