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Busulfan (intravenous use)

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Busulfan (intravenous use)

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Busulfan (intravenous use)

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Alpha-Galactosidase A

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vía oral vía oral vía oral intravenous use intravenous use

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oral use oral use oral use intravenous use intravenous use

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Intravenous conditioning treatment - prior to hematopoietic progenitor cell transplantation

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Intravenous conditioning treatment prior to hematopoietic progenitor cell transplantation

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Guidelines to assess efficacy and safety of normal intravenous immunoglobulin products for marketing authorisations

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Guidelines to assess efficacy and safety of normal intravenous immunoglobulin products for marketing authorisations

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Core SPC for Human normal immunoglobulin for intravenous administration (IVIg) Adoptada en junio de 2000

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Core SPC for Human normal immunoglobulin for intravenous administration (IVIg) Adopted June 2000

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Core SPC for Human and anti-D immunoglobulin for intravenous and/or intramuscular use Adoptada en junio de 2000

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Core SPC for Human and anti-D immunoglobulin for intravenous and/or intramuscular use Adopted June 2000

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Note for guidance on the Clinical investigation of human normal immunoglobulin for intravenous administration (IVIg) Adoptada en junio de 2000

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Note for guidance on the Clinical investigation of human normal immunoglobulin for intravenous administration (IVIg) Adopted June 2000

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Note for guidance on the Clinical investigation of human anti-D immunoglobulin for intravenous and/or intramuscular use Adoptada en junio de 2000

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Note for guidance on the Clinical investigation of human anti-D immunoglobulin for intravenous and/or intramuscular use Adopted June 2000

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Midazolam administrado por vía intravenousa (1 mg dosis única)/ Tenofovir alafenamida (25 mg una vez al día)

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Intravenously administered midazolam (1 mg single dose)/ Tenofovir alafenamide (25 mg once daily)

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Coautor de: "Evidence for inhibition by brain serotonin of mouse killing behaviour in rats ", Nature, 1971; "Evidence for dopamine receptors mediating sedation in the mouse brain ", Nature, 1976; "Postsynaptic receptors are not essential for dopaminergic feedback regulation ", Nature, 1977; "Localization of nigral dopamine-sensitive adenylate cyclase on neurons originating from the corpus striatum ", Science, 1977; "Intranigral kainic acid is evidence that nigral non-dopaminergic neurones control posture ", Nature, 1977; "Drugs abused by humans preferentially increase synaptic dopamine concentrations in the mesolimbic system of freely moving rats ", Proceedings of the National Academy of Sciences of the United States of America, 1988; "Intravenous cocaine, morphine, and amphetamine preferentially increase extracellular dopamine in the `shell' as compared with the `core' of the rat nucleus accumbens ", Proceedings of the National Academy of Sciences of the United States of America, 1995; "Effects of nicotine on the nucleus accumbens and similarity to those of addictive drugs ", Nature, 1996; "Cannabinoid and heroin activation of mesolimbic dopamine transmission by a common mu1 opioid receptor mechanism ", Science, 1977.

Englisch

Co-author of: "Evidence for inhibition by brain serotonin of mouse killing behaviour in rats ", Nature, 1971; "Evidence for dopamine receptors mediating sedation in the mouse brain ", Nature, 1976; "Postsynaptic receptors are not essential for dopaminergic feedback regulation ", Nature, 1977; "Localization of nigral dopamine-sensitive adenylate cyclase on neurons originating from the corpus striatum ", Science, 1977; "Intranigral kainic acid is evidence that nigral nondopaminergic neurones control posture ", Nature, 1977; "Drugs abused by humans preferentially increase synaptic dopamine concentrations in the mesolimbic system of freely moving rats ", Proceedings of the National Academy of Sciences of the United States of America, 1988; "Intravenous cocaine, morphine, and amphetamine preferentially increase extracellular dopamine in the `shell' as compared with the `core' of the rat nucleus accumbens ", Proceedings of the National Academy of Sciences of the United States of America, 1995; "Effects of nicotine on the nucleus accumbens and similarity to those of addictive drugs ", Nature, 1996; "Cannabinoid and heroin activation of mesolimbic dopamine transmission by a common mu1 opioid receptor mechanism ", Science, 1977.

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Coautor del Informe Nacional sobre el Uso Indebido de Drogas elaborado por el Ministerio Italiano del Interior para el Observatorio Europeo de la Droga y las Toxicomanías; evaluador de cinco publicaciones internacionales sobre abuso de sustancias y psiquiatría; contribución en más de 40 publicaciones en revistas científicas de medicina (1994-2005), entre las que cabe mencionar: "Aggressive responding in abstinent heroin addicts: neuroendocrine and personality correlates ", Progress in Psycho-Neuropharmacology and Biology; "Substance use among high-school students: relationship with temperament, personality traits and parental care perception ", Substance Use and Misuse, 2004; "Long-term methadone maintenance effectiveness: psychosocial and pharmacological variables ", Journal of Substance Abuse Treatment, 2003; "Effects of ecstacy on dopamine system function in humans ", Behavioural Brain Research, 2002; "Intravenous flumazemil versus oxazepam tapering in the treatment of benzodiazepine withdrawal: a randomized placebo-controlled study ", Addiction Biology, 2002; Quaglio G., Lugoboni F., Fornasiero A., Lechi A., Gerra G., Mezzelani P., "Dependence on zolpidem: two case reports of detoxification with flumazenil infusion ", International Clinical Psychopharmacology, 2005; Berto D., Tartari M., Tabacchi B., Gerra G., Tamburino G., "Dual diagnosis within Italian prisons - some preliminary data ", International Journal of Prisoners Health, 2005.

Englisch

Co-author of the Italian Ministry of Interior of the National Report on Drug Abuse for the European Monitoring Centre on Drugs and Drug Addiction; referee of five international journals on substance abuse and psychiatry; contributed to over 40 publications in scientific medical journals (1994-2005), including: "Aggressive responding in abstinent heroin addicts: neuroendocrine and personality correlates ", Progress in Psycho-Neuropharmacology and Biology; "Substance use among high-school students: relationship with temperament, personality traits and parental care perception ", Substance Use and Misuse, 2004; "Long-term methadone maintenance effectiveness: psychosocial and pharmacological variables ", Journal of Substance Abuse Treatment, 2003; "Effects of ecstacy on dopamine system function in humans ", Behavioural Brain Research, 2002; "Intravenous flumazemil versus oxazepam tapering in the treatment of benzodiazepine withdrawal: a randomized placebo-controlled study ", Addiction Biology, 2002; Quaglio G., Lugoboni F., Fornasiero A., Lechi A., Gerra G., Mezzelani P. "Dependence on zolpidem: two case reports of detoxification with flumazenil infusion ", International Clinical Psychopharmacology, 2005; Berto D., Tartari M., Tabacchi B., Gerra G., Tamburino G., "Dual diagnosis within Italian prisons -- some preliminary data ", International Journal of Prisoners Health, 2005.

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" LP/CD (Estrus Records - 1993)* "Destroy all astromen" LP/CD (Estrus Records - 1994)* "Project Infinity" LP/CD (Estrus Records - 1995)* "Intravenous Television Continuum]]" LP/CD (One Louder Records - 1996)* "Experiment Zero" LP/CD (Touch & Go Records - 1996)* "Made from Technetium" LP/CD (Touch & Go Records, 1997)* "EEVIAC Operational Index and Reference Guide, Including Other Modern Computational Devices" LP/CD (Epitaph Europe and Touch & Go Records - 1999)* "A Spectrum of Infinite Scale" 2x10"/CD (Epitaph Europe and Touch & Go Records - 2000)* "A Spectrum of Finite Scale" (distribuido en las presentaciones en vivo) (Zerotec - 2001)=== Sencillos/EP ===* "Possession by Remote Control" 7" (Homo Habilis records - 1992)* "Amazing Thrills!

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" LP/CD (Estrus Records - 1993)*"Project Infinity" LP/CD (Estrus Records - 1995)*"Intravenous Television Continuum" LP/CD (One Louder Records - 1996) CD (Australian reissue: Au-Go-Go Records - 1997)*"Experiment Zero" LP/CD (Touch & Go Records - 1996)*"Made from Technetium" LP/CD (Touch & Go Records, One Louder, and Au-Go-Go Records, 1997)*"EEVIAC Operational Index and Reference Guide, Including Other Modern Computational Devices" LP/CD (Epitaph Europe and Touch & Go Records - 1999)*"A Spectrum of Infinite Scale" 2x10"/CD (Epitaph Europe and Touch & Go Records - 2000)*"A Spectrum of Finite Scale" Tour-Only CD (Zerotec - 2001)*"Defcon 5...4...3...2...1" LP/CD (Communicating Vessels/Chunklet] - 2013)===Singles/EPs===*"Possession by Remote Control" 7" (Homo Habilis records - 1992)*"Amazing Thrills!

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traductor de googleIntensive care medicine From Wikipedia, the free encyclopedia (Redirected from Intensive-care medicine) For the academic journal, see Intensive Care Medicine (journal). "CICU" redirects here. For the radio station, see CICU-FM. "Critical care medicine" redirects here. For the academic journal, see Critical Care Medicine (journal). "Intensive Care" redirects here. For the album by pop singer Robbie Williams, see Intensive Care (album). This article includes a list of references, but its sources remain unclear because it has insufficient inline citations. Please help to improve this article by introducing more precise citations. (July 2009) Mechanical ventilation may be required if a patient's unassisted breathing is insufficient to oxygenate the blood. Intensive care medicine or critical care medicine is a branch of medicine concerned with the diagnosis and management of life-threatening conditions requiring sophisticated organ support and invasive monitoring. Contents 1 Overview 2 Organ systems 3 Equipment and systems 4 Medical specialties 5 History 5.1 Florence Nightingale era 5.2 Dandy era 5.3 Ibsen era 5.4 Safar era 6 See also 7 Notes 8 References 9 External links Overview Patients requiring intensive care may require support for instability (hypertension/hypotension), airway or respiratory compromise (such as ventilator support), acute renal failure, potentially lethal cardiac arrhythmias, or the cumulative effects of multiple organ failure, more commonly referred to now as multiple organ dysfunction syndrome. They may also be admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit. Intensive care is usually only offered to those whose condition is potentially reversible and who have a good chance of surviving with intensive care support.[citation needed] A prime requisite for admission to an intensive care unit (ICU) is that the underlying condition can be overcome.[citation needed] Medical studies suggest a relation between ICU volume and quality of care for mechanically ventilated patients.[1] After adjustment for severity of illness, demographic variables, and characteristics of the ICUs (including staffing by intensivists), higher ICU volume was significantly associated with lower ICU and hospital mortality rates. For example, adjusted ICU mortality (for a patient at average predicted risk for ICU death) was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, and 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually. Hospitals with intermediate numbers of patients had outcomes between these extremes. In general, it is the most expensive, technologically advanced and resource-intensive area of medical care. In the United States, estimates of the 2000 expenditure for critical care medicine ranged from US$15–55 billion. During that year, critical care medicine accounted for 0.56% of GDP, 4.2% of national health expenditure and about 13% of hospital costs.[2] Organ systems Intensive care usually takes a system by system approach to treatment, rather than the SOAP (subjective, objective, analysis, plan) approach of high dependency care. The nine key systems (see below) are each considered on an observation-intervention-impression basis to produce a daily plan. As well as the key systems, intensive care treatment raises other issues including psychological health, pressure points, mobilisation and physiotherapy, and secondary infections. The nine key IC systems are (alphabetically): cardiovascular system, central nervous system, endocrine system, gastro-intestinal tract (and nutritional condition), hematology, microbiology (including sepsis status), peripheries (and skin), renal (and metabolic), respiratory system. The provision of intensive care is, in general, administered in a specialized unit of a hospital called the intensive care unit (ICU) or critical care unit (CCU). Many hospitals also have designated intensive care areas for certain specialities of medicine, such as the coronary intensive care unit (CCU or sometimes CICU, depending on hospital) for heart disease, medical intensive care unit (MICU), surgical intensive care unit (SICU), pediatric intensive care unit (PICU), neuroscience critical care unit (NCCU), overnight intensive-recovery (OIR), shock/trauma intensive-care unit (STICU), neonatal intensive care unit (NICU), and other units as dictated by the needs and available resources of each hospital. The naming is not rigidly standardized. For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive care resources (see below) were brought to the room of the patient that needed the additional monitoring, care, and resources. It became rapidly evident, however, that a fixed location where intensive care resources and personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital. Equipment and systems An endotracheal tube Common equipment in an intensive care unit (ICU) includes mechanical ventilation to assist breathing through an endotracheal tube or a tracheotomy; hemofiltration equipment for acute renal failure; monitoring equipment; intravenous lines for drug infusions fluids or total parenteral nutrition, nasogastric tubes, suction pumps, drains and catheters; and a wide array of drugs including inotropes, sedatives, Medical specialties Critical care medicine is a relatively new but increasingly important medical specialty. Physicians with training in critical care medicine are referred to as intensivists.[3] In the United States, the specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine, pediatrics, anesthesiology, surgery or emergency medicine. US board certification in critical care medicine is available through all five specialty boards. Intensivists with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, cardiology, infectious disease, or nephrology. The American Society of Critical Care Medicine is a well-established multiprofessional society for practitioners working in the ICU including nurses, respriatory therapists, and physicians. Most medical research has demonstrated that ICU care provided by intensivists produces better outcomes and more cost-effective care.[4] This has led the Leapfrog Group to make a primary recommendation that all ICU patients be managed or co-managed by a dedicated intensivist who is exclusively responsible for patients in one ICU. However, in the US, there is a critical shortage of intensivists and most hospitals lack this critical physician team member. Other members of the critical care team may also pursue additional training in critical care medicine as intensivists. Respiratory therapists may pursue additional education and training leading to credentialing in adult critical care (ACCS) and neonatal and pediatric (NPS) specialties. Nurses may pursue additional education and training in critical care medicine leading to certification as a CCRN by the American Association of Critical Care Nurses. Paramedics are certified to levels of CCEMT-P, PNCCT-P, CCP-C and/or FP-C depending upon their speciality (e.g. air, ground, adult, pediatric and/or neonatal medicine). Nutrition in the intensive care unit presents unique challenges and critical care nutrition is rapidly becoming a subspecialty for dieticians who can pursue additional training and achieve certification in enteral and parenteral nutrition through the American Society for Parenteral and Enteral Nutrition (ASPEN). Pharmacists may pursue additional training in a postgraduate residency and become certified as critical care pharmacists. Patient management in intensive care differs significantly between countries. In countries such as Australia and New Zealand, where intensive care medicine is a well-established speciality, many larger ICUs are described as "closed". In a closed unit the intensive care specialist takes on the senior role where the patient's primary physician now acts as a consultant. The advantage of this system is a more coordinated management of the patient based on a team who work exclusively in ICU. Other countries have open ICUs, where the primary physician chooses to admit and, in general, makes the management decisions. There is increasingly strong evidence that "closed" intensive care units staffed by intensivists provide better outcomes for patients.[5][6] In veterinary medicine, critical care medicine is recognized as a specialty and is closely allied with emergency medicine. Board-certified veterinary critical care specialists are known as criticalists, and generally are employed in referral institutions or universities. History Florence Nightingale era Florence Nightingale The ICU's roots can be traced back to the Monitoring Unit of critical patients through nurse Florence Nightingale. The Crimean War began in 1853 when Britain, France, and the Ottoman Empire (Turkey) declared war on Russia. Because of the lack of critical care and the high rate of infection, there was a high mortality rate of hospitalised soldiers, reaching as high as 40% of the deaths recorded during the war. Upon arriving, and practicing, the mortality rate fell to 2%. Nightingale contracted typhoid, and returned in 1856 from the war. A school of nursing dedicated to her was formed in 1859 in England. The school was recognised for its professional value and technical calibre, receiving prizes throughout the British government. The school of nursing was established in Saint Thomas Hospital, as a one-year course, and was given to doctors. It used theoretical and practical lessons, as opposed to purely academic lessons. Nightingale's work, and the school, paved the way for intensive care medicine. Dandy era Walter Edward Dandy was born in Sedalia, Missouri. He received his BA in 1907 through the University of Missouri and his M.D. in 1910 through the Johns Hopkins University School of Medicine. Dandy worked one year with Dr. Harvey Cushing in the Hunterian Laboratory of Johns Hopkins before entering its boarding school and residence in the Johns Hopkins Hospital. He worked in the Johns Hopkins College in 1914 and remained there until his death in 1946. One of the most important contributions he made for neurosurgery was the air method in ventriculography, in which the cerebrospinal fluid is substituted with air to help an image form on an X-Ray of the ventricular space in the brain. This technique was extremely successful for identifying brain injuries. Dr. Dandy was also a pioneer in the advances in operations for illnesses of the brain affecting the glossopharyngeal as well as Ménière's syndrome, and he published studies that show that high activity can cause sciatic pain. Dandy created the first ICU in the world, 03 beds in Boston in 1926. Ibsen era Bjørn Aage Ibsen (1915–2007) graduated in 1940 from medical school at the University of Copenhagen and trained in anesthesiology from 1949 to 1950 at the Massachusetts General Hospital, Boston. He became involved in the 1952 poliomyelitis outbreak in Denmark,[7] where 2722 patients developed the illness in a 6-month period, with 316 suffering respiratory or airway paralysis. Treatment had involved the use of the few negative pressure respirators available, but these devices, while helpful, were limited and did not protect against aspiration of secretions. Ibsen changed management directly, instituting protracted positive pressure ventilation by means of intubation into the trachea, and enlisting 200 medical students to manually pump oxygen and air into the patients lungs.[8] At this time Carl-Gunnar Engström had developed one of the first positive pressure volume controlled ventilators, which eventually replaced the medical students. In this fashion, mortality declined from 90% to around 25%. Patients were managed in 3 special 35 bed areas, which aided charting and other management. In 1953, Ibsen set up what became the world's first Medical/Surgical ICU in a converted student nurse classroom in Kommunehospitalet (The Municipal Hospital) in Copenhagen,[7] and provided one of the first accounts of the management of tetanus with muscle relaxants and controlled ventilation. In 1954 Ibsen was elected Head of the Department of Anaesthesiology at that institution. He jointly authored the first known account of ICU management principles in Nordisk Medicin, September 18, 1958: ‘Arbejdet på en Anæsthesiologisk Observationsafdeling’ (‘The Work in an Anaesthesiologic Observation Unit’) with Tone Dahl Kvittingen from Norway. He died in 2007. Safar era The first surgical ICU was established in Baltimore, and, in 1962, in the University of Pittsburgh, the first Critical Care Residency was established in the United States. In 1970, the Society of Critical Care Medicine was formed.[9] See also Portal icon Medicine portal Critical care nursing GOMER Respiratory monitoring Notes Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O'Brien CR, Rubenfeld GD., JM; Goss, CH; Heagerty, PJ; Kramer, AA; O'Brien, CR; Rubenfeld, GD (2006). "Hospital volume and the outcomes of mechanical ventilation". The New England Journal of Medicine 355 (1): 41–50. doi:10.1056/NEJMsa053993. PMID 16822995. Halpern, Neil A.; Pastores, Stephen M.; Greenstein, Robert J. (June 2004). "Critical care medicine in the United States 1985–2000: An analysis of bed numbers, use, and costs". Critical Care Medicine 32 (6): 1254–1259. doi:10.1097/01.CCM.0000128577.31689.4C. PMID 15187502. [dead link] [1]. Healthcare Financial Management Association. "Association between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit". Annals of Internal Medicine. 3 June 2008. Volume 148, Issue 11. pp. 801–809. Manthous CA, Amoateng-Adjepong Y, al-Kharrat T, Jacob B, Alnuaimat HM, Chatila W, Hall JB., CA; Amoateng-Adjepong, Y; Al-Kharrat, T; Jacob, B; Alnuaimat, HM; Chatila, W; Hall, JB (1997). "Effects of a medical intensivist on patient care in a community teaching hospital". Mayo Clinic Proceedings (Abstract) 72 (5): 391–9. doi:10.4065/72.5.391. PMID 9146680. Hanson CW 3rd, Deutschman CS, Anderson HL 3rd, Reilly PM, Behringer EC, Schwab CW, Price J., 3rd; Deutschman, CS; Anderson Hl, 3rd; Reilly, PM; Behringer, EC; Schwab, CW; Price, J (1999). "Effects of an organized critical care service on outcomes and resource utilization: a cohort study". Critical Care Medicine (Abstract) 27 (2): 270–4. doi:10.1097/00003246-199902000-00030. PMID 10075049. "The Danish anaesthesiologist Björn Ibsen a pioneer of long-term ventilation on the upper airways, Louise Reisner-Sénélar, 2009" (PDF format; requires Adobe Reader). Reisner-Sénélar, Louise (2011). "The Birth of Intensive Care Medicine: Björn Ibsen’s Records" (PDF format; requires Adobe Reader).Intensive Care Medicine. Retrieved 2 October 2012. history reference: Brazilian Society of Critical Care SOBRATI Video:ICU History Historical photos References Intensive Care Medicine by Irwin and Rippe Civetta, Taylor, and Kirby's Critical Care The ICU Book by Marino Procedures and Techniques in Intensive Care Medicine by Irwin and Rippe Halpern, NA, Pastores, SM, Greenstein, RJ (June 2004). "Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs.". Critical Care Medicine 32 (6): 1254–9. doi:10.1097/01.CCM.0000128577.31689.4C. PMID 15187502.. History reference: Brazilian Society of Intensive Care - SOBRATI History Society of Critical Care Medicine Reynolds, H.N.; Rogove, H.; Bander, J.; McCambridge, M. et al. (December 2011). "A working lexicon for the tele-intensive care unit: We need to define tele-intensive care unit to grow and understand it". Telemedicine and e-Health. 17 (10): 773–783. doi:10.1089/tmj.2011.0045. Olson, Terrah; Brasel, Karen; Redmann, Andrew; Alexander, G.; Schwarze, Margaret (January 2013). "Surgeon-Reported Conflict With Intensivists About Postoperative Goals of Care". JAMA Surgery. 148 (1): 29–35. doi:10.1001/jamasurgery.2013.403. External links Wikimedia Commons has media related to Intensive-care medicine. Society of Critical Care Medicine Veterinary Emergency And Critical Care Society ESICM : European Society of Intensive Care Medicine ESPNIC: The society for paediatric and neonatal intensive care healthcare professionals in Europe UK Intensive Care Society Scottish Intensive Care Society Hong Kong Society of Critical Care Medicine Chinese Society of Critical Care Medicine Taiwan Society of Critical Care Medicine From Iron Lungs to Intensive Care, Royal Institution debate, February 2012 [show] v t e Intensive care medicine [show] v t e Medicine Rod of Asclepius2.svgMedicine portal Categories: Intensive care medicine Medical specialties Navigation menu Create account Log in Article Talk Read Edit View history Main page Contents Featured content Current events Random article Donate to Wikipedia Wikimedia Shop Interaction Help About Wikipedia Community portal Recent changes Contact page Tools What links here Related changes Upload file Special pages Permanent link Page information Wikidata item Cite this page Print/export Create a book Download as PDF Printable version Languages العربية Български Català Deutsch Español Esperanto Euskara فارسی Français 한국어 Hrvatski Italiano Nederlands नेपाली 日本語 Norsk bokmål Polski Português Română Simple English Svenska Türkçe Edit links This page was last modified on 28 November 2014, at 09:14. 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google trIntensive care medicine From Wikipedia, the free encyclopedia (Redirected from Intensive-care medicine) For the academic journal, see Intensive Care Medicine (journal). "CICU" redirects here. For the radio station, see CICU-FM. "Critical care medicine" redirects here. For the academic journal, see Critical Care Medicine (journal). "Intensive Care" redirects here. For the album by pop singer Robbie Williams, see Intensive Care (album). This article includes a list of references, but its sources remain unclear because it has insufficient inline citations. Please help to improve this article by introducing more precise citations. (July 2009) Mechanical ventilation may be required if a patient's unassisted breathing is insufficient to oxygenate the blood. Intensive care medicine or critical care medicine is a branch of medicine concerned with the diagnosis and management of life-threatening conditions requiring sophisticated organ support and invasive monitoring. Contents 1 Overview 2 Organ systems 3 Equipment and systems 4 Medical specialties 5 History 5.1 Florence Nightingale era 5.2 Dandy era 5.3 Ibsen era 5.4 Safar era 6 See also 7 Notes 8 References 9 External links Overview Patients requiring intensive care may require support for instability (hypertension/hypotension), airway or respiratory compromise (such as ventilator support), acute renal failure, potentially lethal cardiac arrhythmias, or the cumulative effects of multiple organ failure, more commonly referred to now as multiple organ dysfunction syndrome. They may also be admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit. Intensive care is usually only offered to those whose condition is potentially reversible and who have a good chance of surviving with intensive care support.[citation needed] A prime requisite for admission to an intensive care unit (ICU) is that the underlying condition can be overcome.[citation needed] Medical studies suggest a relation between ICU volume and quality of care for mechanically ventilated patients.[1] After adjustment for severity of illness, demographic variables, and characteristics of the ICUs (including staffing by intensivists), higher ICU volume was significantly associated with lower ICU and hospital mortality rates. For example, adjusted ICU mortality (for a patient at average predicted risk for ICU death) was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, and 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually. Hospitals with intermediate numbers of patients had outcomes between these extremes. In general, it is the most expensive, technologically advanced and resource-intensive area of medical care. In the United States, estimates of the 2000 expenditure for critical care medicine ranged from US$15–55 billion. During that year, critical care medicine accounted for 0.56% of GDP, 4.2% of national health expenditure and about 13% of hospital costs.[2] Organ systems Intensive care usually takes a system by system approach to treatment, rather than the SOAP (subjective, objective, analysis, plan) approach of high dependency care. The nine key systems (see below) are each considered on an observation-intervention-impression basis to produce a daily plan. As well as the key systems, intensive care treatment raises other issues including psychological health, pressure points, mobilisation and physiotherapy, and secondary infections. The nine key IC systems are (alphabetically): cardiovascular system, central nervous system, endocrine system, gastro-intestinal tract (and nutritional condition), hematology, microbiology (including sepsis status), peripheries (and skin), renal (and metabolic), respiratory system. The provision of intensive care is, in general, administered in a specialized unit of a hospital called the intensive care unit (ICU) or critical care unit (CCU). Many hospitals also have designated intensive care areas for certain specialities of medicine, such as the coronary intensive care unit (CCU or sometimes CICU, depending on hospital) for heart disease, medical intensive care unit (MICU), surgical intensive care unit (SICU), pediatric intensive care unit (PICU), neuroscience critical care unit (NCCU), overnight intensive-recovery (OIR), shock/trauma intensive-care unit (STICU), neonatal intensive care unit (NICU), and other units as dictated by the needs and available resources of each hospital. The naming is not rigidly standardized. For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive care resources (see below) were brought to the room of the patient that needed the additional monitoring, care, and resources. It became rapidly evident, however, that a fixed location where intensive care resources and personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital. Equipment and systems An endotracheal tube Common equipment in an intensive care unit (ICU) includes mechanical ventilation to assist breathing through an endotracheal tube or a tracheotomy; hemofiltration equipment for acute renal failure; monitoring equipment; intravenous lines for drug infusions fluids or total parenteral nutrition, nasogastric tubes, suction pumps, drains and catheters; and a wide array of drugs including inotropes, sedatives, Medical specialties Critical care medicine is a relatively new but increasingly important medical specialty. Physicians with training in critical care medicine are referred to as intensivists.[3] In the United States, the specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine, pediatrics, anesthesiology, surgery or emergency medicine. US board certification in critical care medicine is available through all five specialty boards. Intensivists with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, cardiology, infectious disease, or nephrology. The American Society of Critical Care Medicine is a well-established multiprofessional society for practitioners working in the ICU including nurses, respriatory therapists, and physicians. Most medical research has demonstrated that ICU care provided by intensivists produces better outcomes and more cost-effective care.[4] This has led the Leapfrog Group to make a primary recommendation that all ICU patients be managed or co-managed by a dedicated intensivist who is exclusively responsible for patients in one ICU. However, in the US, there is a critical shortage of intensivists and most hospitals lack this critical physician team member. Other members of the critical care team may also pursue additional training in critical care medicine as intensivists. Respiratory therapists may pursue additional education and training leading to credentialing in adult critical care (ACCS) and neonatal and pediatric (NPS) specialties. Nurses may pursue additional education and training in critical care medicine leading to certification as a CCRN by the American Association of Critical Care Nurses. Paramedics are certified to levels of CCEMT-P, PNCCT-P, CCP-C and/or FP-C depending upon their speciality (e.g. air, ground, adult, pediatric and/or neonatal medicine). Nutrition in the intensive care unit presents unique challenges and critical care nutrition is rapidly becoming a subspecialty for dieticians who can pursue additional training and achieve certification in enteral and parenteral nutrition through the American Society for Parenteral and Enteral Nutrition (ASPEN). Pharmacists may pursue additional training in a postgraduate residency and become certified as critical care pharmacists. Patient management in intensive care differs significantly between countries. In countries such as Australia and New Zealand, where intensive care medicine is a well-established speciality, many larger ICUs are described as "closed". In a closed unit the intensive care specialist takes on the senior role where the patient's primary physician now acts as a consultant. The advantage of this system is a more coordinated management of the patient based on a team who work exclusively in ICU. Other countries have open ICUs, where the primary physician chooses to admit and, in general, makes the management decisions. There is increasingly strong evidence that "closed" intensive care units staffed by intensivists provide better outcomes for patients.[5][6] In veterinary medicine, critical care medicine is recognized as a specialty and is closely allied with emergency medicine. Board-certified veterinary critical care specialists are known as criticalists, and generally are employed in referral institutions or universities. History Florence Nightingale era Florence Nightingale The ICU's roots can be traced back to the Monitoring Unit of critical patients through nurse Florence Nightingale. The Crimean War began in 1853 when Britain, France, and the Ottoman Empire (Turkey) declared war on Russia. Because of the lack of critical care and the high rate of infection, there was a high mortality rate of hospitalised soldiers, reaching as high as 40% of the deaths recorded during the war. Upon arriving, and practicing, the mortality rate fell to 2%. Nightingale contracted typhoid, and returned in 1856 from the war. A school of nursing dedicated to her was formed in 1859 in England. The school was recognised for its professional value and technical calibre, receiving prizes throughout the British government. The school of nursing was established in Saint Thomas Hospital, as a one-year course, and was given to doctors. It used theoretical and practical lessons, as opposed to purely academic lessons. Nightingale's work, and the school, paved the way for intensive care medicine. Dandy era Walter Edward Dandy was born in Sedalia, Missouri. He received his BA in 1907 through the University of Missouri and his M.D. in 1910 through the Johns Hopkins University School of Medicine. Dandy worked one year with Dr. Harvey Cushing in the Hunterian Laboratory of Johns Hopkins before entering its boarding school and residence in the Johns Hopkins Hospital. He worked in the Johns Hopkins College in 1914 and remained there until his death in 1946. One of the most important contributions he made for neurosurgery was the air method in ventriculography, in which the cerebrospinal fluid is substituted with air to help an image form on an X-Ray of the ventricular space in the brain. This technique was extremely successful for identifying brain injuries. Dr. Dandy was also a pioneer in the advances in operations for illnesses of the brain affecting the glossopharyngeal as well as Ménière's syndrome, and he published studies that show that high activity can cause sciatic pain. Dandy created the first ICU in the world, 03 beds in Boston in 1926. Ibsen era Bjørn Aage Ibsen (1915–2007) graduated in 1940 from medical school at the University of Copenhagen and trained in anesthesiology from 1949 to 1950 at the Massachusetts General Hospital, Boston. He became involved in the 1952 poliomyelitis outbreak in Denmark,[7] where 2722 patients developed the illness in a 6-month period, with 316 suffering respiratory or airway paralysis. Treatment had involved the use of the few negative pressure respirators available, but these devices, while helpful, were limited and did not protect against aspiration of secretions. Ibsen changed management directly, instituting protracted positive pressure ventilation by means of intubation into the trachea, and enlisting 200 medical students to manually pump oxygen and air into the patients lungs.[8] At this time Carl-Gunnar Engström had developed one of the first positive pressure volume controlled ventilators, which eventually replaced the medical students. In this fashion, mortality declined from 90% to around 25%. Patients were managed in 3 special 35 bed areas, which aided charting and other management. In 1953, Ibsen set up what became the world's first Medical/Surgical ICU in a converted student nurse classroom in Kommunehospitalet (The Municipal Hospital) in Copenhagen,[7] and provided one of the first accounts of the management of tetanus with muscle relaxants and controlled ventilation. In 1954 Ibsen was elected Head of the Department of Anaesthesiology at that institution. He jointly authored the first known account of ICU management principles in Nordisk Medicin, September 18, 1958: ‘Arbejdet på en Anæsthesiologisk Observationsafdeling’ (‘The Work in an Anaesthesiologic Observation Unit’) with Tone Dahl Kvittingen from Norway. He died in 2007. Safar era The first surgical ICU was established in Baltimore, and, in 1962, in the University of Pittsburgh, the first Critical Care Residency was established in the United States. In 1970, the Society of Critical Care Medicine was formed.[9] See also Portal icon Medicine portal Critical care nursing GOMER Respiratory monitoring Notes Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O'Brien CR, Rubenfeld GD., JM; Goss, CH; Heagerty, PJ; Kramer, AA; O'Brien, CR; Rubenfeld, GD (2006). "Hospital volume and the outcomes of mechanical ventilation". The New England Journal of Medicine 355 (1): 41–50. doi:10.1056/NEJMsa053993. PMID 16822995. Halpern, Neil A.; Pastores, Stephen M.; Greenstein, Robert J. (June 2004). "Critical care medicine in the United States 1985–2000: An analysis of bed numbers, use, and costs". Critical Care Medicine 32 (6): 1254–1259. doi:10.1097/01.CCM.0000128577.31689.4C. PMID 15187502. [dead link] [1]. Healthcare Financial Management Association. "Association between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit". Annals of Internal Medicine. 3 June 2008. Volume 148, Issue 11. pp. 801–809. Manthous CA, Amoateng-Adjepong Y, al-Kharrat T, Jacob B, Alnuaimat HM, Chatila W, Hall JB., CA; Amoateng-Adjepong, Y; Al-Kharrat, T; Jacob, B; Alnuaimat, HM; Chatila, W; Hall, JB (1997). "Effects of a medical intensivist on patient care in a community teaching hospital". Mayo Clinic Proceedings (Abstract) 72 (5): 391–9. doi:10.4065/72.5.391. PMID 9146680. Hanson CW 3rd, Deutschman CS, Anderson HL 3rd, Reilly PM, Behringer EC, Schwab CW, Price J., 3rd; Deutschman, CS; Anderson Hl, 3rd; Reilly, PM; Behringer, EC; Schwab, CW; Price, J (1999). "Effects of an organized critical care service on outcomes and resource utilization: a cohort study". Critical Care Medicine (Abstract) 27 (2): 270–4. doi:10.1097/00003246-199902000-00030. PMID 10075049. "The Danish anaesthesiologist Björn Ibsen a pioneer of long-term ventilation on the upper airways, Louise Reisner-Sénélar, 2009" (PDF format; requires Adobe Reader). Reisner-Sénélar, Louise (2011). "The Birth of Intensive Care Medicine: Björn Ibsen’s Records" (PDF format; requires Adobe Reader).Intensive Care Medicine. Retrieved 2 October 2012. history reference: Brazilian Society of Critical Care SOBRATI Video:ICU History Historical photos References Intensive Care Medicine by Irwin and Rippe Civetta, Taylor, and Kirby's Critical Care The ICU Book by Marino Procedures and Techniques in Intensive Care Medicine by Irwin and Rippe Halpern, NA, Pastores, SM, Greenstein, RJ (June 2004). "Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs.". Critical Care Medicine 32 (6): 1254–9. doi:10.1097/01.CCM.0000128577.31689.4C. PMID 15187502.. History reference: Brazilian Society of Intensive Care - SOBRATI History Society of Critical Care Medicine Reynolds, H.N.; Rogove, H.; Bander, J.; McCambridge, M. et al. (December 2011). "A working lexicon for the tele-intensive care unit: We need to define tele-intensive care unit to grow and understand it". Telemedicine and e-Health. 17 (10): 773–783. doi:10.1089/tmj.2011.0045. Olson, Terrah; Brasel, Karen; Redmann, Andrew; Alexander, G.; Schwarze, Margaret (January 2013). "Surgeon-Reported Conflict With Intensivists About Postoperative Goals of Care". JAMA Surgery. 148 (1): 29–35. doi:10.1001/jamasurgery.2013.403. External links Wikimedia Commons has media related to Intensive-care medicine. Society of Critical Care Medicine Veterinary Emergency And Critical Care Society ESICM : European Society of Intensive Care Medicine ESPNIC: The society for paediatric and neonatal intensive care healthcare professionals in Europe UK Intensive Care Society Scottish Intensive Care Society Hong Kong Society of Critical Care Medicine Chinese Society of Critical Care Medicine Taiwan Society of Critical Care Medicine From Iron Lungs to Intensive Care, Royal Institution debate, February 2012 [show] v t e Intensive care medicine [show] v t e Medicine Rod of Asclepius2.svgMedicine portal Categories: Intensive care medicine Medical specialties Navigation menu Create account Log in Article Talk Read Edit View history Main page Contents Featured content Current events Random article Donate to Wikipedia Wikimedia Shop Interaction Help About Wikipedia Community portal Recent changes Contact page Tools What links here Related changes Upload file Special pages Permanent link Page information Wikidata item Cite this page Print/export Create a book Download as PDF Printable version Languages العربية Български Català Deutsch Español Esperanto Euskara فارسی Français 한국어 Hrvatski Italiano Nederlands नेपाली 日本語 Norsk bokmål Polski Português Română Simple English Svenska Türkçe Edit links This page was last modified on 28 November 2014, at 09:14. 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