Critical Care Primer

George Cheng M.D. PhD

Harvard combined in Critical Care Training Program

Massachusetts General Hospital

Critical care medicine is the multidisciplinary healthcare specialty that cares for patients with acute, life-threatening illness or injury.

The practice of medicine in intensive care units (North America) or intensive therapy units (UK) is known as critical care medicine.  A specialist who practices intensive care medicine is known as an intensivist, whose training and board certification can be in anesthesiology, surgery, internal medicine, emergency medicine or pediatrics.

Critical Care Medicine is a relatively modern specialty.  The first intensive care units opened in Europe in the late 1950s and spread to North America.  Certification of training in this field did not occur in the United States until 1986.  By the early 2000’s, there were approximately 5000 intensive care units in the USA.  The current ICU model, with the intensivist making the decisions and a support team of specialists acting as consultants, has since been shown to significantly reduces morbidity, mortality and cost.  Critical care, as a specialty, has matured.

Several factors differentiate intensive care from other wards in hospitals:
– availability of invasive monitoring
– utilizing mechanical and pharmacological life sustaining therapies such as mechanical ventilation and vasopressors
– high nursing to patient ratio
– team structure of respiratory therapist, pharmacist, nursing, therapists, dietitians, social worker, and the physician

As the culture of cost containment as the major driving force in healthcare, the intensivist is becoming an essential component in cost control, and quality assurance, strategies.

Data and ICU

With the advent of electronic medical records and large medical database, intensive care units provide a perfectly controlled environment to perform these observational studies.  There is a wealth of information, from medications to procedures to vital signs, generated daily from routine patient care that can be collected.  As the healthcare system become more sophisticated with the way data are collected and analyzed, large ICU database provides an ideal setting for hypothesis driven research.  However, this paradigm sets up a paradox.  The most appropriate individuals (physicians, nurses, pharmacists, respiratory therapist, dietitians, and physical therapists) who have clinically driven questions often lack the skillset of a data scientist that is needed to address those questions.  Thus, time is ripe of collaboration between data scientist and clinical care providers.  This hybridization between distinctive fields of studies will result in tremendous synergy and address some of the most enigmatic areas in ICU care.