Intensive care is unfamiliar territory for most families, and decisions often have to be made quickly. Dr Jonathen Venkatachalam, Senior Consultant in Respiratory & Critical Care Medicine at Aeden Health, who has served as a Medical ICU Director, explains the treatments families most often ask about, and what recovery looks like afterwards.
Mechanical Ventilation: When Do You Consider This?
What a ventilator does
A ventilator is not a treatment in itself. It is a machine that does the work of breathing while we treat the underlying illness and give the body time to recover.
When is it considered?
We consider it when the lungs, the brain or the muscles can no longer keep the oxygen up or the carbon dioxide down.
Comfort and coming off the ventilator
Patients are kept comfortable with sedation, and we aim to wake them and remove the tube as soon as it is safe.
Risks and honest conversations
Ventilation carries risks, and not everyone will benefit. This is why early and honest conversations with patients and families about wishes, expected recovery and what matters most are so important.
Tracheostomy Care: Patients and Carers
Life-saving, but demanding
A tracheostomy can be life saving, but living with one is demanding, for patients and for those who care for them.
What daily care involves
Secretions need to be cleared regularly, the airway needs humidifying, and the tube needs routine changes and daily care.
The toll on carers
Carers often carry this around the clock, and the physical and emotional toll is rarely spoken about.
What makes a real difference
Proper training before going home, home nursing support, speaking valves, cough assist devices and a plan for emergencies make a real difference. Respite for carers is not a luxury. We aim to support the patient and the family together.
Parenteral Feeding: When the Gut Cannot Be Used
Feeding through the gut first
Whenever possible, we feed through the gut. However, there are times when the bowel is blocked, has been operated on, is badly inflamed or is simply not working.
What is parenteral nutrition?
Parenteral nutrition delivers a carefully balanced mix of nutrients directly into the bloodstream, usually through a special line. It is prepared and monitored by a specialist nutrition team.
The risks
It is not without risks, which include line infections and changes to blood sugar and liver tests.
Returning to the gut
We aim to return to feeding through the gut as soon as it can be used. A small number of patients need it for the longer term, and can be taught to manage it at home.
CRRT: A Gentler Dialysis
When standard dialysis is not possible
Patients who are critically ill often have kidneys that have stopped working, along with a blood pressure that is too low to tolerate standard dialysis.
How CRRT works
Continuous renal replacement therapy, or CRRT, runs slowly over 24 hours, removing fluid and waste gently and keeping the blood pressure steadier. It is carried out in the intensive care unit by specialist teams.
Do the kidneys recover?
The kidneys of many patients recover, allowing the treatment to be stopped. Some need ongoing dialysis, and we work with kidney specialists to plan for this early.
Post-ICU Care: Recovery After Intensive Care
Not the end of the journey
Leaving the intensive care unit is not the end of the journey.
What is post intensive care syndrome?
Many survivors experience muscle weakness, poor memory and concentration, breathlessness, disturbed sleep, anxiety, low mood and distressing memories. Families can be affected as well. This is known as post intensive care syndrome, and it is common.
How long does recovery take?
Recovery takes months, and not days. Early rehabilitation, follow up clinics, support for mental health and a clear explanation of what happened in the ICU help patients and their families find their feet.
You are not alone
If you or someone you love is struggling after a critical illness, you are not alone, and help is available.
Next steps
Dr Venkatachalam consults at Aeden Health. To arrange a consultation, book an appointment or read more about The Aeden Physicians. Families looking for support at home can read about The Aeden Nursing.
Related guides: Lung and Respiratory Conditions: A Patient Guide · General Medicine: Common Conditions Explained
Frequently Asked Questions
What does a ventilator actually do?
A ventilator is not a treatment in itself. It is a machine that does the work of breathing while we treat the underlying illness and give the body time to recover.
What does tracheostomy care at home involve?
Secretions need to be cleared regularly, the airway needs humidifying, and the tube needs routine changes and daily care.
What is parenteral nutrition?
Parenteral nutrition delivers a carefully balanced mix of nutrients directly into the bloodstream, usually through a special line. It is prepared and monitored by a specialist nutrition team.
What is CRRT?
Continuous renal replacement therapy, or CRRT, runs slowly over 24 hours, removing fluid and waste gently and keeping the blood pressure steadier. It is carried out in the intensive care unit by specialist teams.
What is post intensive care syndrome?
Many survivors experience muscle weakness, poor memory and concentration, breathlessness, disturbed sleep, anxiety, low mood and distressing memories. Families can be affected as well. This is known as post intensive care syndrome, and it is common.