The practice of critical care medicine can be traced back to the 1850s when Florence Nightingale separated critically ill patients from other patients to monitor them closely. This model was later adopted during the Second World War during the treatment of military personnel. In parts of Europe and the US, there was greater use of mechanical ventilation outside the operating room during and after the polio epidemic (1950’s). Over the years, advances in technology have made monitoring equipment affordable.To care for critically ill patients, intensive care units (ICUs)with the necessary equipment and specially trained staff have become an integral part of hospitals around the world.
Over the last few decades, there have been transformative changes in the field of critical care. These changes have been driven by :
- Improved understanding of patho-physiological processes (e.g., Sepsis, ARDS,etc.)
- Technology innovations leading to smaller, accurate,and more user-friendly medical devices
- Advances in information and communication technology
- Changes in societal expectations which encourage a more human approach to treatment
In the not too distant future, critical care will most likely bear little resemblance to what it is today. These are some possibilities in the future.
- ICUs will be Flexible and support Virtual Care
With improvements in primary care and advances in home care, more patients will be treated outside the traditional hospital setting. The severity of illness of patients requiring hospitalization will be higher than it is now. A higher proportion of hospital beds will be ICU beds.
To manage the fluctuations in demand,there will be flexibility to convert ward beds to ICU beds. ICUs would no longer be just a physically separate unit in the hospital, as it is today. They will be a combination of physically separate units, ICU ward beds spread across the hospital,mobile ICU beds, and home ICU beds. Advanced critical care informatics systems will help intensivists monitor the patients from a centralized monitoring center (located within or outside the hospital) or from anywhere using a handheld device. This will be supported by trained nurses stationed at the patient’s bedside.
- Advances in Wireless Biosensor technology will change Patient monitoring
Innovations in nanoscience and battery technology will make biosensors smaller, thinner, lighter,more flexible, cheaper, and consume lesser power. The accuracy, precision, and range of measurements will improve. Currently, biosensors measure some basic vitals like heart rate, oxygen saturation, blood pressure, etc. In the future, a combination of wearable, implantable and digestible sensors will be able to assess blood chemistry, brain activity, the volume of air moving through the lungs, tiny twitches in the diaphragm, and organ functionality, among many other things.
An increased number of patient data parameters will be monitored. This information will be sent through wireless in real-time to a hybrid cloud-based critical care informatics system.Doctors will have access to more real-time patient data than ever before.
- Improved patient experience and clinical outcomes
An ICU today is a maze of wires and a jungle of blinking monitors and beeping alarms. It can be a very disorienting and traumatic experience for the patients, as alarm noise levels are often very high. “Alarm fatigue” at the end of a shift may sometimes cause caregivers to normalize alarms and not react to them. Currently, patients in the ICU are provided care with unnaturally low light levels during the day and with constant interruptions during the night. This can disrupt the patient’s circadian rhythms, leading to fragmented sleep patterns, delayed recovery, and delirium.
In the future, ICUs will be intelligent, virtual, silent, and have less visible equipment. The number of wires and cables will reduce drastically.Patient monitoring will be done using special cameras and simple wireless biosensor systems. Most blood parameters will be measured by per cutaneous sensors or through breath analyzers. Innovations in mechanical ventilation and extra-corporeal devices will redefine the way ventilation is done in the future. Drug delivery will predominantly be done using trans-dermal patches.
Interactive wireless monitors located next to the patient will display the monitored patient data and trends in real-time. Alarms will become more intelligent and will be through visual or haptic signals remotely, at a central monitoring station, or on a handheld device. Intelligent lighting solutions personalized to the patient’s needs will help improve circadian rhythms.
Family members will be able to stay in the ICU wards, helping in the patients’ recovery process.
- AI-based tools will become a necessity
There will be a lot more real-time patient information available from the biosensors than ever before. The intensivists will not have the capacity to process all this information to draw insights into the patient’s condition for follow-up action. To provide real-time insights into this deluge of information, AI-based tools will become a necessity.
With the availability of more training data over the years,AI-based tools will be more precise and accurate. Advancements in “Explainable AI” will provide caregivers insights into how the AI algorithm arrives at an output. This will lead to a broader acceptance and adoption of AI-based tools in the future.
AI-based tools will be used across a broad range of critical care applications. Some examples are to help predict the deterioration in a patient’s condition well ahead of time ( example, sepsis, organ failure, etc.), suggest timely clinical intervention, improving the clinical and operational workflows, predict the length of stay or death, optimizing the nursing workforce, etc.
- The compelling need to use clinical resources more efficiently
The demand-supply gap in the clinical workforce will only increase over the years. Technology will be used extensively to improve the productivity of the clinical workforce. For example, virtualizing critical care can help improve the productivity of intensivists up to six times.
Nursing staff will focus more on clinical activities. All non-clinical tasks like delivering lunch or medication to the patient, housekeeping (for example, sanitizing, cleaning, lighting, laundry, etc,.), moving the patient, basic clinical tasks (for example, medication reminders, simple operation of instruments, etc.) will be done by specially designed robots.
New training methods using AR/VR, digital twin technology-based simulators will improve quality and reduce the time needed to train nurses.
ICU providers will go through a transformation similar to what happened in the airline industry over the last few decades.Currently, several intelligent autopilots and subsystems support the pilot in flying the plane. Pilots spend most of their time managing these intelligent systems and intervene only when required to bring the systems back into harmony. ICUs will go through a similar evolution, providing an intelligent, safer,virtual environment for the patient and the caregivers.
The future of critical care will be influenced by the following factors.
- Increasing challenges concerning infrastructure, access, cost, and quality of care
- Changes in societal behavior triggered by the current covid pandemic
- Innovations in related technologies like AI, robotics, biosensors,etc.
There will be extensive use of technology to improve patient experience and the quality of life of caregivers while using the available resources efficiently to improve clinical outcomes.
Care providers, startups, and technology companies would need to take cognizance of these future possibilities when charting their strategy.
(Srinivas Prasad is Founder and CEO of Neusights and the views expressed in this article are his own)