Page 116 - Critical Care Notes

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RESP
■ Assess serial ABGs and pulse oximetry monitoring.
■ Use ECG monitoring; assess for and treat arrhythmias.
■ Perform bedside pulmonary function testing.
■ Monitor airway pressures: mean airway pressure, peak inspiratory pressure,
plateau pressure.
■ Provide continuous arteriovenous hemofiltration (CAVH).
■ Maintain hemodynamic stability. Administer vasopressors and inotropes as
indicated.
■ Administer glucocorticosteroids.
■ Administer bronchodilators and mucolytics.
■ Administer surfactant therapy.
■ Place patient in prone position. If unable, use semi-Fowler’s or high
Fowler’s position.
■ Administer diuretic; fluid management. Administer IV fluids cautiously.
■ Evaluate electrolytes, intake and output; weigh daily.
■ Provide sedation or therapeutic paralysis if necessary.
■ Provide pain control.
■ Provide nutritional support. Consider enteral or parental feedings. Use
small-bore feeding tube.
■ Cluster activities to decrease fatigue.
■ Institute VAP and sepsis bundles of nursing care.
■ Other management therapies for ARDS include inhaled nitrous oxide, ECMO,
administration of prostaglandins, statins, albuterol, and recombinant human
activated protein C.
■ Treatment-induced complications include:
■ Cardiac arrhythmias
■ GI bleeding, DIC
■ Malnutrition and paralytic ileus
■ Pneumothorax, pulmonary fibrosis, tracheal stenosis
■ Infections
■ Renal failure, multiple organ dysfunction
Extracorporeal Membrane Oxygenation (ECMO)
ECMO is a modified form of cardiorespiratory bypass. It provides oxygenation
and pulmonary support for patients in severe respiratory failure, particularly
ARDS. Its purpose is to avoid high oxygen concentrations and high peak inspi-
ratory pressures, PEEP, and tidal volume, while allowing the lung to rest and
heal. It can also serve as a bridge to lung transplantation. Specific inclusion and
exclusion criteria are related to its use.
Venovenous (VV) ECMO
The right internal jugular and right common femoral veins are cannulated. The
patient’s blood is circulated through a membrane oxygenator in which O 2 is
infused and CO 2 removed. Blood is then returned to the venous circulation via
the right common femoral vein. ECMO can compensate for approximately 70%
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