Cardiac Intensive Care Department

 

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Dr Santiago M Herrero, MD, Ph.D, FCCP, FCCS

Head Cardiac Intensive Care Department (ICU, Adult and Pediatric Post-Surgical Care, Coronary Unit and Invasive Cardiology Unit for diagnosis and very special procedures).

 

INTRODUCTION

Welcome to the Intensive Care Department at the Jilin Heart Hospital, one of the largest heart centers in Jilin Province. We provide a cardiac intensive care to potential critically ill patients with specific several cardiovascular diseases or after surgery using the latest technology for treatment and the management for the advanced life support.

 

WE SPOKE SEVERAL INTERNATIONAL LANGUAGES

Chinese (Mandarin), German, English and Spanish language.

 

SERVICE PORTFOLIO 

Our Department offers postoperative care to pediatric and adult patients after cardiac surgery. We also take care of patients with acute myocardial infarction and after cardiac catheterization has been performed by the Coronary Unit. Our service treats patients from different wards of the Hospital for the critical care of patients with serious arrhythmias or invasive cardiology procedures such as drainage of pleural and pericardial space.

 

OUR ICU TEAM

 

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Our team strives to continuously improve using their day to day knowledge to attain the highest level of education about critical care medicine.

 

The CARDIAC INTENSIVE CARE DEPARTMENT is a very vital ward in the Jilin Heart Hospital as it deals with the most ill patients.

 
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Intensive Care Department is also sometimes known as Critical Care Units or Intensive Care Unit. In the JHH the ICU is a special ward that provides all intensive care monitoring and treatment in critically ill patients that they need all kind organ support. The JHH it has 40 ICU beds in two wards of 20 beds each, being one of the hospitals that more number of ICU beds available in Asia only for the care of critically ill patients under cardiac diseases and postoperative care.
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 in the JHH
 
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There are several circumstances where a person may be admitted to an ICU. These include after surgery, or following a severe illness detected from an emergency in the inpatient or the outpatient department.
ICU beds are a very expensive and are a limited resource because they provide:
Specialized monitoring equipment
A high degree of medical expertise
Constant access to highly trained nurses (for each bed, we have one specialized nurse)
Some ICUs are attached to areas that treat specific conditions and others specialize in the care of certain groups of people.
For example, in our ICU we specialize in:
Different heart conditions after cardiac surgery and various others
(patients with acute myocardial infarct, after percutaneous coronary intervention, atrial or ventricle septum defects closure, obstructive shock (Tamponade) and requiring pericardiocentesis (remove fluid from pericardium), severe decompensated heart failure or under cardiogenic shock using an intra-aortic balloon pump, etc.
Children (pediatric intensive care, PICU) – for children under 16 years of age with serious conditions, such as a postoperative heart defect after surgery, or if there is a complication during their care in the pediatric ward.
 
What to expect
 
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An ICU can be a fairly daunting environment for both the patient and their family and friends. Our ICU staff completely understand this and are there to help the person being cared for and offer their support to their family.
Patients in ICUs are often prescribed painkillers and medication that can make them drowsy (sedatives) and 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 but don't worry. 
 
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.
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.
 
EQUIPMENT USED IN INTENSIVE CARE  
Intensive care units (ICUs) contain a variety of specialized equipment, which may vary from one unit to another.
The type of equipment an ICU has will depend on the type of patients it specializes in treating. The machines in ICUs make a variety of sounds, such as bleeps and alarms. Some sounds make staff aware of slight changes to a patient’s condition, or alert them when something needs attention. A few alarms require the nurse's immediate attention but most just indicate standard monitoring.
Some of the main ICU machines and what they do are described below.
 
Ventilator
 
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If your lungs have failed and you are unable to breathe on your own, you will need to be attached to a ventilator. A ventilator is a machine that moves oxygen-enriched air in and out of your lungs.
You will usually need to be sedated before being put on a ventilator because it would be very uncomfortable. A sedative is medication that makes you sleepy.
Ventilators can offer different levels of breathing assistance. For example, if you are having problems inhaling (breathing in), a ventilator can be used solely for this purpose.
If you only need help breathing for a couple of days, you may have a tube from the ventilator placed in your windpipe (an endotracheal tube or ETT), usually through your mouth, but sometimes through your nose. The tube will be held in place behind your neck.
However, in the unlikely event if you need assistance with breathing for more than 2 or even 3 weeks, you may have a short operation called a tracheostomy. The tube in your mouth will be replaced by a shorter tube that is placed directly into your trachea (windpipe). As well as being more comfortable, a tracheostomy will make keeping your lungs clean easier and will usually require less sedation.
In some cases, your breathing may be assisted with the use of a non-invasive ventilator. This eliminates the need for invasive breathing tubes and sedation, and reduces the risk of the ventilator causing an infection. 
During non-invasive ventilation, a mask will be securely fitted over your mouth or both your nose and mouth. Air will be passed into the mask to help you breathe.
 
Monitoring equipment
 
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To measure important bodily functions, wires may be attached to various parts of your body by sensor pads linked to computer-style screens. Functions that can be closely monitored include:
heart and pulse rate (measured by an electrocardiogram or ECG)
air flow to your lungs
blood pressure and blood flow
pressure in your veins (known as central venous pressure or CVP)
the amount of oxygen in your blood
your body temperature
Another very specific monitoring system is available. Swan Ganz Catheter (SGC) for continuous monitoring the pulmonary artery and cardiac output (gold standard) and PiCCO System (pulse-induced contour cardiac output).
The monitoring equipment will track every tiny change in your bodily functions and will alert the ICU staff if there are any changes that could be dangerous.
In the hypothetical event if you have a head injury after surgery, the pressure inside your head may be monitored using different kind of monitors.
In some cases, you may also have the pressure in your abdomen (stomach area) monitored. Rising pressure levels can prevent enough blood from reaching your organs and may require further treatment.
 
 
Defibrillator
 
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Defibrillation is a process in which an electronic device gives an electric shock to the heart. This helps establish normal contraction rhythms in a heart having lethal arrhythmia or in cardiac arrest. In recent years small portable defibrillators have become available. These are called automated external defibrillators or AEDs.
All our personnel are trained and allowed to use a properly maintained defibrillator if they're likely to respond to cardiac arrest victims. This includes all first-responding emergency personnel, or even inpatient or in outpatient service. The ICU staff are trained in basic and advanced life support. In the ICU, the defibrillation process is common in patients with onset arrhythmias after cardiac surgery and unstable patients that they need a cardioversion.
The cardioversion is an electric shock in patients with unstable arrhythmia (e.g. atrial fibrillation) to prevent complications or treat to get a normal rhythm. The process gives an electric shock by sensing the patient's rhythm to prevent fibrillation (synchronized cardioversion). 
 
 
IV lines and pumps
 
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Tubes that are inserted intravenously (into a vein in your arm, chest, neck or leg) provide your body with a steady supply of essential fluids, vitamins, nutrients and medication. A tube inserted into the main veins in your neck is known as a central line.
These tubes are called IV lines, IVs or drips. They are often connected to one or more bags of fluid that hang from a pole (drip stands) and are attached to pumps (syringe drivers) that constantly regulate the supply. You may also be given blood intravenously using an IV line.
Medications that are given slowly and continuously by IVs in intensive care can include:
sedatives – to reduce anxiety and encourage you to sleep
antibiotics – medication that is usually given in high doses and used to treat infections caused by bacteria
analgesics – also known as painkillers

 
Kidney support
 
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Your kidneys filter waste products from your blood and manage the levels of fluid in your body. If your kidneys are not working properly, a dialysis machine can replace this function. The procedure is continuous, so called continuous renal replacement therapy (CRRT). During dialysis, your blood will be fed through the machine, which removes many waste products. Your blood will then be returned to your body.
Sometimes in very special cases it is possible to have a catheter placed in the abdominal wall for peritoneal dialysis.
Feeding tube
If you need help breathing through a ventilator, you will not be able to swallow normally.
A feeding tube can be placed in your nose, through your throat and down into your stomach. This is called a nasogastric tube, or NG tube, and can be used to provide liquid food.  The liquid food contains all the nutrients you need in the right amounts, including protein, carbohydrates, vitamins, minerals and fats
If your digestive system is not working, nutritional support can be fed directly into your veins.
 
 
Intra-Aortic Balloon Pump (IABP)
 
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IABP is a mechanical device that increases myocardial oxygen perfusion while at the same time increasing cardiac output. Increasing cardiac output increases coronary blood flow and therefore myocardial oxygen delivery.
It consists of a cylindrical polyethylene balloon that sits in the aorta, approximately 2 centimeters (0.79 in) from the left subclavian artery and counter pulsates. That is, it actively deflates in systole, increasing forward blood flow by reducing afterload through a vacuum effect. It actively inflates in diastole, increasing blood flow to the coronary arteries via retrograde flow. These actions combine to decrease myocardial oxygen demand and increase myocardial oxygen supply.
 
 
Drains
After surgery, tubes called drains may be used to remove any buildup of blood or fluid at the site of the wound. These will usually be removed after a few days. 
 
Catheters
 
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Catheters are thin, flexible tubes that can be inserted into your bladder. They allow urine to be passed out of your body without you having to visit the toilet.
There may be a clear bag hanging from the side of your bed. This is called a Foley catheter and is connected to the tube that goes into your bladder. It is used to measure the amount of urine you produce. This indicates how well your kidneys are working.
 
Suction pumps
Another tube can be passed down the inside of your endotracheal tube (breathing tube) and attached to a suction pump. Suction pumps are used to remove excess secretions (fluid) and help keep your airways clear.
 
Paediatric intensive care equipment
Paediatric intensive care units (PICU) have specialized equipment to care.
Children in intensive care are monitored and treated in much the same way as adults. Your baby's body temperature may be monitored using a small sensor on their skin. The level of oxygen in their blood can also be measured using a clip attached to their hand or foot.  
If your baby or children is unable to breathe on their own, they will require artificial ventilation through a ventilator. They may also need to be fed intravenously (through a tube directly into a vein).
 
SPECIAL ISSUES
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.
 
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.

Copyright 2014 THE JILIN HEART HOSPITAL All Rights Reserved
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