Intensive Care Unit-Myths and Realities.

The name ICU bugs us all,giving a jittery fear running down the spine,all those hollow dreaded sounds of unusual machines,monitors,ventilators, weird looking cables and tubes  going here and there.Conscious/semi-conscious patients laying all over,some fighting for their lives with tubes inside their  mouth and tiny tubules inserted in many different places of body.Intensive Care Units,  are instrumental in saving millions of lives worldwide, they are the worst nightmare for the patient as well as attendants/relatives.Concept of ICU was coined in 1927 at USA,by DR.W.E.Dandy when he started 3 beded  Neuro-surgery post operative  ICU.I’ve been mainly associated to intensive care,critical care and trauma services in little more then a decade long carrier so this is one of my favorite topic.ICUs’ are named differently in different hospitals-Critical Care Unit,Intensive therapy Unit,etc.In general for ICU patients recovery is often a long and slow process.Unawareness about critical illness is one of the scariest thing.

World of ICUS’ are highly poised by Myths.

1. Hospitals admit patient to  ICU unnecessarily.- Every hospital is short of ICU beds,as it is meant for patients who are really sick and very critical so it is insane even to think this.Your patient may not appear that sick but patients are admitted not only for treatment alone but for monitoring and observation purposes also.A patient who suffered convulsion(fit) might appear to be conscious and alert but he needs ICU care to avoid repeated episode,which could be serious or life threatening .
2. Ventilators are of no use ,they are to make money.-Utter rubbish,unawareness is the biggest cause,people fail to understand the usage of ventilators-machine that keeps lungs breathing.Ventilators are used when patient is unable /has less effort to breath himself,in fact the real spanner of works towards creating ICUs’ was  invention of ventilators.ICUs’ cannot be thought without ventilators,modern day surgeries like of CTVS,NUERO,etc.cannot be done without their support.
3. Ventilators are used even on dead patients.-I am sick of answering this,Who is considered as dead- In most of the industrialized world “Irreversible Brain damage” condition has been written in law,where Brain dead patients are considered as Dead. Remaining world considers Brain dead patient as alive until his/her heart stops functioning.So whereas, in former condition even though heart is functioning ventilators can be removed,with due approvals, but in latter ventilators can’t be removed ,as it is legally not allowed, thus giving a false impression among attendants about usage of ventilators .Apart from few industrialized countries Euthanasia is not allowed .
4. All ICUS’ are same.No,lately  medical fraternity has realized the need of intensive care ,earlier hospitals use to have one for all ICU concept ,but now with better funding and general acceptance of critical care need,multi specialty hospitals and tertiary care setups have critical care units for different specialties,like my hospital has CTVS ,NEUROLOGY,LIVER AND KIDNEY TRANSPLANT,ORTHOPEDICS,MEDICAL,RESPIRATORY,GENERAL SURGICAL,PEADIATRIC SURGERY ICUS’.Thus saving many lives.
5. Sudden loss of consciousness/seizure does not require ICU attention.-No,it does.Concept of ICU  is all about extended monitoring and care, which otherwise, is not possible elsewhere.Both situations be it loss of consciousness/seizures are severe medical emergencies,which if not monitored properly may lead to permanent brain damage,paralysis or death.
6. Outcome of a comatose patient can be easily predicted in ICU.- Not even God can do that.Our Brain is such a complex machine that despite numerous studies and advances,we understand it hardly.Comatose patient can come back to senses either in a day or a week or month or year, no one can guess.
7. Tracheostomy, in a already intubated patient,is a wasteful expenditure.-Tracheostomy, is done to a prolonged intubated patient to avoid infections and further complications.Prolonged intubation may cause bacterial and fungal infections.Plus in prolonged ventilated patients,it is tough to excrete secretions which if not sucked out causes many complications like flooding of lungs,Pneumonia,ARDS,etc. 
8. Physical Restrains  are the method to control agitating/anxious patients.- Restraining means tie up.I personally feel physical restrains should be used rarely only when nothing else works,this is done to prevent self extubation( Life support tube inserted in mouth to trachea or windpipe ,comes out on its own) or any other tubes/instruments may come out or may get damaged. Nuances of using physical restrains are higher, person becomes more agitated,might use full force to dismantle restrains,causing injury to oneself,to attending staff,etc.But certain situations like  paranoia(state where person thinks someone is plotting against or trying to harm you,though chemical restrains are used in patients,but due to higher side effects or certain medical conditions where any sedative is contra-indicated,physical restrains are used though unwillingly.
9. Loads of similar investigations done daily,un necessary wastage.- Patients are at the verge in ICUS’.A minute abnormality/disturbance in reports/investigations causes catastrophe,hence to avoid such conditions,tests are conducted repeatedly for correct and quicker treatment.
10. In the name of Infection, Attendants are  allowed to see patient,only once or twice in 24 hours.–Critically ill patients are fragile and often immune compromised i.e., susceptible to even slightest infection,hence it is for the patient’s benefit that less or even no contact is allowed.
11.  Psychological support from relatives in ICU,is a waste of time.  There are certain conditions,where patients are conscious but cannot be shifted from ICU.These patients may develop ICU Psychosis,to avoid this,attendants are often asked to actively communicate with them,even if they can’t speak,they may be able to write,or point to some objects/letters written on paper.Showing photo of beloved one’s,bringing favorite perfume or music,makes them feel connected and thus help them in faster recovery.
12. Doctors providing treatment is fine,but why paramedics are involved.-ICUs’ are not managed by  doctors alone but nurses,physiotherapists,dieticians,speech therapist also play  active  roles,believe me,doctors  see treatment primarily,rest is taken care by these paramedics,ICU outcome and post ICU recovery  depends on them.
13.  Patient’s perception to hearing,taste,touch and sense of smell are never the same post ICU.-Patient’s all senses may be effected by stay in the ICU,but effects gradually disappears but in cases it may take years for overall recovery of patient.
14. Patients are never the same post ICU.-Patients who are out of ICU,needs much attention in terms of treatment,physiotherapy,diet,etc.Many a times recovery is very slow,that it might take years for a full recovery .Few studies have shown that prolonged ventilated and heavily sedated  patients had problems in proper thinking and concentrating,had post -traumatic stress disorder and terrible memories of nightmares. Dr. Dale Needham,heads the critical care physical medicine and rehabilitation program at Johns Hopkins Hospital,rightly says-instead of declaring success when a patient leaves an ICU alive, he and others have a new set of challenges.

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