Intensive Care Unit Training Program
Program Instructor: Yoshiya Miyazaki
1. Program Objectives and Features
<Purpose>
- Based on the knowledge of anesthesia emergency care learned in the first year, students will learn respiratory and circulatory management for critically ill patients, as well as understanding and treating the pathology of organ failure, with a focus on postoperative patient management.
- By working in collaboration with various medical departments, students learn the importance of team medicine.
<Features>
Our intensive care unit aims to practice evidence-based treatment as much as possible, and aims to provide the fastest and most accurate treatment possible while referring to various guidelines. By managing a wide range of cases, including not only those after major surgery but also those with cerebrovascular disease, severe pneumonia, ARDS, acute renal failure, and septic shock, students can understand the pathology of organ failure and efficiently learn treatment using drugs and life-support devices.
2. Guidance system
Yoshiya Miyazaki: Supervising physician (Chief) of the Japanese Society of Anesthesiologists
As a general rule, day shifts and on-call duties are performed one-on-one with the department head.
3. Specific goals to achieve
- General goal
- (a) Mastering basic procedures in critical care
- (b) Understanding the pathology of critically ill patients
- (c) Planning and implementation of treatment plans
- Behavioral goals
- (a) Ability to appropriately assess severity
- (b) Understand and explain pathophysiology
- (c) Ability to develop a treatment plan and select necessary drugs and assistive devices
- (d) Ability to respond appropriately to complications associated with treatment
- (e) Ability to give informed consent to patients and their families
- (f) Able to give a concise presentation of treatment plans and progress
- Experience Goals
- A) Procedures and management to be experienced
- a) Various airway management methods: tracheal intubation, tracheotomy, cricothyroid membrane puncture
- b) Selection of appropriate ventilation mode (including NPPV), weaning, extubation, and bronchoscopy
- c) Thoracic drainage
- d) Defibrillation, pacemaker, IABP, PCPS
- e) Central venous catheterization (ultrasound-guided)
- f) Swan-Ganz catheter insertion and hemodynamic assessment
- g) Arterial cannulation and monitoring, blood gas analysis
- h) Various echocardiograms (vascular, chest wall and transesophageal echocardiogram, abdominal, and neurological)
- i) Various blood purification methods
- j) Fluid and nutritional management (TPN, enteral nutrition)
- k) Management of severe infections (using Gram staining)
- B) Symptoms, pathologies, and diseases to be experienced
- (a) Central nervous system
- Management of postresuscitation encephalopathy (including therapeutic hypothermia)
- Diagnosis and treatment of patients with acute disturbance of consciousness
- Post-craniotomy patient management
- Management of patients with increased intracranial pressure
- Brain death determination
- (b) Respiratory management
- Management of respiratory failure (severe pneumonia, ALI/ARDS)
- Sedation and analgesia during mechanical ventilation
- (c) Circulation management
- Cardiovascular postoperative management
- Selection and use of vasopressors and antiarrhythmic drugs
- Management of various circulatory support devices
- (d) Body fluid management
- Management of acute renal failure (including blood purification)
- (e) Coagulopathy
- Diagnosis and management of DIC (obstetric, severe infection-related)
- (f) Nutrition
- How to assess nutritional status
- Early enteral nutrition
- Nutritional management for various special conditions
- (g) Sepsis
- Understanding the pathology of sepsis and treatment methods in accordance with guidelines
- Understanding and treating the complex pathology of sepsis-associated organ failure (respiratory, liver, kidney, blood coagulation disorders, etc.)
4. Curriculum
Weekly schedule and educational activities for residents (joint with the Department of Anesthesiology)
a) ICU Conference Monday, Thursday, Friday from 8:15 AM
Tuesday and Wednesday 8am
Saturday 8:30 AM
b) Reading group: Every Tuesday and Wednesday after the ICU conference
5. Evaluation Method
The trainees' achievement will be evaluated at the end of their intensive care training by their own self-evaluation and by the head of the intensive care department who actually supervised them on each item of the above-mentioned program.
