Intensive Care “Sans Frontières”

Abstract

The specialty of intensive care has made remarkable progress in a relatively short time. Intensive care units (ICUs) now play a crucial role in acute hospitals, supporting patients who have life-threatening conditions, such as trauma and severe infections, as well as maintaining life after major surgery. Since the earliest admissions, there has been a subtle but compelling change in the nature of patients admitted to hospitals and ICUs who are now older with increasing number of co-morbidities and undergo more complex interventions with a higher incidence of complications. This chapter will discuss some of the implications of the changing hospital population.

References

  1. 1.
    Lassen HC (1953) A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen with special reference to the treatment of acute respiratory insufficiency. Lancet 1:37–41PubMedCrossRefGoogle Scholar
  2. 2.
    Population Division, Department of Economic and Social Affairs. United Nations Secretariat. Long-range world population projections based on 1998 revision. Available at : http://www.un.org/esa/population/publications/longrange/longrange.htm. Accessed Nov 2013
  3. 3.
    World Health Organization. The World Health Report 1998: Life in the 21st century – a vision for all. Available at: http://www.who.int/whr/1998/en/ Accessed Nov 2013
  4. 4.
    Hensher M, Edwards N, Stokes R (1999) The hospital of the future. International trends in the provision and utilization of hospital care. BMJ 219:845–848CrossRefGoogle Scholar
  5. 5.
    Hillman K (1999) The changing role of acute-care hospitals. Med J Aust 170:325–328PubMedGoogle Scholar
  6. 6.
    Hillman K (1998) Restructuring hospital services. Med J Aust 169:239PubMedGoogle Scholar
  7. 7.
    Herring AA, Gind AA, Fahimi J et al (2013) Increasing critical care admissions from U.S. emergency departments. Crit Care Med 14:1197–1204CrossRefGoogle Scholar
  8. 8.
    Oeppen J, Vaupel JW (2002) Demography. Broken limits to life expectancy. Science 296:1029–1031PubMedCrossRefGoogle Scholar
  9. 9.
    Fowler RA, Adhikari NH, Bhagwanjee S (2008) Clinical review: critical care in the global context – disparities in burden of illness, access, and economics. Crit Care 12:225PubMedCrossRefGoogle Scholar
  10. 10.
    Nguyen YL, Angus DC, Boumendil A, Guidet B (2011) The challenge of admitting the very elderly to intensive care. Ann Intensive Care 1:29PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Bagshaw SM, Webb SA, Delaney A et al (2009) Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 13:R45PubMedCrossRefGoogle Scholar
  12. 12.
    Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr, Committee on manpower for Pulmonary and Critical Care Societies (2000) Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 284:2762–2770PubMedCrossRefGoogle Scholar
  13. 13.
    De Rooji SE, Govers A, Korevaar JC, Abu-Hanna A, Levi M, de Jonge E (2006) Short-term and long-term mortality in very elderly patients admitted to an intensive care unit. Intensive Care Med 32:1039–1044CrossRefGoogle Scholar
  14. 14.
    Kaarlola A, Tallgren M, Pettila V (2006) Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med 34:2120–2126PubMedCrossRefGoogle Scholar
  15. 15.
    Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY (2003) Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 29:2137–2143PubMedCrossRefGoogle Scholar
  16. 16.
    Rooji SE, Abu-Hanna A, Levi M, de Jonge E (2005) Factors that predict outcome of intensive care treatment in very elderly patients: a review. Crit Care 9:R307–R314CrossRefGoogle Scholar
  17. 17.
    McDermid RC, Stelfox HT, Bagshaw SM (2011) Frailty in the critically ill: a novel concept. Crit Care 15:301PubMedCrossRefGoogle Scholar
  18. 18.
    Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J 173:489–495CrossRefGoogle Scholar
  19. 19.
    Bergman HB, Ferrucci L, Guralnik J et al (2007) Frailty, an emerging research and clinical paradigm: issues and controversies. J Gerontol A Biol Sci Med Sc 62:731–737CrossRefGoogle Scholar
  20. 20.
    Kaufman SR (1994) The social construction of frailty: An anthropological perspective. J Aging Stud 8:45–58CrossRefGoogle Scholar
  21. 21.
    Kaethler Y, Molnar FJ, Mitchell SL, Soucie P, Man-Son-Hing M (2003) Defining the concept of frailty : a survey of multi-disciplinary health professionals. Geriatr Today 6:26–31Google Scholar
  22. 22.
    Rockwood K, Mitnitski AB, MacKnight C (2002) Some mathematical models of frailty and their clinical implications. Rev Clin Gerontol 12:109–117CrossRefGoogle Scholar
  23. 23.
    CSHA Working Group (1994) Canadian Study of Health and Aging: study methods and prevalence of dementia. CMAJ 150:899–913Google Scholar
  24. 24.
    CSHA Working Group (2000) The incidence of dementia in Canada: the Canadian Study of Health and Aging Working Group. Neurology 55:66–73CrossRefGoogle Scholar
  25. 25.
    Rockwood K, Wolfson C, McDowell I (2001) The Canadian Study of Health and Aging: organizational lessons from a national, multicenter, epidemiologic study. Int Psychogeriatr 13(Suppl 1):233–7PubMedCrossRefGoogle Scholar
  26. 26.
    Donini-Lenhoff FG, Hedrick HL (2000) Growth of specialization in graduate medical education. JAMA 284:1284–1289PubMedCrossRefGoogle Scholar
  27. 27.
    McQuillan P, Pilkington S, Allan A et al (1998) Confidential inquiry into quality of care before admission to intensive care. BMJ 316:1853–1858PubMedCrossRefGoogle Scholar
  28. 28.
    Schein RMH, Hazday N, Pena M, Ruben BH, Sprung CL (1990) Clinical antecedents to in-hospital cardiopulmonary arrest. Chest 98:1388–1392PubMedCrossRefGoogle Scholar
  29. 29.
    Hillman KM, Bristow PJ, Chey T et al (2001) Antecedents to hospital deaths. Intern Med J 31:343–348PubMedCrossRefGoogle Scholar
  30. 30.
    Hillman KM, Bristow PJ, Chey T et al (2002) Duration of life-threatening antecedents prior to intensive care admission. Intensive Care Med 28:1629–1634PubMedCrossRefGoogle Scholar
  31. 31.
    Hourihan F, Bishop G, Hillman KM, Daffurn K, Lee A (1995) The medical emergency team: a new strategy to identify and intervene in high risk patients. Clin Intensive Care 6:269–272Google Scholar
  32. 32.
    Calzavacca P, Licari E, Tee A et al (2010) The impact of rapid response system on delayed emergency team activation patient characteristics and outcomes – a follow-up study. Resuscitation 81:31–35PubMedCrossRefGoogle Scholar
  33. 33.
    Hillman K (2002) Critical care without walls. Curr Opin Crit Care 8:594–599PubMedCrossRefGoogle Scholar
  34. 34.
    Buist M, Bernard S, Nguyen TV, Moore G, Anderson J (2004) Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation 62:137–141PubMedCrossRefGoogle Scholar
  35. 35.
    Jones DA, McIntyre T, Baldwin I, Merder I, Kattula A, Bellomo R (2007) The medical emergency team and end-of-life care: a pilot study. Crit Care Resusc 9:151–156PubMedGoogle Scholar
  36. 36.
    Flabouris A, Chen J, Hillman K et al (2010) Timing and interventions of emergency teams during the MERIT study. Resuscitation 81:25–30PubMedCrossRefGoogle Scholar
  37. 37.
    Chen J, Bellomo R, Flabouris A et al (2009) The relationship between early emergency team calls and serious adverse events. Crit Care Med 37:148–153PubMedCrossRefGoogle Scholar
  38. 38.
    Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C (2010) Rapid response teams. A systematic review and meta-analysis. Arch Intern Med 170:18–26PubMedCrossRefGoogle Scholar
  39. 39.
    Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM (2013) Rapid-response systems as a patient safety strategy. Ann Intern Med 158:417–425PubMedCrossRefGoogle Scholar
  40. 40.
    Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM (2011) Comparison of medical admissions to intensive care units in the united States and United Kingdom. Am J Respir Crit Care Med 183:1666–1673PubMedCrossRefGoogle Scholar
  41. 41.
    Eastman N, Philips B, Rhodes A (2010) Triaging for adult critical care in the event of overwhelming need. Intensive Care Med 36:1076–1082PubMedCrossRefGoogle Scholar
  42. 42.
    Angus DC, Barnato AE, Linde-Zwirble WT et al (2004) Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 32:638–643PubMedCrossRefGoogle Scholar
  43. 43.
    Parr MJA, Hadfield JH, Flabouris A, Bishop G, Hillman K (2001) The medical emergency team: 12 month analysis of reasons for activation, immediate outcome and not-for-resuscitation orders. Resuscitation 50:39–44PubMedCrossRefGoogle Scholar
  44. 44.
    Chen J, Flabouris A, Bellomo R et al (2008) The medical emergency team system and not-for-resuscitation orders: results from the MERIT study. Resuscitation 79:391–397PubMedCrossRefGoogle Scholar
  45. 45.
    Hillman K (2010) dying safety. Int J Qual Health care 22:339–340PubMedCrossRefGoogle Scholar
  46. 46.
    Lorenz KA, Lynn J, Dy SM et al (2008) Improving palliative care at the end of life: a systematic review. Ann Intern Med 148:147–159PubMedCrossRefGoogle Scholar
  47. 47.
    Jones D, Bagshaw SM, Barrett J et al (2012) The role of the medical emergency team in end-of-life care: a multicentre prospective observational study. Crit Care Med 40:98–103PubMedCrossRefGoogle Scholar
  48. 48.
    Lubitz J, Cai L, Kramarow E, Lentzner H (2003) Health, life expectancy, and healthcare spending among the elderly. N Engl J Med 349:1048–1055PubMedCrossRefGoogle Scholar
  49. 49.
    Hapern NA, Pastores SM (2010) Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med 38:65–71CrossRefGoogle Scholar
  50. 50.
    Hapern NA (2009) Can the costs of critical care be controlled? Curr Opin Crit Care 15:591–596CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.The Simpson Center for Health Services Research, SWS Clinical School and Liverpool Hospital, affiliated with the Australian Institute of Health InnovationUniversity of New South WalesLiverpoolAustralia
  2. 2.Center for Clinical Governance Research, Australian Institute of Health InnovationUniversity of New South WalesSydneyAustralia

Personalised recommendations