Category: Critical Care Nursing In critically ill patients, inflammatory and endocrine stress responses induce variations in resting energy expenditure and urinary nitrogen excretion. Nutritional intake may be insufficient and lead to accumulated energy and protein deficits.
Category: Critical Care Nursing In ECMO, weaning depends on the mode. For VA patients, the ECMO blood flow is reduced either over a predetermined time frame set by the clinical team or fairly rapidly with echocardiographic guidance at the bedside.
Category: Critical Care Nursing In ECMO, weaning depends on the mode. For VV mode, the extracorporeal gas flow should be reduced stepwise and then gas flow clamped off from the membrane lung with monitoring of the patient’s arterial oxygenation and carbon dioxide levels.
Category: Critical Care Nursing Severe acute respiratory distress syndrome (ARDS) continues to have a high associated mortality rate, in spite of the use of lung protective strategies that include ventilation with relatively low tidal volumes and pressures.
Category: Critical Care Nursing ECMO can be a rescue therapy for hypoxic respiratory failure, hypercarbia despite plateau pressures >30 cm H2O, severe air leak syndrome, need for intubation for a patient on a lung transplant list or immediate cardiac or respiratory collapse.
Category: Critical Care Nursing In ECMO, air embolus in centrifugal pumps can occur and centers transitioning from roller-head to centrifugal systems often see a rise in events, as the “suction” provided by the centrifugal pump can rapidly pull air from any open stopcock.
Category: Critical Care Nursing In ECMO, pseudoaneurysms present with a pulsatile, palpable bulge and if small, generally can be managed with injection of thrombin. If large or rapidly expanding, however, these defects will usually require surgical intervention.
Category: Critical Care Nursing Access of the femoral artery for VA-ECMO can lead to lower extremity ischemia, pseudoaneurysm formation, dissection and retroperitoneal bleeding. A distal perfusion cannula can be placed to mitigate limb ischemia.
Category: Critical Care Nursing During ECMO, several neurologic complications, including seizures, ischemic stroke, intracranial hemorrhage and brain death may occur. The cause of neurologic injury during ECMO is complex and likely multifactorial.
Category: Critical Care Nursing During ECMO, anticoagulation is administered during cannulation and is continued throughout the ECMO run to mitigate the risk of thrombosis in both the circuit and the patient. Unfractionated heparin remains the standard anticoagulant.
Category: Critical Care Nursing During ECMO, a massive inflammatory response occurs because of blood contact with the ECMO circuit, upregulating the coagulation system. Both activation and consumption of platelets occur, which induce changes in the coagulation cascade.
Category: Critical Care Nursing In patients with respiratory failure on VV-ECMO, right ventricular failure can occur due to pulmonary fibrosis and increased pulmonary vascular resistance from constant exposure to the high-pressure jet returning from the ECMO circuit.
Category: Critical Care Nursing In VV ECMO, the native heart must deliver oxygenated flow to the systemic circulation. VV requires adequate cardiac function. Venous blood is diverted from the patient and reinfused into the right atrium after gas exchange.
Category: Critical Care Nursing In veno-venous ECMO, deoxygenated blood is removed from the venous system and sent via an external pump to the membrane lung where oxygen is added and carbon dioxide removed. Oxygenated blood is then returned to the venous system.
Category: Critical Care Nursing In ECMO, for patients cannulated via the femoral artery, the use of pulse oximetry or arterial blood gas data from the right hand or use of cerebral near-infrared spectroscopy may help follow oxygen saturation levels.
