Critical Care Informatics
- 1 Introduction
- 2 Perceived Need
- 3 Specialties
- 4 Informatics in Clinical Practice
- 5 Research
- 6 Education
- 7 References
Intensive care medicine involves care of the sickest patients across the age spectrum, from neonates through pediatrics and into adulthood . Patients typically require invasive monitoring or advanced organ support, including invasive ventilation, dialysis, blood pressure support and extracorporeal membranous oxygenation (ECMO). The role of clinical informatics is expanding in the critical care environment, with opportunities to advance clinical care, research and training.
The practice of intensive care has a great need for the application of informatics principles. In a fast-paced clinical environment, errors are unfortunately frequent and often preventable. One study estimated the rate per 1000 patient-days of adverse events at 80.5, and preventable adverse events at 36.2 . Care in the ICU is also expensive, accounting for approximately 1/7th of hospital care and 4.1% of national health expenditures . Monitors and frequent observations generate a vast amount of data, but this data is often not cataloged, stored and mined appropriately to be considered valuable “information” . A major task of informaticists in the ICU will be to aggregate this data into information that can be used by clinicians at the bedside .
The practice of critical care occurs in diferent ...
Medical & Surgical Critical Care
Pediatric Critical Care
The pediatric critical care unit is an intensive care specifically for patients between birth and approximately 18 years of age, and practitioners of this specialty are called "Pediatric Intensivists" . Pediatric intensivists are subspecialty-trained pediatricians who have undergone special training in the care of critically ill children. Despite the commonly-held belief that "children are just little adults", studies have shown repeatidly that critically ill children will demonstrate decreased mortality when cared for by pediatric intensivists as compared to care in an Adult ICU .
Neuro Critical Care
Neuro critical care involves intensive care with a focus on injuries of the nervous system, including stroke, traumatic brain injury and status epilepticus. Typically these units are staffed with providers trained in both neurology and critical care medicine, bringing together the right specialists for the care of these patients.
Not necessarily unique to neuro critical care is the practice of multi-modal monitoring, or the integration of several streams of data into a single monitoring system. For example, important to the care of a seizing patient with a non-invasive airway is both the respiratory monitoring (from a ventilator) and the electro-encephalographic (EEG) signals. Integration of these signals for prediction of patient course is an area of active research.
Neonatalogy is the specialty of medicine tasked with the care of the neonate, often premature or with other complicating medical conditions requiring intensive care . Common conditions include congenital disorders requiring surgery such as congenital diaphragmatic hernia, neonatal seizures, neonatal respiratory distress syndrome and extreme prematurity. Neonatal intensive care units (NICUs) are often designated as "closed" units, meaning they accept only patients delivered at that hospital, or "open" units which accept patients from other hospitals or admitted through the emergency department. In the US, NICUs are classified by the American Academy of Pediatrics as level I, II, III or IV depending on the level of service and specialization they provide 
Maternal & Fetal medicine
One unique informatics challenge with NICUs is the care of linked patients - namely, the mother and baby. Much of the history of the fetus comes from the narrative of the delivery, as well as the maternal medical history. Therefore, careful linking of these charts is helpful for the care of the fetus-turned-patient at the time of delivery. Patient "registration" must occur quickly such that orders may be safely placed on the new patient.
Informatics in Clinical Practice
Jacono FJ, De Georgia MA, Wilson CG, Dick TE, Loparo KA. Data Acquisition and Complex Systems Analysis in Critical Care: Developing the Intensive Care Unit of the Future. Healthcare Engineering. 2010.
- Developing a suite of complex tools including: Dimensional Variance, Linear Properties, Nonlinear Properties, Attractor Properties, Predictability
Tele-Medicine & Remote Monitoring
Tele-medicine in a broad sense enables the practice of medicine in geographically-disparate locations . The ICU environment is an appealing one for telemedicine because of the vast array of monitoring systems limit the need for physically examining the patient - although certainly do not completely remove this need. Hospital systems are using telemedicine systems to evaluate and care for critically ill patients, and research in this field is ongoing 
Despite the promises made by the lay press, not all of intensive care medicine can or should be replaced by a camera and a remote television screen . Hands-on care by nurses, physicians and other skilled professionals will be essential, even as we move towards more tele-medicine solutions.
Virtual PICU (http://vpicu.net/) – Randall Wetzel in UCLA
DRAPER Lab, Columbia PREDICT: Pattern Representation and Evaluation of Data through Integration, Correlation, and Transformation
Databases for Research
MIMIC database (MIMIC III - https://www.ncbi.nlm.nih.gov/pubmed/27219127)
VPS – collaborative sharing environment https://portal.myvps.org/login
Fellowship training is available in critical care and clinical informatics. The Accredication Council for Graduate Medical Education (ACGME)  certifies fellowship training programs that meet criteria for academic rigor as well as institutional support and monitoring. A list of applicable fellowships can be found below:
- Pulmonary & Critical Care Fellowships
- Neonatal - Perinatal Fellowships
- Pediatric Critical Care Fellowships
- Clinical Informatics Fellowships
Societies, Conferences & Meetings
Academic societies relevant to the practice of critial care informatics are listed below, with appropriate links:
- Society of Critical Care in Medicine link
- American Medical Informatics Association (AMIA) link
- AMIA Intensive Care Informatics Working Group link
- Wikipedia: Intensive Care Medicine (Accessed 2017-10-18) Link
- Rothschild JM et al. The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med. 2005 Aug;33(8):1694-700 PMID: 16096443
- Halpern NA & Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010 Jan;38(1):65-71 PMID 19730257
- Schmidt, J. Michael. Lecture: Biomedical Engineering and Informatics Applications in Critical Care. Columbia University Medical Center (Accessed: 2017-10-18) Slides
- Pinsky MR & Dubrawski A. Gleaning knowledge from data in the intensive care unit. Am J Respir Crit Care Med. 2014 Sep 15;190(6):606-10 PMID 25068389
- Martich GD, Waldmann CS & Imhoff M. Clinical informatics in critical care. J Intensive Care Med. 2004 May-Jun;19(3):154-63 PMID: 15154996
- Wikipedia: Pediatric Intensive Care Link
- Czaja, Angela S. Children Are Not Just Little Adults ... Pediatric Critical Care Medicine: February 2016 - Volume 17 - Issue 2 - p 178–180 Link
- Wikipedia: Neonatal Intensive Care Unit Link
- American Academy of Pediatrics, Committee on Fetus and Newborn. Levels of neonatal care. Pediatrics. 2012;130(3):587–597. doi:10.1542/peds.2012-1999 PMID 22926177
- Jastremski CA. Nursing informatics. Issues for critical care medicine. Crit Care Clin. 1999 Jul;15(3):563-76. PMID: 10442263
- Adhikari N & Lapinsky SE. Medical informatics in the intensive care unit: overview of technology assessment. J Crit Care. 2003 Mar;18(1):41-7. PMID: 12640613
- Telemedicine | Medicaid (Accessed 2017-10-18) Link
- Slamon N & Greenspan JS. Considerations When Implementing a Pediatric Telemedicine Program. J Pediatr. 2016 Dec;179:5-6 PMID: 27634628
- The Economist. Prescription for the future: How hospitals could be rebuilt, better than before. April 8, 2017 Link
- Accreditation Council for Graduate Medical Education: Website (Accessed 2017-10-18) Site
Submitted by Adam Dziorny