The patient within the critical care environment

2017 ◽  
Author(s):  
Sheila Adam ◽  
Sue Osborne ◽  
John Welch
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Infection Control ◽  
Critically Ill Patients ◽  
Critical Care Unit ◽  
Holistic Approach ◽  
Care Environment ◽  
The Common ◽  
Prolonged Stress ◽  
Dying Patient

Both critical illness and treatment in the critical care unit are extremely stressful, presenting great physical and psychological challenges for patients and their families. There are a range of compensatory responses to stress which may be adaptive, but severe or prolonged stress can induce a destructive spiral of decompensation. The importance of a holistic approach to care cannot be overemphasized; this chapter sets out the priorities of care for critically ill patients, and the common needs and problems for both patients and their families. The issues discussed include the mechanisms of stress in critical illness, the promotion of sleep, use of analgesia and sedation, management of delirium, complications of immobility, mouth, eye, and skin care, infection control, requirements for safe transfer, and care of the dying patient.

Maternal critical care

2020 ◽  
pp. 2701-2705
Author(s):  
Rupert Gauntlett
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Death Rate ◽  
Critical Care Unit ◽  
Post Partum ◽  
The United Kingdom ◽  
The World ◽  
Resource Poor ◽  
Acute Fatty Liver

Critical illness during pregnancy or after giving birth is rare: in the United Kingdom 0.29% of maternities involve admission to a critical care unit, and the maternal death rate is 0.01%. Over 80% of obstetric admissions to critical care occur in the post-partum phase, mainly due to complications relating to massive haemorrhage. Other pregnancy specific conditions that may require critical care support include pre-eclampsia (typically when diagnosis and treatment have been delayed), amniotic fluid embolism, peri-partum cardiomyopathy, and acute fatty liver of pregnancy. Puerperal sepsis remains a major problem in resource-poor parts of the world. Pregnant women who survive critical illness may be particularly prone to long-term psychological morbidity. It is vital that, once physiological stability has been achieved, no time is wasted before a mother is reunited with her baby.

Normal physiology of the renal system

2016 ◽  
Author(s):  
Bruce Andrew Cooper
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Renal Dysfunction ◽  
Critical Role ◽  
Renal Physiology ◽  
Electrolyte Balance ◽  
Care Environment ◽  
System P ◽  
Urine Production ◽  
The Impact

Patients with critical illness often have renal dysfunction, either primary or secondary, that can both complicate and prolong their medical management. Therefore, an understanding of normal renal physiology can help recognize the process or processes that caused the renal dysfunction, and determine the most appropriate corrective and supportive care. The kidney has many important roles other than just urine production. The impact of kidney disease is often predictable. The kidney plays a critical role in fluid and electrolyte balance via many specialized transmembrane pathways. The kidney is also involved in the production and modification of two key hormones and one enzyme. Understanding normal renal physiology can help determine clinical management.This chapter summarizes the important aspects of renal physiology relevant to those who work in a critical care environment.

Assessment and stabilization

2013 ◽  
Author(s):  
Martin Beed ◽  
Richard Sherman ◽  
Ravi Mahajan
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Environment

Assessment and immediate management of an emergencyEarly further managementThe assessment and immediate management of critically ill patients follows the established ABC approach (Approach/Airway, Breathing, Circulation). What follows is a brief summary of the ABC approach adapted for patients within a critical care environment, further details on each system are considered in individual chapters. Any deterioration during assessment and resuscitation should prompt a return to ‘A’....

Hospital Readmission and Post-Acute Care Use After Intensive Care Unit Admissions: New ICU Quality Metrics?

2020 ◽  
pp. 088506662095663
Author(s):  
Christopher F. Chesley ◽  
Michael O. Harhay ◽  
Dylan S. Small ◽  
Asaf Hanish ◽  
Hallie C. Prescott ◽  
...  
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Acute Care ◽  
Hospital Readmission ◽  
Critical Care Unit ◽  
Readmission Rates ◽  
Critical Care Units ◽  
Icu Admission ◽  
Over Time ◽  
Post Acute Care

Objective: Care coordination is a national priority. Post-acute care use and hospital readmission appear to be common after critical illness. It is unknown whether specialty critical care units have different readmission rates and what these trends have been over time. Methods: In this retrospective cohort study, a cohort of 53,539 medical/surgical patients who were treated in a critical care unit during their index admission were compared with 209,686 patients who were not treated in a critical care unit. The primary outcome was 30-day all cause hospital readmission. Secondary outcomes included post-acute care resource use and immediate readmission, defined as within 7 days of discharge. Results: Compared to patients discharged after an index hospitalization without critical illness, surviving patients following ICU admission were not more likely to be rehospitalized within 30 days (15.8 vs. 16.1%, p = 0.08). However, they were more likely to receive post-acute care services (45.3% vs. 70.9%, p < 0.001) as well as be rehospitalized within 7 days (5.2 vs. 6.0%, p < 0.001). Post-acute care use and 30-day readmission rates varied by ICU type, the latter ranging from 11.7% after admission in a cardiothoracic critical care unit to 23.1% after admission in a medical critical care unit. 30-day readmission after ICU admission did not decline between 2010 and 2015 (p = 0.38). Readmission rates declined over time for 2 of 4 targeted conditions (heart failure and chronic obstructive pulmonary disease), but only when the hospitalization did not include ICU admission. Conclusions: Rehospitalization for survivors following ICU admission is common across all specialty critical care units. Post-acute care use is also common for this population of patients. Overall trends for readmission rates after critical illness did not change over time, and readmission reductions for targeted conditions were limited to hospitalizations that did not include an ICU admission.

scholarly journals Review of mechanical ventilation for the non-critical care trained practitioner. Part 2

2021 ◽  
Vol 2 (1) ◽  
pp. 1-16
Author(s):  
Rebecca Shimabukuro Shimabukuro ◽  
ehab daoud
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Adverse Effects ◽  
Critically Ill Patients ◽  
Medical Knowledge ◽  
Specific Training ◽  
Further Training ◽  
Respiratory Therapists ◽  
The Subject ◽  
The Common

There have been a recent shortage of both critical care physicians and respiratory therapists with training in mechanical ventilation that is accentuated by the recent COVID-19 crisis. Hospitalists find themselves more often dealing with and treating critically ill patients on mechanical ventilation without specific training. The first part of this review attempted to explain and simplify some of the physiologic concepts and basics of mechanical ventilation. This second part of the review we will discuss some of the common modes used for support and weaning during mechanical ventilation and to address some of the adverse effects associated with mechanical ventilation. We understand the complexity of the subject and this review would not be a substitute of seeking appropriate counselling, further training, and medical knowledge about mechanical ventilation. Further free resources are available to help clinicians who feel uncomfortable making decisions with such technology Keywords: COPD, ARDS, Weaning, VCV, PCV, ASV, MMV, NAVA, PSV, ATC, VSV, PRVC, APRV

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