Intensive care Flashcards
What are the levels of intensive care
0- ward based, no organ support, may ned oxygen support
1- at risk of deterioration, 24 hour outreach team, 4 hourly obs
2- monitoring or support of single system, staffed one nurse to 2 patients
3- 1:1 nursing, need mechanical ventilation, support of 2 or more organ systems.
Purpose of ICU
Provide intensive support intensive treatment and intensive monitoring.
Types of ICU
Adult, paediatric, neonatal (new-born) and special care baby
Equipment
Ventilator
Oxygen
Fluids
Dialysis- keep fluids in balance when kidneys stop working.
Nasogastric tube- tube from nose to stomach short-term feeding.
Gastrostomy- tube from skin to stomach, long term feeding.
Jejunostomy- tube from skin to small intestine, long term feeding.
Total parenteral nutrition- short or long-term when gastrointestinal tract is not working.
Drugs
Diuretics to remove water Anti-coagulants to thin blood Inotropes to boost Q Noradrenaline to increase cardiac contraction Sedatives
Role of physio in ICU
maintain lung volume improve oxygenation and ventilation optimize secretion clearance maximise musculoskeletal function facilitate return of independence.
Indications for mechanical ventilation
support gas exchange improve alveolar ventilation achieve acceptable ABGs increase lung volumes reduce work of breathing V/Q mismatch
Benefits of mechanical ventilation
Reduce WOB Improve lung volumes Adequate gas exchange Humidification Control of gas exchange
Complications of mechanical ventilation
Difficulty weaning off
Disruption of coughing mechanism
Effects of sedation and paralysis (loss of memory, drowsiness, heaviness)
Psychological effects (PTSD, anxiety, delirium)
Oxygen toxicity (too much oxygen)
Complications due to intubation ( speech, atelectasis, infection)
Volume cycled MV
Delivers set tidal volume at a constant flow rate
Not fixed airway pressure
Pressure cycled MV
Set inspiratory pressure per breath
Varied tidal volume
Minimum RR set and maintained
Doesn’t allow for patient initiated breaths
Assist control MV
Maintains minimum RR regardless of spontaneous breathing.
What is a mandatory breath
Triggered and cycled by ventilator
What is a assisted breath
Triggered by patient and cycled by ventilator
What is a spontaneous breath
Triggered and cycled by patient
Controlled mandatory ventilation
Fully controlled
Used for patients who are unable to breathe
Spontaneous breathing inhibited
Requires heavy sedation
Pressure support ventilation
Minimum RR not set
Breaths triggered by patient
Provides pressure boost to each inspiratory effort
Commonly used for weaning.
CPAP (+/- PS)
Used for weaning
CPAP supports expiration, PS supports inspiration
Spontaneous breathing
High frequency jet ventilation
Delivers small tidal volume
Passive expiration
Patient needs to be heavily sedated to avoid spontaneous breathing.
Extracorporeal membrane oxygenation
Blood continuously pumped from patient to ventilator to mimic gas exchange
Allows heart and lungs time to recover
May be used when other modes of ventilation have failed.
Nitric oxide
Pulmonary vasodilator
Reduce pulmonary artery pressure
Broad problems in ICU
Decreased lung volumes Decreased gas exchange Reduced mucociliary clearance Increased WOB Respiratory muscle weakness.
Decreased lung volumes due to…
V/Q mismatch
Which is due to cephalad displacement f diaphragm, lack of spontaneous respiration and alveoli developing different levels of resistance.
Decreased mucociliary clearance due to…
Impaired cough, high inspiratory pressures, high levels of inspired oxygen, history of smoking, denudation of ciliary by tubing, history of chronic respiratory disease.
Mechanical ventilation for 48 hours + causes…
Reduced diaphragm strength and respiratory muscle endurance.
Increased WOB due to…
Asynchrony between patient and ventilator
Meaning ability of ventilator to respond to patient’s demand for flow during inspiration.
