1、Intensive TherapyHistory of intensive care unitsMid 1800s - isolated wards to prevent the spread of infectious diseases1940 - 50 - specialized care for patients after thoracic or neuro-surgery1990s - general - specialized units- high dependency unitsDefinition of an ICUSpecial area for the managemen

2、t of critically ill patientsunder the supervision of specially trained - medical- allied health professionals- nursing personnelStaffingDirector - intensivistNursingAllied health professionalsPhysiotherapist, pharmacist, dietitianOtherstechnicians, orderlies, clerical staffSpace & environment6 beds/

3、unit (1/100 beds)lighting & filtered air conditioningcentral monitoring & data base computingX-ray viewing areachanging arearelatives waiting areaquiet room (conference, discussion)Single bed space20 feet x 10 feetlarge storage area3 O2, 2 air, 4 suction outlets16 power pointswash basincurtain aroun

4、d bedbench behind the patientEquipment - life -support; monitoring; diagnosticRespiratoryventilators, humidifiers, breathing circuits, tracheal tubespulse oximeter, capnograph, pulmonary compliance monitoringVentilator - Servo 300Displaying the pulmonary dynamicsVentilator - 900 CAttached to a patie

5、ntEquipment - life -support; monitoring; diagnosticCardio-vascular systemdrips, infusion pumps, Swan-ganze catherterECG, blood pressure, CVP monitoringcardiac output measuring deviceHaemodynamic statusElectrocardiographArterial lineEquipment - life -support; monitoring; diagnosticNeurologicalintra-c

6、ranial pressurecerebral perfusion pressurePatientsRenal failure require dialysisPatientsPost cardiac surgeryTracheostomyPatientsPhysiotherapy in ICUMaintain or improve the patients cardio-pulmonary function and prevent complicationsimprove mucociliary clearanceimprove alveolar expansionimprove pulmo

7、nary ventilationmaximise musculo-skeletal functionImproving lung volumeMucociliary clearanceManagement of mechanically ventilated patientsPositioningManual hyperinflation& chestwallcompressionSqueezing the bagSitting upIPPB AdjunctsCPAPIncentive spirometersPEP maskEthical ConsiderationsWho should live and who should not?Cost e