What to expect when you visit ICU - The Patient
It is best to be prepared for your loved one to appear different from the last time you saw them. Patients in an ICU are often unconscious, especially during the early part of their stay. If they wake up, they may feel confused about where they are and what has happened. They may also appear anxious or in pain. To reduce anxiety and pain, sedation and medication to relieve pain may be needed.
While sedated, it may be difficult for them to think clearly. Sometimes the medication may change their perception of what is happening and they may seem angry, hostile, or just different.
They may be bruised and areas of their body may also be swollen from injuries they have sustained. Sometimes a break or tear in the skin may seep fluid.
Frequently, the inability to move, the assisted breathing, the critical illness, and the treatments for blood pressure may cause swelling. The nurses may try to decrease the effect by keeping the head of the bed slightly raised and the hands elevated on pillows. Rings may need to be removed to protect the blood flow to the fingertips.
The experience of first seeing your loved one in an ICU is likely to be upsetting. Critical care nurses and doctors are highly skilled and experienced at supporting relatives dealing with these difficult circumstances, so don’t hesitate to share your feelings with a member of the critical care team. They can also answer any questions you may have.
For many patients some days are good and some are bad as their condition changes. Concentrate on the good days and view the bad days as hurdles that can be overcome. Try not to become discouraged and keep a positive outlook. It is not uncommon for patients to get worse before they get better.
What can the patient hear - will I be aware?
Patients need to be sedated to tolerate the help they need with their breathing. This level of sedation is much much less than is needed for an operation and patients are often partially awake. The nurses and doctors will keep reassuring the patient and make sure that they have plenty of pain relief to minimise any uncomfortable procedures that need to be done.
Relatives often want to know if they can talk to the patient or touch them and this is usually encouraged. Reassuring voices and contact can really help patients.
It is a common misunderstanding that patients would be better being kept "completely" asleep. There has been a lot of research on this and it is clear that patients recover much better if the least amount of sedation as necessary is used, even though patients can look and appear more agitated or distressed at the time.
Some relatives keep a diary of the patient's stay in intensive care and some intensive care units help with this. This can be of great help to the patient later during their recovery filling in the gaps in their memory caused by sedation or medication, particularly for long admissions.
Hallucinations, delusions and nightmares
Patients vary as to how much they remember of their stay in a critical care unit. There are patients who remember nothing at all, a minority remember very little, but most patients can recall the days immediately following extubation (removal of the breathing tube), although these memories are fragmented. Patients can often remember in detail "un-real experiences" - particular objects, individual nurses and important emotional experiences. About half of patients admitted as an emergency to a critical care unit do not even recall their admission to hospital.
Poor recall and loss of memory is due to a combination of the type and severity of the illness, drug treatment and other factors that are, as yet, not understood completely.