The design and function of an intensive care unit.

In 1962 the Ministry of Health circulated a report on progressive patient care which was largely concerned with intensive patient care. Since this report, Regional Hospital Boards have been sympathetic to the establishment of intensive care units, and because of their special skill and knowledge anaesthetists have usually been concerned with the planning and establishment of such units. Over a year ago a new intensive care unit was built at this hospital (Lancet, 1964) based upon experience gained over two years work in a unit of three beds situated in the existing cubicles at the entrance to a general medical ward. Work in the new unit has revealed very few mistakes that were not already known before conversion of an existing ward; furthermore, the number of visitors inspecting the facilities suggested that a description of the planning and running of the unit might be of interest. The scanty literature available on this subject shows that such units serve many purposes; some can be regarded as being concerned with little more than postoperative care, and in some hospitals there is the duplication of both a medical and a surgical intensive care unit. It is contended that such concepts are in error and are possibly due to the inadequacy of available definitions of the criteria for intensive care. If the patient requiring intensive care is denned as one requiring mechanical aid to support vital function until the disease process is arrested or ameliorated, then the aims, the planning and control of such units become much simpler. Furthermore, there is no lowering of nursing standards in the acute wards by removal of seriously ill patients not requiring the apparatus and special skills of the intensive care unit. Patients whose diseases are defined in this way may require artificial pulmonary ventilation, haemoor peritoneal dialysis, cardiac pacemaking, or biochemical correction of severe metabolic disorder; they do not suffer from derangement of but one system. Respiratory failure is often associated with renal impairment, and cardiogenic shock brings both renal and pulmonary ventilation/perfusion ratio defects. The patients can, therefore, no longer be treated satisfactorily in the conventional specialist wards in hospitals, and the greatest chance of survival is provided when treatment is undertaken by a team of medical and nursing staff, with the necessary apparatus and skill, advised as necessary by the consultant referring the patient.