Intensive Care Center

Free consultation

An intensivist can read your relative's ICU file before any decision is made

The file review costs nothing and places your family under no obligation. Send the current ICU summary, the ventilator settings, the medication and infusion list and the most recent laboratory results, and an intensivist replies in writing on whether a transfer is medically sensible and what it would involve.

What the Intensive Care Center is, and who this page is written for

The Intensive Care Center at Biruni Hospital in Istanbul cares for critically ill patients of every age inside a university hospital of more than 600 beds. Three units carry that work: a General Intensive Care unit for adults, a Pediatric Intensive Care unit for children, and a Neonatology unit for newborns, with the Anesthesiology and Reanimation department behind all three.

An intensive care unit of this kind is less a destination than a foundation. Complex surgery, transplant programs and advanced cancer treatment can be offered at all only because intensive care stands behind them, and the hospital's Stroke Center rests on the same base. The units work alongside every surgical and medical department in one building, and a university hospital ICU is built so that imaging, laboratory testing and interventional radiology can be reached at any hour without moving the patient far.

Three situations bring families to this page. Some are weighing a transfer: a relative lies in an ICU abroad, and the family wants to know whether continued intensive care, ventilator weaning or a treatment the current hospital cannot provide would be possible in Istanbul. Others had a relative fall critically ill while visiting Turkey and are trying to understand, from a distance, what is being done. A third group is planning a major operation at this hospital and wants to know what backs it up if things do not go smoothly. Every section below was written with all three in mind.

What modern intensive care actually involves

Intensive care means taking over, temporarily, the work of organs that are failing while the illness behind the failure is treated. A ventilator breathes for lungs that cannot. Blood pressure is held up with continuously infused medication, adjusted against readings taken moment by moment, and when the kidneys stop, a machine similar to dialysis runs at the bedside without pause. Around all of this sits monitoring: heart rhythm, oxygen levels, pressures inside the circulation, and laboratory values rechecked through the day.

One image families often carry into an ICU is of a relative kept asleep for weeks. Modern practice looks different. Sedation is titrated to the least the situation allows, lightened daily where the illness permits so the patient can be examined and can respond, and paired with structured breathing trials that test whether the ventilator is still needed. Comfort while awake, wherever it can be achieved, is the goal rather than unconsciousness.

The ABCDEF bundle, in plain words

Much of what evidence-based intensive care means today is captured in the ABCDEF bundle. In more than 15,000 adults treated across the ICU Liberation Collaborative, higher performance of the bundle was associated with better survival, less delirium and fewer ICU readmissions (Pun et al., Critical Care Medicine, 2019). The letters cover pain assessment and control, daily awakening and breathing trials, careful sedation choices, delirium monitoring and management, early mobility, and family engagement.

The letter F stands for family engagement and empowerment. That element was measured in the study alongside sedation and breathing trials, which means keeping relatives informed and involved belongs to the evidence itself, not to courtesy added on top. It is also why so much of this page is about communication rather than machines.

Early mobility tends to surprise families most. Physiotherapy begins inside the ICU, and a patient may sit on the edge of the bed or take supported steps while still connected to a ventilator, because muscle lost to immobility is among the hardest deficits to win back later.

Transferring a critically ill relative from another country

An international ICU transfer starts with a medical judgment. Published guidelines on transporting critically ill patients are explicit that movement itself carries risk, and that it demands planned equipment, continuous monitoring, trained accompanying personnel and an expected benefit large enough to outweigh that risk (Warren et al., Critical Care Medicine, 2004). So the first question an accepting intensivist asks is not when the flight could leave. It is whether moving this patient would serve this patient.

The file your family sends

A transfer assessment is only as good as the file behind it. What the intensivist needs to see: the current ICU summary or the latest daily note, the exact diagnosis as the treating team states it, the ventilator settings, every infusion and medication with its dose, recent laboratory results together with culture reports, and the most recent imaging. Photographed pages and phone screenshots are acceptable when nothing cleaner can be obtained. Families are rarely handed a tidy dossier, and the review works with whatever can actually be gathered.

The honest possible answers

The written reply can go three ways, and a family deciding what to do next deserves to see all three named in advance.

No acceptance is promised before the file has been read.

How the transfer itself runs

How the center works with a family that is far away

Most relatives of an international ICU patient are not in Istanbul, and communication has to be built for that distance. Ask for updates in writing. A written summary can be translated, reread calmly, shared with relatives in other time zones, and shown to the doctors who treated the patient before. Interpreter support is available for families in their own language, for the difficult conversations as much as the routine ones.

Ask also for one named contact person in the international patient office. Critical illness produces many calls from many relatives, and a single point of contact keeps the account consistent and spares the family from repeating painful questions to strangers.

Visiting an intensive care unit is unlike visiting a ward. Access is restricted to protect patients whose defenses are down, and a relative usually cannot stay at the bedside the way a companion stays in a patient room. Before anyone books a flight, ask the office how visiting currently works in the specific unit, who may enter and at what times. Arrangements in intensive care follow the clinical situation, so the honest answer is a current one rather than a fixed rule printed on a page.

For a relative who does travel, the hospital helps with airport transfer and with finding accommodation nearby, so the practical side of staying close does not fall on the family alone.

After the ICU, and why survival is the start of recovery

Leaving intensive care alive is the beginning of recovery, not the end of the illness. Clinicians call what often follows post-intensive care syndrome: muscle weakness that can take months to rebuild, trouble with memory and concentration, and psychological effects that include anxiety, low mood and intrusive memories. The term was defined in a stakeholders' conference report in Critical Care Medicine in 2012, and that report made a second point families should hear early: the same kinds of effects occur in relatives too, and they are common rather than rare (Needham et al.).

Good intensive care plans for this while the patient is still in the unit. Nutrition, physiotherapy and the daily lightening of sedation all exist partly to shrink what must be recovered afterwards. Once organ support is no longer needed, care steps down to a ward in the same building, and rehabilitation continues there at a pace set by the patient's strength.

For a patient who came from abroad, one question eventually replaces the others: when can we go home. Fitness to travel after critical illness is a medical decision, made near discharge rather than promised in advance, and it comes in grades: a normal commercial flight, a commercial flight with a medical escort and oxygen, or an air ambulance for a patient who still needs intensive care in the air. The treating team puts its assessment in writing, along with a handover summary for the doctors who will take over at home. How long the whole stay in Istanbul lasts cannot be fixed in advance; ward time and rehabilitation usually take longer than the ICU days themselves. Once the patient is back home, that same channel stays open for remote follow-up questions.

What intensive care costs, and why no fixed price exists

Intensive care is billed by the day and by acuity, and an honest fixed price for it does not exist anywhere. A package figure would have to assume how long a critical illness lasts, and nobody knows that in advance. What can be explained is what moves the total.

After the file review, the hospital puts an estimate in writing, stated as a range. The range is honest because critical illness changes course, and the figure moves with it. Air ambulance transport is quoted separately by the transport provider and is a substantial cost of its own; the hospital estimate never includes it.

Questions families ask about intensive care in Istanbul

References

1. Needham DM, Davidson J, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Critical Care Medicine. 2012;40(2):502-509.
2. Pun BT, Balas MC, et al. Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults. Critical Care Medicine. 2019;47(1):3-14.
3. Warren J, Fromm RE, et al. Guidelines for the inter- and intrahospital transport of critically ill patients. Critical Care Medicine. 2004;32(1):256-262.