![]() Consider for specific cases, including:.Not routinely recommended for hemodynamic monitoring.Central venous catheter : used to measure central venous pressure.Arterial line: used to accurately measure blood pressure.Follow relevant monitoring parameters for patients with shock.Follow relevant monitoring parameters for parenteral fluid therapy.VV-ECMO: provides respiratory support onlyĪll critically ill patients require close monitoring of hemodynamic and respiratory status.VA-ECMO: provides respiratory and circulatory support.Consider use in patients who require advanced respiratory and/or circulatory support.Anticipate and manage complications of intubation.Įxtracorporeal membrane oxygenation ( ECMO).Start sedation (see “ Adjunctive care of the ventilated patient”).Select the appropriate ventilator settings and ventilator strategies.Prepare for and perform endotracheal intubation.If indications for invasive mechanical ventilation are present:.Noninvasive positive-pressure ventilation.Start oxygen therapy (if applicable) via one of the following:.Identify airway obstruction and perform basic airway maneuvers.See also “ Management of respiratory failure.” Consider mechanical circulatory support in patients with refractory cardiogenic shock.Perform appropriate diagnostics in shock.Provide immediate hemodynamic support for undifferentiated shock.Evaluate and treat for any clinical features of shock.Provide advanced cardiac life support if cardiac arrest is present.Establish a route of access for parenteral fluid therapy and medications.See also “ ABCDE approach” for more detail. The first step in caring for critically ill patients is resuscitation and stabilization. The decision to admit a patient typically relies on the clinical judgment of the physician and the availability of beds and resources. There are no established general criteria for ICU admission. Step down units ( intermediate care units): units that provide a higher level of care than a general ward but a lower level of care than an ICU.Immediately post- surgery or post-procedure.During treatment for severe illness, often with continuous IV infusions (see “Common conditions treated in the ICU”).While receiving (or in imminent need of) organ support: e.g., mechanical ventilation, vasopressors, extracorporeal therapies.Indicated for patients who require close or continuous monitoring:.Can be general medical or surgical, or specialized units (e.g., neurological, cardiac).Units that provide the highest level of care available in a hospital.Critical care: provision of medical care to critically ill patients by supporting vital organ function.Critical illness: a state of poor health with vital organ dysfunction and/or imminent death. ![]() Typical reasons for admission to an ICU include the need for organ support (e.g., for patients with brain injury, acute coronary syndrome, COPD exacerbation, sepsis, GI bleeding) and/or close, continuous monitoring (e.g., postoperatively or while receiving a high-risk medication). Given the critical nature of ICU care, teamwork and communication, and end-of-life care are essential. Predictive scoring systems (e.g., the SOFA score, APACHE II score) may be useful for the prognostication of ICU patients. After initial resuscitation and stabilization, management of ICU patients typically involves ongoing hemodynamic monitoring (often via invasive devices such as an arterial line) and respiratory monitoring (including interpretation of ventilator alarms for mechanically ventilated patients), supportive care of the critically ill patient (including nutrition and metabolic support, analgesia, and sedation), and the prevention of common complications (e.g., VTEs, pressure ulcers, nosocomial infections, delirium). Critically ill patients are typically cared for in intensive care units ( ICUs), which are designated hospital units dedicated to managing patients who require a higher level of care than that available on a general medical ward or step down unit, staffed by highly trained clinicians.
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