Decoding the Intensive Care Unit (ICU)

Decoding the Intensive Care Unit (ICU)
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Dr Prashant Saxena

The name ICU (Intensive Care unit) has always given everyone shivers! Whenever someone says ICU, we imagine a horrific place where there are patients on ventilators with multiple alarms of monitors, infusion pumps, tubes going inside patients with zillions of wires and complicated leads placed around them and unconscious people who look as if they won’t survive !! Some also feel it is a place full of infections and one has to wear shoe covers and masks else they would catch some deadly viruses too.
It is not uncommon to see that it sometimes becomes a nightmare and one of the worst experiences of an individual and his/her relatives. However, Intensive Care Unit is a place where millions of lives are saved across the world. ICU’s are named differently in different hospitals. The biggest challenge our society faces is their unawareness about ICU processes and protocols and innumerable myths and misconceptions.
The myths, which are associated with ICU’s, that need to be debunked ar:
1. Hospitals admit patients to ICU unnecessarily: ICU is meant only for sick patients and, in fact, every hospital is short of ICU beds and often times, critically ill patients are waiting in the emergency to get an ICU bed allocated. Sometimes, we may have a false belief that our patient does not require ICU but we must remember that there are set criteria for ICU admission which all tertiary health care centres adhere to. For example, an alert patient with a recent episode of fit requires ICU admission.

2. Patients on ventilators don’t come out of it: Unawareness is the biggest cause of this myth: people fail to understand that ventilators are useful to help support breathing in a patient just like dialysis is helpful to support kidneys. Ventilators are used when patient is unable /has less effort to breathe himself/herself. ICUs’ cannot function without ventilators – modern day surgeries like open heart surgery , brain and so cannot be done without this support.

3. Ventilators are intentionally used to prolong ICU stay even in dead patients: In some countries, brain dead patients ( patients with irreversibly damaged brain function) are considered as dead. Still, in some countries, a patient is not considered dead until his/her heart stops functioning and law does not allow ventilators to be removed. This creates a lot of issues for both doctors and relatives as they feel that ventilators are unnecessarily being continued .In India, law prohibits removal of life support or ventilators in critically ill patients and Euthanasia is not allowed.

4. All ICU’s are the same; hospitals unnecessarily create confusions: Critical care has emerged as a top super specialty. Along with the advancements in medicine, technology coupled with better funding and space allocation, multi specialty hospitals and tertiary care centres have critical care units for different specialties, like Cardiac sciences ,Neurology, Transplant, Orthopaedics, Medical, Respiratory, Post operative, Surgical, Pediatric ICUS’. This enables the hospital to keep similar kind of arrangement for similar kind of medical conditions in close proximity thus saving many lives.

5. Unconsciousness or seizures do not require ICU admission: Both situations – be it loss of consciousness or seizures- are severe medical emergencies , which if not monitored properly may lead to permanent brain damage, paralysis or death.

6. Doctors don’t tell clearly the outcome or prognosis of ICU patients: We must remember that ICU patients are extremely sick .It is extremely difficult to predict the exact outcome or duration of ICU stay of some patients especially in conditions like brain trauma, surgery or neurology patients. Believe it or not, it is frustrating for doctors as well not being able to predict exact outcome(s). Coma patients can come back to senses either in a day or a week or month or year – we can’t comment!

7. Tracheostomy is an unnecessary evil: Tracheostomy is an extremely useful procedure which is done in patients who are on a prolonged ventilator support with an aim to increase comfort, reduce sedation requirements, improve mobilisation, provision of speech and clearance of secretions. It also supports reducing ventilator support in select patients , in the sense that it helps in avoiding infections and further complications.

8. Physical Restraints are routinely used so that Doctors/nurses could rest and sleep: Restraining means tying up and is done to prevent self extubation ( removal of ventilator life support tube inserted in mouth) or removal of any other tubes/ intravenous lines by the sick, delirious, restless or agitated patients which may be a life threatening situation .Restraining can only be done after a written approval of a doctor and is audited by the hospital quality team.

9. Lot of unnecessary investigations are done to mint money in ICU: Patients admitted in ICU’s are critical. A minute abnormality or disturbance in reports/investigations may cause a catastrophe; hence to avoid such conditions, some tests are conducted routinely to catch any abnormality , at the right time.

10. Attendants are allowed to see patient, only once or twice in 24 hours as it is comfortable to ICU staff: Critically ill patients are extremely fragile and often immune-compromised i.e., susceptible to even slightest infection or stress; hence for the patient’s benefit, visiting hours are adhered to very strictly.

11. Doctors and nurses must provide psychological support and it is not the responsibility of the relatives: Sometimes patients are conscious but cannot be shifted from ICU as they develop ICU related psychosis. To avoid this, sometimes attendants are asked to actively communicate with them, even if they can’t speak, they may be able to write or point to some objects/letters written on paper. Showing photo of beloved one’s, bringing favorite perfume or music, makes them feel connected and thus help them in faster recovery.

12. Besides doctors, why are there so many people in the ICU: ICUs’ are not managed by doctors alone. Nurses, physiotherapists, dieticians, technicians, educators and general attendants also play an extremely vital role and together as a multidisciplinary team aim for a speedy and fruitful recovery of sick patients.

13. Patient’s perception to hearing, taste, touch and sense of smell are never the same post ICU.-Senses of the patient’s may be effected by stay in the ICU ,but effects gradually disappear. In some cases, it may take years for overall recovery of patient.

14. Patients are never the same post ICU: Patients who are out of ICU may develop stress disorders or memory loss which needs much attention in terms of treatment, physiotherapy, diet and so on. Many a times, recovery is very slow but not irreversible!

 

The author is Head of the Department, Pulmonology & Sleep Medicine and Principal Consultant (Critical Care) at the Max Smart Super Specialty Hospital

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