Elsevier

Journal of Critical Care

Volume 37, February 2017, Pages 270-276
Journal of Critical Care

Clinical Potpourri
What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine

https://doi.org/10.1016/j.jcrc.2016.07.015Get rights and content

Abstract

Since their widespread introduction more than half a century ago, intensive care units (ICUs) have become an integral part of the health care system. Although most ICUs are found in high-income countries, they are increasingly a feature of health care systems in low- and middle-income countries. The World Federation of Societies of Intensive and Critical Care Medicine convened a task force whose objective was to answer the question “What is an ICU?” in an internationally meaningful manner and to develop a system for stratifying ICUs on the basis of the intensity of the care they provide. We undertook a scoping review of the peer-reviewed and gray literature to assemble existing models for ICU stratification. Based on these and on discussions among task force members by teleconference and 2 face-to-face meetings, we present a proposed definition and classification of ICUs. An ICU is an organized system for the provision of care to critically ill patients that provides intensive and specialized medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during a period of life-threatening organ system insufficiency. Although an ICU is based in a defined geographic area of a hospital, its activities often extend beyond the walls of the physical space to include the emergency department, hospital ward, and follow-up clinic. A level 1 ICU is capable of providing oxygen, noninvasive monitoring, and more intensive nursing care than on a ward, whereas a level 2 ICU can provide invasive monitoring and basic life support for a short period. A level 3 ICU provides a full spectrum of monitoring and life support technologies, serves as a regional resource for the care of critically ill patients, and may play an active role in developing the specialty of intensive care through research and education. A formal definition and descriptive framework for ICUs can inform health care decision-makers in planning and measuring capacity and provide clinicians and patients with a benchmark to evaluate the level of resources available for clinical care.

Section snippets

Introduction and overview

Florence Nightingale is widely credited with the establishment of the precursor of the contemporary intensive care unit (ICU). During the Crimean War in 1854, she and a team of nurses created an area of the military field hospital that could provide more intensive nursing care for the most severely injured soldiers. From the time of Nightingale to the mid-1950s, intensive care was primarily intensive nursing care. With the development of techniques of hemodialysis and the widespread

Methods

In 2014, the Council of the WFSICCM decided to strike multinational task forces to address key issues in the organization and delivery of intensive care; one of these was to answer the question “What is an ICU?” Invitations were sent to the approximately 80 professional societies that make up the WFSICCM to nominate representatives to serve on these task forces. Additional task force members were selected on the basis of their interest and expertise in the particular themes addressed. The

Global disparities in critical care capacity

A broadly useful definition of intensive care must take into consideration the international variation in capacity to provide care for the acutely ill. Each year, approximately 164 000 patients are admitted to ICUs in England, Wales, and Northern Ireland; of these, 79% survive to leave hospital (https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports/Summary-Statistics). In the United States, there are approximately 4 million ICU admissions per year, and annual critical care expenditures amount to

What is intensive care?

Intensive care, also known as critical care, is a multidisciplinary and interprofessional specialty dedicated to the comprehensive management of patients having, or at risk of developing, acute, life-threatening organ dysfunction. Intensive care uses an array of technologies that provide support of failing organ systems, particularly the lungs, cardiovascular system, and kidneys. Although the specialty has developed expertise in the comprehensive management of disorders such as sepsis and the

What is an ICU?

A global definition of an ICU must acknowledge the wide international variability that currently exists in the capacity to care for the sickest patients in the health care system. In describing the elements that make care intensive and in grouping these to stratify ICUs on the basis of their capacity to provide that care, we recognize that intensive care is not an absolute concept but rather a relative one defined in relation to the realities of a particular health care system that can vary

What is an ICU?

We propose the following definition of an intensive care unit. An intensive care unit (ICU) is an organized system for the provision of care to critically ill patients that provides intensive and specialized medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during a period of acute organ system insufficiency. Although an ICU is based in a defined geographic area of a hospital, its activities often extend beyond

Toward a classification of ICUs

We propose a categorization of ICUs based on a variety of parameters that reflect the potential of the unit to provide excellent and expert care to the most acute seriously ill patients. Stratification is based on 12 variables:

  • 1.

    Availability of skilled medical personnel

  • 2.

    Availability of skilled nursing personnel

  • 3.

    Availability of other specialists—respiratory therapists, physiotherapists, pharmacists, nutritionists, etc

  • 4.

    Capacity to monitor acutely ill patients

  • 5.

    Availability of resources for the support

Challenges and limitations

Our goal is to create descriptive criteria that are relevant throughout the world, recognizing that access to resources is highly variable and that within any given country or region, cultural and professional values and priorities impact heavily on what defines an ICU. Our descriptions should be seen as both aspirational and minimal. We recognize that in many parts of the world, it may be difficult to meet even the criteria for a level 1 ICU. We do not mean to diminish the efforts of those who

Conclusions

An ICU is more than a geographic locale, although it presupposes a dedicated area within the hospital where the sickest patients can be managed by a specialized multidisciplinary professional team. As the specialty of intensive care matures, its domain expands to include prehospital and emergency care, care of sicker patients on the hospital ward, and the rehabilitation and follow-up of patients who have received intensive care services.

The capacity for providing intensive care varies with

Conflicts

The authors have no relevant financial or academic conflicts of interest to declare.

Acknowledgments

This work was supported in part by a grant from the Canadian Institutes for Health Research and by the WFSICCM.

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