Computers in critical care: opportunities and challenges

Treating acutely ill patients in intensive care units (ICUs) requires assimilating large amounts of patient data. The computer can help process these data and display information in easy to understand formats. Also, knowledge-based systems can provide advice in diagnosis and treatment of common disorders in the ICU. For effective use of computers, systems must be integrated into the total hospital information system and computer data must logically become the primary medical record. Standards are being developed to aid in this process. Although computers have been used in the ICU for 25 years, most hospitals still use the paper medical record. Prototype systems such as the HELP, CARE, and PDMS systems are described. They are integrated ICU systems for computerizing most of the traditional functions in the ICU. Several commercial information management products are also described along with recently developed computerized drug and fluid delivery systems. Finally, prototype knowledge-based programs are presented that provide advice to the clinician on such topics as acid-base balance, hemodynamic monitoring, and shock management.