Patients who are critically ill, often require specialized care that is given only in the MSICU. Some of these treatments can be invasive, resulting in tubes, catheters, intravenous lines, or other medical devices inside part of the patient’s body. Understanding these interventions may help alleviate some of the stress of being in the ICU.
Central lines
These are special IV’s that are inserted into large veins in the patient, in the neck, chest or groin. They allow for administration of specific medications and for monitoring patients. They are inserted using local anesthesia.
Arterial lines
These are small catheters that are inserted into the wrist or upper arm of patients to continually monitor a patient’s blood pressure. They are inserted using local anesthesia.
Thoracic drains
These are small tubes that are inserted between the chest wall and the lungs to remove excess fluid, blood, or air that has accumulated around the lung. They are used in all cardiac surgery patients and in patients with various causes of breathing problems. They are inserted using local anesthesia.
Mechanical ventilation
When patient’s lungs become sick, they may require oxygen via a ventilator to help them breathe. The ventilator gives patients extra oxygen and extra support to the lungs, which allows patients to breathe more comfortably while their body tries to heal.
There are two main type of mechanical ventilation; Invasive and Non-Invasive.
Non-invasive, commonly called BiPAP, is when we attach a ventilator to a special tight-fitting mask around the face. This may be useful for select patients who need a short period of moderate support from a ventilator.
Invasive mechanical ventilation is when we attach the ventilator to a tube that is passed from the mouth down into the lungs. Patients are sedated when the tube is first inserted, but then patients can usually be awake with minimal discomfort. Invasive mechanical ventilation is used during most surgeries (e.g., Cardiac surgery), and if patients’ lungs are extremely sick.
Tracheostomy
A tracheostomy is sometimes required for patients who are on invasive mechanical ventilation for a prolonged period of time, to help ‘wean’ them off the ventilator.
A tracheostomy is a short tube inserted directly in the neck that goes into the trachea. We attach this tube to the ventilator to help patients breathe, but we can intermittently detach it, to allow patients to breathe without the ventilator.
If a tracheostomy is in place some patients may be able to speak once they are able to breathe by themselves without assistance from a ventilator.
A tracheostomy insertion is most often done at the bedside, under general anesthesia by ENT surgeons.
Most tracheostomies done in the ICU are temporary.
Dialysis
Some patients in the MSICU suffer from kidney failure and require a dialysis machine to replace their kidneys. Often, dialysis required in the ICU is temporary, and patient’s kidney function can return to normal.
The type of dialysis done in the MSICU most commonly is referred to as “CRRT”, or Continuous Renal Replacement Therapy as patients are attached to a dialysis machine 24hrs/day. This allows very sick patients to tolerate being dialyzed, minimizing serious side effect.
A dialysis machine is connected to a patient via a specialized central line usually inserted in the neck via the patient’s jugular vein.
Extracorporeal membrane oxygenation
Extracorporeal membrane oxygenation (ECMO) is used for the most severe heart or lung failure. It is a very invasive therapy where large catheters are inserted into the body to remove blood, and pump it through a machine, and then return it to the patient.
This can temporarily completely replace a patient’s heart or lungs. It is usually used for young patients who were previously healthy, who have a sudden illness resulting in failing lungs or hearts who would otherwise pass away. This treatment is only performed as a bridge to anticipated recovery or lung/heart transplant.