Can You Define Critically Ill?

What comes to mind when you hear the term “critically ill”? When we hear that someone is in the critical care unit (CCU) or the intensive care unit (ICU) in the hospital we know they’re probably in bad condition, but what qualifies someone as being critically ill?  Surely, someone with a terminal condition such as malignant cancer or end stage renal disease is critically ill, right? Would they be in the CCU? This concept may cause confusion because there is no standard definition for the critically ill. Rather, the term broadly refers to someone who has a sustained, acute, and life threatening injury or illness.

As I near the end of the 8^th and final week of my basic clinical rotation at Carroll Hospital Center, I have developed a greater understanding of conditions that warrant a patient the constant and intense attention of the health care team in the Critical Care Unit of the hospital. The first thing my experience cleared up is that a patient in the CCU is there with the expectation that they will only be there for several days and thus cases of chronic life threatening conditions, as I listed above, are not always appropriate for the CCU. Scenarios that commonly land someone in the CCU include:

1. Hemodynamic instability: Dangerously low or high blood pressure.

2. Ventilator Dependence: A condition in which breathing fails because the exchange of gases, (CO2 and oxygen) are insufficient to sustain bodily organs thus the patient is dependent on a ventilator.

3. Multiple organ dysfunction syndrome: Progressive failure of multiple separate organ functions.

Underlying diseases that may cause the conditions above include: respiratory distress, inflammation, sepsis, shock, heart attacks, drug over dose, cancer, and end stage renal disease.

Dietitians play a critical role in the care for patients in the CCU. Some important lessons I picked up from my experience in the CCU include:

• ·      Many patients’ in the CCU have increased energy needs due to metabolic stress, ventilator dependence, and wound healing. However, just because a patient is in the CCU does not automatically mean that have increased energy needs. Each patient demands an individual assessment to determine his or her needs.
• ·      Many patients in the CCU are unable to communicate so it is important to gather as much information as possible from family, physical examination, and their medical chart to determine the appropriate nutrition treatment.
• ·      The CCU in the hospital can be an excellent learning opportunity for dietitians, taking the opportunity to work closely with nurses and physicians is an excellent time to enhance medical knowledge and understanding.

Hope this helps clear somethings up!