In this section helpful information is provided for intensive care unit (ICU) patients, their relatives and the general public. As a worldwide representative organisation, we also provide links to different language resources that have been identified. While standards of care may vary from country to country, our aim is to promote the highest standards of intensive and critical care medicine for all mankind, without discrimination.
The World Federation currently has several Task Forces which are developing global statements on topics in intensive and critical care medicine that are important to the public as well as ICU staff. The outcomes from these Task Forces are expected to be published at the end of 2015 or beginning of 2016. A “patient and public” summary of the outcomes will be published here on the following topics:
|What is an ICU?
||How is an ICU defined and what type of care does it offer?
|End of Life
What considerations are important at the end of life?
|The ICU Specialist
||How should ICU doctors be trained, assessed and developed throughout their careers?
||How should decisions be made about which patients should be admitted to an ICU?
What is an ICU?
Intensive care units may also be called critical care units and they essentially describe the same resource. They are synonymous terms. ICUs are sections within a hospital that look after patients whose conditions are life-threatening. These patients need constant, close monitoring and support from equipment and medication to keep normal body functions going. ICUs have higher levels of staffing, with specialist monitoring and treatment equipment that is only available in these areas. The ICU staff are highly trained in caring for the most severely ill patients.
Why might intensive care be required?
Patients usually require admission to an ICU because their medical condition(s) demands interventions, equipment, medications, monitoring and/or clinical expertise that can only be delivered in an ICU. For some patients, care in an intensive care unit is the best option immediately following their operation (surgery). Other patients may require support from a breathing machine (ventilator) for pneumonia or other lung conditions. Certain medications can only be administered in an ICU.
Intensive care units offer a higher level of monitoring and treatment than an ordinary hospital ward. There are more nurses, doctors, physiotherapists and assistants per patient and there is specialist equipment that is only available in the ICU. In general, senior staff are closely involved in the hour-by-hour management of patients. Staff are specially trained to care for the most unwell patients.
“Planned” admissions (organised in advance)
There are some operations (surgical procedures) where patients are best managed in intensive care immediately after their surgery. There are other operations after which patients would normally return directly to the hospital room/ward from the theatre recovery area. A particular patient might have other problems or illnesses that mean their doctors believe a period of observation or treatment in intensive care will assist in their recovery.
The staff will use special transfer equipment to carefully observe the patient throughout the journey to an ICU.There will be a comprehensive handover of all the important medical history of the patient, the reasons for the operation, events that have taken place during the operation and details of the operation itself. The surgeons will usually visit the patient in intensive care a short time later.
There might be occasions when surgery is cancelled due to a lack of intensive care beds. In many countries, intensive care units operate at or very near their full capacity. Trying to assess demand for intensive care beds is a real challenge for staff. If surgery is cancelled it is very likely that an emergency patient required admission.
Patients with an acute illness will generally be seen first by the emergency department team or by one of the general medical, surgical or specialist teams. If the patient’s condition is assessed as requiring a higher level of monitoring or treatment, then they contact the intensive care team. Patients frequently require a period of stabilisation before it is safe to move them to the intensive care unit. For example, it may be necessary to perform emergency investigations in the X-ray department before the patient is moved.
The intensive care team and the admitting team will often reassess the patient together and discuss the further management with the patient, their family or next of kin and sometimes their Primary Care provider. Not all patients will benefit from being taken to intensive care, and sometimes the intensive care team will advise that care in an ICU will not improve the course of their medical condition or that the conditions can be managed on the general ward. In these situations they will assist by ensuring that the patient is comfortable and their dignity is respected. If the team feel the patient will benefit from intensive care, then they will admit the patient to the ICU. Doctors and nurses make these decisions with as much involvement from the patient as is possible.
On the ICU
Following admission to the ICU, it can take several hours to stabilise the patient in their new environment. The staff may have to use more monitoring equipment which may include inserting special "central lines" (long catheters that are usually placed in the large veins in the neck or top of the leg). Emergency treatments may be necessary, such as putting the patient to sleep and inserting a breathing tube into their windpipe and stabilising them on the ventilator. Sometimes kidney dialysis must be started urgently.
While this is happening relatives might be asked for details about next of kin, contact telephone numbers for the family as well as providing families with information about visiting, car parking, and whether there is a facility for you to stay near the unit, especially if it is a specialist unit a long way from home.
The first few hours on intensive care are often a very unstable time and a patient's condition can change from minute to minute. The doctors and nurses will usually explain if they think this is likely. Frequently one of the team will summarise for relatives what has happened so far and what they are expecting in the next few hours. You should not be afraid to ask questions and to ask to speak to the doctors. However please try to understand if they are not available immediately.
Please click here to view our Patient/Family Resources.