The intensive care unit, or ICU, is a hospital or medical center department that treats and manages patients with serious or life-threatening illnesses and injuries. Patients who may need to be admitted to the ICU include those who have been in serious accidents, who are struggling with post-surgical complications, or that have severe and difficult-to-treat infections. Patients may be sent directly to the ICU or may transition there from the emergency room for longer-term care. It is hoped that most patients will eventually recover enough to be transferred out of the ICU. The ICU is staffed by a range of medical staff, including those that specialize in critical and intensive care.
What Is Intensive Care and the ICU?
Intensive care units, or ICUs, are usually found in hospitals, but some larger medical centers may also have an ICU. These are departments that are designated to provide care for patients who are critically or seriously ill or injured. The care provided in the ICU is specialized and provided by staff members that have been trained in this type of intensive care.
The ICU provides very close monitoring of patients who are in critical condition. The patients can be observed around the clock here, important because of the severity of their illnesses. These are patients whose status could change suddenly and who may require quick intervention. To monitor patients and provide life support in the ICU, staff members use a lot of equipment, including heart monitors and ventilators.
About six million people need care in an ICU each year in the U.S. Most of these patients, more than half, are transferred from an emergency department to the ICU. Some of the most common illnesses that lead people to be admitted to an ICU include cardiovascular diseases, respiratory diseases, and neurological conditions. The average length of stay is four days.
While many ICUs are generalized, in that they can treat a variety of critical conditions and patients, there are also specialty ICUs. These are more common in large population areas, specialty hospitals, and large hospitals. Age is one specific factor for specialized ICU care. Some intensive care units are devoted to pediatric care or neonatal care. Care of these younger patients requires specially trained staff and equipment that is different and smaller.
Other types of specialized ICUs include psychiatric intensive care units, which are often found in dedicated psychiatric hospitals. There are also surgical intensive care units for patients with complications or a high risk for complications from surgery, cardiac intensive care units, trauma ICUs, and neurological intensive care units.
Patients in the ICU
There are many reasons why patients may need to be admitted to an ICU. Underlying all these reasons is the fact that patients in intensive care need near-constant monitoring. They also need specialty equipment, often including life support, and they need more time in care than the emergency room can provide. Emergency departments are designed to provide short-term care, while the ICU can provide more extended care.
Examples of patients who need care in the ICU include those that have gone into shock, potentially from a severe infection, those that are experiencing acute or chronic respiratory failure, patients with congestive heart failure that has worsened, and patients with severe kidney failure. Other illnesses that can land a patient in the ICU include those that cause organ failure, bleeding and clotting disorders, chronic illnesses that have caused complications, and neurological conditions.
What to Expect in the ICU
Patients in the ICU can expect to be cared for around the clock, to be monitored constantly, and to be hooked up to a lot of machines that can be intimidating. Many patients are far too sick to be very aware of what is going on, and many may even be unable to maintain consciousness or to speak. Patients may come into the ICU with an advance directive, a document that outlines his or her wishes for how to proceed with medical care.
For loved ones of a patient in the ICU the experience can be very different. It can be very distressing to see a loved one attached to so many machines, in pain, in critical condition, or not even conscious. Visitors should prepare themselves to see this, but should also expect that the staff will be compassionate and open with them about the status of their loved ones. There should be a doctor that meets with the family members regularly to give updates, to answer questions, and to help make decisions about care.
When a patient does not have an advance directive, the family will be asked to make difficult decisions. Family of loved ones in the ICU must expect that there is a possibility they will have to decide about life support and other types of care. They should also expect to have to face the possibility that even with the best care their loved one may not recover or ever be transferred out of the ICU.
The quality of care received in an ICU is highly dependent on the staff. An ICU includes a variety of types of caregivers, such as critical care physicians and nurses, psychiatrists, social workers, nursing assistants, and technicians. The critical care doctors and nurses have special training in this type of medicine, but the ICU also has access to specialists, including surgeons, neurologists, radiologists, pulmonologists, oncologists, and many others who may be needed for consultations or direct care.
Getting Quality Care in the ICU
Making sure that care in the ICU is of the highest quality if often up to the family members of patients who must act as advocates for their vulnerable. If you are facing having a loved one in the ICU, you can take certain steps to maximize care quality. One of the most important things you can do is insist on good communication. Staff in the ICU are busy, but it is important to ensure they talk to you regularly, update you, and give you all the information you need to make the best decisions for your loved one.
Communication in the ICU is key, and it goes both ways. Don’t be afraid to speak up if you are not sure your loved one is getting the best care or if you see something you don’t understand or that bothers you. Take advantage of any support services offered, both for you and your loved one. This may include pastoral services, counseling, translators, or financial and insurance assistance.
The intensive care unit can be a frightening place, but it is also a place that provides a very important type of care. Patients in the worst shape get care here and many are not able to recover. Still, many do recover thanks to good care and are able to transfer out of the ICU after a few days. Take all steps you feel are necessary to advocate for your loved on in the ICU and to make sure care is of the highest possible quality.