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Critical Care
Critical illness can be an overwhelming and stressful experience for both patients and their loved ones. In this section you’ll find important information if you or a loved one is a patient on the Critical Care Unit.
Patients on this unit are critically ill, unstable, require life support or are in need of continuous monitoring. Critical care nurses are the primary care givers on the unit and provide care 24 hours a day. These nurses have had specialized education and possess the necessary skills, knowledge and critical thinking to ensure patient safety and quality care.
The Critical Care Unit at North York General Hospital is a state-of-the-art 24-bed combined medical/surgical and coronary care intensive care unit.
Our patients often require life-sustaining interventions including ventilation, pacemakers and medications to support major organ functions. We provide quality evidenced-based care founded on proven research and best practices.
As one of Canada’s leading community academic hospitals, we are determined to innovate in ways that are most beneficial to our patients’ health outcomes. As a result, we are consistently reviewing and developing new intervention procedures and ways in which we can further improve patient care.
Our compassionate interdisciplinary team provides critical care to adult patients.
Your health care team
Physicians
Nurses
Respiratory therapists
Physiotherapist
Physiotherapy assistant
Dietitian
Pharmacist
Social worker
Clinical team manager
Clinical nurse educator
Clinical and special projects coordinator
Unit secretaries
Patient Experience Partner (PXP)
Team attendants
Learners
Family and friends are welcome to visit their loved one any time of the day. We recommend having two visitors at a time. The number of visitors may change depending on the patient’s health. For the privacy of all our patients, please go directly to your loved one’s room while visiting.
Visitors’ lounge
A visitors’ lounge is available for family and friends and is equipped with a washroom and TV.
When not to visit
If you are not feeling well, please do not visit the Critical Care Unit for the safety of all our patients. Talk to a member of the health care team if you are unsure whether you are able to visit.
What not to bring
To ensure the safety of our patients, fresh flowers, plants, food, fans, and balloons are not allowed in the Critical Care Unit.
Hand washing
To ensure the safety of our patients and yourself, please wash your hands with the hand rinse before and after each visit to the Critical Care Unit to help stop the spread of infection.
Isolation precautions
If your loved one is in isolation, please ensure all isolation precautions are followed before entering and leaving the patient’s room. If you are unsure of the process, please ask a member of the health care team to help you. Learn more about Infection Prevention and Control at North York General Hospital.
Participating in care
Family members are encouraged to participate in the patient’s care. Ask a member of the health care team how you can be more involved in your loved one’s care.
Interprofessional rounds occur from Monday to Friday at 10 a.m., and family members are welcome to join as long as the patient has agreed. Rounds are a good opportunity for families to understand the plan of care for the day and get an update on your loved one’s health.
Please select one family member as the designated spokesperson for the critical care team to share important information with. Members of the health care team are available to provide you with information regarding your loved one’s condition during your visit or by phone (416-756-6458). If you would like to meet with another member of the health care team, please inform the nurse to help make this arrangement.
Your responsibilities as power of attorney
If you are assigned the power of attorney for your loved one, or if they have a living will, please bring a copy of the documentation.
Items to bring for your loved one
Please bring personal items for your loved one such as soap, mouthwash, lotion, hair brush, toothbrush and razor. Any items left at the bedside should be labelled with the patient’s name. Remember to take any valuables items and medications home for safe keeping.
The Wish List Program
North York General Hospital’s Critical Care Unit Wish List Program aims to:
- bring compassionate care to our patients
- enhance the quality of life of our patients
- promote the dignity of our patients
Wishes are brought forward by patients and families based on their unique values and what is important to them. Critical Care Unit staff work together with them to help fulfill these wishes.
For more information, please ask to speak with the Critical Care Unit’s Social Worker or Clinical and Special Projects Coordinator.
Life support is used to support or replace a function of the body. In treatable conditions, life support is used temporarily until the body has healed and can resume normal function. If you or a loved one is on life support, it is important to understand the information outlined here so patients or substitute decision makers can make informed decision regarding care.
Understanding treatment options
Decisions regarding life support are both personal and medical. A treatment may be beneficial if it restores function, relieves suffering or enhances a patient’s quality of life. The same treatment can be considered harmful if it does not offer any benefit or if it actually diminishes a patient’s quality of life. All life support measures are optional treatments.
If a patient or substitute decision-maker chooses not to include some of these therapies in the treatment plan and would like to focus primarily on comfort, it does not mean that all medical care will stop. Care will continue to be provided and guided by the expressed wishes of the patient.
It is important to talk to the health care team regarding the risks and benefits and possible outcomes of each therapy.
Types of Life Support
Vasopressors
Vasopressors are a group of powerful drugs that cause blood vessels to contract, thereby raising blood pressure.
Mechanical ventilation
Mechanical ventilation is used to support or replace the function of the lungs. A machine called a ventilator forces air into the lungs through a breathing tube. The ventilator may be used short term or it may be needed indefinitely for permanent lung disease or trauma to the brain.
Read the brochure: What is a ventilator?
View our FAQs about Ventilators
Noninvasive ventilation (BiPAP)
Noninvasive ventilation is performed with a ventilator or another breathing machine called BiPAP. This is used when a patient cannot fully breathe on their own and needs help getting oxygen into their lungs. The patient wears a special face mask connected to the ventilator or the BiPAP machine.
Artificial nutrition and hydration
Nutrition and hydration may be used temporarily until the patient is well enough to eat and drink or it can be supplied indefinitely. Although potentially valuable and lifesaving, in many situations artificial nutrition and hydration does not necessarily provide appropriate care for dying patients.
Tube feeding
Tube feeding is the administration of a nutritionally balanced liquid formula through a feeding tube. Most commonly, a feeding tube is inserted into the stomach via the nasal passage (nasogastric or “NG” tube). Less commonly, a surgical procedure is performed to insert the feeding tube through the wall of the abdomen into the stomach (gastrostomy tube or “PEG”) or into the small intestine (jejunostomy tube).
Intravenous (IV) feeding
Intravenous (IV) feeding is given to patients who are unable to use their digestive tract. Similar to tube feeding, the IV solutions provide the patient with the total amount of protein, carbohydrate, fat, vitamins and minerals they need.
Dialysis
Dialysis does the work of the kidneys, which removes waste and excess fluid from the blood. Blood circulates from the body through the dialysis machine, where it is filtered and then returned to the body. At North York General Hospital, dialysis can only be performed in the Critical Care Unit. Some patients needing dialysis long-term may require transfer to a hospital with a chronic dialysis unit.
Types of Resuscitation
Cardio pulmonary resuscitation (CPR)
Cardio pulmonary resuscitation (CPR) is an emergency treatment used when the heart and/or breathing stops. CPR is performed in an attempt to restart the heart and breathing. It may consist of artificial breathing and it can include pressing on the chest to mimic the heart’s function to restart circulation. Electric shocks (referred to as defibrillation) and drugs (also known as inotropes and vasopressors) can also be used to stimulate the heart.
Defibrillation
Defibrillation involves sending a powerful electric shock through the heart. It is used when the heart stops beating effectively on its own. If the heart has lost all of its electrical activity or is so damaged that it no longer has enough muscle to pump blood through the body, defibrillation may not be successful in restarting the heart.
No-CPR order
For some patients, CPR may be ineffective in restarting the heart and breathing, and may cause more harm or not align with patient wishes. A No-CPR order instructs health care providers to not attempt CPR, defibrillation or insertion of a breathing tube (also known as intubation) in the event of a cardiac arrest (when the heart stops beating) or respiratory arrest (when breathing stops). This decision is made in consultation with the patient or substitute decision-maker(s). A “no resuscitation order” does not mean “do not treat.”
FAQs about Ventilators
Ventilators
What is a ventilator?
A ventilator is a machine used to help a patient to breathe. It pushes air and oxygen into the lungs through a breathing tube called an endotracheal or tracheostomy tube.
When is a ventilator used?
A ventilator is used whenever a patient’s health condition makes it hard for them to breathe on their own. The health care team works together to ensure the ventilator is not used longer than necessary.
Endotracheal tube
What does intubation mean?
Intubation is a procedure by which an endotracheal tube is inserted into the mouth and down into the trachea (windpipe) when someone is unconscious or cannot breathe on their own. The endotracheal tube is then connected to the ventilator to provide air and oxygen to the lungs. Having an endotracheal tube is referred to as being intubated.
Can a person talk with an endotracheal tube?
Patients on a ventilator are not able to speak because the endotracheal tube goes through the vocal cords (voice box) and prevents them from moving. Once the tube is removed, patients will be able to speak again. At first, the voice may be hoarse and the patient may have a sore throat, but this will gradually go away.
How can I communicate with a person who has an endotracheal tube?
Family and friends play an important role. Even though your loved one cannot talk, it is important to continue to communicate with them. Ask questions that can be answered with “yes” or “no”, with a head nod or a squeeze of the hand. Some patients may be able to write and communicate with a clip board and pen.
Does it hurt to be on a ventilator?
Patients requiring a ventilator may complain of discomfort from the endotracheal tube as it may irritate the throat. Some patients may cough or complain of being short of breath. Our goal is to make your loved one as comfortable as possible.
Tracheostomy tube
What is a tracheostomy tube?
A tracheostomy tube is a small tube placed directly into a patient’s trachea through the neck. This surgical procedure called a tracheostomy is performed in the Critical Care Unit or in the operating room.
When is a tracheostomy needed?
A tracheostomy tube may be needed for patients who need a ventilator for a prolonged period of time, patients unable to cough effectively to clear their secretions, or patients who may have a blocked airway.
What is suctioning?
Patients who require a breathing tube occasionally need suctioning to remove secretions or mucous from the airways to help with breathing. The nurse, respiratory therapist or physiotherapist inserts a small flexible suction catheter into the breathing tube.
Can a person eat or drink on a ventilator?
Patients who are on a ventilator cannot eat or drink. Nourishment is provided through a feeding tube that is inserted through the nose or mouth and down into the stomach.
What does it mean when the ventilator alarm sounds?
The ventilator system monitors the patient and is very sensitive to changes in the patient. When an alarm sounds, it notifies the health care team of these changes and to respond appropriately.
Are there any complications associated with a ventilator?
Patients on a ventilator receive special care to prevent complications such as developing pneumonia. Keeping the head of the bed up at a 30 degree angle and providing oral care will help minimize this risk. Each day, the team will discuss the readiness to discontinue the ventilator and assess the patient’s ability to breathe without help. The team will also practice proper hand washing to help eliminate the spread of microorganisms associated with infection.
Families and friends play an important role in preventing infection by washing your hands often. Please follow the signs on the door to determine if you need to wear a mask, gown, goggles and gloves.
Plan of care
To ensure you and your family are making informed decisions, we recommend you talk about the plan of care as a family, with your health care team. The plan of care should reflect the expressed wishes of the patient.
If the patient lacks capacity to make a decision about resuscitation, the patient’s substitute decision-maker should make decisions in accordance with the patient’s prior expressed wishes (if known) or the patient’s best interests. Please bring any documentation that outlines the wishes of the patient to the hospital so it can be reviewed together with the health care team.
Our social workers and the rest of the health care team are here to support and provide resources for you and your family during this difficult time. Interpretation services can also be arranged if you or your family feel this could be beneficial.
Comfort care
Comfort care is a comprehensive approach to treating symptoms of an illness when there is no cure and focuses on the physical, psychological and/or spiritual needs of the patient. The goal is to achieve the best possible quality of life by relieving suffering, controlling pain and symptoms, and attaining maximum independence.
Delirium is a state of confusion characterized by an inability to focus and fluctuations in behavior and level of consciousness. Delirium is experienced by 20% to 80% of critical care patients and is common for patients with longer hospital stays.
Causes of delirium
- Severe illness including infection
- Certain medications
- Dehydration or malnutrition
- Severe and/or uncontrolled pain
- Interrupted sleep patterns
Types of delirium
- Hyperactive: hyperactive delirium is characterized as restless, agitated, distressed, excessive movement and fidgeting
- Hypoactive: hypoactive delirium is characterized as lethargic, drowsy, unengaged and decreased spontaneous movement
Mixed: mixed delirium is characterized as alternates between hyperactive and hypoactive states
Treatment
Delirium can be treated when the underlying illness or condition is identified. By treating the underlying cause, can reduce symptoms of delirium. Other ways to treat delirium include:
- Avoiding unnecessary medications
- Promote sleep at night and activity during the day
- Promote early mobilization
- Activity and exercise
- Certain medications to improve symptoms
FAQs on Delirium
- Will delirium go away?
Yes, delirium is usually only temporary and often resolves within days. In some cases it may take longer. - What can family and friends do to help?
Friends and family can help by:
• Providing stimulation during the day by visiting, talking to them, watching TV or listing to the radio
• Promote sleep and rest at night by reducing noise and light
• Bring familiar object or activities
• Bring hearing or visual aids
• Say their name, today’s date and their current location to them frequently - Why is activity during the day important?
Activity during the day is important because it decreases the duration of delirium, may decrease the duration of using a mechanical ventilation, and can decrease the duration of a Critical Care Unit and hospital stay. - What types of activities are helpful?
The best activities for patients in the Critical Care Unit include in bed exercises, sitting up in a chair daily and walking.
If you have more questions about delirium, please talk to a member of your health care team.
The Critical Care Unit provides intensive care to our patients requiring life-sustaining interventions and close monitoring. Once those interventions are no longer required, you will be discharged home or moved to another unit in the hospital.
Moving to a medicine unit
Our priority is to ensure patients are receiving care in the right place. Once a patient is well enough to be moved to another unit, every effort will be made to help settle a patient into the new unit in a timely manner.
Moving to a new unit can happen at any time during the day. Your health care team will update you and your family about the details as soon as possible, so you can prepare. It is normal to experience some anxiety during this transition. If you have any questions during the move to another unit, please ask your health care team.
About medicine units
The environment of your new unit will be a little different. Nurses on medicine units will care for more than one patient. You will be shown how to call a nurse for assistance. There will be a full care team on your new unit and a Critical Care Response Team (CCRT) may visit if your health needs closer monitoring.
It is normal to feel tired and weak after being in the Critical Care Unit, which will improve with time. Speak with your health care team if you have any concerns regarding your recovery.
Discharge plans
Once you are ready to be discharged home, a member of your health care team will work with you and your family to develop a plan for your care.
Critical Care Unit: 416-756-6458
Patient Experience and Quality— Room GSE 116 (ground floor): 416-756-6125
The Critical Care Unit is located on the 6th floor, south east, at the General site.