Preparation of the patient includes the preoperative assessment, review of preoperative tests, optimisation of medical conditions, adequate preoperative fasting, appropriate premedication, and the explanation of anaesthetic risk to patients.

1. PREPARATION OF PATIENT BEFORE
ARRIVAL TO ICU
DR.ANJALATCHI MUTHUKUMARAN
VICE PRINCIPAL
ERA COLLEGE OF NURSING
SARFRAZAGANJ, LUCKNOW 226003

2. INTRODUCTION
• Patients who are suffering from serious health disorders are reported to the Intensive Care Unit (ICU) of
a hospital. The Critical Care Unit of a hospital is responsible for providing emergency support to the
patients who need immediate care for their sudden and critical health problems.

3. MEANING OF ICU
• The Intensive Care Unit (ICU) is a separate, self-contained
area within a medical facility, equipped with high-tech
specialised facilities designed for close monitoring, rapid
intervention and often extended treatment of patients
with acute organ dysfunction.

4. WHAT IS PATIENT ?
• Patient comes from the Latin “patiens,” from “patior,”
mean “to suffer or bear”
• The patient, in this language, is truly passive—bearing
whatever suffering is necessary and tolerating patiently
the interventions of the outside expert.
• Patient is very important person in health care services

5. TYPES OF INTENSIVE CARE UNITS (ICUS)
• Intensive care units can be organised based on the
pathologies/conditions treated (e.g. neurological,
trauma, burns, medical or surgical ICUs) or by the age
group of the patient admitted (adult or paediatric).
• Specialized intensive care units include medical, surgical,
pediatric and neonatal intensive care units.

6. INDICATIONS FOR ICU ADMISSION
• Intensive care resources are limited and expensive
and therefore patients should be carefully selected
for admission to ICU
• The decision to admit a patient in the ICU should be made by the
specialist intensivist in agreement with the referring team and it
should be based on the severity of the illness, chronic health and
physiology reserve, and therapeutic susceptibility as well as being
informed by the wishes of patients or caregivers.

7. PRIORITY 1
• No therapeutic limits
• Critically ill unstable patients in need of intensive
treatment and monitoring that cannot be provided
outside the ICU
• High probability of recovery

8. PRIORITY 2
• No therapeutic limits
• Require intensive monitoring
• May potentially need immediate intervention
• Lower probability of recovery

9. PRIORITY 3
• Critically ill
• Reduced likelihood of recovery because of underlying disease or the nature of their acute illness
• Have therapeutic limitations

10. PRIORITY 4
• Generally not appropriate for ICU admission because of:
• low risk of active intervention that could not safely be administered in a non-ICU setting and therefore is
anticipated to have little benefit from ICU care
• Terminal/irreversible illness and facing imminent death

11. WHO NEEDS CRITICAL CARE?
• Patients who undergo invasive surgery, or are affected by an accident with serious injuries,trauma,
serious infections, or people having difficulty breathing may end up in the emergency care unit of a
hospital.

12. THESE EMERGENCY CONDITIONS UNDER THE TREATMENT OF
ICU MIGHT INCLUDE:
• Chest pain with difficulty breathing
• Sudden internal pain in the body
• Organ failure
• Heart condition
• Asthma
• Drug-resistant infections
• Serious accidents (car accidents and burns)
• Emergency care may be needed by a patient of any age.

13. THE INTENSIVE CARE UNIT OF A HOSPITAL APPOINTS A TEAM
OF DOCTORS AND NURSES THAT INCLUDE:
• Intensivist
• Experienced doctors
• Respiratory therapists
• Care managers
• Special Trained Nurses

14. ENSURE THE ICU EQUIPMENT
• Equipment in the ICU is mostly aimed at life-support and the support
of different organs in the body (for example the lungs, the heart or
the kidneys). These include, but is not limited to:[
• Cardiac monitors - to monitor vital signs
• Mechanical ventilator
• Infusion pumps - to regulate the flow of medication titrated via a drip and through
the infusion pump
• Syringe pumps - where a syringe is used to titrate the medication to the patient
• Suction machines
• Oxygen support
• Other respiratory support machines such as BiPAP and CPAP

15. ICU ADMISSION PRIORITIZATION LEVELS[
• Cardiac System-Acute myocardial infarction with complications
• Respiratory system-Acute respiratory failure requiring ventilatory support
• Neurologic system-Acute stroke with altered mental status
• Drug Ingestion and Drug Overdose-Hemodynamically unstable drug ingestion
• Gastrointestinal Disorders-Life-threatening gastrointestinal bleeding including hypotension, angina, continued
bleeding, or with comorbid conditions
• Endocrine-Diabetic ketoacidosis, complicated by hemodynamic instability, altered mental status, respiratory
insufficiency, or severe acidosis
• Surgical-Post-operative patients requiring hemodynamic monitoring/ventilatory support or extensive nursing care
• Others-Septic shock with hemodynamic instability
• Hemodynamic monitoring

16. PATIENT FROM OPERATION THEATRE
prepare them for intensive care unit (ICU) transfer.
The most important tasks of the anesthesiologist can be summarized as follows:
• 1.Preoperative identification and optimization of high-risk patients
• 2.Intraoperative monitoring and therapeutic measures
• 3.Prevention, recognition, and treatment of intraoperative causes leading to unplanned ICU admission
• 4.Organizing transport and handover

17. DESCRIBED A MORE SPECIFIC LIST OF CRITERIA FOR HIGH-
RISK SURGICAL PATIENTS:
• Previous severe cardiorespiratory illness—acute myocardial infarction, chronic obstructive pulmonary
disease, or stroke
• Late-stage vascular disease involving the aorta
• Age > 70 years with limited physiological reserve in one or more vital organs
• Extensive surgery for carcinoma (e.g., oesophagectomy, gastrectomy cystectomy)
• Acute abdominal catastrophe with hemodynamic instability (e.g., peritonitis, perforated viscus,
pancreatitis)
• Acute massive blood loss > 8 units
• Septicemia
• Positive blood culture or septic focus
• Respiratory failure: PaO2 < 8.0 kPa on FIO2 > 0.4 or mechanical ventilation > 48 h
• Acute renal failure: urea > 20 mmol/l or creatinine > 260 mmol/l

18. ESSENTIAL EQUIPMENT /DRUG/DEVICES /HEALTH TEAM
NEED WHILE TRANSPORTATION OF PATIENT

19. REFERENCES
1. Jhanji S, Thomas B, Ely A, Watson D, Hinds CJ, Pearse RM. Mortality and utilisation of critical care
resources amongst high-risk surgical patients in a large NHS trust. Anaesthesia. 2008;63(7):695–700.
2. ↑ Jump up to:1.0 1.1 Bassford C. Decisions regarding admission to the ICU and international initiatives to
improve the decision-making process. Critical Care. 2017. July; 21:174. DOI:10.1186/s13054-017-1749-
3
3. ↑ Jump up to:2.0 2.1 2.2 2.3 2.4 2.5 2.6 Nates JL, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B, Fowler CS,
Byrum D, Miles WS, Bailey H, Sprung CL. ICU admission, discharge, and triage guidelines: a framework
to enhance clinical operations, development of institutional policies, and further research. Critical care
medicine. 2016 Aug 1;44(8):1553-602. DOI:10.1097/CCM.0000000000001856
4. ↑ Jump up to:3.0 3.1 3.2 3.3 3.4 3.5 3.6 Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz JV, Dorman T, Fowler
RA, Meyfroidt G, Nakagawa S, Pelosi P, Vincent JL. What is an intensive care unit? A report of the task
force of the World Federation of Societies of Intensive and Critical Care Medicine. Journal of critical
care. 2017 Feb 1;37:270-6. DOI:10.1016/j.jcrc.2016.07.015