Brother Luo next to her wanted to exchange views with her on the expert lecture.
Xie Wanying said: "The intensive care unit is very important, but it is not the most important thing for surgery right now."
There is always something surprising in what she says.
Everything should be based on evidence, and in medicine, statistical data is the best. Both domestic and foreign statistical data show that, for both adults and children, the proportion of patients who have undergone surgery in the intensive care unit is relatively small.
The biggest benefit of surgery is to perform surgery. If surgery cannot be performed, patients are basically expected and required to be transferred to internal medicine. So considering both factors, it can be seen that the intensive care unit may not be the most important for surgery.
How is it specifically reflected? Look at the various surgical departments. I heard that even neurosurgery is planning to build a neurosurgery-specific intensive care unit similar to the cardiac surgery area in the newly built surgical building. Setting up an intensive care unit in one's own department means that the proportion of postoperative intensive care in surgery is not high, the number of beds required is not large, and even a dedicated ICU doctor is not needed.
In this case, each department takes the maximum profit as the premise, and this money will not be distributed to the intensive care unit. Moreover, in fact, most of the patients admitted to the intensive care unit are acute patients who come in for emergency treatment. Even before the operation, it is unclear whether these patients can undergo surgery, and they may not be classified as surgical patients. In fact, some patients are like this. They die in the ICU after entering the ICU and never survive until the surgery department can intervene.
Xie Wanying gave another example: "Among the critically ill children admitted to the PICU, respiratory diseases account for the largest proportion, followed by neurological diseases and children after surgery. Among the children's respiratory diseases that involve the field of surgery, I am afraid that only a portion of them are cardiogenic. Most of the pulmonary diseases are treated by internal medicine. The two major types of diseases, cardiogenic respiratory diseases and neurological diseases, belong to the two major surgical specialties, cardiac surgery and neurosurgery. The pediatric surgery department of our hospital should be based on pediatric general surgery, which has a short hospital stay in the intensive care unit and a high bed turnover rate. If the preoperative evaluation is done well and the surgical risk is well controlled, I believe the hospital's judgment is that only a few intensive care beds similar to the cardiac surgery area need to be established in the pediatric surgery ward."
In this way, if the listeners do not think carefully about what expert Li said on the stage, they may think it is wrong. Judging from the data, the significance of PICU is great for critically ill children, but it may not be great for pediatric surgery.
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"For surgery, the most important thing is to do a good preoperative evaluation, prevent postoperative risks, and perform the operation well. It will be too late to make amends after the operation." Xie Wanying expressed her basic understanding of surgery.
Furthermore, the ICU ward is now equivalent to a big basket. All patients who cannot be treated in any department are sent there to stay for a few days. But in fact, many medical technologies in the ICU require the support of specialists. The simplest example is that ventilator intubation requires an anesthesiologist. Chest drainage requires a cardiothoracic surgeon. Peritoneal dialysis and ECMO require the assistance of surgeons. Bronchoscopy can be used for endoscopic treatment, but some ICU doctors cannot do it, so they have to ask doctors from respiratory and other departments to do it.
What is the biggest difference between the intensive care unit and the general ward? According to the relevant standards formulated 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.
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