"As a hospital administrator, I am more and more aware of the importance and role of the diagnosis and treatment level of the respiratory and critical care medicine department in the development of the hospital. Professor Tan Yingjun of the Eighth Medical Center of the General Hospital of the People's Liberation Army said in his speech in the respiratory and critical care section of the 19th 301 Academic Conference on Respiratory Diseases. In recent years, the respiratory and critical care medicine profession has developed rapidly, and this is inseparable from the leadership of the discipline masters. In the master forum of the respiratory and critical care section of the 19th 301 Academic Conference on Respiratory Diseases, the "leaders" of subspecialties in the field of respiratory critical care in China gathered together to present a high-standard academic feast for the guests!
Whether it is a lung transplant patient or an ICU patient, the problem to face is respiratory rehabilitation. "For a long time, clinical research on ICU respiratory rehabilitation focused on when it was possible to 'move'." In the sharing session, Professor Zhao Hongmei from the Department of Respiratory and Critical Care of China-Japan Friendship Hospital introduced the relevant content of the diagnosis and treatment management of ICU experience syndrome, she said that the impact of ICU experience syndrome is not only limited to a certain patient, but also causes a serious economic burden to the patient's family, medical and health system and even the whole society. In response to this initiative, Professor Zhao Hongmei said that it is necessary to promote the recovery of patients from six aspects: "language, medicine, equipment, food and living environment". "The concept of respiratory rehabilitation should run through the whole process of ICU medical care." Professor Zhao Hongmei explained that it is necessary to prevent the occurrence of critical illness before patients are admitted to the ICU; Provide high-quality critical care after the patient is admitted to the ICU; The comprehensive management and care of patients should not be relaxed after they leave the ICU. "In short, comprehensive, whole, whole."
Similarly, the clinical diagnosis and treatment of severe pneumonia should also establish a more complete management system based on the whole process and comprehensive thinking. According to Professor Pan Pinhua of the Department of Respiratory and Critical Care Medicine of Xiangya Hospital of Central South University, among ICU patients, patients with severe pneumonia account for 6% and more than 50% in RICU. "The RICU data of Xiangya Hospital of Central South University in 2022 and 2023 show that severe pneumonia patients account for 36.07%~61.04% of RICU patients." As the most common respiratory critical disease, severe pneumonia has a high mortality rate, and a complete comprehensive diagnosis and treatment system and multidisciplinary cooperation strategy are the key elements to reduce the mortality rate of patients. In particular, Professor Pan Pinhua emphasized the importance of pathogenic diagnosis, emphasizing that pathogenic diagnosis should be fast, accurate, and able to distinguish between colonized contamination and real pathogens.
Basic scientific research originates from the clinic and will ultimately serve the clinic, continuously explore the pathogenesis of clinical diseases, and provide a theoretical basis for the further improvement of disease diagnosis and treatment standards and the further research and development of new therapeutic drugs. In recent years, Professor Luo Hong and his team have done a lot of research and attempts in this regard, she introduced at the meeting that the diagnosis of hereditary myclonia related to mucus clearance disorders has been continuously innovated on the basis of guidelines, and the evaluation methods of MCT such as fluorescent particle tracing and nuclear scintigraphy have been successfully used. There is no specific therapy for such diseases except cystic fibrosis, and targeted therapy for pathogenic genes is the main direction of clinical drug development.
Acute respiratory distress syndrome (ARDS) was first reported by Ashbaugh in 1967, and now more and more clinicians have gradually realized that ARDS is a highly heterogeneous clinical syndrome, which can be divided into different subtypes with the help of clinical characteristics, biology and morphology parameters, which is helpful to achieve individualized and precise treatment and help break through the bottleneck of current ARDS treatment. At this meeting, Professor Li Qi from Xinqiao Hospital of Army Medical University shared the topic of "multi-dimensional understanding of ARDS heterogeneity", and introduced the etiology, pathological changes and pathophysiology, biomarkers, imaging, clinical manifestations and treatment response of ARDS. Professor Li Qi said that understanding and identifying the heterogeneity of ARDS can help formulate effective individualized diagnosis and treatment plans, improve efficacy, reduce mortality rate, and improve prognosis and prognosis. "In the future, under the general direction of precision medicine and individualized treatment, and the opportunities created by big data and artificial intelligence, we may be able to find a more complete ARDS diagnosis and treatment strategy."
What is the role of furosemide stress test in the diagnosis and treatment of kidney injury and CRRT? Professor Zhou Feihu of the Department of Critical Care Medicine of the First Medical Center of the PLA General Hospital gave the answer. He introduced that kidney injury is one of the common problems in ICU, due to its complex heterogeneity, some biomarkers can help early diagnosis, but there are certain limitations in assessing whether CRRT is needed; Furosemide stress test (FST) has a role in the prediction of AKI and the use of CRRT, but vasoactive drugs may be influencing factors, which in turn affect the results. Professor Zhou Feihu said that in the future, the evaluation and prediction process of high-risk patients with AKI is worthy of further research, and the monitoring of acute renal stress status should be strengthened to achieve the goal of slowing down the progression of AKI before the emergence of AKI.
According to the annual meeting of cardiopulmonary bypass that just ended last month, the number of ECMO cases in mainland China has risen from more than 13,000 cases to more than 18,000 cases last year. At this meeting, Professor Sun Bing from the Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, introduced the latest progress in the clinical application of ECMO in severe respiratory failure, and discussed and exchanged views on issues such as early tracheostomy, the application of anticoagulation strategies, and the grasp of clinical indications.
Since 2010, Professor Cao Ju from the Department of Medical Laboratory Medicine of the First Affiliated Hospital of Chongqing Medical University has been trying to explore the role of laboratory medicine in the diagnosis and treatment of sepsis. At this meeting, Professor Cao systematically introduced his team's research progress on the molecular mechanism of host immune imbalance caused by sepsis, the drug targets of host-directed immunotherapy, and the immune markers of risk stratification and individualized treatment, which have had a positive impact on the differential diagnosis and treatment of clinical sepsis.
Professor Cheng Zhenshun of the Department of Respiratory and Critical Care Medicine of Zhongnan Hospital of Wuhan University introduced that septic shock is often encountered in clinical practice, although it is difficult to treat, but it is also easy to obtain successful pathophysiological state. Recent studies have shown that massive fluid resuscitation does not improve prognosis, some patients with septic shock may not respond to massive fluid resuscitation, and restrictive fluid resuscitation does not increase mortality, and early use of vasoactive drugs can improve patient outcomes and help correct blood pressure.
Nowadays, immunosuppression accounts for one-third of the ICU, and with the improvement of organ support technology and the ability to diagnose infections early, immunosuppressed people who were previously difficult to survive can survive through diagnosis and treatment. "Unfortunately, however, most of the current guidelines are for immunocompetent patients with respiratory failure." To this end, Professor Xie Fei from the Department of Respiratory and Critical Care Medicine of the PLA General Hospital shared his team's experience in treating immunosuppressed respiratory failure patients in recent years and the diagnosis and treatment process.
"When dealing with immunosuppressed patients, we often have to deal with more unknowns. That's why we often have to ask the question: how to achieve a reproducible, cost-effective, and longitudinal assessment of the degree and nature of immunosuppression in critically ill patients? How to more accurately understand the epidemiological results of ICU-acquired infections in immunocompromised patients...... "Professor Xie Fei expects that in the future, more research and tools focusing on microbial diagnosis and bedside immune function assessment in immunosuppressed populations will emerge to benefit the diagnosis and treatment of clinical patients.