Intensive Care Unit (ICU)

By Abdulla Israr & Simran Rani

Intensive Care Unit (ICU) 

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Introduction

An Intensive Care Unit (ICU) is a specialized hospital area designed for the management of critically ill patients who require continuous monitoring, advanced life support, and multidisciplinary care. ICU provides 24×7 observation and immediate intervention to prevent mortality and complications. ICU care is technology-driven, protocol-based, and requires highly trained staff.

Functions of ICU

A. Clinical Functions

  • Continuous monitoring of vital parameters (ECG, BP, SpO₂, RR, temperature)

  • Mechanical ventilation and airway management

  • Hemodynamic monitoring (CVP, arterial line)

  • Administration of inotropes, vasopressors

  • Management of organ failure (renal, cardiac, respiratory, neurological)

  • Post-operative monitoring (especially major surgeries)

  • Trauma and emergency stabilization

B. Supportive Functions

  • Infection control and isolation

  • Pain and sedation management

  • Nutritional support (enteral/parenteral)

  • Family counseling and communication

  • End-of-life care (if required)

Types of ICU

1. General ICU

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  • Manages mixed medical and surgical cases

  • Suitable for multi-specialty hospitals

2. Medical ICU (MICU)

  • For medical emergencies (sepsis, ARDS, poisoning)

3. Surgical ICU (SICU)

  • Post-operative and surgical complications

4. Cardiac ICU (CCU)

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  • For myocardial infarction, arrhythmias

  • Advanced cardiac monitoring

5. Neonatal ICU (NICU)

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  • For premature and critically ill newborns

6. Pediatric ICU (PICU)

  • For critically ill children

7. Trauma ICU

  • For accident and injury patients

Criteria for Selection of Patient for ICU

Admission Criteria

  • Respiratory failure requiring ventilator

  • Hemodynamic instability (shock)

  • Multi-organ failure

  • Severe sepsis

  • Post-major surgery

  • Unconscious patients (GCS < 8)

  • Cardiac arrest survivors

Exclusion Criteria

  • Terminal illness with no benefit from ICU

  • Stable patients manageable in ward

Layout & Design of ICU

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Location

  • Near Emergency Department and OT

  • Easily accessible from diagnostic areas

Design Features

  • Central nursing station

  • 150–200 sq. ft. per bed (recommended)

  • 8–12 beds per unit (ideal)

  • Isolation rooms with negative pressure

  • Glass partitions for visibility

Zoning

  • Patient care area

  • Nursing station

  • Clean utility area

  • Dirty utility area

  • Equipment storage

  • Relatives waiting area

Physical Facilities Required

  • Central oxygen supply

  • Compressed air

  • Vacuum system (suction)

  • Uninterrupted Power Supply (UPS)

  • Generator backup

  • HVAC with HEPA filters

  • Adequate lighting (300–500 lux)

  • Handwashing stations

Equipment Required in ICU

Bedside Equipment

  • ICU beds (adjustable)

  • Multi-parameter monitors

  • Syringe pumps & infusion pumps

  • Suction machine

  • Defibrillator

  • Ventilator

Advanced Equipment

  • ABG machine

  • Portable X-ray

  • Ultrasound

  • Dialysis machine

  • Crash cart

Staffing Pattern in ICU

Medical Staff

  • Intensivist (1 per shift)

  • Resident doctors

  • Specialists (on call)

Nursing Staff

  • 1:1 ratio (ventilated patient)

  • 1:2 ratio (stable ICU patient)

Paramedical Staff

  • Respiratory therapist

  • ICU technician

  • Pharmacist

  • Dietician

Support Staff

  • Housekeeping

  • Biomedical engineer

  • Security

Support Services Required

  • Laboratory (24×7)

  • Blood bank

  • Radiology

  • Pharmacy

  • CSSD

  • Biomedical maintenance

  • Ambulance service

Quality Parameters for ICU

Structure Indicators

  • Bed occupancy rate

  • Nurse-patient ratio

  • Availability of equipment

Process Indicators

  • Hand hygiene compliance

  • Antibiotic policy adherence

  • Ventilator bundle compliance

Outcome Indicators

  • Mortality rate

  • Ventilator-associated pneumonia (VAP) rate

  • Average Length of Stay (ALOS)

  • Readmission rate

Quality of Process

  • Standard Treatment Protocols (STP)

  • Checklists (central line bundle)

  • Infection control policy

  • Medication safety protocol

  • Documentation standards

Quality of Outcome

  • Survival rate

  • Reduced infection rate

  • Reduced complications

  • Patient satisfaction

  • Ethical end-of-life decisions

Policies & Procedures in ICU

  • Admission & discharge policy

  • Infection control policy

  • Code blue policy

  • Biomedical waste management policy

  • Medication administration policy

  • Visitor policy

  • Restraint policy

  • End-of-life care policy

Evaluation of ICU Services

Methods

  • Clinical audit

  • Mortality review meetings

  • NABH standards compliance

  • Patient feedback analysis

  • Incident reporting system

Tools

  • Key Performance Indicators (KPIs)

  • Root Cause Analysis (RCA)

  • Continuous Quality Improvement (CQI)

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