Critical Care Technology
By Critical Care Expert in Maryland
During the past 20 years, there has been a slowly developing but drastic change in the practice of Critical Care Medicine:
The technology of Critical Care has undergone a revolution. We can support almost any key organ in the body artificially, including lungs (ventilator, extracorporeal membrane oxygenation), kidney (dialysis as well as sophisticated dialysis that does not decrease blood pressure, CVVH), heart (left ventricular assist device, defibrillating pacers, coronary stenting, etc.), liver (MARS), and vascular system (pressor medications, intra-aortic balloon pump). We have sophisticated and accurate ultrasound devices to determine the cause of problems such as lung collapse and low blood pressure. We can quickly and easily perform X-rays, CAT scans, and MRI’s to determine the location and type of problem. We can continuously monitor critical brain functions and adequacy of breathing with devices unheard of just a few years back. Irreversibly damaged organs like the lung, the kidney, the heart, and even the pancreas and small bowel can be transplanted, with results that improve every year. Blockages in arteries and airways can be opened up with minimally invasive procedures that before had been impossible. Advanced surgical procedures such as advanced brain surgery and revascularizations can be performed with the monitoring and care ability of ICU’s to support them. Importantly, the past 10 or 15 years have resulted in the research findings that very early and aggressive treatment of certain conditions like stroke and bacterial infections can result in much better outcomes for patients with these conditions. Finally, with the aging of the American population (and therefore increased chronic and acute diseases), and the above factors, the number of patients who utilize the ICU has risen dramatically recently, allowing more patients to take advantage of these advances to improve their health and quality of life.
However, there are significant problems that have resulted from the increased complexity and volume in the ICU:
A government agency looked at the number of medical mistakes that occur in hospitals, and the effect of these mistakes on patient outcomes. They found that hundreds of thousands of mistakes are made every year, and that a great number of patients are significantly injured by them. The majority of these mistakes happen in the ICU, where unfortunately more of these mistakes result in greater injuries and death to patients in which they happen. Furthermore, because of the complexity of the ICU, and because bad events occur naturally in the ICU more often than anywhere else, these mistakes and their detrimental effects are more difficult to detect.
Implementing the modern treatment algorithms and treatments requires a huge investment and effort in equipment, training, and skill from hospitals and medical personnel. This can be difficult for the hospital and the health care providers to successfully implement on a consistent basis.
Taking care of sicker patients with more infections has changed the organisms so that more infections are now resistant to antibiotics that used to work on them. Some bacteria can be resistant to almost all the available antibiotics, and can actually be impossible to treat. Other types of infections, like infections with fungus, are also becoming more common as patients get sicker and antibiotic use continues to kill the bacteria that they are still able to.
All of this volume and complexity make it nearly impossible to determine whether a poor outcome from an ICU admission is an inevitable result of the disease, or whether it could have been avoided with proper care. ICU outcomes evaluations, probably more than in any other area of medicine, require a specialist review from a Critical Care physician.
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