Objective: To describe the management of patients in an ICU during failure of both primary and backup electrical systems, resulting in nonfunctioning monitors, mechanical ventilators, and other life-support equipment. Design: Case report of power outage and discussion. Setting: A 45-bed cardiothoracic surgical ICU in a tertiary-care teaching hospital. Patients: Postoperative cardiothoracic surgical patients receiving iv infusions of vasoactive medications and mechanical ventilatory support. Main Results: Support measures included the use of pneumatically powered mechanical ventilators, battery-operated transport monitors and infusion pumps, and recruitment of non-ICU personnel to assist with manual ventilation and patient care. Problems identified included communication difficulties caused by failure of electronic telephones, and physical access limitation due to failure of electrical door openers and security locks. Conclusions: Total electrical power failure can occur even when an emergency power system is in place. Although the occurrence of such failure is unlikely, provisions must be made for its occurrence in order to avoid catastrophic patient injury. Such provisions include a mental plan of action, provision of emergency support equipment, physical plant changes, and the provision of power-independent communication systems. Power demands and battery backup capability of equipment should be considered in future equipment purchases. The ICU staff should be aware of the structure and operation of backup electrical power sources.
