Critical care clinics
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The first ICU in Toronto was opened at the Toronto General Hospital as a "Respiratory Unit" in 1958. The early days of this unit have been described in various articles published at the time, such as a description in the Canadian Medical Assn. Journal of the establishment of the Unit itself, including the 4 sine qua nons for intensive care. This article will focus particularly on some of the significant issues that arose in the initial years between the opening of the unit in 1958 and the arrival of clinically available blood gas measurement in the early 1960s.
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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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Critical care clinics · Jul 2023
ReviewFrom Strict Bedrest to Early Mobilization: A History of Physiotherapy in the Intensive Care Unit.
Critically ill patients are at risk of post-intensive care syndrome, including physical, cognitive, and psychological sequelae. Physiotherapists are rehabilitation experts who focus on restoring strength, physical function, and exercise capacity. ⋯ Physiotherapists are assuming more prominent roles in clinical and research leadership, with opportunities for wider interdisciplinary collaboration. This paper reviews the evolution of critical care from a rehabilitation perspective, highlights relevant research milestones, and proposes future opportunities for improving survivorship outcomes.
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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
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.