Critical Care

Referrals to critical care are made by any of the doctors or nurses in the hospital when they are concerned about a patient.

• ICU Steps
• National Institute for Health Research
• Cheshire & Mersey Critical Care Network
• The Faculty of Intensive Care Medicine - for patients
• Intensive Care Society - patients and relatives

Being a critical care patient can be a very traumatic experience. For this reason, we are careful only to put somebody through this experience if they have a chance of getting better with the treatment. 

We do not put somebody through this treatment if it is very unlikely to help them get better. The decision making around who and when to admit someone to critical care is done by senior specialist doctors (consultants) and, whenever possible, in discussion with patients and/or their close family.

A video of people describing what it was like to be a critical care patient.

Critically ill patients require support for failing organs. 

The Critical Care Unit (CCU) includes level three patients who may require the following support:

• Ventilator – for patients who are struggling to breathe and need ventilation by a mask or tube in their windpipe
• Dialysis – for patients whose kidneys are not working
• IV lines and pumps – for patients with falling blood pressure, intravenous medications are provided through lines inserted into a large vein (neck, groin) to maintain blood pressure, provide nutrition and fluids.

We also care for complex post-operative patients who are at risk of organ failure or require additional support because they have had a high-risk operation (high-risk either due to the nature of the surgery, or due to the patients’ chronic health). 

Enhanced recovery pathways are utilised to improve patient outcomes after complex major surgery. Interventions that have a strong evidence base for improving patient outcomes, such as goal directed fluid therapy, are also utilised. Allied health professionals such as physiotherapists, dieticians, speech and language therapists and occupational therapists are key in ensuring patient’s receive rehabilitation and are mobilised as early as possible.

Level two patients are a slightly lower level of dependency. These patients require support for one organ and continuous close monitoring, either due to acute illness or after surgery.

The Critical Care Unit is run by a team of consultant intensivists (a senior doctor specially trained in managing critically ill patients), trainee doctors nurses, pharmacists, and specialist therapists, all of whom will have experience in looking after extremely ill patients.

Formal consultant intensivist ward round takes place twice daily at 9am and at 4.30pm. During this ward round, doctors and nurses discuss the patients’ progress and care, examine the patients, decide on further treatment, and make a plan for the rest of the day. This ward round includes input from other specialist consultants, including microbiologists who specifically advise on infections.

Following discharge from the ICU and HDU, patients have ongoing support from our specialist Outreach team of nursing and physiotherapy staff. The team provides ongoing specialist rehabilitation care as well as a support structure to support patients and their families, as they recover.

Visiting times are 1pm–3pm and 6pm–8pm.

Each level three patient has their own nurse looking after them. Level two patients have one nurse looking after two patients. To improve quality of patient care, we aim, where possible, for the same group of nurses to care for your relative. The nurses will try to form close relationships with you, enabling us to all work together and keep the lines of communication open.

Your relative will be attached to monitoring equipment. They may require assistance with their breathing and could be attached to a ventilator (breathing machine).

Often, they will have tubes and drips and there will be fluid pumps around the bedspace. Please do not be frightened by the equipment or noises, the nurses are trained to look after all the equipment and will answer any queries.

Although your relative may look different and may be sedated with medication to tolerate the machinery, do remember they still need to hear familiar voices and need to be touched. So, let your relative know you are there by talking to them and hold their hands if you'd like to. Although we realise this may be difficult at first, we will do everything to help you.

All our nursing staff wear uniforms according to their grade and a lanyard to highlight their role with their ID. 

Whilst we will do our best to stick to the visiting times, there may be times when your relative is undergoing a procedure or is having their hygiene needs attended to. Therefore, we may ask you to wait in the relatives' room until we allow you on the unit.  The nurse looking after your relative will keep you informed on how long you may be asked to wait. 

We will do our best to keep you informed of your relative's progress, and will ask you to provide a password, so we can offer information via phone calls too. We also have an option to video call your relatives if, for any reason, you are unable to visit. Please ask your relative's nurse for any further information.

We understand having a relative in critical care can be a very anxious time, and we are here to support you too.  Please do not hesitate to discuss any concerns with the nursing staff, nurse coordinators or Matron.

The Critical Care Unit is staffed by approximately 184 registered nurses and 28 healthcare assistants. 

All new registered staff will undertake a 12-month preceptorship programme, be committed to Trust mandatory training and will be included in an extensive training programme within the department, facilitated by our four practice educators. We support career progression, and are invested in developing our workforce both professionally and academically.

The Critical Care Unit supports organ and tissue donation and has specialist staff who support decision making when this is a possibility. Further information on organ donation can be found on the NHS Blood and Transplant website.

Critical care research explores treatment and diagnostic options to decrease complications and improve outcomes for people who are critically ill. Common conditions associated with critical illnesses include sepsis, renal failure, acute respiratory failure and shock. 

Much of our research work is done in collaboration with the University of Liverpool, Liverpool John Moores University, and the Liverpool School of Tropical Medicine. 

Our core research team members are:

• Research Clinical Lead: Professor Dr. med. Ingeborg Welters
• Research Nurse Lead: Karen Williams
• Senior Research Fellows: Dr Alicia Waite and Dr Brian Johnston.

Discover more about Critical Care research.

Information for patients and relatives

Our work is supported by and closely linked to the National Institute for Health Research.

We have a portfolio of research studies that are active and recruiting, ranging from data collection only to more complex interventions and novel therapies. We may speak to you or, should you be too unwell, to your relative about the possibility of participation into a research study. 

Details of the study will be fully discussed with you. You or your relative will then be given time to think about whether you would want to take part in the study and you can withdraw consent at any time without giving a reason. 

All studies performed on our unit have been reviewed and approved by the relevant authorities. If you would like to learn more about clinical research, please watch the video below that has been produced in collaboration with our ICU.

Studies currently open at the Royal Liverpool ICU can be found on our Critical Care research page.

Information for medical professionals and students

Our multi-disciplinary research team is led by Professor Ingeborg Welters. In collaboration with the University of Liverpool, we regularly supervise research projects for graduate and undergraduate students. 

As part of intercalating programmes, we facilitate projects for Master students and final year medical students. We also offer funded and unfunded PhD projects for biomedical graduates. 

Our research group conducts NIHR-funded and commercial studies and cross-specialty collaborations spanning a wide range of topics and activities, including first-in-human studies, experimental medicine, and data science. 

Our research interests include cardiovascular changes during critical illness, rehabilitation and the crosstalk between immune and clotting systems during infection. We closely work with the Liverpool Centre for Cardiovascular Science and the Institute of Life Course and Medical Sciences at the University of Liverpool.

If you are interested in working with us on a research project as a student, researcher or medical trainee, please contact us: ITUResearchTeam@rlbuht.nhs.uk.

We are very proud to have won three staff awards, including two Our Future Together Awards, the Trust’s annual awards ceremony which recognises those who have made an exceptional contribution to life at Liverpool University Hospitals:

• Nursing Star Awards 2021: Team of the Year 
• Our Future Together Awards 2021: Team of the Year
• Our Future Together Awards 2021: Division of the Year.