What the ICU is for

I wrote in a prior blog about iatrogenic injuries and described a gentleman who had an elective cardiac cath, suffered injury to his femoral artery, required massive transfusions, and had an ICU course complicated by abdominal compartment syndrome, renal failure requiring dialysis, respiratory failure requiring mechanical ventilation, and emergent vascular surgery. His course was extraordinarily tenuous, and with multiple organ systems affected, his prognosis was guarded. But this is what the ICU is for. All his injuries were potentially reversible with aggressive resuscitation. Over the course of the last two weeks, we've weaned his sedation so he can follow commands on a mechanical ventilator. We've monitored his heart closely with a pulmonary artery catheter and maintained his blood pressures on potent vasoconstrictor drips. We've assisted his breathing with mechanical ventilation. We've dialyzed him to take off the extra volume he received from his transfusions. We've fed him artificial nutrition and given him broad-spectrum antibiotics for fevers.

Over the course of the last two weeks, in managing many complex and interacting organ systems at once, we got him to the point that he could be extubated. We took out the breathing tube, turned off his sedation, stopped his blood pressure medicines, coaxed his kidneys back to life, and began a long course of rehabilitation. This was the most amazing recovery and reminded me why I like the ICU. The ICU has patients who have planned admissions after cardiac, vascular, neuro, or other surgeries. It also has some patients whose disease processes are so severe that there is no hope of meaningful recovery. But there is a small fraction of patients for whom it is miraculous. It makes the difference between death and a salvaged life. It is for this small percentage of patients who have reversible processes only with the intense specialized care of the intensive care unit that the ICU is truly the fulcrum.