Intensive Care and Critical Care

What is Intensive Care

Intensive care, also known as critical care, is a crucial element of the healthcare system. It includes specialized medical treatment and monitoring for patients with severe illnesses or injuries. Intensive care units (ICUs) are high-functioning sterile environments with multiple critical care equipment. Though the machines and activity level can be overwhelming, these units are responsible for saving many lives. ICUs are sometimes called critical care units (CCUs) or intensive therapy units (ITUs). Artificial intelligence with remote monitoring technologies and mobile ICUs have significantly contributed to intensive care for better patient outcomes.

Types of ICUs

Depending on the medical needs of the patients, there are various types of ICUs.

• Medical Intensive Care Unit (MICU)
• Surgical Intensive Care Unit (SICU)
• Cardiac Intensive Care Unit (CICU)
• Neurocritical Care Unit (NCCU)
• Neonatal and Pediatric Intensive Care Unit (NICU and PICU)
• Burn Intensive Care Unit (BICU)
• Trauma Intensive Care Unit (TICU)
• Oncology Intensive Care Unit (OICU)
• Geriatric Intensive Care Unit (GICU)

Who Needs Intensive Care? 

• People with severe respiratory issues, like pneumonia, acute respiratory distress syndrome (ARDS), or chronic obstructive pulmonary disease (COPD), are required to be in the ICU for artificial ventilation and constant monitoring.
• Cardiovascular emergencies like acute myocardial infarction (heart attack), heart failure, and arrhythmias need intensive care, such as cardiac monitoring, hemodynamic support, percutaneous coronary intervention (PCI), or cardiac surgery.
• Trauma victims from vehicle accidents or falls require immediate surgical intervention and intensive care to stabilize vital signs, stop bleeding, and prevent further complications.
• People who have severe infections can experience systemic inflammatory response syndrome (SIRS), sepsis, or septic shock and require aggressive fluid resuscitation, antibiotic therapy, vasopressor support, and close hemodynamic monitoring in the ICU.
• Individuals with neurological emergencies like acute strokes, traumatic brain injuries, and intracranial hemorrhages require intensive care interventions to manage intracranial pressure, ensure cerebral perfusion (sufficient oxygen to the cerebral tissue), and prevent secondary brain injury.
• Postoperative care after major surgeries requires intensive care to manage postoperative complications, provide pain management, optimize organ function, and promote recovery.
• Premature infants, newborns with congenital anomalies, and children with severe infections, respiratory distress, or complex medical conditions need specialized care in the NICU/PICU.
• Individuals experiencing failure of multiple organs, like kidney and liver, or acute respiratory failure, require intensive care support, hemodynamic support, and mechanical ventilation.
• Critically ill cancer patients undergoing chemotherapy, bone marrow transplantation, or other oncologic emergencies need intensive care management to deal with complications and get better.
• Some medical conditions, like electrolyte imbalances, chronic diseases, or organ transplants, necessitate intensive care for close supervision, regular medications, and specialized therapies.

Critical Components of Intensive Care

The two key components of the ICU are trained healthcare professionals and specialized equipment.

Trained Healthcare Professionals:

An ICU has a multidisciplinary team of skilled healthcare professionals with specialized training and expertise, coordinating for optimal patient outcomes. This team comprises:

• Intensivists (physicians specialized in critical care treatment) 
• Critical care nurses (one nurse for every two patients)
• Respiratory therapists
• Pharmacists
• Dieticians
• Physiotherapists 

Specialized Equipment:

ICUs have specialized medical devices to support critical functions and precise treatments. 

• Ventilators help control the patient’s breathing. They consist of a tube put in the mouth, nose, or through a small cut in the throat.
• Cardiac monitors help track vital parameters such as heart rate, blood pressure, and oxygen levels.
• Hemodynamic monitors, dialysis apparatus, and intracranial pressure monitors are used depending on the patient’s requirements.
• IV lines and pumps provide fluids, nutrition, and medication through insertions in the veins.
• Feeding tubes are placed in the nose through a small cut in the stomach or a vein to provide nutrition to people who cannot eat normally.
• Catheters remove excess blood or fluid from the body. 

Common drugs in an ICU include pain relievers or sedatives to alleviate symptoms related to the condition and reduce discomfort caused by the equipment.

Next Steps After Intensive Care

Patients are discharged from the ICU after recovering to a stage where they don’t need close and continuous supervision or specialized treatment. The hospital transfers them to a regular ward where intensive care is unnecessary. The transition might take a few days to a few months, depending on the person’s condition.

While most people recover from a treatment in an ICU, some might experience side effects while in the ICU, such as:

• Weakness and fatigue
• Stiffness in the body
• Reduced appetite
• Weight loss
• Disturbed sleep 
• Depression and anxiety
• Post-traumatic stress disorder (PTSD)
• Disorientation

Challenges in Intensive Care

Although there are significant advances in medical technology and treatment modules, intensive care faces various challenges. These are as follows: 

• Staff shortage leads to increased workloads and compromised care for patients, requiring a greater degree of care.
• ICUs may also need more beds, equipment, and medicine availability.
• Intensive care has high costs associated with staff, equipment, medications, and procedures.
• ICUs face dilemmas related to end-of-life care, resource allocation, and decision-making for incapacitated patients.
• Severely ill patients are vulnerable to medical errors, sudden events, and infections.
• Coordinating care between the ICU and multiple hospital departments can be complex.
• Priorities and limited resources can compromise quality control.
• Limited visitation times restrict the family’s emotional support to the patient and affect the family’s involvement in patient care.

Intensive care is the best care intended for critically ill patients suffering from treatable serious conditions. Fortis is one of India’s best ECMO machine hospitals and offers a full spectrum of intensive care services provided by highly skilled healthcare professionals.