Intensive care units, where patients are treated on the thin line between life and death and where every second is critical, today offer healing to many patients thanks to advanced technological equipment and experienced specialists. These units, where patients with vital risks receive uninterrupted care and treatment 24 hours a day; Especially in the Covid-19 pandemic that shook the world in 2020, it attracted all the attention. In this process, the ‘intensive care units’ of hospitals were one of the most curious subjects of society. Acıbadem International Hospital General Intensive Care Specialist and Anesthesiology Specialist Prof. dr. Dr. Lütfi Telci answered 5 questions about intensive care units; gave important information and warnings!
Should every hospital have an intensive care unit?
intensive care unit; It is a department where the vital signs of the endangered patient and vital signs such as body temperature, respiration, pulse rate and blood pressure are continuously and uninterruptedly monitored and treated as well as their care. While the patients’ functions in the body are constantly monitored with monitors, specialized doctors intervene immediately in case of side effects. If there is an emergency department in the hospital, the intensive care unit must also be present. The level of intensive care is determined by the branches of medicine the hospital serves. The intensive care level of the teaching hospitals must be at least level 2. The level of intensive care in universities and medical faculties, hospitals should be level 3.
Are the levels of support given to the patient different in the intensive care unit?
Yes, it differs. In intensive care units, patients are divided into three levels based on their health status. Level 1 patients are the mildest group of patients, while level 2 patients are those who need vital support or need close supervision from a physician. Tertiary care patients with health problems such as multiple organ failure and coma are also described as the most severe patient group. Tertiary intensive care units are inevitable in hospitals where major surgeries and treatments are performed. There are about 33 thousand 323 adult intensive care beds, 1st, 2nd and 3rd level in our country.
How often is information provided to relatives of patients?
One of the basic principles of intensive care is to regularly inform the next of kin of first-degree patients. Sometimes patients can be taken to the intensive care unit immediately after the procedure in the emergency room, sometimes only after treatment on the ward. Relatives of the patients are informed daily, if possible at the same hours, by the same specialist about the state of health of the patient being treated in intensive care. Information in the intensive care unit is based on the interpretation of the patient’s values in the past 24 hours. The validity of the comment information provided by us lasts for 24 hours. Daily regular information is the necessity of our work. If there is no change in the patient’s health condition, we inform the patient’s next of kin that his condition is ‘stable’. The information we provide for suddenly changing clinical situations is ‘special news’. We don’t want to give such news, but maybe we should. Sudden deaths are very rare in intensive care units, so relatives of patients are also regularly informed in cases where patients’ health conditions deteriorate. In this way, the relatives of the patients will not be faced with any surprises about the patient’s health in the future.
In general, society has a negative image of the health status of patients in intensive care. The fact that the patient is in intensive care is interpreted in such a way that he will lose his life, is this correct?
The Covid-19 period has already shown that this perception is completely wrong. However, this is a perception that we cannot completely break with the relatives of the patients. However, intensive care units are also places where many patients who are said to be ‘this patient will die’ are cured and brought back to life. Intensive care units are units that treat critical patients whose general condition has seriously deteriorated and whose state of health requires close monitoring, as well as units that serve to monitor the health of the patient immediately after certain surgical procedures and bring them to the room in a healthy manner by excluding the possible risks that may arise. In short, the perception that every patient who enters intensive care will die is absolutely not true.
What are the important and technological developments in intensive care?
Ventilators, in which we can apply artificial ventilation models that have the least negative effect on respiratory physiology, of the long-term artificial ventilation first performed by hand, rank first among the surprising developmental indicators we see in intensive care units. With the artificial respirators we use today, we can ventilate our patients for days, months or even years without side effects. We can set up the same facilities in normal services other than intensive care units and in the homes of our patients who are discharged home. We’ve seen this surprising development that we’ve seen with artificial respirators, also with monitors where we monitor vital signs. Thanks to the broad possibilities offered by technology, it has become possible to treat diseases that were not known before intensive care or whose diagnosis was confirmed after autopsy. In other words, intensive care units today can treat multiple organ failures and many deadly diseases. As long as there are disasters and the possibility of unexpected disasters that we never want to happen, intensive care will continue to rank first among our hospitals’ indispensable services.
Where was the first intensive care unit located?
The practice of “long-term artificial respiration by hand”, which an anesthesiologist in 1952 performed from the operating room in Copenhagen, Denmark and reached with his friends, has developed today in such a way that a history that can be called a turning point in the developments in all branches of medicine, especially in surgical medicine, has taken its place in the history of medicine. The very significant reduction in mortality rates, as evidenced by the clinical results of research and studies, paved the way for the rapid spread of intensive care services across Europe. In 1959, our country’s first Intensive Care Unit began to serve at Haydarpaşa Numune Hospital.