ICU学科建设ppt课件

危重医学与加强医疗病房 Critical Care Medicine and Intensive Care Unit 1 危重病医学 Critical Care Medicine n 研究危重病发生、发展及其预防与治疗 的临床学科。 n 为危及生命的危急重症患者 提供高技术、高质量的生命 器官支持手段的医疗服务。 2 何为 ICU? n Money?-Buy Time n Medicine? n Hospital among Hospital 3 加强医疗科 Intensive Care Unit n 一种集现代医疗、护理技术为一体的医疗组 织管理形式。 n 把危重病人集中起来，对各种危重病人实施 连续的监测、治疗和护理， n 为原发病的治疗创造良好的基础、 赢得宝贵的时间，提高危重病救 治的成功率。 4 n 19世纪 50年代克里米亚战争时期 Nightingale提出 “分级护 理 ”观念 n 1863年第一个术后恢复室（ Recovery Room)建立 n 二次大战中，欧洲各地集中救治创伤及休克病员，形成 早期外科 ICU（ SICU） n 1948-1953年间，洛杉矶、丹麦、瑞典等地脊灰大规模流 行，促成呼吸治疗单位（ Respiratory Care Unit ， RCU) 建立，是文献报道的第一 个 ICU。 n 60年代，欧美等国家相继成立冠心 病治疗病房（ Coronary Care Unit)CCU, n 美国 Baltimore City Hospital 建立了具有现代规范的综合 ICU n 1970年，美国危重病医学会成立。 5 n 80年代初仅数家大型教学医院设立 ICU n 1989年北京召开第一次 “ 加强医疗危重医学座谈会 ” n 1991年 11月召开 “ 全国首届 ICU专题讨论会 ” ， 54所 医院共设 ICU59个（综合 21个，专科 38个） n 1996年 12月 16日北京成立了 “ 中国病理生理学会危 重病医学专委会筹委会 n 1997年 9月在北京正式成立中国病理生理学会危重病 专委会，产生了第一届全国专委会委员 n 2005年 5月，中华医学会重症医学分会在北京成立 6 四个主体部分 n 重症病员。 n 一支训练有素的医护技术人员。 n 完备的生理监测设备及先进的抢救治疗措施 。能动态、定量观察及捕捉瞬息变化，反馈 治疗效果；能作较长时间生命支持，为治疗 原发病争取时间。 n 严格、科学的管理。 7 n Physician (Intensivist) n Physician Assistant* n Nurse Practitioner* n Registered nurse n Nurse n Respiratory Therapist n Clinical Pharmacist n Nutritionist n Technician 人员结构人员结构 8 Physician, Intensivist Nutritionist Nurse Practitioner Clinical Pharmacist ResidentRegistered Nurse Fellow 9 10 11 12 13 14 15 16 The ICU Model in Europe and in the United States -An Interview With Jean- Louis Vincent and Timothy G. Buchman Posted 06/30/2005 17 Timothy G. Buchman, PhD, MD, past president of the Society of Critical Care Medicine and Professor of Surgery at Washington University School of Medicine in St. Louis, Missouri. Jean-Louis Vincent, MD, PhD, past president of the European Society of Intensive Care Medicine and the European Shock Society 18 Open versus Closed ICUs it is very important to place critically ill patients in the hands of a properly trained, experienced doctor who is part of a team available 24 hours a day. The key feature is an integrated team of dedicated experts that brings multiprofessional perspective to bear on the needs of each patient. Intensivists are trained and ideally suited to provide this sort of leadership, which is why I personally practice and support the intensivist-led model. 19 Relative Risk = 0.71 (95% CI = 0.62 0.82) 29% Reduction in Mortality Relative Risk = 0.61 (95% CI = 0.50 0.75) 39% Reduction in Mortality High-Intensity vs. Low Intensity ICU Physician Staffing Pronovost PJ et al, JAMA, 288:2151 (2002)20 Financial solution to the rising ICU requirements The future of “minimally reasonable“ healthcare will be tough, as the cost of medicine continues to increase dramatically and the population will continue to age. In the future we may face a need to limit the expenses for those at the end of their lives. make our care as effective and as efficient as possible. But the greater imperative is to identify those patients for whom care with curative intent will not return them to a satisfactory quality of life. This will require a great deal of education both in the professional community as well as in the general public, which includes all of our patients and their families. 21 The separate ICU specialty curriculum, training and This would be the Spanish model: a mixture of internal medicine, anesthesiology, surgery, and emergency medicine. critical care benefits from the multiple perspectives that intensivists with diverse backgrounds bring to the bedside. I believe that our discipline would become more attractive to medical students if we offered a pathway that did not require prior training in another discipline. 22 About Nursing shortage with a number of ingredients, including a fantastic head nurse, improvement in communication, and the “team approach,“ we now have enough ICU nurses! We certainly need more nurses in the USA, especially those who have achieved advanced competencies and certifications in the care of the critically ill patient. We also especially need strategies that will preserve and use the years of accumulated wisdom that are contained in the aging bodies of our most experienced nurses. 23 The nursing curriculum and education Most nursing schools in Europe now have a separate specialty in intensive care and emergency medicine, such a specialty has increased nurses interest in our discipline. Nurses are professionals who value the same things as physicians: We need to ensure that the ICU remains an environment in which professionalism is maintained, where ideas are valued, and where caregivers feel as safe and as cared for as the patients they treat. we should build a profession that people flock to because it is exciting and rewarding. 24 the physician assistant and nurse practitioner For the lack of ICU physicians in the future, I very much believe in the applications of telemedicine. I think it is much better to have an ICU physician controlling the ICU at a distance This is not a matter of physician shortage so much as it is a strategy to use their training and wisdom most effectively. Advanced practice nurses who partner with intensive care physicians can provide outstanding care to critically ill patients. 25 Relationship between the ED and the ICU In our institution, we manage a so-called “shock lab“ with the emergency doctors. This means that we are called immediately when a critically ill patient is admitted to the ED. Acute care medicine spans many areas of the modern medical center, Innovative training programs that lead to well-trained, hospital-based medical specialists who practice safely and effectively across this continuum have great potential to improve professional satisfaction and patient care. 26 An ICU crisis is approaching in the near future Critical c