Intensive care unit


Intensive care unit

An intensive care unit (ICU), critical care unit (CCU), intensive therapy unit or intensive treatment unit (ITU) is a specialized department used in many countries hospitals that provides intensive care medicine. Many hospitals also have designated intensive care areas for certain specialities of medicine, as dictated by the needs and available resources of each hospital. The naming is not rigidly standardized.

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. [cite web|url=http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijh/vol3n2/icu.xml|date=|publisher=Internet Journal of Health|accessdat=2007-08-25|title=Intensive Care Unit] The first application of this idea in the United States was pioneered by Dr. William Mosenthal, a surgeon at the Dartmouth-Hitchcock Medical Center. [cite web|url=http://dartmed.dartmouth.edu/spring04/html/vs_mosenthal.shtml|date=|publisher=Dartmouth Medicine|accessdate=2007-04-10|title=Remembering Dr. William Mosenthal: A simple idea from a special surgeon] 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.

* [http://www.medicinaintensiva.com.br/icu-history.htm Video: ICU History]

Types

Specialized types of ICUs include:

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. [cite journal | last = Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O'Brien CR, Rubenfeld GD. | title = Hospital volume and the outcomes of mechanical ventilation. | journal = New England Journal of Medicine | volume = 355 | issue = 1 | pages = 41–50 | date = 2006 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=16822995&dopt=Abstract
accessdate = 2006-08-02 | doi = 10.1056/NEJMsa053993
] 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.

taff

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.

References

* [http://www.sccm.org Society of Critical Care Medicine] bio-medical engg.


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