Centralized hospital care for the critically ill.

Abstract

The remarkably effective techniques now available for preserving vital functions in critically ill or injured patients were essentially unknown only 20 years ago. Resuscitation and protracted support of organ function by the use of ventilators, pacemakers, renal dialysis machines, and other potent devices were incentives for the development of critical care facilities. Special care units evolved to facilitate application of these lifesaving techniques. The first of these were postoperative and general intensive care units, followed more recently by units for respiratory, cardiac, and coronary care and for renal dialysis and shock. In most instances such specialty units have funcitoned separately and largely independently of one another. We now recognize opportunities for pooling resources and amalgamating critical care units into facilities physically and administratively closer to a larger critical care service. This underlies the concept of a center for the critically ill which makes it possible to expand the use of available beds, qualified staff, instrumentation, and supplies. Equally important, such an arrangement supports the team approach to patient care, nowhere more urgently needed than in the management of the critically ill patient, who usually has multisystemic disease or injury. Basic to this arrangement is our most recent recognition that there are no fundamental differences between medical and surgical patients, or between cardiac and pulmonary patients. At the same time, we recognize that critical care is a 24-hour-per-day, 7-day-per-week hospital service by well-trained physicians, nurses, and technical personnel who are prepared to take incisive action at the bedside to sustain vital functions.