An intensive care unit, also known as an intensive therapy unit or intensive treatment unit or
critical care unit, 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 invasive 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.
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.
History
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, Bjørn Aage Ibsen established the first intensive care
unit in Copenhagen in 1953.
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.
In the 1960s, the importance of cardiac arrhythmias as a source of morbidity and mortality in
myocardial infarctions was recognized.
This led to the routine use of cardiac monitoring in ICUs, especially after heart attacks.
Specialities
Hospitals may have ICUs that cater to a specific medical speciality or patient, such as those
listed below: Neonatal intensive care unit
Pediatric intensive care unit Psychiatric intensive care unit
Coronary care unit: Also known as Cardiac Intensive Care Unit or Cardiovascular Intensive
Care Unit.
Medical intensive care unit.
Neurological intensive care unit.
Patients here are treated for aneurysms, brain tumors, stroke, rattlesnake bites and post
surgical patients who have undergone various neurological surgeries and require hourly
neurological exams.
Many nurses who work within these units have neurological intensive care certifications.
Once the patients are more stable and off the ventilator, they are transferred to a
neurological care unit.
Trauma intensive care unit.
These are found only in hospitals certified in Trauma and have a dedicated Trauma Emergency
Department equipped with a team of surgeons, nurses, respiratory therapists, and radiological
staff.
Post-anesthesia care unit: 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.
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 or post-operative critical care unit
for closer observation.
High dependency unit: In the United Kingdom and elsewhere, most acute hospitals have a
transitional high dependency unit 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 condition stabilizes enough to qualify them for discharge to a general
ward.
Surgical Intensive Care Unit: 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.
Out of Hospital ICU Mobile Intensive Care Unit
A specialized ambulance staffed by Paramedics.
Equipment and systems
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, and catheters; 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 The available data suggests a relation between
ICU volume and quality of care for mechanically ventilated patients.
After adjustment for severity of illnesses, demographic variables, and characteristics
of different ICUs, 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 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 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.
Intensive care is an expensive healthcare service.
In the United Kingdom, the average cost of funding an intensive care unit is:
£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 ICU quality and management tools
Intensive Care Foundation, a charity in Australia and New Zealand
Geriatric Intensive care unit References
External links "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..
"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: 773–783.
doi:10.1089/tmj.2011.0045.
Olson, Terrah J. Paul; Brasel, Karen J.; Redmann, Andrew J.; Alexander, G. Caleb; Schwarze,
Margaret L..
"Surgeon-Reported Conflict With Intensivists About Postoperative Goals of Care".
JAMA Surgery 148: 29–35.
doi:10.1001/jamasurgery.2013.403.