Dr. Max Harry Weil; pioneer of ICU care

By David Brown
Washington Post / August 6, 2011

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WASHINGTON - Max Harry Weil, a physician who helped found the specialty of critical care medicine and elucidate strategies for treating the sickest hospitalized patients, died July 29 at his home in Rancho Mirage, Calif. He was 84 and had prostate cancer.

Dr. Weil spent most of his career at the University of Southern California, in Los Angeles, where he was on the faculty from 1958 to 1981. He later moved his research organization, the Institute of Critical Care Medicine, to Palm Springs, Calif., and more recently to Rancho Mirage.

Dr. Weil’s work in the hospital and lab contributed to a long list of insights that led to the dramatic improvement in survival of people with severe infections, congestive heart failure, and trauma. He also helped understand, refine, and popularize cardiopulmonary resuscitation.

Among the now-standard features of hospital medicine he helped create are the intensive care unit; the rolling crash cart that brings resuscitation equipment to a person’s bedside; the stat lab, which provides lab results in minutes; the measurement of lactic acid in the blood as a way of determining whether organs are getting enough oxygen; and the computerized monitoring of critically ill patients.

“He had an amazing influence on patient care in the United States,’’ said Henry Masur, chief of critical care medicine at the National Institutes of Health.

Dr. Weil is also thought to have coined the term critical care to describe the suite of expertise and equipment required to save patients in grave condition.

Perhaps his most important insight was the need for a unit that had only those critically ill patients and people with the expertise to care for them, a team that went well beyond physicians to include specially trained nurses, pharmacologists, respiratory therapists, and nutritionists.

“He was among the first to recognize there was something special about these patients,’’ said Clifford S. Deutschman, a physician at the University of Pennsylvania medical school.

In the late 1950s and ’60s, Dr. Weil was part of a small group of physicians who realized that patients with dangerously low blood pressure, a condition known in medicine as shock, had high mortality rates.

Shock kills because there is not enough blood flowing to organs to deliver oxygen and carry away carbon dioxide and waste products. It can be caused by overwhelming bacterial infection, bleeding, hormonal calamities, or severe heart damage. It is treated with infusions of intravenous fluids, drugs that constrict blood vessels or make the heart pump harder, as well as treatments aimed at the underlying problem.

Dr. Weil’s investigation of shock in patients and lab animals, as well as associated physiological events, helped lead to new and better treatments. In 1958, he opened a shock ward with four beds in 1958. It became the precursor of the ICU.

Other pioneers of critical care doing similar work were William Shoemaker, a surgeon at the University of California, Los Angeles, and Peter Safar, an anesthesiologist at the University of Pittsburgh. Notably, none of the three doctors came from the same specialty, evidence that the problem of shock was present in a variety of patients.

Max Harry Weil was born in Baden, Switzerland. His parents were German Jews; his father, a businessman, was temporarily working in Switzerland. In 1936, the family emigrated from Stuttgart, Germany, to the United States, settling in New York City.

Dr. Weil attended the Bronx High School of Science and graduated from the University of Michigan in 1948, interrupting his college career to serve as a psychiatric social worker with the US Army Medical Corps in 1946-47.

He received his medical degree from the State University of New York’s Downstate campus in Brooklyn in 1952 and trained in internal medicine in Cincinnati and Minneapolis. He received a doctorate in physiology from the Mayo Clinic in Rochester, Minn., in 1957.

Much of Dr. Weil’s early work was done in collaboration with Herbert Shubin.