中国12省份重症医学科慢性危重症诊疗现状的调查报告OA北大核心CSTPCD

Objective To understand the current situation of clinical diagnosis and treatment of chronic critical illness(CCI)on the day of investigation in the Intensive Care Unit(ICU)in Chinese Mainland.Methods Starting from the ICU of the Second Affiliated Hospital of Fujian Medical University,a survey questionnaire was distributed through WeChat to physicians with more than 2 years of experience in the comprehensive ICU of 34 hospitals in 12 provinces of mainland China.The survey was completed and the questionnaires collected on September 29,2022,and all medical data of patients in all 34 hospitals on the day of the survey were recorded.All the patients were divided into CCI group and non-CCI group,and the basic information,main diagnosis,major comorbidities and complications,as well as treatment status of the two groups of patients were compared.Results Among the 34 hospitals,there were 22 tertiary Grade A hospitals(64.7％),8 tertiary Grade B hospitals(23.5％),and 4 secondary Grade A hospitals(11.8％).A total of 409 ICU patients were enrolled,including 110(26.9％)in the CCI group and 299(73.1％)in the non-CCI group.The CCI group included 70 cases(63.6％)of mechanical ventilation with tracheotomy or extension,51 cases(46.4％)of sepsis or other severe infection,65 cases(59.1％)of multiple organ failure,48 cases(43.6％)of cerebral hemorrhage,cerebral ischemia or traumatic brain injury,and 24 cases(21.8％)of trauma.Compared with the non-CCI group,the proportion of the patients with the following diagnosis in CCI group significantly increased(P＜0.05),including stroke(31.8％),pneumonia(23.6％),multiple fractures(9.1％),abdominal infection(4.5％),pancreatitis(3.6％),combination with hypothyroidism(8.2％),concurrent aspiration pneumonia(18.2％),multiple organ failure(59.1％,including respiratory system failure 50.9％and central nervous system failure 26.4％),acute respiratory distress syndrome(ARDS,23.6％),drug-resistant bacterial infection(58.2％,including drug-resistant negative bacterial infection 44.5％,drug-resistant positive bacterial infection 9.1％,and drug-resistant fungal infection 20.9％),shock(42.7％,including distributed shock 30％),sepsis(36.4％,including abdominal origin 15.5％,chest and lung origin 14.5％and vascular catheter origin 5.5％),as well as central venous catheters with peripheral implantation(PICC,6.4％)(P＜0.05).In terms of treatment methods,the proportion of patients in CCI group receiving enteral nutrition(90.0％),special grade antibiotics(32.7％),and fiberoptic bronchoscopy(40.9％)significantly increased(P＜0.05).The swallowing function physical examination evaluation(30.9％),swallowing function scale evaluation(18.2％),the rate of using neuromuscular electrical stimulation(24.5％),the rate of using power cycling(16.4％),upper limb exercise(25.5％),and the rate of using diaphragmatic pacemaker(7.3％)in CCI group were significantly higher than those in non-CCI group(P＜0.05).Conclusion The incidence of CCI in ICU patients is high,with stroke,pneumonia,and multiple fractures of the body being the top three main diagnoses.The situation is severe in CCI patients with hypothyroidism,concurrent aspiration pneumonia and ARDS,multiple organ failure,drug-resistant bacterial infection,shock,and sepsis.The excessive use of special grade antibiotics and fiberoptic bronchoscopy in CCI patients,as well as inadequate rehabilitation assessment and treatment,should be taken seriously.