Intensive Care in the 21st. Century
The concept of Intensive Therapy has changed substantially since its origins, which in Argentina dates to the late fifties and early sixties. As all the activities in these Units have evolved, it is more fitting to name them Intensive Care Units: also gradually the concept of progressive care has been installed. As a patient improves from a maximally severe condition, with round the clock monitoring, assisted respiration or ventilation, and one nurse full time care, the controls and nursing care are gradually stepped down and spaced out until discharge to the wards is possible. This is known as Progressive Care.
These Units arose during the poliomyelitis epidemics in Europe in the fifties, as the serious forms of the infection affected and paralyzed the respiratory muscles, and seriously affected the maintenance of life itself. Different machines were invented to assist breathing, the most famous being the ‘Iron Lung’, with only the head of the patient sticking out of this steel box. Nursing and medical care was concentrated for the best attention to these unfortunate patients.
Soon it was found that very severely ill patients had a better chance of surviving if they were looked after in such an area. As polio was defeated by the vaccines developed by Dr. Salk and Dr. Sabin, and technical innovations allowed surgeons to perform evermore complex surgeries, people with a wide variety of serious illnesses were referred to the Intensive Care Unit, which initially were coordinated and run by Anesthesiologists, as they had the most experience with breathing machines. Special clothing was needed to access the area, and the use of rubber gloves and surgical face masks were required to be next to a patient.
As time went by, doctors and nurses began specializing in this type of emergency care, and hospitals saw the wisdom of allotting funds, space and equipment to create such Units; shortly after, specialized units began cropping up for the same general reasons, and according to the Hospital, you might find a Coronary Care Unit, a Respiratory Care Unit, a Stroke Unit, a Surgical Care Unit or others. The British Hospital has a Neonatology Unit (for premature and sick newborn babies), a Children’s Intensive Care Unit, and a Coronary Care Unit within the Adult Intensive Care Unit which is run along the lines of Progressive Care. The physicians who work there are known as ‘intensivists’ and there knowledge and expertise cuts across all the fields in medicine, focusing on correcting the imbalances and causes of extreme life threatening conditions.
The changes have been many, the percentage of patients who recover and leave Hospital has increased dramatically, mainly due to sophisticated on-site diagnostic equipment, to specialized personnel, to the intensive controls, to minute to minute delivery of medicines, and to permanent monitoring and vigilance. Furthermore, except in very special cases, patients now can be visited in the specified time frames by family and friends in their street clothes, which is big emotional help for getting over these dramatic moments in one’s life.
Author: Dr. Jorge Ubaldini (Chief of the Intensive Care Unit).
Translation: Dr. John Emery