1、Intensive care unit,,What is ICU?,Anintensive care unit(ICU), also known as anintensive therapy unitorintensive treatment unit(ITU) orcritical care unit(CCU),is a special department of a hospital or health care facility that providesintensive care medicine.An intensive care unit (ICU) is a specially
2、 staffed and equipped hospital ward dedicated to the management of patients with life-threatening illnesses,injuries or complications.,,History,1852年，Florence Nightingale在克里米亚战争期间，就把可望救活的重伤员安置在最靠近护士站的地方，以加强巡视和及时救治，并主张把术后的患者安置在近手术室的小房间内，度过恢复期后再送回病房。 1863年护理学先驱南丁格尔撰文：“在小的乡村医院里，把病人安置在一间由手术室通出的小房间内，直至病人
3、恢复或至少从手术的即时影响中解脱的情况已不鲜见”。这种专门为术后病人开辟的“小房间”即被认定为ICU的雏形。 1923年，Dandy在美国为脑外科病人开辟术后恢复室。1930年Kirschner在德国创建手术恢复室与ICU混合型病房。 第二次世界大战期间，在欧洲以及军队中逐步建立起创伤单位。1943年建立休克病房。1942年开辟烧伤病房(BurnsUnit)。1945年建立产后恢复室。 1952年丹麦哥本哈根发生脊髓灰质炎大流行，并发呼吸衰竭的患者大量死亡，人工气道持续的手法通气及后期Engstrom呼吸器的应用，使病死率由87%下降至40%以下，随后多家医院相继开设了ICU，并激发了危重病医
4、学的崛起，这是医学发展史上的一个里程碑。,,History of ICU,In 1854,Florence Nightingaleleft for aCrimean War, wheretriageused to separate seriously wounded soldiers from the less-seriously wounded, was observed. Until recently,it was reported that Nightingale reduced mortality from 40% to 2% on the battlefield. Florence
5、Nightingale在克里米亚战争期间，就把可望救活的重伤员安置在最靠近护士站的地方，以加强巡视和及时救治，并主张把术后的患者安置在近手术室的小房间内，度过恢复期后再送回病房。,,Although this was not the case, her experiences during the war formed the foundation for her later discovery of the importance of sanitary conditions in hospitals, a critical component of intensive care.,,,,In
6、 1950,anesthesiologistPeter Safarestablished the concept of Advanced Support of Life, keepingpatientssedated and ventilated in an intensive care environment. Safar is considered to be the first practitioner of intensive care medicine as a speciality. In response to apolioepidemic(where many patients
7、 required constant ventilation and surveillance),,Bjrn Aage Ibsenestablished the first intensive care unit inCopenhagenin 1953.345The first application of this idea in the United States was in 1955 by Dr. William Mosenthal, a surgeon at theDartmouth-Hitchcock Medical Center.6In the 1960s, the import
8、ance ofcardiac arrhythmiasas a source ofmorbidityandmortalityinmyocardial infarctions(heart attacks) was recognized. This led to the routine use of cardiac monitoring in ICUs, especially after heart attacks.7,,Category of ICU,Neonatal intensive care unit(NICU)Pediatric intensive care unit(PICU) Psyc
9、hiatric intensive care unit(PICU)Coronary care unit(CCU) Medical intensive care unit(MICU) Neurological intensive care unit(Neuro ICU) Trauma intensive care unit(Trauma ICU) Post-anesthesia care unit(PACU) High dependency unit (HDU) Surgical Intensive Care Unit (SICU),,综合性ICU (general ICU)、专科ICU SIC
10、U 外科ICU(surgery ICU) CICU，冠心病ICU(coronary intensive care unit, CCU) RICU，呼吸系统疾病ICU(respiratory intensive care unit, RCU) EICU，急诊ICU(emergency care unit) NICU，新生儿ICU(neonatalICU) 心肺重症监护治疗病房(CPICU)心脏外科重症监护治疗病房(CSICU)神经外科重症监护治疗病房(NSICU)危重肾病重症监护治疗病房(UICU),,Type of ICU patients,Intensive care is usually
11、only offered to those whose condition is potentially reversible and who have a good chance of surviving with intensive care support. Patients requiring intensive care usually require support for hemodynamic instability (hypertension/hypotension) airway or respiratory compromise (such as ventilator s
12、upport) acute renal failurepotentially lethal cardiac dysrhythmias, frequently the cumulative effects of multiple organ system failure,,Terminal illness or irreversibleTerminal cancerPermanent brain damage,,Gerneral ICU ward,,Equipment and systems,,,Equipment and systems,Common equipment in an ICU i
13、ncludesmechanical ventilatorsto assist breathing through anendotracheal tubeor atracheostomy tube; cardiac monitors including those withtelemetry; externalpacemakers;defibrillators;dialysisequipment forrenalproblems; equipment for the constantmonitoringof bodily functions; a web ofintravenous lines,
14、 feeding tubes,nasogastric tubes, suction pumps, drains, andcatheters; and a wide array ofdrugsto treat the primary condition(s) of hospitalization.Medically induced comas,analgesics, andinduced sedationare common ICU tools needed and used to reducepainand preventsecondary infections.,,,,,,What do w
15、e do in ICU?,monitoringECG heart rate, rhythm, ischemiaBlood pressure non-invasive invasive arterial,central venous, pulmonary arteryHemodynamic measurement cardiac outputPulse oxymetry and capnographyIntracranial,intraabdominal pressureMany others electrolyte, CNS,,What do we do in ICU?-Treatment,H
16、emodynamic support -inotrope and vasoactive medicationMechanical ventilationOrgan support (eg.dialysis) Sedation and analgesiaTreatment of underlying illnessesEnteral/parenteral nutrition,,,,Quality of care,The available data suggests a relation between ICU volume and quality of care for mechanicall
17、y ventilated patients.10After adjustment for severity of illnesses,demographicvariables, and characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was significantly associated with lower ICU and hospitalmortality rates. A ratio of 2 patients to 1 nurse is recomm
18、ended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical floors. This varies from country to country, though; e.g., in Australia and the United Kingdom most ICUs are staffed on a 2:1 basis (for high-dependency patients who require closer monitoring or more intens
19、ive treatment than a hospital ward can offer) or on a 1:1 basis for patients requiring very intensive support and monitoring; for example, a patient on a mechanical ventilator with associated anaesthetics or sedation such aspropofol,midazolamand use of strong analgesics such asmorphine,fentanyland/orremifentanil.,,Gerneral ICU ward,,,,,,,
