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What is Critical Care?

Critical care (also known as Intensive Care) is the multiprofessional healthcare specialty that cares for patients with acute, life-threatening illness or injury. Most of us will experience a critical illness or injury, either as the patient, family member or friend of a patient.

Critical care can be provided wherever life is threatened - at the scene of an accident, in an ambulance, in a hospital emergency room, or in the operating room. Most critical care today, however, is delivered in highly specialized intensive care units (ICU). Various terminologies like Critical Care Unit (CCU), Intensive Therapy Unit (ITU), Coronary Care Unit (CCU) may be used to describe such services in a hospital.

Critical care is provided by multiprofessional teams of highly experienced and professional physicians, nurses, respiratory care technicians, pharmacists and other allied health professionals who use their unique expertise, ability to interpret important therapeutic information, access to highly sophisticated equipment and the services of support personnel to provide care that leads to the best outcome for the patient.

Patients are rarely admitted directly to the critical care unit. Rather, they are usually admitted from the emergency room, or surgical area where they are first given care and stabilized. The continuum of critical care begins at the moment of illness or injury and continues throughout the patient's hospitalization, treatment and subsequent recovery.

Is Critical Care a new medical speciality?

Critical care evolved from an historical recognition that the needs of patients with acute, life-threatening illness or injury could be better treated if they were grouped into specific areas of the hospital. Nurses have long recognized that very sick patients receive more attention if they are located near the nursing station.

  • Florence Nightingale wrote about the advantages of establishing a separate area of the hospital for patients recovering from surgery.

  • Intensive care began in the United States when Dr. W.E. Dandy opens a three-bed unit for postoperative neurosurgical patients at the Johns Hopkins Hospital in Baltimore. In 1927, the first hospital premature-born infant care center was established at the Sarah Morris Hospital in Chicago.

  • During World War II, shock wards were established to resuscitate and care for soldiers injured in battle or undergoing surgery.

  • In 1947-1948, the polio epidemic raged through Europe and the United States, resulting in a breakthrough in the treatment of patients dying from respiratory paralysis. In Denmark, manual ventilation was accomplished through a tube placed in the trachea of polio patients. Patients with respiratory paralysis and/or suffering from acute circulatory failure required intensive nursing care.

  • During the 1950s, the development of mechanical ventilation led to the organization of respiratory intensive care units (ICUs) in many European and American hospitals. The care and monitoring of mechanically ventilated patients proved to be more efficient when patients were grouped in a single location. General ICUs for very sick patients, including postoperative patients, were developed for the similar reasons.

  • Between 1990 and the present, critical care significantly reduced in-hospital time as well as costs incurred by patients with diseases such as cerebrovascular insufficiency and lung tumors.

  • The development of new and complicated surgical procedures, such as transplantation of the liver, lung, small intestine, and pancreas, created a new and important role for critical care following transplantation.

  • Widespread utilization of non-invasive patient monitoring has further reduced the cost and medical/nursing complications associated with care of critically ill and injured patients. Widespread utilization of non-invasive patient monitoring has further reduced the cost and medical/nursing complications associated with care of critically ill and injured patients.

  • Widespread utilization of pharmacologic therapy for critical care patients with specific organ system failure reduced time spent in both critical care units and in the health care facility.

What kinds of illness and injury usually require critical care?

Typical examples of critical illness include heart attack, poisoning, pneumonia, surgical complications, premature birth, and stroke. Critical care also includes trauma care - care of the severely injured - whether due to an automobile accident, gunshot or stabbing wounds, a fall, burns, or an industrial accident.

What is the difference between critical care and emergency medicine?

Critical care refers exclusively to the treatment of patients who suffer from life-threatening conditions. Emergency room physicians and nurses treat patients who suffer from relatively minor emergencies (sprained ankles, broken arms) to those with major problems including heart attack, knife or gunshot wounds or drug overdoses. In the Emergency Department, physicians and nurses stabilize patients and transport them to the ICU or other area of the hospital for further treatment. The long-term management of critically ill and injured patients is provided by critical care professionals, often in the ICU.

Who is an intensivist?

An intensivist (also known as Critical Care Specialist) is a doctor with subspecialty training, or equivalent qualifications, in critical care. An intensivist directs the care of critically ill and injured patients and works in collaboration with other health care professionals necessary for the care of patients in critical care units.

Who are the members of a multidisciplinary critical care team?

The critical care team includes a diverse group of highly trained professionals who provide care in specialized care units and work toward the best outcome possible for seriously ill patients. All members of the team may be asked to teach patients and their families various strategies to improve health, healing, coping, and well being specific to their area of expertise. Although the members could vary between hospitals, an optimal team would include:

Intensivists (Critical Care Specialists)

Physicians who are board certified in a medical specialty, such as surgery, internal medicine, pediatrics, or anesthesiology, and who also receive special education, training, and subspecialty certification specifically in critical care. Intensivists may be assigned to the ICU on a full-time basis and work with other critical care team members to provide their patients with ongoing and consistent care. These physicians know how specific treatments affect all the organ systems, avoid duplication of procedures and medications, and honor the patient's preferences regarding medical treatment as well as End of Life care (when appropriate). Intensivists may also coordinate the administrative environment of the ICU by setting policies, developing protocols, and facilitating communication among primary care physicians, specialists, patients, and their families.

Critical care nurses

Critical care nurses provide a high level of skilled nursing for total patient care and often facilitate communication between all of the people involved in the care of the patient. Their expertise and continuous presence allows early recognition of subtle, but significant, changes in patient conditions, thereby preventing worsening conditions and minimizing complications that arise from critical illness. Because of their close contact with the family and the patient, critical care nurses often serve as the patient's advocate and become integral to the decision-making process of the patient, family, and critical care team.

Pharmacist or Clinical Pharmacologist

A pharmacist or clinical pharmacologist is a certified specialist in the science and clinical use of medications. The pharmacist with specialty training in the ICU is equipped in recognizing the needs and problems specific to the critical care patient and work with members of the health-care team to foster effective and safe medication therapy.

Registered Dietitian

A registered dietician is a vital part of the medical team that consults with physicians, nurses, therapists, and family members in the ICU. The registered dietician works to improve the nutritional health and promotes recovery of the critical care patient.

Social Worker or Patient Care Co-ordinator

A social worker is a licensed professional that works with the ICU interdisciplinary team to provide a link between treatment plans for the critical care patient and family members. Special knowledge that is acquired through formal, professional social work education, welfare policies and services, and social welfare systems and community resources guide the practice of social work.

Respiratory Therapist or ICU technicians

Respiratory therapists work with the critical care team to monitor and promote airway management of the critical care patient. This may include: oxygen therapy, mechanical ventilation (breathing machine) management, aerosol medication therapy, cardio-respiratory monitoring, and patient and caregiver education.

Physiotherapist and Occupational Therapist

The physical therapist provides services that restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities. The occupational therapist is trained to make a complete evaluation of the impact of the disease on the activities of the critical care patient at home, in work situations, and recreational activities. Both members work cooperatively with other disciplines of the healthcare team to reduce physical and psychological disability of the patient.

How does my regular doctor (primary physician) fit into the team?

Your primary physician is an important link between the critical care team and the patient and family. The primary physician has a complete medical history of the patient, is often a trusted confidante of the family and may be aware of the patient's values, attitudes and health care preferences. Critical care teams often work closely with the primary physician to determine pre-existing illness, allergies, use of medications, and other factors which may influence the health of the patient.