Good morning, everyone, I am Dr Zheng Wang from Department of Surgical Intensive Care Unit and Department of Hepatobilary Surgery. What I want to discuss the video is about quick transformation and establishment of spatial ICU for this coronavirus disease 2019 treatment. As we know, this virus is infecting part in the world quickly and it's written out to public health. It is a big disaster, we must pay more attention about it. According to the classifications, this disease divided into four types, mild, moderate, severe and critical. It depends on the severity of disease and all the patient's clinical manifestations. This figure is from the Lancet. We can see these figures with age older, the ICU requirement is much more. Even the patients is bigger than 65, half of the patients will go into the ICU. So that means the ICU is very important for all the patients to be treated. These are also some data from 41 infected cases in Wuhan City. We can see at the seventh day after onset, the patients with admission. And also, the first day after admission the patient with dyspnoea, and also the percentage is nearly one half. At the tenth date of after onset, the patient will go into the intensive care unit. The percentage is nearly 40%. So it seemed that ICU is the last defense place for the disease. Also, with the guidance for the treatment, the ICU a dimension is very important, especially on the severe and critical cases. It also stresses that the successful therapy on severe and critical cases is the key factor to reduce the mortality of this disease. This strategy consists on the confirmation, complication prevention, and secondary inflammation prevention, and organ support, and psychological treatment. For the intensive care unit, we call it ICU, I think more of the person will be familiar with this. And this picture is also at here, we can see this is the ECMO preparation in the ICU in Xinhua Hospital, Wuhan City. ECMO is one of the important technique to save the critical patients. Also, here is three dimension, and we can see here this dimension construction of our patient's CT, and it will help us to give you some treatment strategy for this. In our ICU, we also have a bundle of critical care organ support technique, such as CRRT, respiratory, ECMO and so on. We also have a static class cleanliness more than 10,000 in total positive in pressure environment. And also for this, if it's suitable for this disease, I want to say no, why, first the confused pathways. As we can see here, this is our ICU draft. The blue line is our medical staff pathway, the red one is patient pathway. It could be applied to most of the patients who use this way, but for the infectious disease, it will be a confused person and we'll make some cross infection. And also we know that this virus could transmit others through respiratory droplet and contact combinations. This is a sample detection picture in Singapore, and the blue line we can see here there is no virus detected, but the yellow line and also the red line we can see here, this is virus detected. It taught us that contact and hand cleaning should be paid more attention. In the general ICU, what we always ignored is the control of respiratory related infectious disease. So the transformation of special ICU for the coronavirus disease is very important. So just we should go back to our all of them experienced from the Department of Infectious Disease. This is the only distribution of the infectious disease, we call the three district with two channels. So what is three district with two channels? The three district are clean area, partly exposed area, also called as buffer area, and exposed areas. So at the same time, the medical staff and patient should go the different way. As we can see this figures, the medical staff will go into this way. So first they will from the clean areas to the buffer areas, and then we will go to the exposed areas, and also go to see the patients. And also for the patients, they go from exposed areas and go back into their room, and there they will see the doctor. So what is important for this three districts with two channels, it could prevent the polluted air and also it could avoid cross infection. Additionally, negative pressure ward is also very important for the Department of Infectious Disease. As we can see here, our other side is 0 pa, and also for the corridor is -10 pa, and also for the ward, -15 pa, and also for the bathroom is -25 pa. What is this benefit or what is the advantage? It will help us to form the airflow direction. It could be like this, the air will flow from the outside and the go back to the corridor and go back to the ward, and finally we'll go back to the bathroom. So this is airflow direction, it could help prevent the polluted air to spread outside. It will help all the patients and help all the medical staff. So learning from all of this experience, we could transform it in our ICU. Here is the new draft, from left side we designed a clear way. We can see here we have the medical staff pathways and also patient pathways. So the different way from here the medical doctor will go back from the clean areas and also go to the buffer areas. And also we can go to the exposed areas and then go back to return back to here, and from the buffer areas on to another treatment, and then go back to the clean areas. And also for the patients, they go to the exposed areas. So this will be help in separate all the pathways. And also we can see here we have the clearly district, this is our buffer areas. From the right side, we can see more clear about airflow direction. So we can see here the corridor is -10 pa, and also for here our medical pathways for here, so this is all the positive pressures. But then in the buffer areas -10, and in the ward -15, all the air flow will go back from outside to inside and didn't go outside. This will help us to prevent the polluted air to outside and to transmit it to other persons. So what's the meaning of this establishment? I think it will be relative separation between staff and the patient. And also, it could also provide different access route to avoid cross infection with optimal airflow directions. So this pictures what I want to say here. It's the first team, our 133 medical doctors, who go to the Wuhan City to help treat the coronavirus disease 2019. And it has been about one month since they left our hospital. So when they arrived at the infected city Wuhan, they did a quick transformations. We can see here, this is also a transient transformation for our all the medical team. So in the hotel, they go to the clarified the three street district. So here, near the door, we can see is exposed areas. And also for here is we call it a semi-exposed areas and buffer areas, and near here bed is a clean area. With this three district it will help us to protect themselves from contamination. And also this tapes could help all the public to keep the virus out of the home as much as possible. We can see here, this is what we want to do reconstructions in your home. Near the door we can see exposed areas and also for here, this is near the shoes we can see there is partly exposed areas and also for this is clean areas. This will avoid bring the virus home, and also with our reconstruction of conditional airflow and also to treat more about keep the bathroom clean, our home will be much safer. So now what I want to summarize here is about ICU technique is the king, and establish of the special ICU is the queen. We believe with the king and the queen combined, we will conquer the virus finally. Thanks for your attention.
