Approximately 5 million patients in the United States require ICU admission each year for the management of life-threatening medical problems. Recently, respiratory failure due to COVID-19 has been one of the most common conditions requiring ICU care. Being in the ICU is often an overwhelming experience, with frequent tests and blood draws and numerous doctors involved in a single patient's care. Here is a general idea of what to expect as a patient in the ICU:
Multidisciplinary care: Care in the ICU is delivered by a close-knit team of doctors, nurses, respiratory therapists, dietitians, physical therapists, occupational therapists, speech therapists, and numerous other professionals. Each of these team members has an important and specific role in the care of patients in the ICU. The team is led by a head physician who coordinates the whole team's efforts and ensures that the plan of care happens as intended. The ICU team may also ask for the assistance of other specialist physicians such as cardiologists, nephrologists, gastroenterologists, or surgeons.
Artificial life support: Patients in the ICU often need life support for one or several major organ systems. Life support in the ICU can mean many different things. Here are three of the most common forms of life support.
- Intubation and mechanical ventilation: To support a patient's breathing, a breathing tube ("endotracheal tube") can be placed through the patient's mouth into the windpipe ("trachea") and connected to a breathing machine ("ventilator"). Patients usually require medications for pain and sedation while on the ventilator.
- Vasopressors: There are many illnesses that can cause a patient's blood pressure to become dangerously low. Vasopressors are a type of medication that can be used to raise a patient's blood pressure. Vasopressors often need to be given through a special, large intravenous (IV) catheter called a "central line" that is usually placed in the patient's neck or groin. Although vasopressors may be effective at increasing a patient's blood pressure, they can also cause unwanted side effects, such as decreasing blood flow (“ischemia”) to other important organs like the intestines and kidneys, as well as hands and feet.
- Dialysis: Many patients who are critically ill develop kidney failure, where the kidneys stop eliminating toxins and fluids and no longer control acid levels in the blood. In some cases, the patient’s doctors may feel that performing dialysis - using a machine to do the work of the kidneys - could be helpful. During dialysis, a special, large IV catheter is placed in the patient’s neck or groin, and blood is removed from the patient and sent through a machine that “cleans” the blood before returning it to the patient through the same catheter. Dialysis does the work of the kidneys while the team waits to see if the patient will improve.
Decision making: Patients who need ICU care are often too sick to make decisions for themselves. The team of doctors in the ICU may need to rely on family members to make medical decisions for the patient; this is called “surrogate decision-making.” The team will provide their assessment of the current situation and ask the surrogate decision-maker to give the medical team insight into how the patient would want to proceed based on the patient’s values. An important part of preparing for the possibility of hospitalization is having discussions with your family about the care that you would want to receive in the event of a serious, life-threatening illness.
