History of critical care medicine: The past, the present and the future

The term “Critical Care Medicine” was first introduced in the late 1950s at the University of Southern California (USC) from the concept that immediately life-endangered patients, the critically ill and injured, may have substantially better chances of survival if provided with professionally advanced minute-to-minute objective measurements. Such measurements were largely based on “real time” electronic monitoring of vital signs, hemodynamic and respiratory parameters, and complementary measurements on blood and body fluids. Care was increasingly delegated to a new generation of dedicated physicians, professional nurses, therapists, and clinical pharmacists in special care units. Since then, progress in the management of the acutely life-threatened patient has been accelerated by rapid advances in both monitoring and measurement technologies and the interventions that were triggered by them. Intubation and mechanical ventilation, hemodialysis, volume repletation guided by measurement of intravascular pressures and cardiac output, resuscitation by the routine use of chest compression, defibrillation and pacemaker insertion came into general use. These individual techniques had progressively evolved over the preceding decades by anesthesiologists in the operating room and postanesthesia recovery units and by cardiologists in the catheterization laboratory. Conventional methods of observation based on physical examination and largely manual measurement of vital signs at the bedside were therefore increasingly superceded by electronic techniques of quantitative monitoring and measurements.