Te Puna Wai Ora, Southern Critical Care - Dunedin Hospital | Southern

Patients with critical illness commonly develop problems with their hearts and circulation. Various factors are involved, some related to the primary disease while others are secondary effects. Problems include changes in: the distribution and volume of body fluid, the condition of the blood vessels and the ability of the heart to pump blood around the body.  Treatment for cardiovascular problems may include fluids therapy and a wide range of medicines to control the heart rate, cardiac function and blood pressure.

Respiratory failure occurs when the respiratory system is no longer able to provide enough oxygen requirements or remove enough carbon dioxide from the body. Hypoxia (not enough oxygen is reaching the tissues) may occur unless there are interventions. Large amounts of carbon dioxide may also build up in respiratory failure. Mechanical VentilationThis is the use of a ventilator (sometimes called a life support machine) to do the breathing for a patient experiencing respiratory failure. The ventilator fills the lungs with air, thereby providing oxygen to, and removing carbon dioxide from, the body via the lungs. Usually the ventilator delivers oxygen directly into the airway of the patient. This is done using an endotracheal tube which is a plastic tube that is passed through the mouth into the larynx (the top of the trachea or windpipe). Conscious patients are usually given a medication to make them sleepy or unconscious and a muscle relaxant to help them relax while the tube is inserted.  Sometimes people may require a ventilator for a long time. If this is the case a tracheostomy (when an opening is made in the trachea) is performed and the endotracheal tube inserted into the opening. For many very ill patients mechanical ventilation lasting only hours or a few days is enough and, after normal breathing is established, the ventilator can be removed.  Unfortunately, a patient whose underlying disease is long-term may become dependent on the ventilator. Their continuing need for mechanical ventilation may be total i.e. 24 hours a day, or it may be limited i.e. only during sleep or occasionally through the day. Noninvasive Positive Pressure Ventilation Some patients may receive ventilation without needing intubation, with the breathing support being delivered via a sealed mask applied to the face. However noninvasive ventilation is useful only in some circumstances and in some patients.  Acute Respiratory Distress Syndrome (ARDS) This is a life-threatening condition. It results from any illness that causes widespread inflammation of the lungs. In ARDS, fluid builds up in the air sacs of the lungs (alveoli) and other lung tissue. When the air sacs fill with fluid, the lungs can no longer fill properly with air and the lungs become stiff. This makes breathing difficult. The main symptom of ARDS is severe shortness of breath. This may develop within minutes or gradually over a few days. A doctor may confirm a diagnosis of ARDS by: a chest x-ray  arterial blood gas analysis, which measures the oxygen content in blood. Treatment depends on the underlying cause but may include a breathing machine (mechanical ventilation) until the lungs heal.

A nasogastric tube is often inserted at the same time as the endotracheal tube. The nasogastric tube is inserted into the stomach via the nose. This tube ensures that patients receive the necessary nutrition while they are in the Intensive Care Unit.

Kidney (or renal) failure is when a patient’s kidneys are unable to remove wastes and excess fluid from the blood. The likelihood that the kidneys will get better depends on what caused the kidney failure. Kidney failure is divided into two general categories, acute and chronic.    In acute (or sudden) kidney failure, when kidneys stop functioning due to a sudden stress, they might be able to start working again. However, when the damage to the kidneys has been continuous and has worsened over a number of years, as in chronic renal failure (CRF), then the kidneys often do not get better. When CRF has progressed to end stage renal disease (ESRD), it is considered irreversible or unable to be cured. There are a number of causes of acute renal failure and in intensive care patients there is often more than one factor that contributes to its development.