Intensive care units: what ICU care involves

Intensive care units, usually called ICUs, are hospital areas for people with life-threatening illness or injury, or those who need close observation after major surgery. They provide continuous monitoring, specialist treatment and, when needed, machines that support organ function, according to Cleveland Clinic and Healthdirect Australia.

An ICU stay means a person needs a higher level of care than a standard ward can provide. The reason for admission and the patient’s response to treatment help determine what happens next.

How ICU care differs from a regular ward

ICUs concentrate specialist staff and equipment around patients who need close, continuous observation or organ support. Healthdirect says ICU patients are monitored 24 hours a day by specialist health-practitioner teams.

• Observation: Bedside devices can track heart activity, oxygen levels and blood pressure.
• Staffing: Healthdirect says ICUs often have one nurse for every one or two patients, a lower patient load than on many wards.
• Equipment: Each bed may have monitors, lines, tubes and other devices. Some patients need life support, such as a ventilator to assist breathing.
• Environment: Healthdirect says ICUs generally have fewer beds and more limits on visitors than other wards. Each hospital sets its own visitor rules.

Cleveland Clinic says critical-care physicians, often called intensivists, work with bedside nurses and may be joined by respiratory therapists, pharmacists, surgeons, advanced practice providers, physical and occupational therapists, nutrition specialists, social workers and case managers. The team depends on the patient’s needs.

Why a patient may be admitted

Cleveland Clinic says clinicians consider the diagnosis, the severity of illness or injury, response to treatment and other medical conditions when deciding whether ICU care is needed. They may also consider a patient’s stated preferences about intensive treatment.

Admission may happen suddenly from an emergency department or after a patient’s condition worsens elsewhere in the hospital, Cleveland Clinic says. Healthdirect says ICU monitoring can also be part of early recovery after major surgery.

Examples of conditions that may require ICU care include serious infection or sepsis, stroke, shock, traumatic injury, traumatic brain injury and sudden failure of the heart, lungs, kidneys or liver, according to Cleveland Clinic.

What patients and visitors may see

Equipment around an ICU bed helps staff monitor a patient and deliver treatment. Healthdirect lists heart monitors and artificial ventilators among common machines, and says alarms can let staff know when a patient’s condition changes.

Lines and tubes may deliver fluids and nutrients or remove waste fluids, Healthdirect says. A ventilator may be used when a patient cannot breathe independently. Cleveland Clinic says some patients may receive organ-support treatments such as extracorporeal membrane oxygenation, or ECMO, for heart and lung support, and continuous renal replacement therapy, a type of dialysis.

Infection precautions and specialist ICUs

A person with a contagious illness, or an infection that is difficult to treat, may receive care in an isolation area. Healthdirect says staff take extra infection-control precautions to limit the spread of germs to staff and other ICU patients.

A neonatal intensive care unit, or NICU, is a specialized ICU for premature babies and babies with serious illness, according to Healthdirect.

How a patient leaves the ICU

Patients move from ICU to another ward when they no longer need the high level of care provided in intensive care, Healthdirect says. They may later need medicines, care instructions or follow-up appointments after leaving the hospital.

The timing of a transfer depends on the underlying illness, surgery or injury and the patient’s progress in treatment.

Planning for treatment preferences

People who expect they may need ICU care can discuss goals of care with their doctor. Healthdirect says an advance care plan records preferences about treatment and life support for use if a person becomes too ill to communicate.

The plan can describe treatments a person would accept or decline, and it can be changed. Healthdirect says a person can still be admitted to ICU even if they choose only some of the treatments offered there.

Frequently asked questions

What is the difference between an ICU and a regular hospital ward?

According to Healthdirect, an ICU provides 24-hour specialist monitoring and typically has fewer beds, more equipment at each bedside, lower nurse-to-patient ratios and tighter visitor limits than other wards. Some ICU patients also need life support.

Why would someone be admitted to the ICU after surgery?

Healthdirect says ICU care can be part of early recovery after major surgery, when a patient needs close monitoring. Cleveland Clinic also lists post-surgery care among reasons a patient may need ICU treatment.

What machines, tubes and alarms might a family see in an ICU?

Healthdirect lists heart monitors and artificial ventilators as common ICU machines. It says tubes may provide fluids and nutrients or remove waste fluids, while alarms can alert staff to a change in a patient’s condition.

What is an advance care plan for ICU treatment?

Healthdirect says an advance care plan records a person’s wishes about treatments and life support if they become too sick to communicate. It can state treatments the person would accept or decline, can be changed and does not rule out ICU admission.

Sources

• Intensive Care Unit (ICU): Care & Admission Eligibility — my.clevelandclinic.org
• What to expect in a hospital intensive care unit (ICU) — www.healthdirect.gov.au