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中华重症医学电子杂志 ›› 2019, Vol. 05 ›› Issue (04) : 297 -301. doi: 10.3877/cma.j.issn.2096-1537.2019.04.001

所属专题: 重症医学 文献

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重症监护:有的放矢,过犹不及
李文哲1, 崔建2, 于湘友2,()   
  1. 1. 200011 上海交通大学医学院附属第九人民医院普通外科
    2. 830054 乌鲁木齐,新疆医科大学第一附属医院重症医学科
  • 收稿日期:2019-08-11 出版日期:2019-11-28
  • 通信作者: 于湘友

Monitoring in intensive care: less is more

Wenzhe Li1, Jian Cui2, Xiangyou Yu2,()   

  1. 1. Department of General Surgery, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
    2. Department of Critical Care Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  • Received:2019-08-11 Published:2019-11-28
  • Corresponding author: Xiangyou Yu
  • About author:
    Corresponding author: Yu Xiangyou, Email:
引用本文:

李文哲, 崔建, 于湘友. 重症监护:有的放矢,过犹不及[J/OL]. 中华重症医学电子杂志, 2019, 05(04): 297-301.

Wenzhe Li, Jian Cui, Xiangyou Yu. Monitoring in intensive care: less is more[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(04): 297-301.

重症疾病所致的负担是医疗卫生领域的主要难题之一,医疗技术的进步使得重症医学科(ICU)中有了更多的数据为临床决策提供依据,但在追求更多的数据信息以期做出更为正确的诊疗决策的同时,应用诸多的监测手段也可能会导致临床决策难度增加,甚至会对患者造成伤害,监测的效益/风险比降低也提示存在医疗资源的浪费。本文针对影响重症监护治疗决策的相关因素进行回顾综述,以期为重症医护人员优化重症监护的临床实践提供参考。

The burden of critically ill diseases is one of the main problems in the field of medical and health care. The progress of medical technology has led to more data in the ICU to provide a basis for clinical decision-making. However, while pursuing more data and information in order to make more correct diagnosis and treatment decisions, the application of monitoring may also increase the difficulty of clinical decision-making, and even cause harm to patients. The reduction of benefit / risk ratio of monitoring also indicates that there is a waste of medical resources. In this paper, the decision-making factors of intensive care were reviewed in order to provide reference for the clinical practice of optimizing intensive care strategy for intensivists.

1
Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries [J]. JAMA, 2016, 315(8): 788-800.
2
Reinhart K, Daniels R, Kissoon N, et al. Recognizing sepsis as a global health priority-a WHO resolution [J]. N Engl J Med, 2017, 377(5): 414-417.
3
Shah NH, Milstein A, Bagley PhD SC. Making machine learning models clinically useful [J]. JAMA, 2019. doi: 10.1001/jama.2019.10306.
4
Attia ZI, Noseworthy PA, Lopez-Jimenez F, et al. An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction [J]. Lancet, 2019, 394(10201):861-867.
5
Hendriks JML, Fabritz L. AI can now identify atrial fibrillation through sinus rhythm [J]. Lancet, 2019, 394(10201): 812-813.
6
Frost P, Wise MP. Recognition and early management of the critically ill ward patient [J]. Br J Hosp Med (Lond), 2007, 68(10): M180-183.
7
Nolan JP, Soar J, Smith GB, et al. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit [J]. Resuscitation, 2014, 85(8): 987-992.
8
Pearse RM, Moreno RP, Bauer P, et al. Mortality after surgery in Europe: a 7 day cohort study [J]. Lancet, 2012, 380(9847): 1059-1065.
9
Churpek MM, Yuen TC, Huber MT, et al. Predicting cardiac arrest on the wards: a nested case-control study [J]. Chest, 2012, 141(5): 1170-1176.
10
Sun Z, Sessler DI, Dalton JE, et al. Postoperative hypoxemia is common and persistent: a prospective blinded observational study [J]. Anesth Analg, 2015, 121(3): 709-715.
11
Turan A, Chang C, Cohen B, et al. Incidence, severity, and detection of blood pressure perturbations after abdominal surgery: a prospective blinded observational study [J]. Anesthesiology, 2019, 130(4): 550-559.
12
Coene KL, Roos AN, Scharnhorst V. Iatrogenic anemia/twenty-five million liters of blood into the sewer: comment [J]. J Thromb Haemost, 2015, 13(6): 1160-1161.
13
Ranasinghe T, Freeman WD. ′ICU vampirism′-time for judicious blood draws in critically ill patients [J]. Brit J Haematol, 2014, 164(2): 302-303.
14
Retter A, Wyncoll D, Pearse R, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients [J]. Brit J Haematol, 2013, 160(4): 445-464.
15
Paulson EK, Thompson WM. Review of small-bowel obstruction: the diagnosis and when to worry [J]. Radiology, 2015, 275(2): 332-342.
16
Jaffe T, Thompson WM. Large-bowel obstruction in the adult: classic radiographic and CT findings, etiology, and mimics [J]. Radiology, 2015, 275(3): 651-663.
17
Ganapathy A, Adhikari NK, Spiegelman J, et al. Routine chest x-rays in intensive care units: a systematic review and meta-analysis [J]. Crit Care, 2012, 16(2): R68.
18
Veldkamp WJ, Kroft LJ, Geleijns J. Dose and perceived image quality in chest radiography [J]. Eur J Radiol, 2009, 72(2): 209-217.
19
Alshamari M, Norrman E, Geijer M, et al. Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review [J]. Eur Radiol, 2016, 26(6): 1766-1774.
20
Sugrue M. Abdominal compartment syndrome and the open abdomen: any unresolved issues? [J]. Curr Opin Crit Care, 2017, 23(1): 73-78.
21
Wintermark M, Sincic R, Sridhar D, et al. Cerebral perfusion CT: technique and clinical applications [J]. J Neuroradiol, 2008, 35(5): 253-260.
22
Parmentier-Decrucq E, Poissy J, Favory R, et al. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors [J]. Ann Intensive Care, 2013, 3(1): 10.
23
Campbell SJ, Bechara R, Islam S. Point-of-care ultrasound in the intensive care unit [J]. Clin Chest Med, 2018, 39(1): 79-97.
24
Henwood PC. Imaging an outbreak-ultrasound in an ebola treatment unit [J]. N Engl J Med, 2019, 381(1): 6-9.
25
Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill [J]. Chest, 2015, 147(6): 1659-1670.
26
Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol [J]. Chest, 2008, 134(1): 117-125.
27
Jozwiak M, Mercado P, Teboul JL, et al. What is the lowest change in cardiac output that transthoracic echocardiography can detect? [J]. Crit Care, 2019, 23(1): 116.
28
Drew BJ, Harris P, Zegre-Hemsey JK, et al. Insights into the problem of alarm fatigue with physiologic monitor devices: a comprehensive observational study of consecutive intensive care unit patients [J]. PLoS one, 2014, 9(10): e110274.
29
Halford GS, Baker R, McCredden JE, et al. How many variables can humans process? [J]. Psychol Sci, 2005, 16(1): 70-76.
30
Jerison HJ, Pickett RM. Vigilance: the importance of the elicited observing rate [J]. Science, 1964,143(3609): 970-971.
31
Monnet X, Teboul JL. Assessment of fluid responsiveness: recent advances [J]. Curr Opin Crit Care, 2018, 24(3): 190-195.
32
Legrand M, Soussi S, Depret F. Cardiac output and CVP monitoring to guide fluid removal [J]. Crit Care, 2018, 22(1): 89.
33
Romagnoli S, Ricci Z, Quattrone D, et al. Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study [J]. Crit Care, 2014, 18(6): 644.
34
Hall LH, Johnson J, Watt I, et al. Healthcare staff wellbeing, burnout, and patient safety: a systematic review [J]. PLoS One, 2016, 11(7): e0159015.
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