Recent advances in intensive careBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7231.358 (Published 05 February 2000) Cite this as: BMJ 2000;320:358
- Stephen Stott, consultant in anaesthesia and intensive care (firstname.lastname@example.org)
- Grampian University Hospitals Trust, Aberdeen AB25 2ZN
Intensive care medicine has had its fair share of publicity over the past few years but mainly for reasons of shortness of resources rather than major medical advances. Despite this and the difficulty of doing research in this heterogeneous and relatively small population group, there have been several significant advances in the past few years. This article discusses some of these as well as the advances in training that have recently taken place.
I wrote this review using information from articles found through the Medline database on topics that I selected. Because of space restrictions it cannot be a comprehensive review of all recent advances. Key words used in the database search included nutrition, intensive care, acute respiratory distress syndrome, and tracheostomy
Acute respiratory distress syndrome
It is now over 30 years since the acute respiratory distress syndrome was described, and it is now known to be the extreme end of a continuum of lung injury. A consensus definition in 1994 (box)1 has allowed accurate classification of lung injury and better standardisation in clinical research. The early reported mortality of 60% now seems to be falling, with recent reports of 30-40% from both the United States2 and the United Kingdom,3 but the reasons for this improvement are still unclear. As these patients usually do not die of respiratory failure but of the development of multiple organ failure, no single treatment that may attenuate the lung injury is likely to be responsible for the increased survival. The improvement in general care, attention to areas such as infection and nutrition, and a better understanding of the pathophysiology of the disease process have contributed substantially to the improved survival. Several areas, however, deserve mention.
Mortality from the acute respiratory distress syndrome is decreasing as increased understanding of its pathophysiology leads to targeted treatments