What Is Critical Care and How It Plays an Important Role?

Creator: Dr. Sehrawat Manisha
Published: 2020-12-08T16:09:25

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What Is Critical Care and How It Plays an Important Role?

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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.

Written by

Dr. Sehrawat Manisha

Medically reviewed by

Dr. Sneha Kannan

December 8, 2020

September 14, 2023

Introduction:

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.

Heart attack.
Heart failure.
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.
Cancer patients.
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-associated pneumonia.
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.

Conclusion

ICU is an important unit of an health care where people with severe health condition get special care. Doctors who work in ICU are called asintensivists or critical care physicians. Patient who are admitted in ICU are given care and attention all the time.

Frequently Asked Questions

1. What Is the Importance of Nursing?

Critical care nursing is essential because it provides complex and specialized care to critically ill patients. The role of critical care nurses is to monitor vital signs, administer medications and treatments, and collaborate with other healthcare professionals to ensure the best possible outcome for the patient. In addition, they play a crucial role in helping critically ill patients recover from life-threatening illnesses or injuries and return to a normal state of health.

2. What Is Critical Care?

Critical care is a specialized medical treatment for life-threatening conditions or severe injuries. Examples include ICU (intensive care unit) care for patients with ARDS (acute respiratory distress syndrome), sepsis, organ failure, or severe trauma. It involves monitoring vital signs, administering treatments and medications, and collaborating with other healthcare professionals to ensure the best possible outcome for the patient. The role of critical care nurses is crucial in this type of care.

3. What Is the Role of a Physician in Critical Care?

The role of a critical care physician is to provide medical care to critically ill patients in a hospital setting, usually in an ICU. They manage patients' complex medical conditions and provide life-support treatments as needed. This includes monitoring vital signs, administering medications and treatments, and collaborating with other healthcare professionals to ensure the best possible outcome for the patient.

4. What Is the Main Role of a Critical Care Nurse?

One key responsibility of a critical care nurse is to monitor and assess the critically ill patient's condition and vital signs, including heart rate, blood pressure, breathing patterns, and oxygen saturation levels, and report any changes to the physician or other healthcare team members. This information helps guide decisions about treatments, medications, and procedures and is crucial in detecting early signs of deterioration in the patient's condition, allowing for prompt and effective intervention.

5. What Is the Meaning of Critical Care Nursing?

Critical care in nursing refers to the specialized care provided to critically ill patients experiencing life-threatening illnesses or injuries. This type of care typically occurs in an ICU or a specialized hospital unit. The primary focus of critical care nursing is to support the critically ill patient's physiological systems and provide life-support treatments as needed, such as monitoring vital signs, administering medications and treatments, and collaborating with other healthcare professionals.

6. What Are the Roles of Critical Nursing?

Critical nursing roles include:
- Monitoring and assessing the critically ill patient's condition and vital signs.
- Administering medications and treatments.
- Collaborating with other healthcare professionals to develop and implement a plan of care.
- Providing life-support treatments, such as mechanical ventilation.
- Maintaining accurate medical records.
- Communicating with patients and their families, providing emotional support, and educating them about their condition and treatment.

7. How Are the Levels of Critical Care Divided?

The levels of critical care in a hospital setting are:
- Level I - Provides the most basic level of critical care services, typically for patients with stable vital signs who are in a stable or improving condition.
- Level II - Provides an intermediate level of critical care services for patients with complex medical needs or requiring closer monitoring.
- Level III - Provides the highest level of critical care services, usually in the ICU, for patients with life-threatening conditions or severe injuries who require constant monitoring and life-support treatments.

8. What Are the Procedures in Critical Care?

Examples of critical care procedures include:
- Artificial ventilation or breathing support using a mechanical ventilator.
- Hemodynamic monitoring, which measures blood flow and pressure.
- Cardiac monitoring, which measures heart function.
- Intravenous (IV) line placement and management.
- Insertion of a central venous catheter (CVC).
- Management of invasive or non-invasive monitoring devices, such as a urinary catheter or nasogastric tube.

9. Who Provides Critical Care?

Critical care is provided by a team of healthcare professionals in a hospital setting, usually in the intensive care Unit (ICU). The team typically includes critical care physicians, nurses, respiratory therapists, pharmacists, and other healthcare professionals, such as physical, occupational, and speech therapists. The team works together to provide medical care and support to critically ill patients, monitor their condition, and make decisions about treatments, medications, and procedures.

10. How to Differentiate ICU and Critical Care?

ICU refers to a specialized unit within a hospital that provides care for critically ill patients who are acutely ill and require close monitoring and life-support treatments. The ICU typically has advanced medical equipment and a highly trained staff, including critical care physicians and nurses. Critical care refers to the specialized medical care provided to critically ill patients, regardless of the location. Critical care is not limited to the ICU and can be provided in other hospital units or even in the patient's home, as long as the patient requires close monitoring and life-support treatments.

11. What Covers Under Critical Care?

Some of the medical services and treatments covered under critical care include:
- Monitoring vital signs, such as heart rate, blood pressure, and breathing rate.
- Administration of medications, including pain management and antibiotics.
- Management of life-support treatments, such as mechanical ventilation and cardiopulmonary resuscitation (CPR).
- Monitoring and management of fluid and electrolyte imbalances.
- Monitoring and management of blood sugar levels in patients with diabetes.
- Management of invasive or non-invasive monitoring devices, such as urinary catheters and nasogastric tubes.

12. What Are the Levels of Critical Care?

There are typically three levels of critical care in a hospital setting: Level I, Level II, and Level III.
- Level I provides the most basic critical care services for patients with stable vital signs who are in stable or improving condition.
- Level II provides an intermediate level of critical care services for patients with complex medical needs or requiring closer monitoring.
- Level III provides the highest critical care services for patients with life-threatening conditions or severe injuries who require constant monitoring and life-support treatments.

13. What Is Done in the First Hour of Critical Care?

The critical care first hour, also known as the "golden hour," is a concept in critical care medicine that refers to the first 60 minutes after a critically ill patient arrives in the hospital. This is a critical period in which the patient's condition can rapidly deteriorate, and prompt and appropriate medical intervention is essential to improve the patient's outcome. During the critical care first hour, healthcare providers perform a comprehensive assessment of the patient's condition, establish a diagnosis, initiate life-saving treatments, and transfer to the appropriate level of care, if necessary. The goal is to stabilize the patient's condition and prevent further deterioration.

14. What Covers Under Critical Care Time?

Critical care time refers to the duration of time during which a patient requires specialized medical care and close monitoring due to a critical illness or injury. This period starts when the patient is first diagnosed with a critical condition and continues until their condition stabilizes and they no longer require close monitoring and life-support treatments.

15. What Happens During a Critical Care Unit?

A critical care unit is a specialized hospital unit providing close monitoring and life-support treatments to critically ill patients. Healthcare providers continuously monitor vital signs, administer medications, manage life-support treatments, and monitor and manage fluid and electrolyte imbalances. In addition, they manage invasive or non-invasive monitoring devices and acute medical emergencies and communicate with the patient and family members.

Sources

Dr. Sehrawat Manisha

General Practitioner

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