Intensive-care unit
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An Intensive-Care Unit (ICU), Critical-Care Unit (CCU), Intensive-Therapy Unit/Intensive-Treatment Unit (ITU) 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.
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[edit] History
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.
[edit] Types
Specialized types of ICUs include:
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[edit] 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.
[edit] 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 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 anaesthetics or sedation such as propofol, Midazolam and use of strong analgesics such as morphine, fentanyl and/or remefentanyl.
[edit] See also
[edit] References
- ^ "Intensive Care Unit". Internet Journal of Health. http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijh/vol3n2/icu.xml. Retrieved 2007-08-25.
- ^ "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.
- ^ "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.
- ^ 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.
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[edit] External links
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