The intensive care unit

The Intensive Care Unit (sometimes called ICU or ITU) is a special ward in the hospital where patients who need close monitoring or specialized treatment are looked after. Many patients in ICU have life-threatening problems; some may be recovering from major surgery; all need close monitoring and specialized staff.

The Organisation of the intensive care

The Intensive care unit is a busy place, lots of staff and lots of procedures happening all the time. You may be perplexed as to who all these people are. Here is an explanation of the intensive care team.

The ICU is run by one or several specialists. Usually the specialist on for the intensive care is looking after all patients in the ward. The specialist is called an "Intensivist" and is a highly trained experienced doctor that has often had training in general medicine, emergency medicine and anaesthetics as well as further specific training and experience in intensive care medicine. They will perform rounds on every patient several times per day. They will devise the treatment plan and monitor its progress. They will order tests, review all results and make adjustments as necessary. All new patients to the unit will be assessed by this specialist, and they will decide when to discharge each patient. There will be an intensivist on the ward every day (yes including weekends). Afterhours they will be on-call for problems, new admissions or whatever may be required. They will often come back into the unit afterhours to help a patient.

The ICU contains other doctors, more junior to the intensivist, they maybe called ICU residents or ICU registrars. These doctors work in shifts around the clock to help look after all the patients in the ward. Many of these doctors are trained in general medicine, emergency medicine, anaesthetics or general practice. Some work part time in the intensive care and have other careers in medicine outside the ICU. Some are specialists in training. All are experienced doctors and are junior only in the sense that they are not intensive care specialists. So the ICU has an experienced doctor in the ward 24hrs a day. This is the only ward in the hospital where this is the case.

It is however the specialized nurses and nursing care that really defines the intensive care unit. There is one nurse per patient at all times in the intensive care unit. These nurses have undergone further training and are experienced in looking after critically ill patients. The nurses are the eyes and ears of the unit, ever present and monitoring they provide for all of the patients' needs. They will interact with the intensive care doctors and the other nurses in the unit, and of course interact with the patient and their family. They are very hands-on, as critically ill patients often can do nothing for themselves. They carry out many of the therapies and tests on patients in the unit.

Other doctors such as surgeons, anaesthetists, physicians and other health professionals, physiotherapists, dieticians etc are also involved in the care of many of the patients. As you can imagine this generates a lot of activity, discussion, and paperwork - hence the intensive part of intensive care.

Why am I in the Intensive Care Unit?

There are two types of patients in the intensive care unit - expected and unexpected.

1) Expected (planned, elective) admissions.

These patients are mostly post operation and have need of close monitoring for some time afterward. Mostly it is the nature of the surgery itself, i.e. major chest, heart, vascular, neurosurgical or spine surgery. Sometimes it may be because of pre-existing medical conditions of the patient that may put them at increased risk for serious post operative complications. Sometimes it is a combination of these two.

2) Unexpected (acute, emergency) admissions.

These patients come from a variety of sources and include

• Acutely unwell patients admitted to the hospital via the emergency centre
• Acutely unwell patients after emergency surgery
• Patients already admitted to the hospital that have experienced a deterioration in their condition and need an increased level of care.
• Post operative patients whose treatment has become more complicated or who have experienced a complication and require and increased level of care.

What types of treatment might I receive in the intensive care unit?

The major treatment types in the intensive care are

1. Ventilated
2. Non-ventilated

Ventilated patients are on a special machine (a ventilator) which controls the amount of oxygen and respirations delivered to the lungs. For this, a tube is inserted into the wind pipe (trachea) via the mouth or nose. Most patients require heavy sedation to tolerate this form of treatment. This treatment is reserved for critically ill patients who are unable to breathe well enough to adequately oxygenate their tissues. You may have heard the term on TV that a patient is in an "induced coma". That term is referring to this type of treatment.

Non-ventilated patients, obviously, are those not on a ventilator. They are usually awake and are receiving other types of treatment to improve their condition.

Some post operative patients are admitted into the ICU shortly after surgery and are still receiving ventilatory support and sedation from the anaesthetist. Commonly these patients are allowed to wake up from the surgery in the ICU. They then are taken off the ventilator when suitable and continue their care in ICU. Some post operative patients are woken up normally at the end of the operation and admitted to the ICU awake and without the requirement of the ventilator.

In all cases the type of treatment - ventilated or non-ventilated - will depend on multiple factors, and it will be up to the doctors sending you to intensive care and the doctors receiving you as to what the most appropriate treatment will be.

Other treatments include all necessary medicines, infusions and other therapies that the patient may require. Commonly ICU patients have multiple intravenous lines or even a central line, an arterial line for blood pressure measurement, and a urinary catheter to monitor the production of urine. ECG, temperature pulse and oxygen measurements are also standard. After that, well, the sky's the limit. Needless to say the ICU doctors will be monitoring all organ systems and intervene with medicines, treatment or surgery when necessary.

How long will I be in Intensive Care?

Again here the answer would be - that depends. Patients must be stable enough and their treatment simplified such that that could be cared for in a normal hospital ward. For many elective post operative patients the ICU stay is 1 or 2 nights. For others it may be longer.

A very small number of patients require prolonged ICU care that may continue for weeks. This thankfully is uncommon.

I have some more questions?

If you are planned to be in intensive care after an operation or have a relative going to intensive care and have further questions please ask your anaesthetist or surgeon. All anaesthetists have ICU training and so do many surgeons. Your team will be able to explain why they want to admit you to the ICU and what you could expect whilst in the ICU.