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Intensive Care ‐ Applied Physiology *

The primary function of intensive care is to maintain the internal environment of the body in the presence of a life-threatening disease or injury, and in particular to prevent circulatory, respiratory and renal insufficiency. This is ordinarily accomplished by means of artificial respiration, and the administration of oxygen, blood, fluids and salt solutions; but, as a rule, therapy is symptomatic since we lack detailed knowledge as to how disturbances of the regulatory functions arise. In some cases these disturbances are a direct result of the disease or injury to the organ in question, but it would seem that insufficiency states are more commonly the result of disorders in the mechanisms which control the function of the organ. We assume that the hypothalamus functions as a supreme control center for the vegetative regulatory functions, but how does this guidance system operate and how is it disordered under pathological conditions ? Knowledge regarding these matters is a prerequisite for adequate intensive care, but so far physiologists have failed the clinicians in this regard. For example, no generally accepted explanation has yet been offered for the peripheral circulatory insufficiency which is probably the commonest direct cause of death. Is it a form of regulatory disturbance, as in the case of respiratory or renal insufficiency, or, as the majority seem to believe, the result of endo-