Intensive care medicine deals with the diagnosis and treatment of life-threatening diseases and conditions. It is closely related to emergency medicine, as intensive medical measures are used to maintain vital functions. The primary goal is to preserve the life of the patient, with the diagnosis being secondary for the time being.
What is intensive care medicine?
Critical care medicine is concerned with the diagnosis and treatment of life-threatening diseases and conditions. The three main aspects of intensive care medicine are monitoring, ventilation, and invasive procedures. In Germany, intensive care medicine was previously not clearly delineated, as it did not comprise an independent specialty, but was assigned to the various sub-specialties of anesthesiology, surgery, internal medicine, neurosurgery, neurology, pediatrics, and cardiac surgery. There is now the “interdisciplinary specialist in anesthesiology and intensive care medicine.” The healthcare sector is seeing a growing number of intensive care centers for intensive therapy, anesthesia, intensive care and intermediate care. They operate under the specialist title “Clinic for Anesthesia and Intensive Care Medicine”. The nursing staff have the specialized advanced training “nurse for anesthesia and intensive care”.
Treatments and therapies
The three main aspects of critical care medicine are monitoring, ventilation, and invasive procedures. Monitoring captures the patient’s vital functions by creating and recording his or her physical data. This includes monitoring cardiac activity, blood pressure, oxygen saturation in various compartments, intracranial pressure (ICP), central nervous pressure (CVP), and pulmonary artery pressure (PAP). The laboratory controls are set up in a close-meshed manner and immediately detect dysfunctions to which the medical staff can react quickly. Ventilation is combined with airway protection. It is performed by tracheotomy or endotracheal intubation. Invasive procedures are the prerequisite for creating access to body cavities and vessels. They are used in organ replacement procedures such as dialysis, extracorporeal oxigenation, and continuous monitoring. Intensive care physicians and nurses work in the intensive care unit, anesthesia, pain management, emergency medicine, intermediate care, ambulance services and the emergency department. Patients who show a life-threatening condition or whose condition can be expected to become threatening are admitted to the intensive care unit. Thus, not only severe diseases lead to intensive medical monitoring and therapy, but also conditions after highly invasive operations. In general, a favorable prognosis must be given, since the aim is to restore vital functions and the associated health, or to achieve a largely autonomous state of the patient. Terminal conditions and diseases do not lead to the intensive care unit, but to palliative medicine. Intensive care medicine treats elementary disorders of respiration, electrolyte balance, hemostasis (blood clotting), various shock states (septic, anaphylactic, hypovolemic, cardiologic) and severe disorders of consciousness. Critical care physicians are also responsible for complex medical conditions such as poisoning, general infections, traumatic brain injury, peritonitis, pancreatitis, neurological disorders (e.g., stroke, severe meningitis, cerebral hemorrhage, myasthenic crisis, subarachnoid hemorrhage, delirium tremens), cardiac disease, multiple organ failure, and renal and pulmonary failure.
Diagnosis and examination methods
Diagnosis confirmation includes all imaging and endoscopic procedures (X-ray, ultrasound, magnetic resonance imaging, CT). Critical care medicine is not synonymous with device medicine. Rather, physicians and medical professionals from a variety of medical professions work together to care for patients. In addition to treatments and therapies familiar from normal wards, critical care medicine uses a wide range of modern equipment to implement its treatment concept. To enable intensive care physicians to monitor the vital functions of their patients, such as heart rate, oxygen levels, respiration, brain activity, circulation and the activity of other organs, they are connected to monitoring devices (monitors).The vital functions are recorded via measuring probes in the form of electrodes and sensors, which transmit this data to the monitoring monitor by means of cabling. There, the recorded data is evaluated and displayed as a curve. The monitoring devices have acoustic and optical alarm signals. For safety reasons, these intensive medical devices react to even the slightest changes. In addition, regular and personal monitoring is carried out by the physicians and nursing staff. Infusion lines are further important instruments of intensive medical care, since many patients require medication or artificial nutrition. This supply takes place via infusion therapy. To ensure that the appropriate medications can be supplied, physicians insert a catheter into the patient’s vein. The nutritional solutions and medications are supplied to the organism via plastic lines. Patients who cannot take in their food independently are fed via a gastric tube. These feeding tubes are inserted into the stomach via the esophagus. Many intensive care patients require a urinary catheter at times for urine removal. Urine is passed through the catheter into a thin plastic tube that provides safe drainage of urine into a collection basin. Ventilators assist the patient’s breathing. The patient is connected to the ventilator via a tube (breathing tube) that is placed through the mouth into the trachea. In this way, oxygen is delivered from the ventilator to the lungs. During this lung supply, the patient cannot speak. However, if he is conscious and responsive, communication is possible via sign boards or sign language. Hemodialysis and hemofiltration (artificial kidney) machines are used for patients with impaired kidney function. They replace the impaired natural kidney activity and enable the necessary blood washing. These devices remove waste products, excess fluid, drug residues and other harmful substances from the body. The connection between the device and the patient’s bloodstream is made via catheters, which direct blood into the device for purification and from there back to the patient. These invasive monitoring methods are supplemented by non-invasive monitoring of the cardiovascular system by means of ECG and blood pressure monitoring, as well as measurement of body temperature and oxygen saturation. To be distinguished from these are the invasive methods of measuring central venous pressure, arterial blood pressure measurement and pulmonary artery catheterization. In addition, automated laboratories assist physicians in collecting frequently required values such as acid-base status, blood gases, hemoglobin and electrolytes in point-of-care testing. For medications, intensivists use analgesics (pain relievers), antiarrhythmics (trachycardic arrhythmias), antidotes (antitoxin, antidote), infectious narcotics, catecholamines (epinephrine, dopamine), relaxants, sedatives (relaxing pharmaceuticals), local anesthetics, nitro preparations, antiastmatics, antihypotensives (against low blood pressure), and spasmolytics/vagolytics (buscopan, atropine sulfate). Patients in intensive care units are at ten times higher risk of infection than patients in normal wards. Favoring factors are age, the underlying disease, concomitant diseases, poor nutritional status, and impaired consciousness. On the therapy side, a large number of measures can lead to a breach of the patient’s immune barrier. Therefore, there are extraordinarily high requirements for a sterile and germ-free environment. For this reason, the wards are equipped with a lock system in which staff and any permitted visitors change their clothes. Medical staff wear a mouth guard to ward off droplet infections and special area clothing. Hands represent the largest reservoir of transmission and therefore must be one hundred percent sterile. Patients with compromised immune systems are transferred to special isolation wards. All equipment used must also be completely sterile and germ-free.
