There are several different types of Units in hospitals that offer care to those patients that are seriously ill. You will hear terms such as 'Intensive Care Units', 'Coronary Care Units', High Dependency Units' and even 'Specialised Intensive Care Units'. Indeed some units combine these functions.

This page aims to eliminate some of the confusion that might result from these different terms. Please click on the links below to answer the following questions:

What is an Intensive Care Unit?

Each year in New South Wales, thousands of patients are admitted into Intensive Care Units (ICUs). These units are designed to deliver the highest of medical and nursing care to the sickest of patients. Some smaller rural and urban hospitals do not have intensive care units while larger metropolitan hospitals may have a number of specialised intensive care units.

History

During the 1960’s and early 1970’s doctors recognised the life-saving potential of placing patients into specialised areas called Intensive Care Units. The purpose of the units was to provide more intensive management for patients following major injury, illness or after major surgery.

First Impressions of an Intensive Care Unit

Physically, most ICUs are large areas with a concentration of specialised, technical equipment and monitors needed to care for the critically ill. Access to the unit is often limited, not only to families but also to other non-ICU staff members. The ICU has a larger ratio of doctors and nurses to patients than found in other areas of the hospital.

Every patient in ICU has a monitor (a television-like screen) that can monitor the patient's heart rate and rhythm, blood pressure, temperature, breathing and many other things. Most patients will have powerful drugs given to them continuously through intravenous infusions (‘I.V’ or ‘drip’). Patients may also be assisted in their breathing by a machine (ventilator). They are attached to the machine by a tube (ETT) inserted into the trachea (windpipe).

For most families of ICU patients there is no previous knowledge of intensive care equipment and procedures. The visitor can be confronted by a lot of activity and noise which can make the environment alien and frightening. One of the most concerning aspects of being in the ICU are the alarms as they seem to go off regularly and come from all around. Almost all ICU equipment uses alarms. However, it is important to remember that most alarms do not signal an emergency, but rather, they assist staff in providing better care by letting the staff know that the patient needs closer attention.

Visiting Family in the Intensive Care Unit

Visiting in most units is restricted in the interests of both patient and family safety and to allow staff to continue the high intensity care required. Children of the patient may be allowed to visit. We recommend discussion with a senior registered nurse or a social worker as to how this visit may affect your child. Visiting hours are usually during the daytime with some units having a ‘quiet-time’ (no visitors) during the middle of the day. Exceptions to these general rules may be made in consultation with senior ICU nursing and medical staff. At times there may be some special requirements to control infection.

The Cardiothoracic Intensive Care Unit (CICU)

The Cardiothoracic ICU (CICU) cares for patients who need heart (cardiac) and chest (thoracic) surgery. Surgical procedures may include operations on the heart, the heart’s blood vessels, the chest or the lungs.

The cardiothoracic patient will require continuous monitoring of the heart and may require insertion of a PA Catheter (Pulmonary Artery Catheter or Swan-Ganz Catheter) or an Intra-Aortic Balloon Pump (IABP).

Some cardiothoracic patients, for a short time after their operation, will require a ventilator (breathing machine) to assist their breathing. This means they will be attached to the machine by a tube in the patient’s mouth (or nose) to the windpipe (trachea).

Most cardiothoracic patients are only in the CICU for 1 – 3 days. Some patients may need a longer stay. A few patients may not improve as quickly and may require transfer to the general ICU for further management.

There are no cardiothoracic intensive care units in the rural areas of NSW. Patients requiring cardiothoracic surgery will be transferred to a major teaching (tertiary) hospital in Sydney.

In Sydney, CICUs can be separate units or combined with a general ICU.

The Neurosurgical Intensive Care Unit (NICU)

The Neurosurgical Intensive Care Unit cares for patients with brain or spinal cord conditions and occasionally other medical or surgical problems.

Many hospitals combine the specialised care of neurosurgical patients with that of seriously ill trauma patients and manage the patients in the Intensive Care Unit. However, some hospitals separate patients who have had neurosurgery into a specific area.

Reasons for admission to a NICU include conditions such as:

• head injuries (from traumas such as car accidents, assaults, falls)
• strokes (cerebrovascular accident or CVA)
• vascular (blood vessel) surgery, e.g. aneurysm (weakness or bulging of an artery) repairs and infections

The Neurosurgical ICU and Intensive Care Units that have neurosurgical services provide brain and spinal cord monitoring and treatments that are specific for the neurosurgical patient. For example, continuous electroencephalogram (EEG) monitoring, intracranial pressure (ICP) monitoring and special spinal cord stabilization techniques are available.

In rural hospitals, many patients with head injuries that do not require surgery are cared for in the local hospital’s ICU. Those patients with a severe neurosurgical condition that is likely to need surgery will require transfer to a major teaching (tertiary) hospital in Sydney. Some rural hospitals close to other state-borders, may transfer these patients to Canberra, Melbourne, Brisbane or Adelaide.

What is a Coronary Care Unit (CCU) ?

The Coronary Care Unit or CCU cares for patients who have heart disease and occasionally other medical or surgical problems.

Conditions such as myocardial infarction (heart attack), angina (chest pain), congestive heart failure (CCF) and arrhythmias (abnormal heart beats) are common reasons to be admitted to CCU.

Patients may come to this unit following procedures such as cardiac angioplasty or the placement of stents in their coronary blood vessels.

The CCU provides the ability to monitor the heart’s rhythm continuously and to use specialized treatment such as thrombolytic therapy (medication that dissolves or breaks-up blood clots). Some tests such as electrocardiography (ECG) may also be performed within the CCU.

Most patients within the CCU can breath without the assistance of a machine (ventilator) – though most will require oxygen (either by nasal prongs or mask). Some may require special masks that assist breathing and oxygenation (CPAP or BiPAP machine).

In most rural hospitals the Coronary Care Unit is often combined with the Intensive Care Unit and the High Dependency Unit to form a Critical Care Unit. In Sydney, Coronary Care Units are specialised units usually separate from the Intensive Care Unit.

If a patient in CCU requires an operation on their heart or heart vessels (cardiac surgery), the patient will be transferred to the Intensive Care Unit (ICU) or Cardiothoracic Intensive Care Unit (CICU) after surgery. In the rural centres, this means the patient will generally need to be transferred to a metropolitan unit prior to surgery.

What is a High Dependency Unit (HDU) ?

Patients admitted into the hospital may require a level of care that cannot be provided on a general ward but does not require admission into an Intensive Care Unit. This area is often referred to as the High Dependency Unit (HDU).

At the same time, patients in the Intensive Care Unit who have had an improvement in their condition may also require a stay in the High Dependency Unit (HDU) before admission to a general ward.

The HDU is similar to ICU except that patients admitted to the HDU are usually less ill or beginning to recover from their operation. There may be fewer nurses and doctors than in the ICU because the patient is not as ill and does not require as much treatment.
Similar to the ICU, patients in the HDU are monitored frequently, assessed daily and the need for continued HDU care is continuously re-evaluated.

In most rural hospitals the HDU is a part of the ICU. In Sydney, the HDU can either be a part of the ICU or a separate unit altogether.

The guidelines, policies and protocols contained within this library are provided as REFERENCE material and are not to be viewed as patient care directives. Before using this material users are directed to read the full DISCLAIMER which outlines the conditions of use.

Publication

• Version 1.1
• First published June 2004
• This version published January 2009
• Reviewer: Kaye Rolls CNC ICCMU