Critical Care Medicine

Critical Care Medicine (CCM) is a specialty that involves the management of patients with life-threatening, frequently complex medical and surgical illnesses in a specialized Intensive Care Unit (ICU) or similar facility. A modern ICU represents the pinnacle of any hospital’s approach to highly technological & sophisticated in-patient care.

The introduction of the ICU units into the medical system goes a long way back. Though the modern facilities and systems are the gift of research in the field of medical science. It is found that during the war, Florence Nightingale separated seriously injured or wounded soldiers from the rest while providing them treatment. This helped greatly in bringing the mortality rate down as the critically injured patients received better care and continuous monitoring.

The CCM physician also called an Intensivist has the necessary training and expertise in the evaluation and management of these critically ill patients. These critically ill patients may have dysfunction or failure of one or more organ systems, including cardiac failure, pulmonary failure, neurologic failure, liver failure, kidney or gastrointestinal system failure.

The Critical Care Department is broadly divided into 2 areas:

1.     Intensive Care Unit (ICU)

 The Intensive Care Unit (ICU), also known as the Intensive Therapy Unit (ITU), is a unit within the hospital that looks after patients whose conditions are life-threatening and need constant, close monitoring and organ support from specialist equipment and medications. Assisting in maintaining the normal function of struggling body systems, this may be in the form of a ventilator to support breathing or dialysis to support the kidneys. Patients admitted to ICU require the support of more than one organ and patients are generally cared for on a 1 nurse to 1 patient ratio.

2.     High Dependency Unit (HDU)

 As a patient’s condition improves and they need less intensive care but may still require close observation, they can be transferred to the HDU. Patients will then move to a general ward elsewhere in the hospital or be discharged home or to an alternative discharge destination.

Some patients who attend for elective surgery or procedures may have a pre-planned HDU admission if they have pre-existing medical conditions or are undergoing a complicated surgery, for example, that may require closer observation initially. The ratio for HDU is generally 1 nurse to 2 patients.

Both ICU and HDU are run by a team of Consultant Intensivists and supported by a team of doctors with a background in Anesthesiology, Intensive care, and Medicine. A large team of highly trained nurses is dedicated to delivering safe, high-quality care to the patients, along with other multi-disciplinary members who can provide specific support and therapies for individual patients.

Mediheal Group of Hospitals provides critical care services round the clock with a team of highly qualified, skilled, and experienced intensivists and nurses. The plan of care for the patient is prepared in consensus with the admitting specialist, the patient, and the family. Periodic multi-disciplinary briefings on the patient’s condition are provided to his / her family. Our Intensive Care is a state-of-the-art unit with 50 Critical Care beds segregated into different ICUs to provide more focused care as per the established protocols. We have specialized ICUs like:

Medical Intensive Care Unit Stroke & Brain Trauma Unit Respiratory Care Unit Renal Intensive Care Unit Cardiac Critical Care Unit Surgical Intensive Care Unit

Our ICUs are managed with the belief that well-planned Critical Care Services and implementation do influence overall outcomes and quality parameters like morality, ICU length of stay, infection, rates, etc.

We have isolation cubicles with Positive / Negative pressure air flows, 1:1 Nursing Care round the clock. We have the latest equipment for patient management including a high-end Central Nursing Monitoring Station, Advanced Ventilators for Invasive / Non- Invasive Mechanical Ventilation, Defibrillators, a fully equipped Dialysis Unit for Renal Support in ICU, a highly trained Cardiology Unit for any need for IABP, LVAD, etc. We have a point of care Ultrasound Machine to assist in all the bedside procedures related to patient management. There is also the availability of Conscious Advanced

Hemodynamic Monitoring to assist in the assessment & management of all critically ill patients. We also have a fluid and patient warming system to optimize and closely monitor the temperature management of all our ICU patients. There is also a provision for Bedside Bronchoscopy in the ICU to aid in the treatment of all the critically ill lung infection cases. The trained Critical Care Team makes every effort to optimize the nutrition status of the patient in consultation with the in-house dietician.

Our Intensive Care Team Practices Evidence-Based Medicine and follows International protocols and quality indicators like ‘FASTHUG’ to enable good outcomes and decreased hospital stay. The ICU outcomes are monitored with tools like ‘APACHE’ scoring and SMR (Standardized Mortality Ratios) that help the department benchmark outcomes against internationally reputed ICUs. Infection control protocols to prevent Healthcare-Associated Infections (HCAI) like Ventilator-Associated Pneumonia (VAP), Catheter-Related Blood Stream Infection (CRBSI), and Catheter-Associated Urinary Tract Infection (CAUTI) are followed rigorously.

The ICU is staffed in a nurse-to-patient ratio of 1:1. All these ICU nurses are given introductory training in critical care nursing and undergo regular teaching programs conducted or arranged by the Department of Critical Care Medicine, to promote Critical nursing care skills and knowledge throughout their stay in the ICU. Patients are at risk of developing chest infections if their lungs are not functioning well enough to prevent a buildup of secretions. Our specialist respiratory physiotherapists use a variety of techniques to assist with the removal of these secretions.

Our Rehabilitation Physiotherapists begin working with patients as early as possible by assisting to exercise their limbs, sit out of bed, walk and regain functional independence.

Our Dietician ensures each individual patient receives the right type of nutrition and that the right amount of calories and nutrients are provided.

Our Speech and language therapist may also visit to assess a patients swallowing function or assist with communication problems in conscious patients.

Our dedicated Pharmacist forms an essential part of the team ensuring the most appropriate drugs are administered to each patient in the correct dosage for each specific condition.

Services offered and procedures performed at Mediheal ICU

• Continuous monitoring for critically ill or injured patients
• Life support measures for patients with multi organ failure
• Post-operative care to transplant patients, critically ill, surgical patients
• Hemodialysis
• Endotracheal Intubation & Advanced Airway Management
• Non-invasive and Invasive Ventilation
• Percutaneous Tracheostomies
• Continuous Advanced Hemodynamic monitoring
• Defibrillation and Cardioversion
• Central Venous Catheter insertion
• Pulmonary Artery Catheter insertion
• Hemodialysis Catheter Insertion
• Perma Cath Insertion
• Arterial Line Insertion
• Per Cutaneous Endoscopic Gastrostomy
• Abdominal Paracentesis
• Lumbar Puncture
• Chest drain insertions (ICD)
• Bedside Fiber-optic Bronchoscopies
• Bedside 2D ECHO
• Bedside Ultrasonography
• Bedside Renal Replacement Therapy
• Post-Operative Pain Management
• Multidisciplinary meetings for complicated patients
• Retrieval services

The ICU at Mediheal Group of Hospitals provides retrieval services to patients from other hospitals that do not have similar facilities. It involves transporting critically ill patients from other health care facilities in a well-equipped ambulance with a team including an Intensivist and an ICU nurse depending on the seriousness of the patient.

Our priority is to save as many lives as possible within realistic expectations. To meet the highest standards, we try to provide total care of the patients by involving doctors from different specialties as may be deemed necessary for different patients

Our goal is to practice Evidence-Based Medicine and incorporate the latest guidelines in inpatient care management to achieve the best possible patient outcomes.

“Quality Care at affordable price” is our motto and our ICU is known for its cost-effectiveness.