Intensive Care Medicine
An intensive-care unit (ICU), critical-care unit (CCU), intensive-therapy unit/intensive-treatment unit (ITU) is a specialized department in a hospital that provides intensive-care medicine. Many hospitals also have designated intensive-care areas for certain specialties of medicine, depending on the needs and resources of the hospital.
Types
Specialized types of ICUs include:
Common equipment in an ICU includes mechanical ventilators to assist breathing through an endotracheal tube or atracheotomy; cardiac monitors including those with telemetry; external pacemakers; defibrillators; dialysis equipment for renal problems; equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains, and catheters; and a wide array of drugs to treat the primary condition(s) of hospitalization. Medically induced comas, analgesics, and induced sedation are common ICU tools designed to reduce pain and prevent secondary infections.
Quality of care
The available data suggests a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illnesses, demographic variables, and characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was significantly associated with lower ICU and hospital mortality rates. A ratio of 2 patients to 1 nurse is recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical floors. This varies from country to country, though; e.g., in Australia and the United Kingdom most ICUs are staffed on a 2:1 basis (for High-Dependency patients who require closer monitoring or more intensive treatment than a hospital ward can offer) or on a 1:1 basis for patients requiring very intensive support and monitoring, for example a patient on a mechanical ventilator with associated sedation such as a midazolam and use of strong analgesics such as morphine, propofol, fentanyl and/or remefentanyl.
Staff
Medical staff typically includes intensivists with training in internal medicine, surgery, anesthesia, or emergency medicine. Many nurse practitioners and physician assistants with specialized training are also part of the staff that provide continuity of care for patients. Staff typically includes specially trained critical care registered nurses, registered respiratory therapists, clinical pharmacists, nutritionists, physical therapists, occupational therapists,certified nursing assistants, social workers, etc.
Mobile intensive-care unitA mobile intensive-care unit (MICU) is an aerial, ground-based, or aquatic ambulance staffed with a medical intensive-care team, to include a physician and nurse. In many countries, they are affiliated with public hospitals and are regulated by a governing body of physicians, such as the Service d’Aide Médicale d’Urgence (SAMU).
Types
Specialized types of ICUs include:
- Neonatal intensive-care unit (NICU)
- Special-Care Nursery (SCN)
- Pediatric intensive-care unit (PICU)
- Psychiatric intensive-care unit (PICU)
- Coronary care unit (CCU)
- Cardiac Surgery intensive-care unit (CSICU)
- Cardiovascular intensive-care unit (CVICU)
- Medical intensive-care unit (MICU)
- Medical Surgical intensive-care unit (MSICU)
- Surgical intensive-care unit (SICU)
- Surgical intensive-therapy (SIT)
- Overnight intensive recovery (OIR)
- Neurotrauma intensive-care unit (NICU)
- Neurointensive-care unit (NICU)
- Burn wound intensive-care unit (BWICU)
- Trauma Intensive-care Unit (TICU)
- Surgical Trauma intensive-care unit (STICU)
- Trauma-Neuro Critical Care (TNCC)
- Respiratory intensive-care unit (RICU)
- Geriatric intensive-care unit (GICU)
- Mobile Intensive-Care Unit (MICU)
- Post Anaesthesia Care Unit (PACU)
Common equipment in an ICU includes mechanical ventilators to assist breathing through an endotracheal tube or atracheotomy; cardiac monitors including those with telemetry; external pacemakers; defibrillators; dialysis equipment for renal problems; equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains, and catheters; and a wide array of drugs to treat the primary condition(s) of hospitalization. Medically induced comas, analgesics, and induced sedation are common ICU tools designed to reduce pain and prevent secondary infections.
Quality of care
The available data suggests a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illnesses, demographic variables, and characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was significantly associated with lower ICU and hospital mortality rates. A ratio of 2 patients to 1 nurse is recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical floors. This varies from country to country, though; e.g., in Australia and the United Kingdom most ICUs are staffed on a 2:1 basis (for High-Dependency patients who require closer monitoring or more intensive treatment than a hospital ward can offer) or on a 1:1 basis for patients requiring very intensive support and monitoring, for example a patient on a mechanical ventilator with associated sedation such as a midazolam and use of strong analgesics such as morphine, propofol, fentanyl and/or remefentanyl.
Staff
Medical staff typically includes intensivists with training in internal medicine, surgery, anesthesia, or emergency medicine. Many nurse practitioners and physician assistants with specialized training are also part of the staff that provide continuity of care for patients. Staff typically includes specially trained critical care registered nurses, registered respiratory therapists, clinical pharmacists, nutritionists, physical therapists, occupational therapists,certified nursing assistants, social workers, etc.
Mobile intensive-care unitA mobile intensive-care unit (MICU) is an aerial, ground-based, or aquatic ambulance staffed with a medical intensive-care team, to include a physician and nurse. In many countries, they are affiliated with public hospitals and are regulated by a governing body of physicians, such as the Service d’Aide Médicale d’Urgence (SAMU).
