This glossary combines technical explanations of key intensive care terms with descriptions of the patient experience, developed with the Les REAnimés group, whom you can contact through Second Life by 101.
As a patient’s condition evolves, the intensive care team may need to reconsider whether ongoing treatments still offer a meaningful benefit. When burdensome or invasive treatment is no longer expected to improve the patient’s condition, some treatments may be limited or stopped, and care may focus on comfort.
In France, treatment that constitutes obstination déraisonnable—unreasonable persistence with treatment—is prohibited by law. Decisions to withhold or withdraw treatment are made collectively by the care team, with an external medical opinion where required, while taking account of the patient’s expressed wishes and keeping those close to them fully informed. The decision is reviewed regularly as the situation changes. The older expression acharnement thérapeutique is now generally replaced by obstination déraisonnable.
Ketoacidosis occurs when the body produces a large amount of acidic substances called ketones. It most often develops when there is not enough insulin, particularly in people with diabetes. It can cause dehydration, abdominal pain, abnormal breathing and changes in consciousness. Prompt treatment is needed to correct the metabolic imbalance and address the cause.
Adrenaline is an emergency medicine. It is given during cardiac resuscitation or through a precisely controlled continuous infusion to support the heart and circulation.
A patient—especially one who is unconscious—may notice nothing when it is administered. Some people describe a sudden sense of warmth or a powerful “boost”, and occasionally a headache.
When a patient cannot eat safely by mouth because of sedation, coma or swallowing difficulties, liquid nutrition can be delivered through a tube into the stomach or, in some cases, the intestine. This is called enteral feeding.
The feed contains protein, carbohydrate, fat, vitamins and minerals. It is used when the digestive system still works and is the closest alternative to normal eating, helping preserve gut function and prevent malnutrition.
From the patient’s perspective: the feed usually comes in a cream-coloured bag connected to a pump and feeding tube. It is painless and has no taste because it does not pass through the mouth. Continuous feeding may reduce feelings of hunger and fullness. In some cases it is given mainly at night to encourage appetite and oral eating during the day.
When the digestive tract cannot be used—for example after some operations, because of infection or because of a blockage—nutrients can be delivered directly into the bloodstream through a large vein. This is called parenteral nutrition.
It provides the energy, protein and other nutrients needed for recovery when enteral feeding is not possible. The solution is usually supplied in a pale or white bag and is given through a central venous catheter because it can irritate smaller veins over time.
Amnesia means loss or absence of memory. It is common for patients to remember little or none of their intensive care stay. Sedative and anaesthetic medicines, severe infection, disrupted sleep and the illness itself can all interfere with the formation of memories.
Some patients describe a complete gap extending from before they became unconscious until several days after waking: “It is as though the film was never put in the camera.” Many later want to reconstruct this missing part of their story, either immediately or months afterwards. Explanations from the team, conversations with family and an ICU diary can help.
Amenorrhoea means that menstrual periods stop. Serious illness and intensive care can temporarily disrupt or stop menstruation as the body directs its resources towards survival. Cycles usually return as recovery progresses, but persistent changes should be discussed with a doctor.
Anaesthesia uses medicines or gases to prevent pain and, where needed, awareness and movement. General anaesthesia makes the patient unconscious; local or regional anaesthesia numbs only a specific area while the patient remains awake.
In intensive care, general anaesthesia or deep sedation may also be used to allow vital organs to rest and to make invasive treatment, such as mechanical ventilation, possible. The moment of induction can feel like falling, being pulled away or becoming suddenly warm. Anaesthesia is not normal sleep and does not necessarily leave a person feeling rested. Some medicines may contribute to vivid dreams or unusual memories.
Anoxia is a complete absence of oxygen supply to tissues. Cells are rapidly damaged when oxygen is unavailable. Prolonged anoxia affecting the brain can cause severe and irreversible neurological and cognitive injury.
Analgesia means reducing or eliminating pain. It may involve pain-relieving medicines, but non-drug approaches can also help. Depending on the cause, heat, cold, positioning, relaxation or physiotherapy may provide effective relief.
Antiarrhythmic medicines prevent or treat abnormal heart rhythms. They act on the heart’s electrical activity to restore or maintain a more regular rhythm.
Antibiotics treat infections caused by bacteria; they do not work against viruses. In intensive care, they are often started quickly when a serious bacterial infection is suspected and adjusted once test results identify the organism.
Immobility, changes in blood clotting and devices placed in large blood vessels—such as catheters or ECMO cannulas—increase the risk of thrombosis, in which a blood clot partly or completely blocks a vein or artery.
Anticoagulant medicines reduce this risk. They are often given as injections under the skin of the abdomen or thighs and may leave temporary bruises or small firm areas.
Antihypertensive medicines lower blood pressure. Different classes act on the heart, blood vessels or kidneys. In an acute situation, the dose may be adjusted frequently according to the patient’s condition and blood-pressure readings.
In this context, aplasia refers to a major fall in white blood cells, often an expected effect of certain cancer treatments. It leaves the body much more vulnerable to infection.
Febrile neutropenia is fever occurring when the white blood-cell count is very low. Because the body is less able to fight infection, it is a medical emergency requiring rapid assessment and antibiotic treatment where appropriate.
A small writing board may be offered to a patient who cannot speak but can write. Practical tip from former ICU patients: felt-tip pens dry out quickly when caps are difficult to replace, so spare pens and an eraser or wipes are useful.
During cardiac arrest, the heart stops pumping blood effectively, so oxygen no longer reaches the brain and other organs. Cell damage begins within minutes and may become irreversible. Immediate cardiopulmonary resuscitation—chest compressions, ventilation and defibrillation when indicated—is essential to restore circulation and reduce the risk of permanent injury.
Tracheal suctioning removes mucus from the airways of an intubated or tracheostomised patient. A thin suction catheter is passed through the breathing tube to clear secretions the patient cannot cough out effectively.
The procedure triggers coughing and can be unpleasant, especially when repeated frequently, but it can also bring considerable relief by making breathing easier. Gentle technique is important because the trachea can become irritated. Suction may also be used during mouth care or to remove saliva when swallowing is impaired.
Asthma causes inflammation and narrowing of the airways. Symptoms include breathlessness, chest tightness, cough and wheezing. Attacks may be triggered by infection, allergy, exercise or irritants.
A severe acute asthma attack is a medical emergency in which the airways become so narrow that usual treatment is not enough. Powerful bronchodilators, oxygen and sometimes ventilatory support may be required.
A stroke occurs when part of the brain loses its blood supply because of a clot or bleeding. It may cause weakness or paralysis, speech difficulties, visual problems or loss of consciousness. Rapid treatment is essential to limit permanent brain injury.
A bacterium is a microscopic living organism. Many bacteria are harmless or beneficial—for example, the gut microbiome supports digestion—while others can cause infection. Antibiotics may be used to help the body fight harmful bacteria.
A multidrug-resistant bacterium has developed resistance to several antibiotics, making infection harder to treat. Preventing transmission in hospital is therefore essential, and staff and visitors may be asked to follow additional isolation precautions when entering the room. See “Isolation”.
In some French ICUs, the “base” is the patient’s routine maintenance infusion. It usually contains saline or a glucose solution, with vitamins or electrolytes added according to need. See “Infusion”.
Patients who are intubated or cannot swallow safely are unable to drink, even though fluids are being provided by other routes. Their mouth can become very dry, especially when a breathing tube prevents the lips from closing fully.
Soft oral-care swabs can be moistened with water, mouthwash or—where safe and permitted—a flavoured liquid, then squeezed out and used to freshen the lips and inside of the mouth. See “Mouth care”.
A bag-valve mask is a hand-operated resuscitation device found in every intensive care unit. It can deliver oxygen before intubation, provide emergency ventilation or temporarily replace the ventilator during certain procedures. “Ambu” is a commonly used brand name.
The identification wristband is an important safety measure. Staff check it before medicines, blood products, tests and procedures to confirm that the right care is being given to the right patient. These checks remain essential even when staff know the patient well, because structured safeguards reduce avoidable human error.
Bronchoscopy uses a thin flexible camera to examine the inside of the airways. In an intubated patient, the scope is usually passed through the breathing tube; otherwise it is generally introduced through the nose or mouth. Samples can be taken to identify infection or other disease, and mucus may be cleared at the same time.
The procedure may be performed under general anaesthesia, sedation or local anaesthetic. It can be uncomfortable when the patient is awake. After a bronchoscopy performed under sedation, the patient may notice easier breathing because secretions have been removed.
COPD is a long-term lung disease, often associated with prolonged smoking, that narrows and damages the airways and makes breathing progressively more difficult. Infections or other lung problems can therefore become particularly serious.
Treatment may include bronchodilators to open the airways, oxygen and ventilatory support. Non-invasive ventilation is often preferred where appropriate because weaning from invasive ventilation can be more difficult in severe COPD.
Ward managers are experienced nurses with additional management training. They coordinate nursing and support staff, oversee the organisation and logistics of the unit and can help families understand how the service operates. See “The intensive care team”.
A tracheostomy tube is placed through a small opening in the front of the neck directly into the trachea. It can replace an oral breathing tube when prolonged ventilation or gradual weaning is expected. It frees the mouth, shortens the airway and can improve comfort.
The tube may have an inflatable cuff that helps prevent secretions entering the lungs. As recovery progresses, the patient may gradually spend longer breathing without the ventilator and may be able to speak, eat and drink with specialist support. Before removal, the tube may be capped to confirm that the patient can breathe through the nose and mouth. Removing it is called decannulation.
A catheter is a soft hollow tube inserted into a blood vessel. Peripheral intravenous cannulas go into small veins in the hand or arm. Central venous catheters enter a large vein in the neck, groin or beneath the collarbone and often have several lumens so that different medicines can be given safely at the same time. Arterial catheters are placed in an artery to monitor blood pressure and take blood samples. Dialysis catheters are larger central lines through which blood is removed and returned.
Central and arterial catheters are inserted using sterile technique and local anaesthetic. The initial injection may sting and the procedure can feel strange or take some time. Small scars can remain where the tube and securing stitches were placed.
An arterial line continuously measures blood pressure and allows frequent blood samples to be taken without repeated needle punctures. It is inserted under local anaesthetic using sterile technique and requires sterile dressing care.
A central venous catheter provides secure access to a large vein for medicines that can damage small veins or must be delivered very accurately, such as noradrenaline. It may also help measure pressures within the circulation. The line is inserted under local anaesthetic using sterile technique and requires careful sterile maintenance.
A dialysis catheter is a large central venous catheter, usually placed in the neck or groin. One lumen carries blood from the patient to the dialysis machine and another returns the filtered blood. Some catheters have an additional lumen for medicines.
Extracorporeal membrane oxygenation (ECMO), also called extracorporeal life support, temporarily supports the lungs or both the heart and lungs in the most severe cases.
Large tubes called cannulas are placed in major blood vessels. A pump moves blood outside the body through a membrane that adds oxygen and removes carbon dioxide before returning it. Venovenous ECMO supports the lungs; venoarterial ECMO also supports the circulation and heart.
ECMO is highly invasive and carries important risks. It is normally established under general anaesthesia, although exceptional circumstances may require local anaesthesia. The large cannulas and securing stitches can leave scars. Further reading: Katia Ghanty, Les frottements du cœur.
The treatment trolley contains the supplies needed for most bedside care, including blood sampling, dressings and medicine administration. Nurses and healthcare assistants check and restock it every day so it is ready in an emergency. Because its surface is used during sterile or clean procedures, visitors should not place personal belongings on it or touch it with unclean hands.
In the French hospital system, a chef de clinique is a doctor who supervises day-to-day clinical care and the junior doctors working in the unit. They help coordinate the care team and define daily objectives for each patient, under the authority of the head of department.
In medicine, shock is a life-threatening failure of the circulation in which blood pressure and blood flow are insufficient to supply the organs. It can rapidly damage the kidneys, lungs, liver and brain. Main types include septic shock caused by severe infection, haemorrhagic shock caused by major blood loss, cardiogenic shock caused by heart failure and anaphylactic shock caused by a severe allergic reaction.
A person may feel profoundly unwell, dizzy or faint, cold and shivery, have ringing in the ears or difficulty speaking, and may lose consciousness as shock worsens. The skin may become pale or mottled.
Anaphylactic shock is life-threatening circulatory failure caused by a severe allergic reaction. It requires immediate emergency treatment. See “Shock”.
Cardiogenic shock is life-threatening circulatory failure caused by the heart being unable to pump enough blood. See “Shock”.
Haemorrhagic shock is life-threatening circulatory failure caused by major blood loss. See “Shock”.
Septic shock is severe circulatory and organ failure caused by an overwhelming response to infection. See “Shock” and “Sepsis”.
Extracorporeal circulation means that blood is temporarily pumped outside the body through a machine. In intensive care this usually refers to ECMO, which supports the lungs alone or both the heart and lungs.
Large cannulas carry blood to a pump and oxygenator, where oxygen is added and carbon dioxide removed, before it is returned to the patient. The treatment is reserved for the most severe situations because it is highly invasive and carries substantial risks. It is usually established under general anaesthesia and can leave scars at the cannula and suture sites. Further reading: Katia Ghanty, Les frottements du cœur.
A heated humidifier warms and moistens the medical gases delivered to a patient. Oxygen and compressed air are naturally dry and can irritate the airways or thicken secretions. Humidification improves comfort and reduces complications. It may be used with an endotracheal tube, non-invasive ventilation mask or high-flow nasal cannula.
A total artificial heart replaces both of the heart’s ventricles with mechanical pumping chambers. Implantation requires major surgery. It may be used in carefully selected patients as a bridge while awaiting heart transplantation and, depending on the device and country, within specialised programmes or clinical research.
Coma is a state of profound unconsciousness. It may be caused by illness or brain injury, or deliberately induced with sedative medicines—sometimes informally called an “induced coma”—to permit treatment and reduce stress on organs.
A person in a coma cannot reliably protect their airway, so intubation and mechanical ventilation are often required. Nobody can know exactly what an unconscious patient hears, but familiar voices may still be perceived. Staff explain procedures before touching the patient, and family members are encouraged to speak calmly to them even if no memory remains later.
Oral nutritional supplements are energy- and protein-rich drinks or desserts, sometimes enriched with vitamins and minerals. They are prescribed when normal food intake is not enough, for example after illness or surgery. They supplement ordinary meals rather than replacing them and help prevent or treat malnutrition.
Awake patients in intensive care are often confused, disorientated or unable to think clearly. This may be part of delirium and can be caused by infection, medicines, pain, sleep disruption, fatigue and the unfamiliar environment; older age increases the risk.
Regular reminders of the place, reason for admission, date and time can help, as can daylight, glasses or hearing aids, family contact and safe mobilisation outside the room. A confused patient may speak or behave in ways that are completely unlike their usual personality, which can be distressing for relatives. The change is generally temporary. One patient described it as: “I am in a cloud, in a fog, floating between different realities.” See “Delirium”.
Obtaining consent can be difficult in intensive care when a patient is unconscious, delirious or has severe neurological impairment. Teams seek the patient’s agreement whenever possible and try to understand their values and wishes through previous statements, advance directives and conversations with people close to them. When the patient cannot decide, care is guided by their best interests and the applicable legal framework. Ask the team or unit psychologist if you have questions.
Physical restraints may occasionally be used when severe agitation, delirium or uncontrolled movement creates an immediate risk that a patient will remove a breathing tube, catheter or feeding tube. Accidental removal can cause serious harm and may require an urgent repeat procedure.
Restraints should be used only when necessary, reviewed frequently and removed as soon as the patient can remain safe. They can be frightening, frustrating and may worsen persecutory thoughts, so the benefit–risk balance must be assessed carefully. In some circumstances, restraints can be released while a trained person remains continuously at the bedside, but this requires medical and nursing agreement.
Corticosteroids are powerful anti-inflammatory medicines that act throughout the body. They are used for a range of conditions, including severe inflammation, asthma, allergic reactions and some forms of shock.
Some intensive care patients cannot regulate their body temperature and need active warming. A forced-air warming blanket is a lightweight inflatable cover placed over the patient and connected to a small machine that circulates temperature-controlled warm air.
Neuromuscular blocking medicines temporarily paralyse skeletal muscles, including the muscles used for breathing. They do not relieve pain or produce unconsciousness, so they must be given with adequate sedation and analgesia. In intensive care they may be used to facilitate mechanical ventilation in certain severe situations.
Decompensation occurs when a previously stable chronic condition suddenly worsens, often because of an infection, a virus, missed treatment or another acute event. Care must treat the trigger while supporting the organ affected by the underlying disease.
Prone positioning means turning a patient onto their front. It is particularly useful in severe respiratory failure because it can improve oxygen exchange. Awake patients may be encouraged to lie prone to avoid intubation, while critically ill ventilated patients are turned under sedation by a trained team.
Patients may also be positioned on their side to improve breathing or relieve pressure on the skin. After a prolonged period face down, the face may look temporarily swollen because fluid has shifted under gravity. This usually resolves within a few hours. Some former patients remember the turning process as though they were being rolled inside a carpet. See “Oedema”.
Multiple organ failure means that several vital organs—such as the lungs, kidneys, heart, liver or brain—are failing at the same time. It is a very serious complication, often caused by a chain reaction following severe infection, shock or major injury. Intensive care supports each failing function while the underlying cause is treated and the body has time to recover.
Delirium is an acute disturbance of attention, awareness and thinking. A patient may be disorientated, unable to follow time or place, or experience hallucinations. It is common in intensive care and can be caused by severe illness, infection, medicines, pain, sleep disruption and the unfamiliar environment.
Delirium may cause agitation, but it can also be “hypoactive”, with the patient unusually quiet and withdrawn. Clear day–night cues, restful nights, daytime activity, clocks, glasses or hearing aids, familiar voices and repeated gentle orientation can help. See “The patient experience”.
Depression can affect both patients and family members after intensive care. It is a recognised response to severe stress and illness, not a personal failure. Symptoms may include persistent low mood, loss of interest, guilt, hopelessness, sleep or appetite changes and difficulty functioning.
Willpower alone is not a treatment. Early support from a GP, psychologist or psychiatrist can improve recovery and reduce the risk of recurrence. Treatment may include psychological therapy, medication or both, tailored to the individual.
Dialysis, also called renal replacement therapy, removes waste products and excess fluid from the blood when the kidneys are unable to do so. Blood travels through a large catheter to a filter in the dialysis machine and is then returned to the patient.
Intermittent dialysis may run for several hours, while continuous renal replacement therapy can operate day and night for several days. An awake patient may feel cold and occasionally develop symptoms such as headache, which should be reported. The machine stands beside the bed, and blood can be seen moving through the tubing with a gentle background sound from the pump.
Dietitians assess nutritional needs and make sure each patient receives an appropriate balance of energy, protein and micronutrients. They support patients whether unconscious and tube-fed or awake and eating independently. Nutrition is a central part of recovery and must be reviewed carefully throughout critical illness.
Advance directives are written instructions prepared in advance by a person to record their wishes for future medical care if they later become unable to express them. In France they may be written in the person’s own words or using a template, such as the form provided by the French Intensive Care Society (SRLF).
Diuretics increase the amount of salt and water removed by the kidneys. They are used when excess fluid has accumulated, including in some forms of heart failure, kidney disease or pulmonary oedema.
In France, organ donation may be possible after brain death and, in specific regulated circumstances, after a decision to withdraw life-sustaining treatment. Organs and certain tissues may be donated.
French law operates on presumed consent: adults are considered potential donors unless they registered an objection or clearly expressed one during life. Discussing your wishes with those close to you, and recording them, can prevent uncertainty at a very difficult time. See “Organ donation”.
A drain is a flexible tube placed in or around an organ to remove blood, air, pus or other fluid that could interfere with healing or function. It may be described by its location, such as a chest, pleural, abdominal or pericardial drain.
Dysphagia means difficulty swallowing. It can develop after prolonged intubation or inactivity of the swallowing muscles, or because of neurological injury. Food, drink or saliva may enter the airway instead of the oesophagus; this is called aspiration and can cause pneumonia.
Warning signs include coughing, choking, a wet-sounding voice or breathlessness during meals. Stop eating or drinking and alert the team if these occur. Assessment by a speech and language therapist, ENT specialist or physiotherapist may lead to modified food textures, tube feeding or swallowing rehabilitation.
Ultrasound uses high-frequency sound waves to show the structure and movement of organs. An external scan is performed by moving a probe over gel on the skin and is usually quick and painless at the bedside.
For some internal scans, the probe is introduced through a natural opening to obtain a closer view. For example, a transoesophageal echocardiogram passes a probe into the oesophagus to produce detailed images of the heart when a standard chest scan is insufficient.
ECMO stands for extracorporeal membrane oxygenation. It is a form of temporary life support for severe lung failure (venovenous or VV-ECMO) or severe heart and lung failure (venoarterial or VA-ECMO).
Large cannulas carry blood to a pump and membrane outside the body, where oxygen is added and carbon dioxide removed before the blood is returned. VA-ECMO also supports circulation. ECMO is highly invasive, carries major risks and is used only when conventional treatment is insufficient. Cannula and suture sites can leave scars. Further reading: Katia Ghanty, Les frottements du cœur.
ECG electrodes are small adhesive sensors attached to the chest to record the heart’s electrical activity on the bedside monitor. Repeated or prolonged use can leave temporary marks or adhesive residue, which usually disappears with washing and time.
Electroencephalogram (EEG) electrodes are placed on the scalp with conductive paste or adhesive to record brain activity. The residue can generally be removed with shampoo.
An unconscious or extremely weak patient may not be able to control urination or bowel movements. A urinary catheter is commonly used to drain and measure urine. Absorbent pads protect the bed during bowel movements, while patients who are able may use a bedpan or urinal.
Laxatives may be prescribed to prevent constipation. If oral treatment is insufficient, an enema may be required. Staff carry out all intimate care with attention to dignity and comfort.
A pulmonary embolism occurs when an artery in the lungs is blocked, most often by a blood clot that has travelled from a vein. It can cause sudden breathlessness, chest pain, rapid heart rate and low blood oxygen. A large embolism can strain the heart and be life-threatening.
Intensive care can feel like an emotional rollercoaster for families because the patient’s prognosis may be uncertain. After discharge, patients may also experience unusually intense positive and negative emotions for a time.
These waves can be confusing for everyone and may leave patients feeling both more alive and more vulnerable. They generally settle gradually. Psychological support can help when strong emotions become difficult to manage.
Endoscopy means looking inside the body with a flexible or rigid instrument carrying a light and camera. The name usually identifies the organ examined—for example, bronchoscopy for the airways or gastroscopy for the stomach. Samples or small procedures can sometimes be performed through the instrument. See “Fibroscopy”.
Occupational therapy helps a patient regain independence by adapting tasks, equipment and the environment to temporary or lasting disability. Examples include preventing objects sliding from a table, creating a customised pressure-relieving cushion, adapting the call bell for a very weak patient or arranging the bed to make independent movement easier.
A pressure ulcer is damage to the skin and underlying tissue caused by sustained pressure, usually over bony areas such as the heels, sacrum, back of the head, shoulder blades or elbows. Immobility, poor circulation and inadequate nutrition increase the risk.
Prevention includes frequent repositioning, pressure-relieving mattresses and cushions, skin checks and adequate nutrition. Deep ulcers can be painful, slow to heal and may affect later rehabilitation. They require specialist dressings and sometimes reconstructive surgery. Family members should only massage or handle pressure areas after checking with the clinical team, because rubbing damaged or reddened skin can make injury worse.
Status epilepticus is a prolonged epileptic seizure or repeated seizures without recovery of consciousness between them. It can damage the brain and compromise breathing and other vital functions, so it requires urgent treatment.
Extubation is the removal of the breathing tube once the patient can maintain their airway and breathe adequately without it. The procedure is brief but can feel unpleasant and often marks an important step beyond the acute phase.
In end-of-life care, the tube may also be removed after a decision to withdraw mechanical ventilation so that the patient can be cared for without invasive equipment, with medicines and support focused on comfort.
Moving from bed into a chair may look like a simple step, but after critical illness it can require enormous effort. Sitting upright helps retrain posture and balance, rebuild back and abdominal muscles, improve bowel function and help clear lung secretions. It is therefore an important whole-body therapy, even when the patient understandably feels they would rather rest. See “Muscle wasting”.
A fibre-optic endoscope is a thin, flexible instrument with a light and optical system or miniature camera used to examine the inside of the body. It may include channels for biopsy forceps or other tools, allowing samples to be taken. The operator controls the tip to navigate safely. See “Endoscopy”.
Prolonged immobility and critical illness can cause dramatic loss of muscle mass and strength. Some patients lose many kilograms. Early mobilisation by physiotherapists and nurses aims to limit this and speed the return of independence.
Seeing a much thinner body for the first time can be shocking. Recovery involves retraining muscles throughout the body: the diaphragm and chest muscles for breathing, the trunk muscles for sitting, and the legs for walking. It takes time, but strength can return progressively.
Intensive care continues around the clock, including nights, weekends and public holidays. Nursing and healthcare-assistant staffing is usually maintained, but fewer doctors may be present out of hours. Emergencies and the sickest patients therefore take priority, while routine discussions and administrative matters are generally easier to arrange during the day.
A PEG is a feeding tube placed directly through the abdominal wall into the stomach, guided by an endoscope passed through the mouth. It allows enteral nutrition and medicines to be given when swallowing is unsafe or oral intake is insufficient.
A PEG is often temporary and can be more comfortable than a tube passing through the nose. The insertion site requires simple daily care and carries a risk of infection. The tube can be removed once the patient can eat and drink safely and meet their needs.
A blood gas test measures oxygen, carbon dioxide, acidity (pH) and other values in arterial or venous blood. Arterial samples are usually taken from the wrist and can be painful because arteries are sensitive. An arterial line avoids repeated needle punctures when frequent tests are needed.
Blood gases are commonly checked in respiratory failure and shock. Local anaesthetic cream or a lidocaine patch may reduce discomfort when there is enough time before sampling, although urgent tests cannot always wait.
Hand hygiene is essential because hands are a major route of infection transmission. Intensive care patients are especially vulnerable. Clean your hands before touching the patient, their belongings or equipment, between potentially contaminating contacts, and when leaving the room.
Alcohol-based hand rub kills most germs when hands are visibly clean. Rub all surfaces—the palms, backs, between fingers, fingertips, thumbs and wrists—until dry. If hands are visibly dirty, wash them with soap and water instead. See “Visiting a patient” for the full technique.
Blood glucose is the concentration of sugar in the blood. A bedside meter measures it from a small drop obtained by pricking a fingertip or earlobe. Monitoring helps ensure that the body has enough glucose for energy without levels becoming dangerously high. Insulin or glucose may be given when illness, diabetes or medicines disturb the balance.
A kidney dish is a small curved disposable container used to collect saliva, vomit, secretions or dressings and to organise items during bedside care. Its shape gives it the familiar “kidney” name.
HeartMate 3 is a left ventricular assist device (LVAD). A mechanical pump draws blood from the left ventricle and sends it into the aorta, supporting a failing heart. It may be used while a patient awaits transplantation, while the heart is assessed for recovery, or as long-term treatment.
The device requires anticoagulation and external power. Batteries and a controller connect through a cable that passes through the skin of the abdomen, which requires careful daily care.
Blood cultures test for bacteria or fungi circulating in the bloodstream. Blood is placed in special bottles containing a growth medium and monitored in the laboratory. Preliminary results may appear quickly, but final identification and antibiotic sensitivity can take several days.
A haemorrhage is significant blood loss, either visible outside the body or internal. Severe bleeding reduces oxygen delivery to organs and can cause shock. Treatment depends on the cause and may include transfusion, surgery, interventional radiology or medicines that support clotting.
A clock can be both helpful and frustrating in intensive care. It supports orientation to time and reality, but during painful or anxious periods it can also make every minute feel very slow. Despite this, clear clocks and calendars are valuable tools for reducing disorientation.
A heated humidifier warms and moistens dry medical gases before they enter the airways. This improves comfort, prevents irritation and stops secretions becoming too thick. It can be used with an endotracheal or tracheostomy tube, a non-invasive ventilation mask or high-flow nasal cannula.
Hypnotic medicines reduce activity in the central nervous system. Depending on the medicine and dose, they can relieve anxiety, promote sleep or produce deep sedation or unconsciousness so that ventilation and invasive procedures are tolerated. They require close monitoring because they can suppress breathing, circulation and awareness.
Targeted temperature management deliberately lowers or controls body temperature—sometimes to around 34–36°C—to protect the brain in selected conditions, such as after cardiac arrest. Cooling may use specialised adhesive pads or internal devices; older improvised methods are now less common.
Patients are normally sedated and rewarmed carefully. Waking while still cold can be extremely uncomfortable, so temperature, shivering and sedation are closely managed.
Iatrogenic describes a disorder or complication caused by medical treatment or a medicine. Intensive care teams take extensive precautions to reduce these risks, but the likelihood of complications rises when a patient is very frail or requires numerous treatments and invasive procedures.
An unconscious patient, or someone who is awake but extremely weak, may lose control of urination or bowel movements. A urinary catheter is commonly used for urine. Absorbent pads are placed beneath the patient for bowel movements so that hygiene can be maintained without changing the entire bed each time.
Critical illness, tube feeding and some medicines can cause significant diarrhoea. Staff do everything possible to manage it and keep the patient clean and comfortable, although elimination may sometimes be continuous. This can feel embarrassing or undignified to an awake patient, but healthcare professionals treat it as a normal bodily function and provide intimate care respectfully.
A myocardial infarction, commonly called a heart attack, occurs when an artery supplying the heart becomes blocked. It can seriously damage the heart muscle and, as a result, affect the entire body.
A healthcare-associated infection is an infection acquired during care in a hospital or other healthcare setting. Despite rigorous infection-prevention measures, these infections are more common in intensive care because patients are particularly vulnerable and often require invasive devices and life-support treatments.
Inotropes are medicines that increase the force of the heart’s contractions. They are used when the heart cannot pump enough blood to meet the body’s needs.
Heart failure means that the heart cannot pump enough blood to meet the body’s needs. Depending on its severity, it can cause marked breathlessness, extreme tiredness and swelling (oedema) due to fluid retention. More severe heart failure can impair other organs, particularly the kidneys.
Acute kidney injury is a sudden reduction in kidney function. The kidneys can no longer remove waste products and excess water from the blood effectively. It may be caused by infection, dehydration, a major fall in blood pressure, certain medicines or severe illness. Depending on its severity, it may require close monitoring, specific treatment or temporary dialysis.
In France, an interne is a junior doctor in specialist training after completing the first six years of medical studies and passing the national selection process. Residents can prescribe under senior supervision, are present throughout the unit and are often among the main doctors speaking with patients and families.
Intubation is a medical procedure in which a breathing tube is passed through the mouth—or occasionally the nose—into the trachea, usually under anaesthesia, so that a ventilator can support the patient’s breathing. Removing the tube is called extubation.
For an awake patient, the tube can feel uncomfortable and create a strong sensation of something being caught in the throat. See “Endotracheal tube”.
Preventing healthcare-associated infections is a central part of hospital care. Isolation precautions may be used either to protect a particularly vulnerable patient from germs carried by others, or to prevent a microorganism carried by the patient—such as a multidrug-resistant bacterium—from spreading to visitors, staff or other patients. The required precautions are usually displayed at the entrance to the room.
Isolation can increase loneliness because visits may be restricted, staff may group care together to reduce cross-transmission and visitors may need protective equipment. Digital communication can be valuable for awake patients, although some also appreciate the quieter environment and the opportunity to rest.
Magnetic resonance imaging, or MRI, is a non-invasive scan that uses a powerful magnetic field and radio waves to produce detailed images of structures inside the body. Because of the magnetic field, some metallic or electronic implants—such as certain pacemakers or prostheses—may be incompatible with the examination and must be checked beforehand.
An MRI usually requires transfer out of the intensive care unit. The necessary monitoring and life-support equipment travels with the patient, accompanied by trained staff throughout. During the scan, the patient lies inside a tunnel-like machine that makes loud, repetitive noises. Scans of the head or upper body can feel enclosed or claustrophobic. Staff remain nearby, monitor the patient continuously and can hear them through an intercom, so any severe anxiety should be reported immediately.
Physiotherapists play a major role in intensive care. They visit patients regularly to preserve joint mobility, stimulate the muscles, clear airway secretions and support weaning from mechanical ventilation. They also guide progressive rehabilitation as the patient begins moving again.
Physiotherapy helps restore physical function. In intensive care it may include airway-clearance techniques, gradual weaning from mechanical ventilation, maintaining joint movement during immobility and rebuilding muscle strength.
For an awake patient, rehabilitation can be physically and emotionally demanding: even sitting in a chair may initially feel like climbing Everest. The patient gradually becomes an active participant again, and early gains can be highly motivating because they mark progress towards discharge. Physiotherapy often continues for an extended period after intensive care.
An endotracheal-tube tie is a strap secured around the breathing tube and the patient’s head to keep the tube at the correct depth. Its position, tension and cleanliness are checked regularly and the tie is replaced whenever necessary. With a tracheostomy, a padded neckband is generally used instead.
A patient hoist allows staff to lift and move a person who cannot move independently while safely managing all attached equipment and tubing. Some hoists can also weigh the patient. They may be mobile devices or ceiling-mounted systems built into the room.
When a treatment would no longer benefit a patient, or when its burdens—such as discomfort, pain or distress—outweigh the expected benefit, the treatment may be withheld or withdrawn. In France, these decisions are governed by the Leonetti and Claeys-Leonetti laws. They are made through a collegial process involving the healthcare team and an external medical opinion, while taking account of the patient’s expressed wishes and providing clear information to those close to them.
The decision is reviewed as the patient’s condition evolves. Withdrawing life-sustaining treatment may allow death to occur sooner. In that situation, palliative care is provided to relieve suffering; French law also permits deep and continuous sedation until death in defined circumstances, so that end-of-life care is as comfortable as possible.
An intensive care bed is an important piece of clinical equipment. It helps protect the patient’s skin, improve comfort and prevent complications. A semi-upright position—often with the head raised by 30 to 45 degrees—can reduce the risk of pneumonia caused by aspiration of contaminated secretions.
Before adjusting the bed, staff check that no catheter, drain, tube or cable could be pulled, displaced or removed. Visitors should always ask the team before operating it. Patients who are unconscious commonly lie on an alternating-air mattress whose cells inflate and deflate in sequence to redistribute pressure and reduce pressure sores. The floating sensation may even influence dreams: some former patients remember being on a boat.
A nasal cannula is a small tube with two prongs that sit just inside the nostrils and deliver additional oxygen. If this is insufficient, oxygen may be given through a mask or reservoir mask, or more intensive support may be needed, such as non-invasive ventilation or invasive ventilation through an endotracheal tube.
The patient needs to breathe through the nose for the oxygen to be delivered effectively. After a long ICU stay, the cannula may become psychologically reassuring and can feel difficult to give up even when no longer required. Higher oxygen flows may dry the nasal lining and secretions; saline nasal care can improve comfort.
A pressure-relieving mattress uses air-filled cells that alternately inflate and deflate, changing the body’s pressure points and reducing prolonged friction and compression. It may make some noise and movement, but it helps protect vulnerable skin. Once a patient is awake and mobile, however, it may not always feel comfortable.
“Metalline” is a commonly used brand name for a small sterile slit dressing placed around a tracheostomy tube. It protects the skin and opening from rubbing against the tube and its neckband.
A bedside monitor—sometimes called a “scope” in French hospitals—continuously displays the heart rate and rhythm, breathing rate, blood pressure and blood oxygen saturation. Sensors and electrodes are connected to it by cables. Alarms alert staff when readings move outside configured limits.
The monitor is also linked to a central monitoring station, allowing the patient’s condition to be observed continuously even when staff are outside the room.
Brain death is not a coma. It is the irreversible loss of all brain function, with no possibility of recovery. A patient’s chest may still rise because of the ventilator, and medicines or extracorporeal support may temporarily maintain circulation, creating an appearance of life even though the person has died.
Brain death is diagnosed according to strict clinical and, where required, confirmatory criteria. Once the diagnosis is established, a death certificate is completed. The body’s functions rapidly become unstable despite life-support machines. In France, brain death is one of the circumstances in which organ donation may be possible.
During weaning from a tracheostomy, several stages help the patient return safely to independent breathing. Once mechanical ventilation is disconnected, a heat and moisture exchanger—often called an “artificial nose”—may be fitted to the outer end of the tracheostomy tube. This small T-shaped device filters particles and helps warm and humidify inhaled air, replacing some of the functions normally performed by the nose.
Noradrenaline is a catecholamine medicine given by continuous intravenous infusion at a very precise rate. It constricts blood vessels and raises blood pressure, helping maintain blood flow to vital organs when circulation is failing.
The infusion may be unnoticeable, particularly if the patient is unconscious. Some awake patients describe warmth, headache or a sensation that their body has been “boosted”.
At night, activity and noise in the unit usually decrease and the lights are dimmed. Staff carry out checks as discreetly as possible and try to protect patients’ sleep. Even so, awake patients often find it difficult to sleep in intensive care, and the quiet hours can sometimes increase anxiety.
When a patient cannot eat safely by mouth—for example because of sedation, coma or swallowing difficulties—liquid nutrition may be delivered through a tube into the stomach or, in some cases, the intestine. This is called enteral nutrition. It is used when the digestive system is still functioning and is the closest alternative to normal feeding.
The formula contains protein, carbohydrate, fat, vitamins and other nutrients needed to prevent malnutrition and support healing. It usually comes in a cream-coloured bag connected by tubing to a feeding pump and gastric tube. The pump controls the rate throughout the day. Feeding is painless and has no taste; most patients do not feel the liquid entering the stomach or experience normal hunger and fullness. In some cases, feeds are given mainly at night to encourage appetite and normal eating during the day.
If the digestive tract is not working or cannot be used—for example after certain operations, infections or blockages—nutrients can be delivered directly into the bloodstream. This is called parenteral nutrition.
The solution provides energy, protein, fats, vitamins and minerals to support recovery. It often appears as a white or milky fluid and is usually infused through a central venous catheter because the concentrated solution can irritate smaller veins over time.
Medicines are often diluted in water-based solutions before being infused, so an ICU patient may receive a large volume of fluid each day. Despite treatments that encourage fluid removal, oedema—swelling caused by fluid accumulating in the tissues—is very common. The hands, limbs and sometimes the face or whole body can become swollen.
Patients are weighed regularly, and diuretics may be used when appropriate to help remove excess fluid. Oedema usually resolves as the patient recovers. It may cause warmth, itching, tight or fragile skin and, when severe, significant pain. Repositioning can redistribute the swelling because fluid moves under the influence of gravity.
Acute pulmonary oedema is a rapid build-up of fluid in the lungs, often related to heart failure. It causes severe breathlessness and may feel like suffocation. Treatment supports the heart, removes excess fluid and maintains breathing and oxygen delivery.
During an ICU stay, changes in the patient’s condition may lead the team to reconsider whether ongoing treatments still offer a meaningful benefit. When burdensome or aggressive treatment is not expected to help, some interventions may be withheld or withdrawn and care may focus primarily on comfort.
French law prohibits obstination déraisonnable, meaning the unreasonable continuation of treatment. The Leonetti and Claeys-Leonetti laws govern decisions to withhold or withdraw treatment. These decisions are made through a collegial process involving the healthcare team and an external medical opinion, taking account of the patient’s wishes and keeping those close to them fully informed. They are reviewed as the patient’s condition evolves. The term replaces the older expression sometimes translated as “therapeutic obstinacy” or “futile treatment”.
An intubated patient may temporarily lose or notice a reduction in their sense of smell because airflow is diverted through the breathing circuit and no longer passes normally through the nose. Smell generally returns afterwards. If anosmia—loss of smell—persists, specialist assessment and smell rehabilitation may be offered.
Opioids are pain-relieving medicines used for moderate to severe pain. Depending on the drug and dose, they reduce the perception of pain and may also cause drowsiness. At high doses, usually combined with a sedative or hypnotic medicine, they can form part of deep sedation.
Computers are central to modern intensive care. Depending on the unit’s systems, they may collect real-time information from the machines connected to the patient, creating a detailed record of monitoring and treatment.
The electronic health record also contains clinical notes and medication orders. Doctors update prescriptions after reviewing test results and throughout the day as vital signs and the patient’s condition change.
High-flow nasal oxygen delivers a large, warmed and humidified flow of oxygen-enriched gas through soft nasal cannulas. It supports patients who are struggling to breathe, improves blood oxygen levels and may avoid or delay the need for invasive mechanical ventilation.
The flow and pressure can initially feel strong, but most patients gradually adapt. A heated humidifier warms and moistens the gas to protect the nasal lining and airways. The temperature can sometimes be adjusted for comfort, but adequate humidification must be maintained. Keeping the mouth closed and breathing through the nose can reduce leakage and make the treatment more effective.
Palliative care aims to relieve symptoms and help a patient live as comfortably as possible. Although it is often associated only with end-of-life care, it includes all measures that improve comfort and can be provided from the acute phase alongside treatments intended to cure or control disease.
When recovery is no longer possible, care may focus entirely on comfort, dignity and relief from pain, breathlessness, anxiety and other distressing symptoms. Palliative care is therefore not “doing nothing”; it is everything that remains important when cure is no longer achievable.
Ventilator-associated pneumonia is a lung infection that develops in a patient receiving invasive mechanical ventilation. Germs normally present in the mouth can travel around the endotracheal tube into the lungs despite preventive measures, adding a new infection to the patient’s original illness.
Prevention includes raising the head of the bed, regular mouth care, suctioning secretions above the tube cuff and checking cuff pressure. These measures reduce risk but cannot prevent every infection in critically ill and particularly vulnerable patients.
In everyday French hospital language, perfusion may refer either to the intravenous cannula itself or to the fluid being administered through it. For the patient, it is often a bag hanging above the bed and slowly emptying through tubing into a vein.
Some former patients remember using the changing bags as a way to mark time—watching the fluid level, counting the bags or comparing the drip to an hourglass.
Under French law, a patient may formally designate an adult personne de confiance, or trusted person. If the patient becomes unable to express their wishes, this person may receive relevant medical information and tell the healthcare team what the patient would have wanted. They may be a relative, friend, neighbour or the patient’s GP.
The trusted person must represent the patient’s wishes rather than their own views, so open discussion in advance is essential. The designation has a formal medico-legal status: it must be made in writing, include both people’s details and signatures, and may be changed or withdrawn at any time. The trusted person may also keep a copy of the patient’s advance directives. This is an important responsibility based on a high degree of trust.
When staff refer to “saturation”, they usually mean peripheral oxygen saturation, measured by a small sensor clipped to a fingertip or sometimes an earlobe. It gives a useful continuous estimate of blood oxygenation, although it is less precise than arterial oxygen saturation measured in an arterial blood-gas sample.
Pneumonia is an infection of the lungs. Bacteria, viruses or fungi inflame the alveoli—the tiny air sacs where oxygen enters the blood—and these spaces may fill with fluid or pus, making breathing difficult.
Severe pneumonia may require respiratory support ranging from supplemental oxygen through a nasal cannula to invasive mechanical ventilation.
Pneumopathy is a broad medical term meaning any disease or disorder of the lungs. It does not necessarily mean an infection.
An infusion pump or syringe driver delivers medicines and fluids through an intravenous catheter. It allows the rate—and therefore the dose—to be controlled with great precision, including for medicines that must be given continuously.
A graduated urine jug is used to empty the patient’s drainage bag and measure urine output accurately. Urine production is an important indicator of kidney function and fluid balance. The total is usually recorded as part of the daily input–output assessment. See “Urinary catheter”.
The lungs perform two essential functions: they transfer oxygen into the blood so that the heart can deliver it to every organ, and they remove carbon dioxide produced by the body’s cells. If carbon dioxide accumulates, the blood can become dangerously acidic.
In respiratory failure, the lungs cannot perform these tasks adequately. Some patients need only additional oxygen or non-invasive pressure support. In more severe cases, intubation and mechanical ventilation allow the team to control the oxygen concentration, remove carbon dioxide and support breathing while using settings designed to protect the injured lungs.
Doctors review and update prescriptions continuously. They do so after considering the latest test results and throughout the day as the patient’s vital signs, machine readings and overall clinical condition change.
Intensive care can be a difficult and potentially traumatic experience for both patients and families. Many units have a psychologist who understands the ICU environment and can support people during the admission and recovery. This specialist knowledge is often particularly valuable when helping patients and relatives make sense of what has happened and identify appropriate follow-up support.
Chest X-rays are performed frequently in intensive care to monitor lung disease and check the position of devices such as endotracheal tubes, gastric tubes and central venous catheters. A mobile X-ray machine allows the image to be taken at the bedside.
A flat detector plate is briefly placed behind the patient’s back; it may feel hard and cold. The machine is positioned over the chest, the image is taken in a moment and the plate is then removed.
The French word réanimation has several related meanings. It can refer to intensive care medicine as a specialty; to the intensive care unit that treats the hospital’s most critically ill patients; to the highly technical treatments used to support failing organs during acute illness; or, for patients, to the entire experience of an ICU stay.
Modern intensive care developed in the 1950s, particularly when patients needing mechanical ventilation were brought together during poliomyelitis epidemics. It is distinct from the emergency department and the post-anaesthesia recovery room, although these services are often confused in popular culture.
In English, intensive care or critical care describes the specialty and unit. Resuscitation usually refers more narrowly to emergency attempts to restore breathing or circulation. Organ-support treatments can maintain a fragile balance while the body recovers, but they also carry risks and cannot always be continued indefinitely. Many former patients describe intensive care as a world apart that leaves a lasting impression.
Intensive care units take an active part in research to improve scientific knowledge and treatment. Information collected during a hospital stay may later be analysed anonymously for audit or research, in accordance with the applicable rules.
Patients—or, when necessary, those close to them—may also be asked for consent to take part in studies comparing treatments or models of care. The information and consent form explains the study in detail. Participation is voluntary, and refusing will not affect treatment or the relationship with the clinical team. When consent was initially provided by a representative, the patient’s own consent is sought once they regain decision-making capacity. Some patients find it meaningful to know that their experience may help improve care for others.
Rehabilitation is the gradual process of addressing physical, cognitive and emotional effects of critical illness so that the patient can return to the fullest possible life. It begins in intensive care with early mobilisation and continues, when needed, in a specialist rehabilitation centre.
After returning home, follow-up may involve medical specialists, physiotherapists and other rehabilitation professionals until the patient feels able to resume everyday activities and roles.
Fluid resuscitation, more precisely called intravascular volume expansion, means giving fluid directly into the circulation to increase circulating blood volume. It is used when blood pressure is too low or the body does not have enough effective circulating volume. The type and amount of fluid are tailored to the cause, the patient’s condition and their response.
A mechanical ventilator delivers a gas mixture tailored to the patient’s needs while controlling or supporting the volume and frequency of breaths. It maintains adequate oxygen levels and helps remove carbon dioxide when the lungs—or sometimes the heart and circulation—cannot do so effectively.
The patient is usually connected through an endotracheal tube placed in the trachea under anaesthesia. The ventilator can be adjusted in different modes, from fully controlling breathing to providing partial assistance as the patient regains strength. Settings are chosen to meet the patient’s needs while protecting the lungs and maximising comfort.
Families often look forward to the patient “waking up”, but the process is usually very different from what films suggest. After prolonged sedation, medicines may take hours or days to leave the body—especially when the liver or kidneys have been affected—and consciousness often returns gradually.
The patient may appear awake yet remain confused, struggle to understand their surroundings or experience unusual sensations and fragmented memories. Former patients describe feeling trapped in fog or quicksand, unable to open their eyes or move their head. Gentle orientation, patience and familiar reassurance are important during this slow transition. See “The patient experience”.
“Saturation” usually means peripheral oxygen saturation, measured by a small sensor clipped to a fingertip or sometimes an earlobe. It provides a useful continuous estimate of blood oxygenation, although it is less precise than the arterial oxygen saturation measured in a blood-gas sample.
The probe is painless at first, but prolonged pressure may become uncomfortable or sore. It can be moved to another finger, a toe or the ear to vary the pressure points. Over time, some patients also find the familiar sensor reassuring.
A CT scan, or computed tomography scan, uses X-rays and computer processing to produce detailed cross-sectional images of the body. The patient lies still on a narrow table that moves through a large ring-shaped scanner, with the arms beside the body or raised above the head depending on the area being examined.
Staff monitor the examination from behind a window and remain within speaking distance through an intercom. An iodine-based contrast agent may be injected through an intravenous line to improve the images. This can cause a brief sensation of warmth spreading through the body.
A bedside monitor—often called a “scope” in French hospitals—continuously records the heart rate and rhythm, breathing rate, blood pressure and blood oxygen saturation through sensors, electrodes and cables. Alarms alert staff when readings move outside the limits set for the patient, and a central station allows monitoring to continue when staff are outside the room.
On a typical display, the green trace is the electrocardiogram and the green number the heart rate. The blue trace represents the pulse wave and the associated number the oxygen saturation. A red trace may show blood pressure measured continuously through an arterial line; the value in brackets is the mean arterial pressure, an important guide to organ perfusion. See “Continuous monitoring”.
Acute respiratory distress syndrome is a severe form of respiratory failure in which the lungs become inflamed and cannot transfer enough oxygen into the blood. It often requires intubation and mechanical ventilation. ARDS has many possible causes, including serious bacterial or viral infection. Treatment addresses the cause while supporting breathing and any other affected organs until recovery is possible.
Tracheal secretions are mucus produced by the lungs and airways. They may become abundant, thick or purulent during infection, and their colour and consistency can help the team assess changes in the patient’s respiratory condition.
For an awake patient who cannot cough effectively, accumulated secretions can be extremely uncomfortable—similar to severe chest congestion without being able to clear it. Noisy breathing or a falling oxygen saturation may indicate that suctioning is needed. See “Tracheal suctioning”.
Sedation uses medicines to reduce awareness and, when necessary, place a patient in a medically induced coma. It may be used to allow an invasive procedure or operation, relieve pain and distress, help the patient tolerate mechanical ventilation, or reduce the demands placed on severely affected organs. The depth of sedation is adjusted to the clinical need and reviewed regularly. See “Anaesthesia”.
Sepsis is a life-threatening organ dysfunction caused by the body’s dysregulated response to an infection. Instead of containing the bacteria, virus or fungus, the immune response begins to damage the body’s own organs, such as the lungs, kidneys, heart or brain.
Sepsis is a medical emergency. Rapid treatment of the infection is essential, alongside support for any organs that are failing.
Weaning means gradually reducing and stopping a treatment as the patient becomes less dependent on it. The term is commonly used for weaning from mechanical ventilation, which may take days or, in some cases, several weeks. It may also refer to gradually reducing vasopressors such as catecholamines.
Weaning from mechanical ventilation is the process of helping a patient regain independent breathing. Ventilator support is reduced gradually according to the patient’s lung function, strength and tolerance. After a long acute illness, weakness of the breathing muscles can make this process slow.
A temporary tracheostomy may make weaning easier by allowing periods off the ventilator while keeping the option of reconnecting it during rest or overnight. Mobilisation—sitting out of bed, standing and progressive exercise—also strengthens the muscles involved in breathing.
Weaning requires repeated effort and can be exhausting or frightening when breathing alone initially feels difficult. Calm reassurance, comfortable positioning and distraction can reduce anxiety. Some patients later describe the positive sensation of their lungs “opening up” as independent breathing returns.
Yes, hair can be washed in intensive care. The technical French term is capiluve. Because it is not an urgent procedure, it is usually offered when staff have enough time to make it a comfortable wellbeing treatment, but patients and families can also ask about it.
An itchy scalp or matted hair can be very uncomfortable, and feeling clean may be deeply reassuring. For long hair, bringing a suitable detangling conditioner or mask can help prevent severe knots caused by prolonged contact between the head and bedding.
Mouth care keeps the mouth clean and reduces the risk of saliva and oral bacteria reaching the lungs. Staff use soft single-ended swabs, usually moistened with an appropriate mouth-care solution, to clean the teeth, tongue, palate and inside of the cheeks. Saliva and pooled fluid at the back of the throat may be suctioned.
The mouth is also checked regularly for damaged teeth, redness, swelling or other abnormalities. This care is particularly important in preventing ventilator-associated pneumonia. It may feel refreshing or slightly intrusive, much like dental care; confused patients may try to bite the swab. See “Oral-care swabs”.
A gastric or feeding tube is a flexible plastic tube whose tip lies in the stomach. It may be used to drain stomach contents or, more commonly, to provide balanced liquid nutrition containing carbohydrate, protein, fat, vitamins and minerals.
The tube can be passed through the nose or mouth. A gastrostomy tube may instead be placed through the abdominal wall directly into the stomach; a jejunostomy tube enters the small intestine. After extubation, a nasal tube leaves the mouth free for speaking, but it can irritate the nose and throat and insertion may be uncomfortable.
Because a gastric tube is easier to dislodge than many other ICU devices, patients sometimes pull it out accidentally or because the sensation is irritating. Unfortunately, it may need to be replaced when it is still required for nutrition or drainage.
An endotracheal tube is a plastic breathing tube passed through the mouth—or rarely the nose—into the trachea so that a ventilator can support breathing. It is secured around the head and must remain at the correct depth for safe and effective ventilation. The securing tie may leave temporary pressure marks on the cheeks.
An inflatable cuff near the lower end seals the space between the tube and trachea. This helps deliver each ventilator breath and reduces the passage of secretions into the lungs. Cuff pressure and tube depth are checked regularly, and secretions above the cuff may be suctioned. A gastric feeding tube is often secured alongside it but passes into the oesophagus rather than the airway.
While intubated, a patient cannot speak, eat or drink normally. The tube can feel frightening and intrusive, and because the mouth remains partly open it often causes marked dryness and thirst. Frequent mouth care is therefore important.
A urinary catheter is a soft flexible tube that drains urine from the bladder into a collection bag. It allows accurate measurement of urine output—an important indicator of kidney function and fluid balance—and keeps an unconscious or immobile patient dry. A small balloon inflated inside the bladder holds the catheter in place.
Like any device placed inside the body, a catheter can increase infection risk. It can also create a persistent sensation of needing to urinate even though the bladder is being continuously emptied. Medicines may help with these catheter-related bladder spasms, and the sensation often becomes less noticeable with time.
A stoma is a surgically created opening on the abdomen that brings part of the digestive or urinary system to the skin. It may be temporary or permanent and allows stool or urine to leave the body when the usual route cannot be used. Waste is collected in a special pouch attached securely to the skin.
A stethoscope amplifies sounds inside the body. Doctors, nurses and physiotherapists use it to listen to the heart, lungs and abdomen and to detect changes in the patient’s condition. It may also be used as one part of checking a gastric tube. The circular chest piece can feel briefly cold against the skin.
Post-traumatic stress disorder can develop after experiencing or witnessing a frightening or overwhelming event, including an intensive care admission. It may affect patients as well as family members.
Possible signs include repeatedly reliving the experience through intrusive thoughts or nightmares, persistent anxiety, avoiding reminders such as hospital appointments, feeling constantly on guard, or marked changes in mood and behaviour that continue for months.
Effective treatments are available, including trauma-focused cognitive behavioural therapy, EMDR and exposure-based approaches. A qualified psychologist or psychiatrist can assess the symptoms and recommend appropriate support. See “Psychological effects after intensive care”.
Tumour lysis syndrome occurs when a large number of cancer cells break down rapidly, either spontaneously or after treatment. Their contents are released into the bloodstream and can disrupt the function of the kidneys, heart or brain. Close monitoring and urgent specific treatment may be required.
Body temperature is an important ICU measurement and is checked many times each day—often at least every two or three hours, and sometimes continuously. It may be measured in the ear or armpit, or through a temperature sensor incorporated into certain catheters or probes.
Monitoring helps identify infection early in patients who are particularly vulnerable. In some situations, controlled temperature management is used to lower body temperature, commonly to around 34–36°C; continuous accurate measurement is then essential.
Thrombosis means the formation of a blood clot inside a blood vessel. Risk increases with prolonged immobility, clotting disorders and devices placed in veins or arteries, such as central catheters or ECMO cannulas.
ICU patients often receive anticoagulants to prevent clots, frequently as small injections beneath the skin of the abdomen or thighs. These may leave bruises or firm areas that generally fade with time.
Washing in intensive care is usually carried out in bed using a bowl of water and disposable washcloths. Staff wash, rinse and dry one area at a time while keeping the rest of the body covered to preserve privacy and warmth.
Patients experience this care differently. It may feel comforting and soothing, or it may cause embarrassment, discomfort or a sense of lost independence. For staff, it is routine clinical care that protects hygiene and skin health. They can slow down and make it a wellbeing moment when the patient enjoys it, or complete it efficiently when the patient would prefer it to be brief.
ICU work is organised around regular bedside rounds. At set intervals—often every two, three or four hours depending on the unit—a nurse and healthcare assistant visit each patient to provide care, check equipment and record observations. Doctors also review patients on their own rounds.
These schedules do not limit urgent care: the team remains available and responds immediately whenever a patient’s condition requires it.
A tracheostomy is a small procedure that creates an opening at the base of the neck and places a breathing tube directly into the trachea. It may be offered when weaning from ventilation is likely to be prolonged or an oral endotracheal tube has become uncomfortable. Once the opening has healed, the tube itself is usually not painful and can make rehabilitation easier by freeing the mouth and reducing facial pressure, dryness and thirst.
The opening is not airtight, so secretions may appear around the tube. Airway suctioning is performed through the tracheostomy. Daily care includes cleaning the surrounding skin, changing the slit dressing and replacing or adjusting the neckband while keeping the tube securely in place. The neckband can irritate the skin, and gentle cooling or massage during care may help.
When a tracheostomy remains in place for a long period, the tube may need periodic replacement. This can feel uncomfortable or frightening and may cause minor bleeding; local or light anaesthesia may be considered depending on the situation. In most ICU patients the tracheostomy is temporary. After the tube is removed, the opening usually closes naturally within a few days, often leaving a small scar low on the neck. See “Tracheostomy tube”.
Clinical handover takes place when one healthcare team transfers responsibility to the next. The outgoing staff communicate all information needed to continue safe care, including recent changes, treatments, risks and priorities.
Handover periods are protected from avoidable interruptions to reduce omissions and loss of information. Staff may appear less available briefly, but handover stops immediately if an emergency requires the team’s attention.
An intrahospital transfer is the movement of a patient to another department for a test, procedure or operation. Monitoring, ventilation and essential treatment must continue throughout, making this a carefully planned clinical procedure.
Depending on the hospital, the patient may travel in the ICU bed or on a narrower trolley with a thinner mattress. Several staff coordinate the move, protect every line and tube and secure the airway. A transport ventilator and portable monitor accompany the patient, together with any infusion pumps or other equipment that cannot be stopped.
When a patient’s heart has irreversibly failed, it may in selected circumstances be replaced with a donated heart. This is called heart transplantation. It requires lifelong specialist follow-up, daily anti-rejection medicines and careful attention to health and lifestyle. A transplanted heart can function well for many years.
Dysphagia is difficulty swallowing. It may result from neurological injury or from prolonged inactivity and weakness of the swallowing muscles. Food, drink or saliva may enter the airway instead of the oesophagus; this is called aspiration and can lead to pneumonia.
Coughing or choking whenever the patient eats or drinks should raise concern. Stop the meal and alert the healthcare team. Assessment by a speech and language therapist, ENT specialist or physiotherapist may lead to modified food textures, temporary tube feeding and swallowing rehabilitation.
An arrhythmia is an abnormal heart rhythm that may be too fast, too slow or irregular. Some are common and harmless, while others prevent the heart from pumping effectively and can cause fainting, collapse or cardiac arrest. Continuous heart monitoring and urgent treatment may be required.
A speaking valve is fitted to the outer end of a tracheostomy tube after the cuff has been deflated. Air enters through the valve during inhalation, but the one-way mechanism directs exhaled air upwards through the throat, mouth and nose. As it passes the vocal cords, the patient may be able to produce voice again.
Speaking is rarely effortless at first. The muscles and breathing pattern must be retrained to control exhaled air and form words, so early sessions can be tiring. Even a weak first voice can nevertheless be a highly satisfying milestone because it allows the patient to communicate more naturally.
Vasopressors are medicines that raise blood pressure by constricting blood vessels. They are used when blood pressure is too low to maintain adequate blood flow to the organs.
Unresponsive wakefulness syndrome, historically called a vegetative state, can occur after severe brain injury. In the absence of sedative medicines, the patient shows sleep–wake cycles and reflex behaviours—such as eye movements, yawning or involuntary movements—but no reliable signs of awareness of themselves or their surroundings.
A mechanical ventilator delivers a gas mixture tailored to the patient’s needs while controlling or supporting the volume and frequency of breathing. It maintains adequate oxygen levels and helps remove carbon dioxide when the lungs—or sometimes the heart and circulation—cannot do so effectively.
The patient is connected through an endotracheal tube placed in the trachea under anaesthesia. Different ventilator modes can provide full support or progressively less assistance as independent breathing returns. Settings are adjusted to the patient’s clinical needs, comfort and lung protection.
Non-invasive ventilation supports breathing through a close-fitting face or nasal mask rather than an endotracheal tube. A ventilator delivers pressurised air to help the patient breathe and, in suitable situations, may avoid intubation.
The pressure can feel strange or uncomfortable at first. Careful adjustment of the settings and choice of mask are essential for both effectiveness and comfort. Once adapted, many patients find the support reassuring. Tightness, pressure areas or air leaking towards the eyes can often be improved by repositioning the mask, changing its type or using protective silicone dressings.
A virus is a microscopic infectious agent that can reproduce only inside living cells. It enters a cell and uses the cell’s machinery to make new copies, which are released and infect other cells.
Antibiotics do not treat viruses. They may nevertheless be needed if a secondary bacterial infection develops during or after a viral illness.
A central venous catheter, or central line, is inserted into a large vein. It provides secure access for medicines that must be delivered precisely or could irritate smaller veins, including catecholamines such as noradrenaline. Some central lines can also help monitor pressures within the circulation.
The catheter is inserted using sterile technique and local anaesthesia. Its dressing and connections require careful sterile maintenance to reduce infection risk.