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Deep Vein Thrombosis (blood clot)

Definition
Deep vein thrombosis (DVT) is a common complication that can affect any immobilized patient. A DVT is a blood clot in the deep veins of the leg or groin. The most serious complication of DVT is a pulmonary embolism, where the blood clot travels into the lung, which can be life threatening.

Causes
The main risk factor for DVT is being immobile, which is common in ICU patients. Some patients are more likely to form blood clots for other reasons including cancer, infections, trauma or genetic reasons

Treatment
To prevent DVT, patients in ICU are treated with low dose blood thinners if it is safe to do so. In patients who cannot take blood thinners, special stockings are used to squeeze the legs until blood thinners are safe to use. If a DVT occurs, it is usually treated with higher dose blood thinners.

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Kidney Failure

Definition
Kidney (renal) failure is the inability of the kidneys to filter waste products and fluid, resulting in a build-up of toxins in the bloodstream and fluid in the body.

Causes
There are many causes of kidney failure. In the ICU it is often caused by shock, infections, or medications. Sometimes kidney failure is temporary in other cases it becomes a life-long disease.

Treatment
Filtering the blood through a machine to remove the waste products may be necessary; this is called dialysis.

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Infections

Definition
Infection means invasion of the body by microorganisms that cause harm to a person. Infection can be caused by bacteria, viruses, or fungus; in ICU most infections are caused by bacteria. Many different parts of the body can be infected, but in ICU the most common sites include the lungs, IV catheters, and the bladder.

Causes
The main risk factor for a lung infection (also known as pneumonia) is being on a breathing machine. IV catheters, especially catheters placed in the deep veins, are essential for caring for ICU patients, but may become infected with time. ICU patients are at risk for bladder infections due to the catheters used to drain urine from the body.

Treatment
When an infection is suspected, tests are performed in order to confirm its presence. When confirmed, infections are usually treated with antibiotics. In some cases removal (and replacement) of catheters will be required.

Liver Failure

Definition
The liver is the largest solid organ in the body. It has many important functions including blood clotting and removal of toxins from the blood. When the liver fails toxins can accumulate in the blood causing confusion, the blood sugar may become low, and the patient may have bleeding. Severe liver failure can be life threatening due to bleeding, infections, or brain swelling.

Causes
Liver failure can develop for many reasons, including shock, infection, ingestion of a poison, or due to chronic diseases (such as alcoholism or heart failure). In ICU the liver may become damaged as a side effect of medications used to treat other important conditions.

Treatment
The treatment of liver failure depends on the cause. The goal is to support the patient’s vital signs while treating the underlying cause of the liver failure, although some causes of liver failure do not have specific treatments.

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Stomach Ulcers

Definition
Stomach ulcers, also known as stress ulcers, occur when the lining of the stomach breaks down related to stomach acidity. This breakdown can result in bleeding, which is often minor but can be severe or even life-threatening.

Causes
Stomach ulcers are more common in ICU patients due to the stress put on the body from being very sick. Most ICU patients are treated with medications which reduce the risk of stomach ulcers by lowered the amount of acid in the stomach.

Treatment
If bleeding occurs because of a stomach ulcer, medications are given to reduce the amount of acid in the stomach. This will help the bleeding stop and the ulcer to heal in many cases. Sometimes patients require direct therapy using a scope (camera) inserted into the stomach through the mouth, and in rare case surgery may be required to stop the bleeding.

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Skin ulcers (pressure ulcers)

Definition
Lying in bed can put pressure on the skin, especially in areas where bones are close to the surface such as the tailbone. This pressure causes the skin to be deprived of blood flow, which can result in skin breakdown. This process can lead to pressure sores, otherwise known as skin (or “decubitus”) ulcers.  

Causes
The primary risk factor for developing pressure sores is prolonged immobilization, which is common in ICU patients. Patients who are malnourished, have chronic muscle weakness, or who have been hospitalized for prolonged periods of time are at particular risk. 

Treatment
The focus is on preventing pressure sores where possible, because they are very difficult to treat once they have occurred. Efforts are made to change the position of patients very frequently to vary the pressure points. Physiotherapists work to maximize strength and mobility, and dieticians strive to optimize patient nutrition.

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Weakness

Definition
Patients in ICU are prone to becoming weak very quickly, a process which is due to problems with nerves (known as neuropathy) or wasting of the muscles themselves (known as myopathy).

Causes
The exact cause of this type of acute weakness is not known, but it is likely related to widespread inflammation of the body caused by being severely ill. Patients who are very sick, those treated with certain types of medications (such as anti-inflammatory steroids), and those with high blood sugar levels are at higher risk.

Treatment
There is no specific treatment for ICU related weakness, and thus the focus is on prevention by good nutrition and physiotherapy. Patients who develop this type of weakness recover very slowly if the underlying cause of their acute illness improves.

Confusion

Definition
The onset of confusion in a hospitalized patient is referred to as delirium, which is very common in the ICU. Delirium may include periods of confusion, agitation, and hallucinations.

Causes
The exact cause of delirium that occurs in ICU patients is not known. The stress of a critical illness or injury, major surgery, lack of sleep, medications, electrolyte abnormalities or infection may all contribute to the problem. The most likely explanation for a patient’s delirium is usually a combination of the above factors.

Treatment
The treatment of delirium is aimed at correcting reversible medical conditions and protecting the patient from being injured. If general supportive care fails to control the agitation, medications and temporary soft restraints may be required to protect the patient from harming himself or herself.

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Medication Side Effects

Definition
All medications administered in the ICU have the potential to cause harmful effects which are not intended, known as side effects. Side effects can be mild (such as a skin rash or diarrhea) or severe (such as bleeding or severe allergy). Before administering any medication, the ICU team (including doctors, pharmacists and nurses) carefully weigh the benefits and risks of each medication, and administer the medication only if the benefits are felt to outweigh the risks. When therapies which carry a high possibility of causing severe side effects are being considered, the ICU team may discuss the situation with the patient or their family beforehand.

Procedural Complications

Definition
Most patients in the ICU require minor procedures to be performed at regular intervals. Most commonly, such procedures involve the placement of lines or tubes, such as feeding tubes, breathing tubes, drainage tubes, or IVs into the deep or superficial veins. All procedures carry a small risk of complications, meaning harmful effects which were not intended. All possible measures are taken to reduce the risk of such complications, but the risk is never zero. Most procedures are performed by doctors, but some are performed by nurses or respiratory therapists. In all cases the person performing the procedure is capable of performing it safely, and is being supervised if necessary. In the event that a patient requires a major procedure (beyond the normal procedures that all patients require), the situation will be discussed with the patient or their family.

Last updated on: May 26th, 2021