What is an intensive care unit (ICU)?

An ICU is a part of a hospital that gives care to people who are critically ill. Patients in the ICU have serious health issues that can be life-threatening. They might:

• have a serious injury
• have a serious illness
• be recovering from major surgery

In the ICU, patients are closely monitored at all times, 24 hours a day, by teams of specialist health practitioners.

The ICU is different from other hospital wards in that:

• there are fewer beds
• each bed has lots of equipment needed to care for very sick patients
• fewer visitors are allowed
• there are fewer patients for each nurse to look after — often there is one nurse for every 1 or 2 patients

In the ICU, patients may need to have life-support. This is needed when a major organ such as the heart or lungs needs help to work properly.

Why are people admitted to the ICU?

You are likely to be admitted to an ICU if you:

• are in a critical condition
• need specialised care
• need to be watched closely at all times

You might need to go to the ICU:

• after major surgery
• following an accident (for example, a car accident or severe burn)
• if you have a serious illness (such as heart failure, kidney failure, stroke or heart attack)
• if you have a serious infection (such as pneumonia or sepsis)

There is usually a special ICU for babies called the neonatal intensive care unit, or NICU. A NICU has specialist medical staff to care for:

• babies born prematurely
• babies with a serious illness

What happens in the ICU?

The ICU can feel like a daunting place for both for you and your visitors. This can be due to the lines, tubes, wires and monitoring equipment at the bedside.

ICU patients can be connected to different machines. The most common machines are heart monitors and artificial ventilators. An artificial ventilator is needed when you can't breathe for yourself.

Many ICU machines beep and make loud noises and alarms. These noises are important because they let staff know if your condition changes.

You may have several tubes going into or out of your body. These tubes give fluid and nutrients to you and get rid of waste fluids.

There are many medical staff in the ICU. Each patient usually has a dedicated specialist nurse. This nurse regularly checks the equipment and any life support systems.

The ICU healthcare team understands how distressing the ICU can be. The staff are available to support your close family.

Contagious diseases

If you have a contagious disease, you need to be cared for in a separate part of the ICU. This is called 'isolation'.

In the isolation section of the ICU, extra precautions are taken by staff to keep infections under control. It's important to stop germs infecting staff or other patients in the ICU.

Isolation can also be needed if you have an infection that is hard to treat. This sometimes happens when germs become resistant to antibiotics.

What should I do before being admitted to the ICU?

Admission to ICU is often unexpected. An example is when you are critically injured in a car accident.

Some people know they will be admitted to the ICU. For instance, it is often normal for someone to go to ICU in the early stages of recovery after major surgery.

People with serious or advanced diseases might expect to be admitted to an ICU at some time. This could happen if your condition gets worse suddenly.

In both these cases, you have time to consider getting an advance care plan beforehand.

Advance care planning

The goal of intensive care is to return you to a quality of life that is acceptable to you. It is important to discuss 'goals of care' as early as possible.

An advance care plan is a valuable document for both your family and the ICU staff. It lists your specific wishes about treatment and life support.

An advance care plan is valuable when you are too sick to speak for yourself.

With an advance care plan, you can specify exactly which treatments you would and wouldn't like to receive. For example, you might want to have antibiotics in the case that you get pneumonia, but you wouldn't want to be placed on a ventilator or to have cardiopulmonary resuscitation (CPR). You can still be admitted to the ICU even if you only want to have some of the treatments that are offered there.

You can discuss advance care plans with your doctor. Sometimes, the doctors will discuss a plan with you when you are admitted to hospital.

You can change your mind at any time about any of the details of your advance care plan.

What should I do when visiting someone in the ICU?

Every patient in ICU is very unwell. Each hospital and ICU has a visitor policy. It's usual that only immediate family are allowed to visit.

You will probably be asked to:

• turn off your mobile phone
• not bring flowers
• not visit if you are feeling unwell

Many ICUs will offer virtual visiting, using iPads, for family and spiritual advisors.

What happens after I'm discharged from the ICU?

You will be moved to another ward when you no longer need the high level of care given in the ICU.

Once you are well enough to go home, you will be discharged. You will usually be given medicines and instructions for care at home.

You may need further care or follow-up appointments. This can be in a hospital, clinic or from your doctor.

Resources and support

For more information on advance care planning, visit the Advance Care Planning Australia website.

To learn more about recommendations from the College of Intensive Care Medicine & the Australian and New Zealand Intensive Care Society, visit the Choosing Wisely Australia website.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.