ITU is a highly technical environment. It often appears bewildering and intimidating for patients, their families and friends. Patients may be unconscious and surrounded by multiple screens, unfamiliar sounds and attached to tubes and wires.
Ventilator
A ventilator is a machine that breathes for a patient unable to breathe by themselves. Once the patient gets better, the amount of support given by the machine is reduced until the patient can breathe by themselves again. The machine is connected to the patient’s windpipe by either:
· An Endotracheal Tube (ET Tube). This is inserted into the windpipe, usually via the mouth but sometimes via the nose
· A Tracheostomy (Trachy Tube). This is a shorter tube, which is inserted into the patient’s windpipe through a temporary opening (tracheostomy) in front of the patient’s neck.
Tracheostomy
Tracheostomies are useful for patients on ITU who are dependent on a ventilator for more than a few days. They are shorter than ET tubes and have several advantages.
· It is more comfortable and reduces the need for sedation.
· There is less risk of infection.
· It helps wean a patient from a ventilator
The insertion of a tracheostomy requires a short procedure which can either be performed in ITU by an intensivist (percutaneous tracheostomy) or in theatres by a surgeon specialising in ENT (Ears, Nose and Throat).
Tracheostomy Information
Weaning
In order to receive the full support of the ventilator, a patient needs to receive a dose of strong painkillers and sedation. Depending on the doses and the type of drugs used, the patient might be fully unconscious or more or less awake. If the patient is sedated, they will not be able to talk, but may be able to hear and feel. Once a patient starts to get better, the process of weaning off the ventilator begins . This is the process of gently reducing the support the ventilator provides, allowing the patient to gradually control more and more of their breathing.
Haemofiltration (Kidney Support)
The Haemofiltration machine filters waste products from the patient’s blood, replacing the function of the kidneys when they aren't working properly.
Lines and Catheters
Intravenous drips (“lines”) give drugs directly into the bloodstream of the patient. If a patient is receiving heart drugs or kidney support (Haemofiltration), a larger line (Central line) may be inserted into the neck or groin . A tube (Catheter) may be inserted into the bladder to monitor a patient's kidney function. All lines and catheters have to be changed on a regular basis to prevent infection.
Monitoring
The patient's condition can be monitored and displayed on a screen at the bedside. It continuously measures parameters such as the patient’s heart rate and blood pressure allowing an accurate update on their condition. It is connected to the patient using wires and leads. These observations are regularly recorded in the patient's chart to monitor the trend over time.
Eating and Feeding
The patient may be fed by an NG tube (Nasogastric Tube), which is a tube going through the patient’s nose and throat to the stomach. If the digestive system is not functioning properly, the patient can be fed through a line (TPN, Total Parenteral Nutrition) The feed is a balanced mixture of fats, carbohydrates and proteins, as well as vitamins, mineral and micronutrients. Feeds given through the NG tube are different from those given through the lines. Feed given through a line requires more monitoring (such as blood tests). When a patient recovers, the NG tube or line can be removed.
