Vincent Jean-Louis, Creteur Jacques
Crit Care. 2015;19 Suppl 3(Suppl 3):S10. doi: 10.1186/cc14728. Epub 2015 Dec 18.
There have really been no single, major, advances in critical care medicine since the specialty came into existence. There has, however, been a gradual, continuous improvement in the process of care over the years, which has resulted in improved patient outcomes. Here, we will highlight just a few of the paradigm shifts we have seen in processes of critical care, including the move from small, closed units to larger, more open ICUs; from a paternal "dictatorship" to more "democratic" team-work; from intermittent to continuous, invasive to less-invasive monitoring; from "more" interventions to "less" thus reducing iatrogenicity; from consideration of critical illness as a single event to realization that it is just one part of a trajectory; and from "four walls" to "no walls" as we take intensive care outside the physical ICU. These and other paradigm shifts have resulted in improvements in the whole approach to patient management, leading to more holistic, humane care for patients and their families. As critical care medicine continues to develop, further paradigm shifts in processes of care are inevitable and must be embraced if we are to continue to provide the best possible care for all critically ill patients.
自重症医学作为一门专业学科诞生以来，确实没有出现过单一的重大进展。然而，多年来护理过程一直在逐步、持续地改进，这使得患者的治疗结果得到了改善。在此，我们将重点介绍我们在重症护理过程中看到的一些范式转变，包括从小型封闭病房到大型、更开放的重症监护病房的转变；从家长式的“独裁”到更“民主”的团队合作；从间歇性到持续性、从侵入性到微创性监测；从“更多”干预到“更少”干预，从而降低医源性损伤；从将危重病视为单一事件到认识到它只是病程的一部分；以及当我们将重症护理延伸到实体重症监护病房之外时，从“四面墙”到“无墙”的转变。这些以及其他范式转变使得患者管理的整体方法得到了改进，为患者及其家属带来了更全面、人道的护理。随着重症医学的不断发展，护理过程中的进一步范式转变是不可避免的，如果我们要继续为所有重症患者提供尽可能好的护理，就必须接受这些转变。
