Finding out that someone you care about is in the hospital is always cause for concern; discovering that he or she has been admitted to the intensive care unit (ICU) can be downright frightening. It means that the patient is suffering from an acute, life-threatening illness or injury requiring the highest level of care available. Nearly 80 percent of people in the U.S. will have a family member or friend with a critical illness or injury that requires this level of care, while two percent will actually be admitted to the ICU as a patient.

How do patients end up in the ICU? They are rarely admitted directly. Instead, they are normally admitted after a visit to the emergency room or immediately after major surgery. A typical ICU can contain patients whose lives are in danger from a broad spectrum of illnesses or traumas. A heart attack, surgical complications, stroke, poisoning, gunshot wounds, burns, and automobile accidents are just a few of the reasons that patients may be admitted to the unit. Some hospitals also have specialized ICUs for patients in particular circumstances, such as neonatal or cardiac intensive care.

It is up to the critical care team of intensivists (ICU physicians), nurses, and technicians to use their expertise and the ICU's specialized equipment to provide the best possible physical care for their patients. The care team also has to be sensitive to the psychological impact of either being a patient in the ICU or visiting someone there. By providing information, reassurance, and support, ICU personnel can do a great deal to ease the stress that accompanies a critical condition.

The appearance of the ICU patient, who is usually attached to multiple machines via various tubes and lines, can contribute to the anxiety of the patient and his or her family. Monitors measure breathing, heart rate, and other body functions, and they often have noisy alarms that alert the ICU staff when those functions go below or above a normal range. An intravenous catheter usually is inserted into the patient's vein so medicine and fluids can be administered as quickly and effectively as possible, while a Foley (urinary) catheter is used to drain urine from the bladder. Depending on the patient's circumstances, an intracranial pressure catheter may be inserted into the brain to monitor brain swelling and drain excess fluid. A mechanical ventilator tube may be inserted into the patient's nose or mouth; patients with serious or long-term respiratory difficulties may even have a tracheostomy tube inserted directly into the neck. It is important to remember that all of this equipment is there to help the patient and should not in and of itself be cause for alarm.

Tonight, we will go inside the ICU (referred to in some hospitals as the critical care unit) and see the amazing resources available to help a hospital's most vulnerable patients. We will hear about the history and development of the intensive care unit in the United States, as well as some of the issues and challenges facing critical care services today. Finally, we will look at some of the biomedical and organizational breakthroughs on the horizon.

Dr. Angus earned his medical degree and completed his residency training in internal medicine at the University of Glasgow in the United Kingdom. Subsequently, he completed a fellowship in critical care medicine combined with a master's in public health degree at the University of Pittsburgh.

Dr. Angus is a member of the Royal College of Physicians and a fellow of the American College of Chest Physicians and the American College of Critical Care Medicine. He has studied the development and application of cost-effectiveness analysis in critical care; the capability and impact of alternative ICU organizational models; traditional and novel ICU risk prediction tools; and the incidence, cost, and short- and long-term outcomes of critical illnesses such as sepsis and respiratory failure.

Dr. Angus has attracted considerable research funding for these studies, authored or co-authored more than 300 publications, and lectured at national and international scientific congresses. Currently, Dr. Angus is leading three large National Institutes of Health (NIH) multicenter studies on the critically ill.

Mitchell P. Fink, M.D.
Watson Professor of Surgery, Anesthesiology, and Critical Care Medicine
Founding Chairman, Department of Critical Care Medicine

Dr. Fink earned his medical degree from the Washington University School of Medicine in St. Louis, Missouri, and completed his internship and residency in surgery at Bethesda Naval Hospital in Maryland.

Dr. Fink has focused his research on alterations in the function of the intestinal barrier due to serious infections or hemorrhagic shock. He has authored more than 160 peer-reviewed publications and 100 invited book chapters and review articles and has edited or co-edited 11 books dealing with various aspects of critical care medicine and the management of trauma and sepsis. He has been a member of the editorial boards of numerous scientific publications and is currently the scientific editor for Critical Care Medicine, the leading journal in the field.

Dr. Fink has been honored with many prestigious awards, including the Millennium Lecturer Award from the Society of Critical Care Medicine in 2000. Dr. Fink co-founded Critical Therapeutics, Inc., a biotechnology company that is developing novel drugs to treat acute life-threatening illnesses, such as septic shock.

Critical Moments: Death and Dying in Intensive Care. Jane E. Seymour. Open University Press, 2001.

Critical Care Nursing: A History. Julie Fairman and Joan E. Lynaugh. University of Pennsylvania Press, 2000.

Hospital Acquired Infection: Causes and Control. Zsolt Filetoth. Whurr Publishers, 2003.

The Intensive Care Unit: What Every Family Need to Know. Steven R. Mohnssen. Robert D. Reed Publishers, 2002.

"ICU: The Episode You Won't Want to Miss." Jason Togyer. PittMed Magazine. May 2003: 25-28.

Mending Bodies, Saving Souls: A History of Hospitals. Guenter B. Risse. Oxford Press, 1999.

www.niaid.nih.gov
The National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health conducts and supports research related to infectious, immunologic, and allergic diseases. Learn more about NIAID research, including sepsis, on the institute's Web site.

www.partnershipforcaring.org/
Partnership for Caring is a national nonprofit organization that partners individuals and organizations to improve palliative care in the United States. The organization offers state-specific information on living wills and medical powers of attorney and operates a national crisis and information hotline dealing with end-of-life issues.

www.sccm.org/
The Society of Critical Care Medicine (SCCM) is a multidisciplinary, multiprofessional organization dedicated to the practice of critical care medicine. SCCM's Web site serves as a clearinghouse for a variety of specialized critical care information for patients, families, and clinicians.

www.survivingsepsis.org/
The Surviving Sepsis Campaign Web site offers basic information about sepsis for the general public. The site explains the three basic forms of sepsis, how to identify the condition, and available treatments.

www.icu-usa.com/
ICU-USA is a private company that maintains computer kiosks in hospitals to provide information for people visiting patients in the ICU. The company's Web site answers questions related to medical conditions, treatments, tests, drugs, medical terms, and other issues specific to the ICU. The site also addresses concerns of patients after they have been released from the ICU.