What to Expect in the Intensive Care Unit
Oncology patients may need the care of an Intensive Care Unit (ICU) for conditions caused by their cancer or related to its treatments, or for other health issues that have occurred. Admission to the unfamiliar environment of the ICU can often cause a great deal of stress for the oncology patient and/or family.
The ICU is a specialized unit within the hospital that cares for patients with acute, life-threatening illnesses and infections. Some patients may be on life support or more invasive forms of heart monitoring that cannot be done on regular hospital floors. This level of care is provided by specially trained physicians, nurses, respiratory therapists, pharmacists, and other allied health professionals who use their expertise to provide intensive treatment and monitoring to the sickest patients. The ICU differs from other nursing floors in many ways. There are many different noises, alarms, and equipment used and the nurses are typically assigned one or two patients.
Why Would I Need the ICU?
There are multiple reasons why a person with cancer may need to go to the ICU. The most common reason is respiratory failure, meaning they cannot breathe comfortably on their own. This can be due to an infection (pneumonia, for example) or bleeding in the lungs. Assistance with breathing may be required for some patients. Another major reason patients are admitted to the ICU is infection, leading to organ damage, which can be life-threatening. Cancer patients often have weakened immune systems as a result of treatment and this puts them at a higher risk for infection.
Why ICU Patients Look the Way They Do
You may not recognize your family member or friend the first time you see them in the ICU. They may have a breathing tube (called an endotracheal tube) in place, and there will be tape or some type of holder across their face holding this tube in place. While the breathing tube is in place, they will not be able to speak, eat, or drink. If needed, they can be given nutrition through a feeding tube that sits in the stomach or through intravenous (IV) lines. While the feeding tube is in place, their head will have to be kept elevated to decrease the risk of stomach contents moving up into the lungs. They can communicate with you if they are awake using a communication board or paper and pen. They may also have special IVs for blood draws, special medications or monitoring. These IV’s are able to stay in place longer and are larger than a typical IV and are placed in the room, using local anesthetics and pain medication.
Sounds You Will Hear In the ICU
Unique alarms are set on each monitor and machine in the unit, depending on each patient’s condition. Most alarms do not signal an emergency. The heart monitor and/or the breathing machine (ventilator) will alarm when the patient moves or coughs. These new sounds can be frightening, but they are important to help the care team care for your loved one. Please see a staff member with any concerns.
Talking to Your Loved One
It is important to talk to your loved one - even if they are not awake. There are special circumstances where the medical staff will want to keep a totally quiet environment, so it is suggested to always check with your nurse before entering the room and waking up a sleeping or sedated (medicated) patient. Family presence is an important part of your loved one’s care, and you can help us to create a safe, healing place.
Sleeping in the ICU
Poor sleep is a common occurrence in the ICU. Patients often find noise to be the main cause of disrupted sleep in the ICU. This noise is often from the monitors and other equipment in the room. Other patients may find it difficult to sleep because they are continuously being woken up to have their temperature taken or blood drawn. Although these are necessary parts of ICU care, they do disturb sleep.
Visiting Hours in the ICU
Visiting hours vary from hospital to hospital, especially in the ICU. It is important to check with the nurse about the visiting hours when your loved one is admitted. While rest is important for critically ill patients, family member visitation does improve patient outcomes. For this reason, many ICU’s are moving towards unlimited visiting hours. Some ICU’s though, still enforce set visiting hours, often only a few hours a day. It is common for visitors to be limited to two people in the room at a time. This is enforced due to the increased amount of monitoring, the number of hospital personnel in and out, and the busy pace of the ICU environment. Visitors may be asked to leave the patient’s room if procedures or other necessary patient interventions need to be done. Visitors under the age of 14 may not be permitted in the ICU, especially during flu season. This is because of the higher risk of transmitting infections from school-age children.
Some Things to Consider
The patient’s acute illness, that is, their reason for transfer to the ICU is of utmost importance, and therefore, the critical care team will work closely with the oncology team to find a plan that works to address the acute illness along with the cancer, when possible. For patients undergoing bone marrow transplant, recontamination will occur once the patient leaves the oncology floor, and arrives in most ICUs. If the patient is receiving chemotherapy, their medication regimen will be reviewed by the critical care team and a decision will be made as to whether to hold the medication in the setting of being acutely ill. These decisions are often made together with the primary oncologist and weighing the risks and benefits of administration.
The ICU is a specialized and highly monitored unit for those patients that may require closer observation and more invasive treatment. The sights and sounds of the ICU can be intimidating, but the critical care teams work closely with patients, their loved ones, and their oncology team for a mutually agreed-upon plan of care to achieve the greatest outcome.