Mercy Health Australia

Intensive Care Medicine, by its very nature, has been both technology-reliant and datarich as a specialty from its inception. Born amid a public health crisis, practitioners in this area have often been forced to innovate in desperate circumstances, developing and adopting emerging technologies that are now taken for granted, to manage severely disordered body systems and evaluate the effectiveness of therapies in real-time at the bedside.

Amidst the ubiquity of Intensive Care support in modern hospitals, it is hard to remember that as a specialty, it is not even a century old. Its history is a litany of disruptors incorporating technology into clinical practice in unconventional ways.

Back in 1952, with Copenhagen in the grip of a polio epidemic and paralysis of the breathing muscles a death sentence, Bjorn Ibsen decided to administer positive pressure ventilation through a plastic tube into the windpipe of a dying 12-year-old outside of an operating room environment. She recovered, and the hospital went on to replicate this practice for paralyzed polio patients across specially designated wards, mortality dropped from over 87 percent to under 15 percent and a new medical specialty was born.

The desire to figure out whether the ventilator was working effectively triggered the re-exploration of gas laws, applied thermodynamics and electrochemistry from the 17th to 19th centuries using technologies developed around World War II and culminated in Severing Haus and Bradley’s development of the first blood gas machine, still on display at The Smithsonian. Blood gas analysis and interpretation, much to the chagrin of medical students everywhere, has since become integral to many areas of clinical practice outside the ICU!

When Werner Forssman got himself expelled from medical practice in Berlin for having the temerity to run a long flexible tube up his arm veins to his heart despite prohibitions from his superiors (and then bragging about it in a medical journal!), little did he foresee its future application by Swan and Ganz to measure right heart pressures and its widespread use in intensive care and interventional cardiology circles.

"Intensive care has come a long way using technology innovatively and collecting and interpreting data in real-time to not just make life-saving interventions for individual patients but also transform healthcare into a more evidence-based, data-driven, quality-focused patient-centric system."

Peter Safar first published “ABC of Resuscitation” in 1957 and established the basis for the CPR we perform today. For added measure, his collaboration with Norwegian doll maker Asmund Laerdal led to the development of mannequins still widely used for CPR training and gave birth to an entire field of simulation-based medical education.

The COVID-19 pandemic certainly raised the profile of Intensive Care worldwide. We “social distanced” to “flatten the curve”, measuring “oxygen sats” at home using pulse oximeters- only seen in hospital settings before this- issued by “COVID Home Monitoring” programs or even purchased online! “Supply chain” entered the household lexicon, explaining every shortage- from toilet paper in Australian supermarkets to PPE and oxygen in hospitals. And as the pandemic threatened to overwhelm intensive care resources worldwide, social media images of exhausted healthcare workers struggling to treat extremely sick patients with limited resources became commonplace. Health Departments scrambled to predict and meet resource needs. The Australian and New Zealand Intensive Care Society's response went above and beyond. Besides releasing real-time guidelines for managing the sickest pandemic patients in the highest-risk aerosol exposure environments, it developed a comprehensive live dashboard (Critical Healthcare Resource InformationSystem- CHRIS, now hosted by the Department of Health, Australia) detailing disease load and ICU activity across Australia and New Zealand by jurisdiction, down to individual hospital level, to inform the pandemic response.

Long before the COVID-19 pandemic, however, the benefits of Intensive Care to patients were simply undeniable. Remember, most patients admitted to modern ICUs would likely have died only a few decades ago. Yet in Australia and New Zealand, mortality after ICU admission in the decade leading up to 2019 was under 10 percent.

Behind the glitter of technology, the specialty has shown a strong commitment to improving patient outcomes, safety, and experience across the entire hospital system, together with an ingrained culture of continuous research and innovation. From APACHEs, POSSUMs, and SOFAs for measuring the degree of illness to developing standardized mortality ratios for benchmarking performance, intensivists have collected and mined data indefatigably to develop measurable metrics and unmercifully scrutinize not only their practice, but driven practice change and spearheaded patient safety initiatives, with incremental improvements to clinical outcomes across the entire healthcare landscape.

The introduction of the Medical Emergency Team (MET, a.k.a. Rapid Response Teams- RRT or Critical Care Outreach Teams- CCOT), dubbed “ICU sans frontiers”, in the noughties reduced the relative risk of in-hospital cardiac arrest by 65 percent, of death from in-hospital arrest by 56 percent, and ICU bed days and hospital bed days by 80 percent and 88 percent respectively. Critical care response to deteriorating patients is now incorporated into the National Safety and Quality Health Service’s standards for hospital accreditation in Australia.

Given the high resource utilization for patients sick enough to need ICU support, any potential for datadriven decision-making to enable early identification and intervention (hopefully translating into less resource use) by Intensive Care teams would be welcome. Application of “big data” approaches, using novel multisystem parameters like MEWS, together with centralized displays of automated continuous monitoring devices (increasingly miniaturized and less intrusive to patients) promises to not only improve health outcomes but also reduce nursing and medical workloads, efficiently targeting care to where it’s needed most within the hospital.

In its brief time as a specialty, intensive care has come a long way using technology innovatively and collecting and interpreting data in real-time to not just make life-saving interventions for individual patients but also transform healthcare into a more evidence-based, data-driven, quality-focused patient-centric system.