Intensive Care Unit

Intensive Care Unit

An intensive care unit (ICU), also known as
a critical care unit (CCU), intensive therapy
unit or intensive treatment unit (ITU) is a special
department of a hospital or health care facility that
provides intensive care medicine.
Intensive Care Unit
Intensive care units cater to patients with the
most severe and life-threatening illnesses and injuries,
which require constant, close 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
Intensive Care Unit
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
Intensive Care Unit
Intensive Care Unit
History
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 (where many patients
required constant ventilation and surveillance), Bjørn
Aage Ibsen established the first intensive care unit
in Copenhagen in 1953.
Specific ICUs
Hospitals may have ICUs that cater to a specific medical
speciality or patient, such as those listed below:
Neonatal intensive care unit (NICU)
Pediatric intensive care unit (PICU)
Psychiatric intensive care unit (PICU)
Coronary care unit (CCU): Also known as Cardiac Intensive
Care Unit (CICU)
Post-anesthesia care unit (PACU)
Neuro ICU
Respiratory ICU
Oncology ICU
PACU
Post-anesthesia care unit (PACU): 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
 Due to high patient flow in recovery units, 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 (HDU) or post-operative
critical care unit (POCCU) for closer observation.
HDU
High dependency unit (HDU): Many hospitals have a
transitional high dependency unit (HDU) for patients
who require close observation, treatment and nursing
care that cannot be provided in 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 conditions stabilises enough to qualify them
for discharge to a general ward.
Surgical Intensive Care Unit (SICU)
Surgical Intensive Care Unit (SICU): 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/trauma.
Number of ICU Beds
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
Coronary Care Unit (CCU)
A coronary care unit (CCU) or cardiac intensive
care unit (CICU) is a hospital ward specialized in the
care of patients with heart attacks, unstable
angina, cardiac dysrhythmia and (in practice) various
other cardiac conditions that require continuous
monitoring and treatment.
Coronary Care Unit (CCU)
The main feature of coronary care is the availability
of the continuous monitoring of the cardiac rhythm
by electrocardiography. This allows early intervention
with medication, cardioversion or defibrillation,
improving the prognosis
Functions of ICU
1. To concentrate in one centralised area the critically
ill patients for close observation and skilled nursing
care by specially trained personnel
2. To enhance the physician’s ability to treat acutely ill
patients through skilled staff and specialised
equipment
3. To provide close personal and monitor-assisted
surveillance of critically ill patients
4. To utilize equipment and highly trained personnel
more effectively and efficiently
Functions of ICU
The surgical ICU, in particular, provides care of post
surgical patients who develop complications and
require close nursing observation and care
The Medical ICU provides care for emergency patients
suffering from coma, shock, haemmorrhage,
convulsions etc.
The Coronary ICU cares for patients with acute
cardiac conditions
Location of ICUs
Most admissions to ICUs are either through the
emergency department or from the OTs following
major surgery
ICUs should be close to the emergency department,
operating rooms, recovery rooms, laboratory, and
radiology
ICUs should be close to vertical transportation for
rapid movement of patients
ICUs should be away from heavy traffic and noise
Number of ICU beds
A minimum of 10% of beds be designated as ICU beds.
Superspeciality hospitals need a higher percentage of
ICU beds
Size of ICU
For effective operations, an ICU should not have more
than 12 to 16 beds
ICUs should have a minimum of 6 beds to be
economically efficient
Design of ICU
The design should provide for maximum visibility of the
patient, and of the monitor
Nursing station should be proximate to the patient rooms
A central nursing station with patients rooms on three
sides is a good option
Patients in cardiac care unit are often alert and ambulant;
they need windows for visual contact with outside world.
Each cardiac patient should have a room or separate
enclosure
Facilities and Space Requirements
Individual rooms with full height glass walls between
the rooms and corridor
Curtains over the glass walls may be drawn when
necessary
Bed space: Requirement is more than 2-3 times more
than general bed. 22 sq. m area for single bed
accommodation is recommended
Rooms should be at least 120 sq. feet with movable
space surrounding the bed
Facilities and Space Requirements
Mechanically or electrically operated beds .
Rooms should be sound proof and air conditioned.
Ceilings, floors and walls should be constructed of
materials with high sound absorption capabilities
Windows should be provided in the rooms
Wall or ceiling installation of equipments should be
done to facilitate easy accessibility, personnel
movement
All toilets should allow wheel chairs
Facilities and Space Requirements
Nurses station should be located so that nurses have
visual contact with each patient
Each unit should have equipment for continuous
monitoring
Computerised individual monitors at the bedside.
Data entered on a bed side terminal is automatically
communicated to the PC located at the nurses station
All units need resuscitation equipment such as
ventilators, gas analysers, infusion pumps, and
defibrillators
Facilities and Space Requirements
One or more emergency carts, also called crash carts, red
carts or blue carts are kept ready in each ICU. Equipments
and medical supplies are assembled on these carts
Essential to have isolation room for infected or critically
ill patients
Head end of each bed should have:
Medical gas outlets- two for oxygen, one for compressed
air and two for suction
Nurses call button
Wall mounted blood pressure equipment
Other Facilities
Treatment room
Room for special procedures
One or two beds with wall mounted dialysis machines
Clean linen storage area
Soiled holding and work area
Storage for house keeping supplies
Cupboard for drugs storage
Hand washing facilities for staff
Room for training, conference etc.
Doctors duty room
Staff lounge
Family waiting room
Codes
Codes are used in hospitals to announce emergencies.
Codes are used to avoid panic among patients and
visitors
Code Blue is for medical emergency
Code Doctor Red is for fire
Code Black for bomb threat
Code White for security emergency
Code Doctor Major for disaster
Code Green for all clear
Thank You