ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－180－Leaders recognize the different skills our team members bring to the field. Consequently we can allow the team to functionbetter by helping individuals serve in the capacity they are best suited for. The foundation for this approach starts with sharingour philosophy with our team. To do so requires that we start with self-reflection to critically identify what we value andimportantly to identify what works well and less well when one works with others.By establishing a respectful and engaged team we allow everyone to shine and to function in a manner conducive to success andpersonal growth. These approaches help establish the base. Tools help people apply the principles reviewed above. For example,it is common for someone to suggest a debriefing might be fruitful, unfortunately without a framework and a tool, suchdiscussion can frequently deteriorate into blame sessions. An after action review tool should be utilized. Such a tool would keepeveryone focused at the actions done and the results attained. The tool would allow folks to take one step back and reflect anddiscuss what did they actually plan on doing and how they planned on doing it. Importantly it would permit the team to take asecond step back and allow them to question the intent and the assumptions in place and thus begin to see the system issues atplay.These newer leadership approaches can be very successful at supporting change and improvement. They are the underpinningsof the quality and safety movement. They help staff feel valued and thus staff are more engaged and they help build resilienceso that everyone can deal with the stressful ICU environment better.SL4Department of Intensive Care Medicine, University Hospital Bern（Inselspital）and University of Bern, Bern, SwitzerlandJukka TakalaThe clinical assessment at the bed side is the basis of all hemodynamic evaluations. No technical monitoring or diagnostic toolcan replace the systematic clinical assessment of circulation, and all results from monitoring and diagnostic devices must be putinto context with the clinical findings. Hemodynamic stability can be verified based on clinical judgement and careful clinicalassessment of the patient. A patient with normal mental state, without obvious, clinically relevant hypotension, normal capillaryperfusion and refill in the periphery and warm skin temperature, normal central and peripheral venous filling, with ongoingdiuresis, and without hyperlactatemia is likely to be stable. A patient who is obviously ill and do not fill one or several of theclinical criteria for stability should be considered possibly unstable. Such signs of inadequate hemodynamics as peripheralvasoconstriction and/or decreased venous filling, hypotension or symptomatic decrease in blood pressure, signs of cerebral orcoronary hypoperfusion, oliguria, and acute reduction in urinary output relate to blood pressure decrease can all be observed insystematic clinical examination. Empty veins and peripheral vasoconstriction signal for hypovolemia, and treatment ofhypovolemia should be treated without delay, while the search for cause must start in parallel. Dyspneic breathing and fullcentral veins suggest an intrathoracic cause of hemodynamic instability. Decreased level of consciousness related tohemodynamic instability should prompt the suspicion of sepsis, very severe low cardiac output. The systematic assessment ofthe patient can be done in less than 60 seconds, and repeated as often as necessary.特別講演 4 2月12日（金）　10：00～10：50　第8会場Bedside assessment of hemodynamics