Why is my loved one at the ICU?
The Intensive Care Unit (ICU) is where very ill/injured patients receive specialized care 24 hours a day. Most patients will be cared for by one nurse. For patients whose health is improving, one nurse may care for two patients.
We treat patients with a variety of injuries and illnesses, including:
We are the trauma center in British Columbia and help care for various traumatic brain injuries, spinal injuries, patients in motor vehicle accidents, falls, and other life threatening injury.
Badly burned patients need fluid, and support for breathing. Our ICU supports major burn patients in the province with dressings, management of airway, ventilation, monitoring of blood pressure and heart function, fluid resuscitation, and physiotherapy.
Vancouver General Hospital is a major provider for solid organ transplant in British Columbia, and one of the largest in Canada, with over 100 transplants each year. Pre and post transplant, some patients need increased supportive care and monitoring.
When a patient is in shock, the body’s organs don’t get enough oxygen and blood pressure for the them to function normally. Our job in the ICU is to help support the heart and lungs with fluids, medications, and ventilation. Four of the most common reasons for shock are:
- Hypovolemic Shock – severe dehydration or massive fluid loss
- Cardiogenic Shock – cardiac or heart failure
- Septic Shock – severe infection resulting in organ failure
- Systemic Inflammatory Response Syndrome (SIRS) – can be caused by massive trauma, severe infection or some other medical conditions.
Acute respiratory failure
The lungs remove carbon dioxide from the blood and replenish it with oxygen. Acute respiratory failure occurs when the lungs do not work well enough to replenish blood with oxygen.
Acute respiratory failure may be the reason for admission to ICU or a complication that occurs in the ICU stemming from many different causes, such as pneumonia, aspiration, trauma, or infection. It can range from mild to severe.
Many patients in the ICU will have a breathing tube inserted and will be placed on mechanical ventilation (a breathing machine). The goal is to support the patient until the lungs are able to heal.
Chronic respiratory failure
If a patient remains critically ill for a long period, the patient becomes very weak. This weakness often prevents a patient from being able to breathe without assistance. Respiratory muscles need to be exercised and slowly strengthened.
When the use of a breathing machine or ventilator is required for more than a few weeks, the physician may need to move the breathing tube from the patient’s mouth to the neck (tracheostomy). This improves the patient’s comfort and can help improve the patient’s breathing.
Infection can be the reason that a patient is admitted to the ICU or infections can develop while a patient is in the ICU. When devices like breathing tubes and intravenous catheters are necessary for treatment, there is a risk for infection.
The most common infection in a patient on a ventilator is pneumonia. Pneumonia can be treated with antibiotics, but may be severe enough to cause sepsis.
Another severe infection that can occur is called “bacteremia” – meaning infection in the blood. Patients can get bacteremia from many sources – bowel, kidneys, lungs etc – or from intravenous catheters needed to treat other conditions. Many patients in the ICU require support for their blood pressure through medication and fluid resuscitation when this occurs.
Renal (Kidney) failure
Kidneys eliminate fluid and waste from the patient’s body – conditions such as sepsis, dehydration, toxic substances, hypo/hypertension can cause renal failure. It can be mild and treated with intravenous fluids and medications. If it is severe, the patient may need to go on dialysis to take over the function of the kidneys. Here in the ICU, we can provide continuous renal replacement therapy over 24 hours.
Neurological or brain conditions
A variety of neurological or brain disorders are seen in ICU. These may include trauma, strokes, infections, lack of oxygen to the brain tissue (cerebral anoxia). They may result in minimal/no neurological deficits, or have a devastating effect on the patient. Every patient is different, and long-term outcome may be difficult to predict.
It is not uncommon for your loved one to be sleepy, confused, agitated, or unconscious. Depending on the patient’s condition, the medical team may sedate or restrain the patient to prevent self-harm. ICU patients are likely to experience confusion and agitation as they are in unfamiliar environments and have disturbances in their sleep patterns.
Bleeding or clotting
Bleeding or clotting is quite common in critically ill patients. Bleeding can occur as a result of pre-existing conditions such as liver failure or gastric ulcers, or these conditions can develop as a result of sepsis. Blood transfusions may be ordered if the patient’s red blood cell count (hemoglobin) drops too low as a result of bleeding.
Blood clots may develop commonly in legs or lungs. To prevent these clots from developing, patients may be given medication, or devices may be placed on the legs to help the blood to keep circulating. These are called sequential compression devices or SCDs.
Multiple Organ Dysfunction Syndrome – MODS
Any type of critical illness that brings a patient to the ICU has the potential to affect other organs. As patients become more ill, organs that may not have been affected at first slowly begin to fail. There is not a specific treatment for this condition – only supportive care with the hope that these organs can eventually recover their function.