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Author: Omid Zad, MD

What happens in the ICU

What happens in the ICU?

Written by Omid Zad, MD on . Posted in Patient Education. 1 Comment on What happens in the ICU?

You just received a call from the hospital that your loved one is admitted to ICU. This sounds scary. You already know what is ICU, but you don’t know what to do.

Let’s answer some of these questions so that you have a better understanding of the ICU outcomes.

Why someone get’s admitted to ICU?

Patients may be admitted to the ICU for a variety of reasons, including:

  • Severe infections
  • Severe sepsis or septic shock
  • Major surgery
  • Heart attacks
  • Stroke
  • Organ failure (respiratory failure, kidney failure, liver failure, ….)

The ICU is staffed with a highly trained team of healthcare professionals who work together to monitor and treat patients around the clock. Patients in the ICU require close monitoring and often need advanced life support measures, such as mechanical ventilation or dialysis. The goal of ICU care is to stabilize patients and help them recover, with the ultimate goal of returning them to their normal lives.

Sometimes, patients require ICU care for closer monitoring to prevent patient from deteriorating or rapid intervention if that happens.

What is the chance of survival for ICU patients?

The average survival rate for all ICU admissions in the United States is difficult to quantify as it can vary depending on numerous factors such as the severity of illness, underlying conditions, and age of the patient. However, according to a systematic review and meta-analysis of ICU mortality rates published in the journal Critical Care Medicine in 2014, the pooled ICU mortality rate across 42 studies was 22.1% (95% confidence interval, 20.9% to 23.3%)1.

In another systematic review published in the Journal of Intensive Care Medicine in 2020, the reported ICU survival rates in the United States varied widely depending on the patient population and reason for ICU admission. Overall, the review found that the reported ICU survival rates ranged from 60% to 92%2.

What is the recovery time after ICU admission?

Patients who have longer ICU stays generally have longer recovery times, as they are more likely to have experienced more severe illness and undergone more intensive treatments. However, studies have shown that many patients continue to experience physical, psychological, and cognitive impairments for months after discharge from the ICU.

One study found that for patients who survived a critical illness requiring ICU admission, the median time to recovery was 5 months for those who spent 1-7 days in the ICU, 8 months for those who spent 8-14 days, and 12 months for those who spent 15 or more days3. Other studies have also reported similar associations between longer ICU stays and longer recovery times4,5.

According to Needham et al. median time to recovery for physical functioning was 6 months, and for psychological and cognitive functioning, was 12 months after ICU discharge. However, some patients may experience impairments for a longer period of time or even permanently4.

Where do patients end up after ICU?

As patients improve, patient may end up in different settings, depending on their medical needs and overall condition. According to a study published in the American Journal of Respiratory and Critical Care Medicine, the most common discharge destination for patients after ICU admission is an acute care hospital (37.7%), followed by home (26.3%), skilled nursing facility (19.1%), and inpatient rehabilitation facility (9.8%)5.

  1. Step down unit
    Most patient will be transferred to lower acuity unit within the hospital after their critical illness is resolved. Depending on the hospital, these units may have different names: Progressive Care Unit (PCU), Intermediate Care Unit, Step-down unit or …. This will give more time for the patient to continue to improve and also finalize any medical treatment and procedures that needs to be completed before discharge.
  1. Skilled nursing facility (SNF)
    A skilled nursing facility is a type of healthcare facility that provides round-the-clock nursing care and rehabilitation services to patients who require a higher level of medical care than what can be provided at home or in an assisted living facility. These facilities are staffed by licensed nurses and therapists who work with patients to help them recover from injuries, illnesses, or surgeries.
  2. Assisted living facility (ALF)
    Assisted living facilities are residential communities designed for seniors or patients who require some level of assistance with activities of daily living (ADLs), such as bathing, dressing, and medication management. Residents typically have their own private living spaces and can receive assistance as needed from trained staff.
  3. Inpatient Rehabilitation Facility (IRF):
    Inpatient rehabilitation facilities are healthcare facilities that provide intensive rehabilitation services to individuals who have suffered from serious illness, injury, or disability. They offer coordinated medical care and therapy programs to help patients regain functional abilities and improve their quality of life. IRFs typically provide more comprehensive and specialized care than traditional hospitals or skilled nursing facilities.

References:

  1. Vincent JL, et al. Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. Lancet Respir Med. 2014;2(5):380-386. doi:10.1016/S2213-2600(14)70061-X.
  2. Brummel NE, et al. Frailty and Subsequent Disability and Mortality among Patients with Critical Illness. Am J Respir Crit Care Med. 2017 Mar 1;195(5):643-52. doi: 10.1164/rccm.201602-0335OC. PMID: 27653930; PMCID: PMC5358987.
  3. Kamdar, B. B., et al. Joblessness and lost earnings after acute respiratory distress syndrome in a 1-year national multicenter study. American journal of respiratory and critical care medicine, 197(8), 1017-1026.
  4. Needham, D. M., et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Critical care medicine, 40(2), 502-509.
  5. Oeyen, S. G., et al. Quality of life after intensive care: a systematic review of the literature. Critical care medicine, 44(6), 1269-1277.
  6. Hua, M., et al. Early and late unplanned rehospitalizations for survivors of critical illness*. American Journal of Respiratory and Critical Care Medicine, 200(9), 1092-1101. doi: 10.1164/rccm.201902-0275OC
What is ICU

What is ICU?

Written by Omid Zad, MD on . Posted in Patient Education. No Comments on What is ICU?

If you or a loved one have ever been hospitalized, you may have heard the term “ICU” thrown around. But what exactly is an ICU? Here you will learn:

An intensive care unit (ICU) is a specialized department within a hospital that provides critical care to patients with life-threatening illnesses or injuries. The ICU is designed to provide 24-hour monitoring and specialized care to help stabilize and treat patients who are experiencing a medical emergency.

Patients in the ICU receive a high level of care from a multidisciplinary team of healthcare professionals, including critical care nurses, respiratory therapists, intensivists (specialist doctors who provide critical care), and other specialists as needed. The ICU team works together to provide continuous monitoring and treatment to help patients recover and stabilize.

What patients are admitted to ICU?

ICU patients include those with severe infections, respiratory distress, heart failure, kidney failure, or any other life threatening conditions and require close monitoring and advanced medical support. The ICU is equipped with specialized equipment and technology to support patients’ vital functions, such as mechanical ventilators to help patients breathe, cardiac monitors to track heart function, hemodialysis to replaced failed kidneys and other advanced devices.

Patients in the ICU are typically connected to a variety of monitoring devices, such as heart monitors, blood pressure monitors, and pulse oximeters, which measure the oxygen saturation of the blood. These devices provide continuous data to the ICU team, allowing them to closely monitor the patient’s condition and adjust treatment as needed.

In the ICU, patients receive personalized care based on their individual needs. Treatment may include medications to manage pain, control blood pressure, or treat infections. Patients may also receive specialized therapies such as dialysis or mechanical ventilation. Patients may require surgery or other procedures, which can be performed in the ICU.

The ICU team provides emotional support to patients and their families during what can be a very stressful and difficult time. Family members are often allowed to visit the patient, but may be restricted in the number of visitors or the length of visits due to infection control measures or other restrictions.

What are different types of ICU?

In large hospitals, there are usually different types of ICUs, each is specialized in certain medical condition. Here are a few examples of some specialized ICUs and their abbreviations, that you may hear in larger institutions:

  • Medical ICU (MICU)
  • Surgical ICU (SICU)
  • Multidisciplinary ICU (MICU)
  • Cardiovascular ICU (CVICU)
  • Trauma ICU (TICU)
  • Neuro ICU (NICU)
  • Pediatric ICU (PICU)
  • Neonatal ICU (NICU)
  • Women’s ICU (WICU)
  • Liver ICU
  • Transplant ICU

Not all hospitals have all of the above ICU’s. Most smaller hospitals with about 200-bed capacity usually have one ICU which is considered as a multidisciplinary ICU (MICU) and manage all patients in one unit.

Who are the ICU Team?

The ICU team typically includes:

  1. Intensivist (critical care physician): A physician who is specially trained in critical care medicine and leads the ICU team.
  2. Nurses: ICU nurses are specially trained to provide skilled, around-the-clock care for critically ill patients, including monitoring vital signs, administering medication, and managing life support equipment.
  3. Respiratory therapists: Respiratory therapists provide specialized care for patients who are experiencing breathing difficulties, including administering oxygen and managing mechanical ventilation.
  4. Pharmacists: ICU pharmacists work with the medical team to ensure that patients receive the correct medications in the correct doses.
  5. Dietitians: Dietitians help to ensure that critically ill patients receive the proper nutrition to support their recovery.
  6. Physical therapists and occupational therapists: These therapists help patients regain strength and mobility during their recovery.

Other members of the ICU team may include medical trainees (students, residents, and fellows), midlevels (nurse practitioners and physician assistants), social workers, case managers, and other specialists as needed to support the patient’s care. The ICU team works together to provide coordinated, comprehensive care to help critically ill patients recover and regain their health.

Due to shortage of Intensivist, not all ICUs in the United States, are run by Intensivist. In those ICUs, other specialists and sub-specialists manage the patients collaboratively. However, evidence shows that ICUs with full-time Intensivist coverage have a better outcome comparing to those that are run by different specialists.

Who is Intensivist?

An intensivist (or critical care physician) is a physician who is specially trained in the care of critically ill patients in the ICU (Intensive Care Unit). Intensivists work as part of a multidisciplinary team of healthcare professionals to provide comprehensive, specialized care to critically ill patients.

The educational requirements for becoming an intensivist typically include:

  1. Medical degree: Intensivists must first earn a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO) degree from an accredited medical school.
  2. Residency training: After completing medical school, aspiring intensivists typically complete a residency program in internal medicine, emergency medicine, pulmonary medicine, or anesthesia. Some other specialties such as nephrology, infectious disease, or cardiology can also pursue training in critical care to become an intensivist. The length of residency training varies depending on the specialty, but it typically lasts three to four years.
  3. Critical care fellowship: Intensivists must also complete a critical care fellowship program, which provides specialized training in the care of critically ill patients in the ICU. Critical care fellowship programs typically last one to two years and provide intensive training in critical care medicine.
  4. Board certification: After completing their fellowship, intensivists may become board certified in critical care medicine by passing an exam administered by the American Board of Internal Medicine (ABIM) or the American Board of Anesthesiology (ABA).

In addition to these educational requirements, intensivists must have excellent communication and leadership skills, as they work closely with other healthcare professionals to coordinate and provide the best possible care to critically ill patients.

What is multidisciplinary round (MDR)?

A multidisciplinary round in the ICU is a regular meeting that brings together healthcare professionals from different disciplines who are involved in the care of critically ill patients. The purpose of the round is to discuss the patient’s current condition, progress, and treatment plan, and to develop a coordinated plan of care that takes into account the perspectives and expertise of all members of the ICU team.

Typically, a multidisciplinary round in the ICU is led by an intensivist or critical care physician, and may include nurses, respiratory therapists, pharmacists, physical therapists, dietitians, social workers, and other specialists as needed. The round usually take place daily during the day.

During the round, each member of the team provides an update on their assessment of the patient, any changes in their condition, and any concerns they have regarding the patient’s care. The team then discusses and develops a coordinated plan of care that takes into account the patient’s medical needs, goals, and preferences, as well as any social or psychological factors that may impact their care. The multidisciplinary round is an important aspect of ICU care, as it helps ensure that all members of the healthcare team are working together to provide the best possible care to critically ill patients.

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Criteria for Defining Stages of Cardiogenic Shock Severity

Written by Omid Zad, MD on . Posted in Cardiovascular. No Comments on Criteria for Defining Stages of Cardiogenic Shock Severity

Background

Risk-stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) staging system for CS severity lacks uniform criteria defining each stage.

Objectives

The purpose of this study was to test parameters that define SCAI stages and explore their utility as predictors of in-hospital mortality in CS.

Methods

The CS Working Group registry includes patients from 17 hospitals enrolled between 2016 and 2021 and was used to define clinical profiles for CS. We selected parameters of hypotension and hypoperfusion and treatment intensity, confirmed their association with mortality, then defined formal criteria for each stage and tested the association between both baseline and maximum Stage and mortality.

Results

Of 3,455 patients, CS was caused by heart failure (52%) or myocardial infarction (32%). Mortality was 35% for the total cohort and higher among patients with myocardial infarction, out-of-hospital cardiac arrest, and treatment with increasing numbers of drugs and devices. Systolic blood pressure, lactate level, alanine transaminase level, and systemic pH were significantly associated with mortality and used to define each stage. Using these criteria, baseline and maximum stages were significantly associated with mortality (n = 1,890). Lower baseline stage was associated with a higher incidence of stage escalation and a shorter duration of time to reach maximum stage.

Conclusions

We report a novel approach to define SCAI stages and identify a significant association between baseline and maximum stage and mortality. This approach may improve clinical application of the staging system and provides new insight into the trajectory of hospitalized CS patients.