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Published online by Cambridge University Press: 07 September 2009
The specialty of intensive care medicine
It is generally agreed that the specialty of intensive care medicine began in Copenhagen in the early 1950s. During the poliomyelitis epidemic at that time, patients were treated by tracheostomy and prolonged manual ventilation. As a result of those measures, the mortality rate was reduced from 87% to an impressive 40%.
Although there are now many types of intensive care units (ICUs), such as medical, paediatric, respiratory, surgical, neurosurgical, cardiothoracic surgery and trauma, they all perform the same basic function: caring for the seriously ill. Caring for a group of these patients in a single space makes economic and medical sense. Our expertise in intensive care has increased enormously since the early 1950s and there are now specialised medical and nursing staff devoted solely to intensive care medicine.
Specialists working with the seriously ill may be familiar with complicated technology, physiology and pharmacology, as well as conventional medicine. However, it is even more important to become familiar with the unique requirements of critically ill patients – to develop expertise in their individual patterns of illness. These patients often do not conform to the conventional artificial divisions of medicine: ‘surgical’ patients develop ‘medical’ diseases. ‘Medical’ patients may develop ‘surgical’ diseases. The body may be looked at as a whole rather than as a series of independent organs. This requires that we break away from the tendency toward increasing medical specialisation based on individual organs.
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