Peking University Third Hospital

Critical Care Medicine Department

In early 1986, medical and nursing personnel led by Professor Chen Haohui, a nationally renowned critical care expert, formed one of the earliest intensive care units in China: the Surgical Intensive Care Unit. In July 1991, the former Surgical Intensive Care Unit moved into the new building in Ward 3 and was formally established as the Department of Critical Care Medicine (ICU). At the end of 2005, the Department of Critical Care Medicine moved into the new surgical building. It had 19 beds and was, at that time, the only entirely single-room ICU ward in China, equipped with advanced hardware and equipment available at the time. After nearly 30 years of development, the Department of Critical Care Medicine has now become one of China’s important critical care centers and is a clinical department integrating medical care, teaching, and research. It admits more than 1,000 patients annually, providing a strong guarantee for the treatment of critically ill patients at the hospital. The establishment of the critical care department not only improved the hospital’s overall medical and emergency-treatment capabilities, but also marked the hospital’s progress toward modernization. Under the leadership of Professors Jin Qingchen and Chen Haohui and through the continuous efforts of several generations, the Department of Critical Care Medicine of Peking University Third Hospital has become one of China’s important critical care centers and is a clinical department integrating medical care, teaching, and research. From the department’s initial 4 beds, it has grown to 19 beds today; the average annual number of patients admitted has risen from 200 to more than 1,000, providing a strong guarantee for the treatment of critically ill patients at the hospital. The Department of Critical Care Medicine currently has 3 specially appointed experts, 3 doctoral supervisors, and 1 master’s supervisor; a medical team comprising 6 professors/chief physicians, 4 associate chief physicians, 2 attending physicians, and 6 resident physicians; and a nursing team made up of 1 associate chief nurse, 8 charge nurses, and more than 50 well-trained nurses. The Department of Critical Care Medicine has advanced medical equipment used in China and internationally, including Dräger ceiling-mounted pendants, Dräger Evita XL, Servo-i, PB840, and other ventilators, a PiCCO monitor, an Aquarius bedside hemofiltration machine, an automatic cough-assist machine, an infusion-pump management system, and portable ultrasound equipment. Its hardware environment and equipment currently rank among the best in China. In his many years of clinical practice, Professor Chen Haohui of the Department of Critical Care Medicine has attached exceptional importance to frontline clinical work. He frequently personally visits the bedside to observe and treat critically ill patients with difficult conditions. Under his guidance and leadership, the Departments of Surgery and Critical Care Medicine successfully rescued many patients considered extremely difficult to treat or even beyond hope of treatment. Over the decades, Professor Chen Haohui has accumulated exceptionally extensive experience in treating difficult cases and rescuing critically ill patients, enabling him to determine the correct course of treatment amid extremely complex changes in patients’ conditions. During the 1980s, he reduced mortality from severe pancreatitis to 20–30%. In the early 1990s, he also implemented safe, low-pressure mechanical ventilation for acute respiratory distress syndrome. Except in cases where the primary disease was untreatable, no deaths caused by ventilator-induced injury or ventilator-associated pneumonia had occurred according to statistics through the end of the 1990s. Beginning in the 1990s, he also set the target for blood-glucose control in patients with severe diabetes at below 120–130 mg/dL, keeping the mortality rate of critically ill patients in the Department of Critical Care Medicine consistently below that reported in domestic and international literature. Through long-term clinical practice, Professor Jin Qingchen of the Department of Critical Care Medicine has accumulated much valuable clinical experience. In particular, in tracheal intubation and central venous catheterization for critically ill patients with difficult conditions, he has distilled many techniques and much experience, which he has taught young doctors hands-on. He was also among the first in China to propose the lung-inflation method for intubated patients, greatly reducing the incidence of ventilator-associated pneumonia. In recent years, under the leadership of Directors Zhu Xi, Yao Gaiqi, and Ma Penglin, the department has vigorously pursued discipline development and the development of a tiered talent structure, combining talent recruitment with talent training. The department organized its staff to compile the Peking University Third Hospital ICU Work Manual, providing a basis for departmental work and making it standardized and efficient. At the same time, the department has frequently engaged in academic exchanges at home and abroad, kept abreast of international advances, and actively developed new projects. In recent years, several doctors have obtained doctoral degrees through their own efforts, and a number of physicians have gone abroad for further training. The department is divided into four specialty groups: 1. Critical Illness Respiratory and Circulatory Group; 2. Critical Illness Gastrointestinal Group; 3. Critical Illness Blood Purification Group; 4. Critical Illness Infection, Coagulation, and Maternal-Obstetric Group. Each specialty group carries out its respective work in an orderly manner, with goals and plans. New projects undertaken in recent years include: continuous bedside high-flow veno-venous hemofiltration; early and advanced goal-directed therapy for shock (EGDT, AGDT); the clinical application of lung recruitment in ARDS; adrenal corticosteroid replacement therapy in stress states; bronchoalveolar lavage; percutaneous endoscopic gastrostomy; intracranial pressure monitoring and mild hypothermia treatment for traumatic brain injury, among others; comprehensive treatment of abdominal compartment syndrome, among other approaches; and ECMO treatment for severe respiratory failure. The Department of Critical Care Medicine has also accumulated extensive experience in the postoperative treatment and nursing of patients following liver transplantation or combined pancreas–kidney transplantation, as well as in the postoperative treatment and nursing of patients with high cervical spinal cord injuries. In the rescue and treatment of various critical illnesses, including various types of shock, acute respiratory distress syndrome, and multiple organ failure, its capabilities have reached a first-class level in China. Patient mortality is lower than the value predicted by the APACHE II severity-of-illness score; the average annual overall mortality rate is below 5%, and the mortality rate for septic shock is below 10%. The department has rescued several patients with dysfunction in six organ systems, attracting considerable attention and acclaim from the critical care community. The department has also been involved in major national emergencies, including SARS, the Wenchuan earthquake, Olympic Games security work, and influenza A. At the end of 2009, it successfully treated the first patient with severe influenza A using ECMO, earning acclaim in the field. In the past 5 years, the department has published more than 50 articles, including 8 SCI articles, and the department as a whole has secured 10 grants of various kinds at the national, provincial, and ministerial levels. It has held national training courses many times, receiving very positive feedback.