intensive care unit

An intensive care unit or icu , CCU is a area in hospital where the patient with life threatening condition and injury are cared with the use of medical skills of medical , nursing and other experienced health personnel.

Classification of ICU

Classification based on qualified staff , complexity of care delivery , types of patients and  speciality.

1. Level 1 ICU:-

Level 1 ICU located in the small hospital and provide resuscitation for short time less than 24 hours.

2. Level 2 ICU:-

Level 2 ICU is  located in larger hospital and provide multisystem support but lack with advanced therapy.

3. Level 3 ICU:-

Level 3 ICU is located in larger hospital with capabilities of multisystem comprehensive critical care for prolonged period with advanced therapy and highly qualified medical personnel's.

4. Open ICU :-

Open ICU is group in which critically ill patients treated and managed by different specialist.

5. Closed ICU:-

Closed ICU is the group which is managed by qualified critical care specialised physician around the clock 24×7.

6. Medical ICU:-

7. Surgical ICU:-

8. Cardiothoracic ICU:-

9 Renal ICU:-

The above medical, surgical , cardiothoracic and renal ICU are based on types of patients for a single specialist critical care .

High Dependency unit:-

HDU or high Dependency unit provide intermediate care between icu or general ward for observing the risk of developing another acute episode of a serious ailment and unpredictable clinical course to support for single organ failure patients.

Organization of critical care unit

1. Design of ICU:-

The Indian hospital follow the minimum set of criteria for hospital by National accreditation Board for hospital (NABH)

And Indian society of critical care medicine (ISCCM).

The hospital and organisations of a critical care unit strategically planned for bed strength , types of patients , needs of ICU for floor space , equipment , monitors, manpower etc for a critical care unit.

2. Bed strength in ICU:-

For effective care ICU should have 6 to 14 beds with the sufficient staff ,devoted medical registrar and speciality for critical care.

3. Location of critical care unit:-

- critical care unit should be ideally located in a separate area with easy access to emergency department , operation theatre , blood bank , radiology department ,and catheterization laboratory .

- there should be wide ramp , corridor and lift to easily transfer in and out of patients.

- critical care unit should be single entry or exit room but with a emergency exit 

4. Environmental conditions :-

The unit should be fully air-conditioned with the humidity and moisture control . Recommended humidity 55 to 60% and with 12 to 16 air exchanges.

5. Equipment for care unit:-

Basic equipment needed are :-

1. Ventilator for per bed .

2. Non-invasive ventilator

3. Multi-channel monitor 

4. Defibrillator and pacemaker

5. Infusion pump 

6. Fluid and bed warmer

7. Specialist bed 

8. Drug cart

9. Emergency cart

10. Bedside trolley

11. Portable x-ray machine

12. ECG monitor

13. Extracorporeal membrane oxygenator (ECMO)

14.  Pressure monitor

15. Thermameter

16. Patient lifting device

17. Suction machine

18. Renal replacement therapy

19. Personal protective equipment

20. Endotracheal tubes , tracheostomy tube ,nasogastric tubes , ICD should be available in different sizes.

21. Refrigerator for storage of emergency drugs

22.  Syringes and vials .

6. Floor space :-

1. Floor space :- 125 to 150 sqft. per patient is recommended.

2. Bed space:- there should be 4 to4.5 ft space between two beds for easy access for intubation and resuscitation.

3. Separate room :-

One to two separate room for isolation to nurse patients .

7. Nurses station:-

There should be central nursing station with telemonitioring device .

8. Organization of human Resources:-

1. Critical care medical team 

- head of critical care medicine for managing unit.

- Critical care medicine consultant

- intensive care specialist

- other specialists

- junior medical officer

- residential care giver

- trainee officer

2. Critical care nursing team 

-  critical care specialist nurse to manage unit

- senior charge nurse

- full time critical care nurse educator

Important note :-

Nurse patients ratio in icu:-

1. For ventilated patients:-

Ratio of nurse and patient 1:1 

2. For nonventilated patients:-

Ratio of nurse and patient 1:2 

3. For EMCO patients

Nurses and patient ratio 2:1 

Other important personnel for care unit:-

1. Respiratory therapist

2. Physiotherapist

3. Icu technician

4. Dietician

5. Clinical pharmacist

6. Radiographer

7. Computer operator and receptionist

8. Biomedical Engineer

9. Hospital attendant

10. Sanitary attendant

11. Security guard for 24 hours.

Other facilities:-

1. Storage room for ventilator , monitor and infusion pumps 

2. Medical store 

3. RO purified water

4. 2 to 3 oxygen outlet

5. 2 to 3 vacuum outlet

6. 1 to 3 compressed air outlet

7. 16 to 18 electronic outlet per patient

8. Handwashing facilities

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