This glossary combines technical descriptions of key terms in intensive care descriptions of the patient experience, developed in collaboration with the group Les REAnimés, which you can contact at Second Life by 101
During an intensive care stay, changes in the patient's state of health may lead to questions about the appropriateness of current treatments. The absence of expected benefit despite heavy and sometimes aggressive care for the patient may lead to limiting the use of certain treatments or interrupting others, or even limiting treatment to ensure comfort. In France, unreasonable obstinacy is prohibited by law. Since 2004, and more recently in 2016, the Léonetti and Claeys-Leonetti laws have provided a framework for what are known as "treatment limitation and cessation" (LAT) decisions. These decisions are made in consultation with the entire healthcare team and an external consultant, taking into account the patient's expressed wishes and keeping the patient's family and friends fully informed. These decisions are re-evaluated every day as the patient's condition evolves.
"Excessive medical treatment" is the former legal term for what is now called "unreasonable obstinacy."
Ketoacidosis is a condition in which the body produces large amounts of acidic substances called ketone bodies. It most often occurs when there is a lack of insulin, particularly in people with diabetes. This buildup of acids can lead to dehydration, abdominal pain, and breathing difficulties or impaired consciousness. Prompt medical attention is necessary to correct these imbalances and treat the underlying cause.
Adrenaline is an emergency medication administered in very small doses during the intensive care phase intensive care cardiac arrest, or administered via an infusion at a continuous and extremely precise rate. Its function is to improve the heart’s function.
The administration of the medication may go completely unnoticed by the patient, especially if they are unconscious, but some describe a sensation of a “boost to the human body as a machine,” a feeling of warmth, and sometimes headaches.
When patients are no longer able to eat by mouth (due to sedation, coma, swallowing difficulties, etc.), they can be fed through a tube placed in the stomach or, in some cases, the intestine: the gastric tube. This is referred to as enteral feeding or nutrition (“enter” meaning stomach).
Enteral nutrition, therefore, involves feeding a person directly into the stomach or intestine. In intensive care, it is used when a patient cannot eat normally but whose digestive system is still functioning.
Nutrients (proteins, carbohydrates, fats, vitamins, etc.) are then administered in liquid form to meet the body’s needs and prevent malnutrition.
This method is the closest to a natural diet and helps keep the intestines functioning properly.
From the patient's perspective:
Visually, they are cream-colored pockets of liquid connected to a tube that is attached to the gastric tube. The tube runs through a pump that regulates the start of the flow.
You can see the liquid flowing from the bag through the tube into the nasogastric tube.
If the liquid is at room temperature or chilled, you may feel it flowing through the tube slightly, but this is painless and tasteless; most of the time, you feel neither hunger nor fullness, as the nutrients are delivered at a constant rate throughout the day. In some cases, it is possible to administer enteral feeding only at night in an effort to stimulate hunger during the day and help the digestive tract readjust to a normal diet.
In some cases, the patient’s digestive tract may not be functioning properly or may not be usable (for example, due to surgery, an infection, or a blockage).In such cases, nutrients are delivered directly into the bloodstream via an IV placed in a large vein (see Catheter).
This is referred to as parenteral feeding or nutrition.
In intensive care, this method allows patients to be fed even if their digestive tract is not is not functioning, providing them with the energy and protein necessary for recovery.
Visually, most parenteral nutrition solutions appear as bags of white liquid. These products are typically administered via catheters because they can irritate small veins over the long term.
Amnesia means the absence of memories.
It is common for patients not to remember all or part of their stay in intensive care. There are many causes of amnesia: sedatives and anesthetics often cause amnesia; severe infection and sleep disturbances directly affect the ability to form memories; and other mechanisms may also play a role in these processes…
Patients who experience amnesia describe a sense of “being absent from themselves”; they sometimes have no memory of the events leading up to being placed in a coma, nor of the time spent in the coma until they wake up, and sometimes not even for several days after waking up. “It’s as if I’d forgotten to put film in the camera,” one patient described. Many patients feel the need to fill in this “gap” in their memory, sometimes quickly, sometimes several months after being discharged from intensive care.
To facilitate the psychological recovery of intensive care patients, it may be helpful to assist them in understanding what happened during the periods they have forgotten. Keeping a journal is a simple and effective solution.
It is common for women’s menstrual cycles to become irregular or stop entirely during a intensive care. The body experiences such a shock that it shuts down its reproductive functions to focus on survival; this is known as amenorrhea.
Anesthesia is the process of “numbing” a person’s sensations using medications or gases that are sedatives (which induce sleep) and analgesics (which relieve pain).
Commonly used in the operating room, anesthesia can be general—in which case the patient is completely “asleep”—or local—in which anesthetic medications are injected directly into the nerves in the area to be treated. Only that area is “numbed”; the patient remains conscious. The primary purpose of anesthesia in the operating room is to ensure the safety of the procedure by completely immobilizing the area and preventing pain.
In intensive care, general anaesthesia is used when organ failure requires total rest: a patient can be "put to sleep" to rest his or her lungs, for example.
From the patient’s perspective, during what is known as the “induction” of anesthesia—the moment the medication is injected—one may feel a sensation similar to being sucked in or falling before losing consciousness, which can be experienced as pleasant or distressing depending on the individual and the context. Thinking about pleasant things as you fall asleep may help you wake up calmly. This is not normal sleep, and you won’t feel “rested” after anesthesia. Depending on the medications and doses used, anesthesia can cause strange dreams.
Anoxia is the absence of oxygen supply. It leads to cell death. Prolonged cerebral anoxia has serious and irreversible consequences for cognitive function.
Analgesia is the suppression of the sensation of pain. This can be achieved with drugs (analgesics), but also with non-medicinal methods: depending on the type of pain to be treated, the use of heat (hot water bottle), cold (ice bladder) or physiotherapy can be highly effective.
Antiarrhythmic drugs are medications used to correct or prevent heart rhythm disorders. They act on the heart’s electrical activity to make it more regular.
Antibiotics are medications used to treat infections caused by bacteria. They have no effect on viruses. In intensive care, they are often administered quickly when a serious infection is suspected.
Bed rest for patients in intensive care, potential coagulation disorders, or foreign objects inserted into the venous and arterial trunks (catheters, ECMO cannulas) can pose a risk of thrombosis: the body forms a clot that can block all or part of a vein or artery, leading to impaired blood flow to an organ or circulation problems.
To prevent blood clots, patients in intensive care are given intensive care , often as subcutaneous injections in the thighs and/or abdomen. This can cause bruising and hardening of the skin, which will go away over time.
Antihypertensive drugs are medications used to lower high blood pressure. They work in different ways depending on their class (on the heart, blood vessels, or kidneys). In acute situations, their use is continuously adjusted based on the patient’s condition.
Aplasia is a significant decrease in white blood cell count. It is generally an expected side effect of certain cancer treatments and makes the body much more vulnerable to infections.
Febrile aplasia is characterized by a significant drop in white blood cell count, accompanied by fever. Aplasia makes the body much more vulnerable to infections. Prompt medical attention is necessary to identify and treat any potential infection.
Writing boards are provided for patients who are unable to speak but can write.
Tips from Réanimé: Remember to replace the markers that dry out quickly when you have trouble closing them, and provide something to wipe them off with to (somewhat) avoid blue fingers and stained sheets!
The heart pumps blood throughout the body, thereby supplying oxygen to the cells of various organs. During cardiac arrest, the supply of oxygen is interrupted, leading to rapid cell death. Within minutes, the consequences can be irreversible (see Anoxia). Therefore, prompt treatment (CPR, ventilation) is essential to minimize potential long-term effects.
Tracheal suctioning is a routine procedure used to clear secretions from an intubated patient. A thin suction catheter is passed through the endotracheal tube to suction out the bronchial secretions that the patient brings up by coughing. The procedure can be alarming because it causes the patient to cough.
This is not a pleasant procedure for patients, especially when it needs to be done frequently, but it is necessary for proper breathing and is nonetheless experienced as a “vital need that one eagerly anticipates” by patients who have difficulty breathing. Afterward, it creates a sense of well-being by improving breathing and giving the sensation that “the bronchial tubes have been cleared.” When performed gently, it can be experienced as a real relief, but it can become unpleasant over time if the trachea is irritated.
The suction system can also be used to remove saliva in patients with swallowing difficulties or during oral care.
Asthma is a respiratory disease that causes inflammation and narrowing of the airways. Symptoms may include difficulty breathing, a tight feeling in the chest, a cough, or wheezing. Attacks can be triggered by various factors, such as infections, allergies, physical exertion, or certain irritants, and their severity varies from person to person. In extreme cases, the condition is referred to as severe acute asthma, which is a particularly severe asthma attack during which the airways constrict significantly and prevent air from flowing properly. The person may have great difficulty breathing despite standard treatments. This medical emergency may require strong medications, oxygen, or respiratory support.
A stroke occurs when a part of the brain is no longer properly supplied with blood, either due to a blood clot or bleeding. It can cause paralysis, speech difficulties, or impaired consciousness. Prompt treatment is essential to minimize long-term effects.
A bacterium is a microscopic living micro-organism. Some bacteria are useful and necessary: they make up what is known as the flora. For example, the intestinal flora helps to ensure proper digestion of food. Other bacteria are dangerous and must be fought. To help the body fight these "bad" bacteria, we use antibiotics.
A multidrug-resistant bacterium is a bacterium that has developed resistance to several antibiotics. It is therefore more difficult to treat, and it is extremely important to prevent its spread within the hospital; this is why you may be asked to follow certain precautions when entering patient rooms: “isolation measures.”
See "isolation."
The “base” is the “basic” infusion administered to all intensive care patients. It generally consists of a volume of neutral fluid (“normal saline” or a glucose solution”), to which vitamins or other electrolytes may be added depending on the patient’s needs.
See Infusion
Patients who are unable to swallow or who are intubated cannot drink water. Hydration is provided through other means, but this often results in a very dry mouth, especially when the patient is intubated through the mouth and therefore cannot completely close the oral cavity. Sticks(resembling large cotton swabs with cotton on one end) canbe dipped in water, fruit juice, or mouthwash, then wrung out thoroughly, to dab the lips and the inside of the mouth. This provides a refreshing sensation or even a pleasant taste if fruit juice is used.
See Oral Care
The BAVU, or “self-inflating bag with a one-way valve,” is a device found in all intensive care units. It is used to pre-oxygenate the patient before intubation, manage certain emergency situations, or take over for the ventilator during certain procedures. It is also sometimes called an AMBU (after the brand name).
The patient identification bracelet is an important component of what is known as patient identification safety. It allows healthcare providers to perform regulatory and protocol-based checks to verify their patient’s identity before providing certain types of care. Even if healthcare providers know their patients very well, the fast pace of work and human fallibility can unfortunately lead to errors. These checks serve as a safeguard and help prevent accidents.
Bronchoscopy or bronchial fibroscopy is an examination in which a small camera positioned at the end of a tube is used to look inside the bronchial tubes. In intubated patients, this is usually done through the intubation tube; in non-intubated patients, it is usually done through the nose. This examination can also be used to take samples for diagnostic purposes.
This procedure can be performed under general anesthesia or simply by numbing the inside of the nose. When performed on a patient who is awake, it can be quite uncomfortable. In a patient who is asleep, bronchoscopy generally causes no pain upon waking; however, since it helps clear the bronchi, the patient may experience a sense of well-being and feel as though their bronchi have been cleared.
Chronic Obstructive Pulmonary Disease, or COPD, is a chronic respiratory disease often associated with long-term smoking.
It gradually makes breathing difficult by obstructing the bronchi and makes any lung condition all the more severe. It causes bronchospasms, which lead to breathing difficulties that may require bronchodilator therapy (to open the bronchi) and mechanical ventilation: noninvasive ventilation is preferred for these patients because weaning invasive ventilation can be difficult.
Nursing managers are nurses who have completed additional training in management. They coordinate the nursing staff and oversee the unit’s logistics. They can be valuable resources in helping you understand how the unit operates. See the page: The intensive care Team
A tracheostomy tube is an alternative to an endotracheal tube, recommended in certain cases—particularly to facilitate weaning from mechanical ventilation. It frees up the mouth by creating an access route through a small opening directly into the trachea. A tracheostomy bypasses the upper airways, thereby reducing the effort required for spontaneous breathing while limiting the risk of pulmonary infection: Like an endotracheal tube, the tracheostomy tube has a cuff that can be inflated to prevent oral or digestive secretions from flowing into the lungs.
A tracheotomy also allows patients to start speaking, eating, and drinking again as they undergo rehabilitation! The patient's comfort is generally greatly improved.
Over time and as the patient undergoes rehabilitation, they can gradually spend more time disconnected from the ventilator, breathing on their own, until they are able to breathe without it: a small plug is then placed over the end of the tracheostomy tube: this red cap hermetically seals the tracheostomy opening, indicating that air is being inhaled and exhaled through the patient’s natural airways (nose, mouth), and helps ensure that everything is functioning properly before “decannulation”—the process of removing the cannula and sealing the opening.
Catheters are flexible, hollow tubes inserted into the patient's veins or arteries.
Central catheters are very easy to insert in intensive care because they are safer access routes (they cannot dislodge) and provide multiple lines for administering different sensitive medications at the same time.
Arterial catheters enable continuous monitoring of blood pressure. They also enable regular blood sampling, often required in intensive care , without the need to prick the patient. Insertion is performed sterilely, under local anaesthetic. Maintenance requires sterile care.
Central venous catheters are needed to secure the administration of many intensive care drugs, such as catecholamines (norepinephrine, for example). In some cases, central catheters can also be used to monitor vessel pressures. Insertion is performed sterilely, under local anaesthetic. Maintenance requires sterile care.
A dialysis catheter is a central venous catheter that is larger in gauge than other catheters and is used to perform dialysis on the patient. It has two lumens: one for drawing blood and a second for returning the “cleaned” blood—purified by dialysis—to the patient. Sometimes, it may have a third lumen for administering medications. The dialysis catheter is usually inserted in the neck (a “jugular” catheter) or in the groin (a “femoral” catheter).
ECC (Extracorporeal Circulation), also known as ECMO, is an organ support system used in extreme cases.
There are two types of extracorporeal circulation: one supplements the failure of the lungs alone, the other supplements the heart-lung system.
In the first case, extracorporeal circulation is used for patients for whom artificial ventilation via intubation or placement on a respirator is not sufficient to oxygenate the blood properly.
Two very large catheters (called cannulas) are inserted into the patient's large venous trunks (often in the groin area), and the blood is pumped through an oxygenation and decarboxylation membrane (where carbon dioxide is purified).
The second case is used in the event of major heart failure, or even heart-lung failure. In this case, cardiac function is supplemented by the machine's pump, which completely replaces the heart and, if necessary, the lungs too. The cannulas are then positioned, one arterial, the other venous.
The use of extracorporeal circulation is an extremely invasive procedure that carries numerous risks and should not be taken lightly. It is generally performed under general anesthesia, but in very rare cases, it may be performed under local anesthesia.
The size of the CEC cannulas often results in scars at the insertion sites, as well as smaller scars in a few places on the body where sutures were placed to securely hold this vital support in place.
Further Reading: Katia Ghanty’s book, *Les frottements du coeur*.
The treatment cart is a key piece of furniture in the intensive care unit. Its drawers contain all the medical supplies needed to perform most procedures: blood draws, dressing changes, and medication administration. It is checked and restocked daily by nurses and nursing assistants to ensure it is always ready to handle emergencies. Although it is cleaned regularly, this area must remain very clean since its surface is used for patient care; therefore, it is best to avoid placing items from outside on it or touching it with hands that are not perfectly clean.
The clinic is the practice at the patient's bedside. The head of the clinic is the doctor in charge of supervising clinical practice, i.e. patient care. Within the unit, interns work under his or her supervision and responsibility. The clinical manager is responsible for coordinating the unit's care team and defining daily objectives for each patient. The clinical director reports to the department head.
The medical definition of shock is a sudden and severe drop in blood pressure.
This medical condition can quickly lead to serious consequences for the organs (kidneys, lungs, liver, etc.)
There are several types of shock: septic shock, caused by a severe infection; hemorrhagic shock, caused by significant blood loss; cardiogenic shock, caused by poor heart function; and anaphylactic shock, caused by a severe allergic reaction.
From the patient’s perspective, shock can be experienced as severe discomfort: dizziness, the onset of loss of consciousness (seeing stars, temporary blindness, ringing in the ears, etc.), chills, a feeling of extreme cold, difficulty speaking, and even total loss of consciousness if the shock worsens. Visually, mottling may appear on the knees, and the skin may become very pale.
Anaphylactic shock is a type of shock caused by a severe allergic reaction.
See "shock"
Cardiogenic shock is shock caused by heart failure.
Hemorrhagic shock is a type of shock caused by massive blood loss.
Septic shock is a type of shock caused by a severe infection.
See "shock," see "sepsis"
Extracorporeal circulation is also known as ECMO.
A heated humidifier, sometimes called a “coquette,” is a small device attached to the ventilator that humidifies and warms the gas mixture delivered to the patient : in fact, air and medical oxygen are dry gases and can irritate the airways or dry out the patient’s secretions. These gases should be humidified to prevent complications and ensure the patient’s comfort. The heated humidifier can be used with any interface: an endotracheal tube, NIV mask, or nasal cannulas for high-flow oxygen therapy.
The total artificial heart is a biventricular assist device (i.e., one that assists both ventricles, the lower chambers of the heart), involving the implantation of two artificial ventricles to replace the native ventricles. This device is implanted during major surgery. This technique is new and is currently used exclusively as part of a research protocol. It is used while patients await a heart transplant.
Coma is an altered state of consciousness:
Coma impairs the patient's ability to protect the crossroads between the airway (to the lungs) and the digestive tract (to the stomach), which is why it is necessary to intubate comatose patients, and place them on artificial respiration. A comatose patient requires extra monitoring. We don't know what a comatose patient hears, but it seems that the presence and voices of loved ones can in some cases be recognized, even if he or she will have little or no memory of them later on. Caregivers explain their actions to the patient and warn him/her before any physical contact. Verbal presence is beneficial for the patient, and you should not hesitate to talk to him or her.
Oral nutritional supplements are beverages or creams that are high in energy, protein, and sometimes vitamins and minerals. They are prescribed when a person is not eating enough to meet their nutritional needs, such as after an illness, surgery, or during a hospital stay.
NUTS help prevent or correct malnutrition. They supplement the regular diet but do not replace it.
It is common for conscious patients in intensive care more or less confused, disoriented, or lost. This is referred to as confusion or delirium. It can be caused by stress, infection, medications, or fatigue. Age is also a significant risk factor. It is advisable to regularly help patients orient themselves in space and time by reminding them where they are, why they are there, and the current date and time. Allowing patients to leave their rooms as soon as their health permits is a good way to reduce the duration of this confusion (a walk down the hallway or even a short tour of the hospital).
Confusion can cause the patient to behave differently than usual, or even to say things that are jarring and very out of character: this can make loved ones feel that the patient is acting strangely, or even cause them distress when the confusion leads to behaviors that are too far removed from the patient’s usual manner. Don’t hesitate to take a step back and look out for yourself: this period is generally temporary.
"I feel like I'm on cloud nine, in a fog; I'm floating between different realities," says a patient
See Delirium
In intensive care, obtaining the patient’s consent is often complicated by coma or delirium. The teams strive to better understand the patient’s values and wishes by communicating with other teams and work to secure the patient’s consent for all care provided. Sometimes, certain neurological conditions can make this very difficult, and in such cases, the patient’s best interests take precedence. If you have any questions about your loved one’s care, please do not hesitate to contact the healthcare team or the psychologist.
In intensive care, restraints are used to limit the erratic movements of patients suffering from cognitive impairments, agitation, or simply difficulty controlling their movements.
In fact, it is common for a patient to pull out a catheter or nasogastric tube—or even to self-extubate (remove the endotracheal tube)—in a moment of panic. Healthcare providers must then repeat the procedure, which carries significant risks (infection, respiratory distress, or cardiac arrest if a life-support device is removed).
Restraints are removed as soon as a patient demonstrates the ability to understand the situation and not to endanger themselves. This assessment is not always easy, and restraints may be kept on a little longer when in doubt, so as not to compromise the situation. For the patient, being restrained can be particularly frustrating and even highly anxiety-provoking; it can exacerbate certain delusions of persecution. The risk-benefit balance must be carefully weighed.
In some cases, it may be possible to remove the patient’s restraints as long as there is someone in the room responsible for ensuring the patient’s safety. The doctor must give approval for this.
Corticosteroids are powerful anti-inflammatory drugs that affect the entire body.
Curare: Some intensive care patients intensive care have difficulty regulating their body temperature; in such cases, it may be necessary to warm them using a “heated blanket.” This is a type of double sheet that is inflated with warm air using a small machine and placed directly on the patient under the regular sheet. The temperature is adjustable and can be tailored to the patient’s needs.
Curare agents are drugs that cause temporary muscle paralysis, including paralysis of the muscles used for breathing. Since they do not eliminate pain or cause loss of consciousness, they are used in combination with hypnotics and analgesics. They are used in intensive care facilitate mechanical ventilation in certain serious situations.
The term “decompensation” is used when the symptoms of a chronic condition that is well-controlled (i.e., stable under treatment) suddenly worsen, usually triggered by an event such as a viral infection, another infection, discontinuation of treatment, etc.
Treatment must therefore address the cause of the decompensation while supporting the function of the chronically diseased organ.
The Prone Position is also known as “D.V.”
The word “decubitus” means “to lie down.” Prone positioning refers to placing patients on their stomachs. This technique is particularly useful in cases of severe respiratory failure because it improves gas exchange (the efficiency of breathing). It can be used in conscious, non-intubated patients to try to avoid intubation, or in the most critically ill patients who are under sedation.
We can also refer to the lateral decubitus position when positioning patients on their side, again generally to facilitate breathing. The lateral decubitus position can also be used in intensive care relieve pressure on specific areas and intensive care prevent or treat pressure ulcers.
Some patients have a vague memory of being turned onto their stomachs while in a coma, associating that sensation with the feeling of being rolled up like a rug.
For family members, this can sometimes be startling because, immediately after the patient is turned onto their back, their face may appear very swollen, somewhat like a boxer’s: this is simply swelling at the back of the skull—which is usually hidden by hair and a pillow—that has shifted onto the face due to gravity. This subsides within a few hours, and ice packs can be applied to speed up the process.
See edema
Multiple organ failure refers to the simultaneous failure of several vital organs, such as the lungs, kidneys, heart, or brain. This very serious complication is generally a chain reaction. intensive care to support vital functions while the body recovers, thereby minimizing the consequences.
Delirium is a specific cognitive state in which the patient may be disoriented (unable to determine where they are or what time it is) or even experience hallucinations. Delirium is common in intensive care; it results from the impact of acute illness and can be exacerbated by severe infection, medications, sleep disorders, etc. It can manifest as severe agitation but also, at times, as total silence (the patient is very calm, conscious but does not speak or respond to stimuli).
To combat delirium, it's important to clearly mark the day-night rhythm, to encourage rest at night and activity during the day, and to reorient the patient: use a clock, remind him where he is and why he's there, and so on.
See the "Patient Experience" page
Depression can follow a stay in intensive care. Depression can also affect caregivers or family members. In fact, it is quite common; it is estimated that it can affect up to 30% of both groups. It is a reaction to the intense stress they have experienced and should be taken seriously.
Like any illness, no one is to blame for this condition, which is difficult to cope with for both the person affected and those around them. Willpower alone is not enough to recover, and depression is treated most effectively when addressed early by qualified professionals (psychiatrists, state-certified psychologists). Medication and therapeutic treatments are available: professionals can guide you through a personalized treatment plan. Early intervention is particularly important because it helps limit or even prevent relapses.
Or extrarenal blood purification (ERBP)
A technique that uses a catheter, a filter (artificial kidney), and a pump—all integrated into a large machine—to remove toxic waste products from the blood that accumulate when the kidneys are not functioning properly or in certain critical situations. Some forms of dialysis, known as intermittent dialysis, can last between 2 and 8 hours depending on the medical indication, but in certain cases—such as in intensive care—continuous dialysis may be initiated; that is, it can last for several days and can be repeated once the filter (artificial kidney) reaches the end of its useful life.
A conscious dialysis patient may feel cold; do not hesitate to ask them about it and to cover them if necessary. Other symptoms, such as headaches, may occur less frequently; do not hesitate to report them to the healthcare team.
The dialysis machine is usually placed next to the bed, and you can see the blood flowing through the tubes in time with the pump, which may produce a slight background noise.
Dietitians are called upon to ensure that patients receive the nutritional intake appropriate for their specific needs. They regularly visit intensive care units intensive care optimize patient nutrition, whether patients are intubated and in a coma or conscious and independent. Patient nutrition is a key factor in their recovery and cannot be left to chance.
Advance directives are a document drafted in advance by the patient, in which the patient expresses his or her wishes in the event that he or she is unable to make decisions.
They can be written on plain paper or using a pre-designed form, such as the one from the Société de intensive care ue Française: available here
Diuretics are medications that increase the excretion of water and salt by the kidneys. They are used, in particular, when there is excess fluid in the body, such as in certain cases of heart or kidney failure.
Organ donation is permitted in France under certain circumstances, particularly following a diagnosis of brain death or after a decision to limit or discontinue treatment (the so-called “Maastricht III” legal framework). All organs and certain tissues may be donated. By default, in France, everyone is considered a potential donor. You can register on the national opt-out registry to clarify your position. Talking to your loved ones about this, or simply carrying a donor card with you, can help avoid difficult decisions if the need arises.
See the Organ Donation page
A drain is a flexible tube placed in the body to remove blood, air, or secretions that could interfere with proper healing or the proper functioning of an organ. Depending on the location of the drain, it may be referred to as a thoracic, pleural, abdominal, or pericardial drain, among others.
Dysphagia, or swallowing disorders, can result from a prolonged period during which the swallowing muscles have not been used or from neurological damage. Weakened muscles prevent proper swallowing, and part of the food bolus may enter the airways: this is known as “aspiration,” which manifests as a cough during eating and can lead to lung infections. Depending on the severity of the condition, aspiration can occur with solid and/or liquid foods.
A swallowing disorder should be suspected when a patient consistently coughs while eating or drinking. In such cases, the meal should be stopped immediately, and the healthcare team should be notified. An evaluation can be conducted by an ENT specialist, a speech-language pathologist, or a physical therapist, and appropriate measures can be taken, such as dietary adjustments, enteral feeding, or rehabilitation.
Ultrasound isn't just for pregnancy!
This is a test used to examine the anatomy and functions of certain organs. An ultrasound can be internal or external:
– In the case of external ultrasounds, the doctor places a probe against the skin over the organ to be examined; this probe emits ultrasound waves that pass through the tissue and are then reflected back as an echo. It is a relatively quick and painless procedure that is performed while the patient is in bed.
– In the case of internal ultrasounds, the probe is inserted into a natural cavity to get closer to the organ being examined. For example, in some cases, an external ultrasound of the heart (transthoracic ultrasound) is not sufficient to clearly visualize the desired structures; the doctor will then perform a transesophageal ultrasound: the ultrasound probe is passed through the mouth into the esophagus to get closer to the heart.
ECMO stands for Extracorporeal Membrane Oxygenation; it is a form of extracorporeal circulation.
There are two types of extracorporeal circulation (ECC): one supports the lungs alone (V-V ECMO), and the other supports both the heart and lungs (V-A ECMO).
Electrodes are small sensors placed on the patient’s chest to measure the heart’s electrical activity. They are usually small adhesive patches with a metal snap in the center that connects them to the cables of the monitor—the screen that displays the waveforms, including the electrocardiogram (ECG) waveform.
Some patients may have marks left on their skin by the electrodes for a while: when the adhesive has been left on for a long time, or when the electrodes have been placed in the same spot multiple times, this causes the skin underneath to peel. These marks fade over time and with showering. Exfoliating the skin thoroughly can speed up the process.
If the adhesive is leaving slightly gray marks on your skin, you can also buy a special anti-adhesive product at a pharmacy to remove those marks.
In the context of an electroencephalogram, we also talk about electrodes, which look a little different and are attached to the skull using a conductive gel and a kind of grayish paste that washes off with shampoo.
A patient who is asleep—or awake but suffering from severe muscle weakness—can no longer control the elimination of urine and stool. For urine, it is standard practice to insert a urinary catheter. For bowel movements, however, incontinence pads are placed under the buttocks to prevent soiling the sheets and to allow for changes as needed without having to remake the entire bed. Patients who are able to do so urinate into bedpans. To prevent constipation and intestinal blockage, laxative gels may be provided to patients. In some cases of constipation that does not respond to oral laxatives, caregivers administer an enema—a necessary procedure that may be embarrassing for the patient but is not necessarily unpleasant.
A pulmonary embolism is the blockage of an artery in the lungs, most often caused by a blood clot (thrombosis).
It can cause sudden shortness of breath, chest pain, or a drop in blood oxygen levels. Severe cases can compromise heart function.
The intensive care unit intensive care a place of emotional ups and downs for loved ones, due to the uncertainty surrounding the patient's prognosis.
After leaving the intensive care unit, patients often describe experiencing emotions that are amplified—both positive and negative—for a period of time (which varies from person to person).
These intense emotional surges can be confusing for loved ones and can leave patients feeling vulnerable—as they experience both a heightened sense of life and greater suffering.
This condition is temporary and eventually returns to normal as time goes on. Psychological counseling can help manage overwhelming negative emotions.
"Endo-" means "inside" and "scopy" means "to look at". The word endoscopy covers all examinations that involve looking inside the body using a probe fitted with a camera. For the sake of clarity, we usually specify the target organ: bronchoscopy or bronchial endoscopy/fibroscopy, for example, for the bronchi, or gastric endoscopy for the stomach. See fibroscopy.
Occupational therapy is a paramedical discipline that aims to adapt the environment and objects to improve a patient’s independence or mobility, based on the specific nature of their disability (whether temporary or long-term).
For example: placing a grip on the tablet to prevent the phone or speaker from slipping; making a custom pillow for a patient with an occipital pressure ulcer; modifying the doorbell so that even an extremely frail patient can use it; adapting the bed to facilitate certain independent movements; and so on.
Pressure ulcers are skin lesions (wounds) caused by bed rest. Bed rest and immobilization, which are necessary for the safety of intensive care patients, can have consequences. Among these are pressure ulcers, which are caused by the pressure the skin undergoes between protruding bones and the mattress; these are known as pressure points:heels, sacrum, head (occipital region), and shoulder blades.
To prevent pressure ulcers, nurses and nursing assistants regularly reposition patients to shift the areas where pressure is applied, perform light massages on pressure points (such as the back of the head, the back, the sacrum, the elbows, and the heels), and ensure that patients receive adequate nutrition. You can help prevent pressure sores by giving your loved ones light massages in the areas you can reach, particularly the elbows and heels.
This type of wound heals slowly and can leave cosmetic and functional sequelae that sometimes hinder rehabilitation. Treatment can be painful, and if the pressure ulcer is very deep, it requires very specific dressings. Pressure ulcers also have a distinctive odor, which can be distressing for the patient. Diffusing essential oils in the room during dressing changes can help alleviate this.
Outside of the intensive care unit, it is advisable to seek medical advice if the discomfort is too severe: reconstructive surgery may sometimes be recommended.
An epileptic seizure state is defined as a prolonged epileptic seizure or a series of repeated seizures without regaining consciousness between them. This condition can severely disrupt brain function and endanger breathing or other vital functions.
Once the patient has regained respiratory autonomy, extubation takes place: the removal of the intubation tube. It's a somewhat impressive and unpleasant moment for the patient, but it's also an important one, marking the end of the acute phase.
NB: in the event of therapeutic failure, and as part of the discontinuation of treatment, extubation may be carried out to allow the patient to live out his or her final moments free from medical restrictions.
Although it may seem trivial, helping an intensive care patient sit up in a chair intensive care an effort often perceived as superhuman. Yet it is necessary for reacclimating the patient to an upright position, strengthening the back and abdominal muscles, promoting proper bowel movements (lying down can lead to constipation), and ensuring proper drainage of the bronchi. It is a form of therapy for the entire body that often leads to minor conflicts with the patient, who struggles to understand why such exertion is required of them in their current condition and would much rather rest!
See muscle wasting
The principle of fibroscopy, a common diagnostic procedure in intensive care, involves examining the inside of the body using an endoscope equipped with an optical fiber. The endoscope, or fibroscope, consists of a flexible tube a few millimeters in diameter into which an optical fiber is inserted. It has a light source at one end. Some models use a mini-camera and are connected to a video screen. They can be equipped with forceps to collect samples for laboratory analysis. A control system allows the endoscope to be maneuvered once inside the body.
See Endoscopy.
Forced immobility leads to muscle wasting, which can be significant during intensive care stays in intensive care . Some patients may lose several dozen kilograms. Regaining independence will take all the longer as a result, which is why physical therapists and nurses intervene early to counteract this process by encouraging patients to move as soon as they are able to tolerate it.
Muscle wasting can be quite shocking the first time a patient realizes the extent of the loss—perhaps while washing and seeing their legs, or when passing by a mirror. This muscle atrophy also means having to relearn everything and rebuild each muscle: the diaphragm and intercostal muscles to breathe on their own, the back muscles just to sit upright in a chair, and the leg muscles to walk again…
It takes time, but it'll come back!
At night, at weekends and on public holidays, intensive care care is provided: these time slots are known as "on-call" periods. To ensure optimum care and continuous monitoring, nurses and orderlies are generally equally numerous during the day and night, on weekdays and on public holidays; doctors, on the other hand, take turns and are less numerous on call. The most serious patients and emergency situations are therefore given priority during these periods, and doctors are less available for interviews or to deal with routine matters, which are more easily handled during the day.
Percutaneous endoscopic gastrostomy (or PEG) is a medical procedure in which a tube (feeding tube) is placed directly into the stomach through the skin to deliver enteral nutrition or medications when a person can no longer eat normally by mouth.
The procedure is performed using a small tube equipped with a camera (an endoscope), which is inserted through the mouth, allowing the catheter to be guided into place with precision.
The placement of a GPE is usually temporary and can improve patient comfort compared to a nasogastric tube. The downside, of course, is the risk of infection.
Once in place, the tube requires minimal care. It can be removed as soon as the patient is able to swallow, eat, and drink on their own without risk.
"Blood gas analysis" refers to a laboratory test performed by drawing arterial or venous blood, depending on the parameters being measured. In most cases, an arterial blood sample is required; this is drawn from the inside of the wrist, where the pulse can be felt.
This procedure is particularly painful due to the innervation of the arterial wall, which is why it may be advisable to insert an arterial catheter to allow continuous access to arterial blood without requiring multiple punctures. Blood gas samples are frequently collected in cases of respiratory failure, as well as in cases of shock. In such cases, the levels of oxygen and carbon dioxide in the blood are monitored, as well as the blood’s acidity (pH).
To reduce pain (though not always eliminate it), applying a lidocaine patch well in advance (at least 2 hours before the blood draw) can help. However, this isn’t always possible when the blood draw is needed on an emergency basis.
Hand hygiene is crucial in intensive care in hospitals in general (… and in everyday life, too!). Indeed, most diseases are transmitted through the hands. intensive care patients intensive care particularly vulnerable, it’s recommended to wash your hands before any contact with the patient, their personal belongings, or equipment in the room, as well as between potentially contaminating interactions, and when leaving the room to prevent spreading germs. You can never wash your hands too much!!
Hand sanitizer (also called hydroalcoholic solution or SHA—pronounced “cha” by healthcare workers) is an alcohol-based gel that allows you to “wash your hands”—or rather, to remove germs from them—without running them under water, simply by rubbing the product into your hands. This is only effective on hands that are visibly clean! If your hands are visibly dirty, you must wash them with soap and water.
To use hand sanitizer properly, you need to make sure to apply it everywhere: between your fingers, on top and underneath them, on your fingertips, and on your wrists.
For a demonstration of proper handwashing techniques and the use of hand sanitizer, see the " Visiting a Patient" page
Blood glucose is the level of sugar in the blood.
A blood glucose meter is a device used to measure blood sugar levels in patients. A very fine needle is used to prick the tip of the finger or earlobe to obtain a drop of blood, which is then placed on a test strip inserted into the meter, yielding a reading that allows the patient’s blood sugar level to be monitored.
This is important to ensure that the patient receives enough sugar to produce the energy needed to support organ function. In cases of diabetes (whether the patient has diabetes or certain medications are causing a diabetes-like condition), treatments can be administered to balance blood sugar levels.
A "haricot" is a small, disposable cardboard container used to collect various fluids as needed: vomit, saliva, secretions.
Caregivers also use it to organize care items, like a small tray. A very useful all-purpose item!
The Heartmate is a cardiac assist device designed for a single ventricle (monoventricular): a pump draws blood from the left ventricle (one of the heart’s chambers) and pumps it back into the aorta (the main artery that carries blood from the heart to the organs). This device can be used temporarily while the patient undergoes rehabilitation in preparation for a future heart transplant, or it can be used permanently. People can live with this device for more than 10 years. It requires anticoagulation therapy, and it is powered by external batteries connected to the device via a wire that exits through the abdomen.
Blood cultures are blood samples taken to detect the presence of bacteria in the blood. Blood is drawn directly into large tubes containing a "culture medium", a liquid that favors the multiplication of the bacteria of interest. Blood culture results may take several days to come back: this is the culture period.
Blood cultures are collected in large vials with colored caps; it might look intimidating, but we don't fill them to the brim!
Bleeding is a significant loss of blood, which can be external (and therefore visible) or internal. When severe, it can prevent organs from receiving an adequate supply of oxygen. Treatment depends on the cause and may require blood transfusions, surgery, or specific medications.
The clock is often the patient’s worst enemy… necessary for regaining a foothold in reality, becoming aware of the passing of time, and gradually regaining a sense of time, but also a reminder that time isn’t passing quickly enough during difficult moments. It’s a staple of intensive care units, intensive care one that sometimes causes its share of annoyance and frustration.
The heated humidifier, sometimes called a “humidifier chamber,”is a small device attached to the ventilator that humidifies and warms the gas mixture delivered to the patient: air and medical oxygen are dry gases and can irritate the airways or dry out the patient’s secretions. These gases should be humidified to prevent complications and ensure the patient’s comfort. The heated humidifier can be used with any interface: an endotracheal tube,a NIV mask, or nasal cannulas for high-flow oxygen therapy.
Hypnotics are medications that reduce central nervous system activity. Depending on the active ingredients used and the dose administered, they can help alleviate anxiety, promote sleep, or—in intensive care—induce a reduced level of consciousness or even an induced coma to improve tolerance to medical procedures (such as ventilation and invasive procedures). Their use requires close monitoring.
For certain pathologies, it is possible to place patients in hypothermia, i.e. to cool their bodies to below 36 degrees, sometimes as low as 34 degrees. This therapy is useful for protecting brain cells.
Several techniques can be used: the “old-fashioned” method involves cooling the patient’s body by placing a bucket of ice in front of a fan at the foot of the bed and creating a tunnel with a sheet. This is called the “ice tunnel.” Machines can also be used for this type of cooling with large adhesive patches that are applied to the patient’s thighs and chest, through which an ice-cold liquid circulates.
Whenever possible, patients are warmed to 36° before being woken up, but sometimes they wake up sooner than expected, or—in the case of an infection—the cooling device may continue to operate, which can be very unpleasant—like the feeling of being plunged into an ice-cold bathtub upon waking.
Iatrogenesis refers to any disorders or complications caused by medical treatment or medication; these are known as iatrogenic complications. intensive care teams intensive care everything in their power to minimize iatrogenesis, but the more treatments and care a patient receives, and the more vulnerable the patient is, the higher the risk of complications.
A patient who is asleep—or awake but suffering from severe muscle weakness—no longer has control over bodily functions and may experience incontinence. For urine, it is standard practice to insert a urinary catheter. For bowel movements, however, incontinence pads are placed under the patient’s buttocks to prevent soiling the sheets and to allow for changes as needed without having to remake the entire bed. The patient’s frail condition, enteral nutrition, and certain medications can contribute to severe diarrhea. The care teams do their best to manage these episodes and keep the patient as clean as possible at all times, but in some cases, elimination is continuous.
This can be very uncomfortable and difficult for conscious patients, who may see it as an infringement on their dignity, but caregivers know full well that it is part of life—and even necessary for life!
A myocardial infarction occurs when an artery supplying the heart becomes blocked. A heart attack can have serious consequences for the heart and, consequently, for the entire body.
Nosocomial infections are infections contracted in the hospital. In intensive care, despite constant attention to hygiene, they affect, on average, 1 in 5 patients due to their extreme fragility and the invasive procedures required for their survival.
Inotropes are medications that improve the heart's contractile force. They are used when the heart can no longer pump enough blood to meet the body's needs.
Heart failure occurs when the heart’s ability to pump enough blood to meet the body’s needs is impaired. Depending on the severity of the failure, this can cause significant shortness of breath, intense fatigue, swelling (edema) due to fluid buildup, and more serious complications that affect all organs, particularly the kidneys.
Acute kidney injury is a sudden decline in kidney function. The kidneys are then no longer able to properly remove waste products and excess fluid from the blood. This condition may be caused by an infection, dehydration, a significant drop in blood pressure, certain medications, or a serious illness. Depending on its severity, it may require close monitoring, specific treatments, or, in some cases, temporary dialysis.
Interns are young doctors who have passed the internship examination (at the end of the 6th year of study). They are authorized to prescribe under the responsibility of the clinic manager. They have a strong presence in our units, and will be your key contacts.
Intubation is a medical procedure in which a tube is inserted through the mouth or nose into the trachea of an anesthetized patient in order to ventilate them (provide oxygen to help them breathe). Extubation refers to the removal of this tube.
The inserted tube goes down into the lungs. For the patient, this can be an unpleasant sensation, with a strange feeling of something being stuck in the throat. See intubation tube
The fight against nosocomial infections is central to hospital management. Isolation is one of the measures taken to limit the spread of germs. This is either to protect the most fragile patients from the germs naturally present in all of us, or to protect visitors and other patients from multi-resistant bacteria carried by a patient. The specific measures to be taken are usually indicated on the room door.
For patients, this means greater isolation, as visits are often restricted, healthcare providers bundle care to minimize the risk of transmission from one patient to another, and visitors must wear the protective gear required for the specific type of isolation. For conscious patients, support through digital means can be invaluable. But some also appreciate the quiet and the chance to finally get some rest!
MRI, or Magnetic Resonance Imaging: This is a non-invasive radiology exam that provides highly detailed images of the internal structures of the human body. The patient lies in the center of amachine that emits electromagnetic waves. Wait times for an MRI are often long.Because MRI uses electromagnetic waves, it is contraindicated for patients withmetallicor electronicdevices(such as pacemakers or prosthetics).
This examination requires moving the patient out of the intensive care unit intensive care which can be stressful for a highly vulnerable patient; however, the necessary equipment is brought along with the patient, and healthcare providers are present to accompany the patient throughout the entire process, which helps to reassure and ensure the patient’s safety.
The exam itself involves passing the patient through the tunnel formed by the machine, which produces a loud, repetitive noise. For some people, and depending on the area being examined, this can be quite distressing:if it’sthe upper body or the head, for example, you may feel a sense of tightness and claustrophobia. The medical staff are right behind the glass; they are present at all times and can hear everything the patient says through microphones: don’t hesitate to call out if you feel too anxious.
Physical therapists play a major role in intensive care. They visit patients daily to maintain joint flexibility and help them exercise their muscles. They also play a very important role in weaning mechanical ventilation and in the rehabilitation of all muscle groups.
Physical therapy is a paramedical discipline aimed at rehabilitating the body. In intensive care aims to improve the patient’s breathing (clear bronchial secretions, weaning the patient off mechanical ventilation), maintain joint range of motion despite the patient’s immobility, and gradually rebuild the patient’s muscle strength.
For a conscious patient, this is a physical and psychological challenge—one that can be grueling and overwhelming at times. Simply getting into a chair feels like climbing Mount Everest! The patient gradually regains control of their movements, and the first improvements come relatively quickly—which is motivating because it signals progress toward discharge. After discharge, physical therapy often remains a long-term support for patients inintensive care.
The lacing, or simply “cord,” is a type of ribbon tied around the endotracheal tube that goes around the face to keep it at the correct depth. This fastening and the insertion depth are checked and adjusted as needed to ensure it remains clean and taut.
In the case of a tracheotomy, the strap is replaced by a foam collar.
For bedridden patients, patient lift systems allow caregivers to lift and move the patient along with all their medical equipment. The challenge is no longer lifting the patients, but organizing all the connections to avoid tangles! Patient lifts are also sometimes used to weigh patients, and can be small , portable devices or built into the room’s structure.
When a patient will not benefit from certain treatments, or no longer benefits from treatments that have been put in place, and in order to keep the discomfort, pain and anguish they cause to a minimum, these treatments may not be undertaken or may be stopped. Since 2004, and more recently in 2016, the Léonetti and Claeys-Leonetti laws have provided a framework for what are known as "treatment limitation and cessation" (LAT) decisions. These decisions are made in consultation with the entire healthcare team and an outside consultant, taking into account the patient's expressed wishes and keeping the patient's family and friends fully informed. These decisions are re-evaluated every day as the patient's condition evolves. Discontinuing certain life-sustaining treatments may accelerate the dying process. Where necessary, care teams provide palliative care, and since 2016 French law has authorized "deep and continuous sedation until death", enabling patients to end their lives as comfortably as possible.
A true preventive tool, the intensive care bed intensive care a piece of equipment that must be handled with care. It helps protect the patient’s skin, ensure their comfort, and prevent certain complications associated with intensive care. In particular, the patient’s position in the bed—often semi-upright at an angle of 30 to 45 degrees—helps reduce the risk of pulmonary infection caused by inhaling contaminated secretions.
Before moving the bed, it is important to make sure that no medical devices (catheters, drains, tubes, or other hoses) are at risk of being pulled, displaced, or torn out. If in doubt, never hesitate to ask the healthcare providers for help or advice!
It is common for patients in a coma to use an air mattress, whose air chambers inflate and deflate at regular intervals to shift the pressure points between the patient’s body and the mattress and minimize the risk of pressure sores. This can create the sensation of floating: some patients have dreams in the ICU in which they are on a boat.
Oxygen goggles, contrary to what their name suggests, are a small tube used to deliver supplemental oxygen to the nostrils when the oxygen in the air is insufficient for the patient. When these are not sufficient, a mask or a mask with a reservoir may be used, or the decision may be made to switch to more intensive therapies such as NIV (noninvasive ventilation) or mechanical ventilation via an endotracheal tube.
It’s often when patients start using this new device that they discover nasal breathing isn’t automatic! After all, you really do have to breathe through your nose for oxygen to reach your lungs.
After weeks in intensive care, they sometimes become a source of comfort for the patient, and it can be emotionally difficult to part with them when they are no longer needed.
Oxygen therapy via oxygen goggles—especially at high flow rates—can significantly dry out the mucous membranes and nasal secretions, and nasal irrigation with saline solution can provide relief.
A pressure-relief mattress is an air-filled mattress that, by circulating air through its air cells, redistributes the pressure points beneath the patient’s body to prevent prolonged friction. It makes some noise and moves around a little, but it effectively relieves pressure on the affected areas.
On the other hand, when you’re fully aware and independent, it’s not always very comfortable!
A metalline is a small, sterile pad that is cut to size and placed around the tracheostomy tube to protect the opening from friction caused by the collar.
A monitor (or "scope") continuously records heart and breathing rates, blood pressure and oxygen saturation in the blood. These data are collected using sensors and electrodes connected to the scope by cables. The monitors are configured to alert nursing staff if the patient's condition is unstable. The monitors are also connected to central monitoring stations, so that the patient's condition can be monitored at all times, even when the nursing staff are out of the room.
Encephalic death, or brain death, is not coma. It is an irreversible state in which a crucial part of the brain is destroyed, with no possibility of recovery. In intensive care, patients can be rendered brain-dead while still connected to machines that maintain the appearance of life: respirators that raise the chest, extracorporeal circulation that circulates blood, adrenalin or noradrenalin that maintain cardiac activity and blood pressure. The diagnosis of encephalic death is based on precise and specific criteria. Once this diagnosis has been made, the death certificate is signed by the doctor. Even if machines can maintain the appearance of life in the body for some time, the functions of a body whose brain has been destroyed become very quickly, very unstable, and it is not possible to maintain things for very long. Encephalic death is one of the situations in which organ donation is authorized in France.
As part weaning , various steps are planned to ensure the patient’s safe return to spontaneous breathing. The “artificial nose” stage occurs when the patient is disconnected from mechanical ventilation. The “artificial nose” is a tip that forms a small “T” shape when positioned on the outer end of the tracheostomy tube; its purpose is simply to protect the airways from contaminants and to humidify the inhaled air, just as the human nose does with its nasal hairs.
Norepinephrine is a medication in the catecholamine class: these are medications administered via infusion at a continuous and extremely precise rate, and their function is to improve heart function or increase blood pressure.
At night, the sounds of the ward fade away, and the lights dim. The nursing staff make their rounds quietly, trying to help the patients sleep. However, patients who are awake often have trouble sleeping, and this can cause anxiety.
When patients are no longer able to eat by mouth (due to sedation, coma, swallowing difficulties, etc.), they can be fed through a tube placed in the stomach or, in some cases, the intestine: the nasogastric tube. This is referred to as enteral feeding or nutrition (enter- meaning stomach).
In some cases, the patient’s digestive tract may not be functioning properly andcannot be used (for example, due to surgery, an infection, or a blockage).Nutrients are then delivered directly into the bloodstream through an IV placed in a large vein (see Catheter).
Medications are administered in water-based solutions to avoid irritating the veins. As a result, patients receive large quantities of fluids every day, and despite treatments designed to promote elimination, it is extremely common for intensive care patients to experience edema. The limbs swell, especially the hands. In some cases, the swelling is generalized to the whole body, including the face. This eventually subsides. Patients are weighed regularly, and when necessary, diuretic treatments (to induce urination) can speed up the resorption process.
From the patient’s perspective, they may experience warmth, itching, or a sensation that the skin is stretching and becoming fragile. In cases of severe edema, this can also cause significant pain. In addition to promoting the elimination of this excess fluid, the distribution of the edema can be altered by changing the patient’s position: edema shifts with gravity.
Acute Pulmonary Edema (or APE) is a rapid buildup of fluid in the lungs, often associated with heart failure. This condition causes severe difficulty breathing and a feeling of suffocation. Treatment aims to support the heart, reduce excess fluid in the lungs, and support breathing and oxygenation of the body.
This is the new legal term for what was previously referred to as “excessive medical treatment.”
It is common for an intubated patient to lose their sense of smell because the airflow is diverted through tubes and no longer stimulates certain sensory receptors along the usual pathway. This sense usually returns afterward. In cases of anosmia (which means loss of smell)—which can occur in rare instances—rehab is possible.
Opioids are analgesic medications used to relieve moderate to severe pain. Depending on the specific compound and the dose administered, they reduce the perception of pain, to the point of inducing drowsiness or an induced coma (usually in combination with a hypnotic).
Computers are invaluable tools in intensive care
More and more services are being computerized. Depending on the level of computerization of the service, the computer can collect, in real time, all data from the connected machines in the patient’s room. This allows for optimal traceability of all monitoring information as well as information regarding the patient’s treatment.
The computer obviously contains the patient’s medical record and prescriptions, which are constantly updated by the doctors in charge of the patient—in the morning after reviewing the latest test results, and throughout the day as vital signs (pulse, blood pressure, oxygen saturation, as well as all other parameters recorded by the machines over the course of 24 hours) and changes in the patient’s condition.
High-flow oxygen therapy(or HFOT) is a medical technique that delivers a large amount of oxygen under pressure to patients through small cannulas placed at the edges of the nostrils. It helps people who have difficulty breathing to breathe more easily, maintain adequate oxygen levels in the blood, and may prevent or delay the need for mechanical ventilation.
The pressure can feel a little intense at times, but you usually get used to it. The gas mixture being administered is warmed using a heated humidifier, also known as a “cooker.” It is possible to lower the heater’s temperature slightly if necessary, but it is important to maintain a certain level of humidity to prevent lung damage or damage to the mucous membranes of the respiratory tract caused by dry gases.
It is necessary to close your mouth and breathe through your nose to prevent the gas mixture administered through the nose from escaping through the mouth.
Palliative care is care provided to relieve symptoms so that patients can live as comfortably as possible.
Although often contrasted with curative care in public discourse and associated in the collective imagination with end-of-life care, palliative care actually refers to all care aimed at providing comfort: care that should be provided starting in the acute phase, alongside curative care (that is, care directly aimed at curing the disease).
At the end of life, or when curative treatment is no longer an option, all care will focus on what is known as palliative care, with the goal of making the patient’s final moments as comfortable as possible. As the saying goes, it is “all that remains to be done when there is nothing else to be done.”
Ventilator-Associated Pneumonias (VAP) are one of the most common complications of mechanical ventilation: bacteria naturally present in the mouth travel up the endotracheal tube despite precautions and regular oral care, causing a respiratory infection that compounds pre-existing problems. Numerous measures are taken in intensive care prevent MV-associated pneumonia: a semi-sitting position in bed, regular oral care, deep throat suctioning, frequent monitoring of the pressure in the cuff at the end of the endotracheal tube that traps oral secretions, etc. However, these measures are not always sufficient to prevent the onset of this infection in intensive care patients, who are, by definition, highly vulnerable.
The word "IV" can refer to the catheter that is inserted ("I'm putting in an IV") or to the fluid being administered ("The IV is finished").
From the patient’s perspective, it is a bag hanging above them, with fluid flowing into their veins through a catheter, and it can sometimes take on a symbolic meaning related to time. One patient said that her IVs had become “a way to mark the passage of time: watching the fluid flow, counting the number of bags, and so on.”
Another one says, “It’s like an hourglass whose grains trickle out slowly, soooo slowly.”
A trusted representative is an adult who has been officially designated in writing by the patient to receive medical information and convey the patient’s wishes if the patient is unable to express his or her will. This person may be afamily member, friend, neighbor, primary care physician, etc.
It is important that this person be able to have in-depth discussions with the patient in order to best represent the patient’s wishes, since they will be speaking on the patient’s behalf and not in a personal capacity. This designation is legally binding and must be made in writing, either on plain paper or on the form provided by the ICU. The designation document must include the contact information for the designated trusted person and bear the signatures of both the patient and the designated trusted person.
The trusted person may keep a copy of the advance directives so that they can present it when the time comes. The appointment of the trusted person may be revised or revoked at any time.
When we talk about “saturation,” we are generally referring to pulse oxygen saturation, which is measured by a sensor that looks like a small clip and is placed on the fingertip or, sometimes, on the earlobe. This measurement is a good indicator of the patient’s oxygenation but is not as accurate as arterial oxygen saturation, which is obtained by drawing an arterial blood sample (the “blood gases”).
Pneumonia is an infection of the lungs.
It occurs when microbes (most often bacteria, but sometimes viruses or fungi) cause inflammation of the alveoli, the small sacs where oxygen exchange takes place.
The alveoli can then fill with fluid or pus, making it difficult to breathe.
Severe pneumonia may require respiratory support ranging from simple supplemental oxygen via a nasal cannula to invasive mechanical ventilation.
The word "pneumopathy" means a lung disease.
An infusion pump (or syringe pump) is a device for injecting drugs and liquids into the veins, via a catheter. The syringe pump or infusion pump can be used to precisely adjust the flow of medication.
The urine collection container is used to empty the patient's urine bag and to regularly measure the amount of urine produced; it is a valuable indicator for assessing kidney function.
These are often large plastic containers stored in the room, which are emptied once a day during the intake/discharge check.
See urinary catheter
The lungs are the organs of respiration. They have two main functions:
In respiratory failure, the lungs fail to play their role. In some cases, a simple "helping hand" may be all that's needed, by providing them with a little more oxygen, or by insufflating the right gas mixture for the body's needs at a certain pressure (see V.N.I.).
In more serious cases, it will be necessary to intubate the patient and put him or her on artificial respiration, so as to be able to precisely control the proportions of the gas mixture adapted to the patient's needs, while providing maximum protection for the lungs weakened by the aggression in question.
Prescriptions are constantly updated by the doctors responsible for the patient, in the morning after reviewing the latest test results, and as the day progresses, according to changes in vital parameters (pulse, blood pressure, oxygen saturation and all other parameters collected by the machines throughout the 24-hour period) and changes in the patient's condition.
The intensive care unit intensive care a challenging environment and experience for patients and their loved ones, and can be traumatic. More and more units are hiring a psychologist to support patients and their loved ones. Patients and their loved ones often describe the psychologist’s knowledge of the intensive care environment, its challenges, and its realities as a major benefit. Psychological support is invaluable in helping patients and their loved ones get through this difficult time and providing guidance for what lies ahead.
Chest X-rays are performed very frequently in intensive care they allow for monitoring the progression of pulmonary disease, as well as verifying the proper placement of tubes (endotracheal tube, nasogastric tube) and venous catheters.
They are performed at the patient’s bedside using a portable X-ray machine. A plate is slid under the patient’s back—it’s a little hard and cold while the “picture” is being taken—then the height of the arm that emits the X-rays to expose the film is adjusted, there’s a little click, and it’s over.
The termintensive care has multiple meanings; it can refer to:
– The medical specialty, which is relatively recent in the history of medicine, is generally considered to have originated in the 1950s, when the first groups of critically ill patients requiring mechanical ventilation were established in the context of the major polio epidemic.
– the ICU cares for the hospital’s most critically ill patients or those at the highest risk of their condition worsening. The general public has little understanding of this specialty and often confuses it with the emergency room or the recovery room after surgery. The portrayal of these units in popular culture is often highly fictionalized and far from reality. People are generally ill-prepared for what to expect when entering an intensive care unit.
– intensive care also intensive care the technical and medical care provided to patients in critical condition in order to support (replace) organs that have become ineffective due to acute illness until the body “gets through” the acute phase; in English, the term “resuscitation” is used. intensive care a form of intensive organ support, cannot be sustained for very long because the balance it helps maintain is highly unstable and fragile.
– For patients, this word often refers to the experience of being in intensive care; as one patient put it, it is “a world apart from which one does not return unscathed.”
To advance scientific knowledge and improve care techniques, intensive care services are actively involved in scientific research. Data collected during the patient's hospital stay may be used anonymously for evaluation and research purposes. In addition, the consent of the patient or his or her family may be sought for comparative studies between different types of treatment or care. For this purpose, a consent form will be sent to the patient, if he or she is able to read and understand it, or to his or her next of kin if necessary, and must be signed. This form details the terms and conditions of the study proposed to the patient or his or her family. Of course, the patient or his or her next of kin are completely free to refuse, and this will in no way alter the care provided or the relationship with the healthcare team. If consent is given by the patient's next of kin, the patient will be asked to give his or her consent again once he or she is once again able to make decisions for him or herself.
From the patients' perspective, participating in research can be rewarding—knowing that their difficult experiences can help improve things for those who come after them.
Rehabilitation refers to the period—which can vary in length—during which the patient gradually works to address their physical and cognitive impairments in order to return to as normal a life as possible. It begins as early as the intensive care known as early rehabilitation) and often continues at a specialized center before the patient returns home, where follow-up care by medical specialists (depending on the organ damage) and allied health professionals (often at least physical therapists) continues to support the patient until they feel ready to resume their daily life.
"Vascular filling" (more accurately referred to as volume expansion) involves administering fluids into the bloodstream to increase blood volume. It is used when blood pressure is too low or when the body lacks circulating volume. The choice and amount of fluid are tailored to the patient's condition, the cause of the initial problem, and the patient's response to treatment.
The respirator (or ventilator) is a machine used to administer a gas mixture adapted to the patient's needs, with controlled volume and frequency. This maintains a stable and sufficient oxygen content in the patient's blood, and removes carbon dioxide. The ventilator assists respiratory function in the event of pulmonary and/or cardiac failure, but is also used when the patient is comatose, to protect the patient's lungs from infection. The patient is connected to the ventilator via an intubation tube placed in the trachea. This tube is always inserted under anaesthetic.
Depending on the patient's needs and level of independence, the ventilator can be adjusted in various ways to provide both the support and comfort the patient needs.
Waking up is an eagerly-awaited moment for the loved ones of intensive care patients. The longer the sedation phase (artificial coma) lasts, the more the elimination organs (liver and kidneys) are affected, and the longer it takes for the sedative drugs to be eliminated: in reality, "waking up" can take days, and very gradually.
It may take the patient a long time to regain their bearings, to understand what is happening around them and the care they are receiving; they may appear awake but disoriented, experience strange sensations, and not fully process everything happening around them at first. Some patients describe this moment as a “sticky sensation, as if I were being sucked into quicksand, with eyes that can’t open and a head that can’t move” or a “long, vague moment, far removed from the clichés portrayed in movies.”
See the " The Patient's Experience" page
When we speak of "saturation", we're usually referring to pulse oxygen saturation, measured by a sensor that looks like a small clip placed on the tip of the finger or sometimes on the earlobe. This measurement is a good reflection of the patient's oxygenation, but is not as accurate as arterial oxygen saturation, obtained from blood gases.
In the short term, wearing the saturation clip is painless, but over time, you may begin to feel discomfort or even pain—a pinching sensation. You can move it to a different finger, put it on your foot, or use a different type of ear clip to vary the pressure. Over time, this small sensor can also become reassuring.
A CT scan, also known as computed tomography, is an X-ray examination. It involves creating thin cross-sectional images of a part of the body. The X-ray tube rotates around the patient’s body, and the images are processed by a computer. These images must then be “interpreted” to enable a diagnosis.
During a CT scan, the patient lies motionless on their back, with their arms at their sides or behind their head, on an examination table that moves through a large ring-shaped scanner. This is where the various images are taken.
The medical staff is within earshot thanks to a microphone and monitors the exam from behind a glass partition to ensure it proceeds smoothly.
Depending on the situation, an iodine-based contrast agent is used to improve image quality; it is usually administered via an IV. This injection may cause some patients to feel a flush of heat.
A monitor (or “scope”) continuously records heart rate, respiratory rate, blood pressure, and blood oxygen saturation. This data is collected using sensors and electrodes connected to the scope via cables. The monitors are configured to alert healthcare staff if the patient’s condition becomes unstable.
These monitors are also connected to central monitoring stations so that the patient’s condition can be monitored continuously, even when healthcare staff are out of the room. Here, the green curve represents the electrocardiogram (the heart’s electrical activity) and the green number corresponds to the heart rate. The blue curve represents the pulse wave, and the number corresponds to pulse oxygen saturation, which allows for monitoring blood oxygenation; the red curve corresponds to blood pressure, measured continuously via an arterial catheter. The numbers represent “blood pressure,” and the number in parentheses represents the mean arterial pressure, a valuable indicator for healthcare providers.
See theContinuous Monitoring page
A.R.D.S., or Acute Respiratory Distress Syndrome, is a major respiratory failure requiring intubation and ventilation of the patient (artificial respiration). A.R.D.S. can have many causes, the most frequent of which are bacterial or viral. Management consists of treating the cause and supplementing the organs while the cause is being treated.
Tracheal secretions are mucus produced by the lungs and airways, which can be abundant and purulent in the event of an infection.
This sticky substance can take on different colors and provides healthcare providers with information about the patient's lung function.
When they build up, they cause significant discomfort for conscious patients—much like the feeling of congestion you get when you have bronchitis, but without being able to cough or clear your throat. Gurgling sounds in the throat or a drop in oxygen saturation may be signs that suctioning is needed.
See "suction."
Sedation is the administration of medications to “put the patient to sleep” or induce an artificial coma. It is used for several purposes: to allow one or more organs to rest, to prevent pain during an invasive procedure (such as an uncomfortable medical procedure or surgery), and to help patients tolerate the ventilator better. See anesthesia.
Sepsis is a severe reaction of the body to an infection.
Instead of simply fighting the microbe responsible for the infection (bacteria, virus, fungus), the immune system triggers an excessive response that can damage its own organs (such as the lungs, kidneys, or heart). Sepsis is a life-threatening emergency and requires appropriate care. Controlling the infection with appropriate treatment is the priority, but organ support may be necessary.
weaning to the gradual discontinuation of treatment. This includes, in particular, weaning , a process that can take anywhere from a few days to several weeks in some cases. It can also refer to weaning .
weaning is the phase of care aimed at restoring the patient's ability to breathe independently.
We will gradually reduce the level of ventilator support; depending on the duration of the acute phase, patients may have lost varying amounts of muscle mass. A temporary tracheostomy can facilitate and accelerate the weaning process, allowing the patient to be disconnected from the ventilator for a few hours a day while retaining the option to reconnect, particularly at night and during rest periods. Muscle rehabilitation is also very important in this process: sitting in a wheelchair, standing, etc., are all ways to rebuild the patient’s chest wall muscles and help them recover more quickly.
weaning a period of gradual adjustments that can be very exhausting for patients, and the initial difficulty breathing on their own can be truly distressing. Soothing stimuli and ways to distract the patient from focusing on their breathing can help prevent them from fixating on it and increasing their anxiety.
Some patients describe a rather pleasant “feeling of their lungs expanding” when they start breathing on their own again.
Yes, you can wash your hair in the intensive care unit! In technical terms, it's called a "capiluve."
Since it’s not considered urgent, it’s usually done on days when caregivers have a little more time on their hands and can set aside a little time to make it a true “well-being” treatment—but you can also request it if needed!
Sometimes the scalp itches, and it can be really soothing for the patient to feel clean on their head, too!
Tips from Réanimé: Providing caregivers with detangling masks for long hair can save even the longest manes—which have been tangled between the scalp and the sheets since the patient’s arrival…
Oral care refers to practices that help keep the oral cavity clean and reduce the risk of pulmonary infection from saliva and the bacteria it contains.
They involve running sticks that look like large cotton swabs—with cotton on one end only—over all the surfaces inside the mouth. You dip the swabs in menthol mouthwash and run them over your teeth, tongue, palate, and the inside of your cheeks. You then swallow any saliva and liquid that has dripped to the back of your throat. You should also use a flashlight at regular intervals to check for any abnormalities, such as damaged teeth, unusual redness, or swelling.
These treatments are necessary to prevent ventilator-associated pneumonia. For the patient, this can feel pleasant and refreshing or a little intrusive, much like a visit to the dentist. Confused patients will often try to bite down on the stick.
See "stick."
A nasogastric tube (or feeding tube) is a plastic tube with one end that extends into the stomach. It can be used to drain the patient’s stomach in certain cases, or, more commonly, to feed the patient during their stay in intensive care. Through this tube, the patient receives a balanced diet containing appropriate amounts of carbohydrates, proteins, fats, vitamins, and minerals. The nasogastric tube can be inserted through the nose or the mouth. Sometimes, a tube called a “gastrostomy tube” can be inserted directly into the small intestine through a minor surgical procedure. A nasogastric tube is more comfortable after extubation because it leaves the mouth free to speak, but it can cause discomfort or even pain along its path, particularly in the nose or at the back of the throat. Insertion through the nose can sometimes be painful.
Since it is not secured as firmly as other, more vital tubes, the accidental dislodging of a nasogastric tube is a common occurrence in the history of intensive care patients—whether due to carelessness or discomfort from the tube. Unfortunately, it is usually necessary to reinsert it so the patient can receive the nutrients needed for a successful recovery, and that is not a very pleasant experience…
The intubation tube is a plastic tube passed through the mouth (or, in rare cases, the nose) and positioned at the crossroads between the two lungs to enable artificial respiration (ventilation). It is usually attached with a cord around the patient's head. This attachment device can dig into the cheeks a little. It is important that the probe does not move, to ensure the most precise and efficient ventilation possible.
The endotracheal tube has a cuff on the outside that is inflated after insertion to fill the entire space between the trachea and the tube, ensuring that no secretions from the mouth or stomach enter the lungs.
The condition of the balloon is checked regularly, and any secretions trapped inside the balloon are suctioned out by physical therapists using a small cannula.
Every day, we check that the endotracheal tube is inserted to the correct depth, and the caregivers replace the tie—a sort of string that holds the tube in place outside the mouth. Attached to the endotracheal tube is the feeding tube, which is directed toward the esophagus.
Intubation prevents:
> to speak
> eat
> drink
This device can be very distressing for some patients, as it fills the mouth and the tube runs across the lower part of the face. With the tube in place, the mouth remains slightly open at all times: this causes the inside of the mouth, the tongue, the inside of the cheeks, etc., to become very dry and can greatly increase the sensation of thirst.
A urinary catheter is a simple, very flexible plastic tube used to drain urine from the bladder in patients who need to have their urine output measured, as well as in comatose patients to prevent them from remaining wet all day.
This tube is connected to a collection bag and is held in place by a small balloon that is inflated inside the bladder, preventing the catheter from slipping out of the body. Measuring urine output is part of monitoring kidney function. The urinary catheter is therefore necessary for intensive care patients intensive care , like any internal device, can lead to infections.
From a sensory standpoint, this can be confusing: since the bladder does not have a wide variety of sensory receptors, the foreign object—the catheter—can be interpreted as the urge to urinate. But in reality, with a catheter in place, the bladder is always empty! Certain medications can help with this sensation (this urge to urinate associated with these sensations is called “catheter urge”), and sometimes it just takes a little time for the body to get used to it.
A stoma is a temporary or permanent connection between a section of the digestive tract (esophagus, intestine, colon, etc.) or a part of the urinary tract and the outside of the body through a small opening in the abdomen. Created during surgery, this opening is designed to allow the passage of stool or urine when they can no longer be eliminated through natural channels. These are then collected in a special pouch, which is attached directly to the skin.
A stethoscope is a medical device that amplifies body sounds, enabling doctors to make a wide range of diagnoses and allowing nurses and physical therapists to detect changes in a patient’s condition by listening.
With a stethoscope, you can listen to the heart, the lungs, and even the abdomen! Nurses actually use it to check the position of the nasogastric tube.
The round tip that rests on the body is sometimes a little cold.
Post-traumatic stress is a disorder that can develop after experiencing or witnessing a violent or traumatic event, such as a serious accident, an assault, or, in this case, hospitalization in intensive care. It can affect both patients and their loved ones.
This should be considered when, several months after being in the intensive care unit, a person continues to relive the trauma in their thoughts or nightmares, experiences severe anxiety, avoids any situations that remind them of the event (such as hospital visits), and exhibits changes in mood or behavior.
This disorder requires appropriate monitoring and support to help the person recover. Effective therapies are available, such as cognitive-behavioral therapy, EMDR, and other approaches like exposure therapy. A consultation with a state-licensed mental health professional (psychiatrist, psychologist) can help clarify the individual’s needs and initiate a treatment plan to restore a sense of calm.
See the page " The Psychological Consequences of intensive care"
Tumor lysis syndrome occurs when cancer cells break down very rapidly, either spontaneously or following treatment. This breakdown releases substances into the bloodstream that can disrupt the functioning of the kidneys, heart, or brain. Close monitoring and specific treatments are sometimes necessary.
The body temperature of intensive care patients intensive care a very important piece of data that is recorded multiple times a day: at least every 2–3 hours, but sometimes much more frequently!
Temperature can be measured in the ear with some thermometers, under the arm with others, or continuously via sensors inserted into certain probes or catheters.
Temperature monitoring enables the early detection of infections, which are common in intensive care all measures taken to prevent them, because patients are particularly vulnerable and it is important to detect these infections as early as possible. In some cases, it may be necessary to induce hypothermia in patients—that is, to lower their body temperature to between 34 and 36°: here too, precise temperature monitoring helps manage this hypothermia.
Thrombosis is a risk associated with bed rest, potential coagulation disorders, or foreign objects inserted into the venous and arterial trunks (catheters, ECMO cannulas). To prevent thrombosis, intensive care patients are given intensive care , often as subcutaneous injections in the thighs and/or abdomen. This can cause bruising and hardening of the skin, which will disappear over time.
In intensive care , personal hygiene intensive care generally performed at the patient’s bedside, using a basin and disposable washcloths. The procedure is carried out one body part at a time, keeping the unwashed area covered to preserve the patient’s modesty.
Work your way through each area, starting by washing the skin with soap and water, then rinsing it off and drying it.
Patients may experience bath time in very different ways: as a moment of comfort and tenderness, of letting go and well-being, or as a source of discomfort, unease, and embarrassment.
From the healthcare providers’ perspective, this is a routine procedure performed to maintain hygiene for all intensive care patients, who are particularly vulnerable and at risk of developing infections: it’s a procedure like any other, one that can be extended a bit if it’s pleasant for the patient (and if there’s time), or performed quickly and efficiently if it’s more comfortable for the patient not to drag things out.
intensive care units intensive care on a schedule based on the “rounds” that healthcare providers make to check on patients. At regular intervals, a nurse-and-caregiver team visits the rooms of the patients in their care to provide treatment and monitor their condition.
Depending on the department and specialty, these rounds are conducted every 2, 3, or 4 hours.
Doctors are also making their rounds at longer intervals.
Everyone remains available to handle any emergency situation outside of their shifts, of course.
A tracheotomy is a minor procedure that involves inserting a breathing tube (a flexible plastic tube) directly into the trachea through an incision at the base of the neck. It is performed to facilitate and accelerate the recovery of independent breathing when theweaning process is taking too long and/or is uncomfortable for the patient.
Once the walls have healed, the device no longer causes pain. It is safe to touch (but do not remove it!). While the device may look intimidating and be a little frightening (some patients may feel disgust), it greatly facilitates rehabilitation and frees up the mouth and throat. Compared to an endotracheal tube, the tracheostomy tube reduces the feeling of pressure from the device on the face, as well as the dryness and thirst associated with having the mouth permanently open when using an endotracheal tube.
Secretions may leak out through the opening around the tube; it is not airtight. And endotracheal suctioning is now performed through this cannula to clear the bronchi.
While the tracheostomy is in place, daily care is provided to:
– Clean the skin around the tracheostomy tube with a gauze pad moistened with sterile water (warm or cool, depending on the patient’s preference) and, if necessary, an antiseptic in cases of inflammation or infection
– Replace the metal sleeve (a pad placed around the probe to prevent friction)
– Changing the tracheostomy tube or collar: This can be a frightening experience for the patient, because if the tube moves, it feels as though it’s going to come out! When the patient is able to assist, they can hold the tube in place against their neck while the caregiver adjusts the length of the collar.
The collar may cause some irritation and become bothersome over time: gently massaging the neck with something cool during grooming sessions—when the collar is temporarily removed—is often appreciated.
When a tracheostomy tube is worn for long periods, particularly in the intensive care unit (ICU), it is common to change the tracheostomy tube every month. The cannula is then removed and the new one reinserted immediately. Light anesthesia may be offered for this procedure, or it may be performed without it, depending on the patient’s condition. This can be somewhat painful and a little distressing, with a sensation of friction against the inner walls, and it may cause minor bleeding.
In most cases, the tracheostomy tube is then removed, and the incision heals on its own within a few days. However, this often leaves a small scar on the lower part of the neck.
See "Tracheostomy Tube."
Handoffs are the times when healthcare teams relieve one another at regular intervals. The team that has finished its shift passes on information to the incoming team. This moment is very important for healthcare providers to ensure continuity of care and the sharing of all the information needed to provide safe patient care.
These moments are set aside as special times during the day, and we minimize interruptions as much as possible to prevent any loss of information or oversights.
This might give the impression that the teams are less available at that time, but in an emergency, the broadcast stops and everyone springs into action!
The term “transport” refers to the movement of a patient to another department within the hospital for an examination or surgical procedure. During this transport, continuity of care and monitoring are maintained. It is a delicate process that requires specific logistics and medical supervision.
Depending on how services are organized and the hospital’s infrastructure, a patient may be transported in their bed or on a stretcher—a sort of simplified bed on wheels that is much narrower so it can fit in elevators, with a thinner mattress than the one used in intensive care which may feel uncomfortable for the patient’s back.
To move the patient onto the stretcher, the sheets are usually pulled: two caregivers on either side of the bed, and one caregiver at the head to coordinate the maneuver, monitor all tubes, and keep the endotracheal tubes in place.
We take the ventilator and a transport monitor that allows us to continue continuous monitoring, as well as all the machines that can’t be turned off: syringe pumps with certain medications, etc.
When a patient’s heart fails, it may be necessary to replace it with the heart of a deceased donor: this is called a heart transplant. This procedure requires lifelong medical follow-up, a strict diet, and daily use of anti-rejection medications. A transplanted heart can function properly for several decades.
Dysphagia, or “swallowing disorders,” can result from a prolonged period during which the swallowing muscles have not been used or from a neurological condition. Weakened muscles prevent proper swallowing, and food may partially enter the airways: this is known as “aspiration,” which manifests as a cough during eating and can lead to lung infections. Depending on the severity of the condition, aspiration can occur with solid and/or liquid foods.
Heart rhythm disorders are characterized by abnormal heartbeats that are too fast, too slow, or irregular. Some are benign and common in the general population, but others can have more serious consequences, preventing the heart from functioning properly and leading to loss of consciousness, dizziness, or cardiac arrest. Continuous cardiac monitoring and emergency treatment may be necessary.
The phonation valve is a tip attached to the outer end of a tracheostomy tube whose cuff has been deflated beforehand; it is astep in weaning that enables speech.
The phonation valve allows air to enter the airways, but a one-way valve system prevents it from escaping through the same route. The only way for exhaled air to escape is to pass back through the normal airways—the throat, mouth, and nose. To achieve this, the cuff attached to the trachea is deflated. This allows the air to travel back up, pass through the vocal cords again, and cause them to vibrate, thereby enabling speech.
“It’s impossible to sing *La Traviata*” from the very first time the vocal valve is engaged, as one patient put it: here again, we’ll have to retrain the body to make the effort to modulate the exhaled air in order to articulate words, and the first few sessions will be tiring—though generally very satisfying, because at last, we can express ourselves!
Vasopressors are medications that raise blood pressure by constricting blood vessels. They are used when blood pressure is too low to ensure adequate blood flow to the organs.
A vegetative state occurs when, following brain damage and in the absence of sedative treatment, the patient is left with only reflexes. These include the alternation of the sleep-wake cycle, reflexes to stimuli such as eye movements, yawning and involuntary movements. Patients in a vegetative state are unaware of their condition and their environment.
Noninvasive ventilation (NIV) is an alternative to intubation that can be used in certain specific cases. It is performed using a ventilator that delivers air in the same way as invasive ventilation but uses a mask that fits tightly over the face instead of an endotracheal tube.
From the patient’s perspective, NIV can be confusing or even unpleasant at first, because the pressure of the air pushing into the airways feels very strange and unusual. It is important to adjust the ventilator settings to the patient’s needs and comfort to ensure good tolerance of this highly effective therapy.
Once the adjustments have been made, the NIV can be soothing and reassuring afterward.
The mask can sometimes feel a little tight, and air leaks can be bothersome, especially if they occur at the top of a nose-and-mouth mask near the eyes. Choosing the right mask and using small silicone pads can help ensure a tight seal and reduce anatomical discomfort.
Viruses are disease-causing microorganisms. They enter the body's cells to multiply ("replicate"). They transmit information that leads the cells themselves to produce numerous copies of the virus, which are then released to infect other cells. Antibiotics do not work on viruses, but can be used when bacterial superinfection occurs in the wake of a viral infection.
The term "central venous access" (CVA) is synonymous with "central catheter."