This article will give anyone insight into what exactly happens in the area of critical care and how it plays a major role in current times.
In current times, critical care is an important part of any healthcare facility where patients with life-threatening conditions get specialized care, constant monitoring, and management. It is often called an intensive care unit (ICU). Doctors who are trained in providing this specialized care and management of patients in an intensive care unit are called intensivists or critical care physicians. Critical care comes into the picture when a person gets extremely sick and needs immediate management. Such patients cannot be admitted to the general ward. If done so, their health and condition may further deteriorate rapidly, and this can put a person's life at risk. These patients are put in the intensive care unit so that they can be monitored round-the-clock by a specially trained team of doctors, nurses, and therapists. In most of the ICUs, primary treating physicians and critical care physicians work hand in hand, sharing the responsibility and taking all urgent and important decisions.
Which Patients Require ICU Admission?
In order to prevent the worsening of general conditions and subsequent development of complications, patients with the following conditions need to be put in an intensive care unit.
Trauma patients, which include road traffic accidents, electrocution, drowning, etc.
Post-operative patients, such as cardiothoracic surgery and neurosurgery.
Respiratory failure, where they have trouble breathing and need continuous oxygen supplementation or possible ventilator support.
Disseminated infections that often lead to septic shock.
Kidney failure patients who require dialysis and dialysis-related complications.
Diabetic patients with dangerously high or low sugar levels.
Severe electrolyte imbalance where levels are corrected under strict monitoring.
Severe bleeding, leading to shock.
Stroke patients who require neurological monitoring.
Drug ingestion or overdose, poisoning.
Organ transplant patients, both pre- and post-transplant.
What Are the Commonly Used Equipment in ICU?
Feeding tube - It is used for feeds and is placed through the nose.
Arterial catheter - For regular and accurate monitoring of blood pressure.
Central venous catheter - A catheter is placed in the large vein for giving medicines and measurement of several other vital parameters.
Urinary catheter - For accurate urine output monitoring as the patients are mostly bed-bound. Dialysis machine - Dialysis catheter and dialysis machine for kidney failure. For carrying out dialysis.
Ventilator - A machine that provides breathing support to patients who are not able to breathe effectively on their own. It is connected to a tube placed in the patient's windpipe and gives breaths at timely intervals.
Tracheostomy tubes - Another kind of breathing tube placed in the wind pipe through a hole in the neck for breathing support.
Several of these types of equipment are attached to monitors and other machines to get a continuous and accurate reading of vital signs, which get displayed on a monitor. All of this plays an important role in making timely decisions regarding managing the patient's condition.
What Are the Procedures Done in the ICU?
Endotracheal Intubation - Placing a breathing tube in the windpipe through the mouth.
Percutaneous Tracheostomy - Placing a small breathing tube in the windpipe through a surgically created hole in the neck. This hole is later closed.
Lumbar Puncture - The removal of cerebrospinal fluid (CSF).
Pleural Tap - The removal of fluid from lungs.
Ascitic Tap - The removal of abdominal fluid. This is usually seen in patients with liver disease and intra-abdominal tumors.
Intercostal Drainage Placement - A large drain is placed in the lungs for continuous drainage of accumulated fluid.
Arterial Line Insertion - A catheter placed in any of the superficial arteries for continuous measurement of blood pressure.
Central Line Insertion - A catheter is placed in one of the large veins.
Hemodialysis Catheter Placement - A special catheter is placed in any of the large veins that can be used for dialysis at the time of need.
Pulmonary Artery Catheter Placement - A large catheter is placed in a cardiac vessel for the measurement of cardiac parameters.
These procedures are done only after an explanation of all the risks and benefits associated, followed by taking due consent.
What Are the Risks and Complications Seen?
Complications of ventilator use:
Ventilator-induced lung injury - This is caused by pressure created in the lungs during mechanical ventilation.
Difficulty to wean off ventilator support - The patient may find it difficult to breathe on his own and continues to require ventilator support for a longer time.
Infections due to multiple types of equipment placed in different parts of the body - These include catheter-related bloodstream infections, urinary tract infections, and septicemia leading to sepsis.
Bedsores or pressure ulcers - As patients are mostly bed-bound, there is a risk of developing pressure ulcers.
Critical illness-associated muscular dystrophy - Muscular weakness due to lack of muscle use for prolonged periods.
Clostridium difficile infection due to antibiotic use - The patient may develop diarrhea due to the use of multiple broad-spectrum antibiotics.
Venous thromboembolism - The lack of mobility may lead to the formation of blood clots, which can circulate and end up in different parts of the body.
Stress ulcers - Critical illness weakens the stomach lining and can lead to the formation of ulcers.
Surgical site infection.
Delirium or confusion, or psychosis.
What to Expect When You or a Family Member Is Admitted to ICU?
Upon admission, the patient and family are explained in detail about the ICU requirements. The current condition of the patient, as well as things to be expected in days to come, are explained too. Besides, any questions that you may have will be answered by the team, such as visiting hours, etc. The briefing by the ICU team helps in reducing the stress and anxiety levels of the patient and family.
Although there are studies showing that increased visitation from family members brings good outcomes in patients by improving recovery rates and reducing emotional stress, visitors are still restricted in ICU so that there is no interruption in the patient's monitoring. This also helps a patient to get adequate rest. Frequent visitation from family also leads to increased workload and stress on the ICU team. One should avoid going to the ICU if unwell as the patients there are mostly in a vulnerable state. Hence, at greater risk for contracting the infection. Always remember to wash hands or use a sanitizer before entering the ICU.
Recent Advancements in Critical Care:
There have been large multicenter randomized control trials, which have led to multiple advances in the field of critical care. Over the last few years, critical care has evolved as a specialized area of medicine. With highly trained physicians and nurses, there has been a lot of improvement in the general care of extremely sick patients. Timely and multidisciplinary management with special attention to areas of infection, nutrition, bedsore prevention, and early mobility has contributed substantially to the improved survival, recovery rates, and overall quality of life of the patients.
Last reviewed at:
08 Dec 2020 - 5 min read
Query: Hi doctor, My query is regarding a female patient aged 28 years. She has been on ventilator by means of a tracheostomy for 50 days. She has been on CPAP mode for two weeks, but unable to sustain respiration off the ventilator. Please help. Read Full »
Most Popular Articles
Do you have a question on Emergency Life Saving Procedure or Heart Attack Symptoms?Ask a Doctor Online