• a
• b
• c
• d
• e
• f
• g
• h
• i
• j
• l
• m
• n
• o
• p
• r
• s
• t
• u
• v
• w

A

 

• Adrenaline / Noradrenaline

  Drug administered by continuous infusion whose function is to improve the work of the heart or increase blood pressure.

Advance directives

Advance directives are a document drawn up in advance by the patient, expressing his/her wishes in the event of incapacity to give his/her opinion. They can be written on plain paper, or use a pre-constructed form.

Amnesia

Patients often do not remember all or part of their stay in intensive care. There are many causes of amnesia: amnesia-inducing drugs, serious infection, sleep disorders, confusion, etc. Allowing patients to understand what happened during the phases they forgot helps them to recover psychologically.

Anesthesia

Anesthesia is the act of “numbing” a person’s senses with sedative (sleep-inducing) and analgesic (pain-suppressing) drugs or gases. Commonly performed in the operating theatre, anaesthesia can be general: the patient is sedated completely; or local: anaesthetic drugs are injected directly into the nerves of the area to be treated. The patient remains conscious. The main purpose of anesthesia in the operating room is to ensure the safety of the operation by totally immobilizing the area, and to prevent pain. In intensive care, general anesthesia is used when organ failure requires total rest: a patient can be sedated to rest the lungs, for example.

Anoxia

Anoxia is the absence of oxygen supply. It leads to cell destruction. Cerebral anoxia has serious and irreversible consequences.

Antalgia or analgesia

Analgesia is the suppression of the sensation of pain. It can be achieved with drugs (analgesics), but also with non-medicinal methods: depending on the pain to be treated, the use of heat (hot water bottle), cold (ice bladder), or physiotherapy can be very effective.

ARDS

ARDS, or Acute Respiratory Distress Syndrome, is a major respiratory failure requiring intubation and ventilation of the patient (artificial respiration). A.R.D.S. can have many causes, the most frequent of which are bacterial or viral. Management consists of treating the cause and supplementing the organs while the cause is being treated.

Arterial cannula

Arterial cannulas enable continuous monitoring of blood pressure. They also enable regular blood sampling, often required in intensive care, without the need to stab the patient. Insertion is performed sterilely, under local anesthetic. Maintenance requires sterile care.

Aspiration

Tracheal suctioning is a routine procedure designed to relieve congestion in intubated patients. A fine suction tube is passed through the intubation tube to draw up the bronchial secretions that the patient coughs up. The gesture can be impressive, as it causes the patient to cough. It’s not a pleasant procedure, but it’s necessary for the patient to breathe properly.

Awakening

Awakening is an eagerly-awaited moment for relatives of patients in intensive care. However, it is often very different from what we see in the movies: the longer the sedation phase (artificial coma) has lasted, the more the organs of elimination (liver and kidneys) have been affected, the longer it will take for the sedative drugs to be eliminated: “waking up” can in fact take place over days and very gradually.

B

• Bacteria

  A bacterium is a microscopic living micro-organism. Some bacteria are useful and necessary: they make up what is known as the flora. For example, the intestinal flora helps to ensure proper digestion of food. Other bacteria are dangerous and must be fought. To help the body fight these “bad” bacteria, we use antibiotics.

• BMR:

  Multi-resistant Bacteria Bacteria that have developed a defense against several antibiotics. It is therefore more difficult to combat, and it is extremely important to prevent its spread within the hospital: this is why certain precautions may be required when entering patients’ rooms: “isolation measures”.

• Blood cultures

  Blood cultures are blood samples taken to detect the presence of bacteria in the blood. Blood is drawn directly into large tubes containing a “culture medium”, a liquid that favors the multiplication of the bacteria of interest. Blood culture results may take several days to come back: this is the culture period.

• Bronchoscopy

  Bronchoscopy, or bronchial fibroscopy, is an examination that involves looking inside the bronchial tubes using a small camera positioned at the end of a probe. In intubated patients, this is usually done through the intubation tube; in non-intubated patients, it is usually done through the nose. This examination can also be used to take samples for diagnostic purposes.

C

• Cannulas

  Cannulas are flexible, hollow tubes inserted into a patient’s veins or arteries. Cannulascan be used to administer medication or monitor vessel pressures. They are often needed to treat intensive care patients. Insertion is performed sterilely, under local anesthetic. Maintenance requires sterile care.

• Cardiac arrest

  The heart circulates blood throughout the body, supplying oxygen to the cells of the various organs. When the heart stops, the oxygen supply is interrupted and cells are rapidly destroyed. In just a few minutes, the consequences can be irreversible. Rapid treatment (cardiac massage, ventilation) is therefore essential to minimize possible after-effects.

• Care manager

  Care managers are nurses with additional management training. They coordinate the nursing staff and oversee the department’s logistics. They can be a valuable resource to help you understand how the department works.

• Central venous catheter

  Central venous catheters are needed to secure the administration of many drugs used in intensive care, such as catecholamines (e.g. noradrenaline). In some cases, central catheters can also be used to monitor vessel pressures. Insertion is performed sterilely, under local anesthetic. Maintenance requires sterile care.

• Clinical Lead

  The clinic is the practice at the patient’s bedside. The clinical lead is the doctor in charge of supervising clinical practice, i.e. patient care. Within the unit, doctors work under his or her supervision and responsibility. The clinical lead is responsible for coordinating the unit’s care team and defining daily objectives for each patient.

• Coma

  Coma is an altered state of consciousness. It can be induced voluntarily by sedative drugs to allow certain organs to rest and pain to be managed: this is a form of general anesthesia. It can also be induced by certain pathologies, or by a head trauma accident. Coma impairs the patient’s ability to protect the airways (to the lungs) and the digestive tract (to the stomach), which is why it is necessary to intubate and place comatose patients on a ventilator. A comatose patient requires extra monitoring. We don’t know what a comatose patient hears, but it seems that the presence and voices of loved ones can in some cases be recognized, even if he or she will have little or no memory of them later on. Caregivers explain their actions to the patient and warn him/her before any physical contact. Talking is beneficial for the patient, and you should not hesitate to talk to him or her.

• Confusion

  It is also common for patients awake in intensive care to be a little confused and lost. This may be due to stress, infection, medication or fatigue. Age is also a major risk factor. It’s a good idea to remind them where they are, on what day and at what time. Allowing patients to leave their rooms as soon as their state of health allows is a good way of reducing the duration of this confusion (a stroll in the corridor, or even a short tour of the hospital).

D

• Delirium

  Delirium is a particular cognitive state in which the patient may be disoriented (no longer knowing where he or she is, no longer seeing where he or she is in time), or even hallucinating. Delirium is common in the intensive care unit, as a consequence of the aggression of acute illness, and can be exacerbated by severe infection, medication, sleep disturbance and so on. It can manifest itself as great agitation, but also sometimes as total mutism (the patient is very calm, aware but not expressing himself or responding to requests). See Patient’s experience To combat delirium, it’s important to clearly mark the day-night rhythm, to encourage rest at night and activity during the day, and to reorient the patient: use a clock, remind him where he is and why he’s there, etc.

• Dialysis or Extra-Renal Replacement Therapy (ERT)

  A technique that uses a catheter, filter (artificial kidney) and pump to cleanse the blood of toxic waste that accumulates when the kidneys malfunction or in certain critical situations. Some so-called intermittent dialysis can last between 2 and 8 hours, depending on the indication, but in some cases, in intensive care, continuous dialysis can be set up, i.e. lasting several days, and repeated at the end of the filter’s useful life (artificial kidney). A conscious dialysis patient may feel cold, so don’t hesitate to ask, and cover up if necessary. Other symptoms may occur less frequently, so don’t hesitate to bring them to the attention of your care team.

• Dieticians

  Dieticians are called in to ensure that patients receive the nutritional intake adapted to their specific needs. They regularly visit intensive care units to optimize patient nutrition, whether the patient is intubated and comatose, or conscious and autonomous. Patient nutrition is a key factor in their recovery and cannot be left to chance.

• Drain

  A flexible tube placed in the body to allow the elimination of blood, air or secretions that could interfere with the proper healing or functioning of an organ.

E

• Encephalic death

  Encephalic death, or brain death, is not coma. It is an irreversible state in which a crucial part of the brain is destroyed, with no possibility of recovery. In intensive care, patients can be rendered brain-dead while still connected to machines that maintain the appearance of life: respirators that raise the chest, extracorporeal circulation that circulates blood, adrenalin or noradrenalin that maintain cardiac activity and blood pressure. The diagnosis of encephalic death is based on precise and specific criteria. Once this diagnosis has been made, the death certificate is signed by the doctor. Even if machines can maintain the appearance of life in the body for some time, the functions of a body whose brain has been destroyed become very quickly, very unstable, and it is not possible to maintain things for very long. Encephalic death is one of the situations in which organ donation is authorized in France.

• Endoscopy

  “Endo-” means “inside” and “scopy” means “to look at”. The word endoscopy covers all examinations that involve looking inside the body using a probe fitted with a camera. For greater clarity, we usually specify the organ targeted: bronchoscopy or bronchial endoscopy/fibroscopy, for example, for the bronchi, or gastric endoscopy for the stomach. See fibroscopy.

• Electrodes

  Electrodes are small sensors placed on the patient’s chest to measure the heart’s electrical activity.

• Enteral nutrition / parenteral nutrition

  When patients can no longer eat by mouth (sedation, coma, swallowing problems, etc.), they can be fed via a tube placed in the stomach: the gastric tube (enteral feeding). Alternatively, if the digestive tract is not functional, food can be passed directly through the veins in infusions (parenteral nutrition). Food is administered in liquid form and covers all the patient’s needs.

• Eschar

  Skin lesion caused by bed rest. Bed rest and immobilization, necessary for the safety of the intensive care patient, can have consequences. These include pressure sores, caused by the pressure exerted on the skin between the protruding bones and the mattress: these are known as pressure points. To prevent pressure sores, nurses and care assistants regularly reposition patients to vary the areas on which pressure is exerted, effleurage pressure points (light massages of the back of the skull, back, sacrum, elbows and heels) and ensure that patients receive adequate nutritional intake. You can play your part in the fight against pressure sores by giving your loved ones light massages in areas accessible to you, such as elbows and heels.

• Extracorporeal circulation or ECMO (ExtraCorporeal Membran Oxygenation)

  There are two types of extracorporeal circulation: one to compensate for lung failure alone, and the other to compensate for heart-lung failure. In the first case, extracorporeal circulation is used in patients for whom artificial ventilation via intubation or placement on a ventilator is not sufficient to oxygenate the blood properly. Two very large catheters (called cannulas) are inserted into the patient’s large venous trunks (often in the groin area), and the blood is pumped through an oxygenation and decarboxylation membrane (where carbon dioxide is purified). The second case is used in the event of major heart failure, or even heart-lung failure. In this case, cardiac function is supplemented by the machine’s pump, which completely replaces the heart and, if necessary, the lungs too. Cannulas are then positioned, one arterial, the other venous. The use of extracorporeal circulation is an extremely invasive procedure involving numerous risks, and cannot be considered lightly.

• Extubation

  Once the patient has regained his or her respiratory autonomy, extubation takes place: the removal of the intubation tube. It can be an unpleasant moment for the patient, but it’s also an important one, marking the end of the acute phase. NB: in the event of therapeutic failure, and when treatment is withdrawn, extubation may be carried out to allow the patient to live out his or her final moments free from medical restrictions.

F

• Fibroscopy

  See Endoscopy. The principle of this examination is to explore the inside of the body using an endoscope fitted with an optical fiber. The endoscope, or fiberscope, consists of a flexible tube a few millimeters in diameter into which an optical fiber is inserted. It has a light source at one end. Some use a mini-camera and are connected to a video screen. They can be fitted with forceps to take samples for laboratory analysis. Once inside the body, a control system is used to guide the probe.

G

• Gastric tube

  A gastric tube (or feeding tube) is a plastic tube whose end terminates in the stomach. It can be used to empty the patient’s stomach in certain cases, or, more frequently, to feed the patient during his or her stay in intensive care. Through the tube, the patient receives a balanced diet, with appropriate quantities of carbohydrates, proteins, lipids, vitamins and minerals. The gastric tube can be inserted through the nose or mouth. Sometimes, a so-called “gastrostomy” tube can be inserted directly into the small intestine by means of a minor surgical procedure.

H

• Hypothermia

  In certain pathologies, it is possible to place patients in hypothermia, i.e. to cool their bodies to below 36 degrees, sometimes as low as 34 degrees. This therapy is useful for protecting brain cells.

• Heart transplant

  When a patient’s heart is failing, it may need to be replaced with the heart of a deceased donor. This procedure requires lifelong medical follow-up, a strict diet, and daily anti-rejection medications. A heart graft can function properly for several decades.

• Heartmate III

  This is a cardiac assist device designed for a single ventricle (univentricular) support. A pump draws blood from the left ventricle (one of the heart’s chambers) and reinjects it into the aorta (the main artery that exits the heart and supplies blood to the organs). This device can be used temporarily while awaiting rehabilitation and recovery, with the aim of a heart transplant at a later stage, or it can be used permanently. One can live with this device for over 10 years. It requires blood anticoagulation and is powered by external batteries connected to the device via a cable that exits through the abdomen.

I

• Iatrogenic

  Any disorder or complication caused by medical treatment or medication. Intensive care teams do their utmost to limit iatrogenicity, but the greater the number of treatments and treatments, the greater the risk of complications.

• Infusion pump or syringe pump

  An infusion pump (or syringe pump) is a device used to inject drugs and liquids into the veins, via a cannula. The syringe pump or infusion pump can be used to precisely adjust the flow of medication.

• Intensive Care

  A care unit for the hospital’s most seriously ill patients, or those most at risk of deterioration. Intensive care also refers to the technical and medical care administered to these patients in a serious condition, in order to supplement (replace) the organs rendered ineffective by the acute illness, while the body “overcomes” the acute phase. Intensive care cannot be continued for very long, as the equilibrium it maintains is highly unstable and fragile.

• Intubation

  A medical procedure involving the placement of a tube, through the mouth or nose, into the trachea of an anesthetized patient in order to ventilate him/her (supply of oxygen to help breathing). Extubation: removal of this tube.

• Intubation tube

  The intubation tube is a plastic tube passed through the mouth (or, in rare cases, through the nose) and positioned at the crossroads between the two lungs to enable artificial respiration (ventilation). It is usually attached with a tape around the patient’s head. This attachment device may dig into the cheeks a little. It’s important that the tube doesn’t move, to ensure the most precise and efficient ventilation possible.

• Isolation

  The fight against nosocomial infections is central to hospital management. Isolation is one of the measures taken to limit the spread of germs. This is either to protect the most fragile patients from the germs naturally present in all of us, or to protect visitors and other patients from multi-resistant bacteria carried by a patient. Specific measures to be taken are usually indicated on the room door.

J

• Junior Doctors

  Junior Doctors are young doctors who have passed the internship examination (at the end of the 6th year of study). They are authorized to prescribe under the responsibility of the head of the clinic. They have a strong presence on our wards, and will be your first point of contact.

L

• Limiting and discontinuing treatments

  When a patient will not benefit from certain treatments, or no longer benefits from treatments that have been put in place, and in order to keep the discomfort, pain and anguish they cause to a minimum, these treatments may not be undertaken or may be stopped. Since 2004, and more recently in 2016, the Léonetti and Claeys-Leonetti laws have provided a framework for what are known as “treatment limitation and cessation” (LAT) decisions. These decisions are made in consultation with the entire healthcare team and an external consultant, taking into account the patient’s expressed wishes and keeping the patient’s family and friends fully informed. These decisions are re-evaluated every day as the patient’s condition evolves. Discontinuing certain life-sustaining treatments may accelerate the dying process. Where necessary, care teams implement palliative care, and since 2016 French law has notably authorized “deep and continuous sedation until death”, enabling the end of life to be as comfortable as possible for the patients concerned.

• Lungs

  The lungs are the organs of respiration. They have two main functions:
  – they supply oxygen to the blood which, thanks to the circulatory action of the heart, feeds the cells of all the organs
  – they purify the carbon dioxide produced by the organs as they function, carbon dioxide which can make the blood too acidic if it accumulates.
  In respiratory failure, the lungs fail to play their role. In some cases, a simple “helping hand” may suffice, by supplying them with a little more oxygen, or by insufflating a gas mixture adapted to the body’s needs at a certain pressure (see V.N.I.).
  In more serious cases, it may be necessary to intubate the patient and put him or her on artificial respiration, so as to be able to precisely control the proportions of the gas mixture adapted to the patient’s needs, while protecting the lungs weakened by the disease process in question as much as possible.

M

• Monitor or scope

  A monitor (or “scope”) continuously records heart and breathing rates, blood pressure and oxygen saturation in the blood. These data are collected by sensors and electrodes connected to the scope by cables. The monitors are configured to alert nursing staff if the patient’s condition is unstable. The monitors are also connected to central monitoring stations, so that the patient’s condition can be monitored at all times, even when the nursing staff are out of the room.

• MRI

  Magnetic Resonance Imaging. This is a non-invasive radiology examination that provides a very detailed view of the internal structures of the human body. The patient passes through the center of a device emitting electromagnetic waves. Waiting times for MRI are often long. Because of its electromagnetic wave technology, MRI is not recommended for patients with metallic or electronic devices (pacemakers, prostheses, etc.).

• Muscle breakdown

  Forced immobility leads to muscle wasting, which can be severe when hospitalization in intensive care is prolonged. This slows the recovery of independance, which is why physiotherapists and nurses intervene at an early stage to stop this phenomenon, mobilizing patients as soon as they are able.

N

• Next of kin

  This is a person of legal age, designated by the patient in advance (family member, friend, neighbor, attending physician, etc.) to receive medical information and record the patient’s wishes if he or she is unable to express his or her wishes. It is important for this person to have in-depth discussions with the patient in order to best convey his or her wishes, since he or she will have to express himself or herself on the patient’s behalf and not in a personal capacity. This designation is medico-legal and must be made in writing, on plain paper or on the form provided by the department. The designation document must specify the contact details of the trusted support person, and include the signature of both the patient and the designated trusted support person. The trusted support person may have a copy of the advance directives in his or her possession, so that he or she can refer to them at the appropriate time. The designation of a trusted support person can be reviewed and revoked at any time.

• Night

  At night, intensive care continues at the same pace as during the day. However, there are fewer doctors (see Guard). It is sometimes possible for relatives to stay with patients overnight, but this should be considered with caution: it’s important for relatives to protect themselves, as a stay in intensive care is always an exhausting ordeal. A night in intensive care is not a time for true rest. On the other hand, for the patient, while a familiar presence can be comforting during the night, it can also affect rest. Discuss this possibility with your nursing team, and listen carefully to their recommendations.

• Non-invasive ventilation (N.I.V.)

  Non-invasive ventilation is an alternative method to intubation, which can be used in certain specific cases. It is performed with a respirator that insufflates air in the same way as invasive ventilation, but uses a mask placed tightly over the face in place of the intubation tube.

• Noradrenaline

  See adrenaline

• Nosocomial infections

  These are infections contracted within the hospital. In the intensive care unit, and despite constant attention to hygiene, they affect an average of 1 in 5 patients, due to their ill health and the invasive techniques necessary for their survival.

O

• Oedema

  Medications are administered in water-based solutions, to avoid irritating the veins. As a result, patients receive large quantities of fluids every day, and despite treatments designed to promote elimination, it is extremely common for resuscitation patients to experience edema. The limbs swell, especially the hands. In some cases, the swelling is generalized to the whole body, including the face. The swelling eventually subsides. Patients are weighed regularly, and when necessary, diuretic treatments (to induce urination) can speed up the resorption process.

• Organ donation

  In France, organ donation is possible in certain circumstances, notably after the diagnosis of brain death or after a decision to limit or stop treatment (Maastricht III legal framework). All organs and certain tissues may be concerned. In France, by default, all individuals are considered donors. It is possible to register on the national refusal register to clarify your position.

• Oxygen spectacles

  Oxygen spectacles are small tubes used to supply additional oxygen to the nostrils if the oxygen present in the air is not sufficient for the patient. When this is not enough, a mask, a mask with reservoir or more intensive therapies such as N.I.V. (non-invasive ventilation) or artificial ventilation via an intubation tube can be used.

P

• Palliative care

  Palliative care is the care provided to alleviate certain symptoms in order to allow the patient to live as comfortably as possible. Often opposed to curative care in media discourse, palliative care is in fact useful care to be carried out from the acute phase onwards, in parallel with curative care (i.e. care aimed directly at recovery). At the end of life, or in the absence of a curative project, all care is focused on so-called palliative care, in order to offer the patient the most comfortable last moments possible. As the saying goes, it’s “all that’s left to do when there’s nothing left to do”.

• P.A.V.M.

  or Ventilator-Acquired Pneumonia: this is one of the most frequent complications of mechanical ventilation: germs naturally present in the mouth pass along the intubation tube despite precautions and regular mouth care, causing a respiratory infection on top of pre-existing problems. Numerous measures are taken in the ICU to prevent this: the half-sitting position in bed, regular mouth care, suctioning at the back of the throat, frequent checks on the pressure of the balloon at the end of the intubation tube, which retains oral secretions, etc. But these measures are not always enough to prevent the occurrence of this infection in ICU patients, who are by definition very fragile.

• Physiotherapist

  Physiotherapists play a major role in intensive care. They work with patients on a daily basis, maintaining joint flexibility and exercising muscles. They also play an important role in weaning patients off mechanical ventilation and retraining the muscles.

• Prescriptions

  Prescriptions are constantly updated by the doctors in charge of the patient, in the morning after reviewing the latest test results, and as the day progresses, according to changes in vital parameters (pulse, blood pressure, oxygen saturation and all other parameters collected by the machines throughout the 24-hour period) and changes in the patient’s condition.

R

• Research

  To advance scientific knowledge and improve care techniques, intensive care units are actively involved in scientific research. Data collected during a patient’s hospital stay may be used anonymously for evaluation and research purposes. In addition, the consent of the patient or his or her family may be sought for comparative studies between different types of treatment or care. For this purpose, a consent form will be sent to the patient, if he or she is able to read and understand it, or to his or her next of kin if necessary, and must be signed. This form details the terms and conditions of the study proposed to the patient or his or her family. Of course, the patient or his or her next of kin are completely free to refuse, and this will in no way alter the care provided or the relationship with the healthcare team. If consent is given by the patient’s next of kin, the patient’s consent will be sought again once he or she is once again able to make decisions for himself or herself.

• Respirator

  See ventilator

• Respiratory weaning

  Phase of treatment designed to restore the patient’s respiratory independance. Depending on the duration of the acute phase, patients may have lost more or less muscle. A transitional tracheostomy can facilitate and accelerate the weaning process, enabling the patient to be taken off the ventilator for a few hours a day, while retaining the possibility of reconnecting it, particularly at night and during rest phases. Muscular rehabilitation is also an important part of this process, with chair positioning, standing, etc., all helping to remuscle the patient’s ribcage and speed up recovery.

S

• Saturation

  When we speak of “saturation”, we’re usually referring to pulse oxygen saturation, measured by a sensor that looks like a small clip placed on the tip of a finger, or sometimes on the earlobe. This measurement is a good reflection of the patient’s oxygenation, but is not as accurate as arterial oxygen saturation, obtained from blood gases.

• Scanner

  A CT scan, also known as a CAT scan, is an X-ray examination. The principle is to produce thin-section images of a part of the body. The X-ray tube rotates around the patient’s body and computerized images are obtained. These must then be ‘read’ to enable a diagnosis to be made. Frequently, an iodine-based contrast agent is used to improve image quality, usually by infusion.

• Sedation

  Administration of drugs to “sedate” the patient, putting him or her into an artificial coma. This is done for a number of reasons: to put one or more organs at rest, to avoid pain during an invasive procedure (unpleasant procedure or surgical operation), to enable patients to better tolerate the respirator. See anesthesia.

• Shock

  Sudden and profound drop in blood pressure. There are several types of shock: septic shock, due to severe infection; hemorrhagic shock, due to severe blood loss; cardiogenic shock, due to malfunctioning of the heart; and anaphylactic shock, due to severe allergy.

T

• Therapeutic overkill

  See Unreasonable obstinacy

• Total Artificial Heart (e.g., CARMAT)

  : This is a biventricular assist device (meaning it assists both ventricles, the lower chambers of the heart), with the installation of two artificial ventricles that replace the native ventricles. This device is implanted during a major surgical procedure. This is a new technique and is currently used exclusively within the framework of a research protocol. It can only serve as a bridge to heart transplantation; long-term survival with this device is not possible.

• Tracheotomy

  A small procedure involving the placement of a breathing tube (flexible plastic hose) directly into the trachea, via an incision at the base of the neck. It is performed to facilitate and accelerate recovery of respiratory independance when the process (weaning) is too long and/or uncomfortable for the patient. In most cases, the tracheostomy is subsequently removed and the orifice heals spontaneously.

• Transport

  Transporting a patient to another hospital department for an examination or surgical procedure. During transport, continuity of care and monitoring continues. It is a delicate procedure requiring special logistics and medical assistance.

U

• Ultrasound

  Ultrasound is an examination used to explore the anatomy and functions of certain organs. Ultrasound can be either internal or external: In the case of external ultrasound, the doctor applies a probe against the skin at the level of the organ he or she wishes to explore. This probe emits ultrasound waves which pass through the tissues and are then sent back to him or her in the form of an echo. This is a relatively quick and painless examination, performed in the patient’s bed. In the case of internal ultrasound, the probe is inserted into a natural cavity to get closer to the organ to be explored. For example, in some cases, an external ultrasound of the heart (trans-thoracic ultrasound) is not sufficient to get a clear view of the desired structures. In this case, the doctor will perform a transoesphageal ultrasound: the ultrasound probe is passed through the mouth into the esophagus to get closer to the heart.

• Unreasonable obstinacy (or therapeutic overkill)

  During a patient’s stay in intensive care, changes in their state of health may lead to questions about the appropriateness of current treatments. The lack of expected benefit, despite heavy and sometimes aggressive treatment, may lead to the use of certain treatments being limited or discontinued, or even to the use of treatments designed to ensure comfort. In France, unreasonable obstinacy is prohibited by law. Since 2004, and more recently in 2016, the Léonetti and Claeys-Leonetti laws have provided a framework for what are known as “treatment limitation and cessation” (LAT) decisions. These decisions are made in consultation with the entire healthcare team and an external consultant, taking into account the patient’s expressed wishes and keeping the patient’s family and friends fully informed. These decisions are reassessed on a daily basis as the patient’s condition evolves.

• Urinary catheter

  A plastic tube used to drain urine from the bladder, connected to a collection bag. These catheters are essential when patients are unconscious. Urinary catheterization helps nursing staff monitor kidney function.

V

• Vegetative state

  A vegetative state occurs when, in the absence of sedative treatment, the patient is left with only reflexes following brain damage. These include the alternation of the sleep-wake cycle, reflexes to stimuli such as eye movements, yawning and involuntary movements. Patients in a vegetative state are unaware of their condition and their environment.

• Ventilator

  The ventilator (or respirator) is a machine used to administer a gas mixture adapted to the patient’s needs, by controlling volume and frequency. This maintains a stable and sufficient oxygen content in the patient’s blood, and removes carbon dioxide. The ventilator assists respiratory function in the event of pulmonary and/or cardiac failure, but is also used when the patient is comatose, to protect the patient’s lungs from infection. The patient is connected to the ventilator via an intubation tube placed in the trachea. This tube is always inserted under anaesthetic.

• Ventral Decubitus (or V.D.)

  The word “decubitus” means lying down. Ventral decubitus means lying on one’s stomach. This technique is particularly useful in cases of severe respiratory failure, as it improves gas exchange (breathing efficiency). Lateral decubitus can also be used to position patients on their sides, again generally to promote breathing. Lateral decubitus can also be used in intensive care to relieve pressure points and prevent or treat pressure sores.

• Viruses

  Viruses are disease-causing microorganisms. They enter the body’s cells to multiply (“replicate”). They transmit information that leads the cells themselves to produce numerous copies of the virus, which are then released to infect other cells. Antibiotics do not work on viruses, but can be used when bacterial superinfection occurs in the wake of a viral infection.

W

• Weaning

  Weaning is the gradual discontinuation of a treatment. This is known as respiratory weaning, a process that can take from a few days to several weeks in some cases. It can also be referred to as catecholamine withdrawal.