[Intensive care medicine today]

Abstract

Physicians, nurses and many other allied health professions join in intensive care as a team for the treatment of patients whose vital functions are either endangered or impaired. Apart from continuous monitoring, which represents the smallest common denominator of all types of intensive-care treatment, intensive-care therapy also encompasses continuous treatment and support of failing organ functions and likewise continuous intensive nursing. The complexity of intensive-care medicine is a strong argument against intensive-care becoming a medical specialty of its own. Nevertheless, the coordination of intensive care-medicine by an experienced intensive care physician is of utmost importance. The present situation in intensive-care medicine is characterised by an increasing tension between new and fascinating medical possibilities (such as right and left ventricular assistance device systems, liver support, pharmacologic treatment of sepsis, avoidance of the complications of critical illness) on the one hand, and limited budgets on the other hand. This conflict is reflected by two basic fears within the population: firstly, the fear that not everything medically possible is being done for the patient due to economic reasons, secondly, a fear of futile treatment at the end of life, merely prolonging inevitable death. Accordingly, ethical questions regarding intensive-care are emerging at all levels of the health system.