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Respiratory critical care forms the central element of modern critical care medicine and demands a working knowledge of respiratory anatomy, physiology, and biology to provide effective support to the critically sick lungs. It has evolved from its origins in the polio epidemic of the 1950s, where positive-pressure mechanical ventilatory support led to substantial survival benefit over negative pressure strategies. It is now a rigorously studied discipline with increasing scientific knowledge of specific lung conditions, their pathophysiological basis, and evidence-based management strategies.
A better understanding of the molecular and physiological basis of conditions has been paralleled by the development of new therapeutic strategies (e.g. non-invasive ventilation) and greater understanding of the risk:benefit balance of interventions. These developments have led to standardization of care and, in many situations, better outcomes for patients.
Modern respiratory critical care requires knowledge of the complexity of lung-systemic organ and comorbid interactions in the critically ill patient, as well as an understanding of specific primary lung pathology, diagnosis, trajectories, and treatments. Further, respiratory critical care is truly multi-disciplinary. Thus, the critical care clinician requires skills taken from intensive care, anaesthesia, respiratory medicine, infectious diseases, cardiology, nephrology, radiology, pathology, and other disciplines. Excellent respiratory critical care dictates close working with specialists from multiple disciplines.
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