Critical Care Treatment

Being in critical care can be a frightening and confusion time for patients and their families. Our goal is to provide the highest standards of care possible and to help patients and families understand what is happening at all stages.

Care is focused in supporting vital organs of critically ill patients and often involves complex equipment and strong medications such as ventilators to assist with the work of breathing and intravenous medication infusions to support low blood pressure. In time it is hoped that these therapies can be weaned as a patients condition improves.

Critical Illness and the critical care environment can lead to periods of confusion and necessary lines and tubes can make communication challenging.

Sedation in ICU

Many patients in intensive care are sedated at least in the early stages after admission. There are a number of reasons why patients may need sedation, including if patients require the help of a ventilator or to allow them to rest and recover. This is more likely in patients who need more support for their breathing, their heart or have a brain injury.

Sedation is normally given through an intravenous drip and will be adjusted in order to keep patients comfortable. The sedation is reduced as a patients condition improves, allowing them to take on more of the work of breathing and built the respiratory muscles again.

Organ Support

During critical illness vital parts of the body (organs) may stop working effectively. This is serious, but in most instances support can be offered until these organs start working again. This may involve a breathing machine (ventilator), medications, which are usually given through an IV drip, or machines such as kidney dialysis

The Ventilator

Many patients admitted to Intensive care struggle to breathe effectively. One of the options that may help is the use of a ventilator. If help from a ventilator is required patients are given sedative medicines in order to help them tolerate the tube in their mouth (ET Tube) that is used to help deliver this support.

As patients get better there will hopefully come a point where you will be able to breathe on your own again. Ventilators have different ways of supporting breathing. This allows patients to be comfortable and conscious before the breathing tube is removed. Sometimes patients require an operation to insert a breathing tube in their necks. This is called a ‘tracheostomy.’ This procedure makes breathing and communication easier and helps expectoration and clearing of secretions.

Communication

Patients who are on a mechanical ventilator or ‘breathing machine’ cannot use their voice. This does not mean that you cannot communicate. Staff will continue to talk to you and you may be able to respond by writing, mouthing words or by gestures. Having to rely on these more basic forms of communication is often frustrating and it can be frightening too. However, it’s important to remember that this phase is often temporary and the staff are here to help you communicate.

Staff in Intensive care will always try to explain what is happening to you. Sedative medicines may greatly reduce your awareness of your surroundings and can also reduce your ability to form accurate memories.

Delirium in Critical Care

Unfortunately, we know that many intensive care patients suffer from sometimes frightening memories of things that did not actually happen. These is called ‘delirium.’ It can sometimes be very difficult for a patient to work out what was real and what is not. We encourage patients to speak to someone about it if they feel they have experienced delirium. Ask the bedside nurse about patient diaries which may help piece together the ICU experience later. Following recovery there happy to arrange a visit the Intensive care unit to discuss what happened in more detail or discuss this outside the unit if you do not feel able to enter the unit.