25 - Critical care medicine

Summary

This chapter will deal with a selection of topics, which are currently of practical and scientific importance. We discuss respiratory support including indication and conditions requiring respiratory support, examine the choice of artificial airway (tracheal tube, mask, tracheostoma). We present practical examples of ventilation strategies: lung-protective ventilation for acute respiratory distress syndrome (ARDS) and non-invasive ventilation for obstructive lung disease (OLD). Weaning from respiratory support will end this part.

Antibiotic therapy can be used as prophylactic therapy or to treat manifest sepsis. The current concept of initial empirical antimicrobial therapy and de-escalating strategy will be described. The part dealing with nutrition contains the steps necessary in practice: estimating the required energy, deciding kind of nutrient and route of administration, and management of problems. We will demonstrate that evidence regarding Vasopressors is sparse and give some practical information for treating cardiac arrest and septic shock.

Antithrombotic therapy goes beyond heparin alone. We exemplify this for deep vein thrombosis and sepsis.

Respiratory support

Indication for respiratory support

Some vague guidance is available to decide whether respiratory support should be provided to the individual patient. Nonetheless it is important to mention here that – on top of the available evidence – patient centredness, ethical considerations, and critical assessment of the actual situation are necessary to appropriately supply this core element of intensive care medicine.