THE INTENSIVE CARE UNIT

THE NEXT GENERATION OR

INTRODUCTION
• ICU is viewed increasingly as an OR in acute care
procedures for critically ill, untransportable patients.

• Other reasons: OR is expensive, allocated to certain

surgeons long waiting list.

• Limitations of an ICU to an OR: less space, infection

control practices are different.
UNTRANSPORTABLE PATIENT
RATIONALE
• As long as the environment is favorable an integrated
OR team can support any critically ill patient - OR
/ICU.
• All the medications and equipments that are
available in the OR is also allowed in the ICU.
• Over head lighting, room temperature, a dropped
instruments can be sterilized in 5 min and etc.
• Transport of critically ill children are more hazardous
than adults.
SO WHAT DO I NEED

Prepared unit and staff

- Understands the operative and anesthetic procedures
A Culture of Safety and Accountability
- How handle sharp instruments, dealing with body fluids,
maintenance and cleaning up.
Infection control
- Hand washing, early removal of catheter and drains, pulmonary
toilet and etc
Anesthesia, Analgesia, and Sedation
USG guided aspiration or drainage procedure
SPECIFIC BED SIDE SURGERY

• Neuro Surgery—Burr hole,Ventriculostomy

• Head and Neck Surgery - Re-opening of thyroid or
parathyroid surgery, tracheotomy
• Thoracic surgery- USG guided thoracocentesis, CTT, re-
opening sternotomy, PDA ligation (rare)
• Abdominal surgery- Paracentesis, peritoneal dialysis
catheter placement, Percutaneous cholecyctostomy,
Enteral feeding access, Endoscopy, Laparotomy,
Laparoscopy
EXTREME OPERATIONS DONE IN THE ICU

• Surgical debridement of necrotizing Fasciitis

• Fasciotomy
• Escarotomy
• Arthrocentesis
• Inferior Vena Cava Filter placement
Surgical critical care team starting bedside
percutaneous tracheostomy. Procedure support nurse
is pictured in middle at the head of bed in order to
manage endotracheal tube.
Dilation of tracheotomy using Ciaglia Blue Rhino® during bedside
percutaneous tracheostomy.
Standard equipment set up for bedside modified percutaneous
tracheostomy using Ciaglia Blue Rhino® kit
Bedside percutaneous endoscopic gastrostomy tube placement.
Bedside laparotomy with abdominal washout. Procedure support
nurse (right) acts as scrub nurse. Critical care nurse (left)
administers sedation and monitors vital signs.
Instruments used for beside laparotomy, including removal of packing and fascial
closure. Additional instruments may be required for more complex procedures,
such as bowel anastomoses or ostomy creation.
CONCLUSION

• It is important to remember that OR is still the

preferred venue to perform the vast majority of
surgical procedures.
• However, the OR is no longer the only location, in
which operative procedures can be safely and
effectively performed.
• The ICU has become an accessory theatre, in which
surgical procedures are now routinely performed.
CONCLUSION

Advantages to perform procedures in the ICU

• Eliminating risks associated with transporting

critically ill patients,
• Avoiding OR availability issues and cost savings
CONCLUSION

Essential in performing surgery in the ICU

• Properly training the ICU personnel, including a

specially trained PSN or mobile OR personnel
• Appropriate patient and procedure selection for the
ICU setting are paramount to minimise the risk of
adverse outcomes.
THANK YOU