Excess oxygen is toxic
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Breathing support and artificial respiration
Many patients with serious illnesses are no longer able to absorb enough oxygen for the body on their own. Then it is necessary to support breathing or to give the patient complete artificial ventilation.
In the case of some diseases, it has proven useful to relieve the patient's restricted respiratory function through mask ventilation. With so-called non-invasive ventilation, the patient receives breathing support via a face or nasal mask in order to relieve the pressure on their own respiratory muscles and improve breathing depth. The patient remains awake and responsive. Sometimes this procedure is also used if, after a long period of artificial respiration, the patient is still too weak to breathe completely on their own.
With artificial ventilation, a tube (tube) is inserted into the windpipe through the mouth, through which ventilation takes place. A machine takes over the breathing. The required oxygen can be administered and the number of breaths and the depth of the breaths can be precisely set. Since a tube in the windpipe is hardly tolerated by an awake patient, the patient is put into a deep sleep with medication. As soon as the function of the lungs improves, controlled ventilation is changed to supportive (assisted) ventilation until the patient can breathe independently again.
Kidney replacement procedure
In some serious diseases, the kidneys are so badly affected that they can no longer perform their function. Since the patient is then no longer able to excrete the breakdown products of the body and the excess fluid, an artificial kidney replacement procedure must be used. To do this, the blood is drained through thin tubes (catheters) that are inserted into a large vein in the neck or in the groin. The toxic breakdown products and excess fluid are removed via a filter and the purified blood is returned to the body.
In most cases, once the healing process has progressed, your kidney function will recover. In some cases, however, permanent blood purification (dialysis) may be necessary later.
Many ICU patients are unable to eat by themselves. However, since the organism needs energy and nutrients, artificial nutrition must be carried out in this case. Whenever possible, we prefer diet via the gastrointestinal tract (enteral nutrition), as this preserves the natural function of the intestine. A thin, soft tube (probe) is inserted into the stomach through the nose.
If the gastrointestinal tract is not functioning properly, nutrition can also be carried out through a large vein (parenteral nutrition). Exactly defined amounts of protein, sugar and fats as well as vitamins and trace elements are then administered via a central venous catheter.
Sedation and pain management
In the intensive care unit, it is often necessary to carry out pain treatment that is adapted to the situation. Many patients experience pain because of their illness or because of the measures that must be taken to support vital functions. Therefore, many patients receive painkillers via access to the bloodstream, which can be precisely dosed according to their desired effect.
In addition, sometimes e.g. during operations or mechanical ventilation a artificial deep sleep (sedation) be initiated. This is also done by drugs that are continuously given into the bloodstream. The depth of the artificial sleep can be controlled on the basis of certain characteristics. Even if the impression arises that the patient is not reacting to visits, sensations and hearing can certainly reach the patient's consciousness.
Intensive care patients need to be turned regularly to avoid bedsores where possible. Special mattresses are also used for this.
With some clinical pictures, especially with accumulation of fluid in the lung tissue in severe lung failure (ARDS), special positioning measures have proven themselves. We often turn these patients, who have to be artificially ventilated, on their stomach. As a result, the dependent lung areas, in which the liquid is preferentially distributed, are better ventilated again.In rare cases where prone positioning is not possible, we place these patients in a special rotation bed that can achieve a similar effect.
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