History of Critical Care in Sri Lanka

Faculty of Critical Care Medicine of the College of Anaesthesiologists & Intensivists of Sri Lanka is an organisation committed to maintaining highest standard of adult critical care in Sri Lanka. We are devoted to all aspects of critical care practice through ongoing professional education, provision of leadership in clinical setting, clinical research and developing guidelines.

Though the modern specialty of intensive care began in the world only about 60 years ago, the concept of critical care and the realisation of the need for a separate level of care with closer attention than was provided for the less ill patients dates back to 1850s.

During Crimean war in 1850s, Florence Nightingale demanded that most seriously ill patients be placed in beds near the nursing station, creating an early focus on the importance of a separate geographical area for critically ill patients.

In 1923, Dr Walter E Dandy opened a special three bed unit for more ill post operative neurosurgical patients at John Hopkins Hospital in Baltimore, USA using specially trained nurses to monitor & manage them.

In 1930, Dr Martin Kirschner designed & built a combined post operative recovery/ intensive care ward in surgical unit at the university of Tubigan, Germany.

But the rapid development of intensive care units that we know today began with the Polio epidemic in 1952-1953 especially in Copenhagen, Denmark which lead to opening up of respiratory units for the many patients requiring mechanical ventilation. In 1953 Dr Bjorn Ibsen, an anaesthetist suggested that positive pressure ventilation should be the treatment of choice for those needing ventilation. The following 20 years saw the speciality growing to the multidisciplinary one that it is today.

By 1960 almost all hospitals in the developed world had a recovery unit attached to the operating room.

Critical Care in Sri Lanka

In Sri Lanka, with the establishment of the thoracic units at the General Hospital, Colombo, an area in the thoracic ward was designated as a recovery area in 1952, where an ECG monitor was available to monitor post-operative patients. In the early 1960s, an East Radcliffe ventilator was also made available in this recovery area. ‘Iron lungs’ were available at the General Hospital Colombo and a number of outstation hospitals.

The commencement of open heart surgery in Colombo was the catalyst to establish an Intensive Care Unit. Dr ATWP Jayawardene had been appointed the Chief Anaesthetist of the Cardiothoracic Unit in Colombo and he was entrusted to plan, design, implement and manage the unit.   He has described in detail the work that went into setting up the unit.1 A building intended for the recovery area at the central quadrangle of the operation theatre complex was identified as been most suitable to house the Intensive Care Unit. This building was in close proximity to the cardiac operation theatre. During negotiation to obtain space for ancillary services, the Chairman of the Hospital Committee Dr EM Wijerama suggested that two beds be reserved for medical patients. This resulted in the unit been open for admission of coronary care patients and both medical and general surgical patients in addition to cardiac surgical patients. This arrangement continued until such time as   other intensive care / coronary care facilities became available at General Hospital, Colombo. The unit also admitted paediatric surgical patients as well as neonates who needed to be ventilated until intensive care facilities were established at the Lady Ridgeway Hospital for Children.

The Surgical Intensive Care Unit (SICU) of the Colombo General Hospital was declared open by the Minister of Health, Hon EL Senanayake on 16th June 1968. The unit had six beds and two incubators. There was facility to monitor the electrocardiogram, invasive blood p

ressure, central venous pressure, core and skin temperature. The Radiometer pH and blood gas machine in the unit was the first blood gas machine in the country. There were three Bennet Pressure cycled ventilators. The unit also had a Morgan Pulmonary Function Machine to assess the lung function of patients awaiting cardiac surgery. As this was the only pulmonary function machine in Sri Lanka even other patients both from Colombo and the outstations were referred to the unit to have pulmonary function tests. This is now called the Cardiothoracic Intensive Care Unit and is a specialised unit for cardiothoracic surgical patients.

In the 1970s patients were ventilated in the thoracic unit at General Hospital Jaffna using an East Radcliffe ventilator.

The second intensive care unit in the country was opened in 1976 at the General Hospital, Colombo. It was called the Recovery Unit which was a misnomer as it was in actual fact a fully-fledged intensive care unit. This is now called Surgical Intensive Care Unit.

The first intensive care unit outside Colombo was opened in 1980 at the Teaching Hospital, Peradeniya. A six bed intensive care unit at General Hospital, Jaffna was started in January 1984. From that beginning intensive care has grown that today there are over 100 adult intensive care units in the country, the majority of which are managed by Anaesthetists with multi-disciplinary input.

A Faculty of Critical Care Medicine was established under the College of Anaesthesiologists of Sri Lanka in 2010. Dr Kumudu Mendis was the first Head of the Faculty. The inauguration of the Faculty and the first Scientific Session was held with Dr Neil Soni, a world renowned intensivist as the Chief Guest. To recognize the growing importance of Critical Care as a separate speciality the name of the College was changed to the College of Anaesthesiologists and Intensivists of Sri Lanka in 2014.

The Board of Study in Anaesthesiology of the Post Graduate Institute of Medicine of the University of Colombo started a post graduate training programme in adult critical care in 2013 as a post MD programme where trainees of anaesthesia & general medicine could follow 3 further years of training.

ATWP Jayawardene. A history of Intensive Care Medicine in Sri Lanka. Sri Lankan Family Physician, 2007, 28, 39-44.

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