Intensive care: Patients' experiences

Intensive care treatments

One of the main reasons people are admitted to an intensive care unit is to enable health professionals to keep a very close eye on their progress. To do this, most people are connected to several different types of monitor, and drips which allow liquids to be passed through tubes in veins, usually at the side of the neck, arm or hand. Various substances are commonly used in drips, including drugs, fluids and liquid food. Most people will also have a urinary catheter, and require at least some help with their breathing. This is provided by a machine called a ventilator ('life support machine'), which takes over the work of breathing for patients, delivering oxygen, breathing rate and breath sizes in tailor made settings to the patient's needs. People who need less support for their breathing may still get oxygen but through a mask put over the nose and mouth. Other patients may have “non-invasive ventilation” through systems known as CPAP or BIPAP. These systems deliver high flow oxygen and support through a very tight fitting mask. CPAP and BIPAP are often used in High Dependency Units. Not all patients tolerate these methods as the masks can feel quite claustrophobic but, when they do these masks, can help to avoid full ventilation and intubation.

Most people had known little about the many different treatments they received in intensive care because they were sedated and, on coming round, too ill or disorientated to be able to take it all in. Very often they couldn't see what was happening around them but they remembered being attached to many 'tubes, wires and drips'.

People were affected differently by the equipment in ICU. Some couldn't sleep very well because of it, others had to be re-sedated to prevent them from pulling out tubes providing vital support. Yet others found the ICU noisy because of the amount of activity, alarms and bleeps. 

Breathing Equipment
Although most people knew very little about the different medicines they received, they did remember having a big breathing tube in their mouths (endotracheal tube), which many found uncomfortable. Some recalled being 'suctioned'. This is when a nurse or physiotherapist passes a smaller tube down the tube to suck out secretions from the chest. Many patients don't like this as it makes them cough and can tire them out. One man recalled being sick when he first came round because the breathing tube had moved to an awkward position in his throat. Others had feared coming off the ventilator for the first time.

If someone is likely to remain on a ventilator for more than a few days, the breathing tube in their mouth is sometimes replaced with a tracheostomy, also referred to as a 'trache' or tracheostomy, usually before a person comes round. A tracheostomy is an opening cut into the trachea (windpipe) through the front of the neck into which a tracheostomy tube is then inserted. The placement of the tracheostomy tube stops air from travelling through the voice box, which results in the patient not being able to produce a voice. One man, who had a tracheostomy inserted because he became extremely uncomfortable with the ventilator, said he preferred having a tracheostomy. Many others found the tracheostomy uncomfortable, 'tight' or 'like a clamp' around the neck. 

Having a breathing tube or a tracheostomy usually means that people can't talk, and many discussed the difficulties associated with communication. For one man it was particularly difficult because he was temporarily paralysed and couldn't use his hands either. Others remembered coming round, trying to communicate by writing and discovering they were too weak to do so. 

One woman had a speaking valve inserted into her tracheostomy which allowed her to communicate. Others discussed how they felt when they had their tracheostomy removed and could talk again.

Because people with breathing equipment couldn't eat or drink, many recalled how they craved for drinks and, when the equipment had been removed, how they were encouraged to eat. 

One man was re-admitted to intensive care when he had breathing problems on a general ward. Another said he'd had problems with his tracheostomy tubes three times and had them replaced on each occasion.

Some people discussed the small scars they'd been left with because they'd had a tracheostomy. For some, the scar was a reminder of all that they'd successfully overcome. Others noted how well their scars had healed, though one woman was seeing a plastic surgeon to improve the appearance of hers.

Drug treatments
Most people acknowledged that in intensive care it wasn't possible to get involved in decisions about their treatments. Many said they didn't know enough about the drugs or were too ill, weak and confused at the time. Some people hadn't been able to communicate with the staff, and so trusted the doctors to make the best decisions about their treatment. One woman who'd worked as an intensive care nurse, however, discussed in detail all the treatments she'd received. Another remembered being given a new drug as a last resort.

Several people talked about individual drugs, such as morphine. A few had hallucinations because of it and chose to be weaned off morphine. Several others recalled the pain they'd had during medical procedures or physiotherapy.

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One person said that his wife discussed his treatments with doctors and they decided to make changes to them because they were affecting his moods. Another recalled how, despite being so weak, she wanted as much information as she could manage. A man who'd had an extremely rare infection said he had to make a difficult decision about surgery.

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A few people said they got infected by MRSA whilst in intensive care and some of them complained about the standards of hygiene and cleanliness. 

 

What is a care bundle?
Care bundles were developed to help achieve standardised health care and best practice. Care bundles are a collection of interventions (usually three to five) that have been recommended as best practices, based on evidence, in the treatment and management of a particular condition. By putting these interventions into a bundle, it is hoped that this will produce a standard approach to delivering core elements of care which will reduce risks for patients. What is in each bundle will vary and it is not intended to be a comprehensive list of all care that should be provided, but should form the basic level of care that should be expected and must be adhered to for every patient, every time. All the tasks are necessary and must all occur in a specified period and place.

Last reviewed May 2015.

Last updated November 2010.

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