Keterangan
Extracorporeal Membrane Oxygenation (ECMO) serves as a critical care lifeline for patients with severe cardiac or respiratory failure unresponsive to conventional treatments. This advanced technology temporarily takes over the function of the heart and lungs, oxygenating the blood and removing carbon dioxide externally. ECMO provides crucial support during severe illnesses, allowing time for the heart and lungs to recover. It is often used in cases of severe ARDS, cardiac arrest, or during complex surgeries. The integration of ECMO into critical care has significantly improved survival rates and outcomes for critically ill patients
Ringkasan
- The session focused on the care of patients undergoing Extracorporeal Membrane Oxygenation (ECMO), a modality increasingly used in intensive care units. ECMO, while initially explored in the 1950s, gained significant prominence during the H1N1 pandemic in 2007 and the COVID-19 pandemic. The lecture highlighted the importance of understanding ECMO principles for intensivists and the need for meticulous monitoring of patients on ECMO support.
- Routine ICU monitoring, including pupillary checks, sensorium assessment, and edema evaluation, are crucial for ECMO patients. Special attention must be given to potential complications like subconjunctival hemorrhage, intracranial bleeds, and limb ischemia. Specific care is needed when specialized Avalon cannulas are used, requiring constant monitoring of cannula position to prevent hypoxia due to displacement.
- There are two primary types of ECMO: veno-venous (VV) ECMO for respiratory failure and veno-arterial (VA) ECMO for cardiac failure. VA ECMO can lead to unique complications like the North-South syndrome, characterized by differential cyanosis of the upper and lower limbs. Vigilant monitoring of limb perfusion using NIRS sensors, pulse palpation, and capillary pulse checks is crucial.
- ECMO machines consist of a pump, heat exchanger, oxygenator, and air-oxygen blender. Monitoring the size, type, and position of cannulas is essential, along with assessing color differences between drainage and return cannulas to detect issues like inadequate oxygenation. Kinks, clots, and tubing integrity must be regularly checked.
- The six 'P's of ECMO monitoring include the patient, machine, pathways, pressures, pump, and parameters (lab values and imaging). Understanding pressure dynamics (P1, P2, P3) helps diagnose issues such as hypovolemia, pump failure, or oxygenator malfunction. The pump speed (RPM) and flow rates, along with mixed venous oxygen saturation (ScvO2/SvO2) must be carefully monitored.
- Ventilation strategy should be designed to minimize lung damage and promote recovery. Lung rest ventilation, characterized by low tidal volume, respiratory rate, and plateau pressures, is preferred. Higher PEEP levels are generally beneficial, but plateau pressures must be kept below 25-28 cm H2O. The importance of personalized nutrition strategies, considering the catabolic state of ECMO patients and potential nutrient trapping in the circuit, was also emphasized.
- Early mobilization, whenever feasible, is critical to prevent muscle weakness. Mobilization requires a multidisciplinary team and careful monitoring for complications like decannulation and hypoxia. Anti-coagulation protocols are crucial to prevent clotting within the ECMO circuit. Proper management of these aspects contributes significantly to improved patient outcomes and survival on ECMO support.
Contoh Sertifikat
Tentang Pembicara
Dr. Gunadhar Padhi
Konsultan Perawatan Kritis Senior, Rumah Sakit Apollo, Navi Mumbai
Pengungkapan Keuangan
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