Intensive care medicine (or ‘critical care medicine’) is concerned predominantly with the management of patients with acute life-threatening conditions (‘the critically ill’) in a specialized unit. It also encompasses the resuscitation and transport of those who become acutely ill, or are injured, either elsewhere in the hospital or in the community. Ai; well as emergency cases, intensive care units admit high-risk patients electively after major surgery.
An intensive care unit is fully equipped with monitoring and technical facilities, including an adjacent laboratory for the rapid determination of blood gases and simple biochemical data such as serum potassium and blood glucose. Patients can receive continuous expert nursing care and the constant attention of appropriately trained medical staff. These conditions and facilities are not available on a general ward. Teamwork and a multidisciplinary approach is central to the provision of intensive care and is most effective when directed and coordinated by a committed specialist. In the UK about 1% of the acute beds in the hospital are usually allocated to intensive care, but elsewhere in the developed world the proportion is often much higher.
In all critically ill patients, the immediate objective is to preserve life and prevent, reverse or minimize damage to vital organs such as the brain and the kidneys. This is achieved by supporting cardiovascular and respiratory function in order to maximize delivery of oxygen to the tissues.
This chapter concentrates on cardiovascular and respiratory problems. Many patients have failure of other organs such as the kidney and liver as well; treatment of these is dealt with in more detail in the appropriate chapters. Feeding the critically ill patient