Critical Care Medicine

An attempt has been made to direct the evolution of critical care medicine based on the author's personal experiences with the development of emergency care and intensive care programs during the past decade, and on review of the available literature.

Abstract

An attempt has been made to direct the evolution of critical care medicine based on the authors' personal experiences with the development of emergency care and intensive care programs during the past decade, and on review of the available literature. Critical care medicine (i.e., acute medicine) includes emergency medical services for life-threatening conditions and intensive care. In contrast to the hitherto often disorganized and haphazardous development of intensive care units, we propose a logical, community-oriented plan to implement present knowledge in multidisciplinary interdepartmental intensive care. Although in very large hospitals more than one intensive care unit may be necessary, the development of separated pure respiratory, medical or surgical intensive care units is discouraged, because most critically ill patients have multiple organ failure. Special intensive nursing care under physician direction, using standardized basic life support techniques, has decreased mortality, for instance, of patients with myocardial infarction. There is evidence suggesting that mortality and morbidity of other types of critically ill patients are further reduced where sophisticated life support around the clock has been provided by teams of physicians from several disciplines who are working fulltime or "most time" in the ICU. The team includes non-physicians, such as nurses, nurses' helpers, inhalation therapists, bioengineers, technicians, administrators and others. Selection of team coordinator and ICU medical director, as well as special training for physician leaders in critical care medicine are discussed. Multidisciplinary programs, institutes or departments in critical care medicine are proposed. They should concern themselves with patient care, teaching and research. Cross-fertilization of laboratory-clinical and health care delivery studies and innovations is possible and desirable. An attempt has been made to direct the evolution of critical care medicine based on the authors' personal experiences with the development of emergency care and intensive care programs during the past decade, and on review of the available literature. Critical care medicine (i.e., acute medicine) includes emergency medical services for life-threatening conditions and intensive care. In contrast to the hitherto often disorganized and haphazardous development of intensive care units, we propose a logical, community-oriented plan to implement present knowledge in multidisciplinary interdepartmental intensive care. Although in very large hospitals more than one intensive care unit may be necessary, the development of separated pure respiratory, medical or surgical intensive care units is discouraged, because most critically ill patients have multiple organ failure. Special intensive nursing care under physician direction, using standardized basic life support techniques, has decreased mortality, for instance, of patients with myocardial infarction. There is evidence suggesting that mortality and morbidity of other types of critically ill patients are further reduced where sophisticated life support around the clock has been provided by teams of physicians from several disciplines who are working fulltime or "most time" in the ICU. The team includes non-physicians, such as nurses, nurses' helpers, inhalation therapists, bioengineers, technicians, administrators and others. Selection of team coordinator and ICU medical director, as well as special training for physician leaders in critical care medicine are discussed. Multidisciplinary programs, institutes or departments in critical care medicine are proposed. They should concern themselves with patient care, teaching and research. Cross-fertilization of laboratory-clinical and health care delivery studies and innovations is possible and desirable. The New Practice of Critical Care MedicineCHESTVol. 59Issue 5PreviewThe panorama of techniques now available for preserving vital functions in the critically ill or injured patient were essentially unknown 20 years ago. For practical purposes, it has been less than a decade since intubation and mechanical ventilation, volume repletion guided by measurements of central venous pressure, and cardiac resuscitation by the use of defibrillators and pacemakers have come into general use outside of the operating room. Progress in the field has been accelerated by the availability of competent monitors which indicate the need for immediate intervention and confirm the appropriateness of resuscitation. Full-Text PDF