外科重症监测治疗.pptVIP

Type of ICU patients Intensive care is usually 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 support) acute renal failure potentially lethal cardiac dysrhythmias, frequently the cumulative effects of multiple organ system failure Type of ICU patients Terminal illness or irreversible Terminal cancer Permanent brain damage Infectious disease? SARS√ --management of mechanically ventilated severe acute respiratory syndrome (SARS) patients in the isolation intensive care unit (ICU)--successful cost ICU is generally the most expensive, technologically advanced and resource intensive area of medical care. In the United States estimates of the 2000 expenditure for critical care medicine ranged from US$15-55 billion accounting for about 0.5% of GDP and about 13% of national health care expenditure (Halpern, 2004). What do we do in ICU?--Treatment Hemodynamic support -inotrope and vasoactive medication Mechanical ventilation Organ support (eg.dialysis) Sedation and analgesia Treatment of underlying illnesses Enteral/parenteral nutrition Scoring System The most commonly utilized scoring systems are the APACHE (acute physiology and chronic health evaluation) system, the MPM (mortality probability model), the SAPS (simplified acute physiology score) system. These were all designed to predict outcomes in critical illness and use severity-of-illness scoring systems with common variables. These include age; vital signs; assessments of respiratory, renal, and neurologic function; and an evaluation of chronic medical illnesses APACHE acute physiology and chronic health evaluation APACHEⅡ 0～71 . More recently, the APACHE III scoring system has been released. This scoring system is similar to APACHE II, in that