Decoded - Intensive Care Unit (ICU)

The name ICU (Intensive care unit) has always given everyone shivers. Whenever someone says ICU, there are so many tubes going inside patients with zillions of wires and complicated leads placed around and over semi or unconscious patients who look as if they won’t survive! Some feel it’s a place where infections are there and one has to wear shoe covers and masks else they would contract serious infections. Intensive Care Units is a place where millions of lives are saved across the world, but it can be a nightmare and the worst experience of an individual and his/her relatives.

ICUs’ are named differently in different hospitals- Critical Care Unit, Intensive Therapy Unit, etc. The biggest challenge our society faces is their unawareness about ICU processes and protocols and innumerable myths and misconceptions.

World of ICU’s are highly poised by myths:

• Hospitals admit patient to ICU unnecessarily- ICU is meant for sick patients only and in fact, every hospital is short of ICU beds and many 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. An alert patient with a recent episode of fit requires ICU admission.

• Patients on ventilators don’t come out of it. Unawareness is the biggest cause; people fail to understand the ventilators are used to help support breathing in a patient just like dialysis supports kidneys. Ventilators are used when the patient is unable or has less effort to breathe himself. ICUs’ cannot be thought without ventilators, modern day surgeries like of open heart surgery, brain, etc. cannot be done without their support.

• 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 the law does not allow ventilators to be removed so it creates a lot of issues for both doctors and relatives and attendants feel that ventilators are unnecessarily being continued.In a country like ours, the law prohibits removal of life support or ventilators in critically ill patients and Euthanasia is not allowed.

• All ICU’s are the same, hospitals unnecessarily create confusions. Critical care has emerged as a top super speciality and along with the advancements in medicine and technology together with better funding and space allocation multi specialty hospitals and tertiary care centres have critical care units for different specialties, like Cardiac, Neurology, Transplant, Orthopaedics, Medical, Respiratory, Postoperative, Surgical, Pediatric ICU's, thus saving many lives.

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

• Doctors don’t tell clearly the outcome or prognosis of ICU patients- We must remember that ICU patients are extremely sick and vulnerable to any small changes in their status. It is extremely difficult to predict the exact outcome or duration of ICU stay of some patients. Especially in brain trauma, surgery or neurology patients it is even frustrating for doctors who are unable to exactly predict the outcome. Coma patient can come back to senses either in a day or a week or month or year, it’s anybody’s guess.

• Tracheostomy is an unnecessary evil. Tracheostomy is an extremely useful procedure which is done in patients who are on a prolonged ventilatory support with an aim to increase comfort, reduce sedation requirements, improve mobilisation, provision of speech, clearance of secretions, help reducing ventilator support etc in selected patients to avoid infections and further complications.

• Physical Restrains are routinely used so that Doctors/nurses could rest and sleep- Restraining means tie 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 life threatening. Restraining can only be done after a written approval of a doctor and is audited by the hospital quality teams.

• A lot of unnecessary investigation is done to mint money in ICU- Patients are almost on the verge in ICU's. A minute abnormality or disturbance in reports/investigations may cause catastrophe, hence to avoid such conditions, some tests are conducted routinely, repeatedly for correct, better and quality treatment.

• 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 immunocompromised i.e. susceptible to even slightest infection or stress, hence for the patient’s benefit and to provide less discomfort and stress, visiting hours are operational in all ICU’s.

• Doctors and nurses must solely provide psychological support and not 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 a photo of beloved ones, bringing favourite perfume or music, makes them feel connected and thus help them in faster recovery.

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

• Patient’s perception of hearing, taste, touch and sense of smell are never the same post ICU.-Patients’ senses may be affected by a stay in the ICU, but it gradually disappears and in some cases, it may take years for overall recovery of the patient.

• 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, etc. Several times recovery is very slow, that it might take years for a full recovery.