Intensive care and communication

Also called ICU, ITU, Critical care, Ventilated patients

Awake on a ventilator and unable to say you're in pain, frightened or thirsty. What the unit can do, and what a family can bring.

What it is

Many people in intensive care are awake for long stretches while unable to speak: a breathing tube through the mouth passes between the vocal cords, and a tracheostomy diverts the air. Add weakness, sedation, delirium and hands that won't grip a pen, and a person who could talk last week is shut in.

Patients describe it afterwards as one of the worst parts of critical care. Not the pain itself, but being unable to tell anyone about it.

Who it can help

Adults and children in intensive and high-dependency care, their families, and the nurses who are trying to understand them at three in the morning.

It also matters for people who already used AAC before admission. Their own system must come with them, and staff must be shown how to use it.

How it works

Communication in intensive care is almost always partner-led. The nurse asks, the patient signals. That makes yes and no the foundation: a blink, a squeeze, a nod, agreed and written on the whiteboard above the bed.

From there: mouthing short words, pointing at a picture or hospital communication board, an alphabet board with the partner pointing, or eye gaze where a unit has it. As strength returns, a tablet app with big targets can take over.

Delirium makes everything harder and is common. It comes and goes, so what failed this morning may work this afternoon.

Getting started

Families: ask the nurse what yes and no is today, and write it where everyone can see. Bring glasses, hearing aids and dentures; they're forgotten surprisingly often.

Keep questions to one idea with a yes or no answer. Is it pain? Is it your chest? Wait, and watch closely.

Ask for a speech and language therapy referral, especially if the stay runs longer than a few days. And bring in the person's own device if they had one, charged and set up.

Where to get help

The unit's speech and language therapists and nurses are the first stop, and the RCSLT sets out what good critical care communication looks like. ICUsteps, the intensive care patient support charity, supports people and families after discharge. Communication Matters covers AAC in hospital.