Critical respiratory disease in the ICU

Question 1

How does a pulse oximetry work?

Answer 1

Based on absorption of light of hemoglobin (because they don’t absorb light the same way if they are oxygenated or not)
Measuring this allows to see the saturation of oxygen in the blood

Question 2

When does oxygen saturation become worrying?

Answer 2

Less than 90% oxygen saturation is weird, and less than 80% is worrying

Question 3

Is the heart rate and the pulse always the same?

Answer 3

Usually yes, except for patients with atrial fibrillations

Question 4

What is “CVP” on an ICU monitor?

Answer 4

The Central Veinous Pressure

Question 5

What is “etCO2” on an ICU monitor?

Answer 5

The amount of CO2 expiration

Question 6

What can you see on an ICU monitor?

Answer 6

A lot of shit..!

Question 7

Why sometimes administer heparin to ICU patients?

Answer 7

It is an anti-coagulant => helps with blood flow

Question 8

What information could you gather from an ICU patient?

Answer 8

• Arterial blood gas (PaO2, PaCO2, pH, lactate)
• Urine output (circulation, kidney function)
• ”Organ function” (liver, brain, heart, kidneys, coagulation, etc.)
• Infection/inflammation (cultures bacteria, PCR viruses, etc.)
• Chest x-ray / CT scan

Question 9

What can be seen on an X-ray of an ARDS (acute respiratory distress syndrome) patient?

Answer 9

A lot of inflammation in the lungs, to many cells recruited => X-ray of lungs is blurry compared to normal

Question 10

What are the 3 different types of respiratory support?

Answer 10

1. Heated humidified high flow therapy
2. Non invasive ventilation (NIV)
3. Conventional oxygen treatment with nasal cannula or face mask

Question 11

What is ARDS and what are the common causes?

Answer 11

ARDS = Acute Respiratory Distress Syndrome
Severe oxygenation difficulties
Not explained by cardiac failure or volume overload
Typical chest radiography/CT (blurry lung image)
Common causes:
- pneumonia (bacterial or viral)
- sepsis
- trauma
- transfusions
- toxins

Question 12

How pronounced are cytokine elevations in Covid-19 compare to ARDS or sepsis?

Answer 12

Cytokine elevation in Covid-19 less pronounced than in ARDS or sepsis

Question 13

What is the cure for ARDS?

Answer 13

There is no cure for ARDS at this time

Treatment focuses on supporting the patient while the lungs heal => definition of intensive care

Question 14

What is endotracheal intubation?

Answer 14

Shoving a tube down a patient’s mouth/trachea (painful, need sedation, risk of infection)

Question 15

What is tracheostomy and what are the advantages?

Answer 15

Slicing a hole in a patient's trachea and put a little tube
Advantages:
- less need of sedation
- facilitates spontaneous breathing 
- reduces risk of infection
- better oral hygiene
- reduced risk of pulmonary aspiration 
- possibility to regain voice

Question 16

What are the 3 impairments post intensive care syndrome can cause (PICS)?

Answer 16

• Physical impairment 25- 80%: reduced strength, neuropathy and myopathy
• Cognitive impairment 30- 80%: memory and executive function
• Psychological impairment 10-60%: depression and anxiety

Question 17

What are the specialized differences in ICU units?

Answer 17

• Different skills and tempo (marathon, not sprint!)
• Focus on recovery rather than survival
• Calm environment, continuity, staff requirement

Question 18

What are the specialized differences in ICU rehabs?

Answer 18

• Patients too sick for regular rehab

* Higher/different staff/patient ratio

Question 19

How long could it take for an ARDS to heal?

Answer 19

May take months!