Objective: This study investigates alarm fatigue among ICU nurses in China and its influencing factors to optimize alarm management. Methods: This study was conducted using a cross-sectional design. In May 2022, electronic questionnaires were distributed to ICU nurses in Beijing tertiary hospitals, using the Chinese version of the alarm fatigue scale and equipment alarm records. Data were analyzed using SPSS 26. Results: Results showed an average alarm fatigue score of 20.70 ± 6.54 (out of 52), indicating a moderate-to-low level. Nurses’ self-assessed health, work attitude, alarm accuracy, and frequency of simultaneous alarms significantly influenced fatigue levels (p < 0.05). Principal component analysis identified five factors, with work intensity, mental health, false alarm rate, and job responsibility being significant predictors (95% CI excluded zero). Alarm records revealed an average of 621 daily alarms in ICUs, 93.93% from monitors, with a false alarm rate of 56.36%, and only 43.64% being valid. Conclusions: This study highlights the multi-factorial nature of alarm fatigue and the need to improve alarm systems and nurse support.

ABSTRACT Aims To analyse the performance of the simulation‐based hemofiltration knowledge and skills competition and provide a reference for continuously improving clinical nursing skills to reform the teaching methods. Methods Based on the guidelines, combined with the clinical practical problems and nursing quality control records of the department, the simulation‐based hemofiltration knowledge and skills competition was created. The competition consists of two parts: a theoretical knowledge part and a skills part, each accounting for 50% of the total score. The final score is the sum of the scores from both parts. The theoretical knowledge part includes required questions, quick answer questions, and challenge questions, with a base score of 100 points. The skills part evaluates the performance in the whole operation process of continuous venovenous hemofiltration (CVVH) from pre‐flushing to the end of the treatment, with a full score of 100 points. Structured scoring criteria were used to analyse the main points deducted in nurses' theoretical and practical parts. Results A total of 15 nurses participated in the competition and were divided into five teams with 3 nurses in each team. Each group's theoretical competition part (including the basic score of 100 points) has a minimum score of 130 points and a maximum score of 210 points. The pre‐flushing and installation time of the skills competition part is 25.60 ± 2.51 min, which is significantly improved from 35.00 ± 1.58 min before the competition (p < 0.01). The main points lost in the theoretical competition part, were pathophysiological knowledge of anticoagulation, characteristics of different hemofiltration modes, acid–base imbalance in regional citrate anticoagulation in CRRT, handling of special alarms and complications associated with repeated catheterization. The main points lost in the skills competition part were touching or interfering with the weighing scales during the startup self‐test, incomplete preparation of reinfusion materials, and timeout. Conclusion The simulation‐based hemofiltration knowledge and skills competition improves the hemofiltration skills of ICU nurses and provides the data for analyses of the relevant shortcomings from the competition results and points lost, which may promote the reform of teaching methods, thus providing a reference for the department to continuously improve specialised nursing knowledge and skills in the future and promote the continuous improvement of nursing quality. Patient or Public Contribution No Patient or Public Contribution.

Objective To verify the accuracy of a Non-Contact Sleep Monitoring Mattress(NCSMM)based on body movement during sleep in assessing sleep quality of patients before neurosurgery in order to provide a more portable and efficient assessment tool for clinical staff.Methods A single-arm trial was conducted on 114 inpatients admitted in our department selected with convenience sampling.Sleep quality data of 1 night were collected through 5 sleep quality assessment tools,including NCSMM,polysomnography(PSG),Patient-Reported Outcome Measurement Information System(PROMIS)Sleep Disturbance scale,Richards-Campbell Sleep Scale(RCSQ),and a wearable device(smart watch for body movements and sleep quality monitoring).The sleep efficiency(≤85%)obtained by PSG was used as the diagnostic standard for sleep disorders.The area under the receiver operating characteristic curve(AUC),sensitivity,specificity,positive predictive value,negative predictive value,and Youden index were calculated for the other 4 tools to evaluate and compare their diagnostic effectiveness.Results The AUC value for NCSMM,PROMIS,RCSQ and smart watch was 0.788(95%CI:0.687～0.888,P<0.001),0.664(95%CI:0.543～0.784,P=0.02),0.723(95%CI:0.600～0.846,P=0.001)and 0.750(95%CI:0.654～0.846,P<0.001),respectively.The diagnostic accuracy rate was 0.774,0.559,0.742 and 0.602,with corresponding Youden index value of 0.488,0.321,0.456,and 0.459.NCSMM demonstrated the best AUC value,sensitivity and Youden index when compared with the other 3 tools.Conclusion NCSMM shows high accuracy in assessing sleep quality in pre-neurosurgery inpatients,and it is a viable portable and efficient assessment tool in clinical practice.

Atherosclerosis (AS) is a chronic vascular disease associated with lipid accumulation. Understanding the molecular mechanisms of AS is essential. Ubiquitin-specific protease 7 (USP7) is a deubiquitination enzyme involved in various cellular processes, including lipid metabolism. In this study, we aimed to elucidate the role of USP7 in AS progression and its underlying mechanism using ApoE-deficient mice. We found that USP7 ablation improved the morphological characteristics of AS in these mice. USP7 knockdown reduced inflammation, evidenced by decreases in inflammatory markers IL-6, TNF-α, and IL-1β by 35, 40, and 38%, respectively (p < 0.01). Additionally, USP7 depletion reduced oxidative stress, indicated by a 30% reduction in malondialdehyde levels and increases in superoxide dismutase and glutathione peroxidase levels by 25 and 28%, respectively (p < 0.01). Moreover, USP7 knockdown blocked lipid accumulation in aortic tissue cells. Mechanistically, USP7 knockdown inhibited enhancer of Zeste Homolog 2 (EZH2) expression, thereby suppressing AS progression. In conclusion, USP7 depletion alleviated AS progression in ApoE-deficient mice by targeting EZH2 expression. USP7 may serve as a therapeutic target for AS.

Abstract Objective To verify whether the bleeding risk assessment guidelines from the 9th American College of Chest Physicians (ACCP) are prognostic for respiratory intensive care unit (RICU) patients and to explore risk factors for hemorrhages, we conducted a secondary data analysis based on our previously published cohort study of venous thromboembolism. Patients and methods We performed a secondary data analysis on the single-center prospective cohort from our previous study. Patients admitted to the RICU at Beijing Chao-Yang Hospital from August 1, 2014 to December 31, 2020 were included and followed up until discharge. Results The study enrolled 931 patients, of which 715 (76.8%) were at high risk of bleeding, while the remaining were at low risk. Of the total, 9.2% (86/931) suffered major bleeding, and no significant difference was found between the two risk groups (p = 0.601). High-risk patients had poor outcomes, including higher mortality and longer stays. Independent risk factors for major bleeding were APACHE II score ≥ 15; invasive pulmonary aspergillosis; therapeutic dose of anticoagulants; extracorporeal membrane oxygenation; and continuous renal replacement therapy. Blood transfusion not related to bleeding appeared to be an independent protective factor for major bleeding (OR 0.099, 95% CI 0.045–0.218, p < 0.001). Conclusion Bleeding risk assessment models from the 9th ACCP guidelines may not be suitable for patients in RICU. Building a bleeding risk assessment model that is suitable for patients in all RICUs remains a challenge. Trial registration ClinicalTrials.gov: NCT02213978.

IntroductionSystematic evaluation of long-term outcomes in survivors of H1N1 is still lacking. This study aimed to characterize long-term outcomes of severe H1N1-induced pneumonia and acute respiratory distress syndrome (ARDS).MethodThis was a single-center, prospective, cohort study. Survivors were followed up for four times after discharge from intensive care unit (ICU) by lung high-resolution computed tomography (HRCT), pulmonary function assessment, 6-minute walk test (6MWT), and SF-36 instrument.ResultA total of 60 survivors of H1N1-induced pneumonia and ARDS were followed up for four times. The carbon monoxide at single breath (DLCO) of predicted values and the 6MWT results didn’t continue improving after 3 months. Health-related quality of life didn’t change during the 12 months after ICU discharge. Reticulation or interlobular septal thickening on HRCT did not begin to improve significantly until the 12-month follow-up. The DLCO of predicted values showed negative correlation with the severity degree of primary disease and reticulation or interlobular septal thickening, and a positive correlation with physical functioning. The DLCO of predicted values and reticulation or interlobular septal thickening both correlated with the highest tidal volume during mechanical ventilation. Levels of fibrogenic cytokines had a positive correlation with reticulation or interlobular septal thickening.ConclusionThe improvements in pulmonary function and exercise capacity, imaging, and health-related quality of life had different time phase and impact on each other during 12 months of follow-up. Long-term outcomes of pulmonary fibrosis might be related to the lung injury and excessive lung fibroproliferation at the early stage during ICU admission.

Rationale, Aims and Objectives: Early exercise has been extensively reported as safe and beneficial for critically ill patients. However, it is not widely implemented as frequently as expected in intensive care units (ICUs). Little is known regarding nurses’ current practice status and their intention toward early exercise. This paper aimed to investigate intensive care unit (ICU) nurses’ current practice, limitations and intention to implement early exercise for ICU patients. Methods: A cross-sectional, multicenter survey with the e-questionnaire was conducted in the ICUs of four tertiary hospitals in Beijing, China. Results: A majority of the participants had experience with early exercise for critically ill patients during the last 3 months. Among 156 nurses who had early exercise experience, 49.3% performed early exercise less than once per week, only 29.5% of them spent >20 min on early exercise per patient, the main form of early exercise was in-bed exercise, with 55.8% performing out-of-bed exercise. Only 24.2% of participants reported having an early exercise guideline to follow in their work. The forms and frequencies of early exercise in different ICUs varied greatly, the emergency ICU was the least ideal, while the respiratory and surgical ICUs were better. Most participants showed positive intention to implement early exercise, and their intentions were significantly correlated with their education level (bachelor degree or above), support from their department, fewer perceived barriers, and working department. Conclusion: Although two-thirds of participants had experience with early exercise for critically ill patients, the implementation details of the early exercise were not ideal, including inadequate frequency and time etc. ICU managers should work to develop guidelines or regulations for early exercise, conduct training programs, overcome the limitations and provide adequate support for nurses to improve early exercise practices.

Sensitivity analysis: We will consider running sensitivity analysis to identify the robustness and stability of merged results by excluding studies with high risk of bias.

Abstract Background Critically ill patients in intensive care units (ICUs) are at high risk of venous thromboembolism (VTE). This study aimed to explore the prophylaxis effect under a guideline-based thromboprophylaxis protocol among critically ill patients in a respiratory ICU. Methods For this single-center prospective cohort study, we followed the thromboprophylaxis protocol, which was drawn up based on relevant guidelines and Chinese experts’ advice. Clinical data were entered into an electronic case report form and analyzed. Multivariate logistic regression was conducted to explore independent risk factors of VTE event under this protocol. Results From August 1, 2014, to December 31, 2020, 884 patients underwent thromboprophylaxis according to this protocol; 10.5% of them received mechanical prophylaxis, 43.8% received pharmacological prophylaxis, and 45.7% received pharmacological combined with mechanical prophylaxis. The proportion of VTE events was 14.3% for patients who received the thromboprophylaxis protocol, of which 0.1% had pulmonary thromboembolism (PTE), 2.0% had proximal deep vein thrombosis (DVT), and 12.1% had isolated distal DVT. There was no significant difference between different thromboprophylaxis measures. Cirrhosis (OR 5.789, 95% CI [1.402, 23.894], P = 0.015), acute asthma exacerbation (OR 39.999, 95% CI [4.704, 340.083], P = 0.001), and extracorporeal membrane oxygenation treatment (OR 22.237, 95%CI [4.824, 102.502], P < 0.001) were independent risk factors for proximal DVT under thromboprophylaxis. Conclusions The thromboprophylaxis protocol based on guidelines applied in the ICU was practicable and could help decrease the proportion of PTE and proximal DVT events. The risk factors of VTE events happening under the thromboprophylaxis protocol require more attention. Trial registration ClinicalTrials.gov: NCT02213978.

Objective:This study aimed to investigate the training experiences and needs of intensive care unit (ICU) general nurses against a background of regular Coronavirus disease (COVID-19) prevention and control.Methods:Using the phenomenological method of qualitative research, semi-structured interviews were conducted with 10 ICU nurses. The interview data were analyzed, sorted, summarized, and refined using the content analysis method.Results:The following five themes were extracted from the interviews, based on the training experiences of the nurses: 1) broadening their thinking; 2) discovering their personal shortcomings; 3) gaining self-confidence; 4) calmly facing frontline work; 5) experiencing high assessment pressure. The training needs of the nurses could be summarized into the following four themes: 1) increased training time; 2) improving the assessment mechanism; 3) establishing a normal rotating-shift training system; 4) balancing the teaching levels.Conclusion:Against a background of regular epidemic prevention and control, ICU training for general nurses is of high practical significance and value. Thus, active exploration and research should be conducted to establish perfect training and assessment mechanisms for these nurses. Additionally, training methods that are suitable for clinical needs should be formulated and training systematization and standardization must be promoted.

BACKGROUND:It has been recommended that critically ill patients start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low in the intensive care unit (ICU), and respiratory therapists and nurses are the primary practitioners of early mobilization in China.AIM:The aim of this study is to investigate the knowledge, attitudes, and perceived barriers of ICU nurses regarding the early mobilization of ICU patients.DESIGN:A descriptive and cross-sectional design was used.METHODS:A cross-sectional design was used, with an e-questionnaire for ICU nurses (n = 227) to assess knowledge and attitudes regarding early mobilization via the "Tencent WeChat" app on their smart phones.RESULTS:As the primary implementers of the early mobilization of ICU patients in China, more than half of ICU nurses passed the knowledge test (scored ≥20/25 points) and had positive attitudes (scored 45/55 points) regarding early mobilization. Nurses had good knowledge (more than 96.5%) of the benefits and stopping indications of early mobilization; however, they had a poor understanding (less than 51.1%) of the population in which early mobilization is applicable and monitoring indicators during early mobilization, and 39.2% of nurses did not support routine implementation of early mobilization for patients in the ICU. The major barriers that they perceived were very heavy workload (76.8%), insufficient equipment and devices (50.2%), lack of written protocols or guidelines (50.2%), inadequate training (47.1%), potential work risks (42.3%), and limited staffing (41.4%).CONCLUSIONS:Although over half of ICU nurses exhibited relatively comprehensive knowledge of and positive attitudes to early mobilization, some misunderstandings, negativity, and barriers remain.RELEVANCE TO CLINICAL PRACTICE:Training programmes should be conducted continuously, especially focused on common misunderstandings and negative attitudes. Organizational support is required to overcome barriers to the implementation of early mobilization.

More and more researchers have recommended critically ill patients to start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low for patients in the intensive care units (ICU) because of various factors. In order to promote the rehabilitation of critically ill patients, a multidisciplinary research team, including academic researchers, ICU head nurses, respiratory therapists, and a software engineer, has developed a virtual reality system for early mobilization in ICU. This system has four main features-the diverse forms of mobilization based on muscle strength, the integration of exercise and cognitive training, the visualization of the mobilization process and the record of the trajectory during mobilization exercises. This paper presents and discusses the development process of this system.

Background: More and more researchers have recommended critically ill patients to start mobilization as early as possible. However, the implementation of ICU early mobilization is not ideal, mainly due to insufficient staff and rehabilitation equipment in ICU, and the lack of exercise intention of patients. Our multidisciplinary research team including academic researcher, ICU head nurses and respiratory therapists and this team have developed a virtual reality system for ICU early mobilization (VREM system) to increase patients’ compliance of early mobilization. This study aimed to evaluate ICU nurses and patients9 acceptance of VREM system. Methods: A cross-sectional survey was conducted in RICU nurses (n = 36) and patients (n = 55). The questionnaire was designed by our research team based on Technology Acceptance Model, consisting of seven dimensions: perceived usefulness, perceived ease of use, perceived ease of learning, perceived applicability, perceived security, perceived satisfaction and intention to use. The score of each item was ranged from 1 (strongly disagree) to 5 (strongly agree). After ICU nurses and patients fully used VREM system at least once, they filled out the acceptance questionnaire. Results: As shown in Figure 1, RICU nurses showed high acceptance of VREM system, the average score for each dimension is higher than 4 points. RICU patients showed also high acceptance of this system and the lowest average score was 3.7. Among the seven dimensions, perceived usefulness was the highest rated domain for nurses and patients9 acceptance. Conclusions: The nurses and patients had good acceptance with VREM system. It also needs to further promote the function of VREM system based on nurses and patients’ suggestion.

阐述社区护士在分级诊疗中参与慢性非传染性疾病（慢性病）管理的优势和劣势以及机遇和挑战，并运用SWOT[strength（优势）、weakness（劣势）、opportunity（机遇）和threat（挑战）]分析法提出了SO战略组合、ST战略组合、WO战略组合、WT战略组合等对策，为社区护士在分级诊疗中有效参与慢性病管理工作提供参考。

Objective: This study aims to identify morphological changes in the lung parenchyma Of acute respiratory distress syndrome (ARDS) survivors after extracorporeal-Membrane oxygenation (ECMO) by high-resolution computed tomography (HRCT) follow-up. Factors influencing these changes are also examined.Methods: Information and lung HRCT scans were collected and studied 1, 3, 6, and 12 months after the Withdrawal of severe ARDS survivors rescued-by ECMO in the Respiratory Care Unit of Beijing Chaoyang Hospital from November 2009 to August 2012. the observation endpoint was set as the time when the lung lesions were basically absorbed or 12 month-a after withdrawal.Results Among nine survivors, one survivor was lost to follow-up. The lesions of two patients which were attributed to bacterial pneumonia and pneumocystis pneumonia, were basically absorbed 1 month after surgery Six patients completed the 12 Month follow-up. Although initial morphological changed varied, different degrees of absorption improvement were Observed in later stages of treatment. Lung HRCT. analysis on the sixth-month indicated that the degree of involvement of the ventral region was greater than that of the dorsal-area. No significant difference was observed in patients in terms of ECMO support time, pre-ECMO Murray score, and APACHE II score, among others.Conclusion: Lung HRCT of severe ARDS survivors after ECMO treatment showed various degrees of morphological changes the lung parenchyma. The severity-of these changes maybe associated with-the-disease duration.

CONTEXT:Paraquat is a widely used herbicide that can cause severe to fatal poisoning in humans. The irreversible and rapid progression of pulmonary fibrosis associated with respiratory failure is the main cause of death in the later stages of poisoning. There are infrequent reports of successful lung transplants for cases of severe paraquat poisoning. We expect that this successful case will provide a reference for other patients in similar circumstances.CASE DETAILS:A 24-year-old female was sent to the hospital approximately 2 hours after ingesting 50 ml of paraquat. She experienced rapidly aggravated pulmonary fibrosis and severe respiratory failure. On the 34th day after ingestion, she underwent intubation and invasive mechanical ventilation. The patient was evaluated for lung transplantation, and veno-venous extracorporeal membrane oxygenation (ECMO) was established as a bridge to lung transplantation on the 44th day. On the 56th day, she successfully underwent a bilateral sequential lung transplantation. Through respiratory and physical rehabilitation and nutrition support, the patient was weaned from mechanical ventilation and extubated on the 66th day. On the 80th day, she was discharged. During the 1-year follow-up, the patient was found to be in good condition, and her pulmonary function improved gradually.CONCLUSION:We suggest that lung transplantation may be an effective treatment in the end stages of paraquat-induced pulmonary fibrosis and consequential respiratory failure. For patients experiencing a rapid progression to a critical condition in whom lung transplantation cannot be performed immediately (e.g., while awaiting a viable donor or toxicant clearance), ECMO should be a viable bridge to lung transplantation.

This is a sporadic H7N9 avian influenza case that was the first severe imported case in Beijing and the first case of Hebei province in China. A 61-year-old female who had rapidly progressive pneumonia with respiratory distress and bilateral exduation and consolidation changes on chest X-ray and computerized tomography (CT) scan that did not respond to ordinary antibiotics was diagnosed with influenza A (H7N9) infection in our hospital on July 19, 2013. Intravenous peramivir, veno-venous extracorporeal membrane oxygenation (VV-ECMO) and continuous veno-venous hemofiltration were given on the same day of lab diagnosis because of severe acute respiratory distress syndrome and acute renal failure. With antimicrobial therapy and other supportive treatment, clinical symptoms and oxygenation of the patient improved gradually. VV-ECMO was successfully removed on the 13th day. The testing for influenza A (H7N9) turned negative on day 16 since the antivirus therapy. Twenty-three days after hospitalization, blood stream infection with multidrug-resistant Acinetobacter Baumannii occurred, which lead to septic shock and death. Whether or not the influenza season in north China, the influenza screening should be carried out as a conventional test for the patients who are suspected of viral pneumonia. For the patients who need mechanical ventilation and ECMO support, the lung protective strategy under the guidance of transpulmonary pressure may be helpful for recovering the lung.