Intensive care

Intensive care units (ICUs) are specialist hospital wards. They provide intensive care (treatment and monitoring) for people in a critically ill or unstable condition.

ICUs are also sometimes known as critical care units or intensive therapy departments.

A person in an ICU needs constant medical attention and support to keep their body functioning. They may be unable to breathe on their own and have multiple organ failure. Medical equipment will take the place of these functions while the person recovers.

When intensive care is needed

There are several circumstances where a person may be admitted to an ICU. These include after surgery, or following an accident or severe illness.

ICU beds are a very expensive and limited resource because they provide:

specialised monitoring equipment
a high degree of medical expertise
constant access to highly trained nurses (usually one nurse for each bed)

Some ICUs are attached to areas that treat specific conditions. Others specialise in the care of certain groups of people. For example, an ICU can specialise in:

nerve disorders
heart conditions
babies (neonatal intensive care, NIC) – for example, for babies born with serious conditions, such as heart defects, or if there is a complication during birth
children (paediatric intensive care, PIC) – for children under 16 years of age

Read more about when intensive care is necessary.

What to expect

An ICU can be a daunting environment for both the patient and their family and friends. ICU staff understand this and are there to help the person being cared for and offer support to their family.

Patients in ICUs are often prescribed painkillers and medication that can make them drowsy (sedatives). This is because some of the equipment used can be very uncomfortable.

A series of tubes, wires and cables connect the patient to this equipment, which may look alarming at first.

Recovery

Once a person is able to breathe unaided, they may no longer need to be in intensive care and can be transferred to a different ward to continue their recovery.

Depending on their condition, the person will either be transferred to a high dependency unit (HDU), which is one level down from intensive care, or to a general ward.

The time it takes to recover varies greatly from person to person. It also depends on things such as age, level of health and fitness, as well as how severe the condition is.

Read more about recovering from intensive care.

Decisions about treatment

If you are admitted to an ICU, and are awake and able to communicate, you have the right to be fully informed and to make decisions about your treatment in partnership with the staff treating you. They should support your choice of treatment wherever possible.

However, if you are heavily sedated, you may not be able to give your consent (permission) to a particular treatment or procedure. In this case, the ICU staff treating you will decide what is best. They will always explain what they are doing to a person in an ICU, even if it appears that the person cannot hear them.

If possible, planned treatments and procedures will also be discussed with the person's family. However, this may not always be possible in an emergency situation, where immediate treatment is needed.

Designated decision maker

Under the Mental Capacity Act (2005), someone who knows they are going into intensive care may nominate someone to make decisions about planned treatment on their behalf.

This person is known as a designated decision maker. If the person in the ICU is unconscious, the designated decision maker has the final say about any planned treatments or procedures. However, a designated decision maker can only be nominated through:

a lasting power of attorney – a legal document in which the person in hospital has granted someone the power to make decisions on their behalf
being made a court appointed deputy – someone chosen to make decisions on behalf of the person in hospital by the Court of Protection, which is the legal body that oversees the implementation of the Mental Capacity Act (2005)

Therefore, a person who is admitted to an ICU in an emergency is not able to nominate a designated decision maker.

Read more about the Mental Capacity Act (2005).

Advance decisions

If you know you are going into intensive care, and there are certain treatments you do not want to have, it is possible to pre-arrange a legally binding advance decision (previously known as an advance directive).

This means that ICU staff will not be able to carry out certain treatments or procedures, even if you are unconscious. However, these documents must be very specific regarding what you do not want done in order for them to apply.

To make an advance decision, you should clearly state your wishes in writing and have it signed by a witness. You need to include specific details about any treatments you do not want to have and the specific circumstances in which they may apply.