| Obj ective(s):To constructing an eCASH concept combined with early rehabilitation nursing plan,and exploring the impact of eCASH concept combined with early rehabilitation nursing on the incidence of ICU-AW in mechanically ventilated patients with severe acute pancreatitis.Methods:1.Construct eCASH concept combined with early rehabilitation nursing planRetrieve relevant literature from January 1,2015 to January 1,2020,and based on the literature review results,summarize and analyze the initial draft of the eCASH concept combined with early rehabilitation nursing plan.Using the expert meeting method,construct an eCASH concept combined with early rehabilitation nursing plan.2.Application of eCASH concept combined with early rehabilitation nursing planA randomized controlled trial was conducted from June 2021 to December 2022 in the ICU department of the grade three hospital.A population of 97 patients with severe acute pancreatitis who received mechanical ventilation were included and randomly divided into a control group(n=48)and a trial group(n=49)by using a random number table.The control group received routine intensive care and early rehabilitation care,while the trial group received eCASH concept combined with early rehabilitation care and the routine care which same to the care applied to the control group.The incidence of ICU-acquired myasthenia,ICU delirium,and subsyndromal delirium,as well as the differences in mechanical ventilation time and ICU stay time between the two groups were compared.Results:1 Baseline data comparison:There was no significant difference in general information,including gender,age,body mass index,medical payment method,primary diagnosis,ARDS severity,APACHE Ⅱ score,and CRRT treatment between the two groups(P>0.05).2 Comparison of evaluation indicators:2.1 The incidence of ICU-acquired myasthenia:The incidence of ICU-acquired myasthenia in the trial group was 18.36%(9/49),and that in the control group was 47.91%(23/48).The difference between the groups was statistically significant(P=0.002).2.2The incidence of ICU delirium:The incidence of ICU delirium in the trial group was 12.24%(6/49),and that in the control group was 22.92%(11/48).There was no significant difference between the groups(P=0.167).2.3The incidence of subsyndromal delirium:The incidence of subsyndromal delirium in the trial group was 12.24%(6/49),and that in the control group was 39.58%(19/48).The difference between the groups was statistically significant(P=0.002).2.4Mechanical ventilation time:The mechanical ventilation time was[77.0(49.0,120.5)]hours in the trial group and[313.0(180.0,468.5)]hours in the control group.The difference between the groups was statistically significant(P<0.001).2.5ICU stay time:The ICU stay time was[143.0(102.0,382.0)]hours in the trial group and[433.5(291.0,690.0)]hours in the control group.The difference between the groups was statistically significant(P<0.001).3 Post analysis results:Considering that CRRT treatment affects the time of patients getting out of bed in clinical practice,which may cause bias,further stratified analysis was carried out.3.1 Baseline data comparison:There was no significant difference in general information,including gender,age,body mass index,medical payment method,primary diagnosis,and APACHE Ⅱ score between the two groups(P>0.05).3.2The effect of CRRT treatment on the incidence of ICU-acquired myasthenia:In the group of patients who received CRRT treatment,the incidence of ICU-acquired myasthenia was 26.32%(5/19)in the experimental group and 59.09%(13/22)in the control group.The difference between the groups was statistically significant(P=0.035)according to the chi-square test.In the group of patients who did not receive CRRT treatment,the incidence was 13.33%(4/30)in the experimental group and 38.46%(10/26)in the control group.The difference between the groups was statistically significant(P=0.030).After adjusting for CRRT treatment before and after,the odds ratio(OR)of ICU-AW incidence in the experimental group compared with the control group was 0.25,with a 95%confidence interval(CI)of 0.10～0.63,indicating that the risk of ICU-AW in the experimental group was 0.25 times that in the control group.3.3The effect of CRRT treatment on the incidence of ICU delirium:In the group of patients who received CRRT treatment,the incidence of ICU delirium was 15.79%(3/19)in the experimental group and 31.82%(7/22)in the control group.The difference between the groups was not statistically significant(P=0.233)according to the chi-square test.In the group of patients who did not receive CRRT treatment,the incidence was 10.00%(3/30)in the experimental group and 15.38%(4/26)in the control group.The difference between the groups was not statistically significant(P=0.839).After adjusting for CRRT treatment before and after,the odds ratio(OR)of ICU delirium incidence in the experimental group compared with the control group was 0.49,with a 95%confidence interval(CI)of 0.16～1.47,indicating that the risk of ICU delirium in the experimental group was 0.49 times that in the control group.3.4The effect of CRRT on the incidence of delirium:In patients receiving CRRT,the incidence of delirium in the experimental group was 15.79%(3/19),while in the control group it was 45.45%(10/22).The difference between the groups was statistically significant(P=0.042)based on a χ2 test.Among patients who did not receive CRRT,the incidence of delirium in the experimental group was 10.00%(3/30),while in the control group it was 34.62%(9/26).The difference between the groups was statistically significant(P=0.025).After adjusting for CRRT treatment before and after,the odds ratio(OR)for the incidence of SSD in the experimental group compared with the control group was 0.23(95%CI:0.08～0.61),indicating that the experimental group had a 0.23 times lower risk of developing delirium compared with the control group.3.5The effect of CRRT on mechanical ventilation time:In patients receiving CRRT,the mechanical ventilation time was[121.0(45.0,263.0)]hours in the experimental group and[337.5(167.5,535.0)]hours in the control group.The difference between the groups was statistically significant(P<0.001)based on a rank sum test.Among patients who did not receive CRRT,the mechanical ventilation time was[73.0(53.8,89.5)]hours in the experimental group and[278.0(189.0,465.5)]hours in the control group.The difference between the groups was statistically significant(P<0.001).Further covariance analysis showed that there was a statistically significant difference in mechanical ventilation time between the experimental and control groups(P=0.035).3.6The effect of CRRT on ICU length of stay:In patients receiving CRRT,the ICU length of stay was[263.0(185.0,429.0)]hours in the experimental group and[435.0(303.0,703.0)]hours in the control group.The difference between the groups was statistically significant(P=0.004)based on a rank sum test.Among patients who did not receive CRRT,the ICU length of stay was[122.0(91.3,230.3)]hours in the experimental group and[382.0(261.3,597.8)]hours in the control group.The difference between the groups was statistically significant(P<0.001).Further covariance analysis showed that there was a statistically significant difference in ICU length of stay between the experimental and control groups(P=0.005).Conclusion(s):Implementing eCASH concept combined with early rehabilitation nursing can helps to reduce the incidence of ICU-acquired myasthenia and sub-delirium syndrome in mechanically ventilated patients with severe acute pancreatitis,shorten the duration of mechanical ventilation and ICU hospitalization,and improve the efficiency of ICU bed turnover rate.Moreover,the eCASH concept combined with early rehabilitation nursing is effective for both patients who received and those who did not receive CRRT. |
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