TAILIEUCHUNG - Core critical care with ECMO in the adult patient: Part 2

(BQ) Continued part 1, part 2 of the document Core critical care with ECMO in the adult patient has contents: ECMO registries and research, ECMO to support organ donation, specifics of intensive care management for the patient on ECMO, patient transfer, liberation from ECMO,. and other contents. Invite you to refer. | Chapter 8 Management of the patient on veno-venous ECMO general principles Introduction Veno-venous ECMO allows gas exchange and is used to support failing lungs. The cardiovascular system remains intact and the heart continues to pump the blood around the patient s body. A simplified view of veno-venous ECMO is that the blood is taken from and returned to the venous system. If the blood is circulated through a functioning oxygenator gas exchange will happen. If there is no oxygenator or no gas flow through the oxygenator the blood will just return in the same state as it drained perhaps a bit cooler if no heat exchanger is in place . The whole-blood volume including the proportion that went through the ECMO circuit is pumped by the heart through the lungs and circulation. Veno-venous ECMO is usually instituted in the context of severe acute respiratory failure. It supports oxygenation and CO2 removal and allows the implementation of safer ventilation strategies. This is inaccurately referred to as protective ventilation any positive-pressure ventilation is deemed to cause damage to the lung and could be called the least-damaging lung ventilation . Veno-venous ECMO can be continued for as long as appropriate investigations are directed at confirming the underlying diagnosis and ensuring specific therapy is administered. Patients supported with veno-venous ECMO frequently have additional non-pulmonary organ failure and require a high level of critical care support . acute renal failure . The day-to-day management of patients on veno-venous ECMO includes all that is common to critically ill patients plus some specific elements. This chapter describes those specific elements. Locally agreed protocols for the care of ECMO patients should be incorporated into training. Monitoring of the patient on veno-venous ECMO has been described in Chapter 4. Stabilization on veno-venous ECMO Insertion of ECMO cannulas should ideally take place in an operating room. A variety of

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• The adult patient
• Core critical care
• ECMO registries
• Support organ donation
• Intensive care management
• Patient transfer
• Managing life threatening situations
• Orthopaedic surger
• Upper gastrointestinal surgery
• Managing the acutely ill adult surgical patient
• Urological surgery
• Case selection
• Cannulation and decannulation
• General principles
• BMC Pediatrics
• Adult mental health services
• Child and adolescent mental health services
• Patient reported outcome measures
• Young persons
• BMC Musculoskeletal Disorders
• Non displaced distal radial fractures
• Adult patients
• Randomized trial
• Patient related wrist evaluation
• BMC Cancer
• Cancer patient
• Supportive care
• Unmet needs
• Young adult
• Cognitive development
• Associated factors
• Acute lymphoblastic leukaemia
• Socioeconomic deprivation
• Volume outcome
• Adult patient
• Septic arthritis
• Hip arthroscopy
• Hip joint
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