Intensive care unit

Intensive care unit

ICU patients often require mechanical ventilation if they have lost the ability to breathe normally.

An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine.

Intensive care units cater to patients with severe or life-threatening illnesses and injuries, which require constant care, close supervision from life support equipment and medication in order to ensure normal bodily functions. They are staffed by highly trained physicians, nurses and respiratory therapists who specialize in caring for critically ill patients. ICUs are also distinguished from general hospital wards by a higher staff-to-patient ratio and access to advanced medical resources and equipment that is not routinely available elsewhere. Common conditions that are treated within ICUs include acute respiratory distress syndrome, septic shock, and other life-threatening conditions.

Patients may be referred directly from an emergency department or from a ward if they rapidly deteriorate, or immediately after surgery if the surgery is very invasive and the patient is at high risk of complications.^[1]

History

In 1854, Florence Nightingale left for the Crimean War, where triage was used to separate seriously wounded soldiers from those with non-life-threatening conditions.

Until recently,^[when?] it was reported that Nightingale's method 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 Peter Safar established the concept of advanced life support, keeping patients sedated and ventilated in an intensive care environment. Safar is considered to be the first practitioner of intensive care medicine as a speciality.

In response to a polio epidemic (where many patients required constant ventilation and surveillance), Bjørn Aage Ibsen established the first intensive care unit globally in Copenhagen in 1953.^[2][3]

The first application of this idea in the United States was in 1951 by Dwight Harken. Harken's concept of intensive care has been adopted worldwide and has improved the chance of survival for patients. He opened the first intensive care unit in 1951. In the 1960s, he developed the first device to help the heart pump. He also implanted artificial aortic and mitral valves. He continued to pioneer in surgical procedures for operating on the heart. He established and worked in several organizations related to the heart.

In 1955, William Mosenthal, a surgeon at the Dartmouth-Hitchcock Medical Center also opened an early intensive care unit.^[4] 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 after heart attacks.^[5]

Types

Hospitals may have various specialized ICUs that cater to a specific medical requirement or patient:

Nurses in a neonatal intensive care unit (NICU)

thumb|A pediatric intensive care unit room at Helen Devos Children's Hospital.thumb|US Army ICU nurse attending to a patient in Baghdad, Iraq

ICU nurses monitoring patients from a central computer station. This allows for rapid intervention should a patient's condition deteriorate whilst a member of staff is not immediately at the bedside.

Mobile ICU of the university hospital in Antwerp, Belgium

Equipment and systems

Common equipment in an ICU includes mechanical ventilators to assist breathing through an endotracheal tube or a tracheostomy tube; cardiac monitors for monitoring Cardiac condition; equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains, and catheters, syringe pumps; and a wide array of drugs to treat the primary condition(s) of hospitalization. Medically induced comas, analgesics, and induced sedation are common ICU tools needed and used to reduce pain and prevent secondary infections.

Quality of care

The available data suggests a relation between ICU volume and quality of care for mechanically ventilated patients.^[7] After adjustment for severity of illnesses, demographic variables, and characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was significantly associated with lower ICU and hospital mortality 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 extreme intensive support and monitoring; for example, a patient on multiple vasoactive medications to keep their blood pressure high enough to perfuse tissue. The patient may require multiple machines; Examples: continuous dialysis CRRT, a intra-aortic balloon pump, ECMO.

International guidelines recommend that every patient gets checked for delirium every day (usually twice or as much required) using a validated clinical tool. The two most widely used are the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC). There are translations of these tools in over 20 languages and they are used globally in many ICU's.^[8]

Operational logistics

In the United States, 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.^[9]

Intensive care is an expensive healthcare service. A recent study conducted in the United States found that hospital stays involving ICU services were 2.5 times more costly than other hospital stays.^[10]

In the United Kingdom in 2003–04, the average cost of funding an intensive care unit was:^[11]

• £838 per bed per day for a neonatal intensive care unit
• £1,702 per bed per day for a pediatric intensive care unit
• £1,328 per bed per day for an adult intensive care unit

Remote collaboration systems

Some hospitals have installed teleconferencing systems that allow doctors and nurses at a central facility (either in the same building, at a central location serving several local hospitals, or in rural locations another more urban facility) to collaborate with on-site staff and speak with patients (a form of [telemedicine]). This is variously called an eICU, virtual ICU, or tele-ICU. Remote staff typically have access to vital signs from live monitoring systems, and telectronic health records so they may have access to a broader view of a patient's medical history. Often bedside and remote staff have met in person and may rotate responsibilities. Such systems are beneficial to intensive care units in order to ensure correct procedures are being followed for patients vulnerable to deterioration, to access vital signs remotely in order to keep patients that would have to be transferred to a larger facility if need be he/she may have demonstrated a significant decrease in stability.^{[12][13][14][15]}

See also

• ICU quality and management tools
• Intensive Care Foundation, a charity in Australia and New Zealand
• Intensive Care Medicine (journal)
• Neonatal intensive care unit
• Open-source ventilator
• Pediatric intensive care unit

References

Further reading

•  , Wikidata Q29581786

External links

• "Intensive Care". NHS choices. UK: National Health Service. 2017-10-18. http://www.nhs.uk/Conditions/Intensive-care/Pages/Introduction.aspx. 
• "Critical Care". MedlinePlus. US: National Library of Medicine, National Institutes of Health. https://www.nlm.nih.gov/medlineplus/criticalcare.html. 
• Society of Critical Care Medicine
• ICUsteps – Intensive care patient support charity
• Organisation for Critical Care Transportation
• Reynolds, H.N.; Rogove, H.; Bander, J.; McCambridge, M. et al. (December 2011). "A working lexicon for the tele-intensive care unit: We need to define tele-intensive care unit to grow and understand it". Telemedicine and E-Health. 17 (10): 773–783. doi:10.1089/tmj.2011.0045. PMID 22029748. https://deepblue.lib.umich.edu/bitstream/2027.42/90470/1/tmj-2E2011-2E0045.pdf. 
• Olson, Terrah J. Paul; Brasel, Karen J.; Redmann, Andrew J.; Alexander, G. Caleb; Schwarze, Margaret L. (January 2013). "Surgeon-Reported Conflict With Intensivists About Postoperative Goals of Care". JAMA Surgery 148 (1): 29–35. doi:10.1001/jamasurgery.2013.403. PMID 23324837. 

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