Patients being transferred to the ICU require careful preparation and prioritization. The ICU team prepares the patient's room with necessary supplies and equipment. High-risk patients from surgery may require ICU admission for monitoring and intervention. The anesthesiologist works to identify and optimize and risks and prevent causes of unplanned ICU admission, ensuring the safe transfer of the surgical patient to intensive care.

1. PREPARATION OF PATIENT BEFORE
ARRIVAL TO ICU
DR.ANJALATCHI MUTHUKUMARAN
VICE PRINCIPAL
ERA COLLEGE OF NURSING
NURSING SUPERINDENTENT ,ELMCH

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. WHAT IS PATIENT ?
• Patient comes from the Latin “patiens,” from “patior,” 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.

4. 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.

6. ROOM DESIGNATION
• Patient Room – HOT ROOM
• Negative pressure anteroom (or hallway if no anteroom) – WARM
ROOM
• Hallway – COLD ROOM

7. HOT ROOM SUPPLY CHECKLIST
• One canister of gray top wipes
• One canister of orange top wipes
• One canister of purple top wipes
• One disposable stethoscope in room
• One disposable thermometer in room
• Replace all black trash bags with red biohazard trash bags

8. CONTINUED
• Replace all black trash bags with red biohazard trash bags
• Move ICU bed into Cold Room in preparation to go pick up patient
• Assign dedicated nurse and warm room assistant
• Label patient room with lime green sticker
• Decrease room temperature
• Remove patient/guest recliner
• Place isolation signage

9. COLD ROOM SUPPLY CHECKLIST
• PPE station
• Staff entrance log
• Small paper bags for storage of used N95 mask
• Evaluate need for telehealth and place communication device if available
• Ensure respiratory has prepared room with oxygen source, ventilator, etc., as
needed

10. WARM ROOM SUPPLY CHECKLIST
• Place isolation signage
• Place PAPR checklist
• Place donning/doffing signage
• Ante room entrance logs
• Small biohazard bags for labs
• Small paper bags for storage of used N95 masks

11. CONTINUED
• Box of regular N95
• Box of small N95
• Three packs of gowns
• Box of small, medium, large gloves
• Five face shields
• Two tall biohazard trash bins
• Red biohazard trash bags
• Biohazard bag for Glidescope stylet
• One canister of grey top wipes
• One canister of orange top wipes
• One canister of purple top wipes

12. 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).[2] Specialized intensive care units include
medical, surgical, pediatric and neonatal intensive care
units.

13. 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.

14. 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

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

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

17. 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

18. 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.

19. 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.

20. 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

21. 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

22. 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

23. 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

24. 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

25. EQUIPMENT /DRUG/DEVICES ACCOMPANY WITH PATIENT

26. 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