Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 81
Filter
1.
Article in Chinese | WPRIM | ID: wpr-912838

ABSTRACT

Cloud technology and the Internet of things ( IOT) technology can be used in building the patient-centered critical care medical information platform.The platform could inenable medical staff to efficiently obtain critical care medical information, and raise critical patients′ cure rates. The authors introduced the critical process of rapidly building and improving the urgent care medical information integration platform in a campus of the First Affiliated Hospital of Zhejiang University Medical School.The IOT platform could effectively interconnect a variety of critical care medical equipments, and features such functions as vital signs monitoring and life support, bedside treatment data retrieval, remote diagnosis and treatment, and cloud sharing. The platform featured the advantages of complete information integration, fast construction, and satisfactory system extensibility. It could improve the medical work efficiency, improve the effect of critical care, and reduce the frequency of contact with patients, hence providing references for rapidly establishing a vital care treatment platform for public health events.

2.
Article in Chinese | WPRIM | ID: wpr-912704

ABSTRACT

Objective:To summarize the achievements in standardized development of pulmonary and critical care medicine discipline, for references of developing respiratory discipline at secondary and tertiary hospitals.Methods:Questionnaire survey was used to understand the input and technical promotion of the secondary and tertiary medical institutions in the standardized construction.Results:The secondary and tertiary medical institutions invested 1.116 billion yuan to carry out standardized development of the discipline, recruiting 1 164 doctors, 2 535 nurses and 334 technicians. In terms of key medical technologies, 58 tertiary medical institutions and 45 secondary medical institutions meet the basic standards of " guidance on medical service capacity of respiratory discipline(2018 edition)" after carrying out standardized development.Conclusions:The discipline of pulmonary and critical care medicine should continue to strengthen its input in the development of respiratory and critical medical integration, with standardized development projects as the breakthrough. Evaluation should be carried out persistently so as to promote the development, for the purpose of improving the prevention and treatment capability of pulmonary and critical care medicine.

3.
Chinese Critical Care Medicine ; (12): 1153-1158, 2021.
Article in Chinese | WPRIM | ID: wpr-909473

ABSTRACT

The Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021 (2021 guideline) was recently released. The guidelines summarized the evidences from literatures through to July 2019, and composed by 6 parts as "screening and early treatment", "infection", "hemodynamic management", "ventilation", "additional therapies" and "long-term outcomes and goals of care" with a total of 93 items and 99 recommendations. Compared with the 2016 guideline (96 recommendations), although the total number of recommendations in the 2021 guideline is similar, the number of "strong recommendations (recommend)" in 2021 guideline has dropped significantly, while as the number of "weak recommendations (suggest)" has increased significantly, and the level of the quality of evidence on which the recommendations are based has been significantly lowered. Furthermore, 2021 guideline has also markedly deleted or simplified the recommendations regarding infection prevention, acute respiratory distress syndrome (ARDS) treatment, nutritional support and so on. While, the most obvious improvement appears in the segment of "long-term outcomes and goals of care", in which the patients and their families could get help in term of determining their physical rehabilitation and discharge follow-up plans and formulating exact goals of care. 2021 guideline did not adopt new and emerging therapies or treatments, such as metagenomic next-generation sequencing (mNGS), diaphragm protective ventilation, timing of initiating renal replacement therapy for acute kidney injury, early mobility, endotoxin adsorption, tranexamic acid, E-medicine and telemedicine, big data & artificial intelligence and other new therapies. Collectively, it may suggest the 2021 guideline tend to be conservative and simplified rather than fairly optimized and logicalized, which may arouse controversy in the future and affect clinician compliance.

4.
Chinese Critical Care Medicine ; (12): 1003-1006, 2021.
Article in Chinese | WPRIM | ID: wpr-909443

ABSTRACT

Objective:To summarize critical cases of emergency helicopter transferring between hospitals and improve the quality and safety of critical care.Methods:The task records of Guangxi Aviation Medical Rescue Training Base from September 2017 to September 2020 were retrieved. The mission acceptance, implementation results, disease spectrum composition, pre-transfer preparation and medical intervention on board were summarized.Results:① General information: a total of 168 patients of helicopter transfer requests were registered, of which 36 patients were transferred, 35 patients were successful, 1 patient had cardiac arrest during the landing phase, and died several hours after continuous resuscitation. Of the 36 patients 30 were males and 6 were females, with median age of 50.5 (29.8, 66.0) years old, the average transfer time was (54.95±17.89) minutes, and the average transfer distance was (205.74±74.68) km. ② Disease spectrum included 11 cases of stroke (30.55%), 7 cases of trauma (19.45%), 5 cases of severe pneumonia (13.89%), 5 cases of heart and macro-vascular diseases (13.89%), 5 cases of abdominal emergency (13.89%), and 3 other conditions (8.33%).③ Severity: 31 patients (86.11%) were severe (≥15) according to acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score; 19 patients (52.78%) were high-risk emergency transport (≥6) according to Hamilton early warning score (HEWS); 6 patients (85.71% of trauma patients) were severe trauma (≥16) according to injury severity score (ISS). ④ Preparation before transfer: remote consultation was carried out to evaluate the latest state of the patient's condition, especially the respiratory and circulatory conditions. Relevant items were reviewed and emergency treatments were implemented when necessary. Targeted preparation was made for accidents that might occur during transfer, such as electrocardiogram (94.44%), blood gas analysis (94.44%), brain CT (36.11%) and other auxiliary examinations, endotracheal intubation or tracheotomy (72.22%), deep vein catheterization (91.67%), placement of gastric tube (86.11%) and urinary tube (88.89%), adjustment of sedative (38.89%), vasoactive drugs (58.33%) and drugs for dehydration and lowering intracranial pressure (33.33%), and fixation of fracture (11.11%), etc. ⑤ On-board medical intervention: cardiac monitoring, blood pressure, respiration and blood oxygen monitoring were carried out in all patients. The parameters of patients using ventilator were adjusted in time (66.67%). The dosage of patients using micropump was adjusted in time (91.67%). Other aspects included the use of sedative and analgesics (38.89%), sputum suction nursing (75.00%), all kinds of catheter nursing (endotracheal intubation/incision nursing of 72.22%, indwelling catheter nursing of 88.89%), and cardiopulmonary resuscitation for patient with cardiac arrest (2.78%).Conclusion:As the patients transferred by helicopter are mainly those of critically ill at this stage, the requirements for airborne medical equipment and rescue technology are high, and there is an urgent need to establish technical specifications and personnel training standards.

5.
Article in Chinese | WPRIM | ID: wpr-908894

ABSTRACT

Objective:To explore the effect of mini-clinical evaluation exercise (MiniCEX) and direct observation of procedural skills (DOPS) formative evaluation in standardized residency training of respiratory and critical care medicine.Methods:The residents who participated in standardized residency training of Zhongshan Hospital, Fudan Unviersity in 2019 were collected in study group, and the residents received the training in previous were collected in control group. The graduation examination scores, the effect of progressive rotations and the satisfaction of residents and examiners were compared between the two groups.Results:The scores of medical history writing, operation and clinical abilities were higher in the study group who were received MiniCEX-DOPS formative evaluation than those in the control group ( P<0.05). The scores of MiniCEX-DOPS evaluation in the third rotation were better than those in the first rotation ( P<0.05). The residents and examiners were generally satisfied with MiniCEX-DOPS evaluation. Conclusion:MiniCEX-DOPS evaluation is effective in residents training of respiratory and critical care medicine, and it is worth popularizing.

6.
Clinics ; 75: e1894, 2020. graf
Article in English | LILACS | ID: biblio-1101090

ABSTRACT

This review aims to verify the main epidemiologic, clinical, laboratory-related, and therapeutic aspects of coronavirus disease 2019 (COVID-19) in critically ill pediatric patients. An extensive review of the medical literature on COVID-19 was performed, mainly focusing on the critical care of pediatric patients, considering expert opinions and recent reports related to this new disease. Experts from a large Brazilian public university analyzed all recently published material to produce a report aiming to standardize the care of critically ill children and adolescents. The report emphasizes on the clinical presentations of the disease and ventilatory support in pediatric patients with COVID-19. It establishes a flowchart to guide health practitioners on triaging critical cases. COVID-19 is essentially an unknown clinical condition for the majority of pediatric intensive care professionals. Guidelines developed by experts can help all practitioners standardize their attitudes and improve the treatment of COVID-19.


Subject(s)
Humans , Male , Female , Child , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Betacoronavirus , Time Factors , Severity of Illness Index , Positive-Pressure Respiration/methods , Critical Illness , Coronavirus Infections/metabolism , Clinical Laboratory Techniques , Reverse Transcriptase Polymerase Chain Reaction , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Diagnosis, Differential , Pandemics , COVID-19 Testing , SARS-CoV-2 , COVID-19
7.
Organ Transplantation ; (6): 185-2020.
Article in Chinese | WPRIM | ID: wpr-817592

ABSTRACT

In December 2019, a number of cases of pneumonia with unknown causes were successively reported in multiple hospitals in Wuhan City, Hubei Province, China. The pathogen is a novel coronavirus, which can lead to novel coronavirus pneumonia (COVID-19) and even threaten the patients' lives. In the following, the COVID-19 epidemic is spreading rapidly in many provinces and cities. It is particularly important to summarize and analyze the clinical characteristics of COVID-19 in solid organ transplantation (SOT) recipients and to optimize the prevention, early diagnosis and treatment strategies. Therefore, we organized Chinese experts in the field of organ transplantation to draft this article according to the characteristics of lung infection of SOT recipients and the characteristics of current COVID-19 by referring to relevant guidelines and specifications at home and abroad, aiming to provide reference for transplant physicians in China. This management strategy will be revised at any time with the deepening understanding of the COVID-19 infection.

8.
Organ Transplantation ; (6): 179-2020.
Article in Chinese | WPRIM | ID: wpr-817591

ABSTRACT

In December 2019, a novel coronavirus pneumonia outbreak in Hubei Province spread rapidly to many provinces and cities. As organ transplantation is in the stage of high-quality development in China, how to carry out organ donation and transplantation in a scientific and orderly manner during the severe epidemic, summarize and analyze the clinical characteristics of COVID-19 on organ transplant recipients, and optimize the prevention, early diagnosis and treatment strategies of COVID-19 to ensure medical safety is essential to the development of organ transplantation and the treatment of the patients with end-stage organ failure as well as the overall situation of the prevention and control of COVID-19 epidemic. Thus, based on the instructions of the National Health Committee, the guidelines are issued by several experts organized by Branch of Organ Transplantation of Chinese Medical Association, providing help to the workers and managers of organ donation and transplantation in China. Approved by the Standing Committee of Branch of Organ Transplantation of Chinese Medical Association, the guidelines adopt the 'expert advice', 'prevention and control strategies' and 'guidance' published in China for reference, and will be revised upon changes of the further understanding of COVID-19 and epidemic control situation.

9.
Infectio ; 23(4): 307-312, Dec. 2019. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1019861

ABSTRACT

Abstract Objective: The goal of this study was to compare the microbiology of severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring admission to the intensive care unit (ICU), in patients with pneumonia compared to those that did not have. Methods: We conducted a retrospective cross-sectional study that included patients with severe COPD exacerbation. We took microbiologic and serologic samples to study the etiology of the exacerbation and chest X-ray to see whether or not it had associated pneumonia. Results: Ninety-one patients were included in the study. 53/91 (58%) had pneumonia. The most prevalent bacteria isolated were H. influenzae (25.3%), Moraxella spp (22%), H. parainfluenza (14.3%), Serratia marcescens (13.2%), mixed flora (9.9%) and methicillin-susceptible Staphylococcus aureus (9.9%). A statistically significant difference could not be demonstrated between the two groups. We detected 24.2% of bacterial resistance in both groups, the most frequent being AMPc (13 cases). Discussion: Bacterial pneumonia in COPD patients is higher in comparison with patients with acute exacerbation. Even though we did not find a significant difference in the microbiology of the groups with or without pneumonia, there are variables such as past smoking related to having pneumonia. Patients with pneumonia also had higher severity scores.


Resumen Objetivo: Comparar la microbiología de las exacerbaciones graves de EPOC (Enfermedad Pulmonar Obstructiva Crónica) que requieren ingreso a la unidad de cuidados intensivos, con y sin neumonía Métodos: se realizó un estudio transversal retrospectivo que incluyó pacientes con exacerbación grave de EPOC que requieren ingreso a la Unidad de Cuidados Intensivos (UCI). Tomamos muestras microbiológicas y serológicas para estudiar la etiología de la exacerbación y radiografía de tórax para ver si tenía o no una neumonía asociada. Seguimos a los pacientes durante su ingreso en la UCI y evaluamos el resultado de la hospitalización. Resultados: se incluyeron 91 pacientes en el estudio. 53/91 ( 58%) tuvieron confirmación de neumonía. Las bacterias más prevalentes aisladas fueron H. influenzae (25.3%), Moraxella spp (22%), H. parainfluenza (14.3%), Serratia marcescens (13.2%), flora mixta (9.9%) y S. aureus meticilino sensible. (9.9% ). No se pudo demostrar una diferencia estadísticamente significativa entre los dos grupos. Detectamos una resistencia bacteriana del 24,2% en ambos grupos, siendo la más frecuente AMPc (13 casos). Discusión: la neumonía bacteriana en pacientes con EPOC es más alta cuando se compara con pacientes con exacerbación aguda. Aunque no encontramos una diferencia significativa en la microbiología de los grupos con o sin neumonía, existen variables como antecedente de cigarrillo asociadas a tener neumonía. Los pacientes con neumonía así mismo tuvieron mayores índices de severidad.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Recurrence , Critical Care , Pulmonary Disease, Chronic Obstructive , Microbiology , Pneumonia , Smoking , Cross-Sectional Studies
10.
Chinese Critical Care Medicine ; (12): 403-406, 2019.
Article in Chinese | WPRIM | ID: wpr-753981

ABSTRACT

Critical care medicine is an important part of modern medicine and has become an important comprehensive second-level discipline of clinical medicine. The department of critical care medicine of the Affiliated Hospital of Guizhou Medical University was established in 1994. After 24 years of development, there are currently 90 beds, 6 sub-specialties (including comprehensive ICU A, B, C 3 subspecialties, internal ICU, emergency ICU, pediatric ICU) of the third-level intensive medical discipline development model, involve severe nervous system, severe circulatory system, severe environmental disorders, severe trauma, severe digestion, severe kidney, severe immunity, severe endocrine, severe respiratory disease, severe infection, severe obstetric disease, severe poisoning, and there are corresponding talent echelons. The three-level discipline construction model has been explored and operated for more than three years. The hospital's critical care medicine discipline has established a larger professional discipline in southwestern China. The rapid and standardized development of critical care medicine in an all-round way was promoted, so as to lead the rapid development of critical care medicine in hospitals, cities, provinces and even surrounding provinces, and to achieve mutual learning, complementary advantages, resource sharing, win-win cooperation and coordinated development.

11.
Chinese Critical Care Medicine ; (12): 400-402, 2019.
Article in Chinese | WPRIM | ID: wpr-753980

ABSTRACT

With the rapid development of modern science and technology, the treatment level of all disciplines of modern medicine has been rapidly improved. The number of critically ill patients in large third-level first-class general hospitals is increasing day by day. Intensive care unit (ICU) has become an important embodiment of the comprehensive strength of a hospital, especially the affiliated hospital of medical university or a tertiary hospital. This paper aims to discuss the role, status and contribution of critical care medicine in the development and construction of modern medicine and general hospitals, the relationship between hospital management and critical care medicine management, and the future development and construction direction of critical care medicine from the perspective of the managers of third-level first-class general hospitals.

12.
Chinese Critical Care Medicine ; (12): 266-268, 2019.
Article in Chinese | WPRIM | ID: wpr-753953

ABSTRACT

Critical care medicine is a relatively young, fast-growing discipline, but it also bears the burden of heavy life. In the past 10 years, critical care medicine has made rapid progress. It has been growing to be mature and complete, its environment and equipment have been improved, and the technical ability has been continuously upgraded. However, the rapid improvement and the diversification of management modes have also brought about some concerns about medical quality. Xinyang Central Hospital is a large prefecture-grade tertiary-class A general hospital in Henan Province. As the director of the department of critical care medicine and the discipline leader of critical care medicine in Xinyang City, the author shared his opinion about how to establish a "standardized, institutionalized and procedural"management model from the perspective of department management in order to ensure medical quality and safety. We should "start from the quality control of critical care medicine, implement the concept of critical care through ward rounds, supervise the quality from the self-examination and self-correction of adverse events", in order to establish a management system for critical care patients and lay a foundation for improving medical quality and sustainable developing of critical care medicine.

13.
Chinese Critical Care Medicine ; (12): 264-265, 2019.
Article in Chinese | WPRIM | ID: wpr-753952

ABSTRACT

The level of critical care medicine is an important index to measure the comprehensive strength of a modern hospital, and it is also a mirror to reflect the level of hospital management. Xinyang City of Henan Province is an old revolutionary district. Xinyang Central Hospital is a prefecture-grade tertiary-class A hospital which is certificated early in Henan Province and the leading unit of the medical and health system in Xinyang. How to build a powerful specialty of critical care medicine to provide a guarantee basis for all disciplines of the hospital and critically ill patients in the city? This needs the considerations of hospital managers. Only through keeping a clear mind, taking the protection of the health of the whole city as the first priority, learning advanced concepts and management experiences continuously, and taking responsibility bravely, we can keep up with the pace of the development of critical care medicine in the whole province and even in the whole country.

14.
Article in Chinese | WPRIM | ID: wpr-774592

ABSTRACT

Mufangji Decoction is a famous herbal formula from Synopsis of Golden Chamber. However,it is easy to be misunderstood due to so its unique compatability. The syndromes treated by Mufangji Decoction included the following aspects:(1) in terms of modern medicine,it could be used to treat acute and chronic heart failure,heart failure aggravated by lung infection,chronic obstructive pulmonary disease acute episode,pulmonary heart disease,bilateral pleural effusion,acute attack of gout,rheumatic fever,rheumatoid arthritis,and rheumatoid arthritis;(2) in terms of symptoms,it could be used to treat asthma,chest tightness,wheeze impacting prostration and dyspnea impacting sitting posture; gastric distention; dark face,cyanotic,and mitral valvular face; edema of head and extremities; dry mouth,thirsty,unwilling to wear thick clothes,intolerance of heat,and irritable; fatigue,shortness of breath,poor appetite,constipation,less urine,yellow color,poor response to diuretics,and diuretic resistance; fast heart rate,which is hard to be controlled by Western medicine and has no response to Zhenwu Decoction; dark red tongue,dry tongue with yellow fur,rapid pulse,or deep tight pulse. In emergency and severe cases,Yang deficiency and fluid retention are normal syndromes of heart failure,while Yang deficiency,fluid retention,and heat are metamorphic syndromes of heart failure,which possessed complex mechanisms of pathophysiology; the mechanisms of Shaoyin heat-conversion syndrome is similar to Yang deficiency,fluid retention,and heat syndrome; the reason of application of gypsum in Mufangji Decoction shall be further studied; the " empty" and " real" in modified Mufangji Decoction are physical signs,rather than pathogenesis.


Subject(s)
Drugs, Chinese Herbal , Therapeutic Uses , Heart Failure , Drug Therapy , Humans , Yang Deficiency , Drug Therapy
15.
Chinese Critical Care Medicine ; (12): 143-145, 2019.
Article in Chinese | WPRIM | ID: wpr-744686

ABSTRACT

With?the?establishment?of?clinical?second-level?discipline?status,?the?development?of?critical?care?medicine?in?China?has?entered?a?rapid?stage.?Compared?with?the?advanced?provinces?in?China,?the?construction?of?critical?care?medicine?in?Henan?Province?started?late?but?developed?rapidly.?In?addition?to?the?hospital?treatment?of?severe?patients,?critical?care?medicine?has?played?an?important?role?in?the?past?natural?disasters?and?public?health?emergencies.?The?First?Affiliated?Hospital?of?Zhengzhou?University?is?the?hospital?to?establish?the?critical?care?discipline,?which?has?led?and?witnessed?the?establishment?and?development?of?the?critical?care?medicine?specialty?in?the?whole?province.?However,?opportunities?and?challenges?coexist,?and?there?are?still?problems?and?difficulties?in?the?development?of?critical?care?medicine,?which?need?our?thinking?and?solving.

16.
Chinese Critical Care Medicine ; (12): 139-142, 2019.
Article in Chinese | WPRIM | ID: wpr-744685

ABSTRACT

Critical?care?medicine?plays?an?important?role?in?public?health?emergencies,?major?disasters?and?treatments?of?critically?ill?patients?as?an?emerging?clinical?discipline.?Our?hospital?put?critical?care?medicine?in?an?important?position?and?apply?multiple?measures?under?the?guidance?of?the?spirit?of?graded?diagnosis?and?national?medical?system?reform?combined?with?our?concept?of?"more?detailed,?more?excellent,?high?quality?and?sustainable?development".?Our?hospital?promote?rapid,?high-quality?sustainable?development?of?critical?care?by?increasing?discipline?construction,?scientific?research,?professional?training,?talent?introduction,?academic?exchange,?information?construction,?and?precision?medical?treatment,?etc.

17.
Chinese Critical Care Medicine ; (12): 108-111, 2019.
Article in Chinese | WPRIM | ID: wpr-744678

ABSTRACT

Objective To investigate the current state of sedation,analgesia and blood glucose management in intensive care units (ICUs) of county hospitals in Guizhou Province of China,and to provide the evidences for improving quality control in critical care medicine.Methods In March 2018,3-4 ICUs of hospitals in every prefecture (one hospital per county) in Guizhou Province were visited to do the field survey.The patients' nursing records within 24 hours after ICU admission were reviewed,and the information such as gender,age,major diagnosis at the ICU admission,the time of admission,were collected.Moreover,the conditions about sedation and analgesia drug use and monitoring,blood pressure,blood glucose as well as and the usage of insulin and ventilator were recorded.Because not all the needed information of every ICU or patient was obtained,only the numbers of the ICUs and patients whose required information had been obtained were analyzed.Results Twenty-eight county hospitals in nine prefectures of Guizhou Province and 152 ICU patients were surveyed.There was a median of 5 (4,7) patients stayed in every ICU on the day of survey.A total of 152 patients were enrolled,with 102 male (67.1%) and 50 female (32.9%);the median age was 65.0 (51.5,74.8) years old;the major diagnosis at ICU admission was mainly cerebral diseases which accounted for 50.0% (76/152),and the second place was digestive system diseases which accounted for 13.8% (21/152);53.8% (78/145) of patients were admitted to ICUs during 08:00-18:00.The percentages of ICUs which had patients received sedation and analgesia were 92.6% (25/27) and 88.9% (24/27) respectively,while only 44.4% (12/27) and 18.5% (5/27) of them were evaluated the depth of sedation and the level of pain respectively.There was 49.0% (71/145) of patients received sedation,and 33.8% (24/71) of them was evaluated by sedation scores;49.7% (72/145) of patients received analgesia,and 13.9% (10/72) of them were evaluated by pain scores.The proportions of invasive mechanical ventilation in the patients with sedation or analgesia were both higher than those in the patients without sedation or analgesia [sedation compared with non-sedation:85.9% (61/71) vs.21.6% (16/74),analgesia compared with non-analgesia:87.5% (63/72)vs.19.2% (14/73),both P < 0.01].The incidence of hypotension was similar between the sedated patients and the non-sedated patients [55.9% (38/68) vs.40.3% (29/72),P > 0.05],while the incidence of hypotension was higher in the patients with analgesia as compared with that in the patients without analgesia with significant difference [56.9% (41/72) vs.38.2% (26/68),P < 0.05].Within 24 hours after ICU admission,there were 40.7% (59/145) and 5.5% (8/145)of patients had hyperglycemia (random blood glucose level ≥ 11.1 mmol/L) or hypoglycemia (random blood glucose level <≤ 3.9 mmol/L) respectively.No insulin was used to control the blood glucose level in the patients who had hypoglycemia or did not have hyperglycemia.However,only 23.7% (14/59) of patients with hyperglycemia were treated with insulin,the initiation of insulin therapy was triggered when median blood glucose level was 19.8 (16.8,24.5) mmol/L.Conclusions The evaluation of analgesia and sedation in the ICUs of county hospitals in Guizhou Province was seriously inadequate and needed to be strengthened urgently.Moreover,the strategy of blood glucose management was also needed to be improved.

18.
Chinese Critical Care Medicine ; (12): 102-107, 2019.
Article in Chinese | WPRIM | ID: wpr-744677

ABSTRACT

Objective To explore the effective strategies of clinical pathway construction in intensive care unit (ICU).Methods From January 2016 to July 2018,1 488 patients were discharged from ICU of Liuzhou Worker's Hospital of Guangxi Zhuang Autonomous Region.The pilot project of "postoperative monitoring of heart disease" with simpler route and less variation was selected first,and then the pilot project was promoted to "post-operative monitoring" after its success.The implementation of the clinical pathway was divided into three stages:the first stage,January 2016 to May 2017,for the pilot phase,a total of 87 patients were enrolled in the clinical pathway trial;the second stage,June 2017 to December 2017,surgical ICU "postoperative monitoring of heart disease" was put into the pathway 111 times;the third stage,January 2018 to July 2018,surgical ICU "postoperative monitoring of heart disease" was entered in the path 116 times;comprehensive ICU "postoperative care" was put into the path 96 times.After carefully analyzed the reasons and sum up the experience,internet+medical treatment (Liuzhou Worker's Hospital became the fifih deep partner of Tencent Inc in the internct+medical field,and carried out the plan and practice of "WeChat wisdom hospital 3.0" in 2017) was used,four aspects of connection,payment,security and ecological cooperation were upgraded,and the construction of 6 level of electronic medical record (EMR) was accelerated.At the same time,through diagnosis related groups system (DRGs),the concept of evidence-based medicine,quality management and continuous improvement as the leading factor,and combined with the construction status of hospital information system (HIS) and EMR system,step by step implementation and design of information management platform for clinical pathway were formulated.The completion rate of clinical pathway,average length of hospital stay,average cost,cure rate and improvement rate were the main observation parameters.Results In the first stage,none of the 87 patients who entered the clinical pathway completed the clinical pathway.In the second stage,the completion rate of surgical ICU clinical pathway was increased from 33.33% in June 2017 to 94.44% in December 2017,and up to 100% in October 2017,and the average completion rate from January to July 2018 was 94.00%.The completion rate of ICU clinical pathway was increased from 81.82% in January 2008 to 92.86% in July 2008.There was a significant difference in the overall clinical pathway completion rate from 2016 to 2018 (x2 =204.300,P =0.000).After the effective implementation of clinical pathway in June 2017,the length of hospital stay of patients was significantly shortened as compared with that before implementation (days:2.96 ± 0.43 vs.6.66 ± 0.75,P < 0.01),and the daily cost was significantly reduced (Yuan:3 550.92 ± 755.51 vs.6 171.48 ± 377.29,P < 0.01).The average length of hospital stay was shortened by about 3.84 days (P < 0.01),and the average daily cost was reduced by about 2 108.39 Yuan (P < 0.01) after the implementation of clinical pathway by surgical ICU "postoperative monitoring of heart disease" as compared with those before implementation.The average length of hospital stay was shortened by about 2.98 days (P < 0.01) and the average daily cost was reduced by 5 094.13 Yuan (P < 0.01) after the implementation of clinical pathway by comprehensive ICU "post-operative monitoring" as compared with those before implementation.At the same time,the cure rate was increased from 1.16% (7/603) to 42.26% (105/227),and the improvement rate was decreased from 94.36% (569/603) to 52.86% (120/227,both P < 0.01) after the implementation of surgical ICU clinical pathway,but there was no significant difference in the cure rate or the improvement rate after the implementation of comprehensive ICU [2.77% (33/1 193) vs.2.22% (2/90),79.21% (945/1 193) vs.97.78% (88/90),both P > 0.05].Conclusions Application of clinical pathway to control ICU quality and guide diagnosis and treatment,more refined diagnosis and treatment schemes including clinical guidelines,average length of stay,average cost of hospitalization,cost-efficiency ratio and so on were completed,which confirmed that the improvement of clinical pathway management strategy originated from clinical were needed.Informatization,intellectualization,standardization and effective control of medical cost of clinical pathway could improve medical quality and accurate management.The integration of ICU clinical pathway construction and HIS could promote the development of digital hospitals.

19.
Article in Chinese | WPRIM | ID: wpr-744660

ABSTRACT

With the continuous advancement of modern medical science and technology,critical care medicine is getting more and more attention from hospital administrators,and has become an important embodiment of the comprehensive strength of a hospital,especially a university affiliated hospital or a third-grade class-A hospital.This paper aims to explain the status,role,contribution and construction approaches of critical care medicine in modern medicine and modem general hospitals from the perspective of third-grade class-A hospital administrators,and to propose noteworthy key links for future construction of critical care medicine based on actual situation.

20.
Article in Chinese | WPRIM | ID: wpr-744658

ABSTRACT

Critical therapy is a goal-directed personalized treatment according to the real-time changes of critical illness and the body's response to intervention,based on the theory of critical care medicine.The combination of a unified theoretical system and different interventional options for each patient promotes therapeutic process.The continuous completion of basic research and clinical evidence expands the basic theory of critical care medicine.At the same time,the rapid increase of bedside monitoring information will lead to a deeper understanding of critical illness.The personalized critical therapy is moving towards more feasible and accurate,and is promoting the overall development of critical care medicine.

SELECTION OF CITATIONS
SEARCH DETAIL