Critical Care

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General Information

Sarcoidosis Week

What Should You Expect as a Patient in an Intensive Care Unit (ICU)?

  1. Multidisciplinary Care: In an ICU, care is delivered by a team of specialized professionals. While the head physician ensures that the agreed upon care plan is faithfully executed, she cannot be expected to be available day and night to respond to emergencies, nor may he be the best person to execute every intervention and procedure that will be required during the course of your care.  Coordinated care requires accurate documentation of interventions and care goals in the medical record and verbal transmission of relevant information during shift changes. Failure to communicate the rationale for teamwork to you and your family members risks leaving the impression that there are too many decision makers or that none is in charge.

  2. How the ICU Works: Entry into an ICU environment is often overshadowed by management of an emergency. Nevertheless, a member of the care team, typically the unit's nurse manager, should explain unit operations and procedures to your surrogate decision makers, family members and to you, when you are able to understand it. You should be informed about the specific roles of different care team members, family and patient support services, such as social workers and spiritual councilors, and about the timing of multidisciplinary rounds and daily care conferences.

  3. Assessing Your Condition: At the outset the admitting physician should establish care goals with you or your surrogate decision maker.  This discussion should include a decision about advanced directives (i.e. to resuscitate or not to resuscitate in case of cardiac arrest) but must not be limited to it. In order for you to judge if proposed care goals are consistent with your values, the physician needs to offer her assessment of the best possible outcome, of the most likely outcome and of the degree of uncertainty about these projections. It is often difficult to make confident projections about likely outcomes at the outset. Therefore your care goals are likely to be revised as more information about your condition accumulates and as your disease progresses or resolves.

  4. Ensuring Consistent Care: In ICU, your body's systems will be monitored at such extremely high rates that the provider may be bombarded with more information than he can reasonably process. It is therefore important that information is presented in an organized and consistent manner. Your care should, therefore, be guided by checklists to ensure that all important health status markers are noted, and that the correct decisions are made for delivery of optimal care. For example, a check list of guided care for such processes as hand washing, control of mechanical ventilation (artificial breathing), the prevention of deep venous thrombosis and sepsis care are typically recorded as a quality control measure and should be prominently displayed. 

  5. Recovering from an ICU Admission: Recovery from a life-threatening illness and related hospital exposures such as mechanical ventilation, deep sedation and medically induced neuromuscular paralysis, is often delayed and incomplete. A significant number of ICU survivors suffer neurocognitive disorders, depression and/or post traumatic stress. Although our understanding of how to prevent such late consequences of ICU care is incomplete, it stands to reason that patient engagement by providers and family members, avoidance of over sedation and early physical rehabilitation ought to minimize such risks.

Four Facts About Critical Care

  1. Acute Respiratory Distress Syndrome (ARDS) is an acute process, which results in moderate to severe loss of lung function. 

  2. In ARDS there is intense inflammation of the lung tissue, which can be caused by a variety of factors. This inflammation in the lung results in a loss of function.

  3. The alveoli lose their ability to exchange oxygen and carbon dioxide with the blood. This loss of function of the alveoli is due to collapse of the air sacs and leakage of fluid (which is called edema) into the air sacs.

  4. This sequence of events can happen rapidly. It can start in one lung and advance to the other. If the inflammation persists over time, the lungs will eventually attempt to heal the damage, which results in the formation of scar tissue.  The formation of scar tissue will continue to create a problem with gas (oxygen and carbon dioxide) exchange.