Intensive care medicine

Mechanical ventilation may be required if a patient's unassisted breathing is insufficient to oxygenate the blood.

Intensive care medicine or 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.

Overview

Patients requiring intensive care may need support for instability (hypertension/hypotension), airway or respiratory compromise such as ventilator support, acute renal failure, potential lethal cardiac arrhythmias, or the cumulative effects of multiple organ failure, now often referred to as multiple organ dysfunction syndrome. They might also be admitted for intensive or invasive monitoring, especially during the critical hours post major surgery when they're too unstable to be transferred to a less monitored unit.

Intensive care is typically provided to those whose condition is potentially reversible and who stand a chance of surviving with intensive support. A primary requisite for admission to an intensive care unit (ICU) is that the patient's underlying condition can be overcome.

Research indicates a correlation between ICU volume and quality of care for mechanically ventilated patients. High ICU volume has been associated with lower ICU and hospital mortality rates. Intensive care medicine is costly, technologically advanced, and resource-intensive. In the United States, expenditure for critical care medicine in 2000 was estimated between US$15–55 billion, accounting for significant portions of GDP, national health expenditure, and hospital costs.

Organ systems

Treatment in intensive care usually adopts a system-by-system approach rather than the SOAP approach of high dependency care. The key systems are considered on an observation-intervention-impression basis to formulate a daily plan. This includes addressing other issues such as psychological health, pressure points, mobilisation, physiotherapy, and secondary infections.

The key ICU systems include: cardiovascular system, central nervous system, endocrine system, gastro-intestinal tract, hematology, microbiology, peripheries, renal, and respiratory system.

Intensive care provision is generally provided in a specialized unit within a hospital known as the intensive care unit (ICU) or critical care unit (CCU). Hospitals often have dedicated ICUs based on specialities, such as the coronary intensive care unit (CCU) or the pediatric intensive care unit (PICU). Naming conventions for these units aren't standardized.

Equipment and systems

An endotracheal tube

Common ICU equipment includes mechanical ventilation to aid breathing, hemofiltration equipment for acute renal failure, monitoring devices, intravenous lines, and a vast array of drugs including inotropes, sedatives, antibiotics, and analgesics.

Medical specialties

Critical care medicine has emerged as a vital medical specialty. Physicians trained in this field are termed intensivists. In the US, the speciality mandates extra fellowship training after the primary residency. Several societies, such as the American Society of Critical Care Medicine, have been established for ICU professionals. Studies suggest that ICU care provided by intensivists yields better outcomes and is more cost-effective. However, there's a notable shortage of intensivists in the US.

Critical care team members might also undergo additional training in critical care medicine. Respiratory therapists, nurses, paramedics, nutritionists, and pharmacists can all specialize further in critical care.

Patient management in intensive care varies between countries. Evidence shows that "closed" ICUs staffed exclusively by intensivists yield better patient outcomes.

In veterinary medicine, critical care is an acknowledged specialty, closely aligned with emergency medicine.

In 1970, the Society of Critical Care Medicine was founded.

What do intensivists do?

Critical care medicine includes providing life support, invasive monitoring techniques, resuscitation, and end-of-life care. Doctors in this specialty are often called intensive care physicians, critical care physicians or intensivists.

See also

• Critical care nursing
• GOMER
• Respiratory monitoring

Resources

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