MICU vs SICU?

[BlueAvenue]

what are the fundamental differences in each unit? I'm talking patient population, acuity, mortality, and procedures. starting respiratory therapy school soon and I'm curious

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[error404]

It's hard to generalize...
But many times the MICU population is older (less trauma,) and hasn't had surgery recently. Sometimes they have more medical problems (COPD, renal failure, being really old,) while the surgical folk can be younger and healthier AT BASELINE (having either driven into a tree or been deemed reasonable surgical candidates.)

 

[lazylikeapanda]

Like their respective names state, one unit is for medicine patient patients and the other for surgical patients. MICU patients are those that were admitted to the hospital for medicine related illness for example pneumonia, GI bleed, hypertension, and were later found to require extra care. An example would be the pneumonia patient who later develops sepsis could require MICU admission for pressors, intensive nursing care, and mechanical ventilation. As Error stated above they tend to be older patients with mulitple co-morbidities. Though you can get younger patients too.

SICU are patients who just came out of surgery and are usually admitted because they're still mechanically ventilated, require pressors or vasodilators, lost a lot of blood in the OR or organ transplanted patients. note that these aren't the only reason for admission. These patients can be young or old and medical co-morbidities vary though many tend to be healthier at baseline. As a general rule surgeons usually don't operate on and anesthesiologist don't provide anesthestic care on medically unstable patients unless the benefits of the procedure outweigh the risk.

That said, you can have a sick medicine patient in the SICU and vice versa if beds are at a premium.
The procedures are for the most part the same, art line placement, central line placement, line changes, intubate and vent. The difference in hte SICU is since surgeons are present they'll do bedside tracheostomies, PEGs, and on really rare occasion ex-laps.

 

[BlueAvenue]

thanks for the replies guys. which unit would you say on average treats the sicker patient? Im starting RT school soon but plan on applying to medschool when Im finished with my degree and critical care has my eye. trauma/cc seems interesting because from what I've read it's mostly non operative intensivist work which I suppose is why most surgeons dislike it, but you can also provide operative intervention when the need arises so that seems like a plus. at the same time the MICU seems like the patients would be sicker but that means higher mortality which could lead to faster burn out. so many variables, I suppose its all relative until my clinicals start

 

[G-Man82]

Why not apply straight to medical school and skip RT school? Otherwise, MICU tends to be sicker patients although its hard to generalize. Transplant patients post-op can be just as sick.

 

[BlueAvenue]

RT is my major and Im still finishing premed requirements. it was the degree that interests me most so I picked it, doing something else wouldn't save me anytime

 

[J ROD]

I did a month long rotation in the ICU as a pharm student in Aug and did two weeks in each.

MICU is more chronic and STICU has more acute problems....

personally I prefered the MICU

 

[G-Man82]

Oh, I didn't know you could do RT as an undergraduate major. Good luck with it then. During my anesthesiology rotations, I saw RT students come in to the ORs to practice intubations alongside medical students at one of our affiliate hospitals. Since you already seem to think you want Critical Care, then it looks like you'll be looking broadly at Anesthesiology, Internal Medicine, or General Surgery during medical school. Keep those specialties in mind when you reach 3rd year because they are the primary specialties that practice CCM.

 

[SLUser11]

SICU are patients who just came out of surgery and are usually admitted because they're still mechanically ventilated, require pressors or vasodilators, lost a lot of blood in the OR or organ transplanted patients. note that these aren't the only reason for admission. These patients can be young or old and medical co-morbidities vary though many tend to be healthier at baseline. As a general rule surgeons usually don't operate on and anesthesiologist don't provide anesthestic care on medically unstable patients unless the benefits of the procedure outweigh the risk.

I would opine that most SICU patients are sicker than what is insinuated here, and they include a lot of patients that are "medically unstable." We have plenty of patients with a thousand medical comorbidities that show up with a "surgical problem," from appendicitis to GI bleed to mesenteric ischemia to ruptured AAA, etc etc. often with multisystem organ failure, e.g. ARDS, ARF or ESRD, CHF, MI, cirrhosis/fulminant liver failure, adrenal insufficiency, and so on.

In my experience, the hardest people to keep alive are the really bad burns with inhalation injury, which is a battle you usually lose, and the cirrhotics with horrible variceal bleeds.


Of course, I am a big believer in the quality of MICU care, and I know there are some super-sick pts there as well.....I just don't know if I can say, at least in my experience in the 20 or so different ICUs I'm familiar with, that the SICU patients are less sick.

 

[smq123]

Of course, I am a big believer in the quality of MICU care, and I know there are some super-sick pts there as well.....I just don't know if I can say, at least in my experience in the 20 or so different ICUs I'm familiar with, that the SICU patients are less sick.

Agreed. There were some patients that I saw in the SICU that were heartbreakingly sick - literally teetering on the edge of death in front of your eyes. But there are some in the MICU that are also barely hanging on by a thread. It's a mix.

 

[proman]

Arguing which unit is sicker is a loser-argument. Everyone who does CCM wants to think they take care of the sickest patient. It's completely understandable. We all have sick patients.

BICU burns are awful, MICU ARDS pulmonary hemorrhages are awful, CSICU bivads with pulmonary HTN are awful. I think my alcoholic cirrhosis with acetaminophen OD who was anhepatic for 3 days waiting for a liver is probably as sick as they come. BTW, the guy got his liver and 2 weeks later is on the floor.

 

[SLUser11]

Arguing which unit is sicker is a loser-argument. Everyone who does CCM wants to think they take care of the sickest patient. It's completely understandable. We all have sick patients.

BICU burns are awful, MICU ARDS pulmonary hemorrhages are awful, CSICU bivads with pulmonary HTN are awful. I think my alcoholic cirrhosis with acetaminophen OD who was anhepatic for 3 days waiting for a liver is probably as sick as they come. BTW, the guy got his liver and 2 weeks later is on the floor.

I wasn't arguing that SICU patients are sicker....I was giving my opinion that SICU patients are also very sick, which I think I made pretty clear since I said it directly.

As for me, I definitely don't brag about having the sickest patients. I want to be able to brag that all my patients are walking out of the hospital and going home. Unfortunately, you have to work with the hand you were dealt....

 

[Boomer]

There's also a distinction to be made between purely surgical patients in SICU (transplants, CABG, etc), who often have enough co-morbidities that they are sick as hell, and the SICU patients who are younger people with trauma. I think that's where some people get the impression that SICU pts have fewer co-morbidities--and in that particular subset that's true, but that doesn't consider everything.

There's really a lot of overlap between SICU and MICU patients. The example of having a surgical issue with multiple underlying medical issues is really pretty common.

For the record, I'm a MICU guy, and occasionally get consults from the SICU--SICU guys take care of their share of folks with multiple issues. One of my most interesting cases was from the SICU--it was a 60-something guy with colon cancer, being treated with oxalaplatin, who developed pulmonary fibrosis. His oncologist wisely stopped the drug, but he continued to progress rapidly (there are a few case reports of this drug doing this--nasty). Chest surgery did a VATS biopsy and SICU took over. I got consulted about a week later, but at this point, there wasn't much left to offer.

In some places, the surgeons/SICU people would have wanted him to be on the MICU service given his underlying issues--and that would've been OK too. Point being, fair amount of overlap.

 

[howelljolly]

That said, you can have a sick medicine patient in the SICU and vice versa if beds are at a premium.
The procedures are for the most part the same, art line placement, central line placement, line changes, intubate and vent. The difference in hte SICU is since surgeons are present they'll do bedside tracheostomies, PEGs, and on really rare occasion ex-laps.

 

[smq123]

When I rotated through SICU as a med student, they were talking about doing a bedside ex-lap on a patient who had an abscess somewhere in his abdominal cavity, but was probably too sick to be moved. It was going to be a last ditch effort.

 

[proman]

There's the VAC dressing change sometimes done at the bedside. 30 minute procedure rarely worth a transport to the OR. The only true reason to do a real bedside ex-lap is for abdominal compartment syndrome. Although, I don't know if the current surgical thinking has shifted away from this (it's been a while). Oh, and some post-cardiac surgery patients have clots or bleeding that requires reopening the chest.

 

[jdh71]

It's wild, but it happens, I promise. I've seen it twice myself.

 

[SLUser11]

There's the VAC dressing change sometimes done at the bedside. 30 minute procedure rarely worth a transport to the OR. The only true reason to do a real bedside ex-lap is for abdominal compartment syndrome. Although, I don't know if the current surgical thinking has shifted away from this (it's been a while). Oh, and some post-cardiac surgery patients have clots or bleeding that requires reopening the chest.

I would have to agree. Having been involved in a handful of bedside laps (?5 or 6), it's usually a crashing patient who isn't stable enough to go to the OR. If they can survive the trip to the OR (and back) then they probably should, because the lighting and ergonomics of an ICU operative case are horrible, not to mention the inherent lack of sterility.

My laparotomies off the top of my head: 3 for abdominal compartment syndrome (2 traumas and 1 necrotizing pancreatitis), 2 looking for dead bowel in a crashing acidotic patient, and 1 to repack uncontrolled bleeding after a damage control laparotomy.

Of course, there are countless bedside intra-abdominal VAC changes or tightening of Wittman patches, but those don't really count, even though the innards are out there in the open.

 

[Tigerz_Fan]

It's wild, but it happens, I promise. I've seen it twice myself.

Same here, and including a bedside AKA and C section.

 

[LadyWolverine]

I watched OMFS do a bedside jaw-wiring of mandibular fx. Now THAT was medieval. You could hear the guy screaming down the hall.

PS I just realized how off-topic that comment was. Sorry. For a second, I thought this was a thread about crazy bedside stuff that would usually be done in the OR.

 

[bulgethetwine]

I watched OMFS do a bedside jaw-wiring of mandibular fx. Now THAT was medieval. You could hear the guy screaming down the hall.

PS I just realized how off-topic that comment was. Sorry. For a second, I thought this was a thread about crazy bedside stuff that would usually be done in the OR.

I've worked in MICU, SICU, Neuro ICU, and CT ICU settings. Of far more importance to me then the question of MICU vs SICU is whether or not the non-ICU attendings are collaborative. This goes beyond closed/open, too.

I have no problem working in 'open' SICUs with two caveats: 1) The surgeon's defer to the ICU team on issues that are 'non-surgical' -- like antibiotic regimens, culture strategies, prophylaxis and the like -- and 2) Communication flows freely between BOTH ICU team and primary team.

There is nothing worse than an old school primary team attending who just doesn't faulking listen to the intensivist advice.

 

[howelljolly]

I've worked in MICU, SICU, Neuro ICU, and CT ICU settings. Of far more importance to me then the question of MICU vs SICU is whether or not the non-ICU attendings are collaborative. This goes beyond closed/open, too.

I have no problem working in 'open' SICUs with two caveats: 1) The surgeon's defer to the ICU team on issues that are 'non-surgical' -- like antibiotic regimens, culture strategies, prophylaxis and the like -- and 2) Communication flows freely between BOTH ICU team and primary team.

There is nothing worse than an old school primary team attending who just doesn't faulking listen to the intensivist advice.

Interesting. I had just visited an open NICU where a PCCM doc and neurosurgeon are on each patient. My initial response was thinking that it must be fascinating for the PCCM. I guess it might be a pain as well.

 

[bulgethetwine]

Interesting. I had just visited an open NICU where a PCCM doc and neurosurgeon are on each patient. My initial response was thinking that it must be fascinating for the PCCM. I guess it might be a pain as well.

It just depends. If they communicate well, then it can be a great collaboration. If they don't communicate well, then the PCCM is a wasted resource, and the Neurosurgeon (in this case) can harm a patient if he/she doesn't have a critical care background.