關(guān)于重癥醫(yī)學進展的探討

1、重癥醫(yī)學進展 ------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,,流行病學統(tǒng)計臨床決策監(jiān)護設備的研發(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.,膿毒癥是機體對于感染引起的失控的炎癥反應所導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: 感染導致的積極液體復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,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