Critical care clinics
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Critical care clinics · Jul 2023
ReviewThinking Clearly: The History of Brain Dysfunction in Critical Illness.
Brain dysfunction during critical illness (ie, delirium and coma) is extremely common, and its lasting effect has only become increasingly understood in the last two decades. Brain dysfunction in the intensive care unit (ICU) is an independent predictor of both increased mortality and long-term impairments in cognition among survivors. As critical care medicine has grown, important insights regarding brain dysfunction in the ICU have shaped our practice including the importance of light sedation and the avoidance of deliriogenic drugs such as benzodiazepines. Best practices are now strategically incorporated in targeted bundles of care like the ICU Liberation Campaign's ABCDEF Bundle.
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Critical care clinics · Jul 2023
ReviewFour Decades of Intensive Care Unit Design Evolution and Thoughts for the Future.
Intensive care unit (ICU) design has changed since the mid-1980s. Targeting timing and incorporation of the dynamic and evolutionary processes inherent in ICU design is not possible nationally. ICU design will continue evolving to incorporate new concepts of best design evidence and practice, better understandings of the needs of patients, visitors and staff, unremitting advances in diagnostic and therapeutic approaches, ICU technologies and informatics, and the ongoing search to best fit ICUs within greater hospital complexes. As the ideal ICU remains a moving target; the design process should include the ability for an ICU to evolve into the future.
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Critical care clinics · Jul 2023
ReviewPalliative Care in the Intensive Care Unit: Past, Present, and Future.
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.
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Critical care clinics · Jul 2023
ReviewDevelopment of the Modern Cardiothoracic Intensive Care Unit and Current Management.
The modern cardiothoracic intensive care unit (CTICU) developed as a result of advances in critical care, cardiology, and cardiac surgery. Patients undergoing cardiac surgery today are sicker, frailer, and have more complex cardiac and noncardiac morbidities. CTICU providers need to understand postoperative implications of different surgical procedures, complications that can occur in CTICU patients, resuscitation protocols for cardiac arrest, and diagnostic and therapeutic interventions such as transesophageal echocardiography and mechanical circulatory support. Optimum CTICU care requires a multidisciplinary team with collaboration between cardiac surgeons and critical care physicians with training and experience in the care of CTICU patients.
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This article gives a historical perspective of visitation in the intensive care unit (ICU) since the establishment of critical care units. Initially, visitors were not allowed because it was thought to be harmful to the patient. ⋯ Virtual visitation was introduced during the pandemic to maintain family presence, but limited evidence suggests that this is not equivalent to in-person visitation. Going forward ICUs and health systems must consider family presence policies that allow for visitation under any circumstance.