Intensive-care medicine


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. Patients requiring intensive care may require support for instability (hypertension/hypotension), airway or respiratory compromise (such as ventilator support), acute renal failure, potentially lethal cardiac arrhythmias, or the cumulative effects of multiple organ failure, more commonly referred to now as multiple organ dysfunction syndrome. They may also be admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit. Intensive care is usually only offered to those whose condition is potentially reversible and who have a good chance of surviving with intensive care support. Since the critically ill are so close to dying, the outcome of this intervention is difficult to predict.[citation needed] A prime requisite for admission to an intensive-care unit (ICU) is that the underlying condition can be overcome. Medical studies suggest a relation between ICU volume and quality of care for mechanically ventilated patients.[1] 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. For example, adjusted ICU mortality (for a patient at average predicted risk for ICU death) was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, and 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually. Hospitals with intermediate numbers of patients had outcomes between these extremes. In general, it is the most expensive, technologically advanced and resource-intensive area of medical care. In the United States, estimates of the 2000 expenditure for critical care medicine ranged from US$1555 billion. During that year, critical care medicine acco

nted for 0.56% of GDP, 4.2% of national health expenditure and about 13% of hospital costs.[2] [edit]Organ systems Intensive care usually takes a system by system approach to treatment, rather than the SOAP (subjective, objective, analysis, plan) approach of high dependency care. The nine key systems (see below) are each considered on an observation-intervention-impression basis to produce a daily plan. As well as the key systems, intensive-care treatment raises other issues including psychological health, pressure points, mobilisation and physiotherapy, and secondary infections. The nine key IC systems are (alphabetically): cardiovascular system, central nervous system, endocrine system, gastro-intestinal tract (and nutritional condition), hematology, microbiology (including sepsis status), peripheries (and skin), renal (and metabolic), respiratory system. The provision of intensive care is, in general, administered in a specialized unit of a hospital called the intensive-care unit (ICU) or critical-care unit (CCU). Many hospitals also have designated intensive-care areas for certain specialities of medicine, such as the coronary intensive-care unit (CCU or sometimes CICU, depending on hospital) for heart disease, medical intensive-care unit (MICU), surgical intensive-care unit (SICU), pediatric intensive-care unit (PICU), neuroscience critical-care unit (NCCU), overnight intensive-recovery (OIR), shock/trauma intensive-care unit (STICU), neonatal intensive-care unit (NICU), and other units as dictated by the needs and available resources of each hospital. The naming is not rigidly standardized. For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive-care resources (see below) were brought to the room of the patient that needed the additional monitoring, care, and resources. It became rapidly evident, however, that a fixed location where intensive-care resources and personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital.