Improvements in intensive care units

Year 2016, Special Issue: 3 Pulmonary and Critical Care Medicine, 36 - 48, 27.11.2016

Sait Karakurt Aslıhan Yalçın Huseyin Arıkan

https://doi.org/10.5472/MMJsi.2902.09

Abstract

We have had some important improvements in the intensive

care units (ICU) like high flow oxygen system (HFOS),

therapeutic hypothermia, extra corporeal membrane oxygenation

(ECMO), extra corporeal carbon dioxide removal (ECCOR),

echocardiography (ECHO) and ultrasonography (US).

HFOS gives oxygen to the patients at rates of flow higher (up

to 60 L/min) than that delivered traditionally in LFOS (up to 16L/

min). It is obtained 1 cmH2O PEEP for every 10L/min of flow

delivered by HFOS. HFOS serves as an important alternative to

noninvasive mechanical ventilation especially in the management

of the patients with hypoxemic respiratory failure.

Post-resuscitation care consists of optimization of oxygenation

and ventilation, avoiding hypotension, treating immediate

precipitants of cardiac arrest such as acute coronary ischemia

and initiating therapeutic (induced) hypothermia. Therapeutic

hypothermia decreases cerebral metabolic rate, blood volume, and

intracranial pressure, prevents reperfusion injury. So hypotermia

protects cerebral functions.

ECMO, the type of cardiopulmonary support, has become an

essential tool in critical care patients with severe respiratory and

cardiac failure, refractory to conventional therapy methods.

Critical care ultrasonography (CCUS) and echocardiography

have utility for intensivist-performed, immediate diagnoses of life

threatening diseases, with no need to transport patients to radiology

or cardiology departments or wait for radiologist or cardiologist on

a consultative basis. CCUS and echocardiography

Keywords

Intensive Care Units, Oxygen inhalation therapy, Extracorporeal membrane oxygenation, Extra corporeal carbon dioxide removal, Hypothermia Induced, Echocardiography, Ultrasonography

References

• Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults: Mechanisms of action and clinical implications. Chest 2015;148: 253-61.
• Ward JJ. High-flow oxygen administration by nasal cannula for adult and perinatal patients. Respir Care 2013; 58: 98-122.