ArticlePDF Available

The first intensive care unit in the world: Copenhagen 1953

Authors:

Abstract and Figures

After an extensive survey of the medical literature we present compelling evidence that the first intensive care unit was established at Kommunehospitalet in Copenhagen in December 1953. The pioneer was the Danish anaesthetist Bjørn Ibsen. The many factors that interacted favourably in Copenhagen to promote the idea of intensive care therapy, half a century ago, are also described.
Content may be subject to copyright.
Review Article
The first intensive care unit in the world: Copenhagen 1953
P. G . B ERTHELSEN and M. CRONQVIST
Department of Anaesthesia, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
After an extensive survey of the medical literature we present
compelling evidence that the first intensive care unit was
established at Kommunehospitalet in Copenhagen in Decem-
ber 1953. The pioneer was the Danish anaesthetist Bjørn Ibsen.
The many factors that interacted favourably in Copenhagen to
promote the idea of intensive care therapy, half a century ago,
are also described.
Accepted for publication 4 September 2003
Key words: Critical care therapy; critical care unit; history;
intensive care therapy; intensive care unit; polio epidemic;
recovery room; respiratory insufficiency.
#Acta Anaesthesiologica Scandinavica 47 (2003)
Disease desperate grown by desperate appliance
are relieved or not at all.’ William Shakespeare,
Hamlet.
FOR the purpose of this investigation we have
defined an intensive care unit as a ward where
physicians and nurses observe and treat desperately
ill patients 24 h a day. The unit may serve patients
from all branches of medicine. The primary goal is to
restore and maintain the function of vital organs,
enhancing the chance of survival.
With this paper we present evidence that the
world’s first intensive care unit was established at
Kommunehospitalet, the Municipal Hospital of
Copenhagen, in 1953 by the Danish anaesthetist
Bjørn Ibsen.
Patient no. 1
December 21st, 1953
6.00 p.m.: A 43-year-old-man was admitted from the
medical ward to the Observation Room (Observa-
tionsstuen), at Kommunehospitalet in Copenhagen,
three days after he had attempted, unsuccessfully, to
hang himself. He was agitated, confused and cyanotic
with laboured respiration. Temperature 38.6Cand
pulse 136. An X-ray showed bilateral infiltrates and
oedema of the lungs. It was felt that fatal cardiopul-
monary failure was imminent.
Oxygen via a facemask and when the oxygen
saturation (monitored with a Milikan Oximeter)
decreased, with positive pressure ventilation from a
bag and mask, was started.
Furthermore, the patient was given one unit of
blood (500 ml), isotonic glucose (1000 ml) and an anti-
biotic (Aureomycin 250 mg four times a day).
December 22nd
7.15 a.m.: The condition of the patient had deteri-
orated. A tube with cuff was passed into his trachea
and manual positive pressure ventilation with 60%
oxygen in N
2
O was started. After the injection of
theophylamine (400 mg) and procaine (100 mg) his
condition stabilized.
10.25 a.m.: Blood pressure 140, pulse 120 and tem-
perature 39.8C.
00.45 p.m.: Oxygen saturation 80%. Increases to 86%
when 100%oxygen was used instead of the O
2
/N
2
O
mixture.
3.00 p.m.: An analysis of the patient’s arterial blood
revealed: bicarbonate 24.5, pH 7.51, pCO
2
31 mmHg,
and oxygen saturation 100%. Clinically the patient
was much improved. The respiration was sufficient
and he was extubated.
December 23rd
10.00 a.m.: The patient wasreturnedtothemedical
ward.
5.00 p.m.: Readmitted in a condition very much like
the one he was in when first admitted to the Observa-
tion Room.
7.55 p.m.: A tracheostomy was performed and posi-
tive pressure ventilation was resumed.
Acta Anaesthesiol Scand 2003; 47: 1190 1195 Copyright #Acta Anaesthesiol Scand 2003
Printed in Denmark. All rights reserved ACTA ANAESTHESIOLOGICA SCANDINAVICA
ISSN 0001-5172
1190
December 24th
The condition of the patient was unaltered. He
appeared dehydrated. A stomach tube was inserted
and an infusion of raw eggs and milk (2500 ml) was
started. He was given another transfusion of blood.
Positive pressure ventilation was continued.
Hyperthermia (41C) was combated by covering the
patient with wet blankets.
December 25th
The patient was somnolent with paralysis of the legs.
His respiration was still insufficient with large
amounts of secretions obstructing the airways. Ther-
apy was continued as outlined above and Penicillin
(2,000,000 IE) was added.
On December 26th the patient died from cardiopul-
monary failure.
The abstract from the medical charts illustrates
many aspects of intensive care even as we know it
today: the continuous recording of the function of
vital organs; the immediate intervention when
changes in the patient’s condition mandated it; moni-
toring of the effect of the intervention.
There is no doubt that what was described in the
records of this patient and in the records of several
others subsequently treated in the Observation Room
was bona-fide intensive care therapy.
Was the Observation Room, at the
Municipal Hospital in Copenhagen, the
first intensive care unit in the world?
In science, the credit goes to the man who convinces
the world, not the man (to) whom the idea first
occurs’. William Osler
When it is impossible to establish who did what,
where and when in medicine, priority is awarded to
the one who first publishes on the subject. Conse-
quently, we carried out a thorough search of the med-
ical literature (see Appendix A).
The first paper on intensive care therapy appeared
in Nordisk Medicin,September18,1958:‘Arbejdet pa
˚en
Anæsthesiologisk Observationsafdeling’(The Work in an
Anaesthesiologic Observation Unit’) (1). The authors
were the Danish anaesthetists Bjørn Ibsen (Fig. 1)
and Tone Dahl Kvittingen from Norway (Fig. 2). The
paper was in Danish but the English resume is shown
in Fig. 3.
The number of patients treated in the intensive care
unit increased from 1 in 1953 to 13 in 1954, 34 in 1955,
91 in 1956 and 120 in 1957. The average length of stay
also increased from 2.1 days in 1954 to 5.3 days in 1957.
Why was an epoch-making paper published in a
language few speak and understand? and why did it
take 5 years before Bjørn Ibsen first published on his
innovation and the results of establishing an intensive
therapy unit? Ibsen cannot, today, remember what
prompted him to publish in a journal with limited
circulation outside the Nordic countries. It is true
that he was the Danish coeditor of Nordisk Medicin
but he was also coeditor of the newly started (1957)
Acta Anaesthesiologica Scandinavica,wherehisideas
and results would have been presented in English.
‘What we did was just to use the principles and
techniques, which served us well in the operating
Fig. 1. Bjørn (Aage) Ibsen (1915). Initiator of the first
multidisciplinary intensive care unit. Ibsen graduated from
medical school, University of Copenhagen, in 1940. From 1949
to 1950 he was Resident in Anaesthesia, Massachusetts General
Hospital, Boston. In 1951 he received his specialist diploma in
anaesthesiology. The turning point in his career came when he
became involved in the treatment of the most severely ill victims of
the 1952 poliomyelitis outbreak in Denmark. In 1954 Ibsen was
elected Head of the Department of Anaesthesiology,
Kommunehospitalet, Copenhagen (Photo c. 1955).
The first ICU
1191
theatre, also on patients with medical diseases’, Bjørn
Ibsen told us when we interviewed him in February
2002. ‘Really we felt that it was not such a big deal and
therefore there was no hurry in publishing the results
of the treatment in the Observation Room.’
In line with this there was no official opening of the
unit. It started little by little in the hospitals newly
opened (July1953) postoperative recovery room(Fig. 4).
In the beginning, the doctors and nurses were on
duty when needed but from April 1954, when Bjørn
Ibsen was appointed Head of a new and independent
department of anaesthesia, the Observation Room
was staffed around the clock.
Bjørn Ibsen was not the first to envisage a special
unit for severely ill patients (2), but it is our contention
that he was the first to follow up on the idea. He
rejected the generally held views on the utility of
treating critically ill medical patients. Instead of the
prevailing fatalism and therapeutic nihilism, Ibsen
chose an aggressive and optimistic approach.
Many factors interacted favourably, in Copenhagen
in the early 1950s, to create a scene where Bjørn
Ibsen’s idea was accepted that critically ill patients
(medical as well as surgical) should be observed and
treated in a special ward by physicians and nurses
trained in restoring and/or maintaining the function
of vital organs. In the years following the Second
World War Danish physicians had contributed signifi-
cantly to the battle against tuberculosis in postwar
Europe. As an appreciation of this effort WHO
decided [at the suggestion of Erik Husfeldt (1901—85)
the first Danish cardio-thoracic surgeon] to establish
the so-called Anaesthesiology Centre Copenhagen in
May 1950. For 23 years, from all over the world, train-
ees came to Denmark for a 1-year course in anaes-
thesiology. And most importantly the teachers were
the leading anaesthetists from the UK, Sweden and
the USA. Among many others, Henry K. Beecher,
H. C. Churchill-Davidson, Stuart C. Cullen, Robert
Dripps, Francis Foldes, Olle Friberg, Torsten Gordh,
T. Cecil Gray, H. W. C. Griffiths, Martin Holmdahl,
R. R. MacIntosh, Eric Nilsson, Jackson Rees, John
W. Severinghaus, Leroy Vandam and Ralph M.
Waters. There is no doubt that the centre increased
the prestige of anaesthetists in Denmark and created
an international stimulating and fruitful professional
Fig. 2. Tone Dahl Kvittingen(19112001). Norwegian coauthor of
the seminal paper on intensive care therapy. After receiving her
medical degree from University of Oslo she completed her basic
training in anaesthesiology at Rikshospitalet in Oslo. In 195556
she attended the WHO-sponsored course on anaesthesiology in
Copenhagen. From 1959 she was Head of the Department of
Anaesthesiology, Trondheim Sentralsykehus [her career was much
more exciting than these few facts suggest: see Strømskag (4)].
Fig. 3. The resu
`me of the first paper on intensive care therapy.
P. G. Berthelsen and M. Cronqvist
1192
milieu in Copenhagen that increased the public
awareness of the potential of this new speciality.
The 1950 report from the Second Commission on
the future organisation of the anaesthetic services in
the hospitals of the municipality of Copenhagen (3)
also helped pave the way. It was coauthored by two
influential professors of surgery [Jens Foged
(1897—1956), chief surgeon, Bispebjerg Hospital, and
Otto Mikkelsen (1895—1960), chief surgeon, Depart-
ment of Surgery I, Kommunehospitalet].
The report recommended that independent
departments of anaesthesia should be established
in all hospitals. The anaesthetists should care for
the patients during the operation and postopera-
tively ‘maintaining a sufficient circulation of blood
by transfusion of blood and plasma, and infuse salt
and water to restore the fluid balance and secure
the best possible oxygen delivery by an energetic
support of the respiratory function’ ... ‘These prin-
ciples for supportive therapy should also be
applied to patients with medical diseases and self-
poisoning’. Furthermore, the report suggested, for
financial and practical reasons, that it would be
prudent to design and designate a room where
patients could recover postoperatively.
Special wards for specific purposes were not
unheard-of in the early fifties. In 1949 Carl Clemmensen,
Head of the Department of Psychiatry at Bispebjerg
Hospital in Copenhagen, established a centre for the
treatment of patients with barbiturate poisoning (5).
Barbiturate poisoning was often lethal in those
days, but by intensive therapy of shock (serum
infusion, electrolyte replacement) and respiratory
insufficiency(lung physiotherapy, prophylactic
penicillin) the mortality rate decreased signifi-
cantly. Nobody, however, extrapolated these
favourable results to other patient categories.
In the late forties postoperative recovery rooms/
wards were established in many hospitals around
the world and also in Denmark. Usually the patients
were observed and treated in such units only for a few
hours postoperatively until the effects of the anaes-
thetic had vanished. In the medical literature we have
found no evidence that such a service was extended
also to patients with medical diseases before Ibsen
started doing so in December 1953.
The pivotal point came with Ibsen’s involvement in
the 1952 polio epidemic in Copenhagen.
When 27 out of 31 poliomyelitis victims, with
respiratory involvement, had died during the first
few weeks of the epidemic Professor H. C. A. Lassen
(1900—74), Head of the Medical Department, Bleg-
damshospitalet, condescended to ask Bjørn Ibsen’s
advice. It must be remembered that, in those days,
anaesthetists were not highly regarded by other phys-
icians. They were seen as technicians who knew a few
gimmicks. When Ibsen was consulted in August 1952
(6) he almost immediately realized that polio patients
died from respiratory insufficiency with carbon
dioxide retention and not from an overwhelming
virus infection of the brain as was generally believed
by the epidemiologists. Ibsen proposed to treat the
patients with tracheal intubation via a tracheostomy
and controlled or assisted manual ventilation with a
bag and a to-and-fro system with a Waters’ cannister.
He first proved his point when a 12-year-old para-
lyzed and cyanotic girl, Vivi, survived when she was
treated as Ibsen advocated (7, 8). In the following
months mortality decreased markedly to approxi-
mately 25%. It soon became clear that it was imprac-
tical to treat patients with respiratory insufficiency in
all the different wards in the hospital. When the
patients were concentrated in three specially desig-
nated wards, each of 35 beds, the quality and effi-
ciency of the treatment of respiratory insufficiency
and circulatory instability improved.
So although the special wards at Blegdammen
treated patients with the same modalities as was
later used in proper intensive care units, nobody
suggested that the concept should be broadened to
encompass all types of patients with critical illnesses.
An important side-effect of Ibsen’s contributions,
during the epidemic, was to increase considerably the
reputation of anaesthetists generally and Ibsen person-
ally. A fact that helped when a year later he needed to
Fig. 4. Kommunehospitalet i n Copenhagen. The ho spital was
inaugurated in 1863. The student nurses’ classroom turned into
the worlds first intensive care unit was on the first floor, right next
to the main entrance (Photo ca. 1980).
The first ICU
1193
convince the health authorities of Copenhagen and his
colleagues at Kommunehospitalet that anaesthetists
were indeed proper doctors and could take care of
patients also outside the operating theatre.
In April 1953 Ole V. Secher (1918—95) became the
first Head of an independent Department of Anaes-
thesia in Denmark at Rigshospitalet in Copenhagen.
Rigshospitalet was the most prestigious hospital in
Denmark at the time. The appointment of Secher
was a wise choice but it was at the expense of Ibsen
who was both older and more experienced. This rejec-
tion was a disappointment to Ibsen, but there is little
doubt that it also acted as an incentive. He became
determined to show the Professors at Rigshospitalet
that they had taken the wrong view. So, in April 1953
when Ibsen became Senior Resident (anaesthetist) in
the Department of Surgery I at Kommunehospitalet
his fighting spirit had been roused. and he needed it
right away. In the surgical department there was dis-
agreement between the surgical senior residents as to
the best postoperative volume replacement therapy.
To solve this problem, Otto Mikkelsen, Chief of the
Department, asked Ibsen to supervise and direct how
surgical patients should be treated in the recovery
room (and the wards) (9). This controversy between
his surgical colleagues allowed Ibsen to take charge of
the recovery room and subsequently made it possible
for him on 21 December 1953 to change a purely
surgical recovery ward into a unit where all types of
patients could receive professional help.
In conclusion, it is beyond reasonable doubt that the
first intensive care unit in the world was established
in the Observation Room at Kommunehospitalet in
December 1953. and that Ibsen, as the initiator, must
be counted as one of the people who were instru-
mental in laying the foundation of our profession.
Acknowledgements
Five (alphabetical order) colleagues have contributed with their
first-hand knowledge and impressions of the events leading up
to the establishment of the first intensive care unit in the world.
Elieser Arge: Senior House Officer (Reservelæge) from August
1953 to September 1955, Departments of Surgery and Anaesthe-
siology, Kommunehospitalet (later Chief Surgeon, Thorshavn,
Faroe Islands).
Bjørn Ibsen: 1 April 1953 to 1 April 1954, Senior Resident
(1. Reservelæge) (anaesthesiology), Department of Surgery I,
Kommunehospitalet. From 1 April 1954, Chief, Department of
Anaesthesiology. Professor of Anaesthesiology, University
of Copenhagen, 1971.
Carl Jørgen Carlsen: Senior Resident from September 1951 to
December 1954, Department of Surgery I, Kommunehospitalet
(later Chief Surgeon, Thisted Sygehus, Denmark).
Ole Juhl: Senior House Officer from April 1953 to December
1956, Departments of Surgery I and Anaesthesiology, Kommune-
hospitalet (later Chief Anaesthetist, Aalborg Kommunehospital,
Denmark).
Hans Heugh Wandall: Senior Resident, Department of
Surgery I, Kommunehospitalet 1950—56 (later director of the
Institute for Experimental Medicine and Surgery, University of
Copenhagen).
Very useful background material has been provided by Niels
Fjeldborg, former Chief of the Department of Anaesthesiology,
Aarhus Amtssygehus, and Henning Sund Kristensen, former
Chief Anaesthetist, Blegdamshospitalet, Copenhagen.
We obtained useful ground plans and pictures of Kommune-
hospitalet from Erik Dauv-Pedersen (Senior Pharmacist) and
Jørgen Wiedemann (Hospital Manager).
Kjell Erik Strømskag, Molde, Norway, provided data on Tone Dahl
Kvittingen — coauthor of the first report on intensive care therapy.
References
1. Ibsen B, Kvittingen TD. Arbejdet pa
˚en anæsthesiologisk
observationsafdeling. Nordisk Med 1958; 38: 1349—55.
2. Kirschner M. Zum Neubau der chirurgischen Universita
¨tskli-
nik Tu
¨bingen. Der Chirurg 1930; 2: 54—61.
3. Betænkning II. Afgivet Af Den Af Magistraten Under 28. Februar
1944 Nedsatte Hospitalskommission. København: J.H. Schultz
Universitetsbogtrykkeri, 1950.
4. Strømskag KE. Et fag pa
˚søyler. Anestesiens historie i Norge.
TanoAschehoug 1999.
5. Nilsson E. On treatment of barbiturate poisoning. A modified
clinical aspect. Acta Med Scand 1951; 139 (Suppl.): 89—98.
6. Ibsen B. The anaesthetist’s viewpoint on the treatment
of respiratory complications in poliomyelitis during the
epidemic in Copenhagen, 1952. Proc Royal Soc Med 1954; 47:
72—4.
7. Wackers GL. Modern anaesthesiological principles for
bulbar polio: manual IPPR in the 1952 polio-epidemic in
Copenhagen. Acta Anaesthesiol Scand 1994; 38: 420—31.
8. Kristensen HS. Comment on the description of the polio
epidemic in Copenhagen 1952. Acta Anaesthesiol Scand 1996;
40: 134—5.
9. Ibsen B. From anaesthesia to anaesthesiology. Personal experi-
ences in Copenhagen during the past 25 years. Acta Anaesthe-
siol Scand 1975; 61 (Suppl.): 29—33.
Address:
Preben G. Berthelsen,MD
Department of Anaesthesia
Gentofte Hospital
University of Copenhagen
Niels Andersens Vej 65
DK-2900 Hellerup
Denmark
e-mail: prbe@gentoftehosp.kbhamt.dk
P. G. Berthelsen and M. Cronqvist
1194
Appendix A
The following sources were searched to find the first article on the
treatment of patients in an intensive care unit:
Index Medicus, 195060
Web of Science (www.wos.isiglobalnet.com). In this database it is
possible to search for author names and words in the titles of 1.5
million papers published between 1945 and 1960. We used the
following search string: icu or sicu or care unit or recovery room
or intensive care or critical care or observation ward.
Ugeskrift for læger (Journal of the Danish Medical Association),
195060
Nordisk Medicin, 1950—60.
Acta Anaesthesiologica Scandinavica, 1957—63.
Anaesthesia, 1955—60.
Der Anaesthesist, 1955—60.
Anaesthesia and Analgesia, 1950—67.
Anaesthesiology, 1952—69.
British Journal of Anaesthesia, 1955—63.
Journal of the American Medical Association, 1950—60.
Lancet, 1950—60.
New England Journal of Medicine, 1950—60.
Surgery, Gynecology and Obstetrics, 1950—60.
Proceedings of the Third Congress of the Scandinavian Society of
Anaesthesiologists. Copenhagen, 11—12 June 1954 (even though
the main topics were respiratory insufficiency and respirators
the concept of an ICU was not mentioned).
Abstracts from the First World Congress of Anaesthesiology.The
Netherlands, 5—10 September 1955 (again no mentioning of
an ICU).
Rushman GB, Davies NJH, Atkinson RS. A short history of anaes-
thesia. The first 150 years. Butterworth and Heinemann, 1996.
Rendell-Baker L, Mayer JA, Bause G. Pioneers and Innovators in
Anaesthesia. In: The History of Anaesthesia. The Fourth Inter-
national Symposium on the History of Anaesthesia. Lu
¨beck:
Verl a g Dr a
¨ger-Druck, 1997.
Atkinson RS. Bjørn Ibsen and his contribution to the start of
intensive therapy as a part of the speciality of anaesthesia
and intensive care. Current Anaesthesia and Critical Care.
1997; 8: 184—186.
Evans TW. Hemodynamic and Metabolic Therapy in Critically
Ill Patients. N Engl J Med, 2001; 345: 1417—18.
Webel N, Harrison B, Southorn P. Anaesthesia origins of the
intensive care physician. In: Proceedings of the 5th International
Symposium on the History of Anaesthesia.Amsterdam:Elsevier
Science, 2002.
Safar P. Development of cardiopulmonary-cerebral resuscita-
tion in the twentieth century. In: Proceedings of the 5th Inter-
national Symposium on the History of Anaesthesia.Amsterdam:
Elsevier Science, 2002.
The first ICU
1195
... The birth of intensive care units (ICU) is often dated back to August 1952, when Bjørn Ibsen ( Figure 1) convinced his colleagues that tracheostomy, suctioning, and the around-the-clock application of positive pressure ventilation were necessary to save the lives of patients with paralyzing forms of poliomyelitis [1]. The new discipline blossomed in the wake of the 1952 Copenhagen polio outbreak [3][4][5][6]. ...
... In an experiment, he made cuts into a dog's chest wall and pleura and used bellows to generate a constant flow of gas through a dog's airway. He found that when said flow was arrested, the dog would agonize, but when the flow was restarted, the dog was resuscitated [3]. ...
... The number of patients with respiratory failure was higher than in any other European country. The Blegdam Hospital, tasked with treating poliomyelitis, had only one tank respirator or iron lung and six cuirass respirators available to accommodate the daily admission of six to 12 patients presenting with respiratory failure [2][3][4][5]8]. ...
Article
Full-text available
The COVID-19 pandemic underscored the critical importance of intensive care units (ICUs), a field institutionalized by Bjørn Ibsen during the 1952 polio epidemic in Copenhagen. Ibsen's groundbreaking innovations, including positive pressure ventilation and real-time physiological monitoring, laid the foundation for modern intensive care medicine. Trained in Denmark and the United States, Ibsen demonstrated the effectiveness of manual ventilation during the polio outbreak after successfully resuscitating a young patient, Vivi Ebert, which in turn led to the creation of the world's first multidisciplinary ICU at Blegdams Hospital. This article explores the historical context and significance of Ibsen's contributions, tracing the evolution of the physiology of breathing from the early concepts of Vesalius and Hook to the widespread application of ventilation techniques. The establishment of the ICU introduced new ethical dilemmas, highlighting the delicate balance between prolonging life and maintaining patient dignity. Ibsen's legacy extends beyond medical advancements to the compassionate care he championed, a principle that remains a cornerstone of modern intensive care. This ethical complexity is a crucial aspect of the history of intensive care medicine.
... Искусственная вентиляция легких (ИВЛ), вентиляция с положительным давлением, с 1950-х гг. является краеугольным камнем лечения тяжелых форм ОДН [3]. Однако, несмотря на значительные достижения в области интенсивной терапии, осложнения и смертность, связанные с интубацией и вентиляцией с положительным давлением, все еще довольно значительны [4]. ...
Chapter
Пятый том руководства «Респираторная медицина» посвящен актуальным вопросам современной пульмонологии – патофизиологии и лечению дыхательной недостаточности, среди которых особое место занимают обновленные разделы по респираторной поддержке и трансплантации легких. Несомненный интерес читателей вызовет раздел по бронхолегочной реабилитации, медико-социальная значимость которой резко возросла в период после пандемии новой коронавирусной инфекции. Впервые представлены данные о применении в лечебно-реабилитационных программах медицинских газов, а также об инновационной организационной модели данного метода лечения – респираторном салоне. Традиционно значимыми являются вопросы организации пульмонологической помощи населению, включая новейшие методы удаленного мониторинга пациентов в домашних условиях, и медицинской экспертизы при бронхолегочных заболеваниях, современные подходы к которым представлены в данном томе. Заключительный раздел объединяет вопросы формирования современной модели врача легочной медицины и его профессиональной самоподготовки, что имеет основополагающее значение в развитии современной пульмонологии. В настоящем издании, составленном с учетом актуальных клинических рекомендаций, рассматриваются вопросы клиники, диагностики и лечения основных заболеваний респираторной системы. Руководство предназначено для повышения квалификации широкого круга врачей: терапевтов, пульмонологов, фтизиатров, аллергологов и иммунологов, онкологов, хирургов, оториноларингологов, педиатров, инфекционистов, патологоанатомов и представителей смежных специальностей. Также издание адресовано студентам старших курсов медицинских вузов, ординаторам, аспирантам и может быть использовано в качестве учебника для подготовки к практическим занятиям и итоговой государственной аттестации.
... P-value represents Jonkheere-Terpstra t-test (C) Theoretical Consensus Immune Dysregulation Framework for defining immune dysregulation with myeloid dysregulation on one axis and lymphoid dysregulation on the other axis. Provides a means of subgrouping patients into four subgroups depending on the level of dysregulation present: (1) balanced -both myeloid and lymphoid dysregulation scores low; (2) lymphoid dysregulationlymphoid dysregulation score is elevated while myeloid dysregulation score is low; (3) myeloid dysregulation -myeloid dysregulation score is elevated while lymphoid dysregulation score is low; ...
Preprint
Full-text available
Progress in the management of critical care syndromes such as sepsis, Acute Respiratory Distress Syndrome (ARDS), and trauma has slowed over the last two decades, limited by the inherent heterogeneity within syndromic illnesses. Numerous immune endotypes have been proposed in sepsis and critical care, however the overlap of the endotypes is unclear, limiting clinical translation. The SUBSPACE consortium is an international consortium that aims to advance precision medicine through the sharing of transcriptomic data. By evaluating the overlap of existing immune endotypes in sepsis across over 6,000 samples, we developed cell-type specific signatures to quantify dysregulation in these immune compartments. Myeloid and lymphoid dysregulation were associated with disease severity and mortality across all cohorts. This dysregulation was not only observed in sepsis but also in ARDS, trauma, and burn patients, indicating a conserved mechanism across various critical illness syndromes. Moreover, analysis of randomized controlled trial data revealed that myeloid and lymphoid dysregulation is linked to differential mortality in patients treated with anakinra or corticosteroids, underscoring its prognostic and therapeutic significance. In conclusion, this novel immunology-based framework for quantifying cellular compartment dysregulation offers a valuable tool for prognosis and therapeutic decision-making in critical illness.
... 2 Saúde (Santa Maria). 2023, v. 49, n. 2: e41350 educação em saúde para alta nas unidades de terapia intensiva pediátrica e neonatal introdução O início da história da Unidade de Terapia Intensiva (UTI) teve como referência, a epidemia de poliomielite em 1952 (1) , em Copenhague, já no Brasil, a UTI apareceu na década de 70 com a finalidade de centralizar recursos materiais e humanos (2) . ...
Article
Full-text available
Com os avanços na Medicina Intensiva houve um aumento na sobrevida das crianças com alguma necessidade especial. Os princípios do Sistema Único de Saúde e as Políticas Nacionais de Humanização propõem estratégias que objetivam a melhora da assistência, como a Educação em Saúde com os pais e familiares. O presente trabalho objetivou analisar as principais estratégias utilizadas no processo de Educação em saúde visando à alta hospitalar nos ambientes da Unidade de Terapia Intensiva Pediátrica (UTIP) e Unidade de Terapia Intensiva Neonatal (UTIN) e suas contribuições. Foi utilizada, para tanto, a Revisão Integrativa da Literatura composta de seis etapas: 1) elaboração da pergunta da pesquisa: Quais as principais estratégias utilizadas no processo de Educação em saúde visando à alta hospitalar nos ambientes da UTIP e UTIN e suas contribuições?; 2) definição das bases de dados: LILACS, MEDLINE, CINAHL, Web of Science, Scopus and SciELO. Vinte e dois artigos compuseram a amostra final, após a aplicação dos critérios de inclusão e exclusão; 3) coletadas as informações para responder ao objetivo; 4) avaliação dos artigos; 5) interpretação dos resultados: prevalência dos estudos realizados nos Estados Unidos; os participantes foram os pais e profissionais de saúde. Houve uma lacuna de 15 anos entre o primeiro e o segundo estudo, o local de maior pesquisa foi a UTIN e a maioria dos estudos pertenceu ao grau de evidência IV e, 6) conclusão: há escassez de estudos de níveis de evidências mais altos na área da saúde; outras categorias da equipe multidisciplinar devem realizar mais pesquisas com esta abordagem e, há necessidade de sensibilizar outros países e as equipes da UTIP a utilizarem esta prática e publicarem seus resultados.
... Surgiu como uma enfermaria onde os médicos e enfermeiras cuidavam de seus pacientes em estado grave 24 horas por dia, com o objetivo principal de restaurar e manter as funções dos órgãos vitais, aumentando a chance de sobrevivência destes. Atualmente, seu conceito transcende o espaço físico, e a terapia intensiva pode ser entendida como um sistema de cuidado que conta com as habilidades interdisciplinares, todos com um objetivo em comum: prevenir futuras deteriorações, através da utilização da tecnologia para proteger sistemas vitais como o respiratório, cardiovascular e renal 4,5 . ...
Article
Full-text available
O objetivo do estudo foi verificar o perfil de Intervenção Farmacêutica em UTI de um Hospital Federal do Rio de Janeiro entre setembro de 2018 a setembro de 2019. O desenho do estudo é descritivo e observacional. O planejamento de formulários e a coleta de dados das intervenções foram realizados pelo Google FormsⓇ. O estudo obteve 354 intervenções aumentando de 38 em 2018 para 309 em 2019. A taxa de aceitação da equipe multiprofissional aumentou de 78,9% para 83,5%. Em 2018, o medicamento mais prevalente foi o omeprazol (13%) e o grupo ATC destaque foi o A (24,1%). Em 2019, o medicamento mais prevalente foi o meropeném (8,6%) e o grupo ATC destaque foi o J (39,4%.) Os principais tipos de intervenção foram interações medicamentosas em 2018 (46,9%) e ajustes de dose em 2019 (31,6%). Desta forma, o estudo promoveu o desenvolvimento de indicadores para avaliar a qualidade e eficiência do serviço farmacêutico.
... Intensive care units (ICUs) in the hospital environment are the units that provide care with the most advanced technology possible to patients with the most serious medical and surgical diseases (Berthelsen & Cronqvist, 2003;Karlsson et al., 2021). ICUs are different from other units in terms of the characteristics of patients and diseases, treatment methods, physical characteristics and emotional environment (Chivukula et al., 2017). ...
Article
Full-text available
This study aimed to test the validity and reliability of the ICU Psychosocial Care Scale in Turkish, which was developed to measure the psychosocial care of cardiac critical patients. This study was a methodological design. The study sample consisted of 180 critically ill cardiac patients meeting the inclusion criteria. The study used the ICU-Psychosocial Care (ICU-PC) Scale and The Intensive Care Experiences Scale for data collection. Data were analyzed using SPSS 22.0 and AMOS V 24.0 statistical package programs. Content validity, construct validity, reliability and concurrent validity tests were performed. The sample (n = 180) was predominantly male (66.1%) with a mean age of 65.96 ± 15.46 years. Confirmatory factor analysis was applied to confirm the 3-dimensional and 14-item structure of the scale. The fit indices of the scale were found to be χ2 = 89.24, df = 52, χ2/df = 1.716, goodness of fit index = 0.94, comparative fit index = 0.97, incremental fit index = 0.97, Tucker-Lewis index = 0.95, root mean square error of approximation = 0.05, standardized root mean square residual = 0.05. Cronbach’s alpha coefficient of ICU-PC scale was 0.87. The ICU-PC scale is a valid, reliable and distinctive scale in assessing the psychosocial care of critically ill cardiac patients.
... The ICU is a fairly new construction in biomedical practice, with the first ICU established in Copenhagen, Denmark, in 1953 by the Danish anesthesiologist Bjørn Ibsen (Berthelsen and Cronqvist 2003). The main objective of the ICU is to stabilize patients by monitoring, maintaining, and treating the basic function of the vital organs. ...
Article
Full-text available
Illness and injury are often accompanied by experiences of bodily objectification. Medical treatments intended to restore the structure or function of the body may amplify these experiences of objectification by recasting the patient’s body as a biomedical object—something to be examined, measured, and manipulated. In this article, we contribute to the phenomenology of embodiment in illness and medicine by reexamining the results of a qualitative study of the experiences of nurses and patients isolated in an intensive care unit during the first wave of COVID-19. Drawing upon the phenomenological concept of embodiment—as developed in the work of Edmund Husserl, Maurice Merleau-Ponty, Jean-Paul Sartre, and Emmanuel Levinas—we reconsider how bodily objectification manifests in complex clinical encounters. We show that, in these settings, objectification is not simply the unilateral act of a clinician objectifying a patient. Rather, both clinicians and patients reported a variety of objectifying experiences influenced by their interactions, the immediate context of the intensive care milieu, and the broader atmosphere of a global pandemic. In light of these findings, we argue that bodily objectification in illness and medicine can often be more complicated than typically presented in the phenomenological literature.
... 9 The most frequently diagnosed and admitted cases for care at ICU were stroke, 10 respiratory failure, 1 road traffic accident, 9 cardiac failure, 11 medical comorbidities (diabetic mellitus, hypertension (HTN), and HIV/AIDS were prominent evidence. [12][13][14] After inpatient cases were admitted to the ICU, there were two existing criteria including inpatient death or prognosis discharge. 15 A significant proportion of cases were faced subsequently dying after inpatient treatment was set with 6-27% ranges. ...
Article
Full-text available
Background The intensive care unit (ICU) is a separate area in which potential health care services for patients who are in critical condition with detailed observation, monitoring, and advanced treatment than other units. This study aimed to assess the incidence and predictors of inpatient mortality after inpatient treatment was started in Debre Markos Comprehensive Specialized Hospital. Methods A facility-based retrospective cohort study was employed among 384 ICU-admitted patients from December 30, 2020 to January 1, 2022. The collected data were entered into Epi Data version 4.2 and exported to STATA 14.0 for further analysis. The Cox proportional hazard regression model was fitted after checking using the Schoenfeld residual and log-log plot test. A categorical variable with an adjusted hazard ratio of 95% CI was claimed for predictors. Result Overall, 384 admitted adult patients were included in the final analysis with a mean (±SD) age of 42.1 (±17.1) years. At the end of the follow-up period, 150 (39.06%) cases died in the ICU. The overall incidence of the mortality rate was 16.9 (95% CI: 13.7-19.55) per 100 person per day. Epidemiologically, 347 (90.36%) cases were medical illness, 25 (6.51%) surgical, and 12 (3.13%) were obstetric cases, respectively. The median length of inpatient stay was found to be 4.9 (IQR ± 2.8) days. In multivariable analysis; being (+) for human immunodeficiency virus (AHR = 0.59, 95% CI: 0.39-0.91), age ≥65yearas (AHR = 1.61, 95% CI: 1.11-2.32), and admission on weekend-time (AHR = 1.48, 95% CI: 1.06-2.06) were predictors of inpatient death. Conclusion The overall in-hospital mortality rate was significantly higher than in the previous study in this hospital with a short median survival time. The inpatient mortality rate was significantly associated with age ≥65 years, being HIV positive, and admission during weekend time. Therefore, effective intervention strategies should be highly needed for ICU team members for early risk factors prevention.
Article
Introduction: The Neonatal and Pediatric ICU is reserved for highly complex care. The family needs of hospitalized patients, when not met satisfactorily, can intensify their suffering. The objective of the study was to understand the needs in relation to comfort, safety, proximity, information and support of family members of patients admitted to the Neonatal and Pediatric ICU and their satisfaction in relation to such services provided by it. Method: observational study with a descriptive design. The population was made up of family members of patients admitted to the unit from March to August 2020 and their needs were investigated through the application of the Inventory of Needs and Stressors of Family Members in Intensive Care (INEFTI). Results: Of the 71 family members participating in the research, 59.1% did not have knowledge about the clinical diagnosis of their relatives. The needs considered most important are related to Security and Information. The least important ones are Support and Comfort. The needs for greatest satisfaction are related to Safety and Proximity to the patient. The least satisfied with Support and Comfort. Conclusion: The present study suggests that the medical team be accessible and understanding and that they provide complete information to family members about the patients admission diagnosis, as well as the causes and consequences of the disease
Article
Objectives Despite the large burden of critically ill patients in developing countries, mechanical ventilation (MV) is scarce in these low-resource settings. In the absence of data, issues like costs and lack of training are often felt to outweigh the benefits of potential MV implementation in such places. We aimed to investigate the impact and feasibility of MV in a surgical ICU in West Africa. Design This is a 7-month retrospective observational study (from October 25, 2022, to May 25, 2023), covering all patients consecutively admitted to ICU. Setting The NGO EMERGENCY’s hospital in Goderich, Freetown, Sierra Leone. The hospital is a referral center for acute care surgery. Patients Critical patients admitted to the hospital’s ICU. Interventions Following brief, practical training of the nursing staff, one basic mechanical ventilator was installed at the hospital’s ICU, under the supervision of two intensivists. Only patients with a body weight of over 15 kg and who met the “extreme criteria” for MV received this life-saving therapy. Measurements and Main Results Of the 195 files of patients admitted to ICU during the study period, 162 were analyzed. The median age was 16 (interquartile range 7–27) and 48.1% of the population were under 14 years. The most common cause of admission was trauma (58.6%), followed by acute abdomen (33.3%), caustic soda ingestion (6.2%), and burns (1.9%). Of the overall population, 26 patients (16%) underwent MV (88.5% trauma cases vs. 11.5% acute abdomen). Median time on MV was 24 hours (12–64). The mortality rate in the MV group was 30.8% (8/26), while in the overall study population, it was 11.7% (19/162). One potentially life-threatening event of tube obstruction was handled appropriately. Conclusions This study strongly supports the implementation of MV in low-resource settings. In our experience, the consistent benefit of reduced mortality among critical patients largely outweighs the associated challenges.
Article
The origin of the modern intensive care physician is the anesthesiologist. Initially, having expertise in oxygen delivery, anesthesiologists provided care to critically ill patients during polio epidemics and cardiac surgery. Later, an anesthesiologist called for the creation of a new subspecialty which has become known as intensive care.The intensivist is the physician responsible for the total care of the critically ill patient in the intensive care unit. Many studies have shown that the intensivist decreases the mortality and morbidity of the critically ill patient, in addition to improving the efficiency of patient care. Although the intensivist is central to the function of critical care units, the origins of the modern-day intensivist remain elusive and ill defined.In the early 20th century, an anesthesiologist defined “anoxemia” and its treatment in the postoperative period. Later, treatment of hypoxia was improved with oxygen delivery via nasal mask. In the 1950s, the polio epidemic and the development of cardiac surgery led to critically ill patients being collected in large wards. Anesthesiologists played an important role in the care of these patients. In the early 1960s, an anesthesiologist identified the need for the intensivist. This paper explores the development of anesthesiologists into intensivists.
Article
Before the renaissance, death was to be accepted as an act of God. From then on, there was a will to attempt resuscitation. The ability to reverse coma-induced airway obstruction, apnea, and pulselessness began in response to accidents caused by general anesthesia in the late 1800s. Around 1900, knowledge existed about the majority of CPR steps. This knowledge, however, was then not assembled into an effective system because of lack of communication between laboratory researchers, clinicians, and rescuers. Open-chest CPR was effectively practiced in operating rooms during the first half of the 20th century. Anglo-American anesthesiologists co-pioneered trauma resuscitation during World War II. Modern cardiopulmonary–cerebral resuscitation (CPCR), which is now giving every person the ability to challenge death anywhere, has been developed since the 1950s. Through research in Baltimore, the chest-pressure and back-pressure arm-lift methods of artificial ventilation, taught for 100 years, were replaced by backward tilt of the head and direct mouth-to-mouth ventilation, and emergency artificial circulation by sternal compressions was rediscovered. Steps A–B–C of basic life-support were extended—to advanced and prolonged life-support. Anesthesiologists pioneered hospital ICUs almost simultaneously on three continents. In the 1960s and 1970s, several groups initiated CPR education research, the development of training aids, effective resuscitation delivery through emergency medical services (EMS) systems, and the multidisciplinary specialty of critical care medicine (CCM). Since the 1970s and 1980s, cerebral resuscitation potentials after prolonged cardiac arrest have been evaluated with ICU outcome models in large animals and in randomized clinical outcome studies. Pharmacologic strategies have given relatively disappointing results. Mechanism-oriented research escalated. Postarrest CBF promotion improved outcome in animals and patients. A breakthrough came in the 1980s and 1990s with the revival of research into therapeutic hypothermia. Mild resuscitative postarrest hypothermia (which is simple and safe) showed a breakthrough effect, extending the normothermic arrest reversibility limit from 5 to 10 min no-flow. Clinical trials of mild hypothermia are being reported now, with positive results. Animal research has begun into “suspended animation for delayed resuscitation” for temporarily unresuscitable cardiac arrest. Education research, delivery programs, and case registries for ongoing outcome evaluation should get higher priority.
Article
The poliomyelitis epidemic of 1952 in Denmark was a key impetus for the development of modern critical care medicine. Mortality among patients with respiratory failure was dramatically reduced by applying techniques normally used in operating rooms and by placing these patients in a designated area of the hospital, where their condition could be constantly monitored by members of the medical staff. The benefits derived from normalizing abnormal physiological functions in these patients represented a clinical vindication of the 19th-century theories of Claude Bernard, who proposed that systems respond to pathogens by maintaining cellular homeostasis. Much of modern critical care practice . . .