Intensive care unit

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Overview

ICU room

An intensive care unit (ICU), critical care unit (CCU) or intensive treatment unit (ITU, popular in the UK) is a specialised department in a hospital 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 response to a polio epidemic (where many patients required constant ventilation and survelliance), Bjorn Ibsen established the first intensive care unit in Copenhagen in 1953.[1] The first application of this idea in the US was pioneered by Dr. William Mosenthal, a surgeon at the Dartmouth-Hitchcock Medical Center.[2] 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.

Types

Specialized types of ICUs include:

  • Neonatal intensive care unit (NICU)
  • Special Care Baby unit (SCBU)
  • Pediatric Intensive Care Unit (PICU)
  • Psychiatric Intensive Care Unit (PICU)
  • Coronary Care Unit (CCU) for heart disease
  • Mobile Intensive Care Unit (MICU)
  • Surgical Intensive Care Unit (SICU)
  • Cardiac Surgery Intensive Care Unit (CSICU)
  • Neuroscience Critical Care Unit (NCCU)
  • Overnight Intensive Recovery (OIR)
  • Neuro Intensive Care Unit (NICU)
  • Burn Wounds Intensive Care Unit
  • Trauma Intensive care Unit (TICU)
  • Shock Trauma Intensive care Unit (STICU)

Equipment and systems

Common equipment in an ICU includes mechanical ventilator to assist breathing through an endotracheal tube or a tracheotomy opening; 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. [3] 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.

Staff

Medical staff typically includes intensivists with training in internal medicine, surgery, or anesthesia. 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, etc.

Related Chapters

References

  1. "Intensive Care Unit". Internet Journal of Health. 
  2. "Remembering Dr. William Mosenthal: A simple idea from a special surgeon". Dartmouth Medicine. Retrieved 2007-04-10. 
  3. Kahn 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. Retrieved 2006-08-02. 

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