Connotation， Key Scientific Issues， and System Building of Classical Herbal Formulae for Critical Care Medicine / 中国实验方剂学杂志

In contemporary clinical practice of traditional Chinese medicine （TCM）， there is a strong emphasis on treating chronic difficult diseases and preventing diseases before they occur （"pre-disease" treatment）. However， the treatment of critical care medicine has not received as much attention and is even facing a trend of diminishing influence in the field of emergency medicine and critical care. Critical care medicine refers to a class of diseases that are characterized by rapid onset， severity， quick progression， and high mortality rates in clinical practice. The growth and development of renowned TCM experts throughout history have invariably been honed through practical experiences in managing critical care medicine. Treatise on Cold Damage （《伤寒论》） is a dedicated work for treating critical care medicine， and the classic prescriptions in Treatise on Cold Damage are particularly central to the treatment of these diseases. In the current clinical context， it is important to break through the prevailing mindset that the strengths of TCM lie solely in treating chronic diseases and maintenance-type illnesses， identify the entry point of TCM in the clinical advantages in the field of critical care medicine， explore the interdisciplinary relationship between Treatise on Cold Damage and critical care medicine， enhance the ability to treat critical care medicine using classic prescriptions， establish a disciplinary system for prescription-based treatment of critical care medicine， reveal clinical evidence for prescription-based treatment of these diseases， and elevate the contribution of TCM in the domain of critical care medicine. These have become a strong call and demand in contemporary TCM clinical practice. Regarding key scientific issues， the system of using classic prescriptions to treat critical care medicine encompasses traditional core theories such as the nature of cold damage， the essence of the six meridians， the implications of specific clauses， and the dosages of classic prescriptions. In the context of future academic inheritance and system construction， it is recommended to focus on clinical challenges， break away from the current limitations of traditional classical disciplinary systems， such as their singular patterns and weak innovative and translational capabilities， suggest defining diseases in critical care medicine responding specifically to TCM， advocate a research model based on combining disease mechanisms with pathology and combining medicinal properties with pharmacology， establish a comprehensive multidisciplinary thinking mode， and encourage collaborative innovative research among medical， educational， research， and manufacturing institutions. This will help chart the path and address key aspects of constructing a comprehensive system for prescription-based treatment of critical care medicine.

Connotation of Xiao Chaihu Decoction combined with Maxing Shigan Decoction based on severe cases and modern pathophysiological mechanism and application for severe pulmonary infection and acute exacerbation of chronic obstructive pulmonary disease in critical care medicine / 中国中药杂志

Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic herbal formula. All of them are derived from Treatise on Cold Damage(Shang Han Lun) by ZHANG Zhong-jing. This combination has the effects of harmonizing lesser yang, relieving exterior syndrome, clearing lung heat, and relieving panting. It is mainly used for treating the disease involving the triple-Yang combination of diseases and accumulation of pathogenic heat in the lung. Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic combination for the treatment of exogenous diseases involving the triple-Yang combination. They are commonly used in exogenous diseases, especially in the north of China. This combination is also the main treatment strategy for coronavirus disease 2019(COVID-19) accompanied by fever and cough. Maxing Shigan Decoction is a classical herbal formula for treating the syndrome of phlegm-heat obstructing the lung. "Dyspnea after sweating" suggests the accumulation of pathogenic heat in the lung. Patients with mild symptoms may develop cough and asthma along with forehead sweating, and those in critical severe may develop whole-body sweating, especially the front chest. Modern medicine believes that the above situation is related to lung infection. "Mild fever" refers to syndromes rather than pathogenesis. It does not mean that the heat syndrome is not heavy, instead, it suggests that severe heat and inflammation have occurred. The indications of Xiao Chaihu Decoction combined with Maxing Shigan Decoction are as follows.(1) In terms of diseases, it is suitable for the treatment of viral pneumonia, bronchopneumonia, lobar pneumonia, mycoplasma pneumonia, COVID-19 infection, measles with pneumonia, severe acute respiratory syndrome(SARS), avian influenza, H1N1 influenza, chronic obstructive pulmonary disease with acute exacerbation, pertussis, and other influenza and pneumonia.(2) In terms of syndromes, it can be used for the syndromes of bitter mouth, dry pharynx, vertigo, loss of appetite, vexation, vomiting, and fullness and discomfort in the chest and hypochondrium. It can also be used to treat alternate attacks of chill and fever and different degrees of fever, as well as chest tightness, cough, asthma, expectoration, dry mouth, wanting cold drinks, feeling agitated, sweating, yellow urine, dry stool, red tongue, yellow or white fur, and floating, smooth, and powerful pulse, especially the right wrist pulse.

Connotation of distal bleeding based on modern pathophysiological mechanism and application of Huangtu Decoction for acute coronary syndrome complicated with acute upper gastrointestinal hemorrhage in critical care medicine / 中国中药杂志

Huangtu Decoction, first recorded in Essentials from the Golden Cabinet(Jin Kui Yao Lue) from ZHANG Zhong-jing in Han dynasty, is used to treat distal bleeding. It is mainly treated for the syndrome of failing to control blood with spleen-yang deficiency. The connotation of distal bleeding is more extensive, including not only upper gastrointestinal bleeding in the traditional sense such as peptic ulcer bleeding, gastrointestinal tumors, gastric mucosal lesions, vascular dysplasia, esophagogastric variceal bleeding, and pancreatic and biliary tract injury, but also other anorectal diseases such as part colon and rectal cancer swelling or polyps, hemorrhoids, and anal fissure and other parts of bleeding such as epistaxis, thrombocytopenia, functional uterine bleeding, threatened abortion, and unexplained hematuria. Distal bleeding also involves syndromes of failing to keep part deficient and cold fluids in interior, such as nocturia, enuresis, clear nose, sweating, cold tears, and leucorrhea, and excessive gastrointestinal bleeding caused by anti-plate and anticoagulant drugs, unexplained positive in the fecal occult blood test, and other modern clinical new problems. The indications of Huangtu Decoction include not only lower blood, defecation before blood, distant blood, hematemesis, epistaxis, and other diseases in traditional Chinese medicine, but also three types of clinical manifestations including bleeding, deficiency syndrome, and stagnant heat syndrome. In the clinic, Huangtu Decoction can be used to treat acute upper gastrointestinal bleeding, acute coronary syndrome complicated with acute upper gastrointestinal bleeding, bleeding events caused by excessive antiplatelet and anticoagulant drugs, unexplained positive in the fecal occult blood test, gastrointestinal tumor with bleeding, thrombocytopenia, and other acute and critical diseases. The dosage of Cooking Stove Earthkey, Rehmanniae Radix, and Asini Corii Colla in Huangtu Decoction is the key to hemostasis.

Connotation of Shenqi Pills based on severe cases in cardiovascular care unit and modern pathophysiological mechanism and application of Shenqi Pills for heart failure, renal failure, cardiorenal syndrome, and diuretic resistance in critical care medicine / 中国中药杂志

Shenqi Pills, first recorded in Essentials from the Golden Cabinet(Jin Kui Yao Lue) from ZHANG Zhong-jing in Han dynasty, have the effect of warming and tonifying the kidney Qi and are mainly used for the treatment of insufficiency of kidney Qi and kidney Yang. According to modern medicine, kidney Qi involves heart function, kidney function, immune function, and so on. The clinical indications of Shenqi Pills include kidney deficiency, abnormal fluid, and abnormal urination, and the last one is classified into little urine, much urine, and dysuria. In clinical settings, Shenqi Pills can be applied for the treatment of heart failure, renal failure, cardiorenal syndrome, and diuretic resistance, as well as endocrine, urological, orthopedic, and other chronic degenerative diseases. Shenqi Pills are ideal prescriptions for the weak constitution and emergency treatment. It is of great value and significance to carry out in-depth research on the connotation of the classic articles by integrating TCM and western medicine based on "pathogenesis combined with pathology and drug properties combined with pharmacology".

Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020 / 医学前沿

This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.

Research progress in cognition, attitude and willingness for organ donation among ICU staff in China / 器官移植

In recent years, organ donation and transplantation have entered a stage of steady development in China. Nevertheless, the shortage of transplant organs and the contradiction between supply and demand of organs are still the bottlenecks to achieve the strategy of "self-sufficiency in organ transplantation" advocated by the World Health Organization (WHO). The key reasons for donor loss described in the "critical pathway of organ donation" defined by the WHO include the identification and referral of potential donors and the maintenance and repair of organs. Smooth development, high efficiency and high-quality development of organ donation cannot be achieved without the support of intensive care medicine, which are highly associated with the cognition, recognition and participation of intensive care unit(ICU) staff. In this article, research progress in ICU staff’s cognition, attitude and willingness for organ donation were reviewed and relevant influencing factors were discussed, aiming to offer targeted suggestions on how to resolve these difficulties.

Application of Gagne's teaching theory combined with scene teaching method in practice teaching of nursing students in department of respiratory and critical care medicine / 中华医学教育探索杂志

Objective:To explore the effects of practice teaching based on Gagne's teaching theory combined with scene teaching method on core competency of nursing students in department of respiratory and critical care medicine.Methods:A total of 42 nursing students from the Respiratory and Critical Care Medicine Department of Beijing Jishuitan Hospital were enrolled and divided into observation group (21 cases) and control group (21 cases) using a random number table. Traditional teaching method was used in the control group, while Gagne's teaching theory combined with scene teaching method was used for teaching the observation group. After teaching, theoretical knowledge and actual operation ability of nursing students were assessed. The core competency of nursing students was evaluated by core competency assessment scale. The independent learning ability of nursing students was evaluated using an assessment tool. The self-evaluation of teaching effect in the two groups was compared. The t test or chi-square test was performed in SPSS 22.0. Results:The scores of theoretical knowledge and actual operation ability in the observation group were (88.10±7.52) and (90.81±4.88), respectively. These scores were significantly higher than those in the control group [(83.62±6.58) and (72.57±8.94), t=2.06, 8.21, P<0.05]. The scores of core competency and independent learning ability were significantly higher in the observation group than in the control group [(185.53±20.19) and (129.09±16.14) vs. (170.52±20.32) and (105.86±12.23), t=2.40, 5.10, P<0.05]. The score of self-evaluation on teaching effect was significantly higher in the observation group than in the control group [28 (25, 29) vs. 21 (20, 22), Z=5.39, P<0.05]. Conclusion:Gagne's teaching theory combined with scene teaching method in practice teaching of nursing students in the department of respiratory and critical care medicine should be promoted because this combined method improves the mastery of theoretical knowledge and actual operation skills, the independent learning ability and core competency of nursing students, and the effect of nursing teaching.

Application of virtual intelligent system in bronchoscopy theory and operation training for PCCM physicians / 中华医学教育探索杂志

Objective:To evaluate the role of virtual bronchoscopy intelligent system in improving the theory and operation level of bronchoscopy in pulmonary and critical care medicine (PCCM) teaching for standardized training specialists.Methods:A total of 50 PCCM physicians who had participated in virtual bronchoscopy training in Xijing Hospital, Air Force Medical University from 2018 to 2021 were selected as research subjects. In this study, self-controlled method was adopted to evaluate the change of assessment indicators after 1 week and 2 weeks of training. Questionnaire survey was also used to evaluate the training effect. SPSS 23.0 software was used for paired t-test and Chi-square test. Results:All the 50 PCCM physicians successfully completed the training of virtual bronchoscopy operation. The theoretical score was significantly improved after the training [(80.0±5.2) points vs. (92.4±3.8) points]. The basic operation time [(1 050.9±103.3) s vs. (386.4±47.7) s], and the number of hitting the bronchial wall [(88.3±12.7) times vs. (27.0±5.3) times] were significantly reduced. The recovery rate of alveolar lavage fluid [(27.6±7.4)% vs. (58.0±8.2)%] and the positive rate of biopsy [(19.2±13.1)% vs. (86.8±10.8)%] were significantly increased. The learning curve of the final score indicated that the score improved more rapidly in the first week of training, and the score improved more slowly in the second week of training. Questionnaires before and after the training indicated that virtual intelligent training could significantly improve the confidence and proficiency of students in bronchoscopy.Conclusion:Through the systematic training of virtual bronchoscopy intelligent system, the PCCM physicians have significantly improved their theoretical knowledge and operational proficiency. Therefore, the virtual bronchoscopy training system has practical significance for improving the overall training effect of clinical bronchoscopy for PCCM trainees, which is worthy of promotion.

The application of 4C teaching combined with case simulation teaching in the practice teaching of respiratory and critical care medicine nursing students / 中华医学教育探索杂志

Objective:To explore the application of 4C teaching combined with case simulation teaching in the practice teaching of respiratory and critical care medicine nursing students.Methods:Eighty nursing practice students from 2019 to 2021 in the Department of Respiratory and Critical Care Medicine of Beijing Chaoyang Hospital Affiliated to Capital Medical University were selected as the research objects, and they were randomized into control group ( n=40) and observation group ( n=40). The control group adopted traditional teaching, and the observation group adopted 4C teaching combined with case simulation teaching. The nursing comprehensive ability and self-directed learning ability of the two groups of nursing students were compared, and the evaluation of teaching methods between the two groups was assessed. SPSS 22.0 was used for Chi-square test and t-test. Results:The scores of theoretical knowledge, ward management, prevention and control of hospital infection, basic nursing, standardized writing of nursing documents, and critical care of nursing students in the observation group were higher than those in the control group ( P<0.05); the scores and total scores of learning awareness, learning behavior, learning strategies, interpersonal relationships, and learning evaluation in the observation group were higher than those in the control group ( P<0.05). The observation group believed that their teaching method was better than the control group in terms of mobilizing learning initiative, improving basic nursing practices, promoting clinical communication skills, improving the ability to analyze and solve problems, enhancing the concept of humanistic care, helping to understand and master knowledge, and improving the overall quality ( P<0.05). Conclusion:The 4C teaching combined with case simulation teaching can improve the comprehensive nursing ability and self-directed learning ability of nursing students in department of respiratory and critical care medicine, and the nursing students have a high opinion of the teaching method.

Application of PBL-based scenario simulation teaching in the standardized residency training in the department of critical care medicine / 中华医学教育探索杂志

Objective:To explore the role and effect of problem-based learning (PBL)-based scenario simulation teaching in the standardized residency training in the department of critical care medicine.Methods:A total of 48 residents who received standardized residency training in the Department of Critical Care Medicine of the First Affiliated Hospital of Soochow University from March 2019 to December 2019 were randomly divided into the experimental group and the control group, with 24 ones in each group. The experimental group used PBL-based scenario simulation teaching, while the control group adopted the traditional teaching. After the end of the teaching, the exam scores of the two groups were observed and compared. Then the questionnaire was used to analyze the differences of the results. SPSS 17.0 was used for t-test. Results:The scores of theoretical assessment (85.50±5.15) and skill assessment (82.38±5.64) in the experimental group were higher than those in the control group[(77.04±8.69) and (70.92±5.65)], and the differences were statistically significant ( P < 0.05). The experimental group was higher than the control group in improving learning interest and efficiency, improving clinical work ability, strengthening clinical thinking ability, improving teamwork ability, and improving doctor-patient communication ability, and the difference was statistically significant ( P < 0.05). Conclusion:The PBL-based scenario simulation teaching has more advantages over the traditional teaching and is worthy of promotion.

Once in a blue moon: A rare case of Duchenne muscular dystrophy complicated by COVID-19

Patients suffering from Duchenne Muscular Dystrophy (DMD) are at higher risk of suffering significant morbidity resulting from COVID-19, considering their pre-existing respiratory insufficiency and immunocompromised state. We present such a case who was admitted to our intensive care unit. A 21-year-old patient, who was a diagnosed case of DMD since the age of 8 and on treatment with steroids, angiotensin-converting enzyme inhibitors, and intermittent home-oxygen support, presented with fever and breathlessness and was diagnosed to have COVID-19 pneumonia. Oxygen support was provided by non-invasive ventilation (NIV), along with therapeutic and supportive treatment, namely, azithromycin, remdesivir, dexamethasone, and heparin. Dyselectrolytemia was corrected and convalescent plasma was transfused. The patient was weaned off NIV and discharged on significant improvement in his general condition. Although the treatment of COVID-19 using convalescent plasma has now fallen out of favor, we found some clinical improvement in our patient. DMD complicated by COVID-19 can seem like a daunting challenge, but providing fundamental, yet, simple treatment measures goes a long way in the patient care

Exploration and practice of building tele-critical care system / 中华危重病急救医学

Objective:To look for the problems faced in the construction of the tele-critical care system, explore the framework of construction of the tele-critical care system, and verify the application effects of the established tele-critical care system.Methods:Through literature review and on-site investigation and demonstration, the causes affecting the construction of the tele-critical care system were explored. Through on-site investigation of the actual situation of the critical care department in relevant hospitals, arguing and choosing intended intensive care unit (ICU) and cooperative third-party communication and equipment companies, and through the Internet of Things and 5G communication technology, a tele-critical care system with the core hospital of the group as the center and the member institutes within the group as the nodes was built. Via the established tele-critical care system, activities such as tele-monitoring, visual remote ward rounds, remote consultation, remote teaching were carried out to verify the functions of the system.Results:The insufficient cognition of relevant personnel, tele-medicine practice certification requirements, information security issues and the barriers of equipment information integration were the main causes affecting the construction of tele-critical care system. There were five parts in the tele-critical care system architecture foundations, including bed unit equipment and audio and video information collection system, lossless and secure transmission of collected information, real-time display of information in the remote center, real-time staff interaction between the centre and the nodal hospitals, and information cloud storage. It has been verified that patients' diagnostic and treatment information can be transmitted safely, losslessly and in real-time by a special line through private 5G network. Through this system, real-time and stable upload of audio and video information of patients and application information of monitors, ventilators and infusion work stations can be achieved; combined with tele-conference connections to conduct two-way communication with local medical staff, real-time tele-monitoring, visual remote ward rounds, remote consultation, remote teaching and other functions can be achieved.Conclusion:The tele-critical care system we established is feasible to construct within the medical group and can safely and effectively realize the functions of real-time tele-monitoring, visual remote ward rounds, remote consultation, and remote teaching.

Survey and analysis on digital construction of primary hospitals in Guizhou Province / 中华危重病急救医学

Objective:To investigate the utilization status and awareness of digital hospital construction among medical staff in critical care department of primary hospitals, so as to promote the process of digital medical health.Methods:One to two doctors and nurses (in the department on that day) from public hospitals in 88 counties and urban areas in 9 cities of Guizhou Province were enrolled of field investigation. The questionnaires form were filled in on-site and sorted out and analyzed by special personnel.Results:A total of 297 medical staff from the department of critical care medicine of 146 hospitals were included. All the questionnaires were filled in with their real names, including 152 doctors and 145 nurses. There were 24 class Ⅲ Grade A hospitals and 122 class Ⅱ and all the hospitals had implemented digital information management. The awareness of hospital digital information management system was generally low among the surveyed medical staff, and the awareness of hospital information system (HIS) was the highest (86.5%), followed by laboratory information management system (LIS, 41.4%) and image archiving and communication system (PACS, 40.7%). The awareness of hospital management system (HERP) was the lowest (7.7%). The total number of remote consultations conducted by hospitals using big data Internet was 25 428 times in 2020, with a median of 24.5 (88.0, 240.0) times in each hospital. From 2018 to 2020, the total number of patients admitted to the intensive care unit of the hospital was 50 473, 57 565 and 57 907, respectively, of which the number of patients over 65 years old accounted for 37.47%, 41.26% and 43.31%, respectively (all P > 0.05). There were 4 242 cases of remote consultation using big data Internet in the department every year, with a median of 257.50 (96.50, 958.25) cases. 12.12% of the departments had independent critical monitoring systems, and 8.75% of them could capture data automatically to form tables. 96.30% of the medical staff participated in systematic and professional training on basic knowledge, basic theory and basic medical care skills through the Internet platform, and the number of meetings, studies and training in the provinces and prefectures were 282 and 357 times per year, respectively. More than 90% of the departments initiated remote consultation, arranged referral or admitted patients who had improved status after treatment in superior hospitals through the Internet platform. Most of the patients (69.02%) were from the lower level of the hospital. The total number of out-patient consultations was 2 959 times per year, with a median of 296 (185 473) times. 54.79% of the departments had fixed service villages, and 28.08% of the departments had fixed service population. The median furthest visit distance was 52.5 (30.0, 80.0) kilometers, and the median average visit distance was 30.0 (20.0, 50.0) kilometers. 54.88% of medical staff believed that the biggest difficulties encountered during house visits were insufficient energy and too large service groups or regions. More than 90% of medical staff had been exposed to cloud learning and cloud training, and most of the surveyed medical staff believed that cloud learning and cloud training greatly improved medical service capacity and service efficiency of medical institutions (71.04% and 67.01%, respectively). Meanwhile, they believe that "Internet + health big data" projects from various aspects brought advantage to medical institutions, but there are also low utilization rate of Internet medical equipment by village doctors, low acceptance for telemedicine and mobile hospitals by farmers. Conclusions:Guizhou public hospitals have implementation of digital information management at the grass-roots level, the surveyed health care workers have a relatively low awareness of the digital information management system, hospital use big data Internet for remote consultation is uneven, intensive care medicine is a clinical discipline used in most remote consultation information system, and can complete two-way referrals. In the past three years, the discipline operation showed an upward trend year by year. Medical staff use artificial intelligence devices such as cloud learning and training to improve medical service capacity and efficiency. The digital transformation of primary hospitals is being continuously improved.

Analysis of treatment for 360 critically ill pregnant and parturient women in intensive care unit / 中华危重病急救医学

Objective:To analyze the clinical characteristics and outcomes of critically ill pregnant and parturient women in intensive care unit (ICU), and to provide clinical experience for the subspecialty construction of critical obstetrics.Methods:The clinical data of critically ill pregnant and parturient women admitted to the department of critical care medicine, the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2019 were collected. The main reasons for maternal transfer to ICU, the causes of maternal death, and organ support measures, etc. were summarized.Results:A total of 39 567 critically ill pregnant and parturient women were admitted to the department of obstetrics in our hospital, and 360 were transferred to ICU, with an average ICU transfer rate of 0.91%. Since 2016, the number of obstetric admissions, the number of ICU transfers and the ICU transfer rate had increased significantly. The average age of severe maternals admitted to ICU was (30.9±5.7) years old. The average acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score was 7 (4, 10). The average length of ICU stay was 1 (1, 2) day. The average ventilator duration was 9.0 (3.0, 17.5) hours. The main delivery mode of pregnant women in ICU was cesarean section (84.72%). Forty-eight patients (13.33%) underwent hysterectomy, of which 42 (87.5%) due to postpartum hemorrhage. The top 3 causes of ICU admission were severe postpartum hemorrhage [36.94% (133/360)], hypertensive disorders of pregnancy [21.67% (78/360)], pregnancy with cardiac disease [15.00% (54/360)]. The leading cause of postpartum hemorrhage in women transferred to ICU was placental abnormality [63.98% (103/161)], followed by uterine atony [28.57% (46/161)]. The average blood loss was (4 019±2 327) mL within 24 hours after delivery, and the number of women who underwent hysterectomy due to postpartum hemorrhage decreased year by year. During the study period, there were 2 maternal deaths, which were indirect obstetric deaths, 3 cases were discharged against-advice (expected death), including 1 indirect death and 2 direct obstetric death; the mortality in ICU was 1.39% (5/360).Conclusions:The most common reasons for pregnant and parturient women to be admitted to ICU were severe postpartum hemorrhage and hypertensive disorders of pregnancy. The leading cause of postpartum hemorrhage was placental problem. Indirect obstetric deaths exceeded direct obstetric deaths, mainly due to pregnancy complicated with cardiac disease and severe pneumonia. ICU has become an important battlefield for rescuing critically ill maternal and an important guarantee for reducing the maternal mortality.

Expert statement on the construction criteria of critical care department in municipal and district designated hospitals under the pandemic prevention and control / 中华危重病急救医学

The global coronavirus disease 2019 epidemic is still in a pandemic state. Aging population with underlying diseases is prone to become severe, and have a higher mortality. The treatment capacity of the critical care department directly determines the treatment success rate of critical illness. At present, there is still a certain gap between domestic and foreign countries in intensive care unit (ICU), which is not only in the allocation of medical staff, but also in the beds and settings. The current medical model cannot fully meet the needs of development. The experience and lessons of many major public health emergencies suggested that " dual track of peace and war" approach in discipline construction of critical care is the best medical model. Following the concept of "combination of peace and war", strengthening the discipline construction of critical care department in municipal and district designated hospitals, allocating reasonable standard ICU, step-down ICU and combat readiness ICU, establishing rapid response team, and strengthening regular training and scientific management may be the key measures to deal with the epidemic.

Assessment of research efficiency of critical care medicine in hospitals affiliated S university based on data envelopment method: taking the 13th Five-Year Plan period as an example / 中华危重病急救医学

Objective:To investigate the static and dynamic trends of scientific research efficiency of the critical care medicine in hospitals affiliated S university during the 13th Five-Year Plan period.Methods:Based on the scientific research data of 16 hospitals affiliated to Beijing S University from 2014 to 2020, the scientific research investment funds and the number of physicians involved in scientific research were selected as input evaluation indexes, and the number of science citation index (SCI) papers, Chinese science citation database (CSCD) papers, and the number of masters and doctors trained were selected as output evaluation indexes, and the evaluation index system of scientific research efficiency of critical care medicine was constructed. SPSS version 23.0 software was used for descriptive data statistics, and data envelopment analysis (DEA)-BCC model and DEA-Malmquist index model of DEAP 2.1 software were used for static and dynamic evaluation of its scientific research efficiency from 2016 to 2020, respectively.Results:① The scientific research technical efficiency (TE) of critical care medicine in 16 hospitals affiliated with S universities varied greatly from 2016 to 2020, but pure technical efficiency (PTE) and scale efficiency (SE) were at a good level, and 6-11 affiliated hospitals in critical care medicine kept DEA effective for 5 consecutive years. ② Dynamic analysis of their total factor productivity (TFP) of scientific research from 2016 to 2020 showed a trend of rising and then falling and then rising again. The mean value was 0.985. The technical efficiency change (TEC) showed a decreasing and then increasing trend, and the technical progress change (TC) showed a slow increasing and then decreasing trend, with a mean value of 0.953. While the mean values of TEC, pure technical efficiency change (PTEC) and scale efficiency change (SEC) were above 1, which showed that the growth of total factor productivity index of research and innovation depended more on the technical efficiency index.Conclusions:The "gain effect" and "catch-up effect" of scientific research efficiency in the specialty of critical care medicine in hospitals affiliated S universities are obvious, but the "growth effect" is not obvious. "Although the research efficiency of the 13th Five-Year Plan period has been significantly improved, there is still much room for improvement in scientific and technological innovation and international academic influence.

Analysis on the operation status of subspecialty of critical care medicine of hospital affiliated to Guizhou Medical University in the past 5 years / 中华危重病急救医学

Objective:Through retrospective analysis of the admission and treatment of patients in the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University over the past 5 years, it provides a basis for the construction of the subspecialty of intensive care medicine.Methods:Collect clinical data of patients admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from January 1, 2016 to December 31, 2020, including gender, age, first consultation department, intensive care unit (ICU) hospitalization time, ventilator use time, main diagnosis, acute physiology and chronic health evaluationⅡ(APACHEⅡ) when transferred into and out of ICU, treatment results, whether to give mechanical ventilation, whether to use a non-invasive ventilator to assist breathing, whether to die in 24 hours, rescue times and success rate, etc. Changes in the above indicators during the 5 years were analyzed.Results:In the past 5 years, our hospital has treated 2 668 patients in the comprehensive ICU with severe neurological, severe circulation, and severe trauma as the main treatment area, including 1 648 males and 1 020 females; aged 6 months to 94 years old, the average age (53.49±19.03) years old. Neurosurgery (907 cases) was the most frequently diagnosed department, the top 3 diseases were cerebral hemorrhage (539 cases), septic shock (214 cases), and hypovolemic shock (200 cases); ICU hospitalization time was 126 (52, 253) hours, ventilator time was 65 (17, 145) hours, APACHE Ⅱ scores were 23.29±8.12 and 12.99±6.37 when transferred into and out of ICU. The proportion of receiving mechanical ventilation was 92.94% (2 147/2 310), and 314 cases used non-invasive ventilators. 84 cases died within 24 hours (mortality was 3.15%). A total of 2 585 rescues were performed, and the rescue success rate was 92.84% (2 400/2 585). From 2016 to 2020, the 5-year cure rates were 65.92%, 65.83%, 61.53%, 65.64%, 69.06%, respectively, and the 5-year mortality were 13.13%, 14.29%, 18.89%, 16.69%, 13.38%, respectively.Conclusions:With the continuous expansion of critical care medicine, the establishment of classified subspecialties can focus on the admission of patients, so that treatment can be professionalized and standardized, improve the cure rate, and reduce mortality. At the same time, medical staff can focus on management and learning related expertise to master the disease, it is also more in-depth, which is helpful for doctors to improve themselves, and is conducive to the proficiency of related sub-specialties, and lays a good foundation for the development of the department.

Analysis of disease composition and outcome of patients in intensive care department of 3A hospitals: analysis of 3 249 cases in the department of Liaocheng People's Hospital from 2019 to 2021 / 中华危重病急救医学

Objective:To provide the basis and direction for the establishment of the database of severe patients by analyizing of the disease composition and outcome of patients in the department of critical care medicine of the 3A hospital.Methods:The clinical data of 3 249 patients admitted to the department of critical care medicine of Liaocheng People's Hospital from January 1, 2019 to December 31, 2021 were retrospectively analyzed, including gender, age, admission time, admission route, diagnosis, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score 24 hours after admission, outcome and other information.Results:The mean age of 3 249 patients was (61.99±18.29) years old, and the proportion of young and old patients aged 60-74 years accounted the largest (34.01%). There were more males (1 800 cases) than females (1 449 cases). The most patients were admitted in January (119 cases) and the least in March (75 cases). The top eight diseases in the department of critical care medicine were respiratory system diseases (21.88%), multiple injuries (12.65%), cardiovascular system diseases (11.48%), gastrointestinal surgery diseases (9.42%), pathological obstetrics (7.76%), digestive system diseases (7.63%), urinary system diseases (5.69%) and nervous system diseases (5.23%). Among 3 249 critically ill patients, 54.36% (1 766 cases) were transferred to the general ward for treatment after improvement, with APACHE Ⅱ score was 17.99±5.51. 15.91% (517 cases) returned to local hospital for further treatment after improvement, APACHE Ⅱ score was 22.48±6.57. 1.51% (49 cases) were transferred to superior hospitals, APACHE Ⅱ score was 21.71±5.18. 24.22% (787 cases) were discharged automatically, APACHE Ⅱ score was 25.64±5.45. 4.00% (130 cases) died in intensive care unit (ICU), APACHE Ⅱ score was 29.08±8.10. The APACHE Ⅱ score of patients who died in ICU was higher than that of patients who were transferred to another department, another hospital or discharged automatically after their condition improved, and the differences were statistically significant (all P < 0.001). Among 3 249 patients, a total of 1 265 patients were admitted to ICU for sepsis caused by aggravated infection, and 44.43% (562 cases) of the 1 265 patients improved to the general ward after treatment, with APACHE Ⅱ score was 18.99±5.46. 19.21% (243 cases) returned to local hospital after treatment with APACHE Ⅱ score was 22.79±6.74. 1.50% (19 cases) were transferred to superior hospitals for further treatment with APACHE Ⅱ score was 21.21±4.81. 31.54% (399 cases) were discharged automatically with APACHE Ⅱ score was 25.55±4.84; 3.32% (42 cases) died in ICU with APACHE Ⅱ score was 27.69±7.92. The APACHE Ⅱ score of patients who died in ICU was higher than that of patients who were transferred to another department, another hospital or discharged automatically after their condition improved, and the difference was statistically significant (all P < 0.001). Conclusions:Among the patient admitted to ICU 2019-2021 in Liaocheng People's Hospital, respiratory system diseases accounted for the first, multiple injuries accounted for the second place, followed by cardiovascular system diseases, gastrointestinal surgery diseases, pathological obstetrics, etc. Males and elderly patients aged 60-74 years have a higher proportion of severe cases. APACHE Ⅱ scores were associated with patients' prognosis.

International clinical research of critical care medicine in 2021 / 中华危重病急救医学

The progress of critical care medicine in 2021 is still encouraging. The new international guideline for management of sepsis and septic shock came out after 4 years. Besides, a couple of preferable clinical evidences were released including restrictive blood transfusion strategy for patients with acute myocardial infarction, prevention of peripheral venous catheter infection, heparin inhalation and driving pressure setting in patients with acute respiratory distress syndrome (ARDS), lower oxygenation target for acute hypoxemic respiratory failure, low level positive end-expiratory pressure in non-ARDS patients with respiratory failure, light sedation or non-sedation strategy, biological phenotypes, as well machine learning in sepsis and ARDS. However, we also encounter negative results such as balanced solution during fluid resuscitation, hypothermia therapy after out-of-hospital cardiac arrest or traumatic brain injury, adrenomedullin-specific antibody adrecizumab therapy and coupled plasma filtration-adsorption (CPFA) therapy for patients with septic shock, extracorporeal carbon dioxide removal (ECCO 2R) implementation in acute hypoxic respiratory failure, continuous infusion of hypertonic saline in patients with traumatic brain injury. Collectively, in the future, individualized diagnosis and management based on the principle of "wise choice" will become the daily practice scene for all intensivists.

Formation and development of discipline system of critical care medicine / 中华危重病急救医学

The discipline system of critical care medicine consists of the knowledge system and thinking system. The knowledge system includes a series of interrelated knowledge points. Knowledge points are relatively independent and smallest units in knowledge. In the process of development, critical care medicine has formed its own characteristic knowledge points based on the knowledge of medicine. Thinking system refers to the way of thinking which consists of various thinking modes linked inseparably. Thinking system provides an essential driving force for the formation and continuous development of knowledge system. The actual composition of critical care medicine discipline is the professionals who know well the thinking system and knowledge system of critical care medicine.