Critical Care Medicine

The Intensive Care Unit (ICU) of the Fourth Affiliated Hospital of Harbin Medical University was established in January 2009 as the hospital's specialized department for centralized monitoring and treatment of critically ill patients. The department has as much as 2,000 square meters of medical space, located on the 5th floor of the newly built surgery building, with 30 beds; in accordance with the special requirements for establishing an ICU, more than one-third of the area is reserved for medical auxiliary rooms. The wards are rationally laid out, addressing not only the requirements of centralized monitoring and treatment of traditional ICU patients and efficient use of medical hardware resources, but also the characteristics of the critically ill population: wards of different isolation levels have been specially established, combined with advanced laminar-flow purification, to maximally prevent cross-infection among patients, safeguard patients' interests, and ensure the smooth progress of treatment work.

The medical feature of the Intensive Care Unit is the use of advanced diagnostic and treatment equipment and techniques to continuously and dynamically monitor the patient's condition, providing standardized, high-quality treatment for critically ill patients through effective interventions. The disciplinary scope covers the treatment of severe pneumonia, severe asthma, respiratory failure, shock, resuscitation, cardiac dysfunction, severe arrhythmias, acute renal insufficiency, central nervous system dysfunction, severe hepatic dysfunction, gastrointestinal dysfunction and major gastrointestinal bleeding, acute coagulation dysfunction, severe endocrine and metabolic disorders, and water-electrolyte and acid-base balance disturbances. At the same time, comprehensive, intensive, and continuous treatment can be provided for elderly patients or perioperative patients of certain major surgeries who have comorbidities in other systems requiring surgery, ensuring the smooth progress of the operation. While providing targeted treatment for critically ill patients, nutritional support, appropriate analgesia and sedation, and rational anti-infection treatment for these patients must be strengthened.

The philosophy of intensive care medicine is to focus on maintaining the overall function of the diseased body, on the interactions among systems, and on the dynamic changes of monitoring indicators and early support of tissue and organ function, in order to gain time for the rescue of critically ill patients and win opportunities for their recovery.

Admission scope of the Intensive Care Unit: 1. Patients with acute, reversible, life-threatening organ dysfunction who may recover in the short term after intensive monitoring and enhanced treatment in the ICU. 2. Patients with various high-risk factors (such as advanced age, major surgery, not yet recovered from general anesthesia, comorbidities of other systems before surgery, impaired consciousness with inability to guarantee airway safety or risk of asphyxiation, various ion disorders or acid-base imbalance, severe malnutrition, pregnancy-induced hypertension, etc.) who have potential life risks and whose risk of death may be reduced through rigorous ICU monitoring and timely effective treatment. 3. Patients with chronic organ insufficiency who experience acute, life-threatening exacerbation and who may return to their original state after rigorous ICU monitoring and treatment. 4. Terminal states of chronic wasting diseases, irreversible diseases, and patients who cannot benefit from ICU monitoring and treatment are generally not within the scope of ICU admission.

ICU patients are managed by physicians specialized in intensive care medicine; the patients' conditions related to other specialties are handled jointly through consultation between ICU physicians and the relevant specialists. Treatment emphasizes early, comprehensive, systematic, multidisciplinary integrated therapy.

The department possesses internationally top-level monitoring, examination, and treatment equipment, including patient monitors, ventilators (suitable for all children and adults except low-birth-weight infants and neonates), fiberoptic bronchoscopes, a GEM3000 blood gas analyzer, a GE ECG machine, defibrillators, vibration sputum expectoration devices, cooling devices (hypothermia therapy devices), infusion pumps, and micro-syringe pumps — all essential ICU monitoring and treatment equipment.

After nearly 2 years of unremitting efforts, and with the care of hospital leadership, the Intensive Care Unit has grown from nothing to something, from weak to strong. The department currently has more than 40 medical staff, including 11 full-time physicians and 35 nurses. The physicians come from different specialties — cardiology, gastroenterology, obstetrics and gynecology, general surgery, urology, and cardiothoracic surgery — working together with mutual learning to form the treatment team and cooperate with specialist physicians in rescuing critically ill patients. In addition to the common diagnostic and treatment skills of clinical departments, each physician is also proficient in cardiopulmonary resuscitation, establishment and management of artificial airways, mechanical ventilation, deep vein and arterial catheterization, fiberoptic bronchoscopy and bronchoalveolar lavage, etc. At present, the ICU has undertaken the rescue of acute, critical, and severe patients throughout the hospital.

All the ICU medical staff hope, through their own efforts, to relieve specialist physicians of worries, enabling them to devote more energy to developing specialty technologies and exploring new therapeutic fields, and they will do their utmost to escort and safeguard them.