Being cared for in intensive care

Care focuses on prevention and the replacement or support of essential organ functions when these are insufficient to meet the patient's needs. This may include the lungs, heart, circulation, kidneys, brain, liver that are in imminent or manifest failure. Below describes different situations and care actions that take place in an intensive care unit. It can help you and your loved ones understand what you have been through. On a daily basis, regular assessments of your condition are carried out through examinations, interpretation of laboratory tests, X-rays and data from monitoring monitors. Intensive care work is carried out in teams with specialised nursing staff constantly close to the patient. Regular rounds are common throughout the day. Doctors from other specialties are consulted for individual problems and issues. 

Contents

1. Breathing
2. Circulation
3. Kidneys
4. Nutrition
5. Skin
6. Pain
7. Sleep and sedation
8. Communication
9. Mobilisation and rehabilitation
10. Activity and occupation
11. Information and conversation

Breathing

Measurements of respiratory function via the ventilator or blood tests are done regularly to help you breathe according to your needs.

Ventilator
Replaces or helps you with your breathing when you have respiratory failure. Oxygen is supplied according to your current oxygen needs. The amount of oxygen in your blood is measured by a device on your skin. It can be placed on your finger, ear, toes or forehead.

Intubation
A tube (endotracheal cannula) is inserted through the mouth or nose into the trachea. The tube creates a free airway and ensures that you get air and oxygen. It can be connected to a ventilator. To accept the tube, painkillers and sedatives are given if needed. You cannot speak when you have a tube in your throat. Not being able to make yourself understood can be frustrating and distressing for many.

Tracheotomy
A short plastic tube (tracheal cannula) is inserted into the trachea at the front of the throat during surgery. It replaces the tube through the mouth (endotracheal tube) if there is a need for controlled free airway and breathing assistance for a longer period of time. The advantages of the tracheal cannula are that there is less irritation in the mouth and throat, it facilitates oral care, breathing and training when the ventilator is removed. There is less scarring on the neck when the cannula is removed. There is the possibility of being able to speak if a speech valve is placed on the tracheal cannula. However, you must be able to breathe on your own and not need ventilator treatment during this time. When using a speaking valve, your voice may sound different than before. It can be uncomfortable when you do not recognize your voice.

Suctioning the airways
Ventilator therapy with a tube in the throat, bed rest, sedation, immobilization impairs the ability to transport and cough up secretions that form in the airways. The staff will help you by suctioning secretions using a suction catheter that is passed down the tube into the trachea. Secretions that accumulate in the mouth and throat are also aspirated.

Bronchoscopy
An examination in which an instrument (endoscope) is used to inspect the lining of the windpipe, the trachea, and the airways in the lungs. During the examination, secretions are suctioned from the airways and cultures are taken to see what bacteria are growing in the airways.

Chest tube
A tube inserted through the chest into the pleura. Blood, fluid and air are drained out through the tube connected to a suction source. 

Circulation

Circulation, which is important for transporting blood and oxygen in the body, is impaired. This can be due to fluid/blood deficiency, heart failure, severe infection or allergic reaction.

Shock
Acute circulatory failure is a life-threatening condition when blood pressure drops sharply.

Circulatory failure
A common condition. Fluid and blood supply, medication and follow-up treatment require regular and close monitoring. This is done by connecting you to a monitoring device where staff can continuously monitor your pulse, heart rate, blood pressure, etc. This is supplemented by examinations such as ECG (heart rhythm and possible damage), ultrasound of the heart (echocardiography), cardiopulmonary X-ray and measurement of cardiac output.

Blood sampling
Sometimes done via a thin plastic tube inserted into an artery (arterial needle). It can also be used to measure blood pressure (invasive blood pressure measurement).

Kidneys

The kidneys maintain, among other things, the fluid and electrolyte balance in the body and regulate the excretion of waste products.

Urinary catheter (KAD)
A tube inserted through the urethra into the bladder that allows the amount of urine produced each hour and day to be monitored.

Fluid balance
The body's fluid balance is checked daily to ensure that the correct amount of fluids and electrolytes are supplied.

Weight
Weight is checked regularly to ensure that the body does not accumulate too much fluid.

Diuretics
Diuretics are given to eliminate excess fluid in the body.

Dialysis
Dialysis treatment is given for acute kidney failure, when there is too much fluid in the body or for serious poisoning. Treatment is carried out using a dialysis machine. The blood circulates through a dialysis catheter located in a blood vessel to the dialysis machine, through a filter that cleans the blood of waste products and fluid.

Nutrition

Thin plastic tubes are inserted through the skin into the bloodstream (PVK, CVK, subcutaneous vein port) to give you infusions (parenteral infusion) containing the nutrients you normally get from food.

Tube
Another option is to feed through a tube that goes through the nose/mouth into the stomach. The tube feeding is continuous and dosed using a tube feeding pump or the tube feeding is given at fixed times using a tube syringe.

Nutrition
The choice of the amount and content of nutrition depends on how ill you are and how you can absorb nutrition through the gastrointestinal tract. Metabolism is affected when you are seriously ill.

Muscle mass
You lose muscle mass due to protein breakdown. Your need for egg white, calories, vitamins, trace elements and electrolytes is met by the tube feed you receive or by additives in the infusions.

Drainage
The tube may also be connected to a collection bag to drain the stomach contents. Diarrhea may be caused by changes in the gut flora due to antibiotic treatment or the initiation of tube feeding. Constipation may occur due to impaired bowel function during immobilization and administration of certain drugs that alter bowel movements.

Oral care
When you don't eat and drink normally but instead have tubes in your mouth, there is a risk of injury/disease in the mouth. Staff perform oral care several times a day to prevent bacterial infections and damage to the oral mucosa. 

Skin

Hygiene
Personal hygiene that you cannot perform yourself is carried out by staff. Washing and skin care with emollient creams is carried out daily

Changes of position
Staff will also ensure that you are regularly turned in bed. This is to prevent pressure sores, which can occur on the body if you lie in one position for too long.

Eyes
Eyes can become dry, irritated and swollen. It can also be difficult to close your eyes if you are sedated. Drops that replace tears prevent drying of the eye mucosa. Special eye chambers are available to protect the eyes.

Pain

Untreated pain can make the course of the disease and recovery more difficult. As recovery progresses and needs change, the supply of painkillers is reduced.

Cause of pain
The cause of pain can be due to the disease process but also largely due to all the interventions required, investigations and treatments. Painkillers are often necessary for various medical procedures to be carried out. For example, mobilization, wound dressings.

Assessing pain
You will be asked to describe the location and nature of the pain, what makes it worse or better, and the degree of pain experienced. Pain can also be assessed using a pain scale (VAS).

Evaluate pain
If you are unconscious or sedated, staff may assess pain based on pain-related behaviors such as movements, facial expressions, and effects on pulse, blood pressure and breathing.

Relatives
Relatives can tell you about your normal resting positions in bed before you became ill. Or if there is any movement or resting position that caused pain before the illness. 

Sleep and Sedatives

In the intensive care unit, you are constantly exposed to frequent stimuli. Depending on the nature of the illness and how critically ill you are, medication may be required to help you sleep.

Sleep
Sometimes sleep is required for 24 hours a day. The depth of sleep needed to achieve calm and rest varies. The depth of sleep affects what you remember afterward from your time in the intensive care unit. It can also affect how you feel after being discharged from the hospital.

Sedation
The staff's task is to achieve acceptable well-being for you with optimal sedation, and to reduce pain, anxiety, and worry. They also aim to enable you to communicate with your surroundings despite the sedative medication. As you recover and your needs decrease, the administration of sleep medication is reduced.

Sleep Rhythm
The sleep rhythm is often disturbed during the care period. The environment in the room is important to create conditions for calm and rest. Lighting should be adjustable for day and night. Sounds from the surroundings, devices, and conversation tones from people are adjusted to minimize disturbances. Good contact with the staff is sought, who continuously inform you about what is happening and provide you with information about time, place, and why you are being treated in the hospital.

Delirium
Experiencing acute confusion is common and is called intensive care delirium - hypoactive delirium, hyperactive delirium, or a mix of both. Signs of this can include psychomotor agitation, hyperactivity such as restlessness, fidgeting, and sometimes aggression. Dreams can be unusual and vivid. Unnatural sensory impressions such as nightmares and even hallucinations occur. It can be difficult to distinguish between dream and reality, and you may lose contact and grounding with reality. Factors that influence the occurrence of this can include the severity of the illness, the duration of stay in the ICU on a ventilator, and the treatment with medications whose side effects can negatively impact.

Rest
In an intensive care unit, something is always happening. A lost circadian rhythm with a lack of rest and sleep can lead to deterioration. Therefore, it is important to have planned rest periods even during the day. Sleep disturbances can occur for some time after intensive care. It is important to process and talk to someone from the intensive care staff about this afterward.

Communication

It can be difficult to make yourself understood or to understand what is happening around you when you are critically ill. If you have a tube (endotracheal tube) in your airways, you cannot speak. Therefore, it will take longer for you to explain your needs and wishes. When no one understands, it is easy to become frustrated, give up trying to express what you want, and become scared and worried. The impact of pain-relieving and sedative medications affects the ability to communicate.

Aids
The staff is used to interpreting reactions and body language with patients who cannot communicate verbally. Aids such as pointing boards/picture books can be used for communication by pointing to a picture when asked a question. Sometimes it works to just read lips. Therefore, the staff must repeatedly inform and explain what is happening and what is planned. Relatives play an important role as they can be a support and explain how you usually want things in different situations.

Mobilization and Rehabilitation

It takes time to recover and regain physical and mental form after the illness. Therefore, it is important to start mobilization and physical activity as early as possible as the condition allows.

Breathing Training
The respiratory muscles are trained through changes in the ventilator settings. If you can breathe on your own, the ventilator is disconnected for short periods, and gradually the time is increased as you can breathe longer periods on your own. Daily breathing exercises with various aids are part of the training.

Muscle Strength
Muscles are trained through passive movements initially performed by the staff. Your joints can easily become stiff, and it usually feels good to move your body. As you get stronger, you perform active movements with support, and eventually, you can perform the movements yourself.

Physical Recovery
The staff regularly performs position changes and turns until you can do it yourself. Sitting up in bed, in a chair, and walking with a walker are other ways to get started. Physical recovery takes a long time and requires training and realistic goals. It can be helpful to set both long-term and short-term realistic goals during the ICU stay. A physiotherapist helps you regain your physical abilities and adapts training based on your conditions.

Activity and Occupation

Even for someone who is critically ill, everyday life can be facilitated by normalizing the situation. Activities are limited to how critically ill you are and how you feel. Relatives can tell what you like to do. Listening to music and audiobooks, watching TV and movies are different ways to stay active. Asking relatives to bring photos of those who mean a lot to you is another way. The staff can also take you out of the care room and change the environment if the condition allows.

Information and Conversations

Doctors and nurses provide regular and recurring information throughout the care period. Not all questions can be answered because it is often difficult to predict how it will go for someone who is critically ill. The staff can then explain what they are doing and update you and your relatives about changes in your condition.