For most of us, critical care used to consist of directly applying physiological and pathophysiological knowledge - which we so proudly and diligently acquired during medical school - in the real world. Pulmonary, cardiac, renal, and later metabolic functions were the concerns of the day and their dysfunction comprised the major determinants of disease. Introducing a new dimension, Pronovost et al.  showed us that team efforts make a great contribution towards improving critical care outcomes. Since Bedford observed the postoperative long-term confusional state back in 1955 , we have come a long way, to understand that the acute impairment of cognitive functions is not only an annoying side issue which is difficult to deal with on the critical care ward, but that it all too often determines the outcome of patients when all other organ functions should have been under control. Defining this 'sixth vital sign' necessitated some evolutionary development in that international terminology had to be agreed on - a process that is still underway. Despite international clarification by means of the International Statistical Classification of Diseases (ICD)-10 and the Diagnostic and Statistical Manual of Mental Disorders (DSM), there is no real gold-standard for diagnosing acute confusional state. © 2009 Springer-Verlag New York.
Mendeley saves you time finding and organizing research
Choose a citation style from the tabs below