Intensive-care unit

ICU room

An intensive-care unit (ICU), critical-care unit (CCU), intensive-therapy unit/intensive-treatment unit (ITU) or High-Dependency Unit (HDU) is a specialized department in a hospital 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

See also: Intensive-care medicine

In 1854, Florence Nightingale left for the Crimean War, where triage 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 Peter Safar established the concept of "Advanced Support of Life," keeping patients 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 (where many patients required constant ventilation and surveillance), Bjørn Aage Ibsen established the first intensive-care unit in Copenhagen in 1953.^{[1] [2]} 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.^[3] 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.

Types

Specialized types of ICUs include:

Neonatal intensive-care unit (NICU) Special-Care Nursery (SCN) Pediatric intensive-care unit (PICU) Psychiatric intensive-care unit (PICU) Coronary care unit (CCU) Cardiac Surgery intensive-care unit (CSICU) Cardiovascular intensive-care unit (CVICU) Medical intensive-care unit (MICU) Medical Surgical intensive-care unit (MSICU) Surgical intensive-care unit (SICU)

Overnight intensive recovery (OIR) Neurotrauma intensive-care unit (NICU) Neurointensive-care unit (NICU) Burn wound intensive-care unit (BWICU) Trauma Intensive-care Unit (TICU) Surgical Trauma intensive-care unit (STICU) Trauma-Neuro Critical Care (TNCC) Respiratory intensive-care unit (RICU) Geriatric intensive-care unit (GICU) Mobile Intensive-Care Unit (MICU) Post Anaesthesia Care Unit (PACU)

Equipment and systems

Common equipment in an ICU includes mechanical ventilators to assist breathing through an endotracheal tube or a tracheotomy; cardiac monitors including those with telemetry; external pacemakers; 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 primary condition(s) of hospitalization. Medically induced comas, analgesics, and induced sedation are common ICU tools designed 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.^[4] 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 1:2 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 medicine, surgery, anesthesia, or emergency medicine. 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 nurses, registered respiratory therapists, clinical pharmacists, nutritionists, physical therapists, occupational therapists, certified nursing assistants, social workers, etc.

Intensive care around the world

In the United Kingdom, intensive-care medicine is an extremely specialised area. 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.^[5]

Intensive Care is an expensive healthcare service. In the United Kingdom, the average cost of funding an intensive-care unit is^[6]:

• £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 ambulance staffed with a medical intensive-care team, to include a physician 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).

See also

• ICU quality and management tools

References

1. ^ "Intensive Care Unit". Internet Journal of Health. http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijh/vol3n2/icu.xml. Retrieved 2007-08-25. 
2. ^ "The Danish anaesthesiologist Björn Ibsen a pioneer of long-term ventilation on the upper airways, Louise Reisner-Sénélar, 2009". https://dl-web.dropbox.com/get/Public/The%20Danish%20anaesthesiologist%20Bj%C3%B6rn%20Ibsen%2C%20Louise%20Reisner-S%C3%A9n%C3%A9lar%2C%202009.pdf?w=a25aff0a. 
3. ^ "Remembering Dr. William Mosenthal: A simple idea from a special surgeon". Dartmouth Medicine. http://dartmed.dartmouth.edu/spring04/html/vs_mosenthal.shtml. Retrieved 2007-04-10. 
4. ^ Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O'Brien CR, Rubenfeld GD., JM; Goss, CH; Heagerty, PJ; Kramer, AA; O'Brien, CR; Rubenfeld, GD (2006). "Hospital volume and the outcomes of mechanical ventilation". New England Journal of Medicine 355 (1): 41–50. doi:10.1056/NEJMsa053993. PMID 16822995. 
5. ^ Bennett, D; Bion, J (1999). "Organisation of intensive care". BMJ (Clinical research ed.) (PubMed Central) 318 (7196): 1468–70. PMC 1115845. PMID 10346777. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1115845. 
6. ^ "Written Answers for 15th June 2005 Page 38". House of Commons. http://www.parliament.the-stationery-office.co.uk/pa/cm200506/cmhansrd/vo050615/text/50615w38.htm. Retrieved 2009-01-17. 

External links

• Society of Critical Care Medicine
• ICUsteps - Intensive-care patient support charity
• Organisation for Critical Care Transportation

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