What Constitutes Critical Care?

Critically ill patients are the most challenging that we see. With some hard work, patience and a little bit of luck they can be extremely rewarding. Over the last 15 to 20 years there have been great developments in what can be offered to critically ill patients in terms of monitoring, care, knowledge and therapies.

Good Critical Care

Good critical care resolves round careful consideration of the patients requirements and requires a team approach. Good nursing is required 24 hours a day in some of these patients. Veterinarians involved in their care require a keen eye for detail and an ability to make decisions quickly based upon the information available.
When thinking about this type of care we really need to be clear in our head about what constitutes a critically ill patient. Critical by definition in medical use are patients that may have rapid changes in their clinical condition either for the better or worse, or those conditions where there is a danger of death. These patients therefore are those that have severe illness with abnormalities in tissue oxygen delivery and therefore at risk of organ failure. As these patients are at risk of “change” in their clinical condition at any time it is important to realise that critical care is a 24 hour a day, 7 day a week discipline!

Ethics

There has been some talk of the ethics of providing this kind of care in veterinary patients. Careful communication with the owner is vital to ensure they are aware of what is happening and they should be involved with decision making, particularly that of when not to treat. Many of these patients have co-morbidities and discussion of prognosis should occur sooner rather than later. It is obvious that treating a patient with metastatic neoplasia and a second serious disease is not fair for patient but some patients provide more of a challenge; the puppy with septic peritonitis, the dog with laryngeal paralysis and aspiration pneumonia. Some people may not enjoy working within an intensive care unit for some of these reasons and these personal opinions should be taken into account when planning staffing for your unit.

Treatment facilities for critical care

The team
There are a number of requirements in order to enable the provision of critical care. First and foremost is a team of people able and willing to participate in management of these conditions. The team should consist of vets and nurses working on rotation through the day. Overnight it is preferable to have both vets and nurses present though it is possible to provide critical care with nurses or vets alone. Communication between staff members must be accurate and informative to alert staff of possible problems and concerns. Nursing and junior staff should have clear instructions as to what to monitor and who to inform should something change. [...]