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History
In 1854, Florence Nightingale left for the Crimean War, where the necessity to separate seriously wounded soldiers from less-seriously wounded was observed. Nightingale reduced mortality from 40% to 2% on the battlefield, creating the concept of intensive care.
In 1950, anesthesiologist Peter Safar established the concept of "Advanced Support of Life," keeping patients sedated and ventilated in an intensive care environment. Safar is considered the first intensivist.
In response to a polio epidemic (where many patients required constant ventilation and survelliance), Bjørn Ibsen established the first intensive care unit in Copenhagen in 1953.[1] The first application of this idea in the United States was pioneered by Dr. William Mosenthal, a surgeon at the Dartmouth-Hitchcock Medical Center.[2] In the 1960s, the importance of cardiac arrhythmias as a source of morbidity and mortality in myocardial infarctions (Heart Attacks) was recognized. This led to the routine use of cardiac monitoring in ICUs, especially in the post-MI setting.
Types
Specialized types of ICUs include:
- Neonatal intensive care unit (NICU)
- Special Care Nursery (SCN)
- Special Care Baby unit (SCBU)
- Pediatric Intensive Care Unit (PICU)
- Psychiatric Intensive Care Unit (PICU)
- Coronary Care Unit (CCU) for heart disease
- Cardiac Surgery Intensive Care Unit (CSICU)
- CardioVascular Intensive Care Unit (CVICU)
- Mobile Intensive Care Unit (MICU)
- Medical Surgical Intensive Care Unit (MSICU)
- Medical-Surgical Critical Care Intensive Care Unit (MSCC)
- Surgical Intensive Care Unit (SICU)
- Overnight Intensive Recovery (OIR)
- Neuroscience Critical Care Unit (NCCU)
- Neurological Intensive Care Unit (NICU)
- Neuro Intensive Care Unit (NICU)
- Burn Wounds Intensive Care Unit (BWICU)
- Trauma Intensive care Unit (TICU)
- Shock Trauma Intensive care Unit (STICU)
- Trauma-Neuro Critical Care Intensive Care Unit (TNCC)
- Respiratory Intensive Care Unit (RICU)
- Geriatrics Intensive Care Unit (GICU)
Equipment and systems
Common equipment in an ICU includes mechanical ventilator to assist breathing through an endotracheal tube or a tracheotomy opening; cardiac monitors including telemetry, external pacemakers, and defibrillators; dialysis equipment for renal problems; equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains and catheters; and a wide array of drugs to treat the main condition(s), induce sedation, reduce pain, and prevent secondary infections.
Quality of care
Medicine suggests a relation between ICU volume and quality of care for mechanically ventilated patients. [3] 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.
Staff
Medical staff typically includes intensivists with training in internal medicine, surgery, anesthesia, or emergency medicine. Many Nurse Practitioners and Physician Assistants with specialized training are also now part of the staff that provide continuity of care for patients. Staff typically includes specially trained critical care Registered Nurses, Registered Respiratory Therapists, Nutritionists, Physical Therapists, Certified Nursing Assistants, etc.
See also
- Medicine
- Surgery
- Surgeon
- Anesthesia
- Anesthesiologist
- CRNA or Certified Registered Nurse Anesthetist
- ASA score or pre-operative physical fitness
- Patient
- Physician
- Rare diseases
- Traumatology
- Health care
- Health profession
- Health care system
References
- ^ "Intensive Care Unit". Internet Journal of Health.
- ^ "Remembering Dr. William Mosenthal: A simple idea from a special surgeon". Dartmouth Medicine. Retrieved on 2007-04-10.
- ^ Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O'Brien CR, Rubenfeld GD. (2006). "Hospital volume and the outcomes of mechanical ventilation.". New England Journal of Medicine 355 (1): 41–50. doi:. Retrieved on 2006-08-02.
