Frequently asked questions
The Intensive Care Unit (ICU) is a specialized part of the hospital that provides treatment to patients with potentially reversible life threatening illnesses. These patients require close and constant monitoring by a team of highly specialized caregivers. The High Dependence Unit is a step-down unit from the ICU for patients who are recovering from an acute illness but are not stable enough to be in the wards. It is also used for monitoring acutely ill patients who may not require ICU care but need closer monitoring than is provided in the wards. Both these units are considered Critical Care Units (CCU).
Any life- threatening illness may require critical care e.g.
ICU patients are usually on pain killers and sleep inducing medication to enable them to tolerate the various tubes that go into their body. These drugs also alleviate the discomfort related the primary illness, position in the bed, and lack of movement. Therefore, the patients appear sleepy and weak. Patients’ increased requirements for intravenous fluid attended by immobility makes them swell, and thus appear puffy. As the patient recovers, the medicines and fluids are tapered off and normal appearance is restored.
Patients in the ICU although sedated may be aware of their surroundings to varying extents. Some may have explicit recall of events in the ICU. Monitoring of brain activity in response to various stimuli e.g. sound (auditory evoked potentials) suggest there is significant brain activity which enables them to hear and remember such events. The goals of ICU sedation, apart from enhancing comfort may also target recall of unpleasant events during the ICU stay.
In the Critical Care Units patients have tubes for feeding and monitoring. A feeding tube may be inserted through the mouth or nose to deliver food into the stomach; or directly through the abdominal wall into the small intestine.
Bed baths are done daily with soap and water or wet wipes. Two care givers carry out this procedure. Every two to four hours the patients are turned to prevent pressure sores. Use of special mattress (ripple mattress) helps to reduce the occurrence of pressure sores.
Life support machines are medical devices used to keep patients alive by supporting vital organs when they start to fail. The most commonly employed machine is the mechanical ventilator (respirator). It delivers air into the lungs when the patient is unable to breathe on their own. The patient is connected to the ventilator using a tube that is inserted into the windpipe (endotracheal tube) and connected through breathing circuits to the breathing machine.
The dialysis machine is used to remove toxins from the blood when kidneys fail.
The infusion pump is used to deliver drugs into the body at a specified rate based body weight or total body surface area e.g. sedatives, pain killers, heart strengthening and blood pressure raising medications.
During the course of illness in the ICU, patients experience pain, discomfort, memory lapses, disorientation and altered sleep cycles. This may lead to post ICU syndrome (delirium, post-traumatic stress disorder). These are alleviated by use of sedatives, hypnotics and pain killers.
Weight loss and muscle weakness may be due to increased nutritional requirements coupled with reduced intake in the setting of critical illness. Use of steroids is also associated with muscle weakness. Physio- and occupational therapy are used to restore muscle function.
Recovery may take weeks, months or years, depending on pre-ICU health status, duration and severity of the critical illness. Working with healthcare providers on both physical and psychological well-being is the cornerstone of the recovery journey.
The high cost of ICU care maybe explained by the need for 24-hour nursing care, physiotherapy, oxygen, ventilator use and dialysis. There are multiple procedures e.g. central line insertion, dialysis, fluid infusions and feeding. Some laboratory and radiology tests may need to be repeated for trend analysis. Loads of medicines serving different purposes e.g. sedation, pain relief, antibiotics, fluids, blood and blood products, antacids and intravenous feeds would definitely increase the monetary requirement.
This is dependent on whether the patient is capable of making rational decisions. If fully alert, the patient may take part in decision making. If in coma, a surrogate decision maker e.g. a lawyer, spouse, adult daughter or son is incorporated in the decision-making process. However, autonomy of the family is respected.
Death rate in the ICU is significantly higher than in the general ward. 40- 60% of the patients admitted to the ICU survive. Survival is enhanced by early diagnosis, early appropriate therapy and early ICU admission.
High mortality rates in the ICU are directly attributed to the severity of the illness. However, some people have advance directives e.g. living will, durable power of attorney for healthcare which guide clinicians on the goals of care in the event of critical illness. Such directives, together with clinician input help to decide whether therapeutic interventions should be administered in full, be withdrawn or withheld. Clarification on the performance of cardiopulmonary resuscitation is also made.
In Kenya, euthanasia (mercy killing) is illegal. A physician or doctor who conducts euthanasia is liable of manslaughter or murder according to Section 213(d) of the penal Code Chapter 63 of the laws of Kenya
ICU patient outcomes are varied. The worst-case scenario is death. Those who survive may make full physical, physiological and cognitive recovery. Others may recover but with attendant Post Intensive Care Syndrome (PICS), or they may be in chronic vegetative state.
Post Intensive Care Syndrome is health problems that persist beyond the duration of critical illness. They may range from subtle neuro-cognitive disturbances to obvious physical problems (ICU acquired muscle weakness).
ICU models that allow extended visitation report reduced occurrence of PICS compared to those with restricted family presence.
Chronic vegetative state is a severe form of either metabolic or traumatic brain injury which renders patients dependent on others for basic life processes. They need to be fed, cleaned, turned and changed throughout their lives. They have no chance for full rehabilitation.
Feel free to ask us any questions related to Critical Care and its activities. We will answer them accordingly.