1

CRITICAL CARE
UNIT

PRESENTED BY
MRS. P. LAXMI BAI
LECTURER
COLLEGE OF
NURSING,
BERHAMPUR 2
 INTRODUCTION

Critical care units (CCU) are designed to meet the

special needs of acutely and critically ill
patients. The delivery of critical care originated
from the need to centralize specially trained
personnel & equipment in a separate area of the
hospital to optimize the care of critically ill &
injured patients. No hospital is complete
without establishment of critical care unit.

Mrs. P. Laxmi Bai, Lecturer 3

DEFINITION OF TERMS

 CRITICAL
CARE :
Critical care is a term
used to describe as the
care of patients who are
extremely ill and whose
clinical condition is
unstable or potentially
unstable.
Mrs. P. Laxmi Bai, Lecturer 4
CRITICAL CARE UNIT
It is defined as the unit
in which comprehensive
care of a critically ill
patient which is deemed
to recoverable stage is
carried out.

Mrs. P. Laxmi Bai, Lecturer 5

CRITICALLY ILL CLIENT
 At high risk for actual or
potential life-threatening
health problems
 More ill
 Required more intensive
and careful nursing care

Mrs. P. Laxmi Bai, Lecturer 6

CRITICAL CARE NURSING

It refers to those
comprehensive specialized
and individualized nursing
care services which are
rendered to patients with
life threatening or
potentially life threatening
conditions and their
families.

Mrs. P. Laxmi Bai, Lecturer 7

CRITICAL CARE NURSE
 Critical care nurse is a
licensed professional
nurse who is
responsible for ensuring
that acutely and critically
ill patients and their
families receive optimal
care.

Mrs. P. Laxmi Bai, Lecturer 8

EVOLUTION OF CRITICAL
CARE

 Critical care evolved from an historical

recognition that the needs of patients with
acute, life-threatening illness or injury
could be better treated if they were
grouped in to specific areas of the
Mrs. P. Laxmi Bai, Lecturer 9
hospital.
 TIME EVENT
PERIOD
1920 Dr. W.E. Dandy
established the first
3-bed neurosurgical
ICU at John Hopkins
Hospital in Baltimore,
USA.
Dr. W.E. Dandy
1927 First premature infant
care center was
established in
Chicago.
PERIOD
World Shock wards
War II established for
(1939- resuscitation
1945)

1960 Nursing shortage

forced grouping of
postoperative
patients in recovery
areas to ensure
attentive care.
It led to
establishment of
recovery rooms in
U.S. hospital
TIME EVENT
PERIOD
1947- Polio epidemic
1948, resulted in dying of
(polio patients from
epidemic respiratory paralysis
) in united states and
Europe

1950 Use of mechanical

ventilation (“iron
lung”) for treatment
of polio.
Development of
respiratory care unit.
TIME EVENT
PERIOD
1951 General ICU’s
developed for sick
and postoperative
patients

1960’s Critical care developed as a specialty in

response to:
• Improved patient outcome with ICU care.
• Advancements in postoperative
resuscitation and monitoring.
• Surgeon’s willingness to perform more
ambitious surgical procedure.
 TIME EVENT
PERIOD

1960- Most U.S. hospitals had at least one ICU.

1969
1970 Formation of Society of critical Care Medicine
(SCCM) in Los Angeles, California

1986 American Board of Medical Specialties

approved a certification of special
competence in critical care for the four
primary board: anesthesiology, internal
medicine, pediatrics, and surgery.
14
History cont…..
 Between 1990 and present, critical care significantly
reduced in-hospital time as well as costs.

 The development of new and complicated surgical

procedures, such as transplantation of the liver, lung,
small intestine, and pancreas, created a new and
important role for critical care following
transplantation.
Mrs. P. Laxmi Bai, Lecturer 15
History cont…..

 Widespread utilization of non-invasive patient

monitoring, pharmacological therapy for critical care
patients with specific organ system failure reduced
time spent in both critical care units and in the health
care facility.

Mrs. P. Laxmi Bai, Lecturer 16

 CRITICAL CARE IN INDIA

Critical care practices in India have evolved significantly

over the past decade. As in most other developing
nations, critical care medicine as a specialty has
developed very slowly and recently in India.

Mrs. P. Laxmi Bai, Lecturer 17

TIME EVENT
PEROD
Early to Development of
mid- coronary care units in
1970s. India.

Late First respiratory care

1970s units was developed by
Dr. Farokh E Udwadia
in two hospitals in
Mumbai- a community
hospital and a private
one to bring down the
mortality of tetanus.
18
Dr. Farokh E Udwadia
Cont…
 The few enthusiastic, trained consultants came
together in 1992 to discuss critical care on a
common platform, and they formed the national
Indian Society of Critical Care Medicine.
(ISCCM). It has over 2000 members today, and
has 16 city branches.

Mrs. P. Laxmi Bai, Lecturer 19

Cont…
 Postdoctoral Fellowship in critical care medicine
conducted by the National Board of Examinations
has recently been announced.

 The training of nurses, technicians, and therapists

has begun in some isolated foci but has not
evolved into a meaningful training activity.
Mrs. P. Laxmi Bai, Lecturer 20
Cont…
 Critical care in India is thus at the crossroads of
development. The field is full of a lot of dynamism,
opportunity and challenges.

Mrs. P. Laxmi Bai, Lecturer 21

EVOLUTION OF CRITICAL
CARE NURSING

 Following the Crimean war (1854-1856), Florence

Nightingale described the advantages of
specialized areas for the recovery of postoperative
patients.

Mrs. P. Laxmi Bai, Lecturer 22

Cont…
 To provide appropriate care, nurses needed
specialized knowledge and skills, and the care
delivery mechanisms needed to evolve to support
the patients’ needs for continuous monitoring and
treatment.

Mrs. P. Laxmi Bai, Lecturer 23

Cont…
 The first intensive care units emerged in the 1950s
to provide care to very ill patients who needed one-
to-one care from a nurse.

 From this environment the specilaity of critical are

nursing emerged. As advances have been made in
medicine and technology, patient care has become
more complex.
Mrs. P. Laxmi Bai, Lecturer 24
 CLASSIFICATION OF CRITICAL
CARE UNITS
ACCORDING TO LEVEL OF ICU

Monitoring, Observation, Short term

LEVEL I
ventilation.

LEVEL II Monitoring, Observation, Long term ventilation

LEVEL III Intensive care, Invasive procedures, Haemodialysis,

Constant support
25
Mrs. P. Laxmi Bai, Lecturer
CLASSIFICATION
ACCORDING WAY OF ORGANIZING ICU
TRADITIONAL
Surgical ICU, Medical ICU, paediatric
ICU

ORGAN Cardiac ICU, Neuro ICU, Renal ICU,

SYSTEM Respiratory ICU

CLIENT Burn ICU, Trauma ICU, stroke ICU

SYNDROME

Neonatal ICU, paediatric ICU , Gynae ICU

CLIENTELE
26
Mrs. P. Laxmi Bai, Lecturer
 CLASSIFICATION OF
CRITICAL CARE PATIENTS
Level 0 Normal ward care

Level 1 At risk of deteriorating , support from critical care

team

Level 2 More observation or intervention, single failing

organ or post operative care

Level 3 Advanced respiratory support or basic respiratory

support ,multiorgan failure

27
Mrs. P. Laxmi Bai, Lecturer
 TYPES OF CRITICAL CARE
UNIT
CCU

General Specialized
Medical Intensive Care Neonatal Intensive Care Unit(NICU)
Unit(MICU) Special Care Nursery(SCN)
Surgical Intensive Care Paediatric Intensive Care Unit(PICU)
Unit Coronary Care Unit(CCU)
Medical Surgical ICU Cardiac Surgery ICU (CSICU)
(MSICU) Neuro Surgery ICU (NSICU)
Burn Intensive Care Unit(BICU)
Trauma Intensive Care Unit
Mrs. P. Laxmi Bai, Lecturer 28
PRINCIPLES OF CRITICAL CARE
NURSING
ANTICIPATION

EARLY DETECTION AND

PROMPT ACTION
COLLABORATIVE
PRACTICE
COMMUNICATION

PREVENTION OF
INFECTION
CRISIS INTERVENTION &
STRESS REDUCTION 29
Mrs. P. Laxmi Bai, Lecturer
1. ANTICIPATION

 One has to recognize the high risk patients

and anticipate the requirements, complications
and be prepared to meet any emergency. Unit is
properly organized in which all necessary
equipments and supplies are mandatory for
smooth running of the unit.

Mrs. P. Laxmi Bai, Lecturer 30

2. EARLY DETECTION AND PROMPT
ACTION :

 The prognosis of the patient depends on the early

detection of variation, prompt and appropriate
action to prevent or combat complication.
Monitoring of cardiac respiratory function is of
prime importance in assessment.

Mrs. P. Laxmi Bai, Lecturer 31

3. COLLABORATIVE PRACTICE :

 Critical Care, which has originated as technical

sub-specialized body of knowledge has evolved
into a comprehensive discipline requiring a very
specialized body of knowledge for the physicians
and nurses working in the critical care unit.
Collaborate practice is more and more warranted
for critical care more than in any other field.
Mrs. P. Laxmi Bai, Lecturer 32
4. COMMUNICATION :

 Intra professional, inter departmental and inter

personal communication has a significant
importance in the smooth running of unit.
Collaborative practice of communication model

Mrs. P. Laxmi Bai, Lecturer 33

5. PREVENTION OF INFECTION :

 Critically ill patients requiring intensive care are at

a greater risk than other patients due to the
immunocompromised state with the antibiotic
usage and stress, invasive lines, mechanical
ventilators, prolonged stay and severity of illness
and environment of the critical unit itself.

Mrs. P. Laxmi Bai, Lecturer 34

6. CRISIS INTERVENTION AND
STRESS REDUCTION

 Partnerships are formulated during crisis.

Bonds between nurses, patients and families
are stronger during hospitalization. As patient
advocates, nurses assist the patient to express
fear and identify their grieving pattern and
provide avenues for positive coping.

Mrs. P. Laxmi Bai, Lecturer 35

Seven C’S of critical care
 Compassion
 Communication (with patient and family).
 Consideration (to patients, relatives and
colleagues and avoidance of Conflict.
 Comfort : Prevention of suffering
 Carefulness (avoidance of injury)
 Consistency
 Closure (ethics and withdrawal of care).
Mrs.P.Laxmi Bai.Lecturer 36
 “It may seem a strange
principle to enunciate
(articulate) as the very first
requirement in a Hospital
that it should do the sick no
harm.” [1859]

Mrs. P. Laxmi Bai, Lecturer 37

Prof. Dr. R S Mehta, BPKIHS 38
39