移动ICU及呼吸机在急诊科的应用.ppt
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1、移动ICU呼吸机在急诊科的应用,瑞思迈(北京)医疗器械有限公司 医用产品市场部 吴易东 email: YidongW,什么是移动ICU?,什么是移动ICU (mobile ICU)?,-配备经过特殊培训的ICU水平的医务人员和必需的ICU水平的移动医疗设备的危重患者转运平台,如院内危重患者转运床、救护车、救护直升机、固定翼救援飞机等。,澳大利亚MedStar紧急救援中心固定翼救援飞机,Flying Intensivists + ICU device equipted FX plane,院内移动ICU,Mobile ICU,Dx or Tx,研发中的院前移动ICU (mobile ICU),岳茂
2、兴,夏锡仪,何东。流动便携式重症监护病房急救车的研制及其在灾害事故急救中的应用。中国危重病与急救医学杂志,2009;21(10):624-625。,流动便携式ICU急救车上医疗救护队人员由 各个专业的专家组成,身体健康,应该是全天候的医疗救护队,一般为45名,包括经过ICU专门训练的外科、麻醉科、内科、骨科医师及专业护理人员各1名。所有人员应该进行强化培训,达到一专多能。,专门的设备柜用于安装心电监护除颤仪、便携式麻醉机、吸引器、呼吸机等 中心供氧和供气系统,Javier Snchez Alejo*, Modoaldo Garrido Martn, Miguel Ortega-Mier,et
3、al. Mixed integer programming model for optimizing the layout of an ICU vehicle. BMC Health Services Research 2009, 9:224.,移动ICU的作用,移动ICU的作用,“在医学发展的今天,“移动ICU”早已不是多年前的一个梦想,已经成为重症医学专业人员应该认真组织、建设和落实的具体工作。” 可以从一个对照研究论文的计算来体会:如果某个地区每年有11000个重症患者需要接受医院间的转运,如若仅应用普通救护车转运,将有484位患者在转运12小时内死亡;若由专业人员进行转运,仅有66位患
4、者死亡,所以,一个专业化的人员梯队,加上必要的装备,可以在这个地区每年挽救400多条生命。 一个省乃至全国呢?!,刘大为,重症患者转运的专业化:一个移动ICU,中国危重病急救医学,2010,22:321322。,从国外文献对移动ICU的作用,Instead of a pharmacologic therapy with potential side effects despite their clinical experience, a dedicated intensive care (IC) ventilator mounted with an IC transport trolley (
5、a mobile ICU) could have been used to facilitate this high-risk air medical transport. with a doctor from the referring hospital, resulted in more stabile transports and a reduction in mortality during the first 12 hours from 7.7% to 3%. ICU mortality was not significantly different (35% versus 28%)
6、. It seems logical to use a specialist team and a mobile ICU for transport of more severely ill patients. -转运后头12小时的死亡率分别为3%(便携ICU呼吸机和移动ICU)和7.7% (普通转运),Van Lieshout EJ, Vroom MV.ICU transport: interhospital transport of critically ill patient with dedicated intensive care ventilator. Chest. 2005 Fe
7、b;127(2):688-9; author reply 689. Ligtenberg JJ, Arnold LG, Stienstra Y, et al. Quality of interhospital transport of critically ill patients: a prospective audit. Crit Care.2005 Aug;9(4):R446-51.,从国外文献看移动ICU的作用,Therefore, a mobile intensive care unit must accompany the patient and must include the
8、same monitoring capability and personnel available in the ICUDetermination must be made before departure concerning whether the patient will receive adequate support on a transport ventilator or will require transport with ICU ventilator. -因此,一个移动ICU应该伴随病人的转运并且应该包含在ICU相同的监测设备.,Reynolds HN, Habashi N
9、M, Cottingham CA, et al. Interhospital transport of the adult mechanically ventilated patient. Respir Care Clin N Am. 2002 8(1):37-50.,从国外文献看移动ICU的作用,CONCLUSIONS: Mobile ICU emerges as a safe and convenient method of in-hospital transport. It allows uninterrupted monitoring, immediate response to ph
10、ysiologic changes, and reduction in human resource consumption. Process of care is improved. Mobile ICU s potential to improve clinical outcomes needs to be tested in different environments, including the prehospital setting. 移动ICU是安全和方便的院内转运方式 移动ICU对临床结果的潜在好处还需要在不同的条件下测试,包括院前急救,Velmahos GC, Demetri
11、ades D, Ghilardi M, et al. Life support for trauma and transport: a mobile ICU for safe in-hospital transport of critically injured patients. J Am Coll Surg. 2004;199(1):62-8.,移动ICU (MICU)用于院内转运是法规和指南要求(荷兰),When looking at our data, transfer by MICU appears to be safe despite the high degree of seve
12、rity of disease. We, therefore, conclude that the safety of the current way of transporting the critically ill is warranted and that the MICU sets a major improvement in quality of care for the critically ill. -根据本文的数据,移动ICU是安全的转运方法,尽管病人严重程度很高 This observational study of MICU transfer shows that tra
13、nsfer by MICU is not associated with major deterioration in patient status and that the implementation of a transport protocol with a mobile Intensive Care Unit has led to an improvement in quality of care on the road, compared to the former way of transfer. -没有与转运有关的病情恶化,与常规方式相比,可以改善医疗质量,Janke S Wi
14、egersma, Joep M Droogh, Jan G Zijlstra, et al. Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team. Critical Care 2011, 15:R75-82.,移动ICU 用于危重患者转院是法规和指南要求(荷兰),From 2009 on, interhospital transfer has been performed by a Mo
15、bile Intensive Care Unit with a specialized retrieval team according to national ICU guideline and law. -根据国家的ICU指南和法规,从2009年起,医院之间的转运将由移动ICU及其专门的医疗团队来执行 Excessive deterioration in pulmonary status is not present in the ICU-transfer and has, therefore,shown improvement in the support of respiratory
16、status before and during transfer compared to transfer by standard ambulance. -严重的肺部情况恶化没有出现在移动ICU,与标准救护车相比,在转运前和转运中显示出更好的呼吸支持效果,Janke S Wiegersma, Joep M Droogh, Jan G Zijlstra, et al. Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialize
17、d retrieval team. Critical Care 2011, 15:R75-82.,非移动ICU医院内转运的不良事件发生,Janke S Wiegersma, Joep M Droogh, Jan G Zijlstra, et al. Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team. Critical Care 2011, 15:R75-82.,危重患者,循环系统: -
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