There is a border, a thin line of separation that sees life in close contact on one side and death on the other. The commitment of doctors and nurses in this frontier land is obviously to allow life to prevail over death. Life and death are not abstract concepts, categories of thought. However, we had to wait until the 20th century for the concepts of cardiopulmonary rehabilitation and the tools necessary to be practiced to take hold in clinical practice. In 1929 Philip Drinker of the Harvard School of Public Health invented the iron lung.
It was used on a large scale during a polio epidemic in the early 1950s. It consisted of a steel tube closed at one end, while the patient's head protruded from the other side with a collar that prevented the escape of the polio. air. By blowing air into the cylinder and then letting it flow out, the lung functions of the patient who had lost the strength to breathe due to polio were mimicked.
From this moment, thanks to Peter Safar, an Austrian anesthetist, pulmonary ventilation became the basic technique of intensive care. The scientific confirmation of this technique occurred shortly thereafter in Denmark. In 1952, within a few months 2722 patients contracted polio and 316 of these suffered respiratory paralysis. What to do? Bjørn Aage Ibsen created the first intensive care unit in Copenhagen. He had rubber tubes of a suitable size prepared to be positioned through the mouth and reach the lung. Since automatic respirators did not yet exist, he convinced two hundred medical students to manually pump air into patients' lungs. In this way mortality was reduced from 90% to 25%. But he also demonstrated that mouth-to-mouth resuscitation could be performed effectively to save lives.
Obviously in the last 50 years not only the terminology has changed, we talk about Intensive Care, but new knowledge has aimed to identify specificities within the vast field of emergency medicine. There are rightly complementary structures such as cardiology, nephrology, pediatric and post-operative intensive care which must operate in close contact with shared organizational models. A world of Critical Care which, at least in our country, however presents many facets which are expressed in fragmentation and poor coordination. Certainly, advanced models of intensive care, in general, have improved the prognosis of even the most complex cases. Further improvements are thought to come from the early diagnosis and treatment carried out before hospitalisation. Those who deal with organ transplants know that for precisely these reasons they have seen the number of donors reduce. But there is an aspect that is not secondary. Working in these departments is also emotionally tiring, but giving a new life to those who were on the brink of death is an experience that gives meaning to such a complex but fascinating job. Seeing a patient come out of a coma and open his eyes is worth the effort.
However, we are witnessing a flight of many doctors from these departments. Among new graduates, the choice of specializing in emergency medicine remains in last place. The Covid pandemic has resulted in a load of patients with respiratory failure in intensive care. The insufficient number of intensive and semi-intensive facilities has made doctors somewhat helpless to deal with this pandemic. We understood that we need more structures and doctors. This frontier medicine must once again become an ambition for young doctors.
Antonio Barracca
