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Pulmonary Critical Care

Pulmonary critical care aims to provide emergency healthcare facilities to patients suffering from severe lung diseases. The absence of oxygen in the body may damage vital organs. Thus, immediate medical intervention in severe lung diseases is essential. The team providing pulmonary critical care comprises expert pulmonologists, general medicine experts, surgeons, and trained nurses.

"Critical Care Medicine"

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Diseases and conditions

  • Respiratory Failure: Respiratory failure is an emergency condition characterized by a low level of oxygen or a high level of carbon dioxide. The symptoms include shortness of breath, rapid breathing, sleepiness or unconsciousness, confusion, and the bluish color of the lips, skin, and fingernails.
  • Acute Respiratory Distress Syndrome: It occurs when fluid accumulates in the small, elastic sacs, or alveoli, in the lungs. Thus, the lungs are unable to supply oxygen to the blood. Symptoms of acute respiratory distress syndrome include shortness of breath, rapid breathing, extreme tiredness, low blood pressure, and confusion.
  • Severe Pneumonia: Pneumonia, an infection that causes inflammation in the air sacs of one or both lungs, ranges from mild to severe. There is an increased risk of severe pneumonia in patients over 65, infants and children, and patients with an underlying medical condition or a compromised immune system.
  • Severe Asthma and COPD: Both asthma and chronic obstructive pulmonary diseases are lung disorders that obstruct the respiratory process. People with poorly controlled asthma are at high risk for developing COPD. When both diseases are present, the condition is known as asthma-COPD overlap syndrome.

Procedures and treatment

  • Non-invasive Ventilation: It involves oxygen delivery through the patient's upper airway with the help of a face mask or nasal mask. It avoids the requirement of invasive ventilatory support, such as an endotracheal airway.
  • Complex Mechanical Ventilation: Complex mechanical ventilation procedures are available for critically ill patients to maintain the level of oxygen in the blood.
  • Prone ventilation: This type of ventilation is provided to patients in prone positions (lying positions). The advantages of prone ventilation include reduced dorsal lung compression, an improved ventral-dorsal transpulmonary pressure difference, and enhanced lung perfusion.
  • Tracheostomy Management: A tracheostomy is a procedure in which the surgeon makes a hole through the neck and trachea to deliver oxygen to patients with obstructed upper airways. There are several complications of tracheostomy, such as infection, bleeding, tracheal damage, laryngeal nerve injury, and blocked tracheostomy due to blood or mucus. Tracheostomy complications may cause breathing difficulties and should be managed immediately.
  • VV ECMO: It is used in patients with respiratory failure. VV ECMO helps in resolving hypercapnia (increased carbon dioxide levels in the blood) and hypoxia (low oxygen levels in the blood) and reduces pulmonary vascular resistance (resistance when blood flows from the pulmonary artery to the heart).
  • ECCO2R: Extracorporeal carbon dioxide removal devices predominantly focus on removing carbon dioxide. However, unlike ECMO, this device does not provide oxygenation.

Faq's

Pulmonary Critical Care is a specialized medical field that focuses on the diagnosis, treatment, and management of patients with severe respiratory conditions requiring intensive care

Non-invasive ventilation refers to the delivery of ventilatory support without using an invasive breathing tube or tracheostomy. It involves providing positive pressure through a mask or nasal interface to help improve oxygenation and relieve respiratory distress.

Non-invasive ventilation may be utilized for various conditions such as acute exacerbations of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary edema, and certain cases of acute respiratory failure.

Complex mechanical ventilation refers to advanced techniques employed in critically ill patients who require more sophisticated ventilator strategies due to complex underlying lung pathology or refractory respiratory failure.

Complex Mechanical Ventilation might be required in cases involving severe acute respiratory distress syndrome (ARDS), post-operative complications, trauma-related injuries, or other complex pulmonary disorders that necessitate customized ventilatory approaches beyond conventional methods.

Prone ventilation involves positioning critically ill patients facing downward (on their stomach) instead of the traditional supine position during mechanical ventilation.

Prone ventilation has been shown to improve oxygenation and reduce mortality rates in patients with moderate-to-severe ARDS by redistributing lung perfusion and improving gas exchange.

ARDS is a severe lung condition characterized by rapid onset of respiratory failure, resulting from various causes such as pneumonia, sepsis, or trauma. It is associated with widespread inflammation and damage to the lung tissue.

The management of ARDS typically involves providing mechanical ventilation with low tidal volumes (lung-protective ventilation), maintaining fluid balance, addressing underlying causes or infections, and potentially utilizing adjunctive therapies like prone positioning or extracorporeal membrane oxygenation (ECMO) in refractory cases.

The complications of pneumonia are difficulty breathing, lung abscess, accumulation of fluid around the lungs, bacteria in the blood, sepsis, acute respiratory distress syndrome, and respiratory failure.

Some causes of respiratory failure are pneumonia, pulmonary edema, chronic obstructive pulmonary disease, asthma, pulmonary embolism, pulmonary fibrosis, pneumothorax, cyanotic congenital heart disease, acute respiratory distress syndrome, bronchiectasis, and HIV-induced respiratory illness.