Overview of Intensive Care
Intensive care units (ICUs) are specially equipped hospital units that provide highly specialized care to patients who suffer from a serious injury or illness. A multidisciplinary team (physicians, nurses, respiratory therapists, pharmacists) trained in care of critically ill or injured patients provides continuous observation and monitoring as well as specialized care. There are over 5000 ICUs in the United States, and different units may specialize in specific areas such as neonatal, pediatric, and cardiac care.
Patients are admitted to the ICU from an emergency room, from an operating room, from another care area within the same hospital, or after being transferred from another hospital. Admission is based on a physician finding that close observation or specialized monitoring and/or therapy is necessary. Once close observation and monitoring or specialized therapies are no longer required, the patient is discharged from the ICU to either a regular hospital room or a concentrated care (step-down) unit where modified observation or therapy can be administered.
Because the level of care required of critically ill patients does not diminish during the night, critical care units are busy 24 hours a day. There are many alarms on the monitoring equipment that sound at all hours, often making rest difficult. As patients improve, one of their first complaints is the lack of sleep they receive. This is usually a good sign that they have improved enough to move from the ICU.
Patients in the ICU
In addition to being closely monitored, patients in ICU often require medication to keep them comfortable, which may diminish their level of responsiveness. The level of sedation will vary from person to person, depending on their condition. Some patients are easily arousable and are able to converse, while others may need to be sedated enough that they are unresponsive to verbal stimulation.
It is important to remember that although ICU patients may not be able to respond to a voice or touch, they may still be able to hear and feel. Visiting family members should talk to them, hold their hand, and let them know they are loved.
Care in the ICU is provided by a multidisciplinary critical care team, which is composed of specially trained physicians, nurses, and other professionals. Each individual brings his or her particular expertise to the team. Members of the team may vary from hospital to hospital.
Physicians: The critical care attending, or intensivist, is a physician who is fully trained in internal medicine, surgery, or anesthesiology. In addition, the physician has received one or more years of specialized training in all aspects of care of critically ill patients. The critical care attending supervises the care of ICU patients. He or she constantly communicates with the other members of the critical care team as well as the primary admitting physician. The critical care attending may also consult with other physicians who are specialists in particular areas of medicine (e.g., heart disease, kidney disease, gastrointestinal disease) or surgery (e.g., general, vascular, or thoracic surgeons).
Nurses: Critical care nurses have received specialized training in caring for critical care patients. The nurses provide around the clock bedside care and monitoring. They are in close contact with the physician in charge as well as other members of the critical care team.
Respiratory therapists: Respiratory therapists are trained in monitoring the respiratory system and in handling any equipment required to assist in respiration. They will monitor all aspects of respiration, from oxygen delivered through a nasal cannula (tube with two short tubes that go into each nostril) to mechanical ventilators. They also administer any respiratory treatment used to improve a patient's respiratory status.
Pharmacists: The ICU pharmacist assists and provides information on drug dosing and drug interactions. This is particularly complex in the critically ill patient.
Physical therapists: Physical therapists are involved in the care of critically ill patients early on in their ICU stay. They help prevent disabilities and facilitate rehabilitation as soon as possible.
Nutritionists: Nutritionists are involved in calculating the nutritional needs of the critically ill patient and monitoring the nutritional balance on an ongoing basis.
Social workers (patient care managers): Social workers assist families in dealing with all aspects of the illness from financial, to accommodations for family members, to long-term planning following ICU and hospital discharge.
Pastoral care workers: Pastoral care workers provide emotional and spiritual support for patients and family members of all denominations.
Pain Control & Sedation in the ICU
Comfort of ICU patients is a major goal. The two most commonly used medications used for patient comfort are pain medication and sedation.
Physicians order the lowest amount necessary to achieve the desired effect. Patients are continuously assessed for adequate pain control or level of sedation. The sedation and pain medications may make patients less responsive, and at times, they may be totally unresponsive. Although this may be disconcerting to families, it is important to have patients adequately sedated for necessary care to be administered. As patients recover and the medications are decreased, the ability to respond appropriately will return.
Local anesthesia causes a loss of sensation in the anesthetized area. A local anesthesia is often used in conjunction with a sedative during certain procedures such as insertion of a central venous catheter.
Occasionally, soft restraints are used in order to prevent patients from inadvertently pulling out their tubes or catheters. The nursing staff constantly monitors restraints.