Application of PDCA Cycle in Tracheal Intubation Training for Emergency Medicine Residents
Conditions: Tracheal Intubation, Medical Education
Sponsor: Guangzhou Panyu Central Hospital

Clinical research protocol
Project name: Application of PDCA Cycle in Tracheal
Intubation Training for Emergency Medicine Residents
leading unit ：The Affiliated Panyu Central Hospital,
Guangzhou Medical University, China.
project leader：Xiaowei Mai
Department: emergency
Research period: October 1 2024 to September 30
2025NCT No.: none.
Version No.: V1.0
Version Date: September 9, 2024

1
Abstract
object name
Application of PDCA Cycle in Tracheal Intubation Training for
Emergency Medicine Residents
goal of study
Tracheal intubation is a high-risk, time-sensitive procedure
essential in emergency airway management. Junior emergency
medicine (EM) residents often face challenges in mastering this
critical
skill.
The
Plan–Do–Check–Act
(PDCA)
cycle
is
a
structured educational framework that may enhance procedural
competency through iterative improvement. This study aimed to
evaluate the impact of a PDCA-based training model on
intubation performance among EM residents.
research design
This was a prospective observational study conducted in the
emergency
department
(ED)
of
a
tertiary
teaching
hospital.
A
PDCA-based clinical skills training program was formally implemented in
the department beginning in October 2024. Residents who performed
tracheal intubation procedures from October 2023 to September 2023
were assigned to the control group, representing training prior to PDCA
implementation. Those who performed intubations from October 2024 to
September 2025 constituted the
intervention
group,
following the
adoption of the PDCA cycle teaching model.
Outcomes were compared between groups, including: success and
failure rates of tracheal intubation,procedure completion time,incidence
of airway-related local trauma or bleeding,reintubation within 3 days due
to airway injury, and resident satisfaction with training.
The
study
protocol
was
approved
by
the
institutional
ethics
committee. Written informed consent was obtained from all participants,
and
all
procedures
complied
with
the
Declaration
of
Helsinki

2
(2013).umulative hospitalization time and mortality were collected.
Total number of
cases studied
100 cases
case selection
Inclusion Criteria:
Emergency medicine residents rotating in the emergency
department during the study period.
Residents who are required to perform tracheal intubation as part
of clinical training.
Residents who have completed baseline theoretical and
simulation-based airway management training.
Voluntary participation with written informed consent.
Exclusion Criteria:
Residents who refuse to participate or withdraw consent.
Residents with prior advanced airway fellowship training or
extensive intubation experience (>50 independent intubations).
Residents who are unable to complete the full PDCA-based
training program due to absence or rotation schedule.
Any medical condition or circumstance deemed by investigators
to interfere with participation or data integrity.
excluded criteria:
1 combined with neurogenic shock, trauma and hemorrhagic
shock; 2 symptomatic patent ductus arteriosus; 3 combined with
congenital heart disease; 4 give up treatment or death within 24 hours
of admission; 5 The legal guardian refused to participate in the study;
6 Key information and information missing.
Treatment plan
This was a prospective observational study conducted in the emergency
department (ED) of a tertiary teaching hospital. A PDCA-based clinical

3
skills training program was formally implemented in the department
beginning in October 2024. Residents who performed tracheal intubation
procedures from October 2023 to September 2023 were assigned to the
control group, representing training prior to PDCA implementation. Those
who performed intubations from October 2024 to September 2025
constituted the intervention group, following the adoption of the PDCA
cycle teaching model.
efficacy
evaluation
The main efficacy indicators: success and failure rates of tracheal
intubation,
Secondary
efficacy
indicators:
procedure
completion
time,incidence
of
airway-related
local
trauma
or
bleeding,reintubation within 3 days due to airway injury, and
resident satisfaction with training.
statistical method
All statistical analyses were performed using SPSS version
26.0 (IBM Corp., Armonk, NY, USA). Categorical variables,
including intubation success rate, incidence of local airway
trauma, extubation failure due to airway injury, and resident
satisfaction rate, were expressed as counts and percentages [n
(%)], and were compared between groups using the chi-square
test (χ² test) or Fisher’s exact test, as appropriate. Continuous
variables, such as intubation completion time, were tested for
normality using the Shapiro–Wilk test. Variables not conforming
to a normal distribution were expressed as median (interquartile
range) and compared using the Mann–Whitney U test. A
two-tailed P value < 0.05 was considered statistically significan
Exclusion Criteria
•
Residents
who
refuse
to
participate
or
withdraw

4
informed consent.
•
Residents with prior advanced airway fellowship training
or
extensive
intubation
experience
(>50
independent
intubations).
•
Residents unable to complete the full PDCA-based
training program due to absence, scheduling conflicts, or early
rotation termination.
•
Residents
with
medical
conditions
or
personal
circumstances that could interfere with participation or data
collection integrity.
Research period
October 2024 1 to September 30 2025

5
一、Research background
Tracheal intubation is a cornerstone of emergency airway management,
critical in conditions such as cardiac arrest, trauma, respiratory failure, and
airway obstruction(1–3). Despite its lifesaving role, tracheal intubation
remains one of the most technically challenging procedures for emergency
medicine (EM) residents(4–6). Studies have consistently shown that junior
residents face difficulty in achieving first-pass success, often resulting in
repeated attempts, airway trauma, hypoxia, aspiration, and adverse patient
outcomes(2,7–10). The steep learning curve, high cognitive load, and
pressure inherent to emergency settings further exacerbate the risk of
procedural failure(11–13).
Traditional didactic training often lacks the iterative reinforcement and
feedback required for skill retention and real-time adaptation(14–15). In
response, the Plan–Do–Check–Act (PDCA) cycle, originally introduced by
Deming for industrial quality improvement, has been adopted in medical
education to improve procedural competency(16–18). The PDCA framework
promotes continuous evaluation and refinement of teaching strategies,
aligning
well
with
modern
competency-based
medical
education
paradigms(19–21).
Recent applications of PDCA in healthcare simulation and airway
management training have demonstrated significant benefits, including
improved first-pass success rates, reduced complication incidence, and
enhanced learner satisfaction(22–29). Particularly in pediatric and neonatal
intensive care units, PDCA-guided programs have standardized procedural
education and bridged the gap between theory and practice(25–26).
However, its integration into emergency airway training—a domain defined
by
unpredictability,
urgency,
and
complexity—remains

6
underexplored(30–34).
二、research objective
This study aims to evaluate the impact of a PDCA cycle-based tracheal
intubation training model for EM residents. We hypothesize that such
structured, iterative, and feedback-driven training can significantly enhance
intubation success, procedural efficiency, safety, and trainee confidence in
high-stakes emergency environments.
三、Research Design Types, Principles, and Test Procedures
1. Research Design
This was
a
prospective
observational
study conducted
in the
emergency
department (ED) of a tertiary teaching hospital. A PDCA-based clinical skills training
program was formally implemented in the department beginning in October 2024.
Residents who performed tracheal intubation procedures from October 2023 to
September 2023 were assigned to the control group, representing training prior to
PDCA implementation. Those who performed intubations from October 2024 to
September 2025 constituted the intervention group, following the adoption of the PDCA
cycle teaching model.
四、case selection
Inclusion Criteria:
(1) Emergency medicine residents rotating in the emergency department
during the study period.
(2) Residents who are required to perform tracheal intubation as part of
clinical training.
(3) Residents
who
have
completed
baseline
theoretical
and
simulation-based airway management training.
1
Voluntary participation with written informed consent.
Exclusion Criteria:

7
(1) Residents who refuse to participate or withdraw consent.
(2) Residents with prior advanced airway fellowship training or extensive
intubation experience (>50 independent intubations).
(3) Residents who are unable to complete the full PDCA-based training
program due to absence or rotation schedule.
(4) Any medical condition or circumstance deemed by investigators to
interfere with participation or data integrity.
Exclusion Criteria
•
Residents who refuse to participate or withdraw informed consent.
•
Residents with prior advanced airway fellowship training or extensive
intubation experience (>50 independent intubations).
•
Residents unable to complete the full PDCA-based training program due to
absence, scheduling conflicts, or early rotation termination.
•
Residents with medical conditions or personal circumstances that could
interfere with participation or data collection integrity.
五、research method
This was a prospective observational study conducted in the emergency
department (ED) of a tertiary teaching hospital. A PDCA-based clinical skills
training program was formally implemented in the department beginning in
January 2024. Residents who performed tracheal intubation procedures
from January 2023 to December 2023 were assigned to the control group,
representing training prior to PDCA implementation. Those who performed
intubations
from
January
2024
to
December
2024
constituted
the
intervention group, following the adoption of the PDCA cycle teaching
model.
Outcomes were compared between groups, including: success and
failure rates of tracheal intubation,procedure completion time,incidence of

8
airway-related local trauma or bleeding,reintubation within 3 days due to
airway injury, and resident satisfaction with training.
The study protocol was approved by the institutional ethics committee.
Written informed consent was obtained from all participants, and all
procedures complied with the Declaration of Helsinki (2013).
PDCA Cycle-Based Training Intervention
1.1 Clinical Case Example for Tracheal Intubation
A 64-year-old male presented to the ED via emergency medical services
with a 20-minute history of sudden loss of consciousness and respiratory
distress. His past medical history included poorly controlled hypertension
and coronary artery disease. On arrival, he was comatose (GCS score: 6,
E1V1M4), with SpO₂ 82%, respiratory rate 10 breaths/min, blood pressure
100/50 mmHg, and heart rate 112 bpm. Pupils were equal and reactive to
light, but sluggish. Lung auscultation revealed diminished breath sounds
with coarse rales bilaterally; cardiac rhythm was regular.
Arterial blood gas revealed: pH 7.18, PaCO₂ 62 mmHg, PaO₂ 49 mmHg,
HCO₃⁻
21
mmol/L.
Cranial
CT
excluded
intracranial
hemorrhage.
A
preliminary diagnosis included altered mental status, acute respiratory failure
(likely mixed central and pulmonary etiology), and possible acute heart failure.
To prevent airway obstruction, aspiration, and further hypoxic brain injury,
the emergency team initiated invasive hemodynamic monitoring and decided
to proceed with immediate tracheal intubation.
1.2 Teaching Implementation
Given the patient’s critical condition, prompt establishment of a secure
airway via endotracheal intubation was required. Informed consent was
obtained from the patient’s family after brief explanation by the attending
physician. The procedure was performed at the bedside by an emergency

9
medicine resident who had completed standardized intubation training and
was supervised by a senior attending. The training and management
approach followed the four stages of the PDCA cycle:
Stage 1: Plan
To
enhance
residents’
competency
in
tracheal
intubation,
the
emergency
department
developed
a
structured
PDCA-based
training
protocol:
（1）Didactic Sessions: Weekly theoretical instruction was conducted by
senior attending physicians in small-group settings every Wednesday
afternoon. Topics included indications and contraindications of adult
intubation, airway anatomy, identification of difficult airway, rapid sequence
induction (RSI), and management of complications.
（2 ）Simulation
Training:
Every
Thursday,
high-fidelity
airway
mannequins were used for hands-on simulation of various clinical scenarios
(e.g.,
COPD
exacerbation,
upper
gastrointestinal
bleeding,
comatose
patients). Instructors demonstrated procedures, emphasized key actions
and safety checkpoints, and provided immediate corrective feedback during
resident practice.
（3）Clinical Practice: Residents were allowed to perform intubations in
clinical settings only after passing theoretical and simulation assessments.
Based on experience level, instructors assigned appropriate cases. Stable
patients with lower intubation difficulty were prioritized for beginners, with
gradual progression to more complex scenarios.
Stage 2: Do
In the case described above, the patient met criteria for emergent
intubation due to coma and hypoxemia. A pre-intubation airway assessment
showed Mallampati class II, acceptable neck mobility, and no oropharyngeal

10
deformities. Equipment prepared included: bag-valve mask, laryngoscope,
7.5 mm endotracheal tube, stylet, lubricating gel, induction drugs, crash cart,
and vital sign monitors.
Under direct supervision, the trained resident performed RSI and
successfully completed intubation within 15 seconds. Tube placement and
depth
were
confirmed
and
mechanical
ventilation
was
initiated.
Post-procedure chest X-ray verified correct tube position, and ventilatory
management was continued.
We analyzed 98 intubation procedures performed by residents in 2023
(control group) and 103 procedures in 2024 after PDCA implementation
(intervention group), comparing outcomes as outlined above.
Stage 3: Check
The effectiveness of PDCA implementation was assessed through both
process monitoring and outcome evaluation. Data collected from the
intervention group were compared to baseline data from the control group.
Definitions:
Successful intubation: Independent completion of tracheal intubation by
the resident following standard operating procedures.
Failed intubation: Three or more unsuccessful attempts to pass the
endotracheal tube to appropriate depth.
Airway trauma: Presence of fresh blood in the airway post-intubation,
excluding bleeding from preexisting pathology (e.g., subglottic mass,
pulmonary hemorrhage).
Extubation failure due to airway injury: Need for reintubation within 72
hours despite meeting extubation criteria, confirmed by laryngoscopic
evidence of edema, vocal cord paralysis, granulation, or subglottic stenosis.
Resident satisfaction: Evaluated via anonymous questionnaire covering

11
subjective learning experience and perceived value of training during their
ED rotation.
Stage 4: Act
Based on outcome data and feedback, the following improvements
were implemented in the subsequent PDCA cycle:
(1)Simulation Enhancement: Increased frequency of practice sessions
for novice residents; established a “failed simulation bank” focused on
difficult airway scenarios.
(2)Visualization Tools: Introduced video laryngoscopy into teaching to
enhance visualization and facilitate real-time instruction.
(3)Assessment System: Developed a standardized scoring system for
intubation
performance
using
instructor
ratings,
video
review,
and
checklist-based evaluation for closed-loop feedback.
In addition, procedural nursing aspects before and after intubation were
emphasized,
including:pre-procedure
safety
checklists,continuous
monitoring
of
vital
signs,reinforcement
of
sterile
techniques,timely
replacement of tube fixation materials,stabilization of head and body
position to prevent tube displacement,and visible labeling of critical lines and
tubes.
All such measures were progressively incorporated into the next
iteration of PDCA-based training to ensure quality, consistency, and
sustainability.
六、Observation items and detection time points
1.
First-Attempt Success Rate of Tracheal Intubation
Observation item: Whether residents complete intubation successfully on the
first attempt.
Detection time point: Immediately during the procedure, confirmed by chest

12
rise, end-tidal CO₂, auscultation, or chest X-ray.
2.
Intubation Completion Time
Observation item: Time required for residents to complete intubation.
Detection time point: Measured in seconds from insertion of the laryngoscope
to confirmation of successful tube placement.
3.
Incidence of Local Airway Trauma
Observation item: Presence of visible bleeding or mucosal injury during
suctioning after intubation.
Detection time point: Within 24 hours post-intubation.
4.
Extubation Failure Due to Airway Injury
Observation item: Need for reintubation caused by airway injury (edema, vocal
cord paralysis, granulation, or subglottic stenosis).
Detection time point: Within 72 hours post-extubation.
5.
Resident Satisfaction With Training
Observation item: Residents’ subjective evaluation of the PDCA training
program.
Detection time point: At the end of the emergency department rotation, via
anonymous questionnaire.
七、standards for efficacy appraisal
1.
Primary Efficacy Standard
First-attempt success rate of tracheal intubation is the primary indicator of
efficacy.
An intervention is considered effective if the PDCA-trained group demonstrates
a statistically significant improvement compared with the control group (P < 0.05).
2.
Secondary Efficacy Standards
Intubation completion time: A reduction in median time compared with controls
indicates improved procedural efficiency.

13
Incidence of airway trauma and extubation failure: Lower rates suggest
enhanced safety and procedural proficiency, even if not statistically significant.
Resident satisfaction score: Higher satisfaction rates reflect better training
experience and improved confidence.
3.
Comprehensive Appraisal
The PDCA training program will be deemed efficacious if it results in significant
improvement in the primary outcome and favorable trends across multiple
secondary outcomes.
Statistical analyses will use chi-square tests for categorical variables and
Mann–Whitney U test for continuous variables, with P < 0.05 considered statistically
significant.
八、Observation of adverse events
1.
Adverse Events of Interest
Local
airway
trauma:
visible
bleeding,
mucosal
laceration,
or
swelling
during/after intubation.
Extubation failure due to airway injury: reintubation required within 72 hours
caused by laryngeal edema, vocal cord paralysis, granulation tissue, or subglottic
stenosis.
Procedure-related
complications:
hypoxemia
(SpO₂
<
90%),
aspiration,
esophageal intubation, dental injury, or hemodynamic instability (e.g., hypotension,
arrhythmia).
Resident-related
adverse
events:
psychological
distress,
fatigue,
or
stress-related reactions during high-risk airway procedures.
2.
Observation Method
Continuous monitoring of vital signs (SpO₂, heart rate, blood pressure) during
and immediately after intubation.
Post-procedure evaluation of the airway via clinical examination, suctioning

14
records, and laryngoscopic confirmation when indicated.
Extubation follow-up within 72 hours to identify delayed complications.
Resident self-report questionnaires and supervisor observation to capture
psychological or human-factor–related adverse events.
3.
Recording and Reporting
All adverse events will be recorded in case report forms (CRFs), specifying type,
severity, onset time, and outcome.
Serious adverse events (SAEs) will be reported to the institutional ethics
committee within 24 hours.
Data will be analyzed to compare incidence rates between the control and
PDCA groups.
九、Data security monitoring
Clinical research will develop a corresponding data security monitoring plan
based on the size of the risk. All adverse events were recorded in detail, properly
handled and tracked until they were properly resolved or stable. Serious adverse
events and unexpected events were reported to the ethics committee, competent
authorities, sponsors and drug supervision and management departments in a
timely manner according to the regulations. The main researchers regularly conduct
a cumulative review of all adverse events, and if necessary, convene a meeting of
researchers to assess the risks and benefits of the study ; research that is greater
than the minimum risk will arrange independent data monitors to monitor the
research data, and high-risk research will establish an independent data security
supervisory committee to monitor the accumulated security data and effectiveness
data to make recommendations on whether the research will continue.
十、Statistical processing
All statistical analyses were performed using SPSS version 26.0 (IBM Corp.,
Armonk, NY, USA). Categorical variables, including intubation success rate,

15
incidence of local airway trauma, extubation failure due to airway injury, and
resident satisfaction rate, were expressed as counts and percentages [n (%)], and
were compared between groups using the chi-square test (χ² test) or Fisher’s exact
test, as appropriate. Continuous variables, such as intubation completion time,
were tested for normality using the Shapiro–Wilk test. Variables not conforming to a
normal distribution were expressed as median (interquartile range) and compared
using the Mann–Whitney U test. A two-tailed P value < 0.05 was considered
statistically significant.
十一、Ethics in clinical research
Clinical research will follow the World Medical Congress ' Helsinki Declaration '
and other relevant provisions. Before the study began, the clinical study was carried
out after the ethics committee approved the test plan. Before each subject is
selected for this study, the researcher has the responsibility to fully and
comprehensively introduce the purpose, procedure and possible risks of this study
to the subjects or their agents, and to sign a written informed consent form. The
subjects should be informed that they have the right to withdraw from the study at
any time. Informed consent should be retained as a clinical research document for
review. The personal privacy and data confidentiality of the subjects will be
protected during the study.
十二、Research progress
1.
Preparation Phase ( September
2024)
•
Finalization of study protocol, ethics committee approval, and trial
registration.
•
Recruitment of eligible emergency medicine residents.
•
Baseline data collection and pre-intervention training using traditional
methods.
2.
Implementation Phase (October 2024
to September
2025)

16
•
Full implementation of the PDCA cycle-based training program.
•
Residents rotate through didactic sessions, simulation training, and
supervised clinical practice.
•
Continuous data collection on intubation performance, adverse events, and
resident feedback.
3.
Evaluation Phase (September 2025)
•
Completion of data collection for both control and intervention groups.
•
Statistical analysis of primary and secondary outcomes.
•
Compilation of results for publication and dissemination.
十四、reference
[1] Johnson J, Milstone AM. Hospital-onset Neonatal Sepsis and Mortality in
Low-resource
Settings:
Will
Bundles
Save
the
Day?
Clin
Infect
Dis
2019;69(8):1368-1369.
[2] Lobe TE. Neonatal shock. Curr Opin Pediatr 1994;6(3):348-52.
[3] Morton SU, Brodsky D. Fetal Physiology and the Transition to Extrauterine
Life. Clin Perinatol 2016;43(3):395-407.
[4] Finnemore A, Groves A. Physiology of the fetal and transitional circulation.
Semin Fetal Neonatal Med 2015;20(4):210-6.
[5] Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of
neonatal sepsis. J Trop Pediatr 2015;61(1):1-13.
[6] Kelm DJ, Perrin JT, Cartin-Ceba R, Gajic O, Schenck L, Kennedy CC. Fluid
overload in patients with severe sepsis and septic shock treated with early
goal-directed therapy is associated with increased acute need for fluid-related
medical interventions and hospital death. Shock 2015;43(1):68-73.
[7] Bughrara N, Diaz-Gomez JL, Pustavoitau A. Perioperative Management of
Patients
with
Sepsis
and
Septic
Shock,
Part
II:
Ultrasound
Support
for
Resuscitation. Anesthesiol Clin 2020;38(1):123-134.

17
[8] Shrestha GS, Srinivasan S. Role of Point-of-Care Ultrasonography for the
Management
of
Sepsis
and
Septic
Shock.
Rev
Recent
Clin
Trials
2018;13(4):243-251.
[9] Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where?
Why? Lancet 2005;365(9462):891-900.
[10] Stoll BJ, Hansen N, Fanaroff AA, et al. Changes in pathogens causing
early-onset
sepsis
in
very-low-birth-weight
infants.
N
Engl
J
Med
2002;347(4):240-7.
[11] Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth
weight neonates: the experience of the NICHD Neonatal Research Network.
Pediatrics 2002;110(2 Pt 1):285-91.
[12] Stoll BJ, Hansen NI, Higgins RD, et al. Very low birth weight preterm infants
with early onset neonatal sepsis: the predominance of gram-negative infections
continues in the National Institute of Child Health and Human Development
Neonatal Research Network, 2002-2003. Pediatr Infect Dis J 2005;24(7):635-9.
[13] Haque KN, Khan MA, Kerry S, Stephenson J, Woods G. Pattern of
culture-proven neonatal sepsis in a district general hospital in the United Kingdom.
Infect Control Hosp Epidemiol 2004;25(9):759-64.
[14] Haque KN. Defining common infections in children and neonates. J Hosp
Infect 2007;65 Suppl 2:110-4.
[15] Kermorvant-Duchemin E, Laborie S, Rabilloud M, Lapillonne A, Claris O.
Outcome and prognostic factors in neonates with septic shock. Pediatr Crit Care
Med 2008;9(2):186-91.
[16] Singer M, Deutschman CS, Seymour CW, et al. The Third International
Consensus
Definitions
for
Sepsis
and
Septic
Shock
(Sepsis-3).
Jama
2016;315(8):801-10.
[17] Brown RM, Semler MW. Fluid Management in Sepsis. J Intensive Care

18
Med 2019;34(5):364-373.
[18] Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign:
International Guidelines for Management of Sepsis and Septic Shock: 2016.
Intensive Care Med 2017;43(3):304-377.
[19] Marik PE, Weinmann M. Optimizing fluid therapy in shock. Curr Opin Crit
Care 2019;25(3):246-251.
[20] Tigabu BM, Davari M, Kebriaeezadeh A, Mojtahedzadeh M. Fluid volume,
fluid balance and patient outcome in severe sepsis and septic shock: A systematic
review. J Crit Care 2018;48:153-159.
[21] Vincent
JL.
Fluid
management
in
the
critically
ill.
Kidney
Int
2019;96(1):52-57.
[22] Jozwiak M, Monnet X, Teboul JL. Pressure Waveform Analysis. Anesth
Analg 2018;126(6):1930-1933.
[23] Swan HJ, Ganz W, Forrester J, et al. Catheterization of the heart in man
with
use
of
a
flow-directed
balloon-tipped
catheter.
N
Engl
J
Med
1970;283(9):447-51.
[24] Absi MA, Lutterman J, Wetzel GT. Noninvasive cardiac output monitoring
in the pediatric cardiac Intensive Care Unit. Curr Opin Cardiol 2010;25(2):77-9.
[25] Levitov A, Frankel HL, Blaivas M, et al. Guidelines for the Appropriate Use
of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill
Patients-Part II: Cardiac Ultrasonography. Crit Care Med 2016;44(6):1206-27.
[26] 刘大为, 王小亭, 张宏民. 重症血流动力学治疗—— 北京共识.
2015;54(3):248-271.
[27] Lichtenstein D. Lung ultrasound in the critically ill. Curr Opin Crit Care
2014;20(3):315-22.
[28] Bihari S, Wiersema UF, Perry R, et al. Efficacy and safety of 20% albumin
fluid loading in healthy subjects: a comparison of four resuscitation fluids. J Appl

19
Physiol (1985) 2019;126(6):1646-1660.
[29] Nikravan
S,
Song
P,
Bughrara
N,
Díaz-Gómez
JL.
Focused
ultrasonography
for
septic
shock
resuscitation.
Curr
Opin
Crit
Care
2020;26(3):296-302.