Intensive Care Units (ICUs) are very specialized areas within a hospital. They look after patients whose conditions are life-threatening and need constant, close monitoring and support from highly trained staff, equipment and medication. Intensive Care Units are run and staffed by specialist doctors and nurses who have undergone extensive training in intensive care. There will also be other specialist staff such as physiotherapists, pharmacists, dieticians and speech therapists who may be involved in the patient’s treatment.
The length of time patients spend in ICU depends on how ill they are and may vary from a few days to a number of months. As patients get better they are sometimes transferred to an area called a high dependency unit (HDU) and then to a general ward in the hospital.
There are many reasons why people may need care in ICU. These range from a planned admission for very close observation following a major operation to supporting the function of major organs such as the lungs, heart and kidneys following a sudden illness. Once a patient is admitted to the unit, the intensive care team will manage their care, although staff from other branches of medicine may be consulted if needed.
Why are people admitted to intensive care?
After some very big or complex operations patients are admitted to intensive care for a period of time for close monitoring. The theatre staff will contact the intensive care unit and arrange to transfer the patient there at the end of the operation.
If you are admitted to the hospital as an emergency you will be seen by the emergency department team or by one of the general medical, surgical or specialist teams. They may decide that you need a higher level of monitoring or specialist treatment than is available on the general ward and then they will contact the intensive care team.
If the teams feel that you will benefit from intensive care you will be admitted to the unit. The most senior doctors and nurses make these decisions with as much involvement from the patient and relatives as is possible.
What is it like on intensive care?
Intensive Care is different from any other ward in the hospital. There are large amounts of special equipment, more staff, activity 24 hours a day and many patients are asleep or sedated.
Patients in intensive care are often very ill and need constant monitoring. This is done by having a lot of staff on the unit and specialist monitoring equipment which may look complicated and even frightening. All beds will have this equipment around them, although it may not all be needed. Some equipment will make beeping noises, others will be silent but may have a bewildering display of graphs and numbers which change. Do not be alarmed at the equipment and the noises being made. The nurses understand what they mean and will, if requested, explain the purpose of the equipment being used.
Many patients in intensive care need help at some time with their breathing. This support can simply be oxygen through a face mask. Other patients need more help, with a tube inserted into their windpipe either through the mouth (endotracheal tube) or directly into their throat (tracheostomy). These tubes are connected to a mechanical breathing machine called a ventilator.
Many patients will, because of their condition, be unable to eat food normally and are therefore fed by different methods depending on their condition. A common method is by a tube through the nose and into the stomach (nasogastric tube).
Why are some patients sedated?
Patients who need help with their breathing often need to be sedated to tolerate the mechanical ventilation. This level of sedation is much less than is needed for an operation and patients are often partially awake. Relatives often want to know if they can talk to the patient or touch them and this is usually encouraged. Reassuring voices and contact can be of real help.
It is a common misunderstanding that patients would be better being kept “completely” asleep but research shows that patients recover much better if the least amount of sedation as necessary is used, even though patients can look and appear more agitated or distressed at the time.
How might all this affect the patient?
No two experiences of intensive care are the same. However for many patients being so ill is a very stressful time.
As they wake up or if they are not fully asleep patients may feel confused about where they are and what has happened. They may also appear anxious or in pain. Sedation and medication to relieve pain and anxiety may be needed.
While sedated, it may be difficult for a patient to think clearly. Sometimes the combination of the medication and being so unwell may change their perception of what is happening and they may seem angry, hostile, or just different.
As mentioned before, at times some patients will need help with breathing and will be supported on a ventilator. Usually in these circumstances, it will not be possible for the patient to talk and this can be frustrating.
It is important, however, that relatives and friends talk to the patient and where appropriate hold their hand. Often patients who are sedated will recognise their relative or friend by touch or the sound of their voice and be reassured by their presence. One of the results of sedation is that the patient may not have any memory of that time and some relatives have found it helpful to keep a diary of the patient’s stay in critical care and some critical care units help with this. This can be of great help to the patient later, during their recovery, by filling in the gaps in their memory caused by sedation or medication, particularly for long periods.
What can relatives do to help?
One of the most helpful things that friends and relatives can do is to visit.
Most intensive care units do not have set visiting times but some ask relatives not to visit between specified times. This allows the patient to have some time to rest. It may also be necessary to limit the number of visitors allowed at the bedside at any one time.
It is advisable to check with the nursing staff what the visiting times are.
Infection control in intensive care is extremely important because patients are very ill and therefore can pick up infection easily. It is essential that all visitors comply with local hygiene policies. The nursing staff can advise what you need to do.
Involvement in nursing care
Sometimes relatives and friends can feel that they are like ‘spare parts’ but they can help, if they wish to, by carrying out simple but important tasks such as combing the patient’s hair or helping with giving sips of water. The nurses will be happy to describe what tasks relatives and friends can do which will benefit the patient and assist in support and comfort during what can be a difficult time for both.
One main contact per family
The intensive care team , as part of the patient’s treatment, will keep relatives informed of progress and of any difficulties being encountered. The team will always do its best to answer immediately your questions but at busy times there may be delay before a team member is available. It is always possible to make an appointment to see a senior team member.
Experience has shown that this works more effectively if the family nominates one person as the contact point. It is also advisable to limit the number of names of any relatives and friends to whom the intensive care staff can give information on the patient’s progress. Having one contact also helps to safeguard patients’ confidentiality.