Intensive Care Unit (ICU)

Dr. Vijayalakshmi Thanasekaraan

Dr. T.Linga devi MBBS MRCP ( UK )

This will be presented as a case scenario:
A BE graduate enters our hospital Emergency Room (ER) at 5.00pm and says his brother, Mr.X, 55years of age felt giddy and fell down at home. He had taken him to a nearby doctor who advised Mr.X to be admitted in an ICU (Intensive care unit). So he asked the Emergency Room doctor, what is meant by ICU for this the Emergency Room (ER) doctor said, I will explain in detail about ICU.
Intensive Care Unit is also called as Critical Care Unit (CCU), Intensive Therapy Department (ITD).
ICU’s are specialized wards in hospitals. Specialized ward means, a ward which has special equipments and where highly specialized care of treatment and monitoring will be given to patients who suffer from serious illness, who are seriously ill, who are in an unstable condition or who suffer from serious injury.

History of ICU

The ICU’s roots can be traced back to the Monitoring Unit of critical patients in the Crimean War which began in 1853 .Because of the lack of critical care and the high rate of infections, there was a high mortality rate of hospitalised soldiers, reaching as high as 40% of the deaths recorded during the war. Nightingale and 38 other volunteers had to leave for the Fields of Scurati, and took their “critical care protocol” with them. Upon arriving, and practicing, the mortality rate fell to 2%. This formed the basis of importance of Intensive Care setting to this date.
 Nurse Florence Nightingale

What are the cases that are referred to ICU?
The cases who get admitted to ICU are those who are very ill or who have life threatening diseases or disorders which require continuous monitoring and treatment.

These cases may have failure of one or more of their systems like heart, lung, kidney, liver, etc.E.g.
• (Patients with heart problem like heart attack (myocardial problem), Chest pain (unstable angina) abnormal heart rhythm (cordial arrhythmias), heart failure, very high blood pressure (systemic hypertension) or very low blood pressure (hypotension, shock)
• Patients with lung problems like severe asthma, severe lung infections (Pneumonia) lung failure (respiratory failure) blood clots in the lungs (pulmonary embolism) coughing out blood (haemoptysis).etc.
• Patients with neurological disorders like blood clot in the brain (acute stroke), coma, bleeding inside the brain (intracerebral hemorrhage) or serve injury to the brain or any infections like meningities, encephalitis, etc. Sometimes patients who develop fits also get admitted in to ICU.
• Patients, with problems of salts, chemicals, minerals in the blood stream (e.g high level of potassium, low level of sodium or varying levels of sugar) may get admitted, to ICU, as immediate treatment is necessary.
• Patients with severe trauma, such as road traffic accidents, gunshot wounds, burns, etc also get admitted in ICU.
• Patients who undergo major operations or those in whom after operations some complications arise also get admitted to ICU.)

Types of Intensive Care Units

1. Medical Intensive Care Unit (MICU).
2. Surgical Intensive Care Unit (SICU).
3. Neurosciences Intensive Care Unit (NICU).
4. Coronary (Cardiac) Care Unit (CCU).
5. Cardio thoracic ICU.
6. Post Operative ICU.
7. Pediatric ICU (PICU)
8. Neonatology ICU (NICU).
9. Burns ICU.
10. Trauma ICU.
11. High Dependent Unit: (HDU) or (HDU): Step down Care:
This is a place where patient’s condition gets stabilized but still needs to be on continuous supervision. Here close observation, nursing care and, treatment which cannot be provided in general wards are given. Once the patient’s condition is stabilized here they can be transferred to general wards.

Equipments and system

ICU has highly specialized life saving and supporting equipments for multiorgam support.
 Endotracheal Tube

 Mechanical Ventilator

Common equipments in an ICU includes
a) Mechanical Ventilators to assist breathing through end tracheal tube or tracheotomy.
b) Cardiac monitors- external pacemakers, defribillators,
c) Dialysis equipment for renal problems.
d) Equipment for the constant monitoring of bodily functions,
e) If the patient has breathing problem they may have masks for oxygen therapy
Or may be connected to a machine called ventilators, through an endo tracheal tube or tracheotomy tube.

Staff in ICU

The specialized Care in ICU is given by multidisciplinary team. The team consists of Doctors (Intensivists), nurses, pharmacists, respiratory therapists who are all specially trained in taking care of critically ill or injured patients Patients have an Intensive Care nurse allocated to, them for each shift.The team continuously observes monitors and treats the patients.

The staffs in the ICU understand and give respect to the feelings of the patients and their attenders and they are very supportive. In ICU, there are counselors available to provide an update about the condition of the patients to the relatives
Other specialists and surgeon’s opinion and advices when necessary may be obtained

Treatment of the patients in ICU includes:

a) Monitoring for vital signs eg.Blood pressure, Heart rate , repiratory rate, oxygen saturation and temperature
b) Giving germ killing medicines( like antibiotics) and additional fluids through veins(intravenous fluids)
c) Giving medicines (drugs) to improve general conditions.
d) Providing enough (adequate) nutrition through a feeding tube and veins.(central lines)
e) Providing adequate infection control.
f) Pain reliefs by giving pain killers (analgesics) and sedatives.

The ICU has certain guidelines to be followed by the visitors.

Visitors should NOT Carry any infection from outside to the ICU.So they should
a) Wash their hands before entering and leaving the Department.
b) Wear overshoes before entering the ICU ward.
c) NOT crowd the patient.
d) NOT take children to ICU.
e) NOT use mobile phones inside the ICU.

Dr.Vijayalakshmi Thanasekaraan
Head of Clinical Services,
Dept. of Pulmonary Medicine
Sri Ramachandra Medical Centre, Porur,
Chennai 600 116.
Dr.T.Linga devi MBBS MRCP ( UK )       
Consultant Physician Ayyappa Clinic
No.1,1st Cross Street,
West C I T Nagar,
Chennai 600 035.