Critical Care Informatics

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Introduction

Intensive care medicine involves care of the sickest patients across the age spectrum, from neonates through pediatrics and into adulthood [1]. 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.

Perceived Need

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 Cite error: Invalid <ref> tag; invalid names, e.g. too many. Care in the ICU is also expensive, accounting for approximately 1/7th of hospital care and 4.1% of national health expenditures [2]. 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” [3]. 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 [4].

Specialties

https://www.ncbi.nlm.nih.gov/pubmed/15154996

Medical Critical Care

Surgical Critical Care

Pediatric Critical Care

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.

Multimodal monitoring

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.

Neonatology

Neonatalogy is the specialty of medicine tasked with the care of the neonate, often premature or with other complicating medical conditions requiring intensive care.

Maternal & Fetal medicine

Nursing Informatics

[1]


Informatics in Clinical Practice

https://www.ncbi.nlm.nih.gov/pubmed/25068389 Gleaning knowledge from critical care

Technologies

https://www.ncbi.nlm.nih.gov/pubmed/12640613

Interoperability

- BedMaster - Novou

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

https://www.ncbi.nlm.nih.gov/pubmed/27634628 Nick Slamon


Research

http://www.mayo.edu/research/labs/clinical-informatics-intensive-care/overview

http://www.rle.mit.edu/incci/

https://www.physionet.org/ - from http://lcp.mit.edu/

Virtual PICU (http://vpicu.net/) – Randall Wetzel in UCLA

DRAPER Lab, Columbia PREDICT: Pattern Representation and Evaluation of Data through Integration, Correlation, and Transformation

http://www.sickkids.ca/Critical-Care/programs-and-services/T3/index.html

Databases for Research

MIMIC database (MIMIC III - https://www.ncbi.nlm.nih.gov/pubmed/27219127)

VPS – collaborative sharing environment https://portal.myvps.org/login

Education

Fellowship training is available in critical care and clinical informatics. The Accredication Council for Graduate Medical Education (ACGME) [5] 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:

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

References

  1. Wikipedia Entry: Intensive Care Medicine (Accessed 2017-10-18) Link
  2. 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
  3. Schmidt, J. Michael. Lecture: Biomedical Engineering and Informatics Applications in Critical Care. Columbia University Medical Center (Accessed: 2017-10-18) Slides
  4. 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
  5. Accreditation Council for Graduate Medical Education: Website (Accessed 2017-10-18) Site

Submitted by Adam Dziorny