68例危重新生儿转运过程中的急救与监护

新生儿转运是将危重新生儿从基层医院或缺乏新生儿重症监护医疗设备和技术的医院 ,转运至有新生儿专科医护人员及现代化医疗设备的新生儿重症监护室 (NICU )医院进行急救监护。我院 2 0 0 3年 4月— 2 0 0 4年 3月率先在本省建立危重新生儿转运系统 (NETS) ,近年来成功转运危重     

提高重症监护病房护理质量有效措施的探讨

综合医院建立重症监护病房(ICU),主要收治病情危重或有潜在生命危险的患者,有助于提高危重患者的抢救存活率,营造一支高素质的ICU专业护理队伍是保证ICU护理工作顺利实施的前提。我院综合ICU床位18张,专科重症监护病房7个,床位68张,承担着非常重要的救治任务。在     

68例危重新生儿转运过程中的急救与监护

新生儿转运是将危重新生儿从基层医院或缺乏新生儿重症监护医疗设备和技术的医院，转运至有新生儿专科医护人员及现代化医疗设备的新生儿重症监护室(NICU)医院进行急救监护。我院2003年4月-2004年3月率先在本省建立危重新生儿转运系统(NFTS)，近年来成功转运危重新生儿68例。现报告如下。     

危重新生儿的转运与转归探讨

目的降低危重新生儿的死亡率。方法建立新生儿转运网络，将基层医院危重新生儿转往具有高水平重症监护中心。包括现场抢救、途中连续监护、治疗。结果共接诊转运危重新生儿568例，占同期NICU住院率71．5％，转运病种前三位分别是新生儿窒息、呼吸系统疾病、早产儿（共占87．5％）。其中499例治愈出院，占87．8％。放弃40例（7．04％），转运病死率，最终病死率分别为0．5％、4．5％。结论建立完善的网络转运系统，转运前重视稳定病情，转运途中专业人员参与，恰当地实施监护、治疗措施是转运成功的关键，为抢救成功提供了保证，可降低新生儿死亡率和伤残率。     

小儿与成人护理技术操作所耗时间的调查分析

以我院内科、外科、儿科二、三级护理患者为例 ,通过比较小儿与成人护理技术操作所占用工作时间的差别及护理人才培养的特殊性 ,探讨综合性医院儿科护理工作的价值。我院是一所综合性教学医院 ,现有核定床位 72 0张 ,儿科设床位 75张 ,其中新生儿 15张。现有护理人员19人 ,实行上下夜值班制。 1997、1998年平均年住院人数 2 372例 ,占全院总住院人数的 16 5 % ,危重患者年平均 413例 ,占全院危重患者的16 6 4% ,目前全院病床与护理人员之比为 1∶0 38,儿科床位与护理人员之比为 1∶0 31。1　方　法以本院内科、外科、儿科住院二、三级护…     

PICU新入护士临床培训体会

儿科重症监护室(pediatric intensive care unit,PICU)是继成人ICU之后建立的儿科领域内的新分科,它的出现使儿科危重症患者的救治和护理有了划时代的变化,使儿科危重症患者能够得到连续不断、系统全面的监护治疗[1]。我院PICU成立6年,固定床位12张,负责全广西危重症患儿的急救     

远程多中心重症监护网络的临床应用

目的 评价应用远程多中心重症监护网络是否能提高入网医院重症监护病房(ICU)危重患者的抢救效率和经济效益.方法 建立医院重症监护专业医师和多科专家组成的会诊中心,通过会诊中心和远程ICU均配备相应的软件平台来实现电子数据的传输、显示和影音交流,对危重病患者进行远程会诊指导.在项目实行后,对入网满1年的医院进行医疗和经济效益评价,并与入网前1年的结果进行比较.结果 至2009年7月止,浙江省共有63家医院加入远程多中心重症监护网络,有1 617例重症监护患者接受了远程会诊,同时进行了173次远程教学查房和72次远程授课.对其中23家入网时间满1年的医院进行了前后数据的比较,结果显示,ICU的平均病死率下降了11.6%(12.9%比14.6%),危重患者转院率下降了38.3%(2.9%比4.7%),ICU床位利用率提高了6.1%(83.4%比78.6%).结论 远程重症监护项目的 实施可以改善患者的临床预后,提高医院经济效益.     

危重新生儿转运护理

新生儿转运系统(newborn emergency transport service,NETS)的建立是新生儿急救工作中重要一环,是将危重新生儿从基层医院转往三级医院的NICU做进一步监护、诊断和治疗的过程,它不是一个简单的转运过程,而是一个连续的监护治疗过程。成功转运能降低危重新生儿的病死率及伤残率。我院于2003年12月—2005年12月转运危重新生儿82例,现将转运情况介绍如下。1资料与方法1.1一般资料转运危重新生儿82例,其中男67例,女15例;胎龄<30周19例,30周~33周20例,34周~36周6例,≥37周37例;体重<1000g6例,1000g~1499g20例,1500g~2499g19例,2500g~3999g35…     

新生儿急救转运的护理研究现状

新生儿急救转运是新生儿急救工作的重要组成部分,是接收单位主动“把流动的NICU（新生儿重症监护室）送到危重儿身边”的双程转运系统^[1]。近年来,由于交通的便利,接收医院对新生儿抢救技术的提高,在严密监护下将危重新生儿转运至上一级医院NICU进行救治,对降低危重新生儿致残率、提高人口素质和降低病死率有着非常重要的意义。但是,由于危重新生儿本身存在严重生理紊乱,     

儿科重症监护病室的患儿心理和护理特点

患儿住入儿科重症监护病室后,唯有在考虑到患儿及其家属的全部需要,才能认为是完全的护理。减少患儿的心理与社会压力才能使其集中力量对付身体上的疾病压力。本文提出对患儿及其家属提供全面的生理—心理—社会护理,这是由于患儿、家属和监护病室三者交织而产生的独特需要和形成的问题,因而也应当三者交织以满足需要和解决问题。 (一)儿科重症监护病室的特点儿科重症监护病室的床位自4至10张,以4张床位的单元最为典型。患儿一般不超过7岁。大都急诊入院,在监护病室住1至     

Capacity of intensive care units in Ghana

PurposeTo document the equipment, resource and bed capacity of Intensive Care Units (ICUs) in the Republic of Ghana.Materials and methodsCross-sectional observational study of all operating ICUs in Ghana. Sixteen operating ICUs in 9 hospitals were identified and surveyed (13 adult and 3 pediatric ICUs).ResultsThere were a total of 113 adult and 36 pediatric ICU beds for a population of 30 million, (0.5 ICU beds per 100,000 people). The median number of staffed ICU beds and ventilators were 5 (IQR 4–6), and 4 (IQR 3–5) respectively. There were 2 pediatric and 6 adult intensivists practicing in the country. About half of the ICUs (56%) were staffed solely by non-intensivist providers. While there is adequate nursing support and availability of essential critical care medications, the current financing model for critical care delivery creates a significant barrier for most patients.ConclusionGhana has a significant shortage of critical care beds that are inequitably distributed across the country and a shortfall of intensivists to staff ICUs. A holistic approach that focuses on the key bottlenecks to quality improvement would be required to improve the capacity and quality of critical care delivery.     

Descriptive analysis of critical care units in the United States.

OBJECTIVE: To gather data about available technology, staffing, administrative policies, and bed capacities of ICUs in the United States. DESIGN AND SETTING: On January 15, 1991, survey instruments were mailed to the administrators of 4,233 hospitals to gather information from the medical director of the institutions' respective ICUs for the purpose of developing a database on ICUs in the United States. The sampling frame for this study was based on all American Hospital Association (AHA) hospitals that stated they have ICUs. MEASUREMENTS: Census questionnaires solicited information on types of hospitals, types of ICUs, number of ICU beds open and closed, technology available to the unit, organizational structure and management of the ICU, as well as the staffing and certification of unit personnel. MAIN RESULTS: Data were obtained on 32,850 ICU beds with 25,871 patients from 2,876 separate ICUs in 1,706 hospitals in the United States. Census responses came from units in all sizes of hospitals within all ten census regions in the country, all states, and all types of hospital sponsorship (federal, state, and local government, private nonprofit and private for profit). The census response rate was 40% of the AHA hospitals that stated that they have ICUs, with specific ICU data on 38.7% of the nation's ICUs. The number of ICUs per hospital increases with overall hospital size. The smallest hospitals (less than 100 beds) usually had only one ICU. As hospital size increased, the single, all inclusive medical/surgical/coronary care units diminished, and in hospitals with greater than 300 beds, specialization of units became prevalent. In absolute terms, hospitals had the following number of ICUs: 1.04 +/- 0.20 (less than or equal to 100 beds); 1.30 +/- 0.65 (101 to 300 beds); 2.37 +/- 1.58 (301 to 500 beds); and 3.34 +/- 2.21 (greater than 500 beds). ICU beds averaged, nationally, 8.09% of hospital-licensed beds with a median of 6.98%. Generally, medical units, pediatric units, coronary care units (CCUs), and medical/surgical/CCUs reported an average of 10 beds per unit. Neonatal units averaged 21 beds, and surgical units averaged 12 beds. The average ICU size, nationally, was 11.7 +/- 7.8 beds per unit. Available technology within hospitals and individual units was increased as hospital size increased; surgical units tended to have more available technology than other unit types. A wide range of organizational arrangements within hospitals determines where the ICU appears in an organizational chart and to whom unit management is accountable. Thirty-six percent of the units were located organizationally within the hospital's department of medicine, while 23% were considered "free standing," having no departmental affiliation. Although units must have a medical director, the perception as to whether this director supervises the day-to-day operation was different in larger vs. smaller hospitals. In hospitals with less than or equal to 100 beds, 72% of the units were perceived to be supervised by the medical director, whereas in larger hospitals (greater than 500 beds), 81% of units were supervised. Study results indicated that medical directors in pediatric, neonatal, and burn units most often were perceived to supervise the unit. Presently, 63% of all ICUs responding are directed by an internist. The next largest group to direct ICUs were surgeons, followed by pediatricians. Pediatrician involvement tended to be exclusive in pediatric and neonatal units. Surgeons directed most surgical and neurologic units and were involved in 21% of mixed medical/surgical units. Internists predominated in medical units and in CCUs, as well as in combined medical/surgical/CCUs. Direction by anesthesiologists, although relatively infrequent, predominated in the surgical unit. Critical care medicine certification of the medical director and attending staff of the ICU increased as hospital size increased, although only 44% of all units stated that thei     

Visitation policies and practices in US ICUs

Introduction

Prior reports suggest that restrictive ICU visitation policies can negatively impact patients and their loved ones. However, visitation practices in US ICUs, and the hospital factors associated with them, are not well described.

Methods

A telephone survey was made of ICUs, stratified by US region and hospital type (community, federal, or university), between 2008 and 2009. Hospital characteristics were self-reported and included the hospitals'' bed number, critical care unit number, and presence of ICU leadership. Hospital and ICU visitation restrictions were based on five criteria: visiting hours; visit duration; number of visitors; age of visitors; and membership in the patient''s immediate family. Hospitals or ICUs without restrictions had open visitation policies; those with any restriction had restrictive policies.

Results

The study surveyed 606 hospitals in the Northeast (17.0%), Midwest (26.2%), South (36.6%), and West (20.1%) regions; most were community hospitals (n = 401, 66.2%). The mean hospital size was 239 ± 217 beds; the mean percentage of ICU beds was 11.6% ± 13.4%. Hospitals often had restrictive hospital (n = 463, 76.4%) and ICU (n = 543, 89.6%) visitation policies. Many ICUs had ≥ 3 restrictions (n = 375; 61.9%), most commonly related to visiting hours and visitor number or age. Nearly all ICUs allowed visitation exceptions (n = 474; 94.8%). ICUs with open policies were more common in hospitals with < 150 beds. Among restrictive ICUs, the bed size, hospital type, number of critical care units, and ICU leadership were not associated with the number of restrictions. On average, hospitals in the Midwest had the least restrictive policies, while those in the Northeast had the most restrictive.

Conclusion

In 2008 the overwhelming majority of US ICUs in this study had restrictive visitation policies. Wide variability in visitation policies suggests that further study into the impact of ICU visitations on care and outcomes remains necessary to standardize practice.     

An overview of intensive care unit services in Nigeria

PurposeTo have a current overview of the state of critical care services in Nigeria, with a view to having information about the basic infrastructure, personnel, equipment, and processes in place to complement the acute peri-operative and medical emergencies in Nigeria.Materials and methodsThis was a cross-sectional survey of public and private intensive care units (ICUs) in Nigeria at the instance of the Intensive and Critical Care Society of Nigeria. Structured questionnaires were sent and collated over a 4-month period. Information on the institutions, ICU equipment and personnel were collected and analyzed using SPSS version 21(Chicago, Illinois). Data are presented in numbers, percentages, medians, and interquartile ranges (IQR) as appropriate.ResultsA total of 30 ICUs spread within all the six geo-political zones in Nigeria took part in this survey. Majority (63.3%) of them were located in teaching hospitals. The median number of ICU beds and equipment in hospitals surveyed were beds, 5(4–6), ventilators, 3 (1–4); multiparameter monitor, 4 (3–5.25) and arterial blood gas machine, 0(0–1). The anaesthetists led in running 90% of the units.ConclusionThis survey showed a low ICU bed capacity and deficits in basic and advanced haemodynamic monitoring equipment. There is also shortage of trained ICU Physicians.     

Critical care capacity in Addis Ababa,Ethiopia: A citywide survey of public hospitals

PurposeWe evaluated critical care capacity in the 15 intensive care units (ICUs) in public hospitals in Addis Ababa, Ethiopia to determine the current state of critical care in the city and inform capacity-building efforts.MethodsWe conducted a cross-sectional survey of ICU medical and nursing directors or their delegates using a standardized questionnaire based on World Federation of Society of Intensive and Critical Care Medicine (WFSICCM) criteria.ResultsICU size ranged from 3 to 15 beds. All ICUs had capacity for mechanical ventilation and vasopressor support, and 53% had intensivists on staff. Ultrasound was available in 93%, while 40% had capacity for invasive blood pressure monitoring. Identified barriers to care included a lack of essential equipment, supplies, medications and specially trained providers. Respondents considered increasing available beds and coordinating between hospitals crucial for capacity building.ConclusionsThere is burgeoning critical care capacity in Addis Ababa, Ethiopia with 103 ICU beds in public hospitals, and the WFSICCM criteria provide a useful framework for evaluating critical care capacity and identifying priorities for capacity building. All ICUs in public hospitals in Addis Ababa were able to provide basic support for patients with life-threatening organ failure but demonstrated marked heterogeneity in critical care capacity.     

Characterizing critical care physician staffing in rural America: A description of Iowa intensive care unit staffing

Purpose

This study aimed to characterize intensive care unit (ICU) physician staffing patterns in a predominantly rural state.

Materials and Methods

A prospective telephone survey of ICU nurse managers in all Iowa hospitals with an ICU was conducted.

Results

Of 122 Iowa hospitals, 64 ICUs in 58 (48%) hospitals were identified, and 46 (72%) responded to the survey. Most ICUs (96%) used an open admission model and cared for undifferentiated medical and surgical patients (88%), and only 27% of open ICUs required critical care or pulmonary consultation for admitted patients. Most (59%) Iowa ICUs had a critical care physician or pulmonologist available, and high-intensity staffing was practiced in 30% of ICUs. Most physicians identified as practicing critical care (63%) were not board certified in critical care. Critical care physicians were available in a minority of hospitals routinely for inpatient intubation and cardiac arrest management (29% and 10%, respectively), and emergency physicians and other practitioners commonly responded to emergencies throughout the hospital.

Conclusions

Many Iowa hospitals have ICUs, and staffing patterns in Iowa ICUs mirror closely national staffing practices. Most ICUs are multispecialty, open ICUs in community hospitals. These factors should inform training and resource allocation for intensivists in rural states.     

An initial comparison of intensive care in Japan and the United States.

OBJECTIVE: The objective of this study was to compare the utilization of, and outcome from, critical care services in selected medical centers providing secondary and tertiary care in the United States and Japan. DESIGN: Prospective data collection on 1,292 patients from each of the participating Japanese study hospitals in 1987 to 1989 and compared with the 5,030 patients in the United States 1982 Acute Physiology and Chronic Health Evaluation (APACHE II) database used to develop the APACHE II equation. Detailed organizational characteristics of the participating ICUs and hospitals were also obtained. SETTING: Data collection took place in the ICUs of 13 U.S. hospitals and six Japanese hospitals. PATIENTS: Data were collected on consecutive, unselected patients from medical, surgical, and mixed medical/surgical critical care units, with a spectrum of medical and surgical diagnoses. MEASUREMENTS AND MAIN RESULTS: U.S. and Japanese ICUs have a similar array of diagnostic and therapeutic modalities. Only 2% (range 0.6 to 3.5) of beds in Japanese hospitals were designated to intensive care. The organization of the Japanese and U.S. ICUs varied by hospital. There were significantly fewer women admitted to Japanese ICUs and a substantially lower proportion of low-risk-of-death patients. Despite a rapidly aging population, there were relatively fewer elderly patients with chronic health ailments in the Japanese ICU population (8%) compared with the U.S. cohort (18%). CONCLUSIONS: In this sample of hospitals, similar high-technology critical care is available in the United States and Japan. Variations in utilization between the two countries represent differences in case mix and bed availability. The APACHE II equation stratified patients in the Japanese patient cohort across the full spectrum of increasing severity of illness.     

全国30个省市三级医院重症监护病房医护人员呼吸治疗工作现状的问卷调查

目的 调查我国三级医院重症监护病房(ICU)呼吸治疗的仪器装备、工作内容和完成人等,为规范和发展呼吸治疗工作提供依据.方法 在2006年8月国内召开的三次大规模会议上发放问卷,调查30个省264家三级医院320个ICU的491名医护人员.结果 有创、无创呼吸机数与床位数之比分别为0.52: 1(2 189/4 185)和0.16:1(672/4 185).320个ICU中,超声、喷射式以及定量雾化吸入器的配用率分别为55.9%(179/320)、33.8%(108/320)和12.1%(39/320);机械通气中呼吸机设置、撤机、拔管主要由医师完成的ICU占92.1%、93.1%、83.5%,更换管路、吸痰、雾化、湿化主要由护士完成的ICU占83.7%、93.9%、91.6%、90.2%.491名回答者中撤机前行自主呼吸试验者占40.9%,不知道或从来不做者占26.2%;有创通气时未监测气道开口端温度者占27.1%;对撤机未拔管患者应用气管内持续滴入/泵入盐水湿化者占34.4%;55.6%的人员使用前检测呼吸机;管路更换频率依次为每周1次占48.1%,1～3 d和3～5 d更换1次者为25.0%、14.7%.结论 目前国内三级医院ICU的呼吸机数量较前已大幅增加,但对其他实用装置的应用尚不足;呼吸治疗工作主要由医生和护理人员共同承担,尚缺少专业的呼吸治疗师;机械通气、气道管理和呼吸机管理等呼吸治疗工作差异较大,缺乏统一的规范.     

A comparison of intensive care unit physician staffing costs at the 3 Mayo Clinic sites

OBJECTIVES: To determine the provider cost of administering intensive care unit (ICU) services, comparing 3 different staffing models for ICU coverage, and to compare the costs of using house staff vs nonphysician providers (NPPs). METHODS: Data were collected on total staff composition and number of beds In ICUs from January 1, 2004, through December 31, 2004, at the 3 Mayo Clinic sites: Rochester, Minn; Jacksonville, Fla; and Scottsdale, Ariz. Institutional or national average staff salaries were used to determine total staffing costs per ICU bed per year at each site. Medicare medical education reimbursements were also taken into account. RESULTS: Costs per ICU bed for physician staffing were $18,630 in Rochester, $37,515 in Jacksonville, and $38,010 in Scottsdale. When NPPs were substituted for house staff, the costs per bed were $72,466 in Rochester, $61,291 in Jacksonville, and $49,909 in Scottsdale. Incremental costs per ICU bed using NPPs were $53,836 in Rochester, $23,776 in Jacksonville, and $11,899 in Scottsdale. CONCLUSION: Use of residents and fellows in ICU staffing at a major tertiary health center is more cost-efficient than use of NPPs. This finding could have Implications for the cost of physician services in nonteaching community hospitals and the methods by which care is provided.