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In 1958, Dr Max Harry Weil and Dr Hebert Shubin opened a four-bed shock ward in LA County - USC Medical Center, Los Angeles, CA, USA to improve the recognition and treatment of serious complications in critically ill patients. In the 1950s, several large polio epidemics, notably in Copenhagen, led to the opening of respiratory units for the many patients requiring mechanical ventilation. Other surgical units followed these examples, such that by 1960 almost all hospitals had a recovery unit attached to their operating rooms.ĭuring the Second World War, specialized shock units were used to provide efficient resuscitation for the large numbers of severely injured soldiers. In 1930, Dr Martin Kirschner designed and built a combined postoperative recovery/intensive care ward in the surgical unit at the University of Tubingen, Germany. In 1923, Dr Walter E Dandy opened a special three-bed unit for the more critically ill postoperative neurosurgical patients at the Johns Hopkins Hospital in Baltimore, MD, USA, using specially trained nurses to help monitor and manage them. During the Crimean War in the 1850s, Florence Nightingale demanded that the most seriously ill patients were placed in beds near to the nursing station so that they could be watched more closely, creating an early focus on the importance of a separate geographical area for critically ill patients. There are several key figures and events commonly associated with the origin of critical care medicine and development of ICUs, although many other unrecognized individuals have certainly contributed to the development of this field. The concept of critical care and realization of the need for a separate specialty in terms of medical and nursing skills and physical unit position evolved over time as it gradually became apparent that seriously ill or injured patients could benefit from closer attention than was provided to less severely ill patients this growing realization came at a time when improvements in technology, monitoring, and therapeutics were enabling greater numbers of such patients to survive. In this article we will look back at where we have come from before briefly reflecting on where critical care medicine is likely to be going in the future. The process of care has also evolved slowly but surely and the changes here have perhaps had the greatest impact on outcomes, with improved teamwork and specialist training, reduced iatrogenicity, earlier patient mobilization, more personal care of the patient and their families, and so forth. Advances in therapeutics have been less dramatic and are less obvious, but are nevertheless present there have perhaps not been many (or any) dramatic changes that have altered critical care practice overnight, but, rather, evolution has come in a succession of small forward-moving steps. Particularly striking also have been the improvements in our understanding of diseases and their pathophysiology. Looking back over the years since the first ICUs were developed, we can clearly see how critical care medicine has developed in terms of technology, with modern respirators replacing the bulky iron lungs of the past, modern ultrasound machines providing instant imaging at the bedside, and modern monitoring systems enabling non-invasive assessment of multiple variables. With the ICU set to occupy an increasingly important place in hospitals worldwide, we must learn from the past and wisely embrace new developments in technology, therapeutics, and process, to ensure that the goals of critical care medicine are met in the future. Critical care medicine is one of the fastest-growing hospital specialties and, looking back, it is clear just how far we have come in such a relatively short period of time. Progress in therapeutics has been less dramatic, but process of care has improved steadily with important changes, including less iatrogenicity, better communication with patients and families, and improved teamwork, which have helped improve outcomes for ICU patients. Since those early days, huge improvements have been made in terms of technological advances and understanding of the pathophysiology and pathogenesis of the disease processes that affect critically ill patients.
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The first ICUs were established in the late 1950s and the specialty of critical care medicine began to develop.