Development Of Intensive Care Medicine Research Articles

The center for intensive care medicine: amodel for interdisciplinary and interprofessional collaboration

The Federal Joint Committee has established requirements for centers for intensive care medicine which, in cooperation with other clinics, are to take on special tasks for intensive care medicine in aregion. High demands are placed on these centers, which it may not be possible to meet without restructuring the existing intensive care structures. In this study, an organizational model for acenter for intensive care medicine based on broad interdisciplinary and interprofessional cooperation is presented for discussion. The organizational model contains proposals for integration of the centers for intensive care medicine into the clinic structure, the management team, the staff composition, the areas of clinical activity, and the further tasks of research, teaching, and education and training. Establishment of the centers for intensive care medicine provides new and forward-looking impetus for the further development of intensive care medicine in Germany. However, for the new organizational model to be implemented effectively, the necessary restructuring measures must be adequately refinanced and supported by hospital management and medical faculties. In addition, asustained willingness for interdisciplinary and interprofessional cooperation is required on the part of all those involved, and employees in this model must be offered attractive long-term positions in intensive care medicine.

Chinese experts' consensus on the application of intensive care big data.

The development of intensive care medicine is inseparable from the diversified monitoring data. Intensive care medicine has been closely integrated with data since its birth. Critical care research requires an integrative approach that embraces the complexity of critical illness and the computational technology and algorithms that can make it possible. Considering the need of standardization of application of big data in intensive care, Intensive Care Medicine Branch of China Health Information and Health Care Big Data Society, Standard Committee has convened expert group, secretary group and the external audit expert group to formulate Chinese Experts' Consensus on the Application of Intensive Care Big Data (2022). This consensus makes 29 recommendations on the following five parts: Concept of intensive care big data, Important scientific issues, Standards and principles of database, Methodology in solving big data problems, Clinical application and safety consideration of intensive care big data. The consensus group believes this consensus is the starting step of application big data in the field of intensive care. More explorations and big data based retrospective research should be carried out in order to enhance safety and reliability of big data based models of critical care field.

Health-related quality of life at 2, 6 and 12 months after critical illness - lessons learnt from a nationwide follow-up of 4,500 ICU admissions

IntroductionThe development of intensive care medicine has led to improved survival of patients with complex illnesses and extensive injuries. Survivors are at risk of acquiring physical and functional deficits that may have negative effects on health-related quality of life (HRQoL). The significance of measuring HRQoL has been underlined by critical care researchers since poor HRQoL is associated with an adverse prognosis.ObjectiveThe aim of this work was to examine the development of HRQoL at 2, 6 and 12 months after ICU discharge in a mixed ICU patient population with an ICU-stay > 96 hrs.MethodsWe analysed admissions during 2008-2014 to 49 ICUs that submitted follow-up data to the Swedish Intensive Care Registry (SIR, http://www.icuregswe.org). HRQoL was measured using the Short Form 36 (SF36) questionnaire at 2, 6, and 12 months after discharge from ICU. SF36 domains, age, gender, illness severity on admission (SAPS3 probabilities) and length of ICU-stay were analysed for the entire cohort and for important diagnostic groups. SF36 scores were compared to an age- and gender-adjusted Swedish normal population. Differences in SF36 domains were analysed using non-parametric methods. Medians and interquartile ranges are presented.ResultsComplete SF36 responses were analysed for 4453, 4019 and 2515 admissions at 2, 6 and 12 months, respectively. HRQoL at 2 months in patients that subsequently were lost to follow-up was generally similar to those with follow-up, but they were younger, less ill and had shorter ICU-stay. Full longitudinal data with complete SF36 responses were obtained in 1438 patients [Age: 66 yrs. (57-73 yrs.), female gender: 37.2%, SAPS3 prob: 0.36 (0.19-0.55), ICU-stay: 7.0 days (4.9-11.5 days)]. SF36 improved over time in all domains (P < 0.001, Table), although some domains remained stable from 6 to 12 months. Patterns of recovery differed between important diagnostic groups (i.e. sepsis, out-of-hospital cardiac arrest, COPD, ARDS). A large proportion of patients (10-25% depending on SF36 domain) had HRQoL scores at 12 months which was below 2 standard deviations of the age- and gender-adjusted Swedish norm. The cardiac arrest group were among those with best, and the COPD group were among those with worst HRQoL at 12 months.ConclusionsHRQoL recovered over 12 months in critically ill patients with a prolonged ICU stay. Recovery varied between diagnostic groups and a large proportion of patients had markedly depressed HRQoL. These findings may have important implications for follow-up and care after critical illness.

Is a Single Entry Training Scheme for Intensive Care Medicine Both Inevitable and Desirable?

The development of Intensive Care Medicine as a recognizable branch of medicine has been underway for more than half a century, with delivery by a number of different service models. This delivery may be entirely by related medical specialties, such as anesthesiology or pulmonology; alternatively, it may be as a standalone-recognized specialty and frequently by a hybrid of these two extremes. A country may have a completely different delivery model from neighboring countries, and different models may exist within a single country. Debate about the most appropriate method of providing critical care services frequently centers around the training. However, an alternative perspective is that training regimes only follow on from another objective, namely to have Intensive Care Medicine represented in important forums by dedicated critical care physicians. A historical perspective of the development of critical care in two countries over a 40-year period is discussed, whereby a transition from a multiple specialty provision of critical care medicine to that of a single binational pathway occurred. The perceived advantages and disadvantages are outlined, offering insights into how possible future challenges in a highly complex medical specialty can be anticipated and strategies formulated.

Obituary: Dr Max Harry Weil

Critical care medicine has lost one of its true leaders, some would say its father-figure. Dr Max Harry Weil (Figure ​(Figure1)1) played such a major role in the development of intensive care medicine as we know it today, making numerous contributions that have shaped the way in which we approach and manage critically ill patients. Figure 1 Dr Max Harry Weil. Born in Switzerland, Dr Weil reached the US when he was just 10. He obtained his MD degree in New York in 1952, a PhD degree from the University of Minnesota in 1957, and an honorary ScD degree from the State University of New York in 2004. He worked for several years as a cardiologist before deciding to devote his time to critical care medicine. As early as 1959 Dr Weil created the famous Shock Unit at the University of Southern California, and then in 1974 started an Institute of Critical Care Medicine. He moved to the University of Health Sciences in 1981 before returning to California in 2007 to create his own Institute - The Weil Institute of Critical Care Medicine in Rancho Mirage. His major contributions are well known to all intensivists, and include improved understanding of the pathophysiology of shock states, of the importance of blood lactate levels, and of the mechanisms of lung edema including the role of colloid osmotic pressure. Many of today's management strategies and therapeutic approaches in critical care medicine are built on foundations put in place by Dr Weil, including the use of fluids (he developed the famous fluid challenge technique) and of vasoactive agents. In more recent years, his research focused on the microcirculation and on cardiopulmonary resuscitation, including monitoring techniques (for example, capnometry) and the role of various therapeutic agents. Not surprisingly, he was an important member of the Wolf Creek conferences on cardiopulmonary resuscitation. As a physiologist and a professor in clinical biomedical engineering, as well as a physician, Dr Weil managed to combine aspects of medicine, physiology, pharmacology, biochemistry and bio-engineering for the benefit of the critically ill. As an innovator and inventor, he owned more than 20 patents for medical equipment and devices he developed to help monitor and treat critically ill patients. Dr Weil trained many hundreds of intensivists from the five continents and remained a faithful mentor to many, if not all, of us. Under his skilled tutorship and guidance, we learned the importance of basing our approach on pathophysiological alterations at the bedside, focusing on the individual patient. He always preferred discerning studies in a small number of patients to large randomized, controlled trials of heterogeneous groups. Dr Weil was a founding member and the first President of the Society of Critical Care Medicine. He was a Master Fellow of the College of Chest Physicians, a Master of the American College of Physicians, and a Fellow of the American College of Cardiology, the Society of Critical Care Medicine, and the American Heart Association. He authored or co-authored more than 600 full peer-reviewed papers. He was actively involved in multiple committees and was a valued member of the editorial boards of many journals, including Critical Care. Dr Weil was widely respected and received awards from several International Societies and groups, including a Lifetime Achievement Award from the World Federation of Societies of Intensive and Critical Care Medicine in 2009. Dr Weil was highly intelligent, quick-thinking, and astute. When he asked you 'What are you up to these days?', you could be sure that by the second sentence of your reply he would already be one step ahead, offering insightful and thoughtful questions and suggestions for your latest project. His strong personality sometimes led to political conflicts: he liked to remind his friends of the trouble he encountered at the University of Southern California when he started inserting central venous catheters in patients. But along with his strength of character came an endearing personality and a truly kind nature - he was always interested not only in how your medical career was progressing but also in your personal and family life, empathic in moments of joy and sadness. Dr Weil died peacefully at the age of 84. True to character, he remained active right up until the last few days of his life. One important event he will miss is the 50th Weil Symposium on Critical Care Medicine due to be held in Las Vegas in April 2012. This will indeed be a big anniversary and the planned memorial service will provide the ideal occasion for us to remember his achievements and to pay our respects to this great friend and father of intensive care.

The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death , A White Paper by the President’s Council on Bioethics

Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes in the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment? In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation.

Scandinavian Emergency Medicine – A toddler steadily walking but still not running

I recently read an editorial that reflected upon the past 25 years of emergency medicine [1]. The mantra of the emergency medicine field is have to know a lot more than a little about everything. Emergency medicine is extremely fascinating, but may also be very frightening to newly graduated colleagues who are just beginning their careers. Scandinavian universities are still not teaching emergency medicine as a discipline; however, this obstacle does not prevent us from publishing a high quality journal from which young doctors can read. Another editorial [2] focuses on the development of intensive care medicine during the past 25 years, stating Intensive care has established its identity and is an acknowledged speciality in medicine. This established identity is the current goal for the much younger discipline of emergency medicine, of which it has been said: It has been small steps in the right direction. Some mistakes but mostly good things [2]. A solid, academic, evidence-based foundation in emergency medicine will provide the field with critical protocol and decision-making knowledge. We have a good start for an academic platform in Scandinavia, and The Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine (SJTREM) is an important resource in supporting this development. There are only two professors of emergency medicine in Norway and one in Sweden, and emergency medicine is defined as a specific speciality only in Sweden. While Sodersjukhuset in Stockholm, the home of the Swedish professor, has had emergency physicians since the late 1990s, emergency medicine officially did not become a subspecialty in Sweden until 2006. There are strong movements in both Finland and Denmark toward the same development, and Norway has begun discussing the need for a defined emergency medicine field. In this regard, we in the Scandinavian countries support each other as best we can. The fact that the president of the European Society of Emergency Medicine is from Sweden will be helpful as we try to reach the goal of emergency medicine as a speciality. A Scandinavian journal is an excellent forum for these discussions. When I began my career approximately 30 years ago, there was no pulseoximetry, CPAP, CT, MRI, or even US, and no thrombolysis or PCI, laparoscopic surgery, GPS or mobile phones. I wonder what they will write about in the next 25 years, and I dream about the device that they use in the TV show Star Trek. Using this device, doctors would simply scan the patient to receive prompt vital signs, blood results, and diagnoses. Simple and easy, no brain work or knowledge necessary. But wait, stop! Brain work is the most fun part. The fact that you have been able to solve a mystery, such as an unknown diagnosis, and discovered a conclusion or at least a treatment that makes the patient feel better is the best part of the whole profession. Reading about the work of others inspires you to work harder and provides new ideas about how to work more efficiently. A journal is a good way to inform the world of your work and thoughts, and we need to share this information to become a stronger field of medicine. We have a young but very strong emergency medicine culture in Scandinavia. In the field of resuscitation, our tiny countries have performed solid research. Together, we have addressed post-resuscitation care as an important, and now well-established, link in the Chain of Survival. The majority of research regarding dispatching protocols comes from our countries. An exiting study that randomised patients to an experimental group receiving adrenalin or another group that did not even receive an i.v. during the resuscitation protocol was recently completed, and we are all eager to learn of the results. Anyone who works in the field of pre-hospital care has knowledge of the Utstein formulas. This little monastery name in Stavanger serves as a symbol of quality work, and many papers drafted from Utstein meetings have provided us with a framework to understand results from studies all over the world. We also have unique patient registries that allow us to follow our patients from birth until death, providing years and years of potential data, which is a goldmine for epidemiological studies. What will be written about the SJTREM in 25 years? Hopefully, it will resemble what Sternbach wrote on the recent 25th anniversary of The Journal of Emergency Medicine, which is that most of the articles in the first issue are relevant to the practitioner today meaning year 2033 for this youngster. By working together as a discipline, I hope that we can make this wish come true and, at the same time, make emergency medicine an established part of everyday medicine in Scandinavia as well as all over the world.

The historical development of intensive care medicine in Germany. Contemporary considerations. 16. The history of development of therapeutic and diagnostic methods in pediatric

The historical development of intensive care medicine in Germany. Contemporary considerations. 16. The history of development of therapeutic and diagnostic methods in pediatric

History of the development of intensive care medicine. 8. Foundation and development of the German Interdisciplinary Society for Intensive and Emergency Medicine

History of the development of intensive care medicine. 8. Foundation and development of the German Interdisciplinary Society for Intensive and Emergency Medicine

The history of the development of intensive care medicine in Germany. Contemporary reflections. 6. Development of medical continuing education in intensive care medicine

The history of the development of intensive care medicine in Germany. Contemporary reflections. 6. Development of medical continuing education in intensive care medicine

The history of the development of intensive care medicine in Germany. Contemporary reflections. 4. Structural development of operative intensive care medicine in the former German Democratic Republic

The history of the development of intensive care medicine in Germany. Contemporary reflections. 4. Structural development of operative intensive care medicine in the former German Democratic Republic

History of the development of intensive care medicine. Contemporary considerations. 3. Structural development of operative intensive care medicine. Part I

History of the development of intensive care medicine. Contemporary considerations. 3. Structural development of operative intensive care medicine. Part I

Ethics in intensive medicine

In more than 30 years of development of intensive care medicine (ICM), our specialty has acquired moral and ethical standpoints, although not without public pressure and discussions. Special commissions dealing, e.g., with brain death, terminal care, ethics of foregoing life-sustaining treatment in the critically ill, withholding or withdrawing mechanical ventilation, and other issues have been formed in a number of medical societies. International consensus conferences have helped to clarify some of the issues. With increasing experience, a multitude of ethical problems have arisen in ICM that have to be dealt with, such as the issue of quality of life. What is an unworthy life? Are we allowed to make judgments for our patients? What is cost-effectiveness in ICM? Other restrictions include bed and equipment shortages in the intensive care unit (ICU), the necessity for triage--undisputed in catastrophe medicine--and how one should proceed in managing elective patients? In situations of limited ICU bed availability, sicker patients will be admitted, sparing out patients who are less ill for observation and those with poor quality of life and poor prognosis. For the future, it will likely be necessary to define the patients who should be admitted to an ICU more than those who should not be admitted. An ICU treatment entitlement index would be directly proportional to the probability of successful outcome and the quality of the remaining life, and would be inversely related to costs for achieving success. The ICU outcome with survival, hospital mortality, and follow-up of ICU patients is considered. DNR (do not resuscitate), the dying patient, terminal care, terminal weaning--DNT (do not treat)--active and passive euthanasia, living wills, quality of life, and cost-effectiveness for ICU patients are defined. Their application in the ICU will be discussed and problems pointed out. Outcome predictions using scores (APACHE III, SAPS II, MPM) have been developed based on previous experience, but should only be applied to patient groups and for quality assurance in ICUs. The most frequent and difficult problem in the ICUs is the vegetative state, which requires an exact diagnosis. The differential diagnosis from other comatose states such as coma, brain death, and locked-in-syndrome is depicted. The ethics of interrupting life-sustaining treatment in critically ill patients have been worked out by a Task Force on Ethics of the Society of Critical Care Medicine (1990). A consensus was found that the patient may judge to forego therapy; ethically it is then appropriate to withhold or withdraw therapy. According to the consensus, withdrawing an already initiated treatment should not necessarily be regarded as more problematic than a decision not to initiate treatment. In my mind, however, there is a great difference between withdrawing or withholding, e.g., ventilation. A dissentive opinion by some members of the Task Force stated that hydration and nutrition other than high-technology or parenteral nutrition are key components of patient care, and should not be equated with medical intervention. The ethical problems associated with active euthanasia (physician-assisted suicide or death) as practised in the Netherlands are also discussed. In most countries this practice seems unacceptable. From 30 years experience in ICM, there are many more ethical questions and case reports without clear solutions. Care decisions for single patients in unacceptable situations should be made after medical evaluation by the intensivist with the medical team and, if possible, by the patient and/or his or her surrogate. Legislation and solutions cannot be expected for single patients, but ethics committees could be helpful in decision-making.

Development of intensive care medicine in Germany

As of 1991, intensive care medicine in Germany is not an independent medical specialty but a part of other main medical specialities such as anesthesiology, internal medicine, surgery, and pediatrics. Accordingly, there is neither formal training nor a separate board examination in intensive care medicine. As in other countries, intensive care units (ICUs) were established during the 1950s and 1960s, triggered by the positive experience with consolidation of polio victims in special respiratory care units. Surgical (or operative) ICUs predominantly are operated by anesthesiology departments, as anesthesiologists' expertise in respiratory and hemodynamic support qualifies them for the management of the critically ill patient in the perioperative phase. This article gives a brief review of the development of intensive care medicine in Germany, thereby providing the historical background for its present national and regional organization, facilities, and education and training programs.

Noninvasive Respiratory Care Unit: A Cost Effective Solution for the Future

Noninvasive Respiratory Care Unit: A Cost Effective Solution for the Future