The intensive care unit (ICU) room is a highly specialized environment,
differing in many ways from a standard hospital room. ICU rooms
are staffed with a higher nursing staffing ratio, typically one
nurse to two rooms, and a premium is placed on patient visibility.
Units are often constructed in such a manner that all patients can
be under continuous observation from the central-nursing station,
either directly or using cameras. Patients are individually monitored
with a variety of bedside physiologic monitors, and ICU rooms are
designed to have redundant gas and electric sources.
Definitions and Terms
- ▪ Headwall: The wall behind the head of a patient in
an ICU, in which electrical, gas, and equipment mounts are deployed—while
headwalls are typical, columns and movable, jointed arms are used
in some units (ie, pediatric) to permit more flexible
bed/crib configurations (Figure 1-1).
- ▪ Physiologic monitor: A piece of medical equipment that
serves as a central aggregation and display location for many medically
significant physiologic variables, including electrocardiogram (ECG),
various pressure waveforms, noninvasive blood pressure, pulse oximetry,
respiration, temperature, and so on (Figure 1-2).
- ▪ Telemetry: Electronic transmission of medical data to a
central analysis station (Figure 1-3).
- ▪ Electrocardiography: Analysis and display of data regarding
cardiac conduction and rhythm (Figure 1-4).
- ▪ Pulse oximetry: Photoelectric, noninvasive measurement
of capillary oxygen levels using light transmission through a capillary
bed to a receiver (Figure 1-5).
- ▪ Impedance pneumography: A technique by which respiratory
rate is measured using electrical changes between ECG leads induced
by changes in intrathoracic air volume during inspiration and expiration.
- ▪ Wall oxygen supply: Oxygen is piped into hospitals from
a central supply source typically on the hospital grounds—gases
are distributed to outlets throughout the hospital which are both
color coded and distributed using gas specific connectors to mechanical
ventilators and/or gas blenders. While colors for medical
gases vary among countries, green (Figure 1-6) is used to indicate
oxygen in the United States (whereas white is used in the United
Kingdom). Wall oxygen is supplied at 50 pounds per square inch (psi)
and distributed throughout the hospital from central liquid oxygen
- ▪ Wall air supply: Compressed air is piped to ICU headwalls
using a separate and distinct piping system and is dispensed at
the bedside through a specific color coded and connector specific
gas outlet—air is blended with oxygen to dispense specific
oxygen concentrations to the patient. In the United States, the
color yellow (Figure 1-7) is used to indicate compressed air (whereas
black and white are used in the United Kingdom). Wall air is typically
supplied at 50 psi.
- ▪ Wall suction: A separate suction system is available at
each ICU bedside and used for a variety of applications (Figure
1-8), including suction on drains (ie, chest tubes, gastric tubes,
abdominal drains, etc.) and pulmonary secretion removal. ...