People are admitted to intensive care units (ICUs) because they need constant, close monitoring and support from equipment and medication to keep normal body functions going. In some hospitals ICUs are called intensive therapy units (ITUs) or critical care units (CCUs). Critical illness is different from any illness that most people are likely to have encountered before. It is often unexpected and sudden, and can strike the previously fit as well as the frail. It is often life-threatening and high levels of treatment and support may be needed, especially in the early stages. People with critical illness basically suffer from failure (and/or dysfunction) of one or more of their body's organ systems such as the heart, lungs, kidneys, liver, or even the brain. All of these organs work closely together in the healthy body, so it is not surprising that when one fails, others often follow. This is called multiple organ failure. People remain in intensive care for varying lengths of time, depending on the nature of the illness, and receive 24-hour one-to-one nursing care and monitoring [see ICNARC website].
Here men and women talk about the emergencies that led a family member, partner or close friend to intensive care.
There are many reasons why people are admitted to ICU. Severe infection (sepsis/ severe sepsis, meningitis, pneumonia), stroke, after resuscitation from cardiac arrest, poisoning, complications following surgery, major trauma from road traffic accidents and burns are all examples of critical illness [see ICNARC website]. Most people said the onset of the person's illness before ICU admission was rapid and unexpected. Many worrying things happened very quickly and they were uncertain about what was actually wrong.
Many people we talked to described symptoms which at first had not caused them any alarm but which had been followed by a sudden unexpected deterioration. Some had been unsure whether to insist on their relative visiting the GP because they hadn't expected things to be as serious as they'd turned out to be. Because nothing like this had ever happened before, many had believed the illness could be treated at home with medication. Those who'd visited a GP or called out doctors or paramedics explained that health professionals themselves had also believed the illness would be treatable at home. Sometimes, when several approaches to the GP had not provided a solution, the relative had called 999, 111 or NHS Direct for advice. One way or another, when the person continued to deteriorate, they were sent to hospital.
People described the panic as they realised how serious the situation was and their attempts to do something about it. One woman described how her sister-in-law, who had been trained, tried to resuscitate her mother who had collapsed.
Sometimes the deterioration occurred while the patient was already in hospital and they had to be transferred to ICU in the same or, sometimes, another hospital.
People were often surprised and shocked to be told quite unexpectedly that their relative's condition had become life threatening, requiring immediate transfer to ICU and possibly an emergency operation.
For most relatives this was their first experience of intensive care, though one man said his wife had been admitted to ICU four times in eight years because of bowel related problems. Another said his wife's bowel problems had led her to have two operations within a very short space of time.
In many cases the condition that needed emergency treatment was one for which there'd been no previous warning signs. One woman said her husband had collapsed at work. Her niece had broken the news to her but she only realised how serious it was when she saw him in hospital. He was later diagnosed with a brain aneurysm.
A few people explained that family members had been admitted to ICU because of very rare conditions, sometimes illnesses they'd never heard of before. Often these can be difficult for doctors to diagnose and the wait to find out what's wrong with the patient extremely distressing. With hindsight several wondered if the severity of the illness could have been alleviated had they or health professionals taken the symptoms more seriously when they'd first appeared.
The problems requiring intensive care were often complex and bewildering to relatives and close friends. While longing for answers and explanations they often had to wait as the doctors worked to make sense of what was going on. Some were told in Accident and Emergency (Emergency Department), others sometime during the patient's ICU stay. One man said he only learnt that his father had had a rare form of pneumonia when they went to an ICU follow-up appointment several months after his father was discharged. A few people said they'd never found out exactly what had gone wrong.
Being told that a relative or close friend has had an accident can be extremely distressing because the news often comes completely out of the blue. There is no build up and no time to prepare mentally, emotionally or practically. Some people said they'd received a phone call telling them of the accident and that they needed to come to the hospital, but were given few other details. Getting to the hospital after hearing such news was also difficult for the one who had to drive, especially if it was a long journey. Not knowing what they'd find when they got there made the journey even more harrowing.
One woman had been on holiday abroad when she received several messages on her phone to call home. After learning that her brother had had a motorbike accident, she and her husband decided they had to cut their holiday short and returned home. Another had been on maternity leave when she received a call from her partner telling her about the car accident he'd had. They both assumed it wasn't serious until he had a scan, which showed he had a ruptured liver. He ended up spending 3 ½ months in intensive care.
One woman said a policeman had visited her at home to tell her that her son had had a motorbike accident. Another was told by her husband's friend that her husband had had an accident on his mountain bike. Like many other people we interviewed, they didn't know how serious the accident had been until they got to the hospital. Most people had no previous experience of intensive care either, though one woman, who was a nurse, said she'd assumed her son would be admitted to ICU because of the injuries he'd had.
Witnessing an accident can also be distressing and traumatic. One woman described how her niece had witnessed her own father's accident and how difficult it had been for her uncle to comfort her when he himself was shocked and having to give information to paramedics. One man described how he reacted when he discovered his wife lying on the floor, struggling to breathe after she'd fallen through a hole in their bedroom floor at home.
In Accident and Emergency (Emergency Department)
In the UK, people who have had an emergency illness or accident are usually first examined by medical staff in the Accident and Emergency/ Emergency Department (A&E/ ED) of the hospital. At this stage, if there has been an illness, relatives or close friends often know very little about why a person has become so ill so quickly, the effects the illness might have or that the illness could be life-threatening. If there has been an accident, relatives often don't know how serious it is or what injuries might have been sustained. The uncertainty of not knowing is extremely stressful and the patient's relatives or close friends have to wait for more information while the patient is being examined or treated.
How long relatives or close friends might have to wait for news about the ill or injured person varies. Medical staff need to examine the patient immediately and talking to relatives can delay vital work that could affect the patient's health. Many people found waiting for news extremely stressful and difficult because of the uncertainty involved. For a few people waiting for news felt 'like eternity' and they described this as the most traumatic time of the entire experience. Some said they waited five to ten hours in hospital before a doctor was able to tell them what was going on.
After being examined in Accident and Emergency (Emergency Department) some patients were admitted to ICU immediately. Others went to general wards or specialist units first but, when their health deteriorated still further, they were transferred to ICU. One man described the support he and his partner were given by an outreach nurse who visited them several times on the ward before his partner was actually transferred to ICU. Outreach services aim to enhance the care of potentially seriously ill patients on the wards and make the transition to or from ICU easier. Outreach nurses also aim to reduce the risk of re-admission to ICU from the wards and to share their specialised nursing skills with other staff in the hospital [see ICNARC website].
Some hospitals don't have ICUs or there may be no vacant beds at the time, and some hospitals don't have the specialist services on site, e.g. Neurosurgery, so that patients may have to be transferred to other hospitals. When these hospitals are some distance away from relatives' homes, this can be an added pressure (see 'Suspending normal routines: visiting ICU every day'.
ICU admissions from within the hospital
Some people are already patients in a hospital ward but are admitted to ICU because their health has deteriorated so much that they now need 24-hour nursing care. A few of these patients may have picked up infections whilst in the hospital itself. One man, whose father was in a general ward at the time of interview, explained that although his father had been admitted to hospital for bowel problems, he developed pneumonia on the ward. He was admitted to ICU for three days and then transferred back to a ward when he started improving again. Other patients go to ICU because of complications during or after surgery. Occasionally patients who have been in ICU may have to be readmitted to intensive care after being on a ward because their health has deteriorated again.
Last reviewed February 2013.
Last updated February 2013.