There are two things that make care in the ICU different than in a regular hospital ward. First of all, the ICU has a larger ratio of doctors and nurses to patients than found in other parts of the hospital. Then, there is the extensive use of advanced technology for patient’s constant monitoring and treatment.

 Some of the main ICU machines and what they do are described below.

 

  • Breathing Equipment Open or Close

    If your lungs have failed and you are unable to breathe adequately on your own, you will need to be attached to a breathing machine (ventilator). A ventilator is a machine that assists a patient's breathing. Patients who need help with their breathing often need to be sedated to tolerate the mechanical ventilation. A sedative is medication that makes you sleepy. This level of sedation is much less than is needed for an operation and patients are often partially awake.

    Two types of support are used in critical care units to help a patient's breathing - Non Invasive Ventilation (NIV) and Invasive Ventilation.

    Non Invasive Ventilation

    This form of breathing support is administered by a mask attached to the patient's head.

    The mask may just cover the nose:

    Nosemask 

    Or, more commonly it covers the patient's nose and mouth:

    Fullfacemask 

    In special circumstances e.g. facial abnormality or burns a full head mask may be used:

     totalfacemask 

    The ventilator used can be a simple device that has a narrow range of adjustment:

    Nippy 

    Such devices are often given to patients who suffer from extreme sleep disturbance due to snoring. The tubing attaches to a small mask that goes over the patient's nose and is attached to the face before they go to sleep. For more information on this therapy click here.

     

    More sophisticated machines are used in ICU to manage the more complex problems that critically ill patients present:

    NIV 

    NIV can also be admistered via the most versatile ventilators on an ICU:

    ServoU 

    These are capable of NIV and invasive ventilation covering a wide range of clinical conditions.

     

     

    Invasive Ventilation 

     

    In this form of breathing support a tube is inserted through either the patient's nose or mouth and into the windpipe. The tube, which is known as an endotracheal tube (ETT) is connected to the ventilator. Ventilators can offer different levels of breathing assistance. The machine can 'breathe' completely for a patient or it can be set to assist a patient's breathing. The support given from the ventilator can be gradually reduced when the patient’s condition improves. This is described as weaning.

    If a patient is likely to remain on a ventilator for more than a few days or if the patient's condition excludes the use of an endotracheal tube in their mouth it is sometimes replaced with a tracheostomy tube. In this case, an operation is carried out to insert a tube into a hole which is made in the neck. Although this can look rather strange, it is actually quite comfortable for the patient compared with having a tube in their mouth. A patient will not usually be able to use their voice while the tracheostomy is in place but in the latter stages of weaning it is often possible to utilise special devices that enable the patient to vocalise whilst connected to the ventilator.

  • Monitoring Equipment Open or Close

    Vital Sign MonitorTo measure important bodily functions, wires may be attached to various parts of your body by sensor pads linked to computer-style screens. Functions that can be closely monitored include:

    Heart and pulse rate (measured by an electrocardiogram or ECG)

    Air flow to your lungs via a ventilator

    Blood pressure and blood flow - arterial line

    Pressure in your veins (known as central venous pressure or CVP)

    The amount of oxygen in your blood - oxygen saturation (“sats”)

    Your body temperature

     

    The monitoring equipment will track every tiny change in your bodily functions and will alert the ICU staff if there are any changes that could be dangerous.

    In some cases, you may also have the pressure in your abdomen (stomach area) monitored. Rising pressure levels can prevent enough blood from reaching your organs and may require further treatment.

     

     

    Bedside monitor

    fukuda

    Every bedspace in the ICU has a monitor provided for it.

    A bedside monitor is a display of major body functions on a device that looks like a television screen or computer monitor. The number of body functions the monitor measures is up to the doctor and nurse.

    The monitor is attached to wires, called leads. At the other end, the leads are attached to sensing devices attached to the patient's body. The sensing device sends electronic signals to the monitor, which displays the readings for the specific body function being monitored.

    The monitor is typically used when the doctor wants to measure functions like the heart rate, respiratory rate, blood pressure and temperature. In addition, special functions such as capnography, oximetry, electroencephalography and cardiac output readings are also used in certain situations. The bedside monitor has alarms that signal the nurse if a body function needs attention. 

    All patients admitted to the ICU have a bedside monitor attached to them. The bedside monitor is normally used the entire time a patient is in the ICU. Being attached to the bedside monitor does not hurt and their are no complications associated with its use.

    Information from the monitor is also collected on a further computer screen by the bedside to collect all the information from multiple devices e.g. ventilator, kidney machine, drug syringes etc. This system is referred to as a Clinical Information System (CIS)

     
  • Clinical Information System (CIS) Open or Close

     

    Metavision

    ICU3

    The system offers minute-by-minute patient information collection and display, creating a complete electronic medical record. 

    The system collects and displays this information automatically from all the medical devices and hospital information systems. The nurse caring for the patient is thus spared the chore of recording manually on to a large chart and is able to spend more time providing vital activities to ensure a best outcome. Each nurse will have a personal login to the system which allows them to configure the screen to their personal preferences.

    The system also incorporates a fully electronic drug prescribing system which assists all staff in the delivery of the correct drug. Drug administration errors are thus minimised and important interactions and allergies are documented and taken note of.

  • IV Lines and Pumps Open or Close

    PumpsTubes that are inserted intravenously (into a vein in your arm, chest, neck or leg) provide your body with a steady supply of essential fluids, vitamins, nutrients and medication. A tube inserted into the main veins in your neck is known as a central line.

    These tubes are called IV lines, IVs or drips. They are often connected to one or more bags of fluid that hang from a pole (drip stands) and are attached to pumps (syringe drivers) that constantly regulate the supply. You may also be given blood intravenously using an IV line.

    Medications that are given slowly and continuously by IVs in intensive care can include:

    Sedatives – to reduce anxiety and encourage you to sleep

    Antibiotics – medication that is usually given in high doses and used to treat infections caused by bacteria

    Analgesics – also known as painkillers

     

  • Kidney Support Open or Close

    HaemofilterYour kidneys filter waste products from your blood and manage the levels of fluid in your body. If your kidneys are not working properly, a kidney machine (haemofiltration machine) can replace this function. During haemofiltration, your blood will be fed through the machine, which removes any waste products. Your blood will then be returned to your body.

    The haemofilter is the ‘heart’ of the haemofiltration process. It is here that blood is filtered, with the removal of water and dissolved solutes. 

     

    The haemofilter is used in situations when the kidneys are not working but are expected to recover their normal function. This short term lack of function or acute kidney failure is quite common in patients with a critical illness and can also follow major surgery. The machine will take over the function of the kidneys allowing the normal healing process to take place that can take up to three months to happen.

    Sometimes the kidneys do not recover and this can lead to a situation known as chronic kidney (renal) failure.  In this instance you will need to be referred to a specialist centre for management and long term kidney support that can take the form of regular haemodialysis of your blood or via a special tube in your abdomen.

    The following sites will provide you with more detailed explanantion of the various options:

    NHS Choices

    Kidney Research

    Renal Med

    Kidney Patient

  • Feeding Tube Open or Close

    If you need help breathing through a ventilator, you will not be able to swallow normally. A feeding tube can be placed in your nose, through your throat and down into your stomach. This is called a nasogastric tube, or NG tube, and can be used to provide liquid food. Sometimes the tube is placed directly into the small intestine (known as 'PEG tube'). 

    If your digestive system is not working, nutritional support can be fed directly into your large veins via a peripherally inserted central catheter (PICC) or via some sort of central venous pressure (CVP) line which is normally inserted via a large vein in your neck.

  • Drains Open or Close

    After surgery, tubes called drains may be used to remove any build up of blood or fluid at the site of the wound. These will usually be removed after a few days.

  • Catheters Open or Close

    Catheters are thin, flexible tubes that can be inserted into your bladder, these are called Foley catheters. They allow urine to be passed out of your body without you having to visit the toilet. There may be a clear bag hanging from the side of your bed and this is connected to the catheter that goes into your bladder. It is used to measure the amount of urine you produce. This indicates how well your kidneys are working.

  • Suction Pumps Open or Close

    Another tube can be passed down the inside of your endotracheal tube (breathing tube) and attached to a suction pump. Suction pumps are used to remove excess secretions (fluid) and help keep your airways clear.

  • Cooler ("Arctic Sun") Open or Close

     

    Cooler

    cooler

    Many ICUs across the UK now use cooling techniques to help heart attack patients regain normal neurological function.

    This “therapeutic hypothermia” is normally induced using cooled pads or ice packs and the patient is cooled to a temperature of 33 degrees C, normal being 37 degrees C. This temperature is maintained carefully by the machine for 24 hours to give the patient’s brain time to recover following the period of poor blood supply during the heart attack. After 24 hours the patient’s temperature is slowly allowed to come back to normal, all sedative drugs are normally stopped and a full examination of the patient’s neurological state is carried out.

  • Recumbant Bike Open or Close

    Used to allow the patient to perform leg exercise whilst in bed. It is often used in patients who have been on an ICU for many days and who are struggling to regain full muscle power. The physiotherapists will program the bike to gradually increase the work required by the patient without tiring them unnecessarily.