Patient Library

What is the ICU?

The Intensive Care Unit — often called the ICU, or in Georgian hospitals the "Reanimatsia" — is a special part of the hospital designed for patients who need constant, close monitoring. Every patient has their own space with specialized equipment and a dedicated team watching over them around the clock.

What does it look like?

It can feel overwhelming at first. You may see monitors with lines and numbers, tubes, IV drips, and machines making beeping sounds. This is all normal. Each device serves a purpose: the monitor shows the heart rate and oxygen levels, the IV delivers fluids and medications, and ventilators (breathing machines) help some patients breathe.

Who works in the ICU?

A team of specialists cares for every patient: ICU doctors (intensivists), specialized nurses, respiratory therapists, pharmacists, and physiotherapists. They work together and communicate constantly. You may not always speak to the same person — but the team always knows what is happening with your loved one.

Can I visit?

Most ICUs allow family visits, though times may be limited. Ask the nurses about the visiting schedule. Even if your loved one seems unconscious or sedated, talking to them gently can be comforting — research suggests patients can often hear even when they cannot respond.

What is anesthesia?

Anesthesia is medication that prevents you from feeling pain during a procedure. It is carefully calculated and administered by an anesthesiologist — a doctor who specializes entirely in keeping you safe and comfortable throughout surgery.

Types of anesthesia

• General anesthesia — you are completely unconscious and feel nothing. Used for major surgeries.
• Regional anesthesia — numbs a large area of your body (like an epidural). You may be awake but feel no pain.
• Local anesthesia — numbs a small area only. Used for minor procedures.
• Sedation — makes you relaxed and drowsy but not fully unconscious. Also called "twilight sleep."

Will I wake up during surgery?

This fear is very common but extremely rare. Modern anesthesia monitoring is sophisticated. Your anesthesiologist continuously monitors your level of unconsciousness and adjusts medication throughout the operation.

What to expect when you wake up

You will wake up in a recovery room. You may feel groggy, cold, or slightly confused — this is normal. Nausea is common but manageable with medication. The nursing team will monitor you closely until you are stable and ready to move.

Fasting rules ("nil by mouth")

Your child's stomach must be empty before anesthesia to prevent complications. The team will give you specific fasting times — typically no solid food for 6 hours and no clear fluids for 2 hours before surgery. Follow these exactly. Do not give any food or drink without checking with the surgical team first.

Talking to your child

Children are perceptive and anxious. Age-appropriate honesty is always better than false promises. You might say: "The doctors will give you special medicine that makes you fall into a deep sleep, and when you wake up, the operation will already be finished." Avoid saying "you won't feel anything" or "it won't hurt at all" — focus on "the doctors will make sure you are comfortable."

On the day

• Bring a comfort item — a favourite toy or blanket is usually allowed in the anaesthesia room.
• Dress your child in comfortable, easy-to-remove clothing.
• Ask if a parent can be present during anaesthetic induction — many hospitals allow this.
• Tell the team about any recent illness, even a cold.

Why controlling pain matters

Poorly controlled pain is not just uncomfortable — it slows recovery. Pain causes stress hormones to rise, makes breathing shallower (which can cause chest infections), discourages movement, and disrupts sleep. Good pain control helps you recover faster and reduces complications.

Types of pain relief used

• Paracetamol / Acetaminophen — safe, effective baseline pain relief given regularly.
• Anti-inflammatories (NSAIDs) — like ibuprofen. Reduce swelling and pain, but not suitable for everyone.
• Opioids — stronger medications like morphine for severe pain. Given carefully and tapered as you improve.
• Nerve blocks — injections that numb specific areas for hours or days after surgery.

How to communicate your pain

Use the 0–10 pain scale. 0 means no pain, 10 is the worst you can imagine. A pain score of 4 or above should always be reported to the nurse — do not wait. The team's goal is to keep you comfortable, not to minimise medication use at the expense of your wellbeing.

What does a ventilator do?

A ventilator is a machine that breathes for the patient — or helps them breathe — when they cannot do so adequately on their own. It delivers carefully measured amounts of oxygen with every breath, maintains the correct pressure in the lungs, and removes carbon dioxide.

Why might someone need a ventilator?

• After major surgery, when the body needs support while recovering from anesthesia.
• During a serious infection (sepsis, pneumonia) that affects the lungs.
• After a brain injury or severe neurological event.
• When the heart is not pumping strongly enough to support breathing.

Is it painful?

Being on a ventilator requires a tube in the throat (endotracheal tube). This is uncomfortable, so patients are given sedation and pain relief to keep them comfortable. The team constantly adjusts these medications. When the patient improves enough, the tube is removed — a process called "extubation."

When will the ventilator be removed?

Every day, the ICU team assesses whether the patient is ready to breathe independently. They perform a "breathing trial" — briefly reducing ventilator support — and monitor how the patient copes. When ready, the tube is removed. Most patients feel significant relief afterwards.

Why do children need heart surgery?

Most children who undergo heart surgery have a congenital heart defect — a structural problem that was present at birth. These range from small holes between heart chambers to more complex abnormalities in valves or major blood vessels. Surgery corrects or repairs the defect so the heart can function more normally.

What is the bypass machine?

For many heart surgeries, doctors use a cardiopulmonary bypass (heart-lung) machine. This device temporarily takes over the work of the heart and lungs — pumping blood and adding oxygen — while the surgeon operates on a still, bloodless field. It sounds frightening but is a well-established, safe technique used for decades.

What happens in the ICU after surgery?

Your child will go directly to the pediatric ICU (PICU) after surgery. They will have drains, IV lines, a breathing tube, and monitoring wires attached. This is expected — it is not a sign that something went wrong. The team will gradually remove these lines and tubes as your child stabilises and improves, usually over 24–72 hours for the breathing tube.

Long-term outlook

The vast majority of children who undergo heart surgery go on to live full, active lives. Many need follow-up care and monitoring throughout childhood. Your cardiologist will guide you on any restrictions and when normal activities can resume.

What counts as a fever?

A temperature above 38°C (100.4°F) is considered a fever. Fever itself is not a disease — it is a sign that the body's immune system is working. Most fevers in children are caused by viral infections and resolve on their own within 3–5 days.

General guidance by age

• Under 3 months: Any fever above 38°C needs urgent medical assessment. Newborns cannot fight infection effectively and fever can be serious.
• 3–6 months: Seek advice if temperature is above 39°C or child seems unwell.
• Over 6 months: Manage at home if child is drinking, reasonably alert, and has no alarming signs.

Warning signs — seek immediate help

• A rash that does not fade when pressed (glass test)
• Stiff neck or severe headache
• Seizure (fit)
• Difficulty breathing
• Child is limp, unresponsive, or unusually difficult to wake
• Fever lasting more than 5 days

The Full Blood Count (FBC)

This is the most commonly ordered blood test. It counts the different cells in your blood: red blood cells (carry oxygen), white blood cells (fight infection), and platelets (help blood clot). A low red blood cell count means anaemia. A high white cell count often signals infection or inflammation.

CRP — C-Reactive Protein

CRP is a marker of inflammation. A high CRP means the body is fighting something — an infection, injury, or inflammatory condition. Doctors watch CRP over time; as it falls, it usually means treatment is working.

Electrolytes

Sodium, potassium, calcium, and magnesium are electrolytes — minerals that carry electrical charges vital for every cell to function. Imbalances can cause muscle weakness, heart rhythm problems, and confusion. IV fluids in hospital are carefully formulated to correct these.

Kidney and liver tests

Creatinine and urea show how well your kidneys are working. ALT, AST, and bilirubin show liver function. These are routinely checked in hospital to ensure organs are tolerating medications and the illness itself.

What is an echo?

An echocardiogram — commonly called an "echo" — uses ultrasound waves to create a moving picture of the heart. It is completely painless, uses no radiation, and typically takes 30–45 minutes. A gel is applied to the chest and a probe is moved across the skin to capture images.

What can an echo show?

• The size and shape of the heart chambers
• How well the heart muscle is contracting (pumping function)
• The condition of the four heart valves
• Blood flow patterns within the heart
• Congenital heart defects
• Fluid around the heart (pericardial effusion)

Types of echo

A transthoracic echo (TTE) is the standard test, performed over the chest wall. A transoesophageal echo (TOE/TEE) involves a probe passed down the throat under sedation — this gives clearer images and is used when more detail is needed or in surgery.

Sedation and analgesia

Patients on ventilators are given sedatives (like propofol or midazolam) to keep them comfortable and prevent distress. Alongside these, opioid pain relievers (like fentanyl or morphine) control pain. Every day, the team aims to use the minimum dose needed — "light sedation" is associated with faster recovery.

Vasopressors

These are medications that constrict blood vessels to maintain blood pressure when the circulation is failing. Noradrenaline (norepinephrine) is the most commonly used. You may see these running via a precise syringe pump — even tiny changes in dose can significantly affect blood pressure.

Antibiotics

Infections in the ICU are life-threatening. Broad-spectrum antibiotics are started early and sometimes given intravenously around the clock. The team regularly reviews whether the current antibiotics are the right choice based on blood culture results.

Blood thinners (anticoagulants)

Patients who are immobile risk blood clots forming in the legs (deep vein thrombosis) or lungs (pulmonary embolism). Low-dose heparin injections — or special compression stockings — help prevent this.

The first 24 hours

The first day after major surgery is about stabilisation. You will likely be in the ICU or a high-dependency unit. Pain will be managed; nurses will monitor vital signs frequently. You may have a urinary catheter, drains, and several IV lines. This is normal and expected.

Early mobilisation

Getting up and moving — even just sitting in a chair — as soon as medically safe is one of the most important things for recovery. Early movement reduces the risk of pneumonia, blood clots, and muscle wasting. It may feel difficult or painful, but the physiotherapy team will support you.

Eating and drinking

Nutrition is medicine after surgery. The team will aim to restart eating and drinking as soon as the gut is working. For some surgeries this is within hours; for others it may take a few days. Good nutrition is essential for wound healing, immune function, and energy.

Emotional recovery

Major surgery affects the mind as well as the body. Feeling emotional, anxious, low, or confused in the days after surgery is common. Some patients experience "ICU delirium" — temporary confusion caused by medications, sleep deprivation, and the stress of critical illness. This typically resolves as recovery progresses.

It's okay not to understand everything immediately

Receiving a significant diagnosis is one of the most stressful events in life. Shock and information overload mean you may not absorb everything in the first conversation. This is completely normal. Always feel free to ask your doctor to repeat or rephrase — and ask if you can record the conversation or bring someone with you.

Key questions to ask your doctor

• What exactly is this condition, in simple terms?
• What caused it, or is the cause unknown?
• What are my treatment options?
• What happens if I choose not to treat it?
• What is the likely outlook with treatment?
• Will this affect my daily life, work, or family?
• Who else should be involved in my care?

Finding reliable information

The internet contains vast amounts of medical misinformation. Stick to established, peer-reviewed sources: national health services (NHS, CDC, WHO), major hospital patient education portals, or ask your medical team to recommend reading material. Avoid forum posts or social media health "influencers" as a primary source.