What are the most common reasons why patients are placed in the intensive care unit (ICU), with rough percentages?
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Retired general internist, former intensive care physician.Updated 6y
Indications are a threatening vital organ failure we want to prevent, or worse, an established vital organ failure, usually:
-circulatory failure, usually circulatory shock (mostly due to sepsis)
-respiratory failure, due to primary lung disease (pneumonia, lung emboli) or secondary to circulatory shock (adult respiratory distress syndrome ARDS, formerly named “Shock lungs”) for which invasive or non invasive mechanical ventilation is needed
-kidney failure: for which we perform hemofiltration (not hemodialysis).
-liver failure, for which we only in the highest levels of ICU have very experimental MARS (AKA Liver Dialysis) system, according to Molecular adsorbent recirculating system (MARS) in acute liver injury and graft dysfunction: Results from a case-control study although effective on the short term, not raising 28 day survival.
-serious brain injury (trauma, stroke, bleeding) where intracranial pressure can be continually monitored, lowered by mannitol or hypertonic saline infusions, dexamethason, hyperventilation, or craniotomy.
-burn patients usually have a combination of circulatory, respiratory, infectious problems, and a breakdown of the barrier function of the seriously damaged skin.People having a myocardial infarction or arrhythmias are admitted to the Coronary Care Unit.
Those needing mechanical ventilation after a cardiac arrest or due to lung edema at present are treated on the Intensive Care Unit, since if the heart arrest caused a post resuscitation coma we for 24 hours keep the patient cooled to 34˚C (to spare the brain, some say 36˚C is as good) thus have to mechanically ventilate them.This graph shows you which people are admitted from the ED to the ICUThis pie chart shows from which departments the patients originated
Patients are typically admitted to the intensive care unit (ICU) for a variety of reasons, ranging from critical illnesses to post-operative care. Common reasons for ICU admissions include:
Respiratory Failure (30-40%): Conditions such as pneumonia, acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD) exacerbations, and severe asthma can lead to respiratory failure, necessitating ICU admission for advanced respiratory support.
Sepsis (20-30%): Sepsis is a life-threatening condition that occurs when the body’s response to infection causes widespread inflammation and organ dysfunction. Patients with severe sepsis or septic shock often require ICU care for close monitoring and aggressive treatment.
Cardiovascular Emergencies (15-25%): Conditions such as acute myocardial infarction (heart attack), heart failure exacerbations, arrhythmias, and cardiac arrest can lead to ICU admissions for hemodynamic monitoring, advanced cardiac support, and interventions.
Neurological Emergencies (10-15%): Stroke, traumatic brain injury, seizures, and other neurological emergencies can lead to ICU admissions for neurocritical care, monitoring, and treatment to prevent further brain damage.
Post-operative Care (10-15%): Patients who undergo complex surgeries or experience post-operative complications may require ICU care for close monitoring, pain management, and support during the recovery period.
Trauma (5-10%): Patients with severe traumatic injuries, such as those from motor vehicle accidents, falls, or assaults, may require ICU admission for resuscitation, stabilization, and surgical interventions.
Gastrointestinal Bleeding (5-10%): Severe gastrointestinal bleeding from conditions such as peptic ulcers, variceal bleeding, or inflammatory bowel disease may require ICU care for hemodynamic stabilization, blood transfusions, and endoscopic interventions.
Acute Kidney Injury (5-10%): Patients with severe acute kidney injury requiring renal replacement therapy (dialysis) may be admitted to the ICU for specialized renal care and monitoring.
It’s important to note that these percentages can vary based on the specific patient population, hospital setting, and regional differences in healthcare practices. Additionally, some patients may have multiple medical conditions that contribute to their need for ICU
Who is the “we” you speak of? Your mother, aunt, father, yes indeed we should help, if you define that we as YOU and your siblings, cousins, … I “wanted” to retire to a life of comfort at age 45. I likely could have done so if all those “you” didn’t think that “we” have an absolute right to stick your hand in “my” pocketbook.
If we want to die at home, we should plan and save for that. A lot of we already die at home – heart attack, accident, self-inflicted gunshot wound. Besides, there is already a we for that. Hospice care is designed just for that and most of the expense is covered by medicare.
Another reason we don’t help people die at home is because we are weak. We urge doctors and hospitals to treat our relatives when it is beyond hopeless. We actually torture them, trying to force them to breathe for one more day. Our urban lifestyles have separated us from the familiarity with the cycle of life and death. Our moral decay has made us more fearful of death and suffering. That is part of the reason healthcare is so expensive in the US. We spend hundreds of thousands of dollars to treat people who are not treatable.
A large majority of people say they want to die at home rather than in any hospital. For what reasons should we not help them to do so?
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Former University Senior Lecturer Computer Science4y
My late mother-in-law was diagnosed with ovarian cancer and wanted to die at home. However, after a while being at home she needed oxygen. She became frightened of possibly not having enough oxygen, and frightened of not having sufficient pain management, despite the regular and frequent visits from a Macmillan (cancer care) nurse.In the end, it was better for her to be in the hospital, where she was able to relax more, knowing that help was instantly at hand should she need it.She was taken to Northampton General Hospital, which had an excellent hospice on the grounds. The hospice not only provided a home-like setting for her with all her needs taken care of right there and right then, but also provided the rest of the family with a room as well. As her time got closer, one or more of the family could be in constant attendance and still have a place to have a shower, brew up a bit of tea, heat a dinner, lie down or sleep, as needed.She could possibly have had all that at home through the Macmillan nursing support, but she feared what might happen in the event that things went wrong and the nurses were not immediately to hand. We all felt that her final weeks were better managed in the hospice at Northampton General because being there helped her deal with her fears of pain or suffocation.(By the way, she herself had been a nurse and had worked at the Royal Marsden, so she had a fairly good knowledge of the treatment of cancer patients and what might happen to her.)My grandfather, on the other hand, died at home a few weeks following his last stroke (of seven). His family managed to care for him, between a home nurse, my mother, my grandmother and my aunt, and he went peacefully.
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Lived in Portugal4y
I was only a kid when my mom died. She had cancer and had been sick for almost 1 year before her death. During that year, she mostly stayed at home, but her last month was so hard that she had to go to the hospital, where she died.A couple of weeks after her death, I remember hidding next to the living-room’s door so I could hear my grandmother (mom’s mother) and my dad arguing/fighting about how my mom’s last wish was to die in her own home and how the doctors had said that it was possible to do that with some palliative home-care.My grandmother was angry because apparently my dad hadn’t authorized my mom’s displacement from hospital to home. But my dad answered that I would still be living in the same house, and he didn’t want for me to have the memory of my dead mom there.I do feel bad that my mom didn’t get her last dying wish. And I feel bad that my grandmother had to hear her dying daughter asking for something and not get it. But I am glad my dad decided that way. My last memories of my mom at our house are of a happy and healthy person (followed by very few and somewhat foggy memories of her being sick at the hospital); and even though I never talked to my dad about it (after all, I wasn’t supposed to have listened that argument)… I thank him and I appreciate his decision-making.
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Management Consultant – Finance at Various Companies(1995–present)4y
Who is the “we” you speak of? Your mother, aunt, father, yes indeed we should help, if you define that we as YOU and your siblings, cousins, … I “wanted” to retire to a life of comfort at age 45. I likely could have done so if all those “you” didn’t think that “we” have an absolute right to stick your hand in “my” pocketbook.If we want to die at home, we should plan and save for that. A lot of we already die at home – heart attack, accident, self-inflicted gunshot wound. Besides, there is already a we for that. Hospice care is designed just for that and most of the expense is covered by medicare.Another reason we don’t help people die at home is because we are weak. We urge doctors and hospitals to treat our relatives when it is beyond hopeless. We actually torture them, trying to force them to breathe for one more day. Our urban lifestyles have separated us from the familiarity with the cycle of life and death. Our moral decay has made us more fearful of death and suffering. That is part of the reason healthcare is so expensive in the US. We spend hundreds of thousands of dollars to treat people who are not treatable.
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Psychiatric Patient Care Technician
· 4y
We should absolutely help them die in the comfort and familiarity of their own homes.Dying, surrounded by comfort and peace, is the best gift we can give people at the end of their lives. Hospitals are necessary, and do good work, but they are hardly calming environments that put a person at ease. They are sterile, noisy, and busy. None of those promotes the emotional well-being of a dying patient.
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Lives in Virginia (1944–present)4y
RelatedAre there people who prefer to die in a hospital bed that is in their own home?
Well, as I write this, my bride is in a hospital bed, in our living room. She has a big bay window where she can see the birds on the bird feeder, and the Momma Doe deer that come up each morning with their fawns. My bride is in the final stages of a genetic disease that destroys her central nervous system- no cure, no treatment, 100% fatal. We have known this was coming for a long time.She would rather be here in her own home, with her kitten curled up beside her. We eat our meals together. I can rub her feet, our grandkids can come visit whenever they like. We can keep her warm, clean, fed and safe. What we CANNOT do is keep her from dying- we have accepted that is going to happen.And she would rather that happen here than in a hospital room. Hospitals are for curing people that are sick or injured. We have been part of the Home Hospice program (plug for Bon Secours- GREAT people) that helps me care for my bride.We’re grownups. We get to make grownup choices about grownup things. This is one of them.Peace
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Librarian
· 4y
Obviously there will be many situations where “home” isn’t an option. If the patient dies in the ER ir ICU after a serious accident or heart attack or whatever, the person will die in hospital.Otherwise, there may well be situations where there are no family members or friends to help with care (24/7 private hospice nursing is not, I think, an option for most), so home may not be suitable. But a physical hospice, or comfort Care in hospital should be
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RelatedAre there people who prefer to die in a hospital bed that is in their own home?
I would rather die in the hospital, so my family wouldn’t have to continue living in a house i died in.
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Former Registered Nurse/Midwife/HIV Specialist4y
RelatedAre there people who prefer to die in a hospital bed that is in their own home?
My brother died of a non-hodgkins lymphoma before his 50th Birthday. He opted to die in hospital because he did not want his young children to be stressed more than necessary. He worried they would be freaked out going into the room he died in.As it happened, he was only in hospital for a very short time before he died. He became hypoxic (breathless) during the night but was determined to wait until morning before his wife took him to the hospital. He was immediatly taken to X-ray to determine if he had recurrent pneumonia. He died on the X-ray table (alone except for the techician) before they could take the first film.I have worked as a palliative care nurse for many years. Many of the surviving partners told me they wish they had not agreed to keep their loved one at home rather than hospital or hospice as they underestimated how exhausting (mentally, physically and spiritually) it was going to be, particularly if they do not have extended family support.Both the UK and Canada healthcare systems provide excellent daytime palliative care but unless you can afford to pay for overnight care, you are more or less left on your own. Most people can cope over a short period of time but once it streaches into weeks or months, the strain becomes unendurable.
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CEO and mother of 3 great kids
· 5y
RelatedIf one chooses to die at home rather than a hospital is this traumatizing for the family who will continue to live there?
I don’t think so as this was the way that most of our ancestors died. Hospitals are a very recent development. I imagine that I would want my loved one to be in an area of comfort when they passed. My father in law recently died this way at home. No hospital equipment would have helped him, and he was receiving nursing assistance and pain medication at home. My mother in law is neither more, nor less, traumatized by the location of his death. She is just sad as a result of his passing. And as far as I know there are no hauntings either.
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Retired From MI Dept Corrections5y
My parents and husband died within six weeks of each other. I kept them home when we knew they were not going to last. They wanted to be home. They were clean, fed, and most importantly, loved completely. The realities are many. Laundry has to be done almost constantly. Meds have to be set and ready all the time. Bathing is needed every day. Meals? I cooked three different meals three times a day, plus had snacks ready. Changing diapers…cleaning shit off your loved ones ass because they forgot how to toilet. Being afraid to sleep because you might miss them calling for you. My husband kicking me so hard he broke blood vessels in my legs. You know what? If I had a chance to do it all over again, would I? You betcha I would. I loved them fiercely and was devoted to them. The funeral home came to pick them up, they complimented me on having such a tidy nursing home. You know what the worst sound in the world for me was? Turning off the oxygen pump for the last time. The silence, the absolutely dead silence. Now, I was fortunate enough to have hospice in to help. I understand some countries don’t have that option. It’s a lifesaver, truly. Someone stayed there while I went shopping, to give me a break. And God bless a woman who saw me sobbing in the parking lot of the grocery store. She asked if I was ok…I told her what was happening. She dropped everything in her hands and just hugged me. The simple reality is not everyone has an option of keeping a loved one home. I get that. In my mind, I loved them so dearly, no one else could take care of them like I could.
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M.A.English litrature from Osmania University (Graduated 1979)
· 5y
RelatedDo a lot of people live literally their entire life wanting to die?
YES that is TRUE. We come into this rough world sans our permission . Unable to handle stress sufferings losing loved ones. Human birth is not everybody’s cup of tea. It just not worth the trouble
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The core issue here is how the old person can be cared for in the best wayOld people often think they can cope, but they cannot and either injure themselves falling down, or they get dehydrated because they find it difficult to go to the lavatory, and they stop drinking adequately. Rapidly a series of problems happen, with urinary tract infection following, and a very sick hospital case.As a relative, more and more falls onto you and this gets to a point at which you cannot cope, as you are generally working and have a family. There is frequently tension between siblings, as very often one or more do not pull their weight, and there is the suspicion that there may be financial irregularities and that wills may get altered……The options available are in the UK are care funded by the Local Council, which can be good, but can be awful. Lightning visits by a different person every day, and chaos and back into hospital again.Private carers are often good, and I used a service for my mother, who was 97. They normally have to be live in, which can be difficult in small houses, and they are not cheap. Most individuals are OK, but some are crooks, and others are nuts of various types. From experience, any nationality other than British were probably OK, but the Brits were doing this job for odd reasons, and weretrouble. You still have to keep tight control on what is going on, and that means a lot of visits.As the elderly person deteriorates, one person may not be able to cope. Hence there is no alternative to a nursing home, which is very expensive. £1200–2000 a week!Old people can be from marvellous to vindictive nightmares who are utterly selfish. The good understand their plight and try and fit in. The old buzzards are a hazard to themselves, and wreck the lives of those nearest and dearest. I was lucky.Sometimes, it is utterly impossible to do anything but get the old person into the best care home. What is the “best” carehome? In a sentence: reputation, availability, not smelly, and not a latter day prison. There are horrors out there.
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I behave a human way
· 6y
RelatedWhy is it so bad that some people want to die?
I attempted suicide. I was 13. At school I was being assaulted, bullied and harassed. Constantly called names and getting beat up. When I was at home I was beat again. My grandmother would take scissors and slash things up that I loved like a jacket my mother wore. Or a teddy bear I had since I was two. She would scream at me that nobody loved me and nobody would ever want me or want to help me. And tell me I might as well stop crying because no one cared. She sometimes would keep food away from me. She felt that I wasn’t well behaved enough to eat her food or at her table.At the time I tried Continue Reading
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Ministry (1969–present)
· 5y
RelatedWhy would you want a death at home when it present emotional and financial challenges for family members and does not automatically equate a good death? What are the realities of dying at home instead of a hospice?
The reality is unless there is enough money to hire good end of life caregivers, people dying at home is a harsh unpleasant way to go. Hospice can only do so much unless you’re rich or have a lot of free help from family and friends. I watched a couple of friends in home hospice die. They had their family and friends support. However the emotional toil on their family and friend was enormous.Each family or individual should weigh their options realistically and financially. Making the last few days or years should be as comfortable for not just the dying but for everyone. There is no glamour iContinue Reading
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Laura D ·
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Complicated life, opinionated, left, bisexual
· 4y
RelatedIf a perfectly sane old person wants to die rather than be a burden to society, why should we stop them?
Imagine you’re 96 years old. You’re perfectly healthy, but your children are dead, your husband is dead, your friends are dead, you live on your own but your old neighbors are dead and you’re too old to make good contact with the new ones.Being a burden on society is one thing. But that often is just the cover of all these things together.Hell yeah someone should have the right to end their lives.I for me believe that ANYONE, no matter their age, should have the right to end their lives whenever they are truly done with it, for whatever reason. It’s not up to anyone else to decide how resilienContinue Reading
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Custom Computer Modeler/Builder (2017–present)
· 4y
RelatedWhy would someone want to spend their last days in the hospital versus the comforts of their home?
Not everyone has the same comforts.
At times, the hospital offers more comforts than most people would ever have in their lives.
That is kinda why homeless people commit crimes in the winter, such that they get sent to prison and have a place to stay.Also, in a hospital, you have trained people standing by to helping with anything that you need.
If you are in pain, they can make sure you die without an ounce of it, and blood filled with morphine.So in general, the hospital is just the better choice for most people.
Being at home, puts a burden on your family, that most people really don’t wantContinue Reading
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Messanger (2015–present)
· 6mo
RelatedDo people who are about to die sometimes say they are ‘going home”?
And yes they do thats where they came from and thats where they are going back,we have it Good living two lives one in the flesh tempauery and the other in the spirit everlasting God is a mighty God,we should be good to him not in prays but in Love he ment us well,we need to position our self to know God our life and world will never be the same.
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RelatedIf old people want to die at home, should we force them into a facility just so they can live longer at the expense of their happiness?
I went through this when I lost my mother 2 yrs ago.She had cancer and didn’t have long to live.She was adamant about staying in her home. She hated the thoughts of being left in a nursing home with strangers to take care of her. She had the opinion that when family had a person moved to a nursing home, they were basically just getting them out of the way, and she had heard horror stories about people being mistreated in those places. Being the only child, I promised her that I would see to it that she never had to go to a nursing home.In Georgia when an elderly person who lives alone goes to Continue Reading
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Advocate for digital privacy for over 25 years
RelatedIf old people want to die at home, should we force them into a facility just so they can live longer at the expense of their happiness?
The short answer is no: provided a person clearly understands the risks no one should be forced into a facility.That said, the more nuanced answer is, it’s not that simple…Older people generally suffer from various chronic medical conditions, some of which can be life-threatening. If an older person is living at home, and most especially if they are living alone, it can take far longer to summon assistance if a medical crisis develops. If they are in a properly-run and well-staffed facility, assistance can be rendered much faster, thus preserving life.However, if the person clearly and completContinue Reading
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MSN in Nursing (college major) & Pain Management, SUNY Upstate Medical Center (Graduated 1995)
· 5y
RelatedIf an elderly person decides to die at home vs in hospital is this ok to allow them to do?
Hospice and palliative care may be provided in a home situation but every family is not able to deal with the person’s hopes and preferences. You would not send a person home without basic services. There are some organizations which are available for people who do not want to die in an acute care facility which may be suitable too.
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Former statistician
· 6y
RelatedWhy is it so bad that some people want to die?
It’s only bad if they are suicide bombers who want to die as a terrorist and take unwilling people with them.If they want to die because they find continuing with their lives intolerable, they have every moral right to do so and to be assisted in a freely chosen exercise of personal autonomy.
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Author 12 Young Adult Mysteries, 3 Adult Mysteries at Lancaster County, PA (2000–present)
· 5y
RelatedWhy would you want a death at home when it present emotional and financial challenges for family members and does not automatically equate a good death? What are the realities of dying at home instead of a hospice?
My sister was diagnosed with glioblastoma in April 2005 and died in November of the same year.It’s a deadly, fast-growing, unrelenting form of cancer. She had 2 surgeries back-to-back, spent time in the hospital then went home.We knew the odds but the cancer team “went through the motions” of treatment. She had chemotherapy and radiation therapy. It was less help than a band-aid.In the 6 months from diagnosis until death, two people were always with her, her husband and another family member.Because of the nature of the surgery, my sister was left paralyzed on her left side. She could feed herContinue Reading
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Studied Life : Think, Imagine, Explore, Execute, Enjoy.at Hindu College, University of Delhi (Graduated 2018)
· 7y
RelatedIf there were a choice, would you prefer do die at home or in hospital?
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