关于重症医学进展的探讨课件.pptx

1、重症医学进展 -2014-2015Advance of Critical Care in 2014-2015Big Data and MIMIC II DatabaseAdvance of Critical Care in 2014-2015屌丝的福音The Age of Big DataAdvance of Critical Care in 2014-2015Volume-大量Velocity-快速Variety-多样Value-价值Advance of Critical Care in 2014-2015Big DataNOT-Randomization非随机化抽样Advance of C

2、ritical Care in 2014-2015Big Data and Traditional MedicineMIMIC DatabaseMultiparameterMultiparameter Intelligent Monitoring in Intelligent Monitoring in Intensive CareIntensive CareAdvance of Critical Care in 2014-2015Big Data and Critical Care MedicineMIMICAdvance of Critical Care in 2014-2015Advan

3、ce of Critical Care in 2014-2015MIMIC II Database流行病学统计临床决策监护设备的研发Advance of Critical Care in 2014-2015MIMIC II Databasehttp:/mimic.physionet.org/database.htmlAdvance of Critical Care in 2014-2015MIMIC II DatabaseDejamDejam,et,et al.Critical care,2014,18:487.al.Critical care,2014,18:487.Advance of C

4、ritical Care in 2014-2015MIMIC II DatabaseFuchs,et al.Fuchs,et al.PlosPlos one.2014,9(4):e93234one.2014,9(4):e93234Advance of Critical Care in 2014-2015MIMIC II DatabaseMoskowitzMoskowitz,et al.,et al.J Intensive Care Med,2014,J Intensive Care Med,2014,Advance of Critical Care in 2014-2015MIMIC II D

5、atabaseZhang,et al.Zhang,et al.PlosPlos one,2014,one,2014,Advance of Critical Care in 2014-2015MIMIC II DatabaseEnglishComputerStatisticsAbilityFairAdvance of Critical Care in 2014-2015Big DataAustraliaChinaSepsisAdvance of Critical Care in 2014-2015Definition DiagnosisClassificationEGDT(Early-Goal

6、Directed Therapy)China guidelines for SepsisSepsis-associated AKIAdvance of Critical Care in 2014-2015Sepsis 3.0定义更新再见，SIRS！你好，SOFA！Advance of Critical Care in 2014-2015Sepsis 1.0-2.0 Definition Sepsis is a systemic,deleterious host response to infection leading to systemic inflammatory response syn

7、drome(SIRS).脓毒症是感染引起的全身炎症反应综合征。Advance of Critical Care in 2014-2015Sepsis 1.0-2.0 DiagnosislHypothermia or fever(body temperature 38.5C)lTachycardia(90 beats/min)lT a c h y p n e a (2 0 breaths/min or PaCO2 1 2 000/mm3),leukopenia(10%).Advance of Critical Care in 2014-2015KaukonenKaukonen,et,et al.

8、JAMA,2014,311(13):2637 al.JAMA,2014,311(13):2637BackgroundAdvance of Critical Care in 2014-2015Sepsis 1.0-2.0 Definition缺陷SpecificityMorbidity MortalityAdvance of Critical Care in 2014-2015Sepsis 3.0 Definition Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host respon

9、se to infection.脓毒症是机体对于感染引起的失控的炎症反应所导致威胁生命的器官功能障碍。（安友仲）Advance of Critical Care in 2014-2015Sepsis Shock 3.0 Definition 1.0-2.0:感染导致的积极液体复苏无法纠正的低血压及组织低灌注状态（Lac，尿量、神志）。3.0:Sepsis 基础上出现的补液无法纠正的低血压及Lac2mmol/L。Advance of Critical Care in 2014-2015Sepsis 3.0 DefinitionSIRS-CARS-MARSOrgan dysfunction(OD)

10、-SOFASOFAAdvance of Critical Care in 2014-2015Sepsis 3.0 DefinitionAdvance of Critical Care in 2014-2015Sepsis 3.0诊断更新T THRHRR RWBCWBCSBPSBPGCSGCSR RAdvance of Critical Care in 2014-2015Sepsis 3.0分型更新SepsisSepsisSevere SepsisSevere SepsisSepticSeptic Shock ShockSevere SepsisSevere SepsisSepticSeptic

11、 Shock Shock精准医疗的前奏Advance of Critical Care in 2014-2015Sepsis 3.0治疗更新EGDT走下神坛？Advance of Critical Care in 2014-2015EGDT(Early-Goal Directed Therapy)Rivers,et al.Rivers,et al.N N EnglEngl J Med J Med 2001,370(18):1368-1377 2001,370(18):1368-1377Advance of Critical Care in 2014-2015EGDT(Early-Goal Di

12、rected Therapy)Rivers,et al.Rivers,et al.N N EnglEngl J Med J Med 2001,370(18):1368-1388 2001,370(18):1368-1388Advance of Critical Care in 2014-2015EGDT(Early-Goal Directed Therapy)Advance of Critical Care in 2014-2015EGDT(Early-Goal Directed Therapy)Advance of Critical Care in 2014-2015EGDT(Early-G

13、oal Directed Therapy)The The ProCESSProCESS Investigators.N Investigators.N EnglEngl J Med 2014;370:1683-1693 J Med 2014;370:1683-1693Advance of Critical Care in 2014-2015EGDT(Early-Goal Directed Therapy)The The ProCESSProCESS Investigators.N Investigators.N EnglEngl J Med 2014;370:1683-1693 J Med 2

14、014;370:1683-1693Advance of Critical Care in 2014-2015EGDT(Early-Goal Directed Therapy)Mouncey.NMouncey.N EnglEngl J Med 2015;372,(14):1301-1311 J Med 2015;372,(14):1301-1311Advance of Critical Care in 2014-2015EGDT(Early-Goal Directed Therapy)Mouncey.NMouncey.N EnglEngl J Med 2015;372,(14):1301-131

15、1 J Med 2015;372,(14):1301-1311Advance of Critical Care in 2014-2015EGDT(Early-Goal Directed Therapy)The ARISE investigators and the ANZICS clinics trail groups.N The ARISE investigators and the ANZICS clinics trail groups.N EnglEngl J Med,2014,371(16):1496-1507 J Med,2014,371(16):1496-1507Advance o

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

17、oal Directed Therapy)http:/www.survivingsepsis.org/About-SSC/Pages/default.aspxhttp:/www.survivingsepsis.org/About-SSC/Pages/default.aspxAdvance of Critical Care in 2014-2015EGDT(Early-Goal Directed Therapy)http:/www.survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdfhttp:/www.survivingsepsis

18、.org/SiteCollectionDocuments/SSC_Bundle.pdfAdvance of Critical Care in 2014-2015EGDT(Early-Goal Directed Therapy)http:/www.survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdfhttp:/www.survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdfAdvance of Critical Care in 2014-2015Sepsis and Alb

19、uminCaironiCaironi et al.N et al.N EnglEngl J Med.2014,370(15):1412-1421 J Med.2014,370(15):1412-1421Advance of Critical Care in 2014-2015Sepsis and AlbuminCaironiCaironi et al.N et al.N EnglEngl J Med.2014,370(15):1412-1421 J Med.2014,370(15):1412-1421Advance of Critical Care in 2014-2015Sepsis and

20、 AlbuminCaironiCaironi et al.N et al.N EnglEngl J Med.2014,370(15):1412-1421 J Med.2014,370(15):1412-1421Advance of Critical Care in 2014-2015Sepsis and AlbuminPatel et al.BMJ,2014,349:g4561Patel et al.BMJ,2014,349:g4561Advance of Critical Care in 2014-2015Sepsis and AlbuminPatel et al.BMJ,2014,349:

21、g4561Patel et al.BMJ,2014,349:g4561Advance of Critical Care in 2014-2015Sepsis and HbHolstHolst,et al.N,et al.N EnglEngl J Med,2014,371(15):1381-1391 J Med,2014,371(15):1381-1391Advance of Critical Care in 2014-2015Sepsis and HbHolstHolst,et al.N,et al.N EnglEngl J Med,2014,371(15):1381-1391 J Med,2

22、014,371(15):1381-1391Advance of Critical Care in 2014-2015Sepsis and HbHolstHolst,et al.N,et al.N EnglEngl J Med,2014,371(15):1381-1391 J Med,2014,371(15):1381-1391Advance of Critical Care in 2014-2015Sepsis and MAPAsfarAsfar,et al.N,et al.N EnglEngl J Med.2014,370(17):1584-1593 J Med.2014,370(17):1

23、584-1593Advance of Critical Care in 2014-2015Sepsis and MAPAsfarAsfar,et al.N,et al.N EnglEngl J Med.2014,370(17):1584-1593 J Med.2014,370(17):1584-1593Advance of Critical Care in 2014-2015Sepsis and MAPAsfarAsfar,et al.N,et al.N EnglEngl J Med.2014,370(17):1584-1593 J Med.2014,370(17):1584-1593Adva

24、nce of Critical Care in 2014-2015Sepsis and SSSOsborn,et al.Osborn,et al.CrotCrot Care Med,2014,342(9):1969-1976 Care Med,2014,342(9):1969-1976Advance of Critical Care in 2014-2015Sepsis Severity ScoreOsborn,et al.Osborn,et al.CrotCrot Care Med,2014,342(9):1969-1976 Care Med,2014,342(9):1969-1976Adv

25、ance of Critical Care in 2014-2015China guidelines for SepsisAdvance of Critical Care in 2014-2015China guidelines for SepsisAdvance of Critical Care in 2014-2015ARDSAdvance of Critical Care in 2014-2015ARDS and SimvastatinTerpstraTerpstra,et al.N ,et al.N EnglEngl J Med.,2014,371(18):1695-1703 J Me

26、d.,2014,371(18):1695-1703Advance of Critical Care in 2014-2015ARDS and NOAdhikariAdhikari,et al.Crit Care Med.,2014,42(2):404-412.,et al.Crit Care Med.,2014,42(2):404-412.Advance of Critical Care in 2014-2015ARDS and NOAdhikariAdhikari,et al.Crit Care Med.,2014,42(2):404-412.,et al.Crit Care Med.,20

27、14,42(2):404-412.Advance of Critical Care in 2014-2015ARDS and PPLee,et al.Crit Care Med.,2014,42(5):1252-1262Lee,et al.Crit Care Med.,2014,42(5):1252-1262Advance of Critical Care in 2014-2015ARDS and PPLee,et al.Crit Care Med.,2014,42(5):1252-1262Lee,et al.Crit Care Med.,2014,42(5):1252-1262Advance

28、 of Critical Care in 2014-2015ARDS and PPHuHu,et al.Crit Care.,2014,18(3):R109,et al.Crit Care.,2014,18(3):R109Advance of Critical Care in 2014-2015ARDS and PPHuHu,et al.Crit Care.,2014,18(3):R109,et al.Crit Care.,2014,18(3):R109Advance of Critical Care in 2014-2015ARDS and PPHuHu,et al.Crit Care.,2

29、014,18(3):R109,et al.Crit Care.,2014,18(3):R109Advance of Critical Care in 2014-2015ARDS and PPHuHu,et al.Crit Care.,2014,18(3):R109,et al.Crit Care.,2014,18(3):R109Advance of Critical Care in 2014-2015ARDS and PPHuHu,et al.Crit Care.,2014,18(3):R109,et al.Crit Care.,2014,18(3):R109Advance of Critic

30、al Care in 2014-2015ARDS and ARMSuzumuraSuzumura,et al.Intensive Care Med,2014,40(9):1227-1240,et al.Intensive Care Med,2014,40(9):1227-1240Advance of Critical Care in 2014-2015ARDS and HFOVHuang,etHuang,et al.Crit Care,2014,18(3):R102 al.Crit Care,2014,18(3):R102Advance of Critical Care in 2014-201

31、5ARDS and HFOVHuang,etHuang,et al.Crit Care,2014,18(3):R102 al.Crit Care,2014,18(3):R102Advance of Critical Care in 2014-2015ARDS and NMVBurnsetBurnset al.CMAJ,2014,186(3):E112-122 al.CMAJ,2014,186(3):E112-122Advance of Critical Care in 2014-2015ARDS and NMVBurnsetBurnset al.CMAJ,2014,186(3):E112-12

32、2 al.CMAJ,2014,186(3):E112-122Advance of Critical Care in 2014-2015ARDS and NMVBurnsetBurnset al.CMAJ,2014,186(3):E112-122 al.CMAJ,2014,186(3):E112-122Advance of Critical Care in 2014-2015ARDS and NMVBurnsetBurnset al.CMAJ,2014,186(3):E112-122 al.CMAJ,2014,186(3):E112-122Advance of Critical Care in

33、2014-2015PN and ENAdvance of Critical Care in 2014-2015允许性低热卡RugelesRugeles,et al.Indian J Crit Care Med,2013,17(6),343-349,et al.Indian J Crit Care Med,2013,17(6),343-349Advance of Critical Care in 2014-2015允许性低热卡RugelesRugeles,et al.Indian J Crit Care Med,2013,17(6),343-349,et al.Indian J Crit Car

34、e Med,2013,17(6),343-349Advance of Critical Care in 2014-2015免疫制剂Arthur,et al.JAMA,2014,312(5):514-524Arthur,et al.JAMA,2014,312(5):514-524Advance of Critical Care in 2014-2015免疫制剂Arthur,et al.JAMA,2014,312(5):514-524Arthur,et al.JAMA,2014,312(5):514-524Advance of Critical Care in 2014-2015免疫制剂Arthu

35、r,et al.JAMA,2014,312(5):514-524Arthur,et al.JAMA,2014,312(5):514-524Advance of Critical Care in 2014-2015GNChen,et al.Crit Care,2014,18(1):R8Chen,et al.Crit Care,2014,18(1):R8Advance of Critical Care in 2014-2015GNChen,et al.Crit Care,2014,18(1):R8Chen,et al.Crit Care,2014,18(1):R8Advance of Critic

36、al Care in 2014-2015GNChen,et al.Crit Care,2014,18(1):R8Chen,et al.Crit Care,2014,18(1):R8Advance of Critical Care in 2014-2015GNWischmeyerWischmeyer,et al.Crit Care,2014,18(2):R76,et al.Crit Care,2014,18(2):R76Advance of Critical Care in 2014-2015GNWischmeyerWischmeyer,et al.Crit Care,2014,18(2):R7

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38、12Advance of Critical Care in 2014-2015Fe2+PieracciPieracci,et al.Cri,Care Med 2014,42(9):2048-2057,et al.Cri,Care Med 2014,42(9):2048-2057Advance of Critical Care in 2014-2015PN or ENHarvey,et al.N Harvey,et al.N EnglEngl J Med,2014,371(18):1673-1684.J Med,2014,371(18):1673-1684.Advance of Critical

39、 Care in 2014-2015PN or ENHarvey,et al.N Harvey,et al.N EnglEngl J Med,2014,371(18):1673-1684.J Med,2014,371(18):1673-1684.Advance of Critical Care in 2014-2015Sedation and AnalgesiaSedation and AnalgesiaAdvance of Critical Care in 2014-2015DeliriumPage,et al.Am J Page,et al.Am J RespirRespir Crit C

40、are Med.2014,189(6):666-673 Crit Care Med.2014,189(6):666-673Advance of Critical Care in 2014-2015DeliriumPage,et al.Am J Page,et al.Am J RespirRespir Crit Care Med.2014,189(6):666-673 Crit Care Med.2014,189(6):666-673Advance of Critical Care in 2014-2015Delirium and StatinsMorandiMorandi,et al.Crit

41、 Care Med.2014,42(8):1899-1909,et al.Crit Care Med.2014,42(8):1899-1909Advance of Critical Care in 2014-2015M-PZhou,et al.Crit Care,2014,18(3):R122Zhou,et al.Crit Care,2014,18(3):R122Advance of Critical Care in 2014-2015M-PZhou,et al.Crit Care,2014,18(3):R122Zhou,et al.Crit Care,2014,18(3):R122Advance of Critical Care in 2014-2015Sepsis AKITo Be ContinuedTo Be Continued 回归病理生理学回归病理生理学Prof.Steve Webb 目前ICU大约有一半的处理是错误的，可悲的是我们自己也不知道哪一半是错的。Advance of Critical Care in 2014-2015