Intensive Care Unit
Encyclopedia
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
that provides intensive-care medicine. Many hospitals also have designated intensive-care areas for certain specialties of medicine, depending on the needs and resources of the hospital.
History
In 1854, Florence NightingaleFlorence Nightingale
Florence Nightingale OM, RRC was a celebrated English nurse, writer and statistician. She came to prominence for her pioneering work in nursing during the Crimean War, where she tended to wounded soldiers. She was dubbed "The Lady with the Lamp" after her habit of making rounds at night...
left for the Crimean War
Crimean War
The Crimean War was a conflict fought between the Russian Empire and an alliance of the French Empire, the British Empire, the Ottoman Empire, and the Kingdom of Sardinia. The war was part of a long-running contest between the major European powers for influence over territories of the declining...
, where triage
Triage
Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...
was used to separate seriously wounded soldiers from the less-seriously wounded was observed. Until recently, it was reported that Nightingale reduced mortality from 40% to 2% on the battlefield. Although this was not the case, her experiences during the war formed the foundation for her later discovery of the importance of sanitary conditions in hospitals, a critical component of intensive care.
In 1950, anesthesiologist
Anesthesiologist
An anesthesiologist or anaesthetist is a physician trained in anesthesia and peri-operative medicine....
Peter Safar
Peter Safar
Peter Safar was an Austrian physician of Czech descent. He is credited with pioneering cardiopulmonary resuscitation.- Early life :...
established the concept of "Advanced Support of Life," keeping patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
s sedated and ventilated in an intensive-care environment. Safar is considered to be the first practitioner of intensive-care medicine.
In response to a polio epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...
(where many patients required constant ventilation and surveillance), Bjørn Aage Ibsen
Bjørn Aage Ibsen
Bjørn Aage Ibsen was a Danish anesthetist and founder of intensive-care medicine. He 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...
established the first intensive-care unit in Copenhagen
Copenhagen
Copenhagen is the capital and largest city of Denmark, with an urban population of 1,199,224 and a metropolitan population of 1,930,260 . With the completion of the transnational Øresund Bridge in 2000, Copenhagen has become the centre of the increasingly integrating Øresund Region...
in 1953. The first application of this idea in the United States was in 1955 by Dr. William Mosenthal, a surgeon at the Dartmouth-Hitchcock Medical Center
Dartmouth-Hitchcock Medical Center
Dartmouth-Hitchcock Medical Center is New Hampshire's only academic medical center and is headquartered on a campus in the heart of the Upper Connecticut River Valley, in Lebanon, New Hampshire....
. In the 1960s, the importance of cardiac arrhythmias as a source of morbidity and mortality
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
in myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
s (heart attacks) was recognized. This led to the routine use of cardiac monitoring in ICUs, especially after heart attacks.
Types
Specialized types of ICUs include:
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Equipment and systems
Common equipment in an ICU includes mechanical ventilators to assist breathing through an endotracheal tubeTracheal intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
or a tracheotomy
Tracheotomy
Among the oldest described surgical procedures, tracheotomy consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea...
; cardiac monitors including those with telemetry
Telemetry
Telemetry is a technology that allows measurements to be made at a distance, usually via radio wave transmission and reception of the information. The word is derived from Greek roots: tele = remote, and metron = measure...
; external pacemakers; defibrillators; dialysis
Dialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
equipment for renal
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
problems; equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes
Nasogastric intubation
Nasogastric intubation is a medical process involving the insertion of a plastic tube through the nose, past the throat, and down into the stomach.-Uses:...
, suction pumps, drains, and catheters; and a wide array of drugs
Pharmacology
Pharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...
to treat the primary condition(s) of hospitalization. Medically induced comas
Induced coma
A barbiturate-induced coma, or barb coma, is a temporary coma brought on by a controlled dose of a barbiturate drug, usually pentobarbital or thiopental...
, analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s, and induced sedation
Sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure...
are common ICU tools designed to reduce pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
and prevent secondary infections.
Quality of care
The available data suggests a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illnesses, demographicDemography
Demography is the statistical study of human population. It can be a very general science that can be applied to any kind of dynamic human population, that is, one that changes over time or space...
variables, and characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was significantly associated with lower ICU and hospital mortality
Mortality
Mortality is the condition of being mortal, or susceptible to death; the opposite of immortality.It may also refer to:* Mortality rate, a measure of the number of deaths in a given population...
rates. A ratio of 2 patients to 1 nurse is recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical floors. This varies from country to country, though; e.g., in Australia and the United Kingdom most ICUs are staffed on a 2:1 basis (for High-Dependency patients who require closer monitoring or more intensive treatment than a hospital ward can offer) or on a 1:1 basis for patients requiring very intensive support and monitoring, for example a patient on a mechanical ventilator with associated sedation such as a midazolam and use of strong analgesics such as morphine, propofol, fentanyl and/or remefentanyl.
Staff
Medical staff typically includes intensivists with training in internal medicineInternal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
, surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
, or emergency medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
. Many nurse practitioners and physician assistants with specialized training are also part of the staff that provide continuity of care for patients.
Staff typically includes specially trained critical care registered nurse
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
s, registered respiratory therapists, clinical pharmacists, nutritionist
Nutritionist
A nutritionist is a person who advises on matters of food and nutrition impacts on health. Different professional terms are used in different countries, employment settings and contexts — some examples include: nutrition scientist, public health nutritionist, dietitian-nutritionist, clinical...
s, physical therapists, occupational therapist
Occupational therapist
An occupational therapist is trained in the practice of occupational therapy. The role of an occupational therapist is to work with a client to help them achieve a fulfilled and satisfied state in life through the use of "purposeful activity or interventions designed to achieve functional...
s, certified nursing assistants, social workers, etc.
Intensive care around the world
In the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, up to 20% of hospital beds can be labelled as intensive-care beds; in the United Kingdom, intensive care usually will comprise only up to 2% of total beds. This high disparity is attributed to admission of patients in the UK only when considered the most severely ill.
Intensive Care is an expensive healthcare service. In the United Kingdom, the average cost of funding an intensive-care unit is:
- £838 per bed per day for a Neonatal Intensive-Care Unit
- £1,702 per bed per day for a Paediatric Intensive-Care Unit
- £1,328 per bed per day for an Adult Intensive-Care Unit
Mobile intensive-care unit
A mobile intensive-care unit (MICU) is an aerial, ground-based, or aquatic ambulanceAmbulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
staffed with a medical intensive-care team, to include a physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
and nurse. In many countries, they are affiliated with public hospitals and are regulated by a governing body of physicians, such as the Service d'Aide Médicale d'Urgence (SAMU
Samu
Samu may refer to:* Samu, nickname for a Homo erectus man found in Vértesszőlős, Hungary* SAMU - Service d'Aide Médicale d'Urgence, an emergency medical service in France.* Servicio de Atencion Medica Urgente, also an emergency medical service...
).