Intensive Care Units

What is an Intensive Care Unit?

Patients whose conditions are life-threatening either through serious injury or illness need constant, close monitoring. The often need equipment and medicine to support normal body functions. This care is provided in an intensive care unit (ICU) that is sometimes called an intensive therapy unit or a critical care unit. ICUs are run by senior doctors and there are more nurses for each patient than in an ordinary ward.

Some hospitals have separate departments for people with particular problems. Occasionally it is necessary to move a patient to a unit in another hospital to provide specialist care.

The length of time patients stay in an ICU depends on the extent of their illness or injuries. Some patients will recover fairly quickly, others may remain in ICU for weeks. Recovery is not possible in all cases and sometimes a patient dies.

What happens when a patient is taken to an ICU?

When a patient is brought to an ICU it can take more than an hour for the doctors and nurses to assess the patient’s condition, make them as comfortable as possible and attach them to the necessary equipment. It is normal to have to wait during this time. This can be frustrating but it is important that the ICU staff stabilise the patient’s condition. A member of staff will explain what is happening as soon as possible.

What does an ICU looks like?

ICUs can vary in size. They may be small with four to six beds or they may be larger with twelve or more beds. ICUs do not have separate male and female sections but efforts will be made to ensure that privacy and dignity are maintained.

Entering an ICU

You may have to press a buzzer and speak to a receptionist or a nurse on an intercom to gain entry to an ICU. Some ICUs have a reception desk near the entrance. Unless you are told otherwise, you should always check with a member of staff before entering.

Is an ICU noisy?

The noise levels in an ICU can vary but it can be quite noisy, especially during the day. There may be beeping noises from some of the equipment and even an occasional alarm sound. This is normal and does not necessarily mean that something is wrong.

Will I recognise my loved one?

Your loved one may look very different from the last time you saw them. Their bodies may be bruised or swollen if they have suffered injuries. They may be attached to lots of equipment. The doctors and nurses will be able to tell you what to expect.

Intensive care units may be found in hospital buildings which are old or new. The age of the building has no bearing on standard of care which should be uniformly high.

Can I touch my loved one?

Tubes and wires often surround a patient in an ICU. It is usually possible to touch your loved one but it is sensible to ask a nurse first.

Can I talk to my loved one?

Patients in ICUs are often unconscious, at least during the early part of their treatment. This is often because they are being given drugs to make them sleepy and comfortable.

A patient may be able to hear even if they cannot respond. Nursing and medical staff will usually talk to unconscious patients and tell them what is happening. Feel free to talk to your loved one and let them know that you are there. It is normal to feel upset at seeing someone you love in an ICU. It is understandable if you find it hard to cope. Members of staff are there to answer any questions you may have. You may find it helpful to have someone with you.

What does all the equipment do?

Equipment surrounding patients is usually there for two reasons.

1 – Equipment that supports a patient’s normal body functions:

Equipment for Breathing

A ventilator is a machine that assists a patient’s breathing. A tube is inserted through either the patient’s nose or mouth and into the windpipe. The tube, which is known as an endotracheal tube, is connected to a machine that blows air and extra oxygen in and out of the lungs. The machine can `breathe’ completely for a patient or it can be set to assist a patient’s breathing. A patient can be weaned off a ventilator gradually when their condition improves. If a patient is likely to remain on a ventilator for more than a few days, the endotracheal tube in their mouth is sometimes replaced with a tracheotomy. In this case, an operation is carried out to insert a tube into a hole which is made in the throat. Although this can look rather strange, it is actually quite comfortable for the patient compared with having a tube in their mouth. A patient will not usually be able to use their voice while the tracheotomy is in place.

Most patients in an ICU require extra oxygen. This may be given through the ventilator or a mask over the nose and mouth may alternatively be used. The mask can be removed for brief periods.

Equipment for fluids

Patients are attached to drips which allow liquids to be passed through tubes into veins, usually in the side of the neck, arm or hand. There are various substances commonly used in drips.

Blood may be needed by a patient. The amount of blood a patient is given is carefully monitored. Blood is obtained from the blood bank of the hospital which constantly replaces its stocks. The blood will have been screened to ensure it is safe for your loved one. Blood is made up of several substances, for example plasma and platelets, which can be given to a patient separately if needed.

Drugs are often given to patients through a drip. A pump is attached to the drip to administer the drugs at the right rate.

Fluids can be used in drips for various purposes including re-hydration and maintenance of blood pressure.

Food in the form of a liquid containing essential nutrients can be given either through the nose via a tube which goes down into the stomach or through a drip.

Tubes which drain waste fluid from different areas of the body can often be seen around a patient.

Kidney equipment

If a patient’s kidneys are working normally the nurses may need to measure how much urine is being made every hour. To do this a urinary catheter will be passed into the patient’s bladder. You will see the tube attached to a bag at the side of the bed.

A haemofilter is used when a patient’s kidneys are not functioning properly. It works in a similar way to a dialysis machine.

The haemofilter removes blood from a vein through a tube then pumps it through a filter to remove excess fluid and waste products. Once it is cleaned, the blood is returned to the patient. Haemofiltration may be done continuously or for several hours every day.

2 – Equipment that monitors a patient’s condition:

Equipment to monitor the heart

Each patient is attached to a machine called a cardiac monitor which monitors their heart rate. Small sticky pads are placed on their chest and are connected to a machine. The machine picks up electrical impulses from a patient’s heart and can detect any abnormalities. The monitor can also show a patient’s breathing rate, blood pressure and temperature. It is normal for the numbers shown on the monitor to keep changing.

Equipment to monitor head injuries

If a patient has a serious head injury it is important that further damage to the brain is prevented. It is essential that any brain swelling and increases in pressure are detected and treated promptly. A small pressure gauge may be inserted through the skull into a patient’s brain to measure the pressure inside the skull. Although this may look alarming it does not cause the patient any pain.

Ask ICU staff for an overall assessment of your loved one’s condition.

The following investigation procedures are used if appropriate.

A CAT scan (Computerised Axial Topography) may be taken. A series of x-rays of the body or head are analysed by computer to show a patient’s body as if it were a series of layers. This provides more information about any abnormalities.

An MRI scan (Magnetic Resonance Imaging) is used more rarely than a CAT scan. It is similar to a CAT scan but is sometimes needed to show finer detail on x-rays.

Many people know that an ultrasound scan can be performed on a pregnant woman to see the baby. Scans can also be used on areas of a patient’s body to find out what is wrong. Gel is placed over the area to be scanned, often the heart or stomach area, and a probe is moved over it to produce a detailed picture on a monitor.

An ultrasound scan of the heart is called an echocardiogram.

An electrocardiogram (ECG) provides a detailed analysis of the condition of a patient’s heart in a similar way to a cardiac monitor.

An Electro-encephalogram (EEG) can detect chemical changes and physical abnormalities in the brain. Sticky pads on the head are attached to a machine which detects minute electrical impulses.

An endoscopy enables doctors to see inside a patient’s body without an operation. Flexible tubes which transmit light are passed down the patient’s throat to view a part of the body such as lungs or stomach.
Some investigations have to be done in another department so your loved one may be moved from the ICU temporarily.