ICU discharge delay was defined as the time between when a patient is determined to be discharge ready and when they leave the ICU.The review describes the status quo,influencing factors,adverse consequences and intervention strategies of ICU discharge delays,in order to improve the attention of domestic intensive care staff to the delay of ICU discharge,and to provide reference for related research.

OBJECTIVE To explore the improvement of diaphragm function after early off-bed mobility intervention in intensive care unit (ICU) patients undergoing mechanical ventilation. METHODS A randomized controlled trial was conducted. A total of 147 adult patients undergoing mechanical ventilation admitted to ICU of Affiliated Hospital of Zunyi Medical University from October 2019 to March 2022 were enrolled. The patients were divided into control group and observation group by convenient sampling. Except for the different intervention programs of early mobility, other treatment and nursing of the patients in the two groups were carried out according to ICU routine. Progressive early activities were performed in the control group, while early off-bed mobility was performed in the observation group. The changes of diaphragm thickness at the end of inspiratory (DTei), diaphragm thickness at the end of expiratory (DTee) and diaphragm thickening fraction (DTF) before and 24, 48, 72 and 96 hours of intervention, and the duration of mechanical ventilation, length of ICU stay and 24-hour re-intubation rate after intervention were compared between the two groups. RESULTS Among the 147 patients, there were 4 cases of detachment in the control group and 5 cases of detachment in the observation group. Finally, 138 patients were enrolled, 69 cases in the control group and 69 cases in the observation group. There was no significant difference in gender, age, diagnosis of ICU, sedatives, muscle strength, ventilator model, acute physiology and chronic health evaluation II (APACHE II) score and DTei, DTee, DTF before intervention between the two groups. The DTei, DTee and DTF in both groups were increased gradually with the extension of intervention time, especially in the observation group [DTei (cm) at 24, 48, 72 and 96 hours of intervention in the observation group were 0.247±0.014, 0.275±0.016, 0.300±0.013 and 0.329±0.013, while in the control group were 0.242±0.015, 0.258±0.013, 0.269±0.014, and 0.290±0.017, effect of time: F = 993.825, P = 0.000, effect of intervention: F = 82.304, P = 0.000, interaction effect between intervention and time: F = 84.457, P = 0.000; DTee (cm) of the observation group were 0.213±0.014, 0.227±0.013, 0.243±0.016, 0.264±0.010, while in the control group were 0.213±0.016, 0.218±0.013, 0.224±0.013, 0.234±0.014, effect of time: F = 385.552, P = 0.000, effect of intervention: F = 28.161, P = 0.000, interaction effect between intervention and time: F = 45.012, P = 0.000; DTF of the observation group were (15.98±4.23)%, (21.35±4.67)%, (24.09±4.44)% and (25.24±3.74)%, while in the control group were (14.17±4.66)%, (18.11±3.92)%, (20.22±4.19)% and (20.98±4.12)%, effect of time: F = 161.552, P = 0.000, effect of intervention: F = 49.224, P = 0.000, interaction effect between intervention and time: F = -4.507, P = 0.000]. The duration of mechanical ventilation and length of ICU stay in the observation group were significantly shorter than those in the control group [duration of mechanical ventilation (hours): 112.68±12.25 vs. 135.32±22.10, length of ICU stay (days): 7.84±1.78 vs. 10.23±2.43, both P < 0.01]. However, there was no significant difference in 24-hour re-intubation rate between the observation group and the control group (0% vs. 2.90%, P > 0.05). CONCLUSIONS Both early off-bed mobility and progressive early activities can prevent diaphragm weakness in ICU patients undergoing mechanical ventilation, and the effect of early off-bed mobility is better. Early off-bed mobility can significantly shorten the duration of mechanical ventilation and length of ICU stay, and it is safe and feasible.

目的 检索汇总成人危重症患者非药物睡眠管理的证据,为ICU医护人员进行睡眠干预提供参考.方法 系统检索国内外数据库及指南网站中关于成人危重症患者非药物睡眠管理的相关文献,检索时限为建库至2023年2月,根据纳入与排除标准筛选文献后,由2名经过循证培训的研究者独立对纳入文献进行质量评价、证据提取和总结.结果 共纳入文献13篇,包括临床指南3篇、系统评价9篇以及随机对照试验1篇.汇总出21条最佳证据,涉及加强护士教育和培训、改善病区环境、减少睡眠中断、合理选择机械通气模式及促进身心放松5个方面.结论 本研究汇总的证据可为成人危重症患者非药物睡眠管理方案的制订提供参考,ICU医护人员应基于证据,在充分考虑科室人力资源及实际情况,并结合患者需求,审慎地将证据应用于临床工作中.

综述重症监护病房(ICU)转出病人主要照顾者准备度的测量工具、ICU转出病人主要照顾者准备度现状及其影响因素,提出提高ICU转出病人主要照顾者准备度的建议,包括提供信息支持、开展过渡护理、重视照顾者心理健康状态和加强网络资源的利用,以期为提高我国ICU转出病人主要照顾者准备度提供指导.

卒中是严重危害人类健康的常见病、多发病,其复发率、致残率及病死率较高,会给患者家庭及社会带来沉重的经济负担.卒中后疲劳(PSF)指患者卒中后出现的持续性、病理性疲劳状态,是影响脑卒中患者生活质量的主要因素之一,因此有效管理PSF成为临床医务工作人员亟待解决的问题.本文主要综述了PSF危险因素及其症状管理方案的研究进展,旨在为PSF的治疗提供参考.