INTENSIVE CARE UNITS (ICU)

"A Critical Care Unit (CCU) or Intensive Care units (ICU) is defined as a specially staffed, specialty equipped, separate section of a hospital dedicated to the observation, care, and treatment of patients with life threatening illnesses, injuries, or a complication from which recovery is possible. It provides special expertise and facilities for the support of vital function and utilizes the skill of medical nursing and other staff experienced in the management of these problems."

Critical Care Unit (CCU) or Intensive Care units (ICU) are specialized units that is designed and staffed to deliver the highest level of medical and nursing comprehensive and continuous care to the critically ill patients who are deemed recoverable but who need supervision and need or likely to need specialized techniques by skilled personnel.

The Units have the following major characteristics like space, equipment and working staff and continuous service and care all around the clock 24 hours x 7 days including instantaneous monitoring of cardiovascular parameter, respiratory function, renal function and the nervous system status.

CLASSIFICATION OF CRITICAL CARE UNIT

• Level - I: Provides Monitoring, Observation and short-term ventilation. Nurse patient ratio is 1:3 and the medical staff are not present in the unit all the time.
• Level - II: Provides Observation, Monitoring and long term ventilation with resident doctors. The nurse-patient ratio is 1:2, junior medical staff is available in the unit all the time, and consultant medical staff is available if needed.
• Level - III: Provides all aspects of intensive care including invasive hemodynamic monitoring and dialysis. Nurse patient ratio is 1:1.

TYPES OF CRITICAL CARE UNIT

1. Medical intensive-care unit (MICU)
2. Surgical intensive-care unit (SICU)
3. Medical Surgical intensive-care unit (MSICU)
4. Coronary intensive care unit (CICU)
5. Cardiac Surgery intensive-care unit (CSICU)
6. Cardio-thoracic intensive-care unit (CTICU)
7. Cardiovascular intensive-care unit (CVICU)
8. Respiratory intensive-care unit (RICU)
9. Neuro-science/Neuro-intensive care unit (NSICU)
10. Neuro-trauma intensive care unit (NTICU)
11. Trauma Intensive care Unit (TICU)
12. Surgical Trauma intensive-care unit (STICU)
13. Trauma-Neuro Critical Care intensive care unit (TNCC)
14. Burn intensive-care unit (BWICU)
15. Neonatal intensive-care unit (NICU)
16. Pediatric intensive-care unit (PICU)
17. Psychiatric intensive-care unit (PSICU)
18. Overnight intensive recovery unit (OIRU)
19. Geriatric intensive-care unit (GICU)
20. Mobile Intensive Care Unit (MICU)

PURPOSE / OBJECTIVE OF ICU

• To provide around-the-clock intensive monitoring and treatment of patients who are severely ill and medically unstable—that is, they have a potentially life-threatening disease or disorder.
• To prevent deterioration of patient condition before other specific treatment are given.
• To meet any emergency at the time because of availability of all lifesaving equipment & supplies e.g.-suction machine, defibrillator, ventilator etc.
• To provide continuous observation and concentrated care for maximum survival of patient.
• To centralize and make the best use of the costly lifesaving equipment.
• To make the best use of the services of technically perfect staff handling the sophistication machine and equipment.
• To provide quality-serving care (compressive nursing care) to critically ill patient patients by the nursing personals, who are professionally, prepared to work in ICU.
• To provide on the job training to the nurse and doctors.
• To educate student with demonstrated skilled care for further research.

THE ADMISSION CRITERIA FOR ICU

The criteria for admission to an ICU are somewhat controversial—excluding patients who are either too well or too sick to benefit from intensive care—there are four recommended priorities which is used by intensivists (specialists in critical care medicine) to decide the admission. These priorities include:

• Critically ill patients in a medically unstable state who require an intensive level of care (monitoring and treatment).
• Patients requiring intensive monitoring who may also require emergency interventions.
• Patients who are medically unstable or critically ill and who do not have much chance for recovery due to the severity of their illness or traumatic injury.
• Patients who are generally not eligible for ICU admission because they are not expected to survive. Patients in this fourth category require the approval of the director of the ICU program before admission.

CATEGORIES OF DISEASES AND DISORDERS ADMITTED IN ICU

Eight categories of diseases and disorders are regarded as medical justification for admission to an ICU.

• These categories include disorders of the cardiac, nervous, pulmonary, and endocrine (hormonal) systems, together with postsurgical crises, trauma and medication monitoring for drug ingestion or overdose.
• Cardiac problems can include heart attacks (myocardial infarction), shock, cardiac arrhythmias (abnormal heart rhythm), heart failure (congestive heart failure or CHF), high blood pressure, and unstable angina (chest pain).
• Pulmonary disorders can include acute respiratory failure, pulmonary emboli (blood clots in the lungs), hemoptysis (coughing up blood), and respiratory failure.
• Endocrine emergency such as diabetic coma
• Neurological disorders may include acute stroke (blood clot in the brain), coma, bleeding in the brain (intracranial hemorrhage), such infections as meningitis, and traumatic brain injury (TBI).
• Trauma- Sever burn injury, Sever accident with multiple injure and acute poisoning
• Medication monitoring is essential, including careful attention to the possibility of seizures and other drug side effects.

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