Abstract
The intensive care unit (ICU) was initially developed in the 1950s to treat patients
who required invasive respiratory support and hemodynamic resuscitation. Since the
beginning, ICU medicine has focused on maintaining sufficient arterial blood flow
and oxygenation to provide adequate tissue oxygen delivery to forestall or reverse
organ failure. Over time, ICU medicine became more intensive, with the administration
of many diagnostic tests and monitors, invasive procedures, and treatments, often
with scant evidence of benefit associated with them. An alternative perspective holds
that ICU patients may represent a group of patients that is especially vulnerable
to iatrogenic harm. We outline a case that presents common ICU dilemmas and discusses
current data that propose that “less is more” when making key diagnostic or therapeutic
choices in the ICU. Further, we assert that providers should skeptically consider
common ICU interventions, trying to account for the potential unintended consequences
of interventions. Finally, we suggest that the guiding principle of ICU medicine should
be primum non nocere: in delicate situations, it may be better not to do something, or even to do nothing,
rather than risk causing harm.
Keywords
intensive care unit - iatrogenic injury - transfusions - resuscitation - arterial
catheters - risk–benefit
