We hope this helps you familiarize with ICU and After-ICU care

Critical Care Medicine has been a dynamic subspecialty and has evolved into a service that is based on evidence from high quality researches. The society of critical care Medicine initiated ICU Liberation collaborative, focused on improving care in Intensive Care units. Our approach of ICU care is based on what we have learnt from this collaborative. The bundle of care consists of various elements and is referred to as ABCDEF Bundle. Our Intensivist led inter-professional team provide care in close collaboration with other specialists and when needed to ensure, you or your loved one receives the best evidence based care.

You can start by clicking on the Tabs that you see on the Left side, to know more on how to stay engaged in the care being provided

Pre session survey

Post session survey

While you are in the ICU

The Intensive Care Unit(ICU) Team
The ICU’s inter professional team consists of multiple disciplines as you can see in the picture(RN,RT, dietitian, clinical pharmacist etc.) the ICU team strives to work in an organized coordinated manner to facilitate faster recovery ensuring patient safety and highest quality of care

The ICU Nurse
The ICU Nurse(RN): Your ICU nurse is a great resource to give you all the information that you need related to patient care.

She, along with the Intensivist also coordinates the care provided by the ICU team which includes multiple disciplines

The rounding process starts with nurse presenting the key elements of ICU care and relevant updates to the ICU team

He/she can also help you get involved in patient care along with the ICU team.

Respiratory therapist(RT):
Your respiratory therapist attends to all respiratory care needs. If your loved one is on ventilator, he/she coordinates with the ICU nurse and initiates evaluations for own ability to breath to facilitate getting your loved one off the ventilator which we often referred to as spontaneous breathing trials

Clinical pharmacist
Clinical pharmacist reviews all the medications along with dosing and frequency in view of critical illness, organ system functions and clinical tolerance.

Dietician
Dietitian on the ICU team ensures evidence-based nutritional support in critical illness. Patients may get nutrition by mouth or through tubes inserted into the stomach or small intestine or sometimes directly into blood stream depending on the clinical condition.

Social Worker
Social worker helps patients and families for all social issues. One of the most valued aspect of ICU care is discussion on advanced directives or a living will. She also helps select and appoint a surrogate or healthcare power of attorney for decision-making when needed.

Physical Therapist(PT):
Physical Therapists help with “E” component of the Bundle. They are part of the ICU team, and their main focus is patient mobility. Therapists will work with physicians and other members of the ICU team to ensure patients are appropriate for therapy before beginning. They will work to improve ROM, strength, balance, and endurance in order to help patients become as independent as possible. Physical therapy for patients in the ICU has been found to be safe and feasible, and research has shown that it has may positive outcomes. These include decreased duration of mechanical ventilation, shorter ICU and hospital lengths of stay, decreased mortality, and improved physical and cognitive outcomes. You can be involved in this aspect of care, as guided by your RN and PT.

After leaving the ICU while you are still in the hospital

You must have understood the changes in medications, and know your updated accurate list of Medications

If you have any equipment, make sure, you have understood how to use them safely.

This is a time; you must make sure that you have your follow-up appointments confirmed for your outpatient follow-up with either your primary care physician and or intensivist for post-intensive care syndrome screening and managemnt.

The aspects of post-intensive care syndrome that may not be apparent today may become apparent after leaving the hospital.

Pre session survey

Post session survey

After leaving the hospital

You will need to watch out for following symptoms

Any physical weakness-ICU acquired weakness

Cognitive Impairenments-Memory Problems

PTSD-Nightmares, Anxiety problems

Depression symptoms

Any inability to get back to your usual lifestyle/routine and work could mean that you may be having post ICU syndrome. The problem with post ICU syndrome is that the duration could be variable and this may last almost six months or a year's and sometimes more. Sometimes, it is impossible to identify this is post-intensive care syndrome unless you are actively screened for it through a battery of tests and evaluation by your primary Physician.

You will need to keep all the documents with you in a safe place.

Know your medications, discard any old medications that you may have and replace them with the new and accurate medications.

Symptoms of ICU aquired weakeness -impairment can be either obvious and or very subtle incresing risk of falls. In general, our patients may:

  • Gait and balance problems
  • Risk of Injuries
  • Inability to safely tranfer from chair to bed or vice versa
  • Nuritional Deficiencies may be present-ViD and Calcium, etc.
  • Feel have difficulty in running routine tasks or responsibilities that once used to be easy
  • Can lead to problems managing medications
  • Appear to be intolerant soley due to weakness

Symptoms of Cognitive Impairment -Cognitive impairment can be either obvious and or very subtle. In general, our patients may:

  • Memory problems including difficulties such as remembering names, finding words, and recalling shopping list.
  • Forget events such as appointments
  • Inability to maintain focus in conversations
  • Impaired judgment and running into conflicts
  • Feel have difficulty in running routine tasks or responsibilities that once used to be easy
  • Have problems managing medications
  • Appear to be intolerant

Management options for Cognitive Impairment -Cognitive impairment can reflect a wide range of potential problems and is sometimes reversible but in typical cases is not. Nevertheless, there may be ways to either (A) improve cognitive impairment or (B) reduce its’ impact. These include:

  • “Brain Exercise” which could take the form of crossword puzzles, Sudoku games, and other mental challenges.
  • Adaptive strategies that can help optimize functional status despite cognitive deficits
  • social support
  • Addressing coexisting issues like anxiety and depression if present
  • Address basic needs such as vision and hearing
  • Formal cognitive rehabilitation
  • A comprehensive medical evaluation to identify any contributing medical causes

Symptoms of PTSD -Common symptoms of PTSD may include:

  • Stressful memories of ICU stay which are hard to suppress
  • Anxiety
  • Nightmares
  • Avoidance of hospitals and fear of becoming ill
  • Disengagement and emotional withdrawal

Management options for PTSD -PTSD sometimes develops a chronic character but like many psychiatric illnesses, it is often very treatable. Popular treatments for PTSD include:

  • Cognitive therapy, which helps people recognize distorted and maladaptive thinking patterns
  • Medications including antipsychotics, antidepressants, and prazosin
  • Exposure therapy, which helps people face the thing that they find frightening.
  • Eye movement desensitization and reprocessing (EMDR). This type of therapy combines exposure therapy with a series of guided eye movements that help you process traumatic memories.

PTSD is typically treated by psychologists and/or psychiatrists – both mental health professionals trained in the management of this condition. If you think you or a loved one has PTSD symptoms, please consider contacting a mental health professional or ask your primary care provider for a referral.

Symptoms of Depression -Common symptoms of depression may include:

  • Feeling hopelesss
  • Feeling sad or “blue
  • Lack of interest in activities that used to be very interesting previously
  • Being unable to sleep or sleeping too much
  • Inability to stay focused
  • Feeling tired all the time

Management options for Depression -Treatment options may include:

  • Medications–either by a primary care physician or a psychiatric specialist
  • Cognitive therapy or cognitive-behavioral therapy, which helps people recognize distorted and maladaptive thinking patterns
  • A combination of medication and psychotherapy, which many experts recognize as the best and most effective course of action.

While some forms of depression are resistant to treatment and may require very specialized interventions like Electroconvulsive Therapy (ECT), and Deep Brain Stimulation, the depression following ICU stay is rarely this severe or refractory. If you think you or your loved one has symptoms of depression following critical illness, please consider contacting a mental health professional or ask your primary care provider for a referral.

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Medical intensive care unit offers comprehensive care to patients with life-threatening illnesses and injuries. We strive to treat the patient as an individual with dignity and respect, as well as support their families during this difficult time.

To help us maintain our patient's privacy and provide the best care possible, please observe the following rules when visiting:

Check at the nurses' station before entering the patient's room, especially if the patient's curtains are closed. If the patient is not available, please return to the waiting room and avoid loitering in the hallway.

Wash your hands or use hand sanitizer when entering and leaving the patient's room unless otherwise posted. This is the best way to prevent the spread of disease.

There may be no more than 2 visitors in the room at a time. Patient's in the ICU often have extra medical equipment in the room, and they heal better with a quiet, low stimulation environment.

Visitors younger than 12 are highly discouraged. There are many new organisms in a hospital that can make children sick, and children may carry in "bugs" of their own that may be transmitted to your loved one.

Please, do not visit your loved one if you are sick with a cold, sore throat or fever.

No food is allowed in the patient rooms.

Please observe quite times from 2pm to 4pm and 10pm to 6am

Adequate rest promotes healing