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Paradigm shifts in critical care medicine: the progress we have made

机译：重症监护医学的范式转变：我们取得的进步

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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.
机译：自该专业成立以来，重症监护医学确实没有任何重大的重大进步。然而，这些年来，护理过程已逐渐，持续地得到改善，从而改善了患者的预后。在这里，我们将重点介绍在重症监护过程中我们已经看到的一些范式转变，包括从小型，封闭式病房向更大，更开放的ICU转移;从父辈的“专政”到更“民主的”团队合作;从间歇性到连续，有创性到无创性监测;从“更多”的干预措施到“更少”的干预措施，从而降低了医源性;从将重大疾病视为一个单一事件，到意识到它只是轨迹的一部分;从“四堵墙”到“无墙”，因为我们在物理ICU以外进行重症监护。这些和其他范式的转变已改善了患者管理的整体方法，从而为患者及其家人提供了更全面，更人性化的护理。随着重症监护医学的不断发展，在护理过程中不可避免地会发生进一步的范式转变，如果我们要继续为所有重症患者提供最好的护理，就必须予以接受。

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