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1、危重病医学 Critical Care Medicine 研究危重病发生、发展及其预防与治疗的临床学科。 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。,何为ICU?,Money?-Buy Time Medicine? Hospital among Hospital,加强医疗科 Intensive Care Unit 一种集现代医疗、护理技术为一体的医疗组织管理形式。 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， 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。,19世纪50年代克里米亚战争时期Nightingale提出
2、“分级护理”观念 1863年第一个术后恢复室（Recovery Room)建立 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） 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。 60年代，欧美等国家相继成立冠心 病治疗病房（Coronary Care Unit)CCU, 美国Baltimore City Hospital 建立了具有现代规范的综合 ICU 1970年，美国危重病医学会成立。,80年代初仅数家大型教学医院设立ICU 1989年北京召开第
3、一次“加强医疗危重医学座谈会” 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） 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 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 2005年5月，中华医学会重症医学分会在北京成立,四个主体部分 重症病员。 一支训练有素的医护技术人员。 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。 严格、科学的管理。,Physician (Intensivist)
4、 Physician Assistant* Nurse Practitioner* Registered nurse Nurse Respiratory Therapist Clinical Pharmacist Nutritionist Technician,人员结构,Physician, Intensivist,Nutritionist,Nurse Practitioner,Clinical Pharmacist,Resident,Registered Nurse,Fellow,The ICU Model in Europe and in the United States,-An Int
5、erview With Jean-Louis Vincent and Timothy G. Buchman Posted 06/30/2005,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
6、 European Society of Intensive Care Medicine and the European Shock Society,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 de
7、dicated 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.,High-Intensity vs. Low Intensity ICU Physician Sta
8、ffing,Pronovost PJ et al, JAMA, 288:2151 (2002),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 lim
9、it 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 educatio
10、n both in the professional community as well as in the general public, which includes all of our patients and their families.,The separate ICU specialty curriculum, training and,This would be the Spanish model: a mixture of internal medicine, anesthesiology, surgery, and emergency medicine.,critical
11、 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.,About Nursing shortage,with
12、 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 pa
13、tient. 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.,The nursing curriculum and education,Most nursing schools in Europe now have a separate specialty in intensive care and emergenc
14、y 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
15、as cared for as the patients they treat. we should build a profession that people flock to because it is exciting and rewarding.,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 be
16、tter 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
17、 patients.,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, Innov
18、ative 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.,An ICU crisis is approaching in the near future,Critical care medicine is the mo
19、st interesting specialty: I am sure it will continue to raise a lot of interest. The importance of the specialty will also increase in the future - we should all be proud to be a part of it.,The most important step is to engage thought leaders, policymakers, and the public in an open and frank discu
20、ssion about available resources We must become diligent about measuring, reporting and improving our performance within presently available resources. Personal insights are of inestimable value when critical care professionals, families, and patients must make difficult decisions on the goals of intensive care.,谢谢！,