Description of specialty
Intensive care developed following the first large-scale successful use of manual positive pressure ventilation by medical students to treat patients with acute respiratory failure. This occurred during the polio epidemic in Copenhagen in the 1950s. Coupled with the need to provide ventilatory support following cardiac surgery, the first intensive care units appeared in the 1960s. Intensive care has since evolved to provide a wide range of organ support and monitoring and is not just focused on ventilatory support.
Intensive care medicine (ICM) is being shaped by:
- modern technology, which facilitates increasingly sophisticated treatments, resuscitative strategies, patient monitoring and organ support. These practices have been refined by the renewed interest in evidence-based medicine in the early 1990s, with improved outcomes from illnesses such as sepsis (eg the Surviving Sepsis Campaign)
- subspecialties such as neurosciences, cardiac and burns that have a high demand for critical care beds and have developed specialised units for their patients
- a growing recognition that a patient’s survival of critical illness is only the first step with an increasing focus on their rehabilitation and long-term support.
Intensive care in the UK has traditionally been provided by physicians from a variety of backgrounds including anaesthesia, medicine and surgery. Following the formation of the Faculty of Intensive Care Medicine (FICM) in 2010, the ICM certificate of completion of training (CCT) was approved by the GMC. This effectively transformed critical care into a standalone specialty, although the majority of intensive care physicians are and continue to be dual trained. The first edition of Guidelines for the Provision of Intensive Care Services (opens PDF, 2.77MB) was launched in 2015 and represented the first step towards the development of a definitive reference source for the planning and delivery of intensive care services in the UK.