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The first intensive care unit in the world: Copenhagen 1953


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.
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Review Article
The first intensive care unit in the world: Copenhagen 1953
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,
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
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
3.00 p.m.: An analysis of the patient’s arterial blood
revealed: bicarbonate 24.5, pH 7.51, pCO
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
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
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
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
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
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
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.
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,
Hans Heugh Wandall: Senior Resident, Department of
Surgery I, Kommunehospitalet 1950—56 (later director of the
Institute for Experimental Medicine and Surgery, University of
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.
1. Ibsen B, Kvittingen TD. Arbejdet pa
˚en anæsthesiologisk
observationsafdeling. Nordisk Med 1958; 38: 1349—55.
2. Kirschner M. Zum Neubau der chirurgischen Universita
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:
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.
Preben G. Berthelsen,MD
Department of Anaesthesia
Gentofte Hospital
University of Copenhagen
Niels Andersens Vej 65
DK-2900 Hellerup
P. G. Berthelsen and M. Cronqvist
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 ( 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),
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
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
... For example, in the mid 40's where the physiological instability of the post-operative patient and the dangers of anaesthesia meant that collective organisation of these patients into one specific area, the recovery room, occurred. With the continued hypervigilance of patient monitoring led directly to the birth of the ICU [4,12,13]. Jackson and Cairns ( [14], p2) describe critical care as the "process of looking after patients who either suffer from life threatening conditions or at risk of developing them". Equally they describe the intensive care unit as a "distinct geographical entity in which high staffing ratios, advanced monitoring and organ support can be offered to improve patient morbidity and mortality". ...
... The ICU as a space is mentioned as early as 1923 with the opening of a three-bedded ICU to monitor and treat post-operative neurosurgical patients [4]. It wasn't until the early 1950s that the precursor to the modern ICU came into being as a result of polio epidemic [12,13]). Prior to this, what would be termed intensive care units appears to be simply recovery rooms [3]. ...
... The nature of critical care is perhaps dichotomous and symbiotic at the same time because of the inter-play between the pathology of disease processes and how care is delivered and perceived [1,40]. First, it has often been described as the application of technology to support and measure failing organ systems to determine appropriate treatment options, which would sit easily with the medical model of diagnosis, treatment and cure [12,41,42]. Second, critical care is also viewed from a psychosociospiritual aspect that is seen as the basis of holistic nursing care and practice and last, critical care is seen as the restoration of physical function which is more applicable to the work of allied health in particular physiotherapy. ...
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Objective: The terms critical care and the Intensive Care Unit (ICU) are often used interchangeably to describe a place of care. Defining critical care becomes challenging because of the colloquial use of the term. Using concept analysis allows for the development of definition and meaning. The aim of this concept analysis is to distinguish the use of the term critical care to develop an operational definition which describes what constitutes critical care. Method: Walker and Avant's eight-step approach to concept analysis guided this study. Five databases (CINAHL, Scopus, PubMed, ProQuest Dissertation Abstracts and Medline in EBSCO) were searched for studies related to critical care. The search included both qualitative and quantitative studies written in English and published between 1990 and 2022. Results: Of the 439 papers retrieved, 47 met the inclusion criteria. The defining attributes of critical care included 1) a maladaptive response to illness/injury, 2) admission modelling criteria, 3) advanced medical technologies, and 4) specialised health professionals. Antecedents were associated with illness/injury that progressed to a level of criticality with a significant decline in both physical and psychological functioning. Consequences were identified as either death or survival with/without experiencing post-ICU syndrome. Conclusion: Describing critical care is often challenging because of the highly technical nature of the environment. This conceptual understanding and operational definition will inform future research as to the scope of critical care and allow for the design of robust evaluative instruments to better understand the nature of care in the intensive care environment.
... 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. ...
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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.
... Grâce à ce dispositif et à une chaîne de solidarité humaine de plus de 1 500 étudiants, médecins, pharmaciens, se relayant toutes les 6 heures, les malades ont pu être sauvés après une ventilation qui pour certains s'est prolongée au-delà de 2 ou 3 mois. La mortalité est passée de plus de 80 % à moins de 40 % avec jusqu'à 70 malades ventilés simultanément au pic de l'épidémie [2,4,5]. ...
Positive pressure ventilation was born in the 50's during the polio epidemic and in front of the imperious necessity to take care of a massive influx of patients with acute respiratory failure. Pragmatic technological and organizational new solutions, based on the need, were put in place, thus giving birth to the first intensive care unit (ICU). Subsequently, innovation was organized and industrialized, and ICU ventilators progressed from generation to generation, to cope with the incredible explosion of knowledge about ventilation. From positive expiratory pressure to non-invasive ventilation, ventilators have been modernized, and now onboard multiple treatment possibilities that have transformed the prognosis of ICU patients. The recent COVID-19 pandemic reminded us that the story is definitively not over. Innovative solutions that are more sober and flexible, but just as effective, are emerging to cover the ever-increasing needs.
Critical care pharmacy has evolved rapidly over the last 50 years to keep pace with the rapid technological and knowledge advances that have characterized critical care medicine. The modern-day critical care pharmacist is a highly trained individual well suited for the interprofessional team-based care that critical illness necessitates. Critical care pharmacists improve patient-centered outcomes and reduce health care costs through three domains: direct patient care, indirect patient care, and professional service. Optimizing workload of critical care pharmacists, similar to the professions of medicine and nursing, is a key next step for using evidence-based medicine to improve patient-centered outcomes.
In this article, the authors review the origins of palliative care within the critical care context and describe the evolution of symptom management, shared decision-making, and comfort-focused care in the ICU from the 1970s to the early 2000s. The authors also review the growth of interventional studies in the past 20 years and indicate areas for future study and quality improvement for end-of-life care among the critically ill.
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.
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.
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 . . .