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AAS Historia Primera UCI 2003
AAS Historia Primera UCI 2003
Review Article
After an extensive survey of the medical literature we present Accepted for publication 4 September 2003
compelling evidence that the first intensive care unit was
established at Kommunehospitalet in Copenhagen in Decem- Key words: Critical care therapy; critical care unit; history;
ber 1953. The pioneer was the Danish anaesthetist Bjrn Ibsen. intensive care therapy; intensive care unit; polio epidemic;
The many factors that interacted favourably in Copenhagen to recovery room; respiratory insufficiency.
promote the idea of intensive care therapy, half a century ago,
are also described. # Acta Anaesthesiologica Scandinavica 47 (2003)
Disease desperate grown by desperate appliance Furthermore, the patient was given one unit of
are relieved or not at all. William Shakespeare, blood (500 ml), isotonic glucose (1000 ml) and an anti-
Hamlet. biotic (Aureomycin 250 mg four times a day).
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The first ICU
December 24th
The condition of the patient was unaltered. He
appeared dehydrated. A stomach tube was inserted
and an infusion of raw eggs and milk (2500 ml) was
started. He was given another transfusion of blood.
Positive pressure ventilation was continued.
Hyperthermia (41 C) was combated by covering the
patient with wet blankets.
December 25th
The patient was somnolent with paralysis of the legs.
His respiration was still insufficient with large
amounts of secretions obstructing the airways. Ther-
apy was continued as outlined above and Penicillin
(2,000,000 IE) was added.
On December 26th the patient died from cardiopul-
monary failure.
The abstract from the medical charts illustrates
many aspects of intensive care even as we know it
today: the continuous recording of the function of
vital organs; the immediate intervention when
changes in the patients condition mandated it; moni-
toring of the effect of the intervention.
There is no doubt that what was described in the
records of this patient and in the records of several
others subsequently treated in the Observation Room
was bona-fide intensive care therapy.
Was the Observation Room, at the Fig. 1. Bjrn (Aage) Ibsen (1915). Initiator of the first
Municipal Hospital in Copenhagen, the multidisciplinary intensive care unit. Ibsen graduated from
first intensive care unit in the world? medical school, University of Copenhagen, in 1940. From 1949
to 1950 he was Resident in Anaesthesia, Massachusetts General
In science, the credit goes to the man who convinces Hospital, Boston. In 1951 he received his specialist diploma in
the world, not the man (to) whom the idea first anaesthesiology. The turning point in his career came when he
occurs. William Osler became involved in the treatment of the most severely ill victims of
When it is impossible to establish who did what, the 1952 poliomyelitis outbreak in Denmark. In 1954 Ibsen was
elected Head of the Department of Anaesthesiology,
where and when in medicine, priority is awarded to Kommunehospitalet, Copenhagen (Photo c. 1955).
the one who first publishes on the subject. Conse-
quently, we carried out a thorough search of the med-
ical literature (see Appendix A). Why was an epoch-making paper published in a
The first paper on intensive care therapy appeared language few speak and understand? and why did it
in Nordisk Medicin, September 18, 1958: Arbejdet pa en take 5 years before Bjrn Ibsen first published on his
Ansthesiologisk Observationsafdeling (The Work in an innovation and the results of establishing an intensive
Anaesthesiologic Observation Unit) (1). The authors therapy unit? Ibsen cannot, today, remember what
were the Danish anaesthetists Bjrn Ibsen (Fig. 1) prompted him to publish in a journal with limited
and Tone Dahl Kvittingen from Norway (Fig. 2). The circulation outside the Nordic countries. It is true
paper was in Danish but the English resume is shown that he was the Danish coeditor of Nordisk Medicin
in Fig. 3. but he was also coeditor of the newly started (1957)
The number of patients treated in the intensive care Acta Anaesthesiologica Scandinavica, where his ideas
unit increased from 1 in 1953 to 13 in 1954, 34 in 1955, and results would have been presented in English.
91 in 1956 and 120 in 1957. The average length of stay What we did was just to use the principles and
also increased from 2.1 days in 1954 to 5.3 days in 1957. techniques, which served us well in the operating
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P. G. Berthelsen and M. Cronqvist
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The first ICU
1193
P. G. Berthelsen and M. Cronqvist
convince the health authorities of Copenhagen and his Carl Jrgen Carlsen: Senior Resident from September 1951 to
colleagues at Kommunehospitalet that anaesthetists December 1954, Department of Surgery I, Kommunehospitalet
(later Chief Surgeon, Thisted Sygehus, Denmark).
were indeed proper doctors and could take care of Ole Juhl: Senior House Officer from April 1953 to December
patients also outside the operating theatre. 1956, Departments of Surgery I and Anaesthesiology, Kommune-
In April 1953 Ole V. Secher (191895) became the hospitalet (later Chief Anaesthetist, Aalborg Kommunehospital,
first Head of an independent Department of Anaes- Denmark).
thesia in Denmark at Rigshospitalet in Copenhagen. Hans Heugh Wandall: Senior Resident, Department of
Surgery I, Kommunehospitalet 195056 (later director of the
Rigshospitalet was the most prestigious hospital in
Institute for Experimental Medicine and Surgery, University of
Denmark at the time. The appointment of Secher Copenhagen).
was a wise choice but it was at the expense of Ibsen Very useful background material has been provided by Niels
who was both older and more experienced. This rejec- Fjeldborg, former Chief of the Department of Anaesthesiology,
tion was a disappointment to Ibsen, but there is little Aarhus Amtssygehus, and Henning Sund Kristensen, former
Chief Anaesthetist, Blegdamshospitalet, Copenhagen.
doubt that it also acted as an incentive. He became
We obtained useful ground plans and pictures of Kommune-
determined to show the Professors at Rigshospitalet hospitalet from Erik Dauv-Pedersen (Senior Pharmacist) and
that they had taken the wrong view. So, in April 1953 Jrgen Wiedemann (Hospital Manager).
when Ibsen became Senior Resident (anaesthetist) in Kjell Erik Strmskag, Molde, Norway, provided data on Tone Dahl
the Department of Surgery I at Kommunehospitalet Kvittingen coauthor of the first report on intensive care therapy.
his fighting spirit had been roused. and he needed it
right away. In the surgical department there was dis-
agreement between the surgical senior residents as to References
the best postoperative volume replacement therapy.
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observationsafdeling. Nordisk Med 1958; 38: 134955.
Department, asked Ibsen to supervise and direct how 2. Kirschner M. Zum Neubau der chirurgischen Universitatskli-
surgical patients should be treated in the recovery nik Tubingen. Der Chirurg 1930; 2: 5461.
room (and the wards) (9). This controversy between 3. Betnkning II. Afgivet Af Den Af Magistraten Under 28. Februar
his surgical colleagues allowed Ibsen to take charge of 1944 Nedsatte Hospitalskommission. Kbenhavn: J.H. Schultz
Universitetsbogtrykkeri, 1950.
the recovery room and subsequently made it possible 4. Strmskag KE. Et fag pa syler. Anestesiens historie i Norge.
for him on 21 December 1953 to change a purely TanoAschehoug 1999.
surgical recovery ward into a unit where all types of 5. Nilsson E. On treatment of barbiturate poisoning. A modified
patients could receive professional help. clinical aspect. Acta Med Scand 1951; 139 (Suppl.): 8998.
6. Ibsen B. The anaesthetists viewpoint on the treatment
In conclusion, it is beyond reasonable doubt that the of respiratory complications in poliomyelitis during the
first intensive care unit in the world was established epidemic in Copenhagen, 1952. Proc Royal Soc Med 1954; 47:
in the Observation Room at Kommunehospitalet in 724.
December 1953. and that Ibsen, as the initiator, must 7. Wackers GL. Modern anaesthesiological principles for
bulbar polio: manual IPPR in the 1952 polio-epidemic in
be counted as one of the people who were instru- Copenhagen. Acta Anaesthesiol Scand 1994; 38: 42031.
mental in laying the foundation of our profession. 8. Kristensen HS. Comment on the description of the polio
epidemic in Copenhagen 1952. Acta Anaesthesiol Scand 1996;
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9. Ibsen B. From anaesthesia to anaesthesiology. Personal experi-
ences in Copenhagen during the past 25 years. Acta Anaesthe-
Acknowledgements siol Scand 1975; 61 (Suppl.): 2933.
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