Who opened the first intensive care unit depends on whom you ask
Intensive care is often credited to Copenhagen in 1953, when Bjørn Aage Ibsen set up constant breathing support for polio patients. Yet in the United States, Dwight Harken is said to have opened an intensive care unit in 1951. Either way, the idea now keeps critically ill people alive around the world, at a steep price.
A task force from the international federation of critical care societies describes the unit as an organised system for the critically ill, combining specialist doctors and nurses, closer monitoring and machines that support failing organs until they recover. Patients come straight from the emergency department, from a ward when their condition collapses, or directly after major surgery that carries a high risk of complications. Depending on the country, the same place may be called an intensive therapy unit or a critical care unit.
Its roots are often traced to Florence Nightingale, who went to the Crimean War in 1854. Sorting the gravely wounded from the rest, and supplying a clean ward, equipment, fresh water and fruit, she saw death rates fall from 60% to 42% and eventually to 2.2%. The modern unit came a century later: Ibsen's in Copenhagen during the polio epidemic, Harken's in 1951, and another opened in 1955 by the surgeon William Mosenthal at Dartmouth-Hitchcock Medical Center. In the 1960s doctors realised how many heart attack patients died from disturbed heart rhythms, and continuous cardiac monitoring became routine.
A typical bay holds a ventilator feeding air through a tube in the windpipe or neck, heart monitors, a tangle of drips, feeding tubes and drains, and pumps delivering drugs; induced comas and sedation help control pain. Guidelines call for daily delirium checks with validated tools such as CAM-ICU, which exist in over 20 languages. Staffing matters: after adjusting for how sick patients are, more staff is linked with lower death rates, and one nurse for every 2 patients is recommended, against 4 or 5 on an ordinary ward. Nurses form the largest professional group, and their leadership style affects measured quality.
Systems differ sharply. Up to 20% of American hospital beds may be classed as intensive care, compared with at most 2% in Britain, which admits only the very sickest. American stays involving intensive care cost 2.5 times as much as other hospital stays. Some hospitals now run tele-ICUs, where remote clinicians watch live vital signs and records and advise the bedside team.
Source: Intensive care unit
