The Intensivists CRITICAL Role in your Care

Intensive Care Medicine is a branch of medicine concerned with the provision of life support or organ support systems in patients who are critically ill and who usually require intensive monitoring.

Patients requiring intensive care usually require support for hemodynamic instability (hypertension/hypotension), airway or respiratory compromise (such as ventilator support), acute renal failure, potentially lethal cardiac dysrhythmias, and frequently the cumulative affects of multiple organ system failure. Patients admitted to the intensive care unit not requiring support for the above are usually admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit.

Ideally, intensive care is usually only offered to those whose condition is potentially reversible and who have a good chance of surviving with intensive care support. A prime requisite for admission to an Intensive Care Unit is that the underlying condition can be overcome. Therefore treatment is merely meant to win time in which the acute affliction can be resolved.

Medical studies suggest a relation between intensive care unit (ICU) volume and quality of care for mechanically ventilated patients. 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.

ICU care is generally the most expensive, high technology and resource intensive area of medical care. Common equipment in an intensive care unit (ICU) includes mechanical ventilation to assist breathing through an endotracheal tube or a tracheotomy; hemofiltration equipment for acute renal failure; monitoring equipment; intravenous lines for drug infusions fluids or total parenteral nutrition, nasogastric tubes, suction pumps, drains and catheters; and a wide array of drugs including inotropes, sedatives, broad spectrum antibiotics and analgesics.

Critical care medicine is a relatively new but increasingly important medical specialty. Physicians who have training in critical care medicine are referred to as intensivists. The specialty requires additional fellowship training for physicians who complete their primary training in internal medicine, anaesthetics, or emergency medicine. Accreditation in critical care medicine is available through the Joint Faculty of Intensive Care Medicine of the Royal Australasian College of Physicians and the Australia and New Zealand College of Anaesthetists. Intensivists with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, cardiology, infectious disease, or nephrology. The Australia and New Zealand Intensive Care Society (ANZICS) is the established society for practitioners who work in the ICU.

Medical research has repeatedly demonstrated that ICU care provided by intensivists produces better outcomes and is more cost effective care. This has led to the recommendation that all ICU patients should be managed by a dedicated intensivist who is exclusively responsible for patients in one ICU. In
Australia, where Intensive Care Medicine is a long established speciality, ICUs are described as 'closed'. In a closed unit the intensive care specialist takes on the senior role where the patient's primary doctor now acts as a consultant. Other countries have open Intensive Care Units, where the primary doctor chooses to admit and generally makes the management decisions. There is increasingly strong evidence that 'closed' Intensive Care Units staffed by Intensivists provide better outcomes for patients2,3.


References

1. 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 on 2006-08-02.

2.  Manthous CA, Amoateng-Adjepong Y, al-Kharrat T, Jacob B, Alnuaimat HM, Chatila W, Hall JB. (1997). "Effects of a medical intensivist on patient care in a community teaching hospital." (Abstract). Mayo Clinic Proceedings 72 (5): 391-9. Retrieved on 2006-09-02.

3. Hanson CW 3rd, Deutschman CS, Anderson HL 3rd, Reilly PM, Behringer EC, Schwab CW, Price J. (1999). "Effects of an organized critical care service on outcomes and resource utilization: a cohort study." (Abstract). Critical Care Medicine 27 (2): 270-4. Retrieved on 2006-09-02.