Intensive care unit

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Intensive care unit


ICU patients may requiremechanical ventilation if they have lost the ability to breathe normally.
An intensive care unit (ICU), also known as a critical care unit (CCU), intensive therapy
unit or intensive treatment unit (ITU) is a special department of a hospital or health care facility
that provides intensive care medicine.
Intensive care units cater to patients with the most severe and life-threatening illnesses and injuries,
which require constant, close monitoring and support from specialist equipment and medication in
order to ensure normal bodily functions. They are staffed by highly trained doctors and critical care
nurses who specialise in caring for seriously ill patients. Common conditions that are treated within
ICUs include trauma, multiple organ failure and sepsis.
[1]

Patients may be transferred directly to an intensive care unit from an emergency department if
required, or from a ward if they rapidly deteriorate, or immediately after surgery if the surgery is very
invasive and the patient is at high risk of complications.
[2]

Contents
[hide]
1 History
2 Specialities
o 2.1 Out of Hospital ICU
3 Equipment and systems
4 Quality of care
5 Operational logistics
6 See also
7 References
8 External links
History[edit]
See also: Intensive care medicine
In 1854, Florence Nightingale left for a Crimean War, where triage, used to separate seriously
wounded soldiers from the less-seriously wounded, was observed. Until recently, it was reported that
Nightingale reduced mortality from 40% to 2% on the battlefield. Although this was not the case, her
experiences during the war formed the foundation for her later discovery of the importance of
sanitary conditions in hospitals, a critical component of intensive care. In
1950, anesthesiologist Peter Safar established the concept of "Advanced Support of Life",
keeping patients sedated and ventilated in an intensive care environment. Safar is considered to be
the first practitioner of intensive care medicine as a speciality. In response to
a polio epidemic (where many patients required constant ventilation and surveillance), Bjrn Aage
Ibsen established the first intensive care unit inCopenhagen in 1953.
[3][4][5]
The first application of this
idea in the United States was in 1955 by Dr. William Mosenthal, a surgeon at the Dartmouth-
Hitchcock Medical Center.
[6]
In the 1960s, the importance of cardiac arrhythmias as a source
of morbidity and mortality in myocardial infarctions (heart attacks) was recognized. This led to the
routine use of cardiac monitoring in ICUs, especially after heart attacks.
[7]

Specialities[edit]


ICU Nurse attending to a patient in Baghdad, Iraq.

ICU nurses monitoring patients from a central computer station. This allows for rapid intervention should a patients
condition deteriorate whilst a member of staff is not immediately at the bedside.


Nurses in a neonatial intensive care unit (NICU)
Hospitals may have ICUs that cater to a specific medical speciality or patient, such as those listed
below:
Neonatal intensive care unit (NICU)
Pediatric intensive care unit (PICU)
Psychiatric intensive care unit (PICU)
Cardiovascular intensive care unit (CVICU)
Coronary care unit (CCU): Also known as Cardiac Intensive Care
Unit (CICU)
Post-anesthesia care unit (PACU): Also known as the post-
operative recovery unit, or recovery room, the PACU provides
immediate post-op observation and stabilisation of patients
following surgical operations and anesthesia. Patients are usually
held in such facilities for a limited amount of time, and must meet a
set physiological criteria before transfer back to a ward with a
qualified nurse escort takes place. Due to high patient flow in
recovery units, and owing to the bed management cycle, if a patient
breaches a time frame and is too unstable to be transferred back to
a ward, they are normally transferred to a high dependency unit
(HDU) or post-operative critical care unit (POCCU) for closer
observation.
High dependency unit (HDU): Many hospitals have a transitional
high dependency unit (HDU) for patients who require close
observation, treatment and nursing care that cannot be provided on
a general ward, but whose care is not at a critical enough level to
warrant an ICU bed. These units are also called step-down,
progressive and intensive recovery units and are utilised until a
patient's conditions stabilises enough to qualify them for discharge
to a general ward.
[8]

Surgical Intensive Care Unit (SICU): A specialized service in larger
hospitals that provides inpatient care for critically ill patients on
surgical services. As opposed to other ICUs, the care is managed
by surgeons trained in critical-care/trauma.
Out of Hospital ICU[edit]
Mobile Intensive Care Unit (MICU)
A specialized ambulance staffed by Paramedics.
Equipment and systems[edit]


Clinicians in an intensive care unit
Common equipment in an ICU includes mechanical ventilators to assist breathing through
an endotracheal tube or a tracheotomy; cardiac monitors including those with telemetry;
external pacemakers; defibrillators; dialysis equipment for renal problems; equipment for the
constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes,
suction pumps, drains, andcatheters; and a wide array of drugs to treat the primary condition(s) of
hospitalization. Medically induced comas, analgesics, and induced sedation are common ICU tools
needed and used to reduce pain and prevent secondary infections. Bed Head Unit/Panel, Medical
Rail System also called as Wall Utilizer.
Quality of care[edit]
The available data suggests a relation between ICU volume and quality of care for mechanically
ventilated patients.
[9]
After adjustment for severity of illnesses, demographic variables, and
characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was
significantly associated with lower ICU and hospital mortality rates. A ratio of 2 patients to 1 nurse is
recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical
floors. This varies from country to country, though; e.g., in Australia and the United Kingdom most
ICUs are staffed on a 2:1 basis (for High-Dependency patients who require closer monitoring or
more intensive treatment than a hospital ward can offer) or on a 1:1 basis for patients requiring very
intensive support and monitoring; for example, a patient on a mechanical ventilator with associated
anaesthetics or sedation such as propofol, Midazolam and use of strong analgesics such
as morphine, fentanyl and/or remifentanil.
Operational logistics[edit]
In the United States, up to 20% of hospital beds can be labelled as intensive-care beds; in the
United Kingdom, intensive care usually will comprise only up to 2% of total beds. This high disparity
is attributed to admission of patients in the UK only when considered the most severely ill.
[10]

Intensive care is an expensive healthcare service. In the United Kingdom, the average cost of
funding an intensive care unit is:
[11]

838 per bed per day for a neonatal intensive care unit
1,702 per bed per day for a paediatric intensive care unit
1,328 per bed per day for an adult intensive care unit
See also[edit]
ICU quality and management tools
Intensive Care Foundation, a charity in Australia and New Zealand
Geriatric Intensive care unit
References[edit]
1. Jump up^ "What is Intensive Care?". London: Intensive Care
Society. 2011. Retrieved 2013-05-25.
2. Jump up^ Smith, S. E. (2013-03-24). "What is an
ICU". wiseGEEK. Bronwyn Harris, ed. Sparks, Nevada: Conjecture
Corporation. Retrieved 2012-06-15.
3. Jump up^ Takrouri, M.S.M. (2004). "Intensive Care Unit". Internet
Journal of Health (Sugar Land, Texas: Internet Scientific
Publications) 3 (2). doi:10.5580/1c97. ISSN 1528-
8315.OCLC 43535892. Retrieved 2007-08-25.
4. Jump up^ Reisner-Snlar, L. (2009), "Der dnische Ansthesist
Bjrn Ibsen ein Pionier der Langzeitbeatmung ber die oberen
Luftwege", Doctoral Thesis (in German) (Frankfurt am Main,
Germany: Johann Wolfgang Goethe
University), OCLC 600186486. Translation of introduction
available here.
5. Jump up^ Reisner-Snlar, L. (2009). "The Danish
anaesthesiologist Bjrn Ibsen a pioneer of long-term ventilation on
the upper airways".
[dead link]

6. Jump up^ Grossman, D.C. (Spring 2004). "Vital Signs:
Remembering Dr. William Mosenthal: A simple idea from a special
surgeon". Dartmouth Medicine (Dartmouth College, Geisel School
of Medicine) 28 (3). Retrieved 2007-04-10.
7. Jump up^ "Histria da Terapia Intensiva" [Intensive Care
History] (video in English linked to from website). Sociedade
Brasileira de Terapia Intensiva (Brazilian Society of Critical Care)
websiteEnglish version. Produced by Tfran Ediao de Imagens.
Uploaded to YouTube by user: Thiago Francisco. 2008-06-06.
8. Jump up^ "Intensive Care Patients Experiences: High
Dependency Units" (compiled patient
testimonials), healthtalkonline.org (Oxford, England: DIPEx),
November 2012
9. Jump up^ Kahn, J.M.; Goss, C.H.; Heagerty, P.J.; Kramer, A.A. et
al. (2006-07-06). "Hospital volume and the outcomes of
mechanical ventilation". New England Journal of Medicine 355 (1):
4150. doi:10.1056/NEJMsa053993. PMID 16822995.
10. Jump up^ Bennett, D.; Bion, J. (1999). "Organisation of intensive
care". BMJ (Clinical research ed.) 318 (7196): 1468
70. doi:10.1136/bmj.318.7196.1468. PMC 1115845.PMID 1034677
7.
11. Jump up^ Winterton, R. (2005-06-15), "Written Answers text:
Trent Strategic Health Authority", Hansard - House of Commons
Debates (Westminister, England: Stationary Office, Parliament),
Volume 435, part 87, column 520W.
External links[edit]

Wikimedia Commons has
media related to I ntensive
care units.
"Intensive Care". NHS choices. UK: National Health Service.
"Critical Care". MedlinePlus. US: National Library of
Medicine, National Institutes of Health.
Society of Critical Care Medicine
ICUsteps - Intensive care patient support charity
Organisation for Critical Care Transportation
Reynolds, H.N.; Rogove, H.; Bander, J.; McCambridge, M. et al.
(December 2011). "A working lexicon for the tele-intensive care unit:
We need to define tele-intensive care unit to grow and understand
it". Telemedicine and e-Health. 17 (10): 773
783. doi:10.1089/tmj.2011.0045.
Olson, Terrah J. Paul; Brasel, Karen J.; Redmann, Andrew J.;
Alexander, G. Caleb; Schwarze, Margaret L. (January 2013).
"Surgeon-Reported Conflict With Intensivists About Postoperative
Goals of Care". JAMA Surgery 148 (1): 29
35. doi:10.1001/jamasurgery.2013.403.
[hide]
V
T
E
Intensive care medicine

Health science
Medicine
Medical specialities
Respiratory therapy

General terms
Intensive care unit (ICU)
Neonatal intensive care unit (NICU)
Pediatric intensive care unit (PICU)
Coronary care unit (CCU)
Critical illness insurance

Conditions
Organ system failure
Shock sequence

SIRS
Sepsis
Severe sepsis
Septic shock
Other shock

Cardiogenic shock
Distributive shock
Organ failure

Acute renal failure
Acute respiratory distress syndrome
Acute liver failure
Respiratory failure
Multiple organ dysfunction syndrome
Polytrauma
Coma

Complications
Critical illness polyneuropathy / myopathy
Critical illnessrelated corticosteroid insufficiency
Decubitus ulcers
Fungemia
Stress hyperglycemia
Stress ulcer

Iatrogenesis
Methicillin-resistant Staphylococcus aureus
Oxygen toxicity
Refeeding syndrome
Ventilator-associated lung injury
Ventilator-associated pneumonia

Diagnosis
Arterial blood gas
Catheter
Arterial catheter
Central venous catheter
Pulmonary artery catheter
Blood cultures
Screening cultures

Life supporting treatments
Airway management
Chest tube
Dialysis
Enteral feeding
Goal-directed therapy
Induced coma
Mechanical ventilation
Therapeutic hypothermia
Total parenteral nutrition
Tracheal intubation

Drugs
Analgesics
Antibiotics
Antithrombotics
Inotropes
Intravenous fluids
Neuromuscular-blocking drugs
Recombinant activated protein C
Sedatives
Stress ulcer prevention drugs
Vasopressors

ICU scoring systems
APACHE II
Glasgow Coma Scale
PIM2
SAPS II
SAPS III
SOFA

Organisations
Society of Critical Care Medicine
Surviving Sepsis Campaign
European Society of Paediatric and Neonatal Intensive Care

Related specialties
Anesthesia
Cardiology
Internal medicine
Neurology
Pediatrics
Pulmonology
Surgery
Traumatology

Categories:
Intensive care medicine
Hospital departments
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