Definition
Critical care medicine is the practice of administering immediate and continuous treatment to patients suffering from a life-threatening condition.
The conditions, ranging from heart attack, stroke, and severe respiratory insufficiency, to burns and gunshot wounds, can cause serious
systemic complications, such as respiratory distress and failure of at least one organ. Critical care medicine usually is administered in
a separate area of the hospital, and practiced by highly skilled and specialized healthcare professionals. Intensivists coordinate the
administrative environment of the intensive care unit (ICU) by setting policies, developing protocols and facilitating communication
among specialists, patients and their families.
Life-Threatening Conditions
Brain Injuries consist of damage to nerves, blood vessels, and tissues in or around the brain. A common example of a brain
injury is a stroke, which occurs when a blood vessel bringing oxygen-rich blood to the brain bursts or is clogged due to
a blood clot. Patients with brain injuries often need continuous monitoring and receive assisted breathing.
Cardiovascular Dysfunction is the result of conditions, such as hypotension (very low blood pressure), hypertension
(very high blood pressure), arrhythmias (change in the normal heart beat pattern), and heart attack. People suffering
any type of cardiovascular dysfunction often require continuous, invasive cardiovascular monitoring or multiple drug
therapies to keep blood vessels open.
Complications from Childbirth or Prematurity are life-threatening risks or problems for a mother or her infant
during the first 28 days after birth. For example, babies born prematurely often need to be isolated from other infants,
and receive supplemental oxygen and mechanical ventilation to help them breathe.
Complications from Infection/Sepsis include illnesses or syndromes that arise from bacterial, viral, or other microbial infection.
For example, sepsis is a syndrome that may develop from infection associated with pneumonia, trauma, surgery, or diseases such as
cancer and AIDS. Sepsis may trigger the onset of both abnormal clotting and bleeding, resulting in multiple organ failure and
ultimately death. Patients with sepsis may require medication to minimize problems with blood circulation, as well as mechanical
ventilation to assist with breathing.
Pulmonary Dysfunction or difficulty breathing, puts patients at risk of organ failure due to a lack of oxygen.
These patients require supplemental oxygen or assisted breathing from a mechanical ventilator. Pulmonary problems can
be caused by pneumonia, pulmonary embolism (clot in blood vessels of the lungs), severe asthma and, most commonly, smoking-related illness.
Trauma is an injury caused by physical force, such as a motor vehicle accident, burn, shotgun wound, stab wound, or fall and
is the leading cause of death for people under the age of 40. Many trauma victims experience interrupted breathing or loss
of blood, and may require ongoing, specialized care, such as tube feeding and 24-hour monitoring, to survive and recover.
Critical Care Setting
Critical care can be provided wherever life is in jeopardy – at the scene of an accident, in an emergency room – but is most
often administered in a special area of the hospital, known as the intensive care unit (ICU). There are various types of ICUs, including
the medical intensive care unit (MICU), the surgical intensive care unit (SICU), the mixed medical-surgical intensive care unit, the
pediatric intensive care unit (PICU), the neonatal intensive care unit (NICU), the coronary care unit (CCU), and the burn unit.
The concept of the ICU evolved from the recognition that seriously ill patients could be better treated if they were grouped together into
specific, separate areas of the hospital where skilled personnel and equipment could be concentrated. Today, more than 5,000 ICUs
are operational across the United States. Nearly 50 percent of patients in the ICU are age 65 and older.
Treatment
ICUs provide a higher level of care, compared with other areas of the hospital. For example, patients are given a higher nurse-to-patient
ratio and immediate access to physicians. In an ICU, patients also might receive invasive cardiovascular and respiratory monitoring,
assisted breathing from a mechanical ventilator, drugs for heart and blood pressure support, acute kidney replacement therapies, tube feeding, etc.
Value
Cost of critical care in an ICU is about 28 percent of the total hospital costs for acute care – $47 billion in 1990. In the ICU,
the diverse team of experts, physicians, nurses, respiratory therapists, make the most efficient and effective use of resources
and offer their patients a greater chance of survival when they might otherwise die. When their talents and the most sophisticated
medical technology cannot save a person, these professionals offer patients and their families counsel and medical advice to help them make
difficult end-of-life decisions.
