What To Expect When Your Loved One Is in the Intensive Care Unit

Intensive care unit
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If your loved one has been admitted to the intensive care unit of a hospital, this means that his or her illness is serious enough to require the most careful degree of medical monitoring and the highest level of medical care. The intensive care unit (ICU) may also be referred to as the critical care unit or the intensive care ward.

Your loved one may be medically unstable, which means that his or her condition could change unexpectedly and may potentially rapidly become worse.

Normally, people who are very sick only need to stay in the ICU for a short period of time, until their illness becomes stable enough for transfer into the regular hospital ward. In the meantime, you may want to know what to expect while your loved one is being cared for in the ICU. You may also want to know under what circumstances you should anticipate that your loved one will be stable enough to be discharged from the ICU and admitted to a standard hospital ward.

What Types of Intensive Care Units Are There?

The ICU is a part of the hospital where patients receive close medical monitoring and care. Some hospitals also have specialized ICUs for certain types of patients:

  • Neonatal ICU (NICU): Care for very young or premature babies
  • Pediatric (PICU): For children who require intensive care
  • Neurological ICU: Specialized care for neurologically unstable patients
  • Cardiac care unit (CCU): Care for patients with serious or unstable heart problems
  • Surgical ICU (SICU): Care for patients who are recovering from surgery

Why Do Some People Need to Be Admitted to the Intensive Care Unit (ICU)?

There are a number of different reasons that warrant an admission to the ICU, and your loved one likely has one of more of these conditions:

  • Medically unstable: Patients who are medically unstable who require close monitoring and frequent adjustments of medical therapy are often admitted to the ICU because it is a setting that is well suited for close monitoring and fast response.
  • Need support for breathing: Some patients have to be admitted to the ICU because they cannot breath on their own and require respiratory support through a machine, such as a ventilator, to continue breathing. Many hospital wards cannot support care of a patient who is on ventilator support for breathing. Intubation is the placing of a breathing apparatus for respiratory support. Removal of respiratory support, which is extubation, takes place when a patient is able to breath independently.
  • Lower level of consciousness: If your loved one is unconscious, unresponsive or in a coma, he or she may require care in the ICU, particularly if he or she is expected to improve. People who are unconscious may have endured severe brain injury or very extensive medical problems, requiring close care to optimize the chances of recovery.

What Type Of Extra Care Is Provided in the ICU?

The ICU allows health care providers, such as doctors, nurses, nursing assistants, therapists and specialists, to provide a level of care that they may not be able to provide in another setting:

  • Close and frequent monitoring of vital signs: While in the ICU, patients are monitored more frequently than they can be in the regular hospital unit. Vital signs, such as heart rate, blood pressure and respiratory rate, as well as parameters such as oxygen and carbon dioxide level, may be monitored continuously with electronic devices that are positioned for monitoring at all times. And, in addition to the continuous monitoring, nurses also may manually check vital signs more frequently in the intensive care unit than they would on the regular hospital ward.
  • Central location displays vital sign values: While your loved one has continuous monitoring of vital signs, the blood pressure and heart rate readings will be visible on digital devices near the bed. In addition, many ICUs are also equipped with centrally located screens that display patients’ vital signs outside the room. This allows nurses to read several patients’ vital signs even when they are not in the patients’ rooms, and to become aware of important changes promptly.
  • Close adjustment of fluids, electrolytes and medications: In addition to close medical monitoring, the ICU is a setting where patients are able to receive more frequent and complex fine-tuning of important therapies, such as intravenous fluids and electrolytes such as sodium, potassium, calcium and magnesium. A number of powerful medications may produce unpredictable effects that require an immediate response. Such medications are preferably given in the ICU setting.
  • Can have some procedures: Certain procedures that can be done at a patient's bedside are not well suited for a regular hospital ward. For example, people who have a ventriculoperitoneal (VP) shunt may need some interventions that require a sterile environment to prevent infection, but that do not necessarily need to be done in the operating room. These types of procedures can be performed efficiently in the ICU while avoiding moving and disrupting the patient.
  • Semi-open rooms: The rooms in an ICU are not typically closed off. While there may be curtains for privacy, patients are more visible and accessible to the nurses and doctors who staff the intensive care unit. This allows the healthcare staff to keep a closer watch on patients and to be able to carry out a faster response to any sudden problems.
  • Fewer patients per nurse: Generally, the ICU is staffed with more nurses per patient than a regular hospital ward is. This allows each nurse to keep track of each patient's many complex and changing medical details and to administer more involved therapies to patients.
  • Nurses with ICU training and experience: Often, the nurses and nursing assistants who staff the ICU have specialized training and experience in caring for ICU patients. Sometimes, nurses even specialize in caring for patients in specialized ICUs such as the CCU or the PICU. In some ICUs, a head nurse who is particularly experienced in ICU care oversees the patient care.
  • May have specialized ICU doctors: Sometimes doctors who are specially trained in ICU care also staff the ICU. This is not always the case, however, and it depends on each specific hospital and situation. For example, if your loved one has had a serious heart condition requiring a stay in the CCU, he or she may be cared for by a doctor who specifically takes care of patients while they are in the CCU until discharge to the regular hospital unit, where another doctor will care for them. On the other hand, at some hospitals, the same doctor who cares for a patient in the CCU continues to care for that patient and manage the medical condition even after the patient becomes stable and is transferred to the regular hospital unit. And some hospitals have a system that combines both approaches.

There Are More Restrictions for Visitors in the ICU

For a number of reasons, visitors are much more restricted in the ICU than in the regular hospital room. Some of these reasons include:

  • Preventing spread of infection
  • Maintaining quiet for other patients because they do not have privacy in the ICU
  • Allowing your loved one to rest and recover
  • Less space in the ICU
  • Allow staff to frequently check on patients—hospital staff may be able to delay medications or monitoring for half an hour or so until visitors leave on the regular floor, but cannot do so in the ICU.

When Will Your Loved One Get Discharged From the ICU?

Your loved one will most likely improve enough to be discharged from the ICU. Some hospitals have a step down unit, which provides an intermediate level of care that is less intense than the ICU, while providing closer care than the regular unit. Criteria for discharge from the ICU include extubation, stabilization of vital signs, improved alertness, less frequent need to adjust IV fluid, electrolytes, and medications, and overall medical stability.

A Word From Verywell

If your loved one has been admitted to the intensive care unit, you are likely under a great deal of stress as you experience uncertainty and unpredictability.

Not every patient is the same, and your loved one is unique. His or her path to recovery may be smoother or more complicated than that of others, and often, the unpredictability of illnesses that cause patients to need ICU care make the whole prognosis somewhat unpredictable.

Despite the serious circumstances that warrant admission to the ICU, most patients are able to leave the ICU and continue care on a standard hospital ward for a short time, and eventually recover from their illness, leaving the hospital to go home.

Source:

Zhonghua W, Zhong B, Xue J, Analysis of factors affecting the prognosis of ICU patients by multiple logistic regression model: a retrospective cohort study of 1 299 patients in 12 consecutive years, 2017 Jul;29(7):602-607.

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