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An investigation of the development of intensive care of adults in England and Wales

Gilbertson, Alfred (2011) An investigation of the development of intensive care of adults in England and Wales. Doctoral thesis, University of Liverpool.

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Abstract

The development of adult intensive care in England and Wales has been researched using primary and secondary literary sources and the oral history of participants in intensive care in England and Wales from soon after its inception until the present (2011). The development of theory has been inductive. In 1952 Bjørn Ibsen, a Danish anaesthetist, treated patients with bulbo-spinal poliomyelitis (polio) with a regime based on intubation of the trachea (windpipe) and intermittent positive-pressure ventilation (IPPV) of the lungs. This resulted in a reduction of mortality of about fifty percent in patients in Copenhagen with this condition. This dramatic result is considered to have initiated the development of modern intensive care throughout the world. The significance of this event is re-evaluated: IPPV was not new. It was in common use in anaesthesia in 1952. It was not more successful than treatment in advanced negative-pressure cabinet respirators in use in the United States. The use of IPPV in paralytic polio was not inevitable. Nevertheless, IPPV did have advantages that made it generally preferable in intensive care. It was applicable to a wider range of conditions which cause respiratory failure, the equipment required was much less expensive and generally available than advanced cabinet respirators and it allowed unrestricted access to the patient. Ibsen’s contribution was to bring an anaesthetic technique into use in an infectious disease unit and later into intensive care units. He also extended the applicability of IPPV by combining it with the use of relaxant drugs. The development of respiratory support techniques in the 40 years before 1952 is described and it is argued that some of these earlier practitioners should be credited with having practised what would later be called intensive care. For a decade after the introduction of IPPV in paralytic polio and tetanus its use in the United Kingdom was largely by infectious disease physicians, sometimes in collaboration with anaesthetists. The development of the specialty of anaesthesia to a point where anaesthetists were able to become the major participants in intensive care after polio and tetanus had become rare after 1963 is described. Intensive care is not simply a matter of connecting a patient to a mechanical respirator: The part played by nurses in the US and the UK in establishing intensive care units is stressed. Oral histories have shown that medical participation was for many years often by one or two enthusiastic clinicians whose work in intensive care was not given financial or sessional recognition and was in addition to full-time work in their base specialties Funding of units, apart from a contribution for nurses’ salaries, was largely from local or regional budgets, often supported by charitable donations. Since the 1980s intensive care has received government funding and has been recognised nationally and internationally as an independent specialty and full-time medical cover for ICUs has been provided. However, these processes are (in 2011) not complete and further development may be anticipated.

Item Type:Thesis (Doctoral)
Subjects:R Medicine > RC Internal medicine
Departments, Research Centres and Related Units:Academic Faculties, Institutes and Research Centres > Faculty of Medicine > School of Health Sciences
Status:Unpublished
ID Code:4737
Deposited On:07 Aug 2012 08:47
Last Modified:07 Aug 2012 08:47

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