Progress in intensive care medicine has been considerable over the past quarter century, accomplished usually by a succession of small steps rather than by any one dramatic change, and linked to advances in health care across other disciplines. Importantly, we have learned that not everything that improves physiologic measures improves survival; thus, physiologic surrogates need to be tested in large-scale trials whenever feasible. Indeed, prospective randomized clinical trials are ongoing to clarify many of the areas of confusion and debate highlighted in this document, and further studies will be needed to evaluate supportive care modalities as well as new pharmacologic interventions. read
Intensive care medicine has become a recognizable identity, with a unique knowledge base and sophisticated skill set, which requires considerable health-care resources to be delivered optimally. Until recently, words such as “performance measurement,” “accountability,” “management,” and “leadership” were not part of our traditional vocabulary. However, today we are beginning to measure what we do, to set goals, and to make plans to achieve them within our ICUs and in the context of the hospitals and broader health-care systems in which we work. The need for ICU beds has increased substantially over time and will continue to do so as a result of our aging population. Reflecting on our past and building on our strengths, the next 25 years promise to be exciting and challenging for all involved in intensive care medicine. Diuretic use has decreased in recent years, as it may worsen renal function, especially in the presence of hypovolemia. The so-called renal-dose dopamine has not been demonstrated to produce outcome benefit, and has been largely abandoned.