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| [[File:VIP Bird2.jpg|right|thumb|[[Mechanical ventilation]] may be required if a patient's unassisted breathing is insufficient to [[Oxygenation (medical)|oxygenate]] the blood.]]
| | ==Intensive Care Medicine== |
| '''Intensive care medicine''' or '''critical care medicine''' is a branch of [[medicine]] concerned with the [[diagnosis (medicine)|diagnosis]] and management of life threatening conditions requiring sophisticated [[organ support]] and [[invasive monitoring]].
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| ==Overview==
| | Intensive care medicine, also known as critical care medicine, is a branch of medicine concerned with the diagnosis and management of life-threatening conditions requiring sophisticated organ support and invasive monitoring. Patients requiring intensive care may require support for [[hemodynamic instability]], [[airway]] or [[respiratory compromise]], [[acute renal failure]], or the effects of multiple organ dysfunction syndrome (MODS). |
| Patients requiring intensive care may require support for instability ([[hypertension]]/[[hypotension]]), airway or [[respiratory compromise]] (such as [[medical ventilator|ventilator]] support), [[acute renal failure]], potentially lethal [[cardiac arrhythmias]], or the cumulative effects of [[multiple organ failure]], more commonly referred to now as [[multiple organ dysfunction syndrome]]. They may also be admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit. | |
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| Intensive care is usually only offered to those whose condition is potentially reversible and who have a good chance of surviving with intensive care support.{{Citation needed|date=August 2013}} A prime requisite for admission to an [[intensive care unit]] (ICU) is that the underlying condition can be overcome.{{Citation needed|date=August 2013}}
| | ===History=== |
| | The development of intensive care medicine is relatively recent, with the first intensive care units (ICUs) being established in the 1950s. The specialty has grown rapidly since then, driven by advances in medical technology and a better understanding of critical illness. |
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| Medical studies suggest a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illness, demographic variables, and characteristics of the ICUs (including staffing by intensivists), higher ICU volume was significantly associated with lower ICU and hospital mortality rates. For example, adjusted ICU mortality (for a patient at average predicted risk for ICU death) was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, and 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually. Hospitals with intermediate numbers of patients had outcomes between these extremes.
| | ===Intensive Care Units (ICUs)=== |
| | ICUs are specialized hospital wards equipped with advanced medical technology and staffed by specially trained healthcare professionals. They provide intensive monitoring and treatment for patients with severe and life-threatening illnesses and injuries. |
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| In general, it is the most expensive, technologically advanced and resource-intensive area of medical care. In the [[United States]], estimates of the 2000 expenditure for critical care medicine ranged from US$15–55 billion.<!--Is this lower bound given in the full cited article? The abstract suggests it is $55.5bn, which I presume forms the basis for the following figures; perhaps somebody with journal access could check...--> During that year, critical care medicine accounted for 0.56% of [[Gross Domestic Product|GDP]], 4.2% of national health expenditure and about 13% of hospital costs.
| | ====Types of ICUs==== |
| ==Organ systems==
| | * '''Medical ICU (MICU):''' Focuses on patients with medical conditions such as [[sepsis]], [[pneumonia]], and [[heart failure]]. |
| Intensive care usually takes a system by system approach to treatment, rather than the [[Subjective Objective Assessment Plan|''SOAP'']] (subjective, objective, analysis, plan) approach of high dependency care. The nine key systems (see below) are each considered on an observation-intervention-impression basis to produce a daily plan. As well as the key systems, intensive care treatment raises other issues including psychological health, pressure points, mobilisation and physiotherapy, and secondary infections.
| | * '''Surgical ICU (SICU):''' Caters to patients recovering from major surgery. |
| | * '''Neonatal ICU (NICU):''' Specializes in the care of ill or premature newborn infants. |
| | * '''Pediatric ICU (PICU):''' Provides care for critically ill children. |
| | * '''Cardiac ICU (CICU):''' Dedicated to patients with severe cardiac conditions. |
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| The nine key IC systems are (alphabetically): [[cardiovascular system]], [[central nervous system]], [[endocrine system]], [[gastro-intestinal tract]] (and nutritional condition), [[hematology]], [[microbiology]] (including sepsis status), peripheries (and skin), [[renal]] (and metabolic), [[respiratory system]].
| | ===Common Conditions Managed in ICUs=== |
| | * '''[[Sepsis]]:''' A life-threatening response to infection that can lead to tissue damage, organ failure, and death. |
| | * '''[[Acute Respiratory Distress Syndrome (ARDS)]]:''' A severe lung condition causing respiratory failure. |
| | * '''[[Myocardial Infarction]]:''' Commonly known as a heart attack, it occurs when blood flow to the heart is blocked. |
| | * '''[[Stroke]]:''' A medical emergency where the blood supply to part of the brain is interrupted or reduced. |
| | * '''[[Traumatic Brain Injury (TBI)]]:''' Occurs when an external force injures the brain. |
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| The provision of intensive care is, in general, administered in a specialized unit of a [[hospital]] called the [[intensive care unit]] (ICU) or critical care unit (CCU). Many hospitals also have designated intensive care areas for certain specialities of medicine, such as the coronary intensive care unit (CCU or sometimes CICU, depending on hospital) for heart disease, medical intensive care unit (MICU), surgical intensive care unit (SICU), pediatric intensive care unit (PICU), neuroscience critical care unit (NCCU), overnight intensive-recovery (OIR), shock/trauma intensive-care unit (STICU), neonatal intensive care unit (NICU), and other units as dictated by the needs and available resources of each hospital. The naming is not rigidly standardized. For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive care resources (see below) were brought to the room of the patient that needed the additional monitoring, care, and resources. It became rapidly evident, however, that a fixed location where intensive care resources and personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital.
| | ===Treatments and Interventions=== |
| | Intensive care medicine involves a range of treatments and interventions, including: |
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| ==Equipment and systems==
| | * '''Mechanical Ventilation:''' Provides respiratory support for patients who are unable to breathe adequately on their own. |
| [[File:Sondeintubation.jpg|thumb|right|An endotracheal tube]]
| | * '''Hemodynamic Monitoring:''' Involves the use of catheters and other devices to monitor blood pressure, cardiac output, and other vital signs. |
| Common equipment in an intensive care unit (ICU) includes [[mechanical ventilation]] to assist breathing through an [[Tracheal intubation|endotracheal tube]] or a [[tracheotomy]]; [[hemofiltration]] equipment for [[acute renal failure]]; monitoring equipment; [[intravenous]] lines for drug infusions fluids or [[total parenteral nutrition]], [[nasogastric tube]]s, suction pumps, drains and [[catheters]]; and a wide array of [[pharmacology|drugs]] including [[inotrope]]s, [[sedatives]], broad spectrum [[antibiotics]] and [[analgesics]].
| | * '''Renal Replacement Therapy:''' Includes dialysis and other methods to support kidney function in patients with acute renal failure. |
| | * '''Nutritional Support:''' Ensures that critically ill patients receive adequate nutrition, often through enteral or parenteral feeding. |
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| ==Medical specialties== | | ===Healthcare Professionals in Intensive Care=== |
| Critical care medicine is a relatively new but increasingly important medical specialty. [[Physician]]s with training in critical care medicine are referred to as intensivists. In the United States, the specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine, [[pediatrics]], [[anesthesiology]], [[surgery]] or [[emergency medicine]]. US board certification in critical care medicine is available through all five specialty boards. Intensivists with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, cardiology, infectious disease, or nephrology. The American [[Society of Critical Care Medicine]] is a well-established multiprofessional society for practitioners working in the ICU including nurses, respriatory therapists, and physicians. Most medical research has demonstrated that ICU care provided by intensivists produces better outcomes and more cost-effective care. This has led the [[Leapfrog Group]] to make a primary recommendation that all ICU patients be managed or co-managed by a dedicated intensivist who is exclusively responsible for patients in one ICU. However, in the US, there is a critical shortage of intensivists and most hospitals lack this critical physician team member.
| | The care of critically ill patients in the ICU is provided by a multidisciplinary team, including: |
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| Other members of the critical care team may also pursue additional training in critical care medicine as intensivists. [[Respiratory therapists]] may pursue additional education and training leading to credentialing in adult critical care (ACCS) and neonatal and pediatric (NPS) specialties. Nurses may pursue additional education and training in critical care medicine leading to certification as a CCRN by the American Association of Critical Care Nurses. Paramedics are certified to levels of CCEMT-P, PNCCT-P, CCP-C and/or FP-C depending upon their speciality (e.g. air, ground, adult, pediatric and/or neonatal medicine). Nutrition in the intensive care unit presents unique challenges and critical care nutrition is rapidly becoming a subspecialty for dieticians who can pursue additional training and achieve certification in enteral and parenteral nutrition through the American Society for Parenteral and Enteral Nutrition (ASPEN). Pharmacists may pursue additional training in a postgraduate residency and become certified as critical care pharmacists.
| | * '''Intensivists:''' Physicians specialized in intensive care medicine. |
| | * '''Critical Care Nurses:''' Nurses with specialized training in the care of critically ill patients. |
| | * '''Respiratory Therapists:''' Professionals who manage ventilators and other respiratory support devices. |
| | * '''Pharmacists:''' Provide expertise in the use of medications in critically ill patients. |
| | * '''Dietitians:''' Ensure appropriate nutritional support for patients. |
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| Patient management in intensive care differs significantly between countries. In countries such as Australia and New Zealand, where intensive care medicine is a well-established speciality, many larger ICUs are described as "closed". In a closed unit the intensive care specialist takes on the senior role where the patient's primary physician now acts as a consultant. The advantage of this system is a more coordinated management of the patient based on a team who work exclusively in ICU. Other countries have open ICUs, where the primary physician chooses to admit and, in general, makes the management decisions. There is increasingly strong evidence that "closed" intensive care units staffed by intensivists provide better outcomes for patients.
| | ===Ethical and Legal Considerations=== |
| | Intensive care medicine often involves complex ethical and legal issues, such as decisions about the initiation or withdrawal of life-sustaining treatments, patient autonomy, and end-of-life care. |
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| In [[veterinary medicine]], critical care medicine is recognized as a specialty and is closely allied with emergency medicine. Board-certified veterinary critical care specialists are known as criticalists, and generally are employed in referral institutions or universities.
| | ==See Also== |
| | * [[Emergency Medicine]] |
| | * [[Anesthesiology]] |
| | * [[Pulmonology]] |
| | * [[Cardiology]] |
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| ==History== | | ==Categories== |
| | | [[Category:Intensive Care Medicine]] |
| ===Florence Nightingale era===
| | [[Category:Medical Specialties]] |
| [[File:Florence Nightingale 1920 reproduction.jpg|right|thumb|upright|Florence Nightingale]] | | [[Category:Critical Care]] |
| The ICU's roots can be traced back to the Monitoring Unit of critical patients through nurse [[Florence Nightingale]]. The [[Crimean War]] began in 1853 when Britain, France, and the Ottoman Empire (Turkey) declared war on Russia. Because of the lack of critical care and the high rate of infection, there was a high mortality rate of hospitalised soldiers, reaching as high as 40% of the deaths recorded during the war. Upon arriving, and practicing, the [[mortality rate]] fell to 2%. Nightingale contracted [[typhoid]], and returned in 1856 from the war. A school of nursing dedicated to her was formed in 1859 in England. The school was recognised for its professional value and technical calibre, receiving prizes throughout the British government. The school of nursing was established in Saint Thomas Hospital, as a one-year course, and was given to doctors. It used theoretical and practical lessons, as opposed to purely academic lessons. Nightingale's work, and the school, paved the way for intensive care medicine.
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| ===Dandy era===
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| [[Walter Edward Dandy]] was born in [[Sedalia, Missouri]]. He received his BA in 1907 through the [[University of Missouri]] and his [[Doctor of Medicine|M.D.]] in 1910 through the [[Johns Hopkins University School of Medicine]]. Dandy worked one year with Dr. [[Harvey Cushing]] in the Hunterian Laboratory of Johns Hopkins before entering its boarding school and residence in the Johns Hopkins Hospital. He worked in the Johns Hopkins College in 1914 and remained there until his death in 1946. One of the most important contributions he made for neurosurgery was the air method in ventriculography, in which the cerebrospinal fluid is substituted with air to help an image form on an X-Ray of the ventricular space in the brain. This technique was extremely successful for identifying brain injuries. Dr. Dandy was also a pioneer in the advances in operations for illnesses of the brain affecting the glossopharyngeal as well as Ménière's syndrome, and he published studies that show that high activity can cause sciatic pain. Dandy created the first ICU in the world, 03 beds in Boston in 1926.
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| ===Ibsen era===
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| [[Bjørn Aage Ibsen]] (1915–2007) graduated in 1940 from medical school at the University of Copenhagen and trained in anesthesiology from 1949 to 1950 at the Massachusetts General Hospital, Boston. He became involved in the 1952 poliomyelitis outbreak in Denmark, where 2722 patients developed the illness in a 6-month period, with 316 suffering respiratory or airway paralysis. Treatment had involved the use of the few negative pressure respirators available, but these devices, while helpful, were limited and did not protect against aspiration of secretions. Ibsen changed management directly, instituting protracted positive pressure ventilation by means of intubation into the trachea, and enlisting 200 medical students to manually pump oxygen and air into the patients lungs. At this time Carl-Gunnar Engström had developed one of the first positive pressure volume controlled ventilators, which eventually replaced the medical students. In this fashion, mortality declined from 90% to around 25%. Patients were managed in 3 special 35 bed areas, which aided charting and other management. In 1953, Ibsen set up what became the world's first Medical/Surgical ICU in a converted student nurse classroom in Kommunehospitalet (The Municipal Hospital) in Copenhagen,<ref name="dropbox" /> and provided one of the first accounts of the management of tetanus with muscle relaxants and controlled ventilation. In 1954 Ibsen was elected Head of the Department of Anaesthesiology at that institution. He jointly authored the first known account of ICU management principles in Nordisk Medicin, September 18, 1958: ‘Arbejdet på en Anæsthesiologisk Observationsafdeling’ (‘The Work in an Anaesthesiologic Observation Unit’) with Tone Dahl Kvittingen from Norway. He died in 2007.
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| ===Safar era===
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| The first surgical ICU was established in Baltimore, and, in 1962, in the University of Pittsburgh, the first Critical Care Residency was established in the United States.
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| In 1970, the [[Society of Critical Care Medicine]] was formed.
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| ==See also==
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| {{portal|Medicine}}
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| *[[Critical care nursing]]
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| *[[GOMER]]
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| *[[Respiratory monitoring]]
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| ==Notes==
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| {{reflist|30em}}
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| ==References==
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| *[http://www.lww.com/product/?0-7817-3548-3 Intensive Care Medicine by Irwin and Rippe]
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| *[http://www.lww.com/product/?978-0-7817-6869-6 Civetta, Taylor, and Kirby's Critical Care]
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| *[http://www.lww.com/product/?978-0-7817-4802-5 The ICU Book by Marino]
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| *[http://www.lww.com/product/?0-7817-4334-6 Procedures and Techniques in Intensive Care Medicine by Irwin and Rippe]
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| *{{cite journal | pmid = 15187502 | doi = 10.1097/01.CCM.0000128577.31689.4C | last1 = Halpern | author-separator =, | first1 = NA | author-name-separator= | last2 = Pastores | first2 = SM | last3 = Greenstein | first3 = RJ | title = Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs. | journal = [[Critical Care Medicine]]| volume=32 | issue=6 |date=June 2004 | pages=1254–9}}.
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| *History reference:
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| *[http://www.sobrati.com.br Brazilian Society of Intensive Care - SOBRATI]
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| *[http://www.medicinaintensiva.com.br/personagens.htm History]
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| *[http://www.sccm.org Society of Critical Care Medicine]
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| *{{cite journal |first1=H.N. |last1= Reynolds |first2= H.|last2= Rogove |first3= J. |last3= Bander |first4= M. |last4= McCambridge |first5= E. |last5= Cowboy |first6= M. |last6= Niemeier |displayauthors=4 |journal= Telemedicine and e-Health. |date= December 2011 |volume= 17|issue= 10 |pages= 773–783 |doi=10.1089/tmj.2011.0045 |url= http://www.liebertonline.com/doi/abs/10.1089/tmj.2011.0045 |title= A working lexicon for the tele-intensive care unit: We need to define tele-intensive care unit to grow and understand it}}
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| *{{cite journal |first1=Terrah |last1= Olson |first2= Karen|last2= Brasel |first3= Andrew |last3= Redmann |first4= G. |last4= Alexander |first5= Margaret |last5= Schwarze |journal= JAMA Surgery. |date= January 2013 |volume= 148|issue= 1 |pages= 29-35 |doi=10.1001/jamasurgery.2013.403 |url= http://archsurg.jamanetwork.com/article.aspx?articleid=1558103 |title= Surgeon-Reported Conflict With Intensivists About Postoperative Goals of Care}}
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| ==External links==
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| {{Commons category}}
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| *[http://www.sccm.org Society of Critical Care Medicine]
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| *[http://www.veccs.org Veterinary Emergency And Critical Care Society]
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| *[http://esicm.org ESICM : European Society of Intensive Care Medicine]
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| *[http://espnic-online.org ESPNIC: The society for paediatric and neonatal intensive care healthcare professionals in Europe]
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| *[http://www.ics.ac.uk/ UK Intensive Care Society]
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| *[http://www.scottishintensivecare.org.uk/- Scottish Intensive Care Society]
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| *[http://www.hksccm.org Hong Kong Society of Critical Care Medicine]
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| *[http://www.csccm.org Chinese Society of Critical Care Medicine]
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| *[http://www.tsccm.org.tw/English/eng001.asp Taiwan Society of Critical Care Medicine]
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| *[http://richannel.org/from-iron-lungs-to-intensive-care From Iron Lungs to Intensive Care], [[Royal Institution]] debate, February 2012
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| {{Intensive care medicine}}
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| {{Medicine}}
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| {{Portal bar|Medicine}}
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| [[Category:Intensive care medicine|*]]
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| {{links}} {{health}}[[Category:Medical specialties]]
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| <references />
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Intensive Care Medicine[edit]
Intensive care medicine, also known as critical care medicine, is a branch of medicine concerned with the diagnosis and management of life-threatening conditions requiring sophisticated organ support and invasive monitoring. Patients requiring intensive care may require support for hemodynamic instability, airway or respiratory compromise, acute renal failure, or the effects of multiple organ dysfunction syndrome (MODS).
History[edit]
The development of intensive care medicine is relatively recent, with the first intensive care units (ICUs) being established in the 1950s. The specialty has grown rapidly since then, driven by advances in medical technology and a better understanding of critical illness.
Intensive Care Units (ICUs)[edit]
ICUs are specialized hospital wards equipped with advanced medical technology and staffed by specially trained healthcare professionals. They provide intensive monitoring and treatment for patients with severe and life-threatening illnesses and injuries.
Types of ICUs[edit]
- Medical ICU (MICU): Focuses on patients with medical conditions such as sepsis, pneumonia, and heart failure.
- Surgical ICU (SICU): Caters to patients recovering from major surgery.
- Neonatal ICU (NICU): Specializes in the care of ill or premature newborn infants.
- Pediatric ICU (PICU): Provides care for critically ill children.
- Cardiac ICU (CICU): Dedicated to patients with severe cardiac conditions.
Common Conditions Managed in ICUs[edit]
Treatments and Interventions[edit]
Intensive care medicine involves a range of treatments and interventions, including:
- Mechanical Ventilation: Provides respiratory support for patients who are unable to breathe adequately on their own.
- Hemodynamic Monitoring: Involves the use of catheters and other devices to monitor blood pressure, cardiac output, and other vital signs.
- Renal Replacement Therapy: Includes dialysis and other methods to support kidney function in patients with acute renal failure.
- Nutritional Support: Ensures that critically ill patients receive adequate nutrition, often through enteral or parenteral feeding.
Healthcare Professionals in Intensive Care[edit]
The care of critically ill patients in the ICU is provided by a multidisciplinary team, including:
- Intensivists: Physicians specialized in intensive care medicine.
- Critical Care Nurses: Nurses with specialized training in the care of critically ill patients.
- Respiratory Therapists: Professionals who manage ventilators and other respiratory support devices.
- Pharmacists: Provide expertise in the use of medications in critically ill patients.
- Dietitians: Ensure appropriate nutritional support for patients.
Ethical and Legal Considerations[edit]
Intensive care medicine often involves complex ethical and legal issues, such as decisions about the initiation or withdrawal of life-sustaining treatments, patient autonomy, and end-of-life care.
See Also[edit]
Categories[edit]
