Intensive care medicineFrom Wikipedia, the free encyclopedia"CICU" redirects here. For the radio station, seeCICU-FM."critical care medicine" redirects here. For the academic journal, seeCritical Care Medicine."high dependency unit" redirects here. For the New Zealand psychedelic rock band, seeHigh Dependency Unit."Intensive Care" redirects here. For the album by pop singer Robbie Williams, seeIntensive Care (album).This article includes alist of references, butits sources remain unclear because it has insufficientinline citations.Please help toimprovethis article byintroducingmore precise citations.(July 2009)

Mechanical ventilationmay be required if a patient's unassisted breathing is insufficient tooxygenatethe blood.Intensive care medicineorcritical care medicineis a branch ofmedicineconcerned with thediagnosisand management of life-threatening conditions requiring sophisticatedorgan supportandinvasive monitoring.Contents[hide] 1Overview 2Organ systems 3Equipment and systems 4Medical specialties 5History 5.1Florence Nightingale era 5.2Dandy era 5.3Ibsen era 5.4Safar era 6See also 7Notes 8References 9External linksOverview[edit]Patients requiring intensive care may require support for instability (hypertension/hypotension), airway orrespiratory compromise(such asventilatorsupport),acute renal failure, potentially lethalcardiac arrhythmias, or the cumulative effects ofmultiple organ failure, more commonly referred to now asmultiple 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.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]A prime requisite for admission to anintensive care unit(ICU) is that the underlying condition can be overcome.[citation needed]Medical studies suggest a relation between ICU volume and quality of care for mechanically ventilated patients.[1]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.In general, it is the most expensive, technologically advanced and resource-intensive area of medical care. In theUnited States, estimates of the 2000 expenditure for critical care medicine ranged from US$1555 billion. During that year, critical care medicine accounted for 0.56% ofGDP, 4.2% of national health expenditure and about 13% of hospital costs.[2]Organ systems[edit]Intensive care usually takes a system by system approach to treatment, rather than theSOAP(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.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.The provision of intensive care is, in general, administered in a specialized unit of ahospitalcalled theintensive 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.Equipment and systems[edit]

An endotracheal tubeCommon equipment in an intensive care unit (ICU) includesmechanical ventilationto assist breathing through anendotracheal tubeor atracheotomy;hemofiltrationequipment foracute renal failure; monitoring equipment;intravenouslines for drug infusions fluids ortotal parenteral nutrition,nasogastric tubes, suction pumps, drains andcatheters; and a wide array ofdrugsincludinginotropes,sedatives, broad spectrumantibioticsandanalgesics.Medical specialties[edit]Critical care medicine is a relatively new but increasingly important medical specialty.Physicianswith training in critical care medicine are referred to as intensivists.[3]In the United States, the specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine,pediatrics,anesthesiology,surgeryoremergency 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 AmericanSociety of Critical Care Medicineis 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.[4]This has led theLeapfrog Groupto 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.Other members of the critical care team may also pursue additional training in critical care medicine as intensivists.Respiratory therapistsmay 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.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.[5][6]Inveterinary 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.History[edit]Florence Nightingale era[edit]

Florence NightingaleThe ICU's roots can be traced back to the Monitoring Unit of critical patients through nurseFlorence Nightingale. TheCrimean Warbegan 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, themortality ratefell to 2%. Nightingale contractedtyphoid, 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.Dandy era[edit]Walter Edward Dandywas born inSedalia, Missouri. He received his BA in 1907 through theUniversity of Missouriand hisM.D.in 1910 through theJohns Hopkins University School of Medicine. Dandy worked one year with Dr.Harvey Cushingin 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 Mnire'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.Ibsen era[edit]Bjrn Aage Ibsen(19152007) 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,[7]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.[8]At this time Carl-Gunnar Engstrm 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,[7]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 p en Ansthesiologisk Observationsafdeling (The Work in an Anaesthesiologic Observation Unit) with Tone Dahl Kvittingen from Norway. He died in 2007.Safar era[edit]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.In 1970, theSociety of Critical Care Medicinewas formed.[9]See also[edit]Medicine portal

Critical care nursing GOMER Respiratory monitoringNotes[edit]1. Jump up^Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O'Brien CR, Rubenfeld GD., JM; Goss, CH; Heagerty, PJ; Kramer, AA; O'Brien, CR; Rubenfeld, GD (2006). "Hospital volume and the outcomes of mechanical ventilation".The New England Journal of Medicine355(1): 4150.doi:10.1056/NEJMsa053993.PMID16822995.2. Jump up^Halpern, Neil A.; Pastores, Stephen M.; Greenstein, Robert J. (June 2004). "Critical care medicine in the United States 19852000: An analysis of bed numbers, use, and costs".Critical Care Medicine32(6): 12541259.doi:10.1097/01.CCM.0000128577.31689.4C.PMID15187502.3. Jump up^[dead link][1].Healthcare Financial Management Association.4. Jump up^"Association between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit".Annals of Internal Medicine. 3 June 2008. Volume 148, Issue 11. pp. 801809.5. Jump up^Manthous CA, Amoateng-Adjepong Y, al-Kharrat T, Jacob B, Alnuaimat HM, Chatila W, Hall JB., CA; Amoateng-Adjepong, Y; Al-Kharrat, T; Jacob, B; Alnuaimat, HM; Chatila, W; Hall, JB (1997). "Effects of a medical intensivist on patient care in a community teaching hospital".Mayo Clinic Proceedings(Abstract)72(5): 3919.doi:10.4065/72.5.391.PMID9146680.6. Jump up^Hanson CW 3rd, Deutschman CS, Anderson HL 3rd, Reilly PM, Behringer EC, Schwab CW, Price J., 3rd; Deutschman, CS; Anderson Hl, 3rd; Reilly, PM; Behringer, EC; Schwab, CW; Price, J (1999). "Effects of an organized critical care service on outcomes and resource utilization: a cohort study".Critical Care Medicine(Abstract)27(2): 2704.doi:10.1097/00003246-199902000-00030.PMID10075049.7. ^Jump up to:ab"The Danish anaesthesiologist Bjrn Ibsen a pioneer of long-term ventilation on the upper airways, Louise Reisner-Snlar, 2009"(PDF format; requiresAdobe Reader).8. Jump up^Reisner-Snlar, Louise (2011)."The Birth of Intensive Care Medicine: Bjrn Ibsens Records"(PDF format; requiresAdobe Reader).Intensive Care Medicine. Retrieved 2 October 2012.9. Jump up^history reference: Brazilian Society of Critical CareSOBRATIVideo:ICU HistoryHistorical photosReferences[edit] Intensive Care Medicine by Irwin and Rippe Civetta, Taylor, and Kirby's Critical Care The ICU Book by Marino Procedures and Techniques in Intensive Care Medicine by Irwin and Rippe Halpern, NA, Pastores, SM, Greenstein, RJ (June 2004). "Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs.".Critical Care Medicine32(6): 12549.doi:10.1097/01.CCM.0000128577.31689.4C.PMID15187502.. History reference: Brazilian Society of Intensive Care - SOBRATI History Society of Critical Care Medicine Reynolds, H.N.; Rogove, H.; Bander, J.; McCambridge, M. et al. (December 2011)."A working lexicon for the tele-intensive care unit: We need to define tele-intensive care unit to grow and understand it".Telemedicine and e-Health.17(10): 773783.doi:10.1089/tmj.2011.0045. Olson, Terrah; Brasel, Karen; Redmann, Andrew; Alexander, G.; Schwarze, Margaret (January 2013)."Surgeon-Reported Conflict With Intensivists About Postoperative Goals of Care".JAMA Surgery.148(1): 2935.doi:10.1001/jamasurgery.2013.403.External links[edit]Wikimedia Commons has media related toIntensive care medicine.

Society of Critical Care Medicine Veterinary Emergency And Critical Care Society ESICM: European Society of Intensive Care Medicine ESPNIC: The society for paediatric and neonatal intensive care healthcare professionals in Europe UK Intensive Care Society Scottish Intensive Care Society Hong Kong Society of Critical Care Medicine Chinese Society of Critical Care Medicine Taiwan Society of Critical Care Medicine From Iron Lungs to Intensive Care,Royal Institutiondebate, February 2012[show] v t eIntensive care medicine

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