With advances in the understanding of shock pathophysiology and the development of hemodynamic theory and monitoring technologies, clinical strategies for shock assessment and treatment are undergoing substantial changes. First, finer delineation of the pathophysiological stages of shock enables multidimensional evaluation of circulatory status and thereby improves therapeutic precision. Second, individualized interpretation of monitoring variables within evidence-based and physiological frameworks provides a feasible approach to personalized hemodynamic interventions in critically ill patients. Third, because shock evolves in distinct temporal phases, hemodynamic phenotypes and treatment responsiveness change over the disease course, necessitating concomitant dynamic adjustment of therapeutic targets. Accordingly, defining an overall therapeutic goal, decomposing it into operational, tiered sub-targets, and continuously recalibrating these targets throughout the clinical course have become key requirements of contemporary critical care hemodynamic management. This review organizes hemodynamic management around clinically verifiable endpoints. The overarching goal of hemodynamic management is to maintain adequate tissue perfusion and oxygenation while minimizing treatment-related iatrogenic injury, thereby reducing the risk of cellular hypoxic damage and multiple organ dysfunction. Guided by this goal, clinical decision-making can be structured as a continuous loop of “identifying hypoperfusion—qualitative mechanistic phenotyping (allowing mixed shock)—tiered quantitative monitoring—goal decomposition (perfusion pressure, flow, oxygen metabolism)—intervention with metric binding—reassessment and dynamic recalibration,” consistent with the time-varying nature of shock pathophysiology.

Neurocritical care involves complex pathophysiological mechanisms, and its incidence is higher, injuries are more severe, and treatment is more challenging in high-altitude environments. This consensus, based on the latest domestic and international evidence-based medical data, establishes a standardized, goal-oriented framework for neurocritical care management applicable in high-altitude regions and nationwide. The consensus was developed following international standards for evidence quality assessment and underwent two rounds of Delphi expert consultation, resulting in 32 recommendation statements covering three parts: management systems, monitoring and assessment, and core strategies. Key updates include: advocating for the establishment of independent neurocritical care units and implementing precise tiered diagnosis and treatment based on the "Five Differences in Critical Care" concept; constructing a "trinity" multimodal brain monitoring system centered on cerebral blood flow, cerebral oxygenation, and brain function, emphasizing routine bedside transcranial Doppler ultrasound, cerebral oximetry, and continuous electroencephalography monitoring; shifting management strategies from mild hypothermia therapy to targeted temperature management, and defining the "446" target management pathway for the supercritical stage; emphasizing the assessment of static and dynamic cerebrovascular autoregulation functions through multimodal methods to achieve individualized optimal mean arterial pressure management; elevating cerebrospinal fluid management goals to the level of "glymphatic system" function maintenance; implementing a multidisciplinary collaborative, whole-process management model focusing on patients' long-term neurological functional outcomes; de-escalation criteria include multidimensional indicators such as recovery of brain structure, restoration of cerebrovascular autoregulation, improvement in cerebrospinal fluid dynamics, and reduction in biomarker levels; and integrating cutting-edge technologies like artificial intelligence into post-critical care management and rehabilitation planning. This consensus systematically integrates the entire process of neurocritical care management, reflecting the modern connotation of goal-oriented, dynamic, and multimodal integration in neurocritical care medicine. It aims to adapt to new trends such as deepening understanding of pathophysiological mechanisms, the integration of medicine and engineering, and the empowerment of artificial intelligence, thereby further advancing the discipline of critical care medicine.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is the primary cause of mortality in sepsis, with its core pathophysiological mechanism being severe ischemia and hypoxia in critical units—composed of microcirculation and the mitochondria of functional cells—resulting from disruptions in blood flow and oxygen flow following a dysregulated host response. Due to the systemically convergent yet clinically heterogeneous nature of the host response, current understanding and management strategies for hemodynamics remain inconsistent, often leading to inadequate resuscitation or overtreatment. To improve the quality of care, based on a systematic review of the "blood flow-oxygen flow" theory, an expert panel emphasizes reevaluating septic shock from an integrated perspective of blood flow and oxygen flow, and has formulated the Expert Consensus on Blood Flow and Oxygen Delivery Phenotyping and Clinical Management of Septic Shock (2025). The consensus proposes that clinical typing of blood flow-oxygen flow should comprehensively consider cardiac function, vascular tone, oxygen flow utilization status in critical units, and disease trajectory, while optimizing subtype identification by integrating host response phenotypes and artificial intelligence technologies. It advocates establishing a continuous assessment system through multi-site oxygen flow monitoring for organ perfusion, peripheral perfusion monitoring, and critical care ultrasound. Under the framework of the "critical care triangle", the consensus promotes the implementation of individualized, bundled management strategies, providing guidance for multiple management points to restore blood flow-oxygen flow matching, reduce the risk of organ failure, and decrease patient mortality.

Critically ill patients are at high risk for hospital acquired infections, which can significantly increase the mortality rate and treatment costs for these patients. Therefore, in the process of treating the primary disease, strict prevention and control of new hospital infections is an essential component of the treatment for critically ill patients. The treatment of critically ill patients involves multiple steps and requires a concerted effort from various aspects such as theory, management, education, standards, and supervision to achieve effective prevention and control of hospital infections. However, there is currently a lack of unified understanding and standards for hospital infection prevention and control. To address this, in March 2024, a group of experts in critical care medicine, infectious diseases, and hospital infection from China discussed the current situation and issues of hospital infection control in the intensive care unit together. Based on a review of the latest evidence-based medical evidence from both domestic and international sources, 2024 Expert Consensus on Hospital Acquired Infection Control Principles in the Department of Critical Care Medicine was formed, aiming to provide a basis for the development of hospital infection prevention and control strategies in the field of critical care medicine.

Catheter related blood stream infection (CRBSI), a common complication in the department of critical care medicine, may result in longer stay in the department of critical care medicine, increased hospitalization costs, even sepsis that leads to increased mortality in severe patients. The infection control of CRBSI has become the focus of the department of critical care medicine and even hospital management as well as the core of quality control. At present, the prevention program of CRBSI in the department of critical care medicine has been basically in place, and the national standards for infection prevention during central venous catheter placement and maintenance have been established. The establishment and implementation of these norms can effectively reduce the incidence of CRBSI, but CRBSI in the department of critical care medicine is still common and serious, indicating that there are defects in the aseptic operation during central vein catheterization and use. The corre- sponding operation process should be investigated and improved, and efforts should be made from the aspects of theory, management, education, norms, and supervision to avoid or reduce the occurrence of CRBSI and even achieve zero infection by improving and implementing various sensory control requirements in clinical operation.

The department of critical care medicine has a high prevalence of hospital acquired infections, which are closely associated with prognosis of critically ill patients. With hospital acquired infections as the axis, the treatment of critically ill patients can be divided into three phases: management of the primary disease and support of organ function, treatment of various complications resulting from the primary disease, and control of further damage and new complications. The cycle of the last two phases may put the patient in a state of Persistent inflammation, Immunosuppression, and Catabolism Syndrome (PICS), which ultimately leads to a poor prognosis. Fine control of the above three stages to reduce the risk of hospital acquired infections is a non-negligible component of the critical care process. Therefore, how to understand, prevent and treat hospital acquired infections is a top priority in the current development of critical care medicine. This review provides a comprehensive overview of strategies for the prevention and management of hospital acquired infections in critical care, covering five areas: changing the perception of hospital acquired infections, standardizing specific prevention interventions, consolidating the theoretical basis, recognizing that hospital acquired infection prevention are treatments, and integrating treatment to quality assurance. The aim is to develop the concept of severe treatment based on the prevention and control of severe patients, reduce the risk of hospital acquired infections of severe patients and improve the quality of critical care.

Background:Acute respiratory distress syndrome (ARDS) is a leading cause of postoperative respiratory failure after cardiac surgery, and the mortality rate is extremely high. Although prone positioning (PP) may be safe and effective for ARDS, it is still not widely adopted in cardiac surgery patients. We aimed to assess the efficacy and safety of early PP in ARDS after cardiac surgery. Methods:This is a single-center retrospective cohort study. We included adult intensive care unit (ICU) patients who developed ARDS with arterial pressure of oxygen to fraction of oxygen ratio (P/F) ≤200 mmHg within 72 hours after cardiac surgery between 1 January 2019 and 1 August 2023. The outcomes were P/F after 1 session of PP, duration of mechanical ventilation (MV) and ICU stay, and adverse events. Results:In total, 79 patients who underwent PP and 87 patients who underwent supine position (SP) were included. The mean time to perform PP after ICU admission was 38.0 hours. The P/F improved significantly after 1 session of PP treatment [160.0 (127.8-184.3) vs. 275.0 (220.0-325.0) mmHg, P<0.001], the duration of MV and ICU stay in the PP group were significantly shorter than those in the SP group [84.0 (64.0-122.0) vs. 120.0 (97.0-182.0) h, P<0.001; 6.0 (5.0-8.0) vs. 8.0 (6.0-12.0) days, P<0.001, respectively]. No adverse events were observed during the PP even in patients with intra-aortic balloon pump (IABP). Conclusions:Early PP treatment is effective and safe for patients with moderate to severe ARDS after cardiac surgery and it is even safe in a subgroup placed with IABP.

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through“ICU diaries”and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.

Neurocritical care is an important branch of critical care medicine. The mechanism of critical neurological damage is complex and diverse, and the pathophysiology changes rapidly. Different pathophysiological changes determine different degrees of brain injury. In a special plateau environment, the incidence of critical neurological disease is higher, the age of onset is younger, the disease progress is faster, and the degree of damage is more severe. In order to standardize the diagnosis and treatment, enhance monitoring and management, provide timely and precise treatment, prevent irreversible brain injury, and improve the prognosis of patients with critical neurological illness at high altitudes, the Research Group of Calm Treatment of China, Research Group of Critical Care Ultrasound of China, and the Quality Control Center of Critical Care Medicine in Tibet formulated the Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes on the basis of full discussion and communication of relevant critical medical experts and neurosurgery experts according to domestic and foreign literature and years of experience in clinical application and promotion. The main contents of the consensus are as follows.(1) According to the pathophysiological mechanism of neurological involvement in critical illness, scenarios of neurocritical care at high altitudes can be divided into cerebral hemorrhage at high altitudes, severe traumatic brain injuries, ischemic stroke, cerebral edema at high altitudes, and septic encephalopathy (8.4 points).(2) It is recommended to use cerebral blood flow, brain function monitoring and cerebral oxygen saturation as a 'triad' monitoring core in management of neurocritical care at high altitude, to as well as cerebrospinal fluid dynamics monitoring and brain structure surveillance (9.0 points).(3) It is recommended to grade patients quickly, and the '5-avoids' approach based on 'brain protection' theory were adhered to avoid fever, seizures, anxiety, agitation or pain, shivering, stimulation and nociception, according to different levels. Especially in the 'super critical' stage, with the protection of '446'targets, choose the window for analgesia and sedation (8.4 points).(4) It is recommended to monitor systemic and cerebral hemodynamic continuously and dynamically in order to improve systemic perfusion and optimize cerebral perfusion simultaneously (8.4 points).(5) It is recommended to choose the method of direct measurement of intracranial pressure by intraventricular catheter or optic nerve sheath diameter under ultrasound to estimate intracranial pressure, and choose the appropriate target mean arterial pressure to ensure optimal brain perfusion (8.8 points).(6) It is recommended to use transcranial Doppler ultrasound to evaluate the blood flow velocity and blood flow waveform of the bilateral cerebral arteries. It is recommended to target the blood flow velocity of M1 at 40 cm/s in the 'super critical' period (8.2 points).(7) In the 'super critical' period, we recommend to routinely monitor BIS and maintain the BIS value around 40 as the goal to guide the depth of sedation; those with conditions can be monitored by quantitative electroencephalography to assist determining whether there are non-convulsive seizures, and perform diagnostic evaluation of the prognosis (8.6 points).(8) It is recommended to monitor brain oxygen levels routinely, starting early in the ICU admission of patients with critical neurological conditions at high altitudes, which can assist in the assessment of brain damage (8.6 points).(9) It is recommended to evaluate the cerebral blood flow self-regulation ability routinely to achieve the optimal cerebral perfusion pressure in time and timely adjust the intensity and scheme of treatment (8.2 points).(10) It is recommended to emphasize the importance of target arterial partial pressure of carbon dioxide in the artery in critical illness and neurocritical care at high altitudes (8.0 points).(11) It is recommended to devote attention to the importance of targeted temperature management in in critical illness and neurocritical care at high altitudes (8.6 points).(12) It is recommended that multidisciplinary consultation and multi-professional cooperation could improve the management in critical neurological illness at high altitudes (8.8 points).(13) It is recommended that the constitution of improvement in brain structure imaging, pressure normalization of cerebrospinal fluid and restoration of cerebral blood autoregulation could be as the de-escalation triad (8.0 points).(14) It is recommended to be cautious of paroxysmal sympathetic hyperreactivity patients in neurocritical and critical illness at high altitude (8.0 points).(15) It is recommended to be cautious about the management of agitation (delirium) and cognitive function of patients in TBI at high altitudes(8.0 points).(16) It is recommended to assess the itinerary of the rehabilitation in a timely manner for critically sick patients at high altitudes (8.2 points).(17) It is recommended to be cautious of post-traumatic hydrocephalus and related neuroendocrine abnormalities in patients with critical neurological illness at high altitudes (7.6 points).

医院环境清洁程度、灭菌消毒效果与医院感染存在紧密关联,而医院感染控制与管理是保障医院安全运营的基础,也是国家有效应对重大突发公共卫生事件的重要保障.《现代医院感染管理质量控制》一书根植于现代医院感染控制要点,结合编者多年实践经验,系统阐述了医院感染的概念、监测方法、应急预案等,并对医院感染类别与基础性问题进行了分析,可降低医院感染概率,为应对重大突发公共卫生事件提供理论与实践参考.此外,本书还以近年来我国颁布的医院感染管理法规、标准、规范为依据,在充分考虑临床医学、预防医学、医院管理学等对医院感染管理的要求后对医院感染相关内容进行了梳理、讨论及分析.本书结构层层递进,从多个维度阐述医院感染预防及控制特点,将法规、标准、规范与医院感染质量控制实际工作紧密结合,可作为医院感染管理专职人员参考书,也可供临床医务人员学习借鉴,对各级医疗机构感染管理专职人员而言是不可多得的学习资源.

Purpose:Little epidemiological data exist on patients with severe infection in the plateau region of China, and the data that do exist are lacking in quality. Using the medical records of patients with severe infection in the Department of Intensive Medicine (intensive care unit; ICU) of the People's Hospital of Tibet Autonomous Region, this study analyzed the epidemiological and clinical characteristics of patients with septic shock in plateau area (Tibet), with the ultimate aim of reducing the incidence and mortality from this condition.Methods:Clinical data on 137 patients with septic shock in the studied ICU from November 2017 to October 2019 were retrospectively analyzed using SPSS, Version 21.0.Results:Among the 137 patients with septic shock, there were 47 survivors and 90 in-hospital or post-discharge deaths. There were 91 male patients and 46 female patients. The incidence of septic shock was 11.3%, and mortality rate was 65.7%. Median age was 55 years old, median APACHE-II score on the day of admission was 17, median SOFA score was 11, and median number of organ injuries was one. APACHE-II score (P = 0.02), SOFA score (P < 0.001), and the number of organ injuries (P < 0.001) were higher among patients who died than among survivors. The infections were mainly pulmonary and abdominal, and the main pathogen was gram-negative bacteria.Conclusion:The incidence and mortality of septic shock in ICU wards in Tibet are very high. The APACHE-II score, SOFA score, and the number of organ damage on the first day after diagnosis are independent risk factors for septic shock. To some extent, this study reflects the epidemiological characteristics of septic shock in the plateau region of China (≥ 3,650 m above sea level) and provides data that can support the prevention and treatment of sepsis in the future. More and deeper epidemiological studies of septic shock are necessary.

Objective To explore the relationship between the post-operative peak value of central venous pressure (CVPp) and the incidence of acute kidney injury (AKI) in patients who had undergone cardiopulmonary bypass surgery (CBS). Methods Clinical data were retrospectively collected from 1 May 2016 to 1 May 2018 from all patients undergoing CBS in the Department of Intensive Care Medicine, Peking Union Medical College Hospital. The CVP values immediately after transfer to ICU (CVP 0h) and at 6 h(CVP 6h), and CVPp within 48 h(CVPp 48h) of transfer to ICU, the incidence of AKI after 48 h of transfer to ICU and in-hospital mortality were recorded. The receiver operating characteristic (ROC) curve was used to evaluate the clinical value of CVP-related indicators in predicting AKI after CBS and determine the optimal threshold. The risk factors for AKI and in-hospital mortality after CBS were analysed using single factor and multifactorial Logistic regression. Results A total of 485 patients after CBS who met the inclusion and exclusion criteria were enrolled, with an incidence of AKI after 48 h of transfer to ICU of 25.2% (122/485) and an in-hospital mortality rate of 2.5% (12/485). The ROC curve analysis showed that the area under the curve (AUC) for CVPp 48h to predict AKI after CBS was 0.634 (95% CI: 0.577-0.692, P < 0.001), with an optimal threshold value of 14 mm Hg, sensitivity of 49.6% and specificity of 63.5%. Multifactorial logistic regression analysis showed that hypertension(OR=2.505, 95% CI: 1.581-3.969, P < 0.001), pulmonary hyperten-sion(OR=2.552, 95% CI: 1.573-4.412, P < 0.001), prolonged aortic block time(OR=1.009, 95% CI: 1.004-1.014, P=0.001), and CVPp 48h≥14 mm Hg(OR=1.613, 95% CI: 1.030-2.526, P=0.037) were independent risk factors for AKI after CBS; CVPp 48h≥14 mm Hg was an independent risk factor for in-hospital death(OR=8.044, 95% CI: 1.579-40.979, P=0.012). Conclusions CVPp 48h is associated with AKI in patients who have undergone CBS. The monitoring and management of CVP might be a way to improve the prognosis of these patients.

Objective To explore the situation of fungal detection in adult patients with severe diseases in Tibet region, and further analyze the influencing factors of fungal detection. Methods All patients admitted to the Department of Critical Care Medicine Tibet Autonomous Region People's Hospital from January 1, 2018 to December 31, 2019 were retrospectively analyzed. According to the results of fungal detection, the patients were then divided into the positive group and the negative group. The distribution of fungal strains detected and clinical data of the two groups were collected by the electronic medical record system. Multivariate Logistic regression was used to analyze the influencing factors of fungal detection. Results A total of 755 severe patients (4917 specimens were submitted) were enrolled, including 142 patients with positive fungal detection and 613 patients with negative fungal detection.Of which, 192 fungal strains were detected, including 183(95.3%) Candida strains, 7(3.7%) Aspergillus strains and 2(1.0%) other fungi strains. Among Candida genus, there were 164 strains (89.6%) of Candida albicans, 9 strains (4.9%) of Candida glabrata, 7 strains (3.8%) of Candida parapsilosis, 2 strains (1.1%) of Candida krusei, and 1 strain (0.6%) of Candida tropicalis. Among Aspergillus, there were 3 strains (42.8%) of Aspergillus fumigatus, 2 strains (28.6%) of Aspergillus niger, and 2 strains (28.6%) of Aspergillus flavus. Multivariate Logistic regression analysis showed that, high sequential organ failure assessment score (OR=1.402, 95% CI: 1.277-1.538, P < 0.001), severe digestive diseases (OR=2.671, 95% CI: 1.465-4.872, P=0.001), the duration of tracheal intubation ≥48 h(OR=2.661, 95% CI: 1.611-4.397, P=0.000), the use of carbapenemes ≥24 h (OR=2.825, 95% CI: 1.522-5.245, P=0.001), the use of cephalosporins plus beta lactamase inhibitor ≥24 h (OR=2.678, 95% CI: 1.679-4.272, P=0.000), and the long ICU stay (OR=1.043, 95% CI: 1.011-1.076, P=0.008) were independent risk factors for fungal detection in adult patients with severe diseases. High altitude of residence (OR=0.999, 95% CI: 0.999-1.000, P=0.040) and the high hemoglobin level (OR=0.994, 95% CI: 0.988-0.999, P=0.020) were protective factors. Conclusions Positive fungal detection in adult patients with severe diseases in the Tibet area is not uncommon, and Candida albicans is the main strain detected. The factors affecting the detection of fungi involve many aspects. Corresponding preventive measures should be taken according to the characteristics of Tibet.

Background The activation and assembly of the NLRP3 inflammasome is dependent on the interaction between NLRP3 and the intermediate filament protein vimentin in an acute respiratory distress syndrome (ARDS) model. We investigated the role of vimentin in this process using human fetal lung (HFL-1) fibroblasts with vimentin transfer genes or gene knockdown and lipopolysaccharide (LPS) intervention. Methods HFL-1 cells [con-vector + LPS, vimentin-pCMV3 (VIM-pCMV3), con-siRNA, and vimentin siRNA (VIM-siRNA)] were treated with LPS. An oxidative stress damage assessment, apoptosis analysis, and quantification of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and IL-10 by enzyme linked immunosorbent assay (ELISA) were performed. Immunoblotting was used to reveal the autophagy pathway. Results We demonstrated that in response to LPS vimentin expression was lower in the HFL-1 cells with the vimentin gene knocked down. Specifically, an increase in oxidative stress, a decrease in mitochondrial membrane potential, or an increase in calcium ion permeability resulted in an increase in the fibroblast apoptosis rate. In addition, the inflammatory response after vimentin gene knockout was upregulated, as indicated by higher levels of TNF-a, IL-1β, IL-6, and IL-10. Importantly, the mechanism of suppression of vimentin in the lung fibroblasts was caused by a decrease in autophagy, an increase in mitochondrial membrane protein, and a decrease in mitochondrial function, which may contribute to the augmented cellular injury generated during the response to LPS. Conclusions This study provides insights into whether vimentin may interfere with the inflammatory cascade by activating the autophagy pathway of mitochondrial lung fibroblasts in the early stage of acute lung injury (ALI).

Coronavirus disease 2019(COVID-19) poses a challenge to hospitals for the prevention and control of public health emergencies. As the main battlefield of preventing and controlling COVID-19, large public hospitals should develop service protocols of diagnosis and treatment for outpatient, emergency, hospitalization, surgery, and discharge. The construction of medical protocols should be based on the risk factors of key points and focused on pre-inspection triage and screening, to establish a rapid response mechanism to deal with exogenous and endogenous risk factors. Implementation of all-staff training and assessment, strengthening the information system, and use of medical internet service are important. This study explores the construction of medical protocols in large public hospitals during the pandemic, and provides a reference for the orderly diagnosis and treatment in hospitals during the pandemic. © 2021, Peking Union Medical College Hospital. All rights reserved.

Abstract Background Serum lactate has long been used to evaluate hypoxia and predict prognosis in critically ill patients, however, discrepancy in lactate measurements between different sites have not been recognized as a useful tool for monitoring hypoxia and evaluating outcome. Methods Data were obtained from the clinical information system of the intensive care unit (ICU) in a tertiary academic hospital for 1582 ICU patients with vasoactive drug requirement and valid paired blood gas. The mortality rates were compared between patients with sustained negative venous to arterial lactate gradient (VALac) and the others using the Cox proportional hazard model. Predictive factors associated with negative VALac were searched. Results A sustained negative VALac was significantly associated with higher 30 day ICU mortality [Adjusted hazard ratio (HR) = 2.31, 95% confidence interval (CI), 1.07–4.99; p = 0.032. Propensity score- weighted HR: 2.57; 95% CI, 1.17–5.64; p = 0.010]. Arterial lactate in the first blood gas pair, 24-h arterial lactate clearance, use of epinephrine, mean positive end-expiratory pressure level, and extracorporeal membrane oxygenation initiation showed statistically significant association with sustained negative VALac during the first 24 h. Conclusion The sustained negative VALac in the early stage of treatment may suggest additional information about tissue hypoxia than arterial lactate alone. Critical care physicians should pay more attention to the lactate discrepancy between different sites in their clinical practice.

目的 基于疾病诊断相关组(DRG)比较分析医院感染患者的经济负担情况,为医院感染防控提供支持.方法 采用回顾性分析方法分析某院2018—2020年住院患者医院感染病例的住院日数及医疗费用,并与DRG同组患者的住院日数及费用等进行比较.结果 2018—2020年医院感染病例数分别为694、1102、819例次,同期DRG分组病例数分别为72707、92837、59398例次;各年份医院感染患者的平均住院日均高于DRG同组患者(31.07 d VS 13.05 d,65.98 d VS 47.51 d,35.38 d VS 13.45 d),差异均有统计学意义(均P<0.01);各年份医院感染患者的平均住院费用均高于DRG同组患者(12.29万元VS 3.84万元,17.18万元VS 4.12万元,15.75万元VS 4.43万元),差异均有统计学意义(均P<0.01).从感染部位来看,导管相关血流感染的平均住院费用最高,2018—2020年各年份分别为22.57、35.88、26.80万元.导管相关血流感染患者的三年平均住院日数为102.00 d、住院费用为28.42万元,较之DRG同组患者的平均住院日数及费用分别增加88.78 d、24.27万元.结论 住院患者发生医院感染将显著增加患者的直接经济负担,控制导管相关血流感染是减轻医院感染经济负担的重中之重,在DRG支付方式下,做好医院感染预防与控制势在必行.

In the current situation of Corona virus disease 2019， “to prevent import from abroad and to defend internal rebound” is the general principle. Facing the changes in the epidemic situation， especially the winter and spring epidemics， it is a huge challenge to carry out a scientific, precise and flexible program for the prevention and control of healthcare-associated infections so that to ensure the safety of healthcare workers and patients. After more than a year of anti-epidemic work， Peking Union Medical College Hospital has summarized and formulated a four-level retractable and releasable hierarchical program of prevention and control. It is dynamically adjusted according to the responsive level of public health emergencies in Beijing and the relevant regulations of epidemic prevention and control. Various departments can also respond quickly to ensure the resumption of work. This program provides reference for the prevention and control of coronavirus disease 2019 and other sudden infectious diseases.

Objective The aim of this study is to establish a hospital-based prevention and control system of respiratory-borne diseases for seasonal influenza and to verify the effect. Methods Influenza cases reported by Peking Union Medical College Hospital in the three flu seasons from November 2017 to February 2020 were retrospectively analyzed. According to the location of occurrence, the influenza cases are divided into hospital influenza cases and non-hospital influenza cases. The incidence of influenza cases in hospital before and after the implementation of the prevention and control system of respiratory diseases were compared. Results A total of 5427 influenza cases that met the inclusion and exclusion criteria were selected for this study. Among them, there were 335 cases (6.17%, 335/5427) of hospital influenza and 5092 cases (93.83%, 5092/5427) of non-hospital influenza. There were 1594 (29.37%, 1594/5427) influenza cases in the 2017-2018 influenza season, 2579 (47.52%, 2579/5427) cases in the 2018-2019 influenza season, and 1,254 (23.11%, 1254/5427) cases in the 2019-2020 influenza season.The incidence of hospital influenza of the 2019-2020 influenza season (3.51%) is much lower than those of the 2017-2018 influenza season (7.59%) and 2018-2019 influenza season (6.59%) (P 0.05). Compared with the 2017-2018 influenza season and 2018-2019 influenza season, the relative risk (RR) of hospital influenza cases in the 2019-2020 influenza season is 0.53 (95%CI:0.39-0.74) and 0.46 (95%CI:0.33-0.65) respectively. Conclusions Hospital-based prevention and control system of seasonal influenza may effectively prevent influenza cases from appearing in hospital.

目的 调查北京协和医院ICU医务人员手卫生依从性现状,并分析其存在差异的深层次原因.方法 采用单盲、便利抽样法,对2019年1月至12月北京协和医院经手卫生多维度培训后的ICU医务人员进行手卫生现状调查,计算手卫生依从率,并比较不同手卫生时刻及不同类别/来源的医务人员手卫生依从率的差异.结果 共285名符合纳入和排除标准的ICU医务人员入选本研究.其中医生85名、护士171名、护理员21名、保洁员8名;本院医护人员104名、进修医护人员152名.共观察手卫生指征总数23661次、手卫生执行总数21360次,总体手卫生依从率为90.28％(21360/23661).世界卫生组织规定的5个手卫生时刻依从率由高至低依次为接触患者体液后(95.63％,765/800)、无菌操作前(94.39％,2121/2247)、接触患者后(91.59％,7916/8643)、接触患者周围环境后(88.91％,4026/4528)、接触患者前(87.76％,6532/7443),差异有统计学意义(P<0.001);不同类别人员的手卫生依从率由高至低分别为护士(94.52％,11186/11834)、护理员(93.49％,1665/1781)、医生(84.78％,8427/9940)、保洁员(77.36％,82/106),差异有统计学意义(P<0.001).本院医护人员的手卫生依从率(93.45％,7844/8394)高于进修医护人员(87.96％,11769/13380),差异有统计学意义(P<0.001).结论 北京协和医院ICU医务人员手卫生依从性总体较好,但不同手卫生时刻及不同类别人员之间仍存在一定差异,可能与医务人员的手卫生防护意识、科室对不同类别医务人员的培训和监督力度不同有关.