Intensive Care Unit (ICU) Guide
Last Updated 02/15/2021
Authors:Mary Jo S. Farmer, MD, PhD, FCCP; Justin K. Lui, MD; Megan L. Llamas, RRT, MHA; David W. Unkle, APRN‑BC, MSN, FCCP; Munish Luthra, MD, MBBS, FCCP; Christopher L. Carroll, MD, FCCP; Brian Carlin, MD, FCCP; Adebola O Adesanya, MBBS, FCCP; Kalpalatha K. Guntupalli, MD, FCCP
Preparing for the ICU
Navigating an intensive care unit (ICU) experience can be challenging for families. The more you understand, the easier it will be for you to focus on your loved one.
Patient Guide: COVID-19 and the ICU
During the COVID-19 pandemic, many hospital procedures have changed, including those in the ICU. Learn more about what you can expect if you or a loved one is hospitalized during this time.
Patient Guide: Preparing for the ICU
As a patient or caregiver, you’ll feel better prepared and more comfortable if you take certain steps before moving to the intensive care unit (ICU). For example, you can consider getting an advance directive and discuss your hopes and goals for treatment.
You can also take some of the stress out of your experience by talking with the health care providers (HCPs). They are experienced, caring professionals who are willing to help.
Health care providers know that patients are increasingly racially and ethnically diverse. HCPs have skills that are applicable to any culture and tradition. The care team in the ICU will know that some patients may distrust health care institutions because of prior personal or historical discrimination and that this may impact treatment decisions.
The ICU team will work to understand specific patient health care beliefs in the context of each patient’s cultural and social background. In the ICU, the care team will encourage patients and caregivers to articulate their own understanding of the disease process, and the HCPs will try to use language that patients and caregivers understand. This approach facilitates mutual understanding and discussions about treatment decisions.
What is an ICU?
ICUs provide around-the-clock monitoring and care for the most seriously ill patients. Specially trained doctors and nurses provide care in these units.
People in the ICU need close monitoring. They may also need special equipment, including:
- A breathing machine, or ventilator
- Monitors to check heart rate, blood pressure, and other vital signs
- Intravenous (IV) lines for medications and fluids
People may receive treatment in the ICU for:
- Serious illnesses
- Breathing problems
- Heart attack or heart rhythm problems
- Kidney failure
- Recovery from a major surgery
- Infections (also called sepsis)
- Stroke
- Very low or very high blood pressure
- Injuries or accidents
- Brain injury
- Drug overdose or poisoning
- Severe trauma (like a car accident)
Maybe, but not everyone who goes into an ICU needs a ventilator. Ventilators are machines that help people breathe or breathe for them.
If a ventilator is needed, you’ll have a team of health care professionals who can explain the situation to you. The patient may need a ventilator to help with:
- Airway inflammation
- Sick lungs
- Respiratory distress
- Poor ability to clear their own lung secretions
- Weak lung function
Who makes treatment decisions in the ICU?
If possible, try to think ahead about treatment before a move to the ICU. Patients in the ICU may be sedated or too sick to make decisions for themselves. Ask if the patient has or wants an advance directive or living will. These documents spell out the type of care people do and don’t want for themselves.
If a patient doesn’t have a living will, doctors may ask the patient’s care partner to make decisions about care. The medical team can help you make a decision and may have options you can choose from.
If you need to make health care choices for the patient, consider:
- What the patient would want—not what you would want
- Past conversations you and the patient have had
It’s not always easy to know what to do. Try to consider the patient’s comfort and wishes when making treatment decisions. Most hospitals have social workers and chaplains who can support you.
If you think the patient is not getting proper care, ask your hospital’s ethics committee to review your case. Someone from your ICU team can help arrange a meeting for you, or you may feel more comfortable asking a social worker or chaplain about this.
How do I communicate with the health care team?
Ask the patient today about his or her desires for health care. You are the patient’s best advocate.
Patients can authorize which family members or friends they want to receive information from HCPs. If you do this now, it will simplify things if the patient needs to go into the ICU. Ask the health care team if you have any questions about how to do this.
Work with the patient to:
- Choose a contact person. Let the care team know how you’d like to receive communications and updates. It’s usually a good idea for the family to have one point person. This person can receive and relay information to other loved ones.
- Set up a family meeting. You can ask for a family meeting with the health care team at any time. This gives your group a chance to meet privately with doctors, nurses, and other providers. The ICU team may also recommend a family meeting in some situations.
- Talk with the HCPs. Express your own understanding of the disease, and ask providers to use nonmedical language when they respond. This can create mutual understanding and improve discussions about treatment decisions.
- Use a patient communicator app. The Society of Critical Care Medicine has a free app. It aims to improve communication between patients, families, and HCPs. Find the app on iTunes or Google Play.
Who makes treatment decisions in a medical crisis?
It’s a good idea to understand the different levels of care for each hospital code status before you’re in a stressful situation in the hospital. These codes determine the level of care a hospital patient receives in a critical medical situation.
Patients can make a choice for themselves ahead of time. If a patient isn’t able to make a decision, doctors may ask family members, caregivers, or advocates to decide.
Full code
The health care team will perform cardiopulmonary resuscitation (CPR) or use electric shocks to get the heart beating again. They may also use a tube or ventilator to help with breathing. All patients receive this care unless they or their care partner says otherwise.
Do not resuscitate (DNR)
Treatment will still continue even if a patient has a DNR status. But the health care team will not perform CPR or use a ventilator if a patient’s heart or lungs stop working. A patient can choose to be DNR ahead of time, or the care partner may make this decision if a patient cannot.
Comfort care
If treatment will not work, a patient’s care partner and health care team may decide to provide comfort care. Doctors and nurses will only offer care to keep a patient comfortable, such as pain medication. They will not perform other treatments, tests, or procedures.
Taking comfort
If you or the patient you care for needs to go to the ICU, a specially trained team will provide comprehensive, compassionate treatment. The health care team will use the latest advances in medical care to give the patient the best care possible.
Staying in the ICU
Patient Guide: Staying in the ICU
When you understand more about how the ICU works, you may feel more at ease. Get to know the ICU care team. You may feel more comfortable if you do. You can also learn about the equipment and technology that providers use for care. Be sure to ask a nurse, doctor, or other provider if you have any questions that aren’t answered here.
The care team
Large teams of health care professionals work around the clock in the ICU to help patients. You also are an essential part of the patient’s care team, and your input is valuable.
You may need to talk to many different doctors and providers throughout the patient’s ICU stay. Don’t be surprised if many HCPs ask you the same questions. It’s important that you answer their questions as completely as you can. You may also notice different providers on the weekends or at night.
The ICU team includes:
Attending physicians
These doctors are in charge of a patient’s care. They may train and supervise residents, interns, and medical students.
Doctors and physician assistants (PAs)
These providers have special training in ICU medicine. They may also have training in other areas, such as lung disease or anesthesia.
Nurses and nurse practitioners
ICU nurses provide daily bedside care. They have extra training and experience caring for critically ill patients. ICU nurses often care for only one or two patients at a time.
Pharmacists
Pharmacists see patients with the ICU team. They provide support for medications typically used in the ICU. They help make sure dosing is correct and side effects are managed.
Consulting doctors
The ICU team may work with doctors who are experts in different areas. This can include heart, lung, or kidney specialists.
Fellows
ICU fellows are doctors who are getting extra training in ICU medicine. Fellows may supervise residents, interns, and medical students.
Respiratory therapists
These providers care for people with breathing problems. Respiratory therapists give breathing treatments. They know how to operate and set up breathing machines.
Social workers
They provide support for patients and families. Social workers help with insurance and other financial concerns. They can also arrange for rehabilitation services and connect you with counselors or support groups.
Dietitians
They make sure patients get proper food and nutrition. Dietitians can also provide meal plans for after your loved one leaves the hospital.
Physical therapists
These providers help people regain their strength. Physical therapists teach exercises and encourage people to stretch and move when possible.
Speech therapists
They treat people with talking, swallowing, or eating problems. These types of issues are common for people in the ICU.
Case managers
These nurses manage all aspects of a patient’s care in the ICU. They work closely with the rest of the ICU team to create treatment and recovery plans.
ICU equipment explained
You’ll see a lot of machines and tubes in the ICU. People in the ICU need special equipment for treatment and monitoring.
Routine tests
Patients in the ICU need regular blood tests to help doctors decide on a treatment path. Patients with lung disease may also need regular X-rays to check the status of their lungs.
Tubes
Endotracheal tube
This plastic tube goes through the nose or mouth. It connects to a ventilator or respirator to help with breathing.
Tracheostomy tube
This tube goes through the patient’s neck and into the trachea. It connects to a machine to help with breathing. A doctor usually inserts a tracheostomy tube during a surgical procedure. The procedure is performed if the patient needs long-term help with breathing.
Nasogastric (NG) tube
This tube is threaded through the patient’s nose or mouth and into the stomach. It’s used to give medicine or liquid food if a person can’t swallow. People on breathing machines often need an NG tube. Health care providers may also use an NG tube to drain the stomach of air, blood, or fluid.
Foley catheter
This thin tube goes into the bladder and allows urine to drain into a bag. It’s used so people who are critically ill don’t need to get out of bed to urinate.
Central line and arterial line
Central and arterial tubes go into the larger veins in the neck, under the collarbone, or in the thigh. They’re used to give medicine or fluids that can’t be given through smaller veins in the arm.
Dialysis catheter
A dialysis catheter is inserted into the arm or neck. It’s used to move blood out of the patient’s body, through a dialysis machine (which filters the blood), and back into the patient.
Chest tube
This tube is placed between the ribs and into the space around the lungs. It helps drain air or fluid from the chest and helps people breathe more easily.
Monitors
Pulse oximeter
A pulse oximeter goes on a finger, toe, ear, or forehead. It measures how fast the heart beats and how much oxygen is in the blood.
Blood pressure cuff
A cuff wraps around the upper arm or leg. It measures blood pressure. A machine with a timer may measure blood pressure automatically at certain times.
Rectal thermometer
This thin tube is inserted into the anus. It continuously records body temperature.
Electrocardiograph (ECG or EKG) leads
ECG leads are wires attached to sticky pads on the chest. They measure heart rhythm and rate.
Frequently Asked Questions
Questions about treatment and care
Why is the patient groggy?
Some treatments can be uncomfortable or painful. Patients may get medicine to help them relax, and those drugs can make them sleepy.
The ICU team will use medicine such as sedatives carefully so that the patient has as normal a sleep cycle as possible. As the patient gets better, doctors may reduce the use of these medicines.
Why is the patient tied to the bed?
The ICU team may use restraints to keep patients from hurting themselves or removing important tubes and wires. Restraints don’t hurt and are used only when needed.
Why can’t the patient talk to me?
Patients may not be able to talk if they have a breathing tube or they get medicine that makes them sleep. If the patient is awake, try writing notes on paper. Patients who aren’t awake may still hear you, so feel free to talk to them as long as the doctor says it’s okay. You should speak clearly and try to stay as positive as you can.
Questions about hospital policies and services
Why do I need to sign so many forms?
People in the ICU can’t always talk or make decisions for themselves, so you may need to make decisions for them. Hospital staff may ask you for a health care proxy, a next-of-kin form, or other forms.
Why can’t I visit more often?
ICU visiting hours are shorter because patients need more care and rest. Make sure you visit only during visiting hours, and get proper rest so that you can care for the patient when he or she leaves the hospital.
Is there help or support for me?
Hospital chaplains and social workers provide support for patients and their caregivers. They can provide counseling or refer you to a counselor. Social workers also help with transportation, lodging, and financial concerns.
Questions about end-of-life decisions
What if the patient doesn’t get better?
Unfortunately, not everyone in the ICU gets better. The care team will talk with you about the patient’s condition and help you understand the options. Doctors may suggest:
- Palliative care, which focuses on providing relief from symptoms, pain, and the stress of serious illness; or
- Hospice care, which provides comfort, pain management, and care for people near the end of life.
Sometimes, treatment doesn’t work, and patients are too sick to say what they want. If a patient doesn’t have a living will or advance directive, the doctor will ask the patient’s family or advocate to make treatment decisions. See Treatment Decisions Link to Treatment Decisions section in Preparing for the ICU section. for more information.
End-of-life issues can be difficult to discuss. The ICU team will establish common ground and trust with the patient when discussing end-of-life issues, even though the HCP and the patient may come from different social and cultural backgrounds. The care team is committed to understanding patient beliefs with respect to end-of-life attitudes, customs, and requests for specific types of care.
The doctor may ask to perform an autopsy if your loved one dies. This medical exam can help you and the doctor understand how the patient died. Autopsies do not interfere with funeral arrangements. In most cases, you have the right to refuse an autopsy.
Providing advanced care
ICUs offer the most advanced treatments in a compassionate, supportive environment for the best care possible.
Leaving the ICU
As the patient starts to recover, you can learn about the next steps for treatment and care. You may want to ask about insurance and the costs of various options.
The ICU team members will talk with you about what may come next. They will want to hear about your expectations and any concerns you may have.
Patient Guide: Leaving the ICU
When people in the ICU start to feel better, they may:
- Move to another unit in the hospital
- Return home
- Transfer to another health care facility
Determining next steps
Patients in the ICU get a full evaluation before any decision is made about next steps. Options may depend on the patient’s insurance. Members of the team who may evaluate the patient include:
- Doctors
- Case manager
- Social worker
- Physical and occupational therapists
If the patient can’t be cared for at home, let the health care team know. There may be other options, including rehabilitation and skilled nursing facilities.
Step-down unit
- Another unit in the hospital
- Provides a level of care between the ICU and a general hospital unit
- Offers close monitoring and specialized care
Long-term acute care hospital
- Provides specialized care for an extended time
- Includes nursing, respiratory, and rehabilitation services
- Average stay is 3 to 4 weeks
Rehabilitation facility
- Offers physical, occupational, and speech therapy for several hours each day
- Helps people safely regain their independence
- Average stay is at least 2 weeks
Skilled nursing facility
- Offers long-term residential care and promotes activities of daily living
- Includes physical and occupational therapy and other services as needed
Recovery and post-intensive care syndrome
Full recovery after the ICU can take months or even years. Some people may experience post-intensive care syndrome (PICS) after leaving the ICU.
PICS is a collection of physical, emotional, and mental symptoms:
- Symptoms can linger after leaving the ICU.
- Symptoms may include muscle weakness and issues with thinking, memory, and attention.
- There are treatment options and support for people with PICS.
Talk to a doctor if you or the patient you care for experiences symptoms. You can watch this video to find out more about PICS.
Beginning a new phase
Patients leave the ICU only when doctors determine that it’s safe. Challenges might remain, but the patient no longer needs intensive monitoring and treatment. Other HCPs and facilities can help you navigate life outside the ICU.