Senior Brother Luo next to her wanted to share his views on the expert lectures with her.
Xie Wanying said: "The intensive care unit is very important, but it is not the most important for surgery now."
There is always something surprising about what she says.
Everything must be based on evidence, and in medicine it is best to use statistical data. Both domestic and foreign statistical data show that, regardless of the type of disease treated in the intensive care unit, the proportion of patients after surgery is skewed.
Less.
The biggest benefit of surgery is surgery. If surgery cannot be performed, the patient is basically expected and required to be transferred to the internal medicine department. So taking the two together, it shows that the intensive care unit may not be the most important for surgery.
What is the specific manifestation? Looking at each surgical department, I heard that even the Department of Neurology is planning to build a dedicated intensive care unit for neurosurgery, similar to the cardiac surgery area, and place it in the newly built surgical building. Building an intensive care unit in its own department means that the Department of Surgery
The proportion of postoperative intensive care is not high, the number of hospital beds required is small, and there is not even a need for specialized ICU doctors.
In this case, all departments are based on the premise of maximizing profits, and this money will not be allocated to the intensive care unit to make money. Moreover, in fact, most of the patients admitted to the intensive care unit are acute patients who come in from the emergency department. Such patients are often treated even before surgery.
It's hard to say whether surgery can be performed, or not, and they may not necessarily be classified as surgical patients. In fact, some patients are like this. They are admitted directly to the ICU and die in the ICU before they can survive surgery.
Xie Wanying once again gave an example: "Among the critically ill children admitted to the PICU, respiratory diseases occupy the first place, followed by neurological diseases and children after surgery. Among them, children with respiratory diseases involve the field of surgery, and I am afraid that
Only some of them are cardiogenic. For pulmonary origin, most of them are treated by internal medicine. The two major diseases of cardiogenic respiratory diseases and neurological diseases belong to the two major specialties of surgery, cardiac surgery and neurosurgery. The pediatric surgery department in our hospital
It should be based on pediatric general surgery. The length of stay in the intensive care unit is not long and the bed turnover rate is high. If the preoperative assessment is done well and the surgical risk is well controlled, I believe the hospital’s judgment is that it only needs to be performed in the pediatric general surgery ward.
Establish several intensive care beds similar to the extracardiac area."
In this way, what Dr. Li said on the stage may be wrong if the listener does not think carefully. Judging from the data, the significance of PICU is great for children with critical illness, but it may not necessarily be of great significance to critically ill children.
Pediatric surgery is of great significance.
"In surgery, the most important thing is to do a good preoperative assessment, prevent postoperative risks, and do the surgery well. It will be too late to fix everything after the surgery." Xie Wanying said her basic understanding of surgery.
Furthermore, the intensive care unit ward is now equivalent to a big basket, and patients who cannot be handled by any department are sent there to stay for a few days. But in fact, many medical technologies in the intensive care unit require the support of specialist doctors. Finally,
A simple example: ventilator intubation requires an anesthesiologist. Chest drainage requires a cardiothoracic surgeon. Peritoneal dialysis and ECMO require the assistance of a surgeon. Bronchoscopy can perform endoscopic treatment. Some ICU doctors cannot do it and have to call the respiratory department and other departments.
The doctor used to do it.
What is the biggest difference between the intensive care unit and the general ward? According to the relevant standards set by the national health department, the actual ratio of the number of nurses to the number of beds in the hospital is 0.4 to 1 in the general ward, and about 2.5 to 3 to 1 in the ICU.