The Intensivists CRITICAL Role in your Care
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.
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.
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
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.
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
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.
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.
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.
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.
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