When oral feeding is contraindicated, early parenteral nutrition is started. In parenteral nutrition, carbohydrates (dextrose), proteins (amino acids), lipids, and electrolytes are given through a large vein. Oral feeds are restarted as early as possible when the patient is recovering.
Medical Intensive Care Units (MICUs) provide comprehensive care for a wide variety of medical illnesses, including respiratory conditions, heart diseases, gastrointestinal diseases, and
blood infections.
By Kshalini Nonis
The Intensive Care Unit (ICU) comprises specialist hospital wards that provide treatment for patients who are very ill. They are staffed with specially trained healthcare professionals and contain sophisticated monitoring equipment. When a loved one goes into the ICU it could be a very trying time for the family members. We had a chat with Dr Heshan Amarathunge , Former MO Anaesthesia Pottuvil Hospital and District General Hospital Hambantota and Former MO Neonatal ICU – Tangalle Hospital regarding the ICU.
Q: Can you briefly describe the ICU and also the different types of ICU and their functions?
ICU stands for intensive care unit. An intensive care unit (ICU) is a separate unit inside a hospital that provides specialised medical care and treatment. It operates in collaboration with other departments within the hospital. Intensive care units may be categorised according to the specific illnesses or disorders they treat or by the age category of the patients they accept.
Specialised intensive care units include medical (MICU), surgical (SICU), paediatric (PICU), and neonatal intensive care units (NICU).
Medical Intensive Care Units (MICUs) provide comprehensive care for a wide variety of medical illnesses, including respiratory conditions, heart diseases, gastrointestinal diseases, and blood infections.
A Surgical Intensive Care Unit (SICU) provides medical care during the perioperative period (for patients who have just had surgery or for those who may need surgery in the near future) or following critical injuries.
A paediatric intensive care unit (PICU) offers specialised medical treatment to severely ill children and adolescents.
A neonatal intensive care unit (NICU) is a specialised unit that provides medical treatment for newborn babies who are either ill or delivered prematurely.
In addition, there are specialised ICUs, including the neurotrauma ICU, cardiothoracic ICU (CT ICU), cardiac ICU (CICU), and trauma ICU.
Q: What types of patients are kept in the ICU?
An ICU is a specialised unit inside a hospital that provides medical treatment and monitoring to those in critical conditions. Individuals in the ICU have severe medical conditions that can be life-threatening. It can be following a serious injury, suffering from a serious illness, or recovering from major surgery.
Q: What is a patient’s recovery rate?
Many factors influence the ICU recovery rate and duration of stay. These factors include the severity of the current illness, comorbid conditions, age, immunity, and infections.
Q: Can you describe the ICU set-up ?
ICU is designed with several separated beds. Each bed has individual monitors and machines.
Q: What is the ICU team and their responsibilities?
The ICU team includes an intensive care physician, a consultant microbiologist, ICU nurses, physiotherapists, occupational therapists, healthcare assistants, and dieticians. In addition, other healthcare staff are linked to the ICU. Intensivist doctors are highly trained doctors specialising in anaesthesia, internal medicine, surgery, or paediatrics.
ICU nurses are highly trained nurses who monitor patients continuously and provide specialised care to ICU patients. A physiotherapist helps in the rehabilitation of bodily functions related to muscles, bones, or nerves.
Q: What are the indications for ICU admission?
Indications for ICU admission can be broadly divided into three categories.
Individuals suffering from a serious illness
Individuals following serious
physical injuries
Patients who are recovering from a
major surgery
Intensive care is indicated for patients who need or are expected to need advanced respiratory support, patients who need support for two or more organ systems, and individuals who have persistent impairment of one or more organ systems who also need treatment for the short-term failure of another organ.
Q: Can you tell us the admission procedure?
Admission to an ICU can be pre-planned or sudden. For routine ICU admissions, an ICU bed is reserved. In case of an emergency, the patient can be accepted only if there are free beds in the ICU in the same hospital. If not, the patient will be transferred to the closest ICU. Sri Lanka has only a limited number of ICU beds. So in the government sector, only a limited number of patients can be accommodated at once. Several factors are considered when prioritising ICU admissions, including medical diagnosis, age, co-existing diseases, the severity of the condition, and prognosis. When a patient is accepted, he or she will be admitted to the ICU. During the admission, the Intensivist assesses the patient and decides on the management during the ICU stay.
Q: What about ICU care and monitoring?
Most of the ICUs provide 1-to-1 nursing care, which means one nurse is assigned to monitor the patient 24x7. Patients are connected to different machines to monitor heart rate, blood pressure, breathing rate, blood oxygen levels, exhaled carbon dioxide levels, temperature, fluid input/output, etc. These measurements are used to optimise the hemodynamics, ventilation, nutrition, and metabolism of the patient. In addition, some of the patients are connected to a machine (a ventilator), which controls their breathing. During an ICU stay, medications, fluids, and nutrients are given intravenously (through a vein).
Q: What about nutrition for those in the ICU?
Proper nutrition is needed for ICU patients to prevent malnutrition, maintain proper physiology, improve immunity, and prevent muscle wasting. Most of the ICU patients are unconscious and/or are unable to take food through the mouth and have a risk of aspiration.
When oral feeding is contraindicated, early parenteral nutrition is started. In parenteral nutrition, carbohydrates (dextrose), proteins (amino acids), lipids, and electrolytes are given through a large vein. Oral feeds are restarted as early as possible when the patient is recovering.
Q: What are some of the complications that can arise in the ICU?
Infections
Venous thromboembolism (blood clot formation inside veins)
Delirium (mental confusion)
Bed ulcers (bed sores)
Q: What about emergency situations in the ICU?
Patients can go into cardiorespiratory arrest during an ICU stay. In addition, they can have heart attacks, abnormal heartbeats (arrhythmias), massive bleeding, delirium, etc.
Q: When can a patient be discharged from the ICU?
When vital signs and hemodynamical parameters are stable
Return to normal consciousness
Recovery from the acute illness or disability
If the same care can be given in a non-ICU setting,
An ICU patient will be transferred to a HDU or to a general ward prior to discharge from the hospital.
Q: What is the difference between ICU and HDU?
High-dependency care units (HDUs) are units that provide intermediate levels of patient care, ranging between the intensive care unit (ICU) and general ward.
Q: Why do patients go to HDU?
When less critical care than in the ICU or more critical care than in a general ward is needed.
Q: Finally can you give us a check list/summary?
The ICU is a separate unit that provides specialised medical care and treatment. Only critically ill patients are managed in an ICU. ICU staff are highly trained to give specialised medical care and maintain special monitoring of the patient. Most of the relatives are curious about their loved ones admitted to the ICU. Always limit your visits to the ICU to prevent infections. ICU staff will provide the best possible care to your loved ones at the ICU, so always have patience to support them.
