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(WHO) Intensive Care Unit (ICU)

The document discusses guidelines for determining when patients require intensive care monitoring and treatment after surgery. Key factors in deciding whether intensive care is needed include the type of surgery performed, any complications during or after surgery, and the patient's condition in terms of breathing, blood pressure, and level of consciousness. The document also outlines criteria for safely discharging patients from intensive care to a hospital ward and minimum equipment and monitoring recommended for an intensive care unit.

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53 views4 pages

(WHO) Intensive Care Unit (ICU)

The document discusses guidelines for determining when patients require intensive care monitoring and treatment after surgery. Key factors in deciding whether intensive care is needed include the type of surgery performed, any complications during or after surgery, and the patient's condition in terms of breathing, blood pressure, and level of consciousness. The document also outlines criteria for safely discharging patients from intensive care to a hospital ward and minimum equipment and monitoring recommended for an intensive care unit.

Uploaded by

desiveronika
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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INTENSIVE CARE UNIT

Background

It is often difficult to know for certain whether a particular patient needs to


be nursed postoperatively in the intensive care unit (ICU), if one exists in
your hospital.

The person making the decision, surgeon or anesthetist, has to balance the
risk of the patient dying from an avoidable cause in an ordinary ward room
against the waste of expensive resources if a patient is admitted to the ICU
and it proves to not be clinically indicated later on.

Intensive monitoring is generally required in the following cases:


 Cranial neurosurgery
 Head injuries with airway obstruction
 Intubated patients, including tracheostomy
 Major trauma – post-operatively
 Abdominal surgery for a condition neglected for more than 24 hours
 Chest drain in the first 24 hours
 Ventilation difficulties
 Airway difficulties, potential or established, e.g. post-thyroidectomy,
removal of a large goitre
 Unstable pulse or blood pressure, high or low
 Anuria or oliguria
 Severe pre-eclampsia or eclampsia
 Surgical sepsis
 Complications during anesthesia or surgery, especially unexpected
hemorrhage
 Hypothermia
 Hypoxia
 Neonates, after any surgery
INTENSIVE CARE UNIT
Post-Operative Ventilation
Mechanical ventilation, i.e. intermittent positive pressure ventilation
(IPPV), may be a planned part of postoperative management for a
major operation, or decided on at the end of surgery because
circumstances demand it.

IPPV should be continued postoperatively under the following


circumstances:

 Respiratory depression or oxygen saturation <80%


 Deteriorating general condition
 Severely distended abdomen
 Severe chest trauma
 Head injury or after intracranial surgery

There are non-surgical reasons for


ventilation, including organophosphate
poisoning, snakebite, tetanus and some
head injuries, but probably only if the
patient is breathing on admission. Avoid giving long-acting muscle
relaxants to facilitate IPPV.
Usually the decision to ventilate is quite If the patient is “fighting” the
easily made from the above ventilator, ask if he or she is
observations.  hypercarbic?
 in pain?
With no ventilator, a patient in  hypertensive?
respiratory failure will rapidly die of Treat these first before giving a
hypoxia and hypercarbia. Many people muscle relaxant
die purely from the lack of a short
period of ventilation in the
postoperative period or after trauma.
INTENSIVE CARE UNIT
Discharge from the ICU
The decision to discharge the patient from the ICU depends on the
quality of care to be found on the ward to which the patient will be
transferred

The following conditions should be met before discharging the


patient from ICU:

 Conscious
 Good airway, extubated and stable for several hours after extubation
 Breathing comfortably
 Stable blood pressure and urine output
 Hemoglobin >6 g/dl or blood transfusion in progress
 Minimal nasogastric drainage with the presence of bowel sounds;
abdomen not distended
 Afebrile
 Looks better, sitting up, not confused

Pressure for beds to treat more urgent cases may mean that
these guidelines have to be modified.

If a patient dies after discharge from the ICU, try to find out
why the death took place and to learn from it, especially if it
appears that the death was avoidable.

Try to put a system in place where patients discharged from


ICU are followed up for a week. Find out what happened to
them.
INTENSIVE CARE UNIT
Equipment for the ICU
The ICU does not necessarily need to have ventilators other expensive
machines.

An ICU might be a ward where


 Oxygen is available
 IV infusions are kept running overnight
 Measurements and observations are made at least every hour
for the following
□ Blood pressure
□ Pulse rate
□ Oxygenation
□ Urine output
□ Level of consciousness
□ Other general observations of the patient

The monitoring of a patient all night long is the deciding


factor in the success or failure of the ICU. Another important
feature is whether staff take action when the measurements or
observations show that something is wrong.

The provision of one or more simple and reliable electric


ventilators (not gas or oxygen dependent) will double the
usefulness of a basic ICU. Small, portable mains/battery
ventilators with integral compressors are available, although
they are relatively expensive.

The pulse oximeter should be


the minimum standard of
monitoring in every operating
room where regular, major
surgery is carried out

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