Department of Surgery, University of Virginia, Charlottesville, VA, USA.
Crit Care Med. 2010 Sep;38(9 Suppl):S483-93. doi: 10.1097/CCM.0b013e3181ec68c9.
Surgical and trauma intensive care units provide the facilities, resources, and personnel needed to care for patients who have been severely injured, present with acute surgical emergencies, require prolonged and complex elective surgical procedures, or have severe underlying medical conditions. Correcting the immediately evident physiologic derangement is only the first step in the care of these patients, because in many cases their prognosis and ultimate outcome will depend on whether additional insults accrued during their intensive care unit and hospital stay will prevent them from a full recovery. The nature, number, and complexity of the interventions used to provide advanced support requires a unique attention to the concept of patient safety, particularly when the population involved is that most vulnerable to injury and with the least amount of physiologic reserve to recover from it. The medical community, the public, and even regulatory agencies have focused on specific preventable complications that are common in surgical and injured patients, such as medical errors, healthcare-associated infections, and venous thromboembolism. Enough scientific knowledge has been obtained through well-conducted clinical trials to generate detailed evidence-based guidelines for the prevention and management of some of these pathologies, but still there are outstanding questions in terms of the applicability of the recommendations to the critically ill. In addition to clinical and technical expertise, performance improvement and quality monitoring activities provide direction for system solutions required to properly address many complications that are not provider specific.
外科和创伤重症监护病房提供了必要的设施、资源和人员，以照顾那些遭受严重伤害、出现急性外科急症、需要长期复杂的择期手术或患有严重基础疾病的患者。纠正明显的生理紊乱只是这些患者治疗的第一步，因为在许多情况下，他们的预后和最终结果将取决于他们在重症监护病房和住院期间是否会因额外的损伤而无法完全康复。为提供高级支持而使用的干预措施的性质、数量和复杂性需要特别关注患者安全的概念，特别是当涉及到最容易受伤且生理储备最少的人群时。医学界、公众甚至监管机构都关注一些常见于外科和受伤患者的可预防并发症，如医疗差错、与医疗保健相关的感染和静脉血栓栓塞症。通过精心设计的临床试验已经获得了足够的科学知识，为预防和管理其中一些病理学提供了详细的循证指南，但在将这些建议应用于重症患者方面仍存在一些悬而未决的问题。除了临床和技术专业知识外，绩效改进和质量监测活动为解决许多不属于特定提供者的并发症所需的系统解决方案提供了方向。
