The intensive care unit is a specialized medical service in which the most serious patients are hospitalized until their vital functions are no longer threatened.

Different units of an intensive care unit are distinguished:

The Continuous Monitoring Unit (ICU)

It is intended to take care of patients at risk of vital failure requiring close monitoring. They must be able to cope with the failure if it occurs and prepare the patient for his rapid transfer to the intensive care unit.

The intensive care unit (ICU)

It is empowered to deal with a single failure for a limited period.

Resuscitation

It is intended for the prolonged management of patients with multiple failures.

All the services are not necessarily available in all hospitals: this is particularly the case with resuscitation. On the other hand, all hospitals, public or private, have a 24-hour continuous surveillance service.

The intensive care units each have their own specialty:

• Cardiologique;
• Nephrological;
• Respiratory;
• Vascular neurological;
• Hematologic;
• Neonatal;
• Pediatrics;
• Management of severe burns;
• And many more

Patients are admitted to intensive care when one or more vital functions fail as a result of:

• Severe infection (septic shock);
• Intense dehydration;
• From an allergy;
• A heart problem;
• Drug poisoning;
• From polytrauma;
• Of a coma;
• Acute renal failure;
• Acute respiratory failure;
• Cardiac arrest;
• Major surgery such as heart or digestive surgery;
• And many more

In an intensive care unit, the condition of the patients and the treatments implemented require specialized personnel.

The specialization of the medical staff on site depends on the type of activity:

• In a resuscitation unit, resuscitators are present;
• In an intensive care unit in cardiology (ICU), cardiologists;
• In a continuous monitoring unit, anesthetists;
• And many more

The doctors are specialists in anesthesia-intensive care or in intensive care and work in collaboration with all the specialists of the hospital: physiotherapists, technicians in medical electroradiology, nurse in general care (IDE), hospital service agents …

Continuity of monitoring and 24-hour care is ensured with the help of a large number of paramedics and the permanent presence of a medical team on site, to respond immediately to any urgent situation – two IDEs for five patients in intensive care, one IDE for four patients in ICU and USC.

All the resuscitation services have equipment to ensure continuous monitoring of the main body functions and the condition of patients.

The surveillance equipment includes:

• Electrocardioscopes;
• Blood pressure monitors;
• Colorimetric oximeters – infrared cell placed in the pulp of a finger to measure the percentage of oxyhemoglobin in the blood;
• Central venous catheters (VVC).

And the constants monitored are as follows:

• Cardiac frequency ;
• Respiratory rate ;
• Arterial pressure (systolic, diastolic and mean): it can be discontinuous, thanks to the cuff which inflates at regular intervals, or continuous, via a catheter implanted in the radial or femoral artery;
• Central venous pressure (PVC);
• Oxygen saturation;
• Temperature: it can be discontinuous – measured using a thermometer – or continuous using a probe;
• And others according to needs: intracranial pressure, cardiac output, depth of sleep, etc.

The data of each patient – individual rooms – are displayed in real time in each room and in parallel on a screen located in the central hall of the service so that the staff can monitor all patients simultaneously. If one of the parameters changes suddenly, an audible alarm is triggered instantly.

Resuscitation is a highly technical environment where it is possible to set up many assistance systems:

• Respiratory assistance: oxygen glasses, oxygen mask, tracheal intubation, tracheostomy and respiratory physiotherapy sessions;
• Cardiac and respiratory assistance: drugs to restore normal arterial pressure, respiratory assistance machine which improves the oxygen supply to the organs, extracorporeal circulatory assistance machine;
• Renal assistance: continuous or intermittent dialysis;
• Artificial nutrition: enteral nutrition by tube in the stomach or parenteral nutrition by infusion;
• Sedation: light sedation – the patient is conscious – with general anesthesia – the patient is in an induced coma;
• And many more

Finally, hygiene and comfort care, called nursing, are provided daily by nurses, nursing assistants and physiotherapists.

Resuscitation services are open to families and loved ones whose presence and support are a key part of recovery. Psychologists, social workers, administrative agents and religious representatives are available to support patients and their families.

A survey by the Department of Research, Studies, Evaluation and Statistics (DREES) estimates the number of beds – adults and children, public and private – in France in 2018:

• At 5 in intensive care;
• To 5 in intensive care unit;
• At 8 in continuous monitoring unit.

A survey carried out in November 2020 by the Société de Pneumologie de Langue Française (SPLF) and the National Professional Council of Pneumology identified all the long-term care structures, intensive care units, intensive respiratory care units (USIR) and continuous pneumological surveillance (USC) on national territory:

• The USIRs, backed by pneumology departments, are exclusively located in CHUs: 104 beds in 7 regions;
• The pulmonary USCs backed by pulmonology departments: 101 beds, or 81 USC beds + 20 beds in structures combining USIR and USC.

It is very difficult to predict the prognosis of patients admitted to intensive care. The evolution – improvement or worsening – of the patient’s clinical condition will determine, on a case-by-case basis, his chances of survival and good recovery.

Published in October 2020, the Covid-ICU study – Covid-19 infection in Intensive Care Unit, “intensive care unit” – included 4 French, Belgian and Swiss adults with acute respiratory distress syndrome linked to infection with SARS-CoV-244. Ninety days after their admission to intensive care, the mortality was 2%.