關(guān)于重癥醫(yī)學(xué)進(jìn)展的探討

1、重癥醫(yī)學(xué)進(jìn)展 ------2014-2015,Advance of Critical Care in 2014-2015,Big Data and MIMIC II Database,Advance of Critical Care in 2014-2015,屌絲的福音,The Age of Big Data,Advance of Critical Care in 2014

2、-2015,Volume---大量Velocity---快速Variety---多樣Value-----價值,Advance of Critical Care in 2014-2015,Big Data,NOT-Randomization非隨機(jī)化抽樣,Advance of Critical Care in 2014-2015,Big Data and Traditional Medicine,MIMIC DatabaseMul

3、tiparameter Intelligent Monitoring in Intensive Care,Advance of Critical Care in 2014-2015,Big Data and Critical Care Medicine,MIMIC,Advance of Critical Care in 2014-2015,Advance of Critical Care in 2014-2015,MIMIC II Da

4、tabase,,流行病學(xué)統(tǒng)計(jì)臨床決策監(jiān)護(hù)設(shè)備的研發(fā),Advance of Critical Care in 2014-2015,MIMIC II Database,http://mimic.physionet.org/database.html,Advance of Critical Care in 2014-2015,MIMIC II Database,Dejam, et al. Critical care,2014,18:487

5、.,Advance of Critical Care in 2014-2015,MIMIC II Database,Fuchs, et al. Plos one.2014, 9(4):e93234,Advance of Critical Care in 2014-2015,MIMIC II Database,Moskowitz, et al. J Intensive Care Med,2014,,Advance of Critical

6、Care in 2014-2015,MIMIC II Database,Zhang, et al. Plos one, 2014,,Advance of Critical Care in 2014-2015,MIMIC II Database,EnglishComputerStatistics,Ability,Fair,Advance of Critical Care in 2014-2015,Big Data,Australia

7、China,Sepsis,Advance of Critical Care in 2014-2015,,Definition DiagnosisClassificationEGDT(Early-Goal Directed Therapy)China guidelines for SepsisSepsis-associated AKI,Advance of Critical Care in 2014-2015,Sepsis 3.

8、0定義更新,再見，SIRS！你好，SOFA！,Advance of Critical Care in 2014-2015,Sepsis 1.0-2.0 Definition,,Sepsis is a systemic, deleterious host response to infection leading to systemic inflammatory response syndrome (SIRS).,膿毒癥是感染引起的全身炎

9、癥反應(yīng)綜合征。,Advance of Critical Care in 2014-2015,Sepsis 1.0-2.0 Diagnosis,Hypothermia or fever (body temperature 38.5°C)Tachycardia (>90 beats/min)Tachypnea (>20 breaths/min or PaCO2 12 000/mm3), leukopenia (10

10、%).,Advance of Critical Care in 2014-2015,,Kaukonen, et al. JAMA,2014,311(13):2637,Background,Advance of Critical Care in 2014-2015,Sepsis 1.0-2.0 Definition,,缺陷,Specificity,Morbidity M

11、ortality,Advance of Critical Care in 2014-2015,Sepsis 3.0 Definition,,Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection.,膿毒癥是機(jī)體對于感染引起的失控的炎癥反應(yīng)所導(dǎo)致威脅生命的器官功能障礙。（安友仲）,Adv

12、ance of Critical Care in 2014-2015,Sepsis Shock 3.0 Definition,,1.0-2.0: 感染導(dǎo)致的積極液體復(fù)蘇無法糾正的低血壓及組織低灌注狀態(tài)（Lac，尿量、神志）。,,3.0: Sepsis 基礎(chǔ)上出現(xiàn)的補(bǔ)液無法糾正的低血壓及Lac>2mmol/L。,Advance of Critical Care in 2014-2015,Sepsis 3.0 Definition,,

13、SIRS---CARS---MARSOrgan dysfunction (OD)----,SOFA,Advance of Critical Care in 2014-2015,Sepsis 3.0 Definition,,Advance of Critical Care in 2014-2015,Sepsis 3.0診斷更新,,THRRWBC,SBPGCSR,Advance of Critical Care in 2014

14、-2015,Sepsis 3.0分型更新,,SepsisSevere SepsisSeptic Shock,Severe SepsisSeptic Shock,精準(zhǔn)醫(yī)療的前奏,Advance of Critical Care in 2014-2015,Sepsis 3.0治療更新,EGDT走下神壇？,Advance of Critical Care in 2014-2015,EGDT (Early-Goal Directed Th

15、erapy),Rivers, et al. N Engl J Med 2001,370(18):1368-1377,Advance of Critical Care in 2014-2015,EGDT (Early-Goal Directed Therapy),Rivers, et al. N Engl J Med 2001,370(18)::1368-1388,Advance of Critical Care in 2014-2015

16、,EGDT (Early-Goal Directed Therapy),Advance of Critical Care in 2014-2015,EGDT (Early-Goal Directed Therapy),Advance of Critical Care in 2014-2015,EGDT (Early-Goal Directed Therapy),,The ProCESS Investigators .N Engl J M

17、ed 2014; 370:1683-1693,Advance of Critical Care in 2014-2015,EGDT (Early-Goal Directed Therapy),The ProCESS Investigators .N Engl J Med 2014; 370:1683-1693,Advance of Critical Care in 2014-2015,EGDT (Early-Goal Directed

18、Therapy),Mouncey.N Engl J Med 2015; 372,(14):1301-1311,Advance of Critical Care in 2014-2015,EGDT (Early-Goal Directed Therapy),Mouncey.N Engl J Med 2015; 372,(14):1301-1311,Advance of Critical Care in 2014-2015,EGDT (Ea

19、rly-Goal Directed Therapy),The ARISE investigators and the ANZICS clinics trail groups..N Engl J Med ,2014,371(16):1496-1507,Advance of Critical Care in 2014-2015,EGDT (Early-Goal Directed Therapy),The ARISE investigato

20、rs and the ANZICS clinics trail groups..N Engl J Med ,2014,371(16):1496-1507,Advance of Critical Care in 2014-2015,EGDT (Early-Goal Directed Therapy),http://www.survivingsepsis.org/About-SSC/Pages/default.aspx,Advance o

21、f Critical Care in 2014-2015,EGDT (Early-Goal Directed Therapy),http://www.survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdf,,Advance of Critical Care in 2014-2015,EGDT (Early-Goal Directed Therapy),http://www.s

22、urvivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdf,,Advance of Critical Care in 2014-2015,Sepsis and Albumin,Caironi et al. N Engl J Med.2014,370(15):1412-1421,Advance of Critical Care in 2014-2015,Sepsis and Albu

23、min,Caironi et al. N Engl J Med.2014,370(15):1412-1421,Advance of Critical Care in 2014-2015,Sepsis and Albumin,Caironi et al. N Engl J Med.2014,370(15):1412-1421,,,,,,,,Advance of Critical Care in 2014-2015,Sepsis and A

24、lbumin,Patel et al. BMJ, 2014,349:g4561,Advance of Critical Care in 2014-2015,Sepsis and Albumin,Patel et al. BMJ, 2014,349:g4561,Advance of Critical Care in 2014-2015,Sepsis and Hb,Holst, et al. N Engl J Med,2014,371(15

25、):1381-1391,Advance of Critical Care in 2014-2015,Sepsis and Hb,Holst, et al. N Engl J Med,2014,371(15):1381-1391,Advance of Critical Care in 2014-2015,Sepsis and Hb,Holst, et al. N Engl J Med,2014,371(15):1381-1391,,Adv

26、ance of Critical Care in 2014-2015,Sepsis and MAP,Asfar, et al. N Engl J Med.2014,370(17):1584-1593,Advance of Critical Care in 2014-2015,Sepsis and MAP,Asfar, et al. N Engl J Med.2014,370(17):1584-1593,Advance of Critic

27、al Care in 2014-2015,Sepsis and MAP,Asfar, et al. N Engl J Med.2014,370(17):1584-1593,,,Advance of Critical Care in 2014-2015,Sepsis and SSS,Osborn, et al. Crot Care Med,2014,342(9)::1969-1976,Advance of Critical Care in

28、 2014-2015,Sepsis Severity Score,Osborn, et al. Crot Care Med,2014,342(9)::1969-1976,Advance of Critical Care in 2014-2015,China guidelines for Sepsis,Advance of Critical Care in 2014-2015,China guidelines for Sepsis,Adv

29、ance of Critical Care in 2014-2015,ARDS,Advance of Critical Care in 2014-2015,ARDS and Simvastatin,Terpstra ,et al. N Engl J Med.,2014,371(18):1695-1703,Advance of Critical Care in 2014-2015,ARDS and NO,Adhikari, et al.

30、Crit Care Med.,2014,42(2):404-412.,Advance of Critical Care in 2014-2015,ARDS and NO,Adhikari, et al. Crit Care Med.,2014,42(2):404-412.,Advance of Critical Care in 2014-2015,ARDS and PP,Lee, et al. Crit Care Med.,2014,4

31、2(5):1252-1262,Advance of Critical Care in 2014-2015,ARDS and PP,Lee, et al. Crit Care Med.,2014,42(5):1252-1262,Advance of Critical Care in 2014-2015,ARDS and PP,Hu, et al. Crit Care.,2014,18(3):R109,Advance of Critical

32、 Care in 2014-2015,ARDS and PP,Hu, et al. Crit Care.,2014,18(3):R109,Advance of Critical Care in 2014-2015,ARDS and PP,Hu, et al. Crit Care.,2014,18(3):R109,Advance of Critical Care in 2014-2015,ARDS and PP,Hu, et al. Cr

33、it Care.,2014,18(3):R109,Advance of Critical Care in 2014-2015,ARDS and PP,Hu, et al. Crit Care.,2014,18(3):R109,Advance of Critical Care in 2014-2015,ARDS and ARM,Suzumura, et al. Intensive Care Med,2014,40 (9):1227-124

34、0,Advance of Critical Care in 2014-2015,ARDS and HFOV,Huang,et al. Crit Care ,2014,18(3):R102,Advance of Critical Care in 2014-2015,ARDS and HFOV,Huang,et al. Crit Care ,2014,18(3):R102,,Advance of Critical Care in 2014-

35、2015,ARDS and NMV,Burnset al. CMAJ,2014,186(3):E112-122,Advance of Critical Care in 2014-2015,ARDS and NMV,Burnset al. CMAJ,2014,186(3):E112-122,Advance of Critical Care in 2014-2015,ARDS and NMV,Burnset al. CMAJ,2014,18

36、6(3):E112-122,Advance of Critical Care in 2014-2015,ARDS and NMV,Burnset al. CMAJ,2014,186(3):E112-122,Advance of Critical Care in 2014-2015,PN and EN,Advance of Critical Care in 2014-2015,允許性低熱卡,Rugeles, et al. Indian J

37、 Crit Care Med, 2013,17(6),343-349,Advance of Critical Care in 2014-2015,允許性低熱卡,Rugeles, et al. Indian J Crit Care Med, 2013,17(6),343-349,Advance of Critical Care in 2014-2015,免疫制劑,Arthur, et al. JAMA,2014,312(5):514-52

38、4,Advance of Critical Care in 2014-2015,免疫制劑,Arthur, et al. JAMA,2014,312(5):514-524,,Advance of Critical Care in 2014-2015,免疫制劑,Arthur, et al. JAMA,2014,312(5):514-524,Advance of Critical Care in 2014-2015,GN,Chen, et a

39、l. Crit Care, 2014,18(1):R8,Advance of Critical Care in 2014-2015,GN,Chen, et al. Crit Care, 2014,18(1):R8,Advance of Critical Care in 2014-2015,GN,Chen, et al. Crit Care, 2014,18(1):R8,Advance of Critical Care in 2014-2

40、015,GN,Wischmeyer, et al. Crit Care, 2014,18(2):R76,Advance of Critical Care in 2014-2015,GN,Wischmeyer, et al. Crit Care, 2014,18(2):R76,Advance of Critical Care in 2014-2015,魚油,Grau-Garmona, et al. Crit Care Med, 2015,

41、43(1):31-39,Advance of Critical Care in 2014-2015,魚油,Zhu, et al. Intensive Care Med, 2014,40(4):504-512,Advance of Critical Care in 2014-2015,Fe2+,Pieracci, et al. Cri, Care Med 2014,42(9):2048-2057,Advance of Critical C

42、are in 2014-2015,PN or EN,Harvey, et al. N Engl J Med,2014,371(18):1673-1684.,Advance of Critical Care in 2014-2015,PN or EN,Harvey, et al. N Engl J Med,2014,371(18):1673-1684.,Advance of Critical Care in 2014-2015,Sedat

43、ion and Analgesia,Advance of Critical Care in 2014-2015,Delirium,Page, et al. Am J Respir Crit Care Med.2014,189(6):666-673,Advance of Critical Care in 2014-2015,Delirium,Page, et al. Am J Respir Crit Care Med.2014,189(6

44、):666-673,Advance of Critical Care in 2014-2015,Delirium and Statins,Morandi, et al. Crit Care Med.2014,42 (8):1899-1909,Advance of Critical Care in 2014-2015,M-P,Zhou, et al. Crit Care, 2014,18(3):R122,Advance of Critic

45、al Care in 2014-2015,M-P,Zhou, et al. Crit Care, 2014,18(3):R122,Advance of Critical Care in 2014-2015,Sepsis AKI,To Be Continued … …,回歸病理生理學(xué),Prof. Steve Webb,目前ICU大約有一半的處理是錯誤的，可悲的是我們自己也不知道哪一半是錯的。,Advance of Critical Car