Surgical Critical Care: General ICU Concerns

Intra-Hospital Transport

Intra-Hospital Transport of Critically Ill Patients

  • Risk of Adverse Effects: 50-70%
    • Include: Hemodynamic Changes, Increased ICP, Arrhythmias, Respiratory Derangements & Cardiac Arrest
    • 1/3 of Mishaps are Equipment Related
  • Should Generally Be Avoided if Not Necessary

ICU-Acquired Weakness

Basics

  • Definition: Weakness in Extremity & Respiratory Muscles During ICU Stay
  • Critically Ill Patients Lose Up To 5% of Lean Body Mass Daily
  • Weakness of Respiratory Muscles Impairs Ability to Wean from Mechanical Ventilation
    • Even if the Initial Primary Pulmonary Process Improves
    • May See Decreased Vital Capacity & Decreased Negative Inspiratory Force
    • Prolonged Bedrest Causes V/Q Mismatch with Intrapulmonary Shunting & Hypoxia

Complications

  • Increased ICU & Hospital Length of Stay
  • Increased Mortality
  • Increased Discharge to Skilled Nursing Facilities or Rehabilitation Centers
  • Decreased Physical Functioning

Nurse-to-Patient Ratios

Generally Preferred Minimum Nurse-to-Patient Ratios

  • ICU/Critical Care: 1:1.5-2
  • Step-Down Units: 1:3-4
  • Medical-Surgical Floors: 1:5-6
  • Emergency Room: 1:4
  • Trauma Patients in the ER: 1:1
  • Operating Room: 1:1
  • PACU: 1:2

Complications of Increased Ratios

  • Increased Risk of Postoperative Complications
  • Increased Risk of Infection
  • Increased Mortality
  • Decreased Patient Satisfaction
  • Increased Risk of Patient Falls & Pressure Ulcers
  • Nursing Fatigue & Burnout